The ruling from the 5th U.S. Circuit Court of Appeals is narrow, applying only to the eight employers who objected to providing the coverage. The conservative court declined to make the ruling apply nationwide.

“While we were predicting the worst, at the moment insurers will still have to cover preventive services, including PrEP, except for the original plaintiffs. That is the good news,” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in an email, referring to a common HIV preventative treatment. But, Schmid lamented that the court found that the coverage requirement for HIV prevention was adopted in violation of the Constitution, and that the case is going back to a lower court for resolution of other issues that could further muddy the coverage issue.

The requirements in question were adopted by federal health officials under provisions of the Affordable Care Act, sometimes referred to as Obamacare. Challengers raised religious and procedural objections to some of the requirements.

U.S. District Judge Reed O’Connor in Texas ruled last year that the requirements violated the Constitution. In its ruling Friday, a three-judge 5th Circuit panel said the coverage requirements in question were adopted unconstitutionally because they came from a body — the United States Preventive Services Task Force — whose members were not nominated by the president and confirmed by the Senate.

Not all preventive care is threatened by the ruling and attorneys on both sides said that some employers could decide to adopt copays or deductibles that would keep the affected coverages, including HIV preventatives, available, if not free.

An analysis prepared last year by the KFF, a nonprofit, found that some screenings, including mammography and cervical cancer screening, would still be covered without out-of-pocket costs because the task force recommended them before the health care law was enacted in March 2010.

Meanwhile, the opinion left some issues unresolved, including whether coverage can be required that was adopted from recommendations by two other entities, the Public Health Service’s Advisory Committee on Immunization Practices, and the Health Resources and Services Administration.

“The bad news is, the court still finds the mandate to cover USPSTF recommended services unconstitutional and now asks the lower court to review both the HRSA and ACIP preventive services,” Schmid said.

The U.S. Department of Health and Human Services did not immediately respond to an emailed request for comment Friday afternoon.

Ruthia He, the founder and CEO of Done Global Inc., allegedly conspired with the company’s clinical president, David Brody, and others to provide easy access to stimulants, including Adderall, a drug used to treat ADHD, in exchange for payment of a monthly subscription fee, the Justice Department said in a news release.

He was arrested in Los Angeles and Brody in San Rafael, California on charges of conspiracy to distribute controlled substances and distribution of controlled substances. If convicted, they each face a maximum sentence of 20 years in prison. It’s not clear if He and Brody have obtained attorneys who can speak on their behalf.

He and Brody ran the scheme to “unlawfully enrich themselves” and made over $100 million by increasing monthly subscription revenue, which therefore increased the value of the company, federal officials said.

news Aug 26, 2023

The ADHD drug market is already stretched thin. Now it's facing a back-to-school supply strain

Health & Science Aug 17, 2023

‘A burden to families': ADHD medication shortage impacts patients nationwide

Principal Deputy Assistant Attorney General Nicole M. Argentieri accused He and Brody of exploiting telemedicine “and spending millions on deceptive advertisements on social media.”

“They generated over $100 million in revenue by arranging for the prescription of over 40 million pills,” Argentieri said in a statement. “These charges are the Justice Department’s first criminal drug distribution prosecutions related to telemedicine prescribing through a digital health company. As these charges make clear, corporate executives who put profit over the health and safety of patients — including by using technological innovation — will be held to account.”

The pair allegedly obtained subscribers by spending millions on what officials called deceptive social media advertisements, targeting drug seekers, and intentionally structuring the Done platform to facilitate access to Adderall and other stimulants, the news release alleges.

Part of the scheme allegedly included limiting the information available to Done prescribers and instructing them to prescribe Adderall and other stimulants even if the Done member did not qualify.

He tried to maximize profits by adding an “auto-refill” function that allowed subscribers to elect to have a message requesting a refill of the drug every month, the Justice Department said.

He and Brody are also accused of conspiring to defraud pharmacies as well as Medicare and Medicaid.

The Justice Department said that He and Brody allegedly continued with the scheme even after being made aware that Done members had overdosed and died and that there was material posted online about how people could obtain Adderall and other stimulants from the company.

Done, which says it makes high-quality psychiatric chronic care more affordable and accessible, did not immediately respond to a request for comment on Thursday. He and Brody could not be reached at phone numbers listed for them.

In 2022, the Wall Street Journal reported that some clinicians said they felt that the company was pressuring them into prescribing stimulants. That same year, the Drug Enforcement Administration opened an investigation looking at Done’s practice of prescribing controlled substances, the WSJ reported.

The DEA lists Adderall as a schedule II drug with a high potential for abuse. It is included in the same category as Vicodin, OxyContin, and methamphetamine.

This story first appeared on NBCNews.com. More from NBC News:

• Former ICU nurse is arrested on suspicion of replacing fentanyl with tap water
• FDA advises Covid vaccine makers to target new contagious strain for fall shots
• Women increasingly fear being prosecuted for using abortion pills, advocacy groups say

A report published Monday from the research group Rand Corp. found that in 2022, the prices hospitals charged to private and employer-based insurance providers were, on average, 254% higher than what Medicare would have paid for the same services. 

“These very high payments ultimately result in higher premiums for health insurance coverage and can result in those needing care having to pay high prices to get it,” said Stacie Dusetzina, a health policy professor at Vanderbilt University in Nashville, Tennessee, who wasn’t involved with the report. 

The new findings were based on an analysis of health insurance claims data from more than 4,000 hospitals in 49 states and Washington, D.C., from 2020 through 2022. It included both inpatient and outpatient services. In total, the study analyzed about 6% of what private insurance paid out to hospitals during the time period.

Brian Briscombe, a health care cost analyst at Rand Corp. who led the report, said the high prices charged to private insurers mean patients will also end up paying more, either directly, in the form of higher copays or out-of-pocket payments, or indirectly, in the form of a smaller paycheck. 

About 160 million people in the U.S. get their health insurance through their jobs, Briscombe said. “When you think about it in the way of an economist, all of it is paid by the patient. I mean, if it cost my job half as much to have health care, my salary would go up,” he said.

Health Care

news Apr 30

Walmart to shutter health centers, virtual care service in latest failed push into health care

news Mar 15

Why UnitedHealth, Change Healthcare were targeted by ransomware hackers, and more cybercrime will hit patients, doctors

In 2022, hospital services accounted for 42% of health care spending for people with private health insurance, and price hikes from hospitals were a significant contributor to the rise in the average amount spent per person. 

The report found wide variation in hospital prices among states.

Hospitals in Arkansas, Iowa, Massachusetts, Michigan and Mississippi charged private insurance prices below 200% of what Medicare would pay.

California, Florida, Georgia, New York, South Carolina, West Virginia and Wisconsin charged private insurance prices that were above 300% of what Medicare would pay. 

The report also found that hospitals often charged higher prices for prescription drugs administered by a health care worker, compared to prices charged for the same drugs given in a similar setting, such as a physician’s office.

Briscombe attributed the price discrepancies to the enormous pricing power hospitals wield. If a hospital has limited competition in a given region, for example, it can often charge patients and insurers whatever it wants.

“Obviously, some hospitals cost more because they’re better,” he said. “But as you get more market share, you kind of become the big game in town and it becomes very hard for an employer to say, ‘We won’t use that hospital.’”

Meanwhile, Medicare often pays less in part because it has more negotiating power with hospitals, said Cynthia Cox, a vice president at KFF, a group that researches health policy issues. Most people on Medicare are older adults with underlying health conditions and represent a large portion of hospital revenue. 

Molly Smith, group vice president for policy at the American Hospital Association, the hospital industry’s trade group, called the report’s findings “a skewed and incomplete picture of hospital spending.”

An AHA report published in January found that in 2022 Medicare “significantly” underpaid hospitals for the cost of providing care to patients. 

For every dollar hospitals spent caring for Medicare patients, they were only reimbursed 82 cents, according to the report. In all, Medicare underpayments totaled $99.2 billion, it said. 

“In benchmarking against woefully inadequate Medicare payments, Rand makes an apples-to-oranges comparison that presents an inflated impression of what hospitals are actually getting paid for delivering care while facing continued financial and other operational challenges,” Smith said.

Dusetzina, from Vanderbilt University, said the Rand report’s findings are consistent with earlier studies showing that private insurance often pays higher prices.

“The one benefit for commercially insured individuals is that they do have out-of-pocket limits for in-network care, so even if the prices are very high, as long as the systems where they are getting care are in-network, there is an upper limit on what they would pay,” she noted.

Cox said there has been a push for more pricing transparency from hospitals, which would allow insurers to negotiate for lower rates and patients to shop around for a better deal. 

A federal rule from the Centers for Medicare and Medicaid Services requires hospitals to post their prices. However, reports have shown that very few hospitals comply with the rule.

Cox added that pricing transparency can be a bit complicated because it’s not always obvious how much a service will cost and for what reason.

“It’s not always clear from looking at price transparency data exactly how much someone’s being paid,” she said. “For example, you might see that an MRI looks like it costs 20 cents, but really it’s 20% of some other numbers.” 

Briscombe said the Rand report is intended to empower and inform employers and patients. 

“When you think about the price of anything, whether you’re buying a Lamborghini, you think, ‘Is it overpriced?’” he said. “Well, the only person who can decide that is the person buying it.”

This story first appeared on NBCNews.com. More from NBC News:

• 40 people work to free two horses stuck in mud for hours in Connecticut
• ‘His body and my neck’: Woman recalls punk singer’s stage dive that sent her to hospital paralyzed
• Bronny James receives medical clearance to be drafted into NBA, reports say

The findings underscore the exorbitant cost of cancer care in the United States.

The results were based on survey responses taken from nearly 1,300 cancer patients and survivors from March 18 through April 14. 

Overall, 47% of patients reported medical debt related to their cancer treatment, with half carrying debt that exceeded $5,000. More than two-thirds carried their debt for more than a year; about a third carried the debt for over three years.

Virtually all — 98% — had health insurance at the time the debt was incurred.

“While it is terrific that 98% had some form of coverage, what this tells us is that’s clearly not enough,” said Karen Knudsen, the CEO of the American Cancer Society. “Cancer care is really devastating to people’s financial position.”

Medical debt can have serious implications for health, Knudsen said. Patients are more likely to be behind on their recommended cancer screenings or skip or delay medication. They may also go without essentials such as food, clothing and transportation.

Biden Administration Mar 28

Biden announces new rule to protect consumers who purchase short-term health insurance plans

Health care Mar 9

Insurer delays and denials hamper patients seeking at-home breathing machines

Health & Science Apr 24

Senate launches investigation into high prices of Ozempic and Wegovy in the U.S.

The survey also found that Black and Hispanic patients with medical debt were about twice as likely as white respondents to report being denied care due to their debt.

“It’s very disturbing,” Knudsen said. “Black people in the country are more likely to owe more and more likely to carry the debt for longer.” 

The financial strain often skewed younger, with nearly three-quarters of cancer patients ages 35 to 44 carrying medical debt.

“We were really dismayed to see that,” Knudsen said. “That strain has been shown to be durable in their lifetime, impacting their choices, their ability to take jobs and of their choice to have a life that they would like.” 

Dr. Fumiko Chino, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York City, is deeply familiar with the high cost of cancer care. 

In 2007, her husband, Andrew, died from a rare form of endocrine cancer. His insurance, which had a lifetime limit of $500,000, was insufficient to cover the total cost of his cancer treatments, and after his death, debt collectors turned to her to demand payments. It wasn’t until a decade later that Chino learned she wasn’t responsible for the debt. 

“It is a pervasive problem. We really have an affordability gap,” Chino said. “We’re talking hundreds of thousands, up to millions of patients every single year that are really facing excruciating decisions between their life and their life savings.”

Arthur Caplan, the head of the Division of Medical Ethics at NYU Langone Medical Center in New York City, noted that many of the people with medical debt had so-called high deductible health plans, which likely contributed to the financial burden.

High-deductible plans usually have lower monthly premiums, but require the patient to pay much more out-of-pocket before coverage kicks in.

“While people are insured, sometimes they don’t have very good insurance,” he said.

Still, the high cost of cancer care can cause financial strain for people with good health insurance, too, he added.

“These cancer treatments can go on and on,” he said. “They can also cost a lot of money for diagnostic testing, genetic testing, and pretty soon you say, ‘Well, I have a policy of a million dollars and it’s gone.’”

Knudsen said the findings highlight the importance of finding cancers in people earlier.

“We know that not only is there a better outcome when cancers are caught earlier, but it’s the case that there is a significant reduction in cost,” she said.

This story first appeared on NBCNews.com. More from NBC News:

• Paralympian loses medals and equipment in Brazilian floods but is improvising to qualify for Paris
• Washington AG investigating clergy abuse says Seattle Archdiocese won’t cooperate
• Gay couple files first-of-its-kind class action against NYC for IVF benefits

 A plush octopus by Jellycat. A neck pillow by XpresSpa. Graphic sleeping masks by Geyoga.

The accessories weren’t designer. But these cozy, low-budget pieces stood out Sunday at the second Debt Gala, where some 200 pajama-clad revelers dressed for its “Sleeping Baddies” theme raised over $15,000 for medical bill relief. Hosted in Brooklyn one night before the Met Gala, the populist benefit’s thrifty getups and raunchy comedy routines marked a far cry from its glitzy, star-studded inspiration that collects millions of dollars annually for the renowned art museum’s costume department.

It’s one of several alternative galas that have recently emerged around the city with hopes to democratize the exclusive springtime fundraiser’s spectacle and leverage its fanfare to highlight other causes. Brooklyn Public Library revived its People’s Ball in 2022 as an inclusive declaration of fashion’s existence among “the everyday New Yorker.”

“Why should this wonderful, fun display of creativity and showmanship just be reserved for these wealthy elite when there’s so many amazing, creative New Yorkers who deserve to get the red-carpet treatment?” said Debt Gala co-founder Molly Gaebe.

This year’s beneficiaries are the Debt Collective, a debtors’ union born from the Occupy Wall Street movement, and Dollar For, a non-profit that reports having eliminated almost $50 million in medical debt by ensuring lower-income patients get discounted health services.

The prevalence of health care debt has prompted billions of dollars in relief from governments and private donors. A 2022 Kaiser Family Foundation survey found that four in 10 adults have some form of medical- and dental-related debts — with even greater numbers among Black and Hispanic adults, the uninsured and women.

Debt Gala tickets ranged from $35-$1,000. Attendees were encouraged to wear red squares — a nod to debtors’ status “in the red” and a symbol of solidarity. Handbags by Steve Madden composed almost all the items up for grabs at a silent auction.

Jared Walker, the founder of Dollar For, said the fundraiser aligned better with his nonprofit’s mission than more elaborate, black-tie events.

The Washington-based organization connects financially strapped families facing overwhelming medical expenses with legal teams who help them obtain charity care. Walker said every dollar raised will eliminate over $25 of medical debt.

“I don’t want to do the old-school, golf tournament-type charity event,” Walker said.

Organizers had pitched the event as a night for those “that may never be able to buy a house” and a “red carpet for the people.” Dinosaur slippers and pink curlers contrasted with the Louboutins and bedazzled tiaras of past Met Galas. One attendee dressed in moccasins and a plaid, wearable blanket exclaimed that they’d been “wearing this all yesterday!”

The accessory of the evening might have been the sleeping eye mask. Winston Koone and Anuraag Baxi wore black ones that read “Shut Up” and “Sleeping Beauty.” Koone paired that with a $30 ring bought at a corner store. Baxi finally got the chance to break out a robe set purchased for a long flight.

“We’re here with things we found in our closets, dressing up not to mock — because I will definitely be watching tomorrow — but to show that… there is a different side to the world that maybe tomorrow doesn’t focus on,” Koone said.

The anti-capitalist sentiment and attention to New York’s greater cultural scene continued through a series of sometimes crude standup comedy sets and lively drag queen performances. Comedian Tina Friml joked that she wore a plain outfit because she sleeps in street clothes — before later confessing that she actually falls asleep naked.

Many artists lack good health insurance, comedian Chanel Ali told The Associated Press, making the cause especially relevant to the creative community. Ali said she has peers who “will not let you call an ambulance no matter what” because “they don’t want to get stuck with the bill.”

The concept came to the organizers several years ago at a wine bar in Manhattan’s Theater District after watching Met Gala coverage. The pun came first: Debt Gala. But they soon decided that the vastness of medical debt and opportunity to exponentially increase the impact of the money collected made it an equally good cause to support, according to director and Debt Gala co-founder Tom Costello.

Debtors at Sunday evening’s gala emphasized the need to fight health care inequalities baked into the system of medical debt. Philip Bjerknes, a longtime Brooklyn resident, said he incurred around $50,000 in hospital bills during a one-month institutionalization against his will after a suicide attempt.

Wearing a Brooks Brothers night gown from eBay, Bjerknes said medical debt can be very embarrassing and that he was “completely destabilized” by his experience.

“At the end of the day, the material support is what we need,” Bjerknes said. “To get to that with fun and fashion is awesome.”

___

Associated Press coverage of philanthropy and non-profits receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content. For all of AP’s philanthropy coverage, visit https://apnews.com/hub/philanthropy.

The move took longer than promised to finalize and fell short of Democratic President Joe Biden’s initial proposal to allow those migrants to sign up for Medicaid, the health insurance program that provides nearly free coverage for the nation’s poorest people.

But it will allow thousands of migrants to access lucrative tax breaks when they sign up for coverage after the Affordable Care Act’s marketplace enrollment opens Nov. 1, just days ahead of the presidential election.

While it may help Biden boost his appeal at a crucial time among Latinos, a crucial voting bloc that Biden needs to turn out to win the election, the move is certain to prompt more criticism among conservatives about the president’s border and migrant policies.

The action opens up the marketplace to any participant in the Obama-era Deferred Action for Childhood Arrivals program, or DACA, many of whom are Latino.

Xavier Becerra, the nation’s top health official, said Thursday that many of those migrants have delayed getting care because they have not had coverage.

“They incur higher costs and debts when they do finally receive care,” Becerra told reporters on a call. “Making Dreamers eligible to enroll in coverage will improve their health and well-being and strengthen the health and well-being of our nation and our economy.”

The administration’s action changes the definition of “lawfully present” so DACA participants can legally enroll in the marketplace exchange.

Then-President Barack Obama launched the DACA initiative to shield from deportation immigrants who were brought to the U.S. illegally by their parents as children and to allow them to work legally in the country. However, the immigrants, also known as “Dreamers,” were still ineligible for government-subsidized health insurance programs because they did not meet the definition of having a “lawful presence” in the U.S.

The administration decided not to expand eligibility for Medicaid for those migrants after receiving more than 20,000 comments on the proposal, senior officials said Thursday. Those officials declined to explain why the rule, which was first proposed last April, took so long to finalize. The delay meant the migrants were unable to enroll in the marketplace for coverage this year.

More than 800,000 of the migrants will be eligible to enroll in marketplace coverage but the administration predicts only 100,000 will actually sign up because some may get coverage through their workplace or other ways. Some may also be unable to afford coverage through the marketplace.

Other classes of immigrants, including asylum seekers and people with temporary protected status, are already eligible to purchase insurance through the marketplaces of the ACA, Obama’s 2010 health care law, often called “Obamacare.”

Johnson & Johnson on Wednesday said it plans to pay $6.5 billion over 25 years to settle nearly all of the thousands of lawsuits in the U.S. claiming its talc-based products caused ovarian cancer, pending approval of the claimants.

Those cases have for decades caused financial and public relations trouble for J&J, which contends that its now-discontinued talc baby powder and other talc products are safe for consumers. About 99% of the talc-related lawsuits filed against J&J and its subsidiaries stem from ovarian cancer. 

The company recorded a charge of about $2.7 billion in the first quarter to raise its reserve for talc claims to about $11 billion.

The deal, pending approval by claimants, would allow J&J to resolve the lawsuits through a third bankruptcy filing of a subsidiary company, LTL Management. Courts have rebuffed J&J’s two previous efforts to resolve the lawsuits through the bankruptcy of that subsidiary, which was created to absorb the company’s talc liabilities.

J&J will begin a three-month voting period for claimants, in hopes of reaching a 75% support threshold needed for a bankruptcy settlement that would end the litigation entirely and prevent future lawsuits. Claimants did not have the opportunity to vote in LTL Management’s previous bankruptcy cases, J&J executives said on a call with investors on Wednesday.

J&J has the “significant support of the overwhelming majority of the claimants” based on conversations with their lawyers or representation, the executives added.

“We firmly believe this plan is in the best interest of claimants and should receive a favorable and immediate confirmation from the bankruptcy court,” said Erik Haas, J&J’s worldwide vice president of litigation, during the call.

He contended the settlement is a far better recovery for claimants than would be likely in a trial.

“As that track record shows, most of bearing claimants have not recovered, nor are they expected to ever recover anything at trial,” Haas said. “At the rate at which use cases have been tried, it would take decades to try the remaining cases meaning most claimants will never see their day in court.”

Still, litigation has resulted in some large verdicts for claimants. That includes a roughly $2 billion award in favor of 22 women who blamed their ovarian cancer on asbestos in J&J’s talc products.

Shares of J&J closed more than 4% higher Wednesday.

J&J said the remaining pending lawsuits relate to a rare cancer called mesothelioma and will be addressed outside of the new settlement plan. The pharmaceutical giant said it has already resolved 95% of mesothelioma lawsuits filed to date.

J&J noted on Wednesday that it has reached “final and comprehensive” settlements to resolve an investigation by a coalition of more than 40 states into claims the company misled patients about the safety of its talc baby powder and other talc-based products.

The company has also reached an agreement in principle to resolve claims brought by suppliers of its talc, which include Imerys Talc America, Cyprus Mines Corporation and their related parties.

Memorial Hermann-Texas Medical Center said in a statement Friday that their ongoing investigation found that a doctor had made “inappropriate changes” in a database for people awaiting liver transplants. Memorial Hermann’s statement didn’t name the doctor, but the University of Texas Health Science Center at Houston, or UTHealth Houston, issued a statement defending Dr. Steve Bynon, calling him ”an exceptionally talented and caring physician” with survival rates that are “among the best in the nation.”

Bynon is an employee of UTHealth Houston who is contracted to Memorial Hermann. UTHealth said its faculty and staff, including Bynon, are assisting with the inquiry into Memorial Hermann’s liver transplant program and are “committed to addressing and resolving any findings identified by this process.”

Memorial Hermann said a doctor made changes to the donor acceptance criteria, which includes factors like the age and weight of the deceased donors. The hospital said the inappropriate changes were only made to the liver transplant program, but since there is shared leadership over both the liver and kidney transplant programs, they inactivated both.

Shutting down the transplant programs during the investigation is prudent with an “allegation of this magnitude,” said Karen Maschke, a research scholar at the Hastings Center, a medical ethics think tank. “They know full well that when they put a program on hold, it’s going to have a really serious impact on patients. So I think they probably don’t make that decision lightly.”

Such allegations of manipulating a transplant waiting list can undermine the public’s trust in the organ allocation system, Maschke said.

Without fairness, transparency and accountability in a transplant program “you lose, the trust of patients, but also donors,” Maschke said, “because, donors won’t want to provide organs if they think that the institution is not going to manage the allocation system fairly.”

Memorial Hermann said in a statement Thursday to The New York Times that a doctor in the liver transplant program admitted to changing patient records. The newspaper identified the doctor as Bynon.

The U.S. Department of Health and Human Services said in a statement that they were “working across the department to address this matter.” The Organ Procurement and Transplantation Network, or OPTN, said it “cannot comment on any potential or ongoing review of a member organization.”

The death rate for people waiting for a liver transplant at Memorial Hermann was higher than expected in recent years, according to publicly available data from the Scientific Registry of Transplant Recipients, which evaluates U.S. organ transplant programs.

Data from OPTN shows that four patients died or became too ill for a transplant in 2021, 11 in 2022, 14 in 2023, and so far this year, that number was at five.

The UTHealth statement said that Bynon treated “patients with higher-than-average acuity and disease complexity.”

Memorial Hermann said they’ve been working with patients who were on the lists to ensure they get the care they need, including being transitioned to another transplant program if necessary. Memorial Hermann also said it was working with UTHealth Houston to make changes so they can reactivate the program under different leadership.

Led by its chairman, Sen. Gary Peters, D.-Mich., the inquiry by the Homeland Security and Governmental Affairs Committee centers on three of the nation’s largest private-equity firms: Apollo Global Management, the Blackstone Group and KKR. According to the information requests, Peters’ staff conducted interviews with over 40 emergency department physicians who expressed “significant concerns” about patient safety and care resulting from the aggressive practices of private-equity firms in the arena. Those practices include improper billing, retaliation and anti-competitive activities, the committee’s letters to the companies said.

Recipients of the letters, which were sent Monday, were asked to provide documents and information by April 17, and to arrange a meeting with the committee no later than May 3.

NBC News recently estimated that 40% of U.S. hospital emergency departments were overseen, staffed or managed by companies owned by private-equity firms.

The Homeland Security Committee inquiry is the second Senate investigation focused on private equity’s impact on patient care. In December, the Budget Committee launched a bipartisan investigation into two hospital systems associated with private-equity firms, seeking to assess the profits they have generated in their deals and whether those transactions harmed patients and clinicians. Sens. Sheldon Whitehouse, D.-R.I., who chairs the committee, and Chuck Grassley of Iowa, the ranking Republican, are leading that examination.

The new letters from the Homeland Security Committee requesting information about emergency department operations also went to four companies backed by the private-equity firms. Three are hospital staffing companies: U.S. Acute Care Solutions, which is financed by Apollo; Envision Healthcare, formerly owned by KKR; and TeamHealth, a Blackstone company. The other recipient is LifePoint Health, owned by Apollo, which operates 62 acute care hospitals in 16 states and runs the largest chain of rural hospitals in the U.S. Apollo and LifePoint Health are also subjects of the Senate Budget Committee investigation.

In recent years, private-equity firms have invested $1 trillion and become significant players in many sectors of the health care industry, including hospitals, nursing homes, physician practices, mental health facilities and emergency department staffing companies. To finance their health care takeovers, private-equity owners typically burden the companies they buy with debt, then slash company costs to increase earnings and appeal to new buyers in a few years.

These cost-saving practices are central to the new Senate inquiry, Peters said in a statement. “I am concerned that our nation’s largest emergency medicine staffing companies may be engaging in cost-saving measures at the expense of patient safety and care, which could put our nation’s emergency preparedness at risk,” Peters’ statement said. “I am pressing these companies and their private equity owners for needed transparency so that we better understand how their business practices could be affecting patient safety, quality care, and physicians’ abilities to exercise independent judgment in providing patient care.”

In a statement, a spokesperson for Apollo said, “We continue to welcome all discussions with the senators regarding our funds’ investing track record in the healthcare space.” A spokesperson for Envision said, “Envision intends to work transparently with Senator Peters on his request. Our clinicians care for patients and communities in their greatest time of need. Our number one priority is always the well-being of our clinicians and the patients they serve.” A spokesperson for Lifepoint said the company “looks forward to responding to Chairman Peters’ inquiry received today and to furthering any conversations with Senators who have an interest in our operations and commitment to our communities.”

KKR and Blackstone declined to comment.

As interest rates have risen recently, the costs associated with some of these companies’ debt loads have become onerous, creating financial difficulties. Last year, for example, Envision Healthcare, the staffing company formerly owned by KKR, filed for bankruptcy. It continued operating while in bankruptcy and emerged having restructured. Another emergency department staffing company collapsed last year — American Physician Partners — leaving hospitals it had served scrambling for replacement staffing.

Academic studies show that private-equity firms’ involvement in health care is associated with significant cost increases for patients and payers, such as Medicare. A lower quality of care has also been associated with the firms’ investments in health care, including 10% higher mortality rates at nursing homes owned by private equity. A study last year showed patients at private equity-owned hospitals fell more often and contracted more infections.

A TeamHealth spokesman said the company is reviewing the letter from Peters. “The top priority for TeamHealth and our clinicians is always delivering high-quality, safe patient care,” he added in a statement. “We look forward to engaging with the Committee and demonstrating our uncompromised commitment to our clinicians and communities.”

Private-equity firms’ health care deals are also under the microscope at the Federal Trade Commission, which overseas corporate mergers for potential anti-competitive activities. Last fall, the FTC sued U.S. Anesthesia Partners Inc., one of the country’s top anesthesia staffing companies, and its private-equity backer, Welsh, Carson, Anderson & Stowe, accusing the entities of scheming for over a decade to acquire anesthesia practices in Texas, monopolize the market, drive up prices for patients and generate profits. Both companies are fighting the suit, contending it is “misguided” and “meritless.”

Mitchell Li is one of the emergency physicians interviewed by investigators at the Homeland Security Committee. Founder of Take Medicine Back, an organization pushing to take the profession of medicine back from corporate control, Li said in an interview, “The emergency department is the canary in the coal mine for the whole U.S. health care system. We are the first to see the breaking point and we are beyond that. Private equity and the corporate practice of medicine puts our nations’ ability to respond to disaster at risk.”

This story first appeared on NBCNews.com. More from NBC News:

• Will Medicare raise your monthly premiums to cover Wegovy?
• Oregon re-criminalizes small amounts of hard drugs after 2020 voter initiative is overturned
• Michigan ends ban on surrogacy contracts

New York legislators and families are speaking at the state’s capital on Tuesday, in support of “baby bonds” for those children who lost a parent or caregiver during the COVID-19 pandemic, marking four years since it ravaged the country.

State Senator Jamaal Bailey (D-NY) and Assemblywoman Catalina Cruz (D-NY) introduced a bill in May 2023 called the New York Covid-19 Children’s Fund, a program that would establish savings accounts for those grieving children.

The proposed legislation, currently sitting in committee in both houses of the state legislature, would set trust funds starting with $1,000 deposits for New York children who lost a guardian to COVID. The account would gain an additional $1,000 per year until the child turns 18.

Bailey represents New York’s 36th district, which includes parts of the Bronx and Westchester. He says the grief these children face is everlasting, but if the bill passes, the assistance given will also act as a commitment from the state toward their well-being.

“Though nothing can fill the void left by a parent, grandparent, or caregiver during the pivotal moments of a child’s life, this legislation is a way to show our young people that despite their unimaginable loss, we stand by them, we believe in them, and we’re committed to investing in their future,” Bailey told NBC New York.

Once age 18, those eligible can access these publicly-funded savings accounts to afford qualified life expenses, such as college or starting a small business.

In New York State alone, nearly 18,000 children have lost a primary or secondary caregiver to COVID, and in the tri-state area, the estimate is over 28,000 impacted, according to data by the Global Reference Group on Children Affected by COVID-19.

Queens Assemblywoman Catalina Cruz represents one of the most diverse areas in the nation. She believes this potential financial investment would provide a safety net for an eligible child and plans to continue to push for the cause whether or not the bill passes this or next week given the upcoming state budget.

“When you’re looking at what investments to make in the state budget, I think you really have to look at what are the principles. What are our core beliefs as a state and as legislators? I can’t find a more noble reason to be in Albany than to support children who lost a parent or caregiver during this pandemic,” Cruz told News 4 before the rally.

Based on data from the National Institutes of Health, an estimated 216,000 children lost a co-residing caregiver to COVID-19 in the United States, while 77,000 lost a parent and 17,000 lost the only caregiver in the household.

Black and Latino children were more than twice as likely to lose a caregiver over white children. Based on the NIH data, 70% of caregivers lost were those children of color under 14 years old.

Veronica Fletcher, 49, is a Brooklyn widow whose husband, Joseph Trevor Fletcher, died from COVID-19 on the evening of April 11, 2020. Joseph Fletcher, an immigrant from Grenada, worked for the Metropolitan Transit Authority for over 17 years and left behind three children, Joshua, Zachary, and Madison.

In February, State Senator Steve Rhoads (R-NY) and Assemblyman Michael Durso (R-NY) announced a separate COVID-related bill named after the late Brooklyn father, the “Joseph Fletcher Act.” This proposed legislation would amend the workers’ compensation law for essential workers relating to certain claims for benefits based on death due to COVID-19.

“As we memorialize and heal, let us also take action and care for who remains, by supporting and passing ‘Baby Bonds,’ along with scholarships, a New York State memorial and the ‘Joseph Trevor Act’ for Workmans’ Compensation for our heroic fallen essential workers,” said Fletcher to News 4.

The day of advocacy is led by the community group COVID Survivors for Change, founded by Queens resident Christopher Kocher, who noted a full schedule of over a dozen meetings with legislators, including with the chair of Government Operations.

Other organizations like Elmhurst Hospital and the New York Immigration Coalition have supported the New York baby bonds for COVID orphans.

Kocher foresees some obstacles to the bill’s passage, including an “out of sight, out of mind” mentality now toward the pandemic and securing the necessary budget to implement plans. According to Kocher, the anticipated funding amount, which ranges from $50 million to $150 million, depends on the actual number of eligible families.

If the baby bonds are approved, New York would come second in the U.S. to California, which allocated $100 million in the state budget for the Hope, Opportunity, Perseverance, and Empowerment for Children Trust Account Fund.

 Check out NBC New York’s documentary, A Hidden Pandemic: More than a Number

This story uses functionality that may not work in our app. Click here to open the story in your web browser.

Rural emergency hospitals receive more than $3 million in federal funding a year and higher Medicare reimbursements in exchange for closing all inpatient beds and providing 24/7 emergency care. While that makes it easier for a hospital to keep its doors open, experts say it doesn’t solve all of the challenges facing rural health care.

People might have to travel further for treatments for illnesses that require inpatient stays, like pneumonia or COVID-19. In some of the communities where hospitals have converted to the new designation, residents are confused about what kind of care they can receive. Plus, rural hospitals are hesitant to make the switch, because there’s no margin of error.

“It’s ironic” that the facilities that might need the most help can’t afford to take the risk, said Carrie Cochran-McClain, chief policy officer at the National Rural Health Association. She pointed to having to give up certain services and benefits, such as a federal discount program for prescription drugs.

The government, which classifies hospitals by type, rolled out the rural emergency option in January 2023. Only 19 hospitals across the U.S. received rural emergency hospital status last year, according to the University of North Carolina’s Sheps Center for Health Services Research.

The majority are in the South, with some in the Midwest, and hospitals in Nebraska and Florida recently started to explore the option.

The designation is aimed at a very specific population, said George Pink, deputy director of the Sheps Center’s Rural Health Research Program, and that’s rural hospitals on the brink of closure with few people getting inpatient care already.

That was the case for Irwin County Hospital in Ocilla, Georgia, which was the second rural emergency hospital established in the U.S.

Weeks prior to converting, the hospital received at least $1 million in credit from the county so it could make pay employees — money that county board of supervisors chairman Scott Carver doubted he’d see returned.

“We operate on a $6 million budget for the county, so to extend that kind of line of credit was dangerous on our part to some degree,” he said. “But … we felt like we had to try.”

Irwin County Hospital became a rural emergency hospital on Feb. 1, 2023. Quentin Whitwell, the hospital’s CEO, said it was an ideal candidate.

“We’re still finding out what some of the impacts are, given that it’s a new thing,” said Whitwell, who through his company Progressive Health Systems owns and manages six hospitals in the Southeast, most of which are rural emergency hospitals or have applied for the designation. “But the change to a rural emergency hospital has transformed this hospital.”

A combination of state programs and tax credits, plus the new designation, means the hospital has $4 million in the bank, Carver said. Simply put, the work was worth it to him.

Traci Harper, a longtime Ocilla resident, isn’t so sure. About a year ago, she rushed her son to the hospital for emergency care for spinal meningitis.

Because the new designation requires the hospital to transfer patients to larger hospitals within 24 hours, Harper’s son was sent to another in-state facility and three days later ended up getting the care he needed in a hospital in Jacksonville, Florida.

“That’s two hours away,” she said. “The whole time I could have taken him there myself, but nobody told me that.”

Nebraska’s first rural emergency hospital opened in February in a city called Friend.

Warren Memorial Hospital had reached a breaking point: Federal pandemic relief money had dried up. The city, which owns the hospital, had to start extending lines of credit so hospital employees could get paid. A major street repair project was even delayed, said Jared Chaffin, the hospital’s chief financial officer and one of three co-CEOs.

“Back in the summer, we were barely surviving,” said Amy Thimm, the hospital’s vice president of clinical services and quality and co-CEO.

Though residents expressed concerns at a September town hall about closing inpatient services, the importance of having emergency care outweighed other worries.

“We have farmers and ranchers and people who don’t have the time to drive an hour to get care, so they’ll just go without,” said Ron Te Brink, co-CEO and chief information officer. “Rural health care is so extremely important to a lot of Nebraska communities like ours.”

The first federal payment, about $270,000, arrived March 5. Chaffin projects the hospital’s revenue will be $6 million this year — more than it’s ever made.

“That’s just insane, especially for our little hospital here,” he said. “We still have Mount Everest to climb, and we still have so much work ahead of us. The designation alone is not a savior for the hospital — it’s a lifeline.”

That lifeline has proven difficult to hold onto for Alliance Healthcare System in Holly Springs, Mississippi, another one of Whitwell’s hospitals and the fourth facility in the country to convert.

Months after being approved as a rural emergency hospital in March 2023, the Centers for Medicare and Medicaid Services reneged on its decision.

Hospital CEO Dr. Kenneth Williams told The Associated Press that the government said the hospital isn’t rural because it is less than an hour away from Memphis. A CMS spokesperson said the facility was “inadvertently certified.”

The hospital has until April to transition back to full service, but many in the community of largely retirees believe the hospital has closed, Williams said. Patient volume is at a record low. If the federal payments stop coming, Williams isn’t sure the hospital will survive.

“We might have been closed if we hadn’t (become a rural emergency hospital), so … something had to be done,” he said. “Do I regret all of the issues that for some reason we’ve incurred that the other (hospitals) have not? I don’t know.”

Though Alliance appears to be one of few facilities that have been negatively impacted by converting to a rural emergency hospital, Pink said it’s too soon to know if the federal designation is a success.

“If my intuition is correct, it will probably work well for some communities and it may not work well for others,” he said.

Cochran-McClain said her organization is trying to work with Congress to change regulations that have been a barrier for rural facilities, like closing inpatient behavioral health beds that are already scarce.

Brock Slabach, the National Rural Health Association’s chief operations officer, told the AP that upwards of 30 facilities are interested in converting to rural emergency hospitals this year.

As Whitwell sees it: “As this program evolves, there will be more people that I think will understand the value.” ___

The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

UnitedHealthcare has rejected several requests from her doctors for coverage of a machine Armant needs to breathe as she deals with the fatal illness.

“They are no good,” Armant said, typing slowly into a device that speaks for her. “I can’t do without the machine.”

Doctors around the country say UnitedHealthcare and other insurers have made it harder to get coverage for certain home ventilators that patients like Armant need as their lungs fail. They say patients often must struggle first with less effective — and cheaper — devices before some insurers will pay. In other cases, insurers balk at paying for a second machine needed when patients transfer from their bed to a wheelchair.

Temple University doctoral student Jaggar DeMarco waited more than three years to get his.

“Breathing is not a luxury,” he said. “It’s really the bare minimum, and that’s what we’re asking for.”

Some physicians believe insurers are making it harder on patients because more of the devices are being prescribed. Spending by the federal government’s Medicare program on the ventilators jumped from about $3 million to nearly $269 million between 2009 and 2017, according to the U.S. Department of Health and Human Services Office of Inspector General.

Insurers say they do cover the machines, but that coverage can depend on several factors.

These “noninvasive” ventilators help patients breathe around the clock by forcing air into the lungs, often through a mask. They are called noninvasive because they don’t require trachea surgery to open the airway, like ones used in hospitals.

The machines have battery backups so they can keep working when the power goes out. They also are more powerful than other devices meant to be used mainly at night for conditions like sleep apnea. At around $1,200 a month, they can be three times as expensive as those devices.

These ventilators can help prolong the life of someone with Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis, doctors say.

But insurance rejections have picked up for those patients and people dealing with advanced cases of chronic obstructive pulmonary disease, said Chuck Coolidge, chief strategy officer for VieMed, which provides respiratory equipment for patients in 46 states.

That includes both initial approvals and reauthorizations, he said.

“In early 2023, it was almost like a switch flipped,” he said.

UnitedHealthcare spokeswoman Heather Soule said her company covers the machines and re-evaluates requests if it gets new information. Coverage can depend on the patient’s condition, terms of their health plan or guidelines from the federal government’s Medicare program.

Those guidelines give insurers room to reject many ventilator requests, even those for seriously ill patients, said Dr. John Hansen-Flaschen, a pulmonary medicine expert with the University of Pennsylvania.

Government-funded Medicare Advantage plans run by UnitedHealthcare now deny nearly all initial requests for the ventilators, said Dr. Cathy Lomen-Hoerth, a neurologist with the University of California San Francisco.

In West Virginia, Dale Harper says it took several months and a personal plea before UnitedHealthcare would cover a ventilator for his 25-year-old son, Jacob, who has a rare and aggressive form of ALS.

After appeals from Jacob’s doctor failed, Harper called a number on his insurance card and asked for a supervisor.

“I said, ‘I can feed him, I can help him go to the bathroom, I can move him from one place to the other,’” the Winfield, West Virginia, resident recalled. “The only thing I cannot do is breathe for him … and he can’t breathe.”

Harper said ventilator coverage was approved within an hour of that call early last year.

Doctors caring for Armant, who lives outside New Orleans, say they usually get decent ventilator coverage.

“No one thought there would be a problem,” said Deidre Devier, an LSU Health experimental psychologist who specializes in cognitive disorders.

They first sought coverage in May, 2022, and Devier said Armant has only had it for around three months near the end of that year. She said a medical device company has been providing Armant’s ventilator for free while her case was appealed. But those appeals have ended.

Armant’s daughter said she’s considering starting hospice care, which would allow for ventilator coverage but prevent her mom from seeing her regular doctors. She’s also looking online for a refurbished machine.

“She doesn’t have $20,000″ to buy the machine, Terrellyn Armant said.

Representatives of both patients with UnitedHealthcare coverage gave the insurer written permission to discuss their cases, but Soule declined to comment on the record.

Coverage complications aren’t limited to UnitedHealthcare. DeMarco, the Temple student, said Aetna denied a request for a second breathing machine, and then several appeals. Eventually, his father’s employer essentially overruled the insurer and allowed coverage.

news Mar 7

UnitedHealth working to restore Change Healthcare systems by mid-March, company says

news Feb 25

These are the 10 U.S. cities with the best quality of life—none are in Florida

Doctors recommend a second ventilator for people who use wheelchairs during the day. That avoids mistakes in adjusting the machine’s settings when moving someone from their bed.

“I’m constantly angry that my life and what I can do with (it) is sometimes determined by insurance companies and bureaucracy,” said the 30-year-old DeMarco, who has chronic respiratory failure.

An Aetna representative said the company could not comment on individual cases. But he added that Aetna does cover second ventilators in certain circumstances. Aetna’s policy bulletin says they are medically necessary for people who need an additional ventilator for their wheelchair during the day.

Ventilator coverage problems started picking up after technology improvements made the devices easier to use, according to Dr. Lisa Wolfe, a professor at Northwestern’s Feinberg School of Medicine. That led to a rise in use for patients with conditions that are not immediately life-threatening.

She said she thinks insurers are reacting to that expanded use.

ALS patients without ventilator access have limited options. They can use a device that’s covered but doesn’t work as well. They may get ventilator coverage by entering hospice care or having a tracheostomy.

They also might wind up bouncing in and out of hospitals, said Hansen-Flaschen, the Penn physician.

“Or they die prematurely, and it’s a wretched death because they can’t breathe,” he said.

“We don’t feel safe being so far away from a birthing center,” said Alderson, noting her advanced maternal age of 45. “I was sitting in a hair salon a few days ago and some people started joking about me giving birth on the side of the road. And in that moment, I just pictured all the things that could go wrong with my baby and broke down in tears in front of strangers.”

A growing number of rural hospitals have been shuttering their labor and delivery units, forcing pregnant women to travel longer distances for care or face giving birth in an emergency room. Fewer than half of rural hospitals now have maternity units, prompting government officials and families to scramble for answers. One solution gaining ground across the U.S. is freestanding midwife-led birth centers, but those also often rely on nearby hospitals when serious complications arise.

The closures have worsened so-called “maternity care deserts” — counties with no hospitals or birth centers that offer obstetric care and no OB providers. More than two million women of childbearing age live in such areas, the majority of which are rural.

Ultimately, doctors and researchers say, having fewer hospital maternity units makes having babies less safe. One study showed rural residents have a 9% greater probability of facing life-threatening complications or even death from pregnancy and birth compared to those in urban areas — and having less access to care plays a part.

“Moms have complications everywhere. Babies have complications everywhere,” said Dr. Eric Scott Palmer, a neonatologist who practiced at Henry County Medical Center in rural Tennessee before it ended obstetric services this month. “There will be people hurt. It’s not a question of if — simply when.”

The issue has been building for years: The American Hospital Association says at least 89 obstetric units closed in rural hospitals between 2015 and 2019. More have shuttered since.

The main reasons for closures are decreasing numbers of births; staffing issues; low reimbursement from Medicaid, the federal-state health insurance program for low-income people; and financial distress, said Peiyin Hung, deputy director of the University of South Carolina’s Rural and Minority Health Research Center and co-author of research based on a survey of hospitals.

Officials at Saint Alphonsus, the hospital in Baker City where Alderson wanted to give birth, cited a shortage of OB nurses and declining deliveries.

“The results are devastating when safe staffing is not provided. And we will not sacrifice patient safety,” according to an emailed statement from Odette Bolano and Dina Ellwanger, two leaders from the hospital and the health system that owns it.

While they said financial concerns didn’t factor into the decision, they underlined that the unit had operated in the red over the last 10 years.

A lack of money was the major reason why Henry County Medical Center in Paris, Tennessee, closed its OB unit. CEO John Tucker told The Associated Press that it was a necessary financial step to save the hospital, which has been struggling for a decade.

The percentage of births there covered by Medicaid — 70% — far exceeded the national average of 42%. Tennessee’s Medicaid program paid the hospital about $1,700 per delivery for each mom, a fraction of what the hospital needed, Tucker said.

Private insurance pays hospitals more — the median topped $16,000 for cesarean sections in Oregon in 2021. State data shows that’s more than five times what Medicaid doles out.

Tucker also said the number of deliveries had dropped in recent years.

“When volumes go down, losses actually get bigger because so much of that cost is really fixed,” he said. “Whether we’ve got one baby on the floor or three, we still staff at the same level because you kind of have to be prepared for whatever comes in.”

Six days before the Tennessee unit closed, just one woman was there to deliver. All of the other rooms contained empty beds and bassinets. The special care nursery was silent — no beeping machines or infants’ cries. Art had been removed from the walls.

Lacy Kee, who was visiting the ward, said she’ll have to drive 45 minutes and cross the state line into Kentucky to give birth to her third child in early October. She’s especially concerned because she has gestational diabetes and recently had a scare with her fetus’ heart rate.

Kee also had to switch from the Henry County obstetrician she trusted for her other pregnancies, Dr. Pamela Evans, who will stay at the hospital as a gynecologist.

Evans fears that things like preterm deliveries, infant mortality and low-birthweight babies — a measure in which the county already ranks poorly — are bound to get worse. Prenatal care suffers when people must travel long distances or take lots of time off work for appointments, she said. Not all insurance covers deliveries out of state, and some alternative in-state hospitals families are looking at are an hour or more away.

Evans’ office and exam rooms contain bulletin boards covered with photos of infants she’s brought into the world. During a recent visit, Katie O’Brien of Paris handed her a new photo of her son Bennett — the third of her children Evans delivered. The two women cradled the baby and hugged.

The closure “makes me absolutely want to cry,” said O’Brien, 31. “It’s a horrible thing for our community. Any young person looking to move here won’t want to come. Why would you want to come somewhere where you can’t have a baby safely?”

About two hours away, inside a house in the woods, a handful of women sat in a circle on pillows for a prenatal group meeting at The Farm Midwifery Center, a storied place in Summertown, Tennessee, that’s more than a half-century old.

Led by midwife Corina Fitch, the women shared thoughts and concerns, and at one point tied on scarves and danced together. One by one, Fitch pulled them into a bedroom to measure bellies, take blood, listen to fetal heartbeats and ask about things like nutrition.

Betsy Baarspul of Nashville said she had an emergency C-section in a hospital for her first child. She’s now pregnant with her third, and described the difference between hospital care and birth center care as “night and day.”

“This is the perfect place for me,” she said. “It feels like you’re held in a way.”

Some states and communities are taking steps to create more freestanding birth centers. Connecticut Gov. Ned Lamont recently signed legislation that will license such centers and allow them to operate as an alternative for low-risk pregnancies.

Alecia McGregor, who studies health policy and politics at the Harvard T.H. Chan School of Public Health, called midwife-led birth centers “a major sort of contender among the possible solutions” to the maternity care crisis.

“The kinds of lifesaving procedures that can only be conducted in a hospital are important for those very high-risk cases,” McGregor said. “But for the majority of pregnancies, which are low-risk, birth centers can be a very important solution to lowering costs within the U.S. health care system and improving outcomes.”

A lack of data and the small number of births in freestanding centers or homes prevents researchers from fully understanding the relationship between birth settings and maternal deaths or severe injuries and complications, according to a 2020 report from the National Academies of Sciences, Engineering, and Medicine.

The Farm said fewer than 2% of clients end up having C-sections, and a report on deliveries in its first 40 years showed 5% of clients were transported to the hospital — which Fitch said can happen because of things like water breaking early or exhaustion during labor. Clients usually give birth at The Farm or in their own homes.

“We always have a backup plan,” she said, “because we know birth is unpredictable and things can come up.”

Rural hospitals will need to be part of the equation, doctors told the AP, and they believe governments must do more to solve the maternal care crisis.

Oregon politicians mobilized when the Baker City hospital announced in June that it was shutting down its birth center — including Oregon Gov. Tina Kotek, U.S. Sen. Ron Wyden and Baker County Commissioner Shane Alderson, Alisha’s husband. As a temporary fix, they suggested using OB nurses from the U.S. Public Health Service Commissioned Corps, a branch of the country’s uniformed services that largely responds to natural disasters and disease outbreaks.

It was a novel and “innovative” idea to request federal nurses to boost staffing at a rural maternity unit, Wyden’s office said. While it didn’t end up panning out, the public health service sent experts to Baker City to assess the situation and recommend solutions — including looking into establishing a freestanding birth center.

Shane Alderson wants to help people who are facing the same tough decisions his family had to make. He said rural communities shouldn’t be stripped of health care options because of their smaller size or because of the number of low-income people with public insurance.

“That’s not equitable,” he said. “People can’t survive like that.”

___

Rush reported from Baker City, Oregon, and Kuna, Idaho. Ungar reported from Paris, Tennessee, and Summertown, Tennessee.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

They will have to call drugstores over several days to find one with the properly sized first dose. Then they’ll do that again for their second dose, and probably the third. And that’s only if the patient has insurance or the means to afford a drug that can cost more than $1,300 a month.

“This is not for the weak-willed,” said Fitch, who is president of the Obesity Medicine Association and also consults for drugmakers.

Supply problems and insurance complications have made it difficult for people to start — and stay on — Wegovy and similar medications that are transforming obesity treatment, according to doctors and patients around the country. They say getting the high-demand, injectable drugs requires persistence and a fair amount of luck.

People starting on Wegovy have to take injections of gradually increasing strength before they reach the so-called maintenance dose that they stay on.

The drug’s maker, Novo Nordisk, says that demand has forced it to restrict the supply of those smaller, initial doses in the U.S. The company also is warning those taking another weight-loss drug, Saxenda, to expect difficulty filling prescriptions “for the remainder of 2023 and beyond.”

Another drugmaker, Eli Lilly, has said it expects tight supplies until year’s end for its diabetes treatment Mounjaro, which also is prescribed for weight loss.

Finding Wegovy can become a part-time job for patients, said Dr. Diana Thiara, medical director of the weight management clinic at the University of California, San Francisco.

Thiara said some wind up driving 45 minutes or more to get prescriptions filled, a barrier for hourly workers who can’t leave their job and for people without cars.

“It’s usually patients who are a little bit more privileged, able to take off from work to go make those drives,” Thiara said.

One of Fitch’s patients, Mike Bouboulis, has taken Saxenda, Mounjaro or Ozempic, a Novo diabetes drug with the same active ingredient as Wegovy, since around 2019. It became much harder for him to find the drugs in the past year, after their popularity exploded.

Refilling a prescription involved calling five to seven pharmacies.

“They all know what you’re calling for, and they all have the same answer: ‘I don’t know. We’ll see tomorrow,’” said the 35-year-old small business owner who lives outside Boston.

Pharmacy technician Lizzy Nielsen used insider knowledge to start Wegovy earlier this year.

She regularly checked drug wholesalers’ supply lists, refreshing her screen each morning, and then ordering Wegovy for her pharmacy as soon as she saw it in stock.

“I was really lucky … because that’s when it was like starting to be constantly back-ordered,” the 42-year-old West Springfield, Massachusetts, resident said.

While patients have had to deal with shortages of many medications in the past year, those taking weight-loss drugs can face coverage complications too.

The federal Medicare program for people age 65 and older doesn’t cover obesity medicines, but some privately run Medicare Advantage or Medigap plans do, according to Novo. Coverage from Medicaid programs for people with low incomes varies.

Doctors and patients say many insurers have stopped covering Ozempic and Mounjaro outside their approved use for diabetes. Some insurers and employers don’t pay for Wegovy.

Novo Nordisk even offers a form letter on its Wegovy website to help doctors request coverage.

Bouboulis, the Boston-area resident, said his insurer stopped covering Mounjaro earlier this year. He then tried switching back to Ozempic but found that also was no longer covered.

He’s taking low doses of leftover Ozempic until he can find coverage.

“I know the insurance companies don’t want to pay, but between (them) and the pharmaceutical industry, they need to find some kind of nice middle ground because these medications, they can save people’s lives,” said Bouboulis, who has lost around 80 pounds since he started taking them.

Employers and insurers that do pay for the weight-loss treatments often require patients to get pre-approval or to first try other strategies like diet and exercise.

Some require patients to show they’ve lost 5% of their body weight after six months on the drugs in order to continue coverage. Supply problems make that hard, Thiara noted.

“A lot of patients are not staying on it consistently because they can’t get it,” she said.

Dr. Laura Davisson estimates that less than 30% of her patients with insurance through an employer or an individual plan have obesity medicine coverage.

Davisson directs a weight-loss program in West Virginia, a state that consistently ranks as having one of the highest obesity rates in the country. The state’s Medicaid program doesn’t cover Wegovy, but neighboring Pennsylvania’s does.

“For me, it’s either they have coverage through insurance, or they’re not taking it,” she said. “No one can afford it.”

Coverage may improve over time, as it has with other obesity treatments like bariatric surgery.

About 46% of large U.S. employers cover obesity medicines like Wegovy, according to the benefits consultant Mercer. Another 18% are considering it. Mercer’s experts say employers are still trying to learn about how the added cost will affect them and what other support patients may need.

Dr. Deborah Horn says she thinks supply problems and coverage will eventually smooth out, but it may take a couple years. She noted that the FDA may soon approve Mounjaro to treat obesity, which could improve coverage.

Drugmakers also are developing other weight-loss medications, including easier-to-take pills.

In the meantime, more patients are realizing that they can get medical help for their disease and don’t have to manage it on their own, said Horn, an obesity medicine expert at UTHealth Houston.

“I feel like this is the beginning of the change in obesity care, where we will see every year better and better medications coming to market and people getting their disease under control,” she said. “We’re just in the hard part … right now.”

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

While such regulation has been sought for decades by allies of older adults and those with disabilities, the proposed threshold is far lower than many advocates had hoped. It also immediately drew ire from the nursing home industry, which said it amounted to a mandate that couldn’t be met.

With criticism expected, a promise made with fanfare in President Joe Biden’s 2022 State of the Union speech had its details revealed as many Americans turned away from the news for a holiday weekend.

“Establishing minimum staffing standards for nursing homes will improve resident safety,” Health Secretary Xavier Becerra said in a statement. “When facilities are understaffed, residents suffer.”

The American Health Care Association, which lobbies for care facilities, called the proposal “unfathomable,” saying it will worsen existing problems and cost homes billions of dollars.

“We hope to convince the administration to never finalize this rule as it is unfounded, unfunded, and unrealistic,” said AHCA’s president, Mark Parkinson, the former Democratic governor of Kansas.

The proposed rules, which now enter a public comment period and would take years more to fully take effect, call for staffing equivalent to 3 hours per resident per day, just over half an hour of it coming from registered nurses. The rules also call for facilities to have an RN on staff 24 hours a day, every day.

The average U.S. nursing home already has overall caregiver staffing of about 3.6 hours per resident per day, according to government reports, including RN staffing just above the half-hour mark.

Still, the government insists a majority of the country’s roughly 15,000 nursing homes, which house some 1.2 million people, would have to add staff under the proposed rules.

Chiquita Brooks-LaSure, who heads the Centers for Medicare and Medicaid Services, or CMS, called the move “an important first step.” CMS oversees nursing homes.

A senior White House official, speaking on the condition of anonymity ahead of the announcement, said the Biden administration was open to revisiting the staffing threshold once implemented.

“I would caution anyone who thinks that the status quo – in which there is no federal floor for nursing home staffing – is preferable to the standards we’re proposing,” said Stacy Sanders, an aide to Becerra. “This standard would raise staffing levels for more than 75% of nursing homes, bringing more nurse aides to the bedside and ensuring every nursing home has a registered nurse on site 24/7.”

The new thresholds are drastically lower than those that had long been eyed by advocates after a landmark 2001 CMS-funded study recommended an average of 4.1 hours of nursing care per resident daily.

Most U.S. facilities don’t meet that threshold. Many advocates said even it was insufficient, not taking into account quality of life, simply determining the point at which residents could suffer potential harm.

After the Democratic president elevated the issue in his State of the Union speech, advocates were initially elated, expecting the most significant change for residents since the Nursing Home Reform Act of 1987. That changed after a copy of a new CMS-funded study on the subject was inadvertently posted this week, claiming there is “no obvious plateau at which quality and safety are maximized.”

Advocates were bereft, saying they felt betrayed by administration officials they thought to be allies. As word of the proposal became public early Friday some were even more blistering.

news Dec 15, 2022

Less Than 50% of Nursing Home Residents Have Received Omicron Booster Ahead of Expected Winter Covid Wave

Apr 6, 2022

Report: Nursing Home Residents Are Subjected to Ineffective Care, Poor Staffing

Richard Mollot, who leads the Long Term Care Community Coalition, called it “completely inadequate” and a blown chance of “a once-in-a-generation opportunity” that “flouts any evidence” of what residents need and fails to make good on the heart of Biden’s promise. He begrudgingly acknowledged the 24/7 RN rule could bring small improvements to the worst facilities, but he otherwise was withering in his criticism.

Calling the move “heartbreaking” and “nauseating,” he said it would do more harm than good, putting a government imprimatur on poorly staffed homes and imperiling wrongful-death lawsuits.

“It is a tremendous dereliction of duty,” he said. “We are continuing to allow nursing homes to warehouse people and to rip the public off.”

Current law requires only that homes have “sufficient” staffing, but it leaves nearly all interpretation to states. Thirty-eight states and the District of Columbia have their own staffing regulations. Some are so low that advocates say they’re meaningless, and, across the board, enforcement is often toothless.

The problem has long been apparent to front-line nurse aides – the low-paid, overwhelmingly female and disproportionately minority backbone of facility staffs – and to residents themselves, whose call bells go unanswered, whose showers become less frequent and who lie hungry, awaiting help with meals.

The coronavirus pandemic, which claimed more than 167,000 U.S. nursing home residents, brought the greatest attention to poor staffing in history. But, in its wake, many homes saw their staffing grow even thinner.

Across all job types, Bureau of Labor Statistics data shows nursing homes have 218,200 fewer employees than in February 2020, when the first U.S. outbreak of the coronavirus arrived at a nursing home outside Seattle.

AHCA has waged a relentless campaign claiming facilities were teetering, with Medicaid subsidies insufficient, widespread hiring issues and rampant home closures. But there has been no sign of widespread closures, the profitability of homes has repeatedly been exposed and critics have argued, if they just paid better, the workers would come.

Katie Smith Sloan, the head LeadingAge, which represents nonprofit nursing homes, said it was meaningless to create a rule requiring facilities to hire additional staff when the industry was already in a workforce crisis and “there are simply no people to hire.”

“To say that we are disappointed that President Biden chose to move forward with the proposed staffing ratios despite clear evidence against them is an understatement,” she said.

Nix has struggled with a combination of autoimmune diseases since 2011. Brain and spinal surgeries didn’t ease her symptoms. Nothing worked, she said, until she started intravenous immunoglobulin infusions late last year. Commonly called IVIG, the treatment bolsters her compromised immune system with healthy antibodies from other people’s blood plasma.

“IVIG turned out to be my great hope,” she said.

That’s why, when Nix’s health insurer started denying payment for the treatment, she turned to Facebook and Instagram to vent her outrage.

“I was raising Cain about it,” said Nix, 53, of Statesville, North Carolina, who said she was forced to pause treatment because she couldn’t afford to pay more than $13,000 out of pocket every four weeks. “There are times when you simply must call out wrongdoings,” she wrote on Instagram. “This is one of those times.”

Prior authorization is a common cost-cutting tool used by health insurers that requires patients and doctors to secure approval before moving forward with many tests, procedures, and prescription medications. Insurers say the process helps them control costs by preventing medically unnecessary care. But patients say the often time-consuming and frustrating rules create hurdles that delay or deny access to the treatments they need. In some cases, delays and denials equal death, doctors say.

That’s why desperate patients like Nix — and even some physicians — say they have turned to publicly shaming insurance companies on social media to get tests, drugs, and treatments approved.

“Unfortunately, this has become a routine practice for us to resort to if we don’t get any headway,” said Shehzad Saeed, a pediatric gastroenterologist at Dayton’s Children’s Hospital in Ohio. In March, he tweeted a photo of an oozing skin rash, blaming Anthem for denying the biologic treatment his patient needed to ease her Crohn’s disease symptoms.

In July, Eunice Stallman, a psychiatrist based in Idaho, joined X, formerly known as Twitter, for the first time to share how her 9-month-old daughter, Zoey, had been denied prior authorization for a $225 pill she needs to take twice a day to shrink a large brain tumor. “This should not be how it’s done,” Stallman said.

The federal government has proposed ways to reform prior authorization that would require insurance companies to provide more transparency about denials and to speed up their response times. If finalized, those federal changes would be implemented in 2026. But even then, the rules would apply only to some categories of health insurance, including Medicare, Medicare Advantage, and Medicaid plans, but not employer-sponsored health plans. That means roughly half of all Americans wouldn’t benefit from the changes.

The 2010 Patient Protection and Affordable Care Act prohibits health insurance plans from denying or canceling coverage to patients due to their preexisting conditions. AHIP, an industry trade group formerly called America’s Health Insurance Plans, did not respond to a request for comment.

But some patient advocates and health policy experts question whether insurers are using prior authorization as “a possible loophole” to this prohibition, as a way of denying care to patients with the highest health care costs, explained Kaye Pestaina, a KFF vice president and the co-director of its Program on Patient and Consumer Protections.

“They take in premiums and don’t pay claims. That’s how they make money,” said Linda Peeno, a health care consultant and retired Kentucky physician who was employed as a medical reviewer by Humana in the 1980s and later became a whistleblower. “They just delay and delay and delay until you die. And you’re absolutely helpless as a patient.”

But there’s reason to hope things may get marginally better. Some major insurers are voluntarily revamping their prior authorization rules to ease preapproval mandates for doctors and patients. And many states are passing laws to rein in the use of prior authorization.

“Nobody is saying we should get rid of it entirely,” said Todd Askew, senior vice president for advocacy at the American Medical Association, in advance of the group’s annual meeting in June. “But it needs to be right-sized, it needs to be simplified, it needs to be less friction between the patient and accessing their benefits.”

Customers are increasingly using social media to air their complaints across all industries, and companies are paying attention. Nearly two-thirds of complainants reported receiving some sort of response to their online post, according to the 2023 “National Consumer Rage Survey,” conducted by Customer Care Measurement & Consulting in collaboration with Arizona State University.

Some research suggests companies are better off engaging with unhappy customers offline, rather than responding to public social media posts. But many patients and doctors believe venting online is an effective strategy, though it remains unclear how often this tactic works in reversing prior authorization denials.

“It’s not even a joke. The fact that that’s how we’re trying to get these medications is just sad,” said Brad Constant, an inflammatory bowel disease specialist who has published research on prior authorization. His work found that prior authorizations are associated with an increased likelihood that children with inflammatory bowel disease will be hospitalized.

Saeed said the day after he posted the picture of the skin rash, the case was marked for a peer-to-peer review, meaning the prior authorization denial would get a closer look by someone at the insurance company with a medical background. Eventually, the biologic medicine Saeed’s patient needed was approved.

Stallman, who is insured through her employer, said she and her husband were prepared to pay out of pocket if Blue Cross of Idaho didn’t reverse the denial for the drug Zoey needed.

Bret Rumbeck, a spokesperson for the insurer, said Zoey’s medication was approved on July 14 after the company consulted an outside specialist and obtained more information from Zoey’s doctor.

Stallman posted details about the ordeal online only after the insurer approved the drug, in part, she said, to prevent them from denying the treatment again when it comes up for a 90-day insurance review in October. “The power of the social media has been huge,” she said.

Nix had been insured by Blue Cross Blue Shield of Illinois through her husband’s employer for almost two decades. Dave Van de Walle, a spokesperson for the company, did not specifically address Nix’s case. But in a prepared statement, the company said it provides administrative services for many large employers who design and fund their own health insurance plans.

Nix said an “escalation specialist” from the insurance company reached out after she posted her complaints on social media, but the specialist couldn’t help.

Then, in July, after KFF Health News contacted Blue Cross Blue Shield of Illinois, Nix logged in to the insurer’s online portal and found that $36,000 of her outstanding claims had been marked “paid.” No one from the company had contacted her to explain why or what had changed. She also said she was informed by her hospital that the insurer will no longer require her to obtain prior authorization before her infusions, which she restarted in late July.

“I’m thrilled,” she said. But “it just should never have happened this way.”

Biden’s remarks will build on previous initiatives to limit health care costs, with the Department of Health and Human Services releasing new estimates showing 18.7 million older adults and other Medicare beneficiaries will save an estimated $400 per year in prescription drug costs in 2025 because of the president placing a cap on out-of-pocket spending as part of last year’s Inflation Reduction Act.

Gearing up for his 2024 reelection campaign as inflation remains a dominant concern for voters, the Democratic president has emphasized his policies to help families manage their expenses, as well as a spate of government incentives to encourage private sector development of electric vehicles, clean energy and advanced computer chips.

Republican lawmakers have criticized Biden’s policies by saying they have spurred higher prices that hurt the well-being of families.

The Biden administration plans to limit what it calls “junk” insurance plans, such as short-term policies that can deny basic coverage as people transition between employers and still need temporary health care coverage.

Neera Tanden, director of the White House Domestic Policy Council, highlighted the case of a man in Montana who received a $43,000 health care bill because his insurer said his cancer was a pre-existing condition.

“That’s not real insurance — that’s junk insurance,” Tanden told reporters on a phone call previewing Biden’s remarks. “We will propose a rule to crack down on these plans.”

The president also announced new guidance on medical billing stemming from 2020’s No Surprises Act. The guidance would limit the ability of insurers that contract with hospitals to claim provided care was not in network and have customers pay more money. Health plans also would need to disclose facility fees that are increasingly charged to patients and can surface as an unexpected cost in a medical bill.

“Frankly, what they are doing is gaming the system — this is not allowed,” Tanden said.

The Consumer Financial Protection Bureau and Treasury Department also are seeking information on third-party credit cards and loans that are specifically used to pay for health care. The higher costs and interest charges can discourage people in need of treatment from seeking care.

The president is expected to also highlight previous efforts to reduce health care costs, including a plan allowing Medicare to negotiate lower prices for prescription drugs and a $35 monthly price cap on insulin for people in Medicare Part B.

Hospitals and other health care providers in New York would be banned from reporting medical debt to credit agencies under a bill passed this week by the state’s legislature — a measure intended to limit the damage that illness and injury can do to someone’s financial health.

If signed by Gov. Kathy Hochul, the law would make New York the second state, after Colorado, to prohibit medical debt from being collected by credit reporting agencies or included in a credit report.

National credit reporting agencies had already voluntarily agreed to not report medical debts under $500, but advocates say additional protections are needed.

A bad credit report often means difficulty renting a house, buying a car, or securing a loan. And unlike someone whose credit is damaged by reckless spending or a bad investment, people often find themselves hit with huge, unexpected medical bills simply because they’ve suffered from disease or injury.

“Medical debt is different than other debt. It’s spontaneous. It doesn’t reflect someone’s credit worthiness,” said Assembly member Amy Paulin, a Brooklyn Democrat.

In at least a dozen states, lawmakers have introduced legislation aimed at curtailing the financial burden that comes with medical debt. Some of those bills would keep medical debt from tanking credit scores and create medical debt relief programs, while other proposals would protect personal property from collections.

Colorado’s law stops medical debt from being included on credit reports and factored into credit scores, except under very narrow circumstances.

An estimated 100 million Americans have amassed nearly $200 billion in collective medical debt, according to the Kaiser Family Foundation.

New York’s legislation would impact about 740,000 adult New Yorkers and their families who had medical debt in collections on their credit reports as of February 2022, according to a study done by Urban Center, a think tank that conducts economic and social policy research.

Some Republican lawmakers fear the legislation could have unintended consequences.

Republican Assemblymember Josh Jensen, who voted against the bill, said that while there is a need to ensure emergency medical debt doesn’t haunt people, the legislation is too expansive and should not apply to non-emergency care.

“There’s a concern that people could incur an amount of debt with no intention to pay it back, rather than the intended reasoning of the legislation to ensure people who need that critical care can get it without worrying the debt will follow them around forever,” said Jensen.

The bill would go into effect immediately if signed by Hochul, a Democrat.

“Medical debt is a serious problem that creates a crushing burden for many New Yorkers and unfairly undermines their financial security,” Chuck Bell, advocacy program director for nonprofit Consumer Reports, said in a statement. “This bill protects the right of New Yorkers to obtain the health care services they need without fear of having their credit records unfairly ruined.”

Most got dropped for not filling out paperwork.

Though the eligibility review is required by the federal government, President’s Joe Biden’s administration isn’t too pleased at how efficiently some other states are accomplishing the task.

“Pushing through things and rushing it will lead to eligible people — kids and families — losing coverage for some period of time,” Daniel Tsai, a top federal Medicaid official recently told reporters.

Already, about 1.5 million people have been removed from Medicaid in more than two dozen states that started the process in April or May, according to publicly available reports and data obtained by The Associated Press.

Florida has dropped several hundred thousand people, by far the most among states. The drop rate also has been particularly high in other states. For people whose cases were decided in May, around half or more got dropped in Arkansas, Idaho, Kansas, Nevada, New Hampshire, Oklahoma, South Dakota, Utah and West Virginia.

By its own count, Arkansas has dropped more than 140,000 people from Medicaid.

Mar 19, 2023

How to Shop for New Insurance If You Lose Medicaid Coverage

news Apr 19, 2023

How to Avoid Getting Dropped From Medicaid as States Narrow Coverage

The eligibility redeterminations have created headaches for Jennifer Mojica, 28, who was told in April that she no longer qualified for Medicaid because Arkansas had incorrectly determined her income was above the limit.

She got that resolved, but was then told her 5-year-old son was being dropped from Medicaid because she had requested his cancellation — something that never happened, she said. Her son’s coverage has been restored, but now Mojica says she’s been told her husband no longer qualifies. The uncertainty has been frustrating, she said.

“It was like fixing one thing and then another problem came up, and they fixed it and then something else came up,” Mojica said.

Arkansas officials said they have tried to renew coverage automatically for as many people as possible and placed a special emphasis on reaching families with children. But a 2021 state law requires the post-pandemic eligibility redeterminations to be completed in six months, and the state will continue “to swiftly disenroll individuals who are no longer eligible,” the Department of Human Services said in statement.

Arkansas Gov. Sarah Huckabee Sanders has dismissed criticism of the state’s process.

“Those who do not qualify for Medicaid are taking resources from those who need them,” Sanders said on Twitter last month. “But the pandemic is over — and we are leading the way back to normalcy.”

More than 93 million people nationwide were enrolled in Medicaid as of the most recent available data in February — up nearly one-third from the pre-pandemic total in January 2020. The rolls swelled because federal law prohibited states from removing people from Medicaid during the health emergency in exchange for providing states with increased funding.

Now that eligibility reviews have resumed, states have begun plowing through a backlog of cases to determine whether people’s income or life circumstances have changed. States have a year to complete the process. But tracking down responses from everyone has proved difficult, because some people have moved, changed contact information or disregarded mailings about the renewal process.

Before dropping people from Medicaid, the Florida Department of Children and Families said it makes between five and 13 contact attempts, including texts, emails and phone calls. Yet the department said 152,600 people have been non-responsive.

Their coverage could be restored retroactively, if people submit information showing their eligibility up to 90 days after their deadline.

Unlike some states, Idaho continued to evaluate people’s Medicaid eligibility during the pandemic even though it didn’t remove anyone. When the enrollment freeze ended in April, Idaho started processing those cases — dropping nearly 67,000 of the 92,000 people whose cases have been decided so far.

“I think there’s still a lot of confusion among families on what’s happening,” said Hillarie Hagen, a health policy associate at the nonprofit Idaho Voices for Children.

She added, “We’re likely to see people showing up at a doctor’s office in the coming months not knowing they’ve lost Medicaid.”

Advocates fear that many households losing coverage may include children who are actually still eligible, because Medicaid covers children at higher income levels than their parents or guardians. A report last year by the U.S. Department of Health and Human Services forecast that children would be disproportionately impacted, with more than half of those disenrolled still actually eligible.

That’s difficult to confirm, however, because the federal Centers for Medicare & Medicaid Services doesn’t require states to report a demographic breakdown of those dropped. In fact, CMS has yet to release any state-by-state data. The AP obtained data directly from states and from other groups that have been collecting it.

Medicaid recipients in numerous states have described the eligibility redetermination process as frustrating.

Julie Talamo, of Port Richey, Florida, said she called state officials every day for weeks, spending hours on hold, when she was trying to ensure her 19-year-old special-needs son, Thomas, was going to stay on Medicaid.

She knew her own coverage would end but was shocked to hear Thomas’ coverage would be whittled down to a different program that could force her family to pay $2,000 per month. Eventually, an activist put Talamo in contact with a senior state healthcare official who confirmed her son would stay on Medicaid.

“This system was designed to fail people,” Talamo said of the haphazard process.

Some states haven’t been able to complete all the eligibility determinations that are due each month. Pennsylvania reported more than 100,000 incomplete cases in both April and May. Tens of thousands of cases also remained incomplete in April or May in Arizona, Arkansas, Indiana, Iowa, New Mexico and Ohio.

“If states are already behind in processing renewals, that’s going to snowball over time,” said Tricia Brooks, a research professor at the Georgetown University Center for Children and Families. “Once they get piles of stuff that haven’t been processed, I don’t see how they catch up easily.”

Among those still hanging in the balance is Gary Rush, 67, who said he was notified in April that he would lose Medicaid coverage. The Pittsburgh resident said he was told that his retirement accounts make him ineligible, even though he said he doesn’t draw from them. Rush appealed with the help of an advocacy group and, at a hearing this past week, was told he has until July to get rid of about $60,000 in savings.

Still, Rush said he doesn’t know what he will do if he loses coverage for his diabetes medication, which costs about $700 a month. Rush said he gets $1,100 a month from Social Security.

In Indiana, Samantha Richards, 35, said she has been on Medicaid her whole life and currently works two part-time jobs as a custodian. Richards recalled receiving a letter earlier this year indicating that the pandemic-era Medicaid protection was ending. She said a local advocacy group helped her navigate the renewal process. But she remains uneasy.

“Medicaid can be a little unpredictable,” Richards said. “There is still that concern that just out of nowhere, I will either get a letter saying that we have to reapply because we missed some paperwork, or I missed a deadline, or I’m going to show up at the doctor’s office or the pharmacy and they’re going to say, ‘Your insurance didn’t go through.’”

Lieb reported from Jefferson City, Missouri, and DeMillo from Little Rock, Arkansas. Also contributing were AP reporters Anthony Izaguirre in Tallahassee, Florida; Marc Levy in Harrisburg, Pennsylvania; and Arleigh Rodgers in Bloomington, Indiana. Rodgers is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

It’s the latest legal skirmish over mandates in former President Barack Obama’s signature health care law, commonly known as “Obamacare,” which took effect 13 years ago.

Enforcing the judge’s order could jeopardize preventive care for at least some of an estimated 150 million insured people, Alisa Klein, arguing for the administration, told three 5th U.S. Circuit Court of Appeals judges in New Orleans.

Jonathan Mitchell, arguing for the law’s challengers, said a stay on the ruling is unnecessary. Insurers and employers who provide employee health insurance would be unlikely to drop preventive coverage before the case is finally resolved because they would risk prosecution if they lose, he argued. “No rational employer or insurer can take the risk,” he said.

That drew a skeptical response from Judge Leslie Southwick. “I don’t quite see how that fits into our analysis,” said Southwick, who during the hearing asked attorneys to try to reach an agreement on how and when the lower court ruling should be enforced pending appeal. “You may be right, but it really is speculation if you want us to apply some of our sense of how insurance companies react.”

The March ruling by U.S. District Judge Reed O’Connor affected requirements for coverage driven by recommendations by the U.S. Preventive Services Task Force. O’Connor ruled that because the task force is made up of volunteers, enforcing its recommendations violates the Constitution’s Appointment Clause, which lays out how government officials can be appointed.

As appeals continue, the administration isn’t attempting to block immediate enforcement of O’Connor’s ruling as it applies to the handful of Texas plaintiffs who filed suit. But it should not apply to the millions of people affected nationwide, Klein argued.

Southwick questioned that assertion. “Once the district court decided that all these decisions were beyond the authority of the body that made it, I’m not sure what relief would have been appropriate,” he said.

Not all preventive care is affected under the judge’s ruling. An analysis by the nonprofit KFF foundation found that some screenings, including mammography and cervical cancer screening, would still be covered without out-of-pocket costs because the task force recommended them before the health care law was enacted in March 2010.

O’Connor, a nominee of former President George W. Bush, is the same judge who ruled more than four years ago that the entire Obama health care law was unconstitutional. That ruling was overturned by the U.S. Supreme Court.

Those suing the federal government in this case include a conservative activist and a Christian dentist who oppose coverage for contraception and HIV prevention on religious grounds. The appellate judges are Edith Brown Clement and Southwick, who were also nominated by Bush; and Stephen Higginson, nominated by Obama.

An immediate ruling is not expected.

As a public health instructor, she taught college students about racial health disparities, including the fact that Black women in the U.S. are nearly three times more likely to die during pregnancy or delivery than any other race. Her home state of Alabama has the third-highest maternal mortality rate in the nation.

Then, in 2019, it nearly happened to her.

What should have been a joyous first pregnancy quickly turned into a nightmare when she began to suffer debilitating stomach pain.

Her pleas for help were shrugged off, she said, and she was repeatedly sent home from the hospital. Doctors and nurses told her she was suffering from normal contractions, she said, even as her abdominal pain worsened and she began to vomit bile. Angelica said she wasn’t taken seriously until a searing pain rocketed throughout her body and her baby’s heart rate plummeted.

Rushed into the operating room for an emergency cesarean section, months before her due date, she nearly died of an undiagnosed case of sepsis.

Even more disheartening: Angelica worked at the University of Alabama at Birmingham, the university affiliated with the hospital that treated her.

Her experience is a reflection of the medical racism, bias and inattentive care that Black Americans endure. Black women have the highest maternal mortality rate in the United States — 69.9 per 100,000 live births for 2021, almost three times the rate for white women, according to the Centers for Disease Control and Prevention.

Black babies are more likely to die, and also far more likely to be born prematurely, setting the stage for health issues that could follow them through their lives.

“Race plays a huge part, especially in the South, in terms of how you’re treated,” Angelica said, and the effects are catastrophic. “People are dying.”

To be Black anywhere in America is to experience higher rates of chronic ailments like asthma, diabetes, high blood pressure, Alzheimer's and, most recently, COVID-19. Black Americans have less access to adequate medical care; their life expectancy is shorter.

From birth to death, regardless of wealth or social standing, they are far more likely to get sick and die from common ailments.

Black Americans’ health issues have long been ascribed to genetics or behavior, when in actuality, an array of circumstances linked to racism — among them, restrictions on where people could live and historical lack of access to care — play major roles.

Discrimination and bias in hospital settings have been disastrous.

The nation’s health disparities have had a tragic impact: Over the past two decades, the higher mortality rate among Black Americans resulted in 1.6 million excess deaths compared to white Americans. That higher mortality rate resulted in a cumulative loss of more than 80 million years of life due to people dying young and billions of dollars in health care and lost opportunity.

A yearlong Associated Press project found that the health challenges Black Americans endure often begin before their first breath.

The AP conducted dozens of interviews with doctors, medical professionals, advocates, historians and researchers who detailed how a history of racism that began during the foundational years of America led to the disparities seen today.

“She made me feel like my concern wasn’t important"

Angelica Lyons’ pregnancy troubles began during her first trimester, with nausea and severe acid reflux. She was prescribed medication that helped alleviate her symptoms but it also caused severe constipation.

In the last week of October 2019, while she was giving her students a test, her stomach started to hurt badly.

“I remember talking to a couple of my students and they said, ‘You don’t look good, Ms. Lyons,'" Angelica recalled.

She called the University of Alabama-Birmingham Hospital’s labor and delivery unit to tell them she was having a hard time using the bathroom and her stomach was hurting. A woman who answered the phone told her it was a common pregnancy issue, Angelica said, and that she shouldn’t worry too much.

“She made me feel like my concern wasn’t important, and because this was my first pregnancy, I decided not to go because I wasn’t sure and thought maybe I was overreacting,” Angelica said.

The pain persisted. She went to the hospital a few days later and was admitted.

She had an enema — a procedure where fluids are used to cleanse or stimulate the emptying of bowels — to alleviate her constipation, but Angelica continued to plead with them that she was in pain.

“They were like, ‘Oh, it’s nothing, it’s just the Braxton Hicks contractions,'" she said. “They just ignored me.”

She was sent home but her stomach continued to ache, so she went back to the hospital a day later. Several tests, including MRIs, couldn’t find the source of the issue.

Angelica was eventually moved to the labor and delivery floor of the hospital so they could monitor her son’s heartbeat, which had dropped slightly. There, they performed another enema that finally helped with the pain. She also was diagnosed with preeclampsia, a dangerous condition that can cause severe pregnancy complications or death.

Then she began to vomit what appeared to be bile.

“I got worse and worse with the pain and I kept telling them, ‘Hey, I’m in pain,’” Angelica said. “They’d say, ‘Oh, you want some Tylenol?’ But it wasn’t helping.”

She struggled to eat dinner that night. When she stood up to go to the bathroom, she felt a sharp pain ricochet throughout her body.

“I started hollering because I had no idea what was going on," she said. "I told my sister I was in so much pain and to please call the nurse.”

What happened next remains a blur. Angelica recalls the chaos of hospital staff rushing her to labor and delivery, putting up a blue sheet to prepare her for an emergency C-section as her family and ex-husband tried to understand what went wrong.

She later learned that she nearly died.

“I was on life support,” recalled Angelica, 34. “I coded.”

She woke up three days later, unable to talk because of a ventilator in her mouth. She remembers gesturing wildly to her mother, asking where her son, Malik, was.

He was OK. But Angelica felt so much had been taken from her. She never got to experience those first moments of joy of having her newborn placed on her chest. She didn’t even know what her son looked like.

Maternal sepsis is a leading cause of maternal mortality in America. Black women are twice as likely to develop severe maternal sepsis, as compared to their white counterparts. Common symptoms can include fever or pain in the area of infection. Sepsis can develop quickly, so a timely response is crucial.

Sepsis in its early stages can mirror common pregnancy symptoms, so it can be hard to diagnose. Due to a lack of training, some medical providers don’t know what to look for. But slow or missed diagnoses are also the result of bias, structural racism in medicine and inattentive care that leads to patients, particularly Black women, not being heard.

“The way structural racism can play out in this particular disease is not being taken seriously,” said Dr. Laura Riley, chief of obstetrics and gynecology at Weill Cornell Medicine and New York-Presbyterian Hospital. “We know that delay in diagnosis is what leads to these really bad outcomes.”

In the days and weeks that followed, Angelica demanded explanations from the medical staff of what happened. But she felt the answers she received on how it occurred were sparse and confusing.

A spokesperson for the University of Alabama at Birmingham said in a statement to The Associated Press that they couldn’t talk about Angelica’s case because of patient privacy laws. They pointed to a recent internal survey done by its Obstetrics and Gynecology department that showed that most of its patients are satisfied with their care and “are largely feeling respected,” and said the university and hospital “maintain intentional, proactive efforts in addressing health disparities and maternal mortality.”

Angelica’s son, Malik, was born eight weeks early, weighing under 5 pounds. He spent a month in intensive care. He received home visits through the first year of life to monitor his growth.

While he’s now a curious and vivacious 3-year-old who loves to explore the world around him, Angelica recalls those days in the ICU, and she feels guilty because she could not be with him.

“It’s scary to know I could have died, that we could have died,” Lyons said, wiping away tears.

History of racist medical practices amid and after slavery

For decades, frustrated birth advocates and medical professionals have tried to sound an alarm about the ways medicine has failed Black women. Historians trace that maltreatment to racist medical practices that Black people endured amid and after slavery.

To fully understand maternal mortality and infant mortality crises for Black women and babies, the nation must first reckon with the dark history of how gynecology began, said Deirdre Cooper Owens, a historian and author.

“The history of this particular medical branch … it begins on a slave farm in Alabama,” Owens said. “The advancement of obstetrics and gynecology had such an intimate relationship with slavery, and was literally built on the wounds of Black women.”

Reproductive surgeries that were experimental at the time, like cesarean sections, were commonly performed on enslaved Black women.

Physicians like the once-heralded J. Marion Sims, an Alabama doctor many call the “father of gynecology,” performed torturous surgical experiments on enslaved Black women in the 1840s without anesthesia.

And well after the abolition of slavery, hospitals performed unnecessary hysterectomies on Black women, and eugenics programs sterilized them.

Health care segregation also played a major role in the racial health gap still experienced today.

Until Congress passed the Civil Rights Act of 1964, Black families were mostly barred from well-funded white hospitals and often received limited, poor or inhumane medical treatment. Black-led clinics and doctors worked to fill in the gaps, but even after the new protections, hospitals once reserved for Black families remained under-resourced, and Black women didn’t get the same support regularly available for white women.

That history of abuse and neglect led to deep-rooted distrust of health care institutions among communities of color.

“We have to recognize that it’s not about just some racist people or a few bad actors,” said Rana A. Hogarth, an associate professor of History at the University of Illinois, Urbana-Champaign. “People need to stop thinking about things like slavery and racism as just these features that happened that are part of the contours of history and maybe think of them more as foundational and institutions that have been with us every step of the way.”

Some health care providers still hold false beliefs about biological differences between Black and white people, such as Black people having “less sensitive nerve endings, thicker skin, and stronger bones.” Those beliefs have caused medical providers today to rate Black patients’ pain lower, and recommend less relief.

The differences exist regardless of education or income level. Black women who have a college education or higher have a pregnancy-related mortality rate that is more than five times higher than that of white women. Notably, the pregnancy-related mortality rate for Black women with a college education is 1.6. times higher than that of white women with less than a high school degree.

In Angelica Lyons’ home state of Alabama, about 40 mothers die within one year after delivery. The toll on Black mothers is disproportionate.

The state's infant mortality rate for 2021 was 7.6 deaths per 1,000 live births. The disparities between Black and white babies is stark: The infant mortality rate in 2021 for white mothers was 5.8, while the infant mortality rate for Black mothers was 12.1, an increase from 10.9 from the prior year.

Black babies account for just 29% of births in Alabama, yet nearly 47% of infant deaths.

A 2020 report by the Alabama Maternal Mortality Review Committee found that more than 55% of 80 pregnancy-related deaths that they reviewed in 2016 and 2017 could have been prevented.

Alabama launched its Maternal Mortality Review Committee in 2018 to investigate maternal deaths. But Dr. Scott Harris, Alabama’s Department of Public Health State Health Officer, said work remains to collect a fuller picture of why the disparities exist.

“We certainly know that from national numbers as well that Black women have worse maternal outcomes at every income level, which is pretty startling,” said Dr. Harris. “Age matters and just overall ZIP code matters. Unfortunately, where people live, where these children are born, is strongly associated with infant mortality. I think we’ll see something similar for maternal outcomes.”

And concerns about access and barriers to care remain.

In Alabama, 37% of counties are maternity care deserts — more than 240,000 women live in counties with no or little care. About 39% of counties don’t have a single obstetric provider.

Alabama is not alone in this. More than 2.2 million American women of childbearing age live in maternity care deserts, and another 4.8 million such women reside in counties with limited access to maternity care.

Angelica Lyons said she wanted to seek maternal care at another hospital but the University of Alabama was the only one near her home equipped to handle her high-risk pregnancy, which included high blood pressure near the beginning.

Dr. Harris acknowledged the lack of access to care is a barrier for Black women who live in the state’s rural areas. Much of the state’s public health efforts are targeted along the rural Black Belt, which gets its name from the rich soil but it was also a region where many plantations were clustered.

Centuries later, the Black Belt continues to be a high-poverty region with a large Black population. More than half of the nation’s Black population lives in the South.

“We’ve talked a lot about structural racism and the impact of that on African American women and how it has no place in society,” Harris said. “I think we have to publicly call it what it is.”

"My own primary care wasn’t listening to me”

Angelica Lyons’ traumatic birth experience was not the only one in her family. After two miscarriages, her younger sister, Ansonia, became pregnant in 2020, and it was difficult.

Doctors told her she was suffering from regular morning sickness, though she was vomiting blood.

She was eventually diagnosed with an excessive vomiting disorder, hyperemesis gravidarum, and was extremely dehydrated. Ansonia spent months in and out of the same hospital where her sister had been treated.

“They said, ‘Welcome to the pregnancy, sweetheart. This is what pregnancy is,’” Ansonia, 30, recalled. “I told her, ‘No, this is not normal for me to be throwing up 10 to 20 times a day.’ My own primary care wasn’t listening to me.”

Ansonia said throughout her pregnancy she encountered hospital staff that made stereotypical jokes, calling her child’s father her “baby daddy,” a trope often lobbed at Black parents.

“She said, ‘So, your baby daddy, where does he work?’” Ansonia recalled. “I said, ‘I don’t know what a baby daddy is but the father of my child is at work.’ She asked where he worked and I told her he had two businesses and she acted like she was surprised.”

Ansonia said staff assumed she didn’t have any health insurance, when she had insurance through her employer.

Ansonia has Type 2 diabetes and had issues with her blood pressure and heart throughout the pregnancy. She started to see a cardiologist and by the time she was 21 weeks pregnant, she was diagnosed with congestive heart failure. She was placed on a medley of medications, and her doctors decided to deliver the baby early via C-section.

Ansonia was scared, given everything she witnessed her sister go through nearly two years prior.

“There were several times I told my boyfriend that I thought that I was going to die,” she said.

The C-section went well. Ansonia’s son, Adrien, was due in July 2021 but he was born at the end of May.

He spent his first five days in the intensive care unit, then was hospitalized for another two weeks for some early breathing problems.

Cesarean delivery rates are higher for Black women than white women, 36.8% and 31%, respectively, in 2021.

Problems continued for Ansonia after the delivery. She ended up needing a blood transfusion and was unable to see her son for his first few days of life.

A few months postpartum, she was still vomiting and having fainting spells that led to her being admitted to the hospital off and on. Her arms suffered from bruising from needles used to treat her throughout the pregnancy. She had always been slow to heal from any bruising, a common problem for diabetics.

Yet a doctor who had been involved throughout her entire pregnancy questioned why she had bruises on her arms and asked if she “smoked weed” or took any other recreational drugs. The hospital declined to comment, citing patient privacy laws.

“I said, ‘This is from me being stuck so many times and having to be in the hospital.’ I told him I don’t do any drugs,” she said.

He still sent her blood work off to be tested. The tests came back negative.

“That just made me not trust them, it made me not want to go back,” she said.

Recognition and legislation

There are indications that the sufferings of Black mothers and their babies are being recognized, however late.

In 2019, U.S. Rep. Lauren Underwood, an Illinois Democrat, and Rep. Alma Adams, a North Carolina Democrat, launched the Black Maternal Health Caucus. It is now one of the largest bipartisan congressional caucuses. The caucus introduced the Black Maternal Health Momnibus Act in 2019 and again in 2021, proposing sweeping changes that would increase funding and strengthen oversight. Key parts of the legislation have been adopted but the bill itself has yet to be approved.

Biden’s budget for fiscal year 2024 includes $471 million in funding to reduce maternal mortality and morbidity rates, expand maternal health initiatives in rural communities, and implicit bias training and other initiatives. It also requires states to provide continuous Medicaid coverage for 12 months postpartum, to eliminate gaps in health insurance. It also includes $1.9 billion in funding for women and child health programs.

U.S. Secretary of Health and Human Services Xavier Becerra told The Associated Press more must be done at all levels of government to root out racism and bias within health care.

“We know that if we provide access to care for mother and baby for a full year, that we probably help produce not just good health results, but a promising future for mom and baby moving forward,” he said.

They caused this to my body by "not listening to me"

Shelonda Lyons always taught both her daughters the bitter truth of racism, hoping it would prepare them to navigate life growing up in Birmingham, the Deep South city known for its place in civil rights history.

“When we were young, she was showing us those images of all the Black people being hung, being burned on the trees,” Angelica said, pointing to a book that remains on the family’s coffee table. “She wanted us to understand it, to know where we lived and that racism was something that we might have to deal with.”

But Shelonda never could have prepared for the treatment her daughters endured during their pregnancies. She remembers feeling helpless and angry.

“It’s like a slap in the face to me because at what point do you realize that you’re dealing with human beings? That it doesn’t matter what color they are,” she said, adding that now she worries any time they or her grandsons need to go to the doctor. “I don’t have a lot of trust.”

Angelica underwent two surgeries in the weeks that followed her C-section to repair internal damage and address her infection. She had to wear a colostomy bag for several months until she healed.

More than three years later, her stomach remains disfigured.

“I love my child, I love him all the same but this isn’t the body I was born with," she said. “This is the body that they caused from them not paying attention to me, not listening to me.”

___

Kat Stafford, based in Detroit, is a national investigative race writer for the AP's Race and Ethnicity team. She is a 2022 Knight-Wallace Reporting Fellow at the University of Michigan.

This story uses functionality that may not work in our app. Click here to open the story in your web browser.

Although, NYC Care is designed to make health care affordable, the program notes that it is not an insurance plan. While not an insurance plan, under NYC Care, members will have a similar experience to individuals with health insurance have “such as a membership card, a regular doctor, high-quality customer service, access to affordable medications, and more,” according to the program’s website.

What does being a member of NYC Care provide?

NYC Care provides:

• A membership card to access health care at NYC Health + Hospitals patient care locations across the city
• Allows members to choose their own primary care provider
• Allows members to receive preventive care like vaccinations, routine screenings and mammograms
• Allows members to get access to mental health support and substance abuse services
• Allows members to get their first appointment in two weeks or less
• Customer service representatives who speak your language and can help you day or night
• Access to low-cost prescription medications
• Support from a primary care team that also includes nurses, medical assistants, social workers, pharmacists, and nutritionists
• Affordable quality health care where the cost to receive health care is based on your family size and income.

What are the eligibility requirements to qualify for NYC Care?

In order to be eligible for NYC Care, one must be a resident of one of the five boroughs of New York City. Additionally, one cannot qualify for any other health insurance plan available in the state and must not be able to afford health insurance based on federal guidelines.

NOTE: If you do not qualify for NYC Care or any other health insurance plan, you may still be eligible to receive services under the NYC Health + Hospitals Options program.

Additionally, it is important to note that NYC Health + Hospitals, which runs NYC Care, will keep personal information private and does not keep records about immigration status so that everyone can seek health care without fear.

How much will services cost as a member of NYC Care?

This program does not have membership fees, monthly fees, or premiums. Rather, members will pay for services received based on reduced rates determined by your family size and income.

If you are approved as a NYC Care member, you will receive a membership card in that mail that is unique to you and shows your fees for health care services.

Members should carry this card as one would a health insurance card: when visiting your primary care doctor and when getting health care services at any NYC Health + Hospitals locations.

For more information, click here.

“It could be an enormous public health calamity,” Ken Raske of the Greater New York Hospital Association (GNYHA) previously told NBC New York. He has described the mood among hospital managers as “extremely apprehensive,” and a strike would send already busy hospitals into full-on crisis mode.

The New York State Nurses Association has more than 9,000 members threatening to conduct strikes at four hospitals where contracts expired on Dec. 31. (Ver detalles en español aquí.)

“Our ERs are backed up, the tripledemic is raging,” said Raske. “Even if one hospital would have a strike, it could ripple through the entire system.”

News of the potential strike comes as the city deals with what is being called a tridemic — simultaneous and serious spikes in infections with COVID, the flu and the respiratory condition RSV. In an effort to keep case numbers down and relieve pressure on hospitals, the city has already issued an advisory (not a mandate) suggesting that people go back to wearing masks indoors.

But what would a theoretical strike mean for you and your health care? Here’s what we know so far.

What Hospitals Could See Nurses Go On Strike?

First off, it’s important to note that not all NYC hospitals would have nurses go on strike, not by a longshot. A week ago, there were eight private hospitals that were looking at potential nursing strikes. But as of Friday evening, four of those hospitals have come to tentative agreements with their nursing staffs, and would avoid strikes if the unions vote to approve the deals.

Here are the four hospitals where no tentative agreement has yet been reached (as of Friday evening) — meaning a strike is still very much on the table:

• Montefiore
• Mount Sinai Hospital
• Mount Sinai Morningside and West
• BronxCare

Four hospitals have reached at least tentative agreements, which must be voted on by members of the nurses union: New York-Presbyterian Hospital, Maimonides Hospital, Richmond University Medical Center and Flushing Hospital and Medical Center. If approved, those hospitals would avoid a strike. Maimonides ratified their new contract on Friday.

To clarify, just because one hospital were to see a strike, it doesn’t necessarily mean the others would too. In theory, nurses going on strike at one hospital wouldn’t have any impact on the nurses’ decision at another hospital. Each of the hospitals negotiates individually with their own nurses, so depending on how talks go, there could be no strikes at all, a single strike or as many as four strikes.

Hospitals Jan 5, 2023

NYC Hospitals Start Moving Sick Babies, Diverting Ambulances as Nurse Strike Looms

Hospitals Jan 4, 2023

Hospitals to Cancel Elective Procedures, Discharge ASAP as Nurse Strike Looms: Sources

Hospitals Jan 2, 2023

NY-Presbyterian Reaches Tentative Deal to Avoid Nurses Strike: Sources

What Impact Would a Strike Have on Health Care?

For those worried about what a strike could mean on their health care, there are already impacts happening, or very soon will be.

Mount Sinai Health System is beginning to divert “a majority” of ambulances from four of its facilities, and is transferring babies from its neonatal intensive care units to other hospital systems, according to a memo from hospital leadership to staff, a copy of which was obtained by News 4.

Here is a summary of what changes the memo stated would occur soon, as early as Friday:

• Diverting ambulances from Mount Sinai Hospital, Mount Sinai West, Mount Sinai Morningside and Mount Sinai Beth Israel
• Canceling elective surgeries, and scheduling only emergency surgeries at the main and Morningside facilities
• Transferring some patients: “In addition, this – sadly – means transferring NICU babies outside the Mount Sinai Health System to ensure they get the care they so desperately need”
• Discharging “as many patients as appropriate” and shifting services – inpatient care at the main and West facilities, and emergency and child psychiatry at the Morningside campus

A source who works at Mount Sinai said that the parents of the 50+ babies in the NICU did not appear to have been notified yet that their young ones would have to be moved to another facility — although no babies had yet been transferred as of Thursday evening (in fact, sources said one had been transferred in).

A Mount Sinai spokesperson said that the plan is to move patients on Friday if no deal is in place. As for the other hospitals on the list, it was not immediately clear what contingency plans have already been put into effect or will soon be.

One thing that patients and visitors could expect to see: A lot more travel and trade nurses.

NBC New York has learned that the other hospitals that have not reached agreements with their nursing staffs have already started shelling out tens of millions of dollars in nonrefundable down payments to have traveling temporary nurses on reserve — a huge expense they must shoulder, even if no strikes take place.

The GNYHA said the hospitals having to turn to this more expensive option works against the interest of the nurses in the union because it forces hospitals to spend money that could go to the nurses. However, it also increases the leverage of nurses once the strike notice is issued.

A nurse involved in negotiations estimated the cost of trade nurses is around $10,000 a week, per travel nurse. While the skillset for trade nurses is the same as union nurses, patients who have spent large amounts of time with specific nurses or become familiar with them may have to get used to seeing new faces if a strike were to happen and last for a while.

How Likely Is It That a Strike (or Strikes) Will Occur?

For now, tough to say for certain. It all depends on what the respective hospitals offer the nurses, and if they decide to accept the offers.

NBC New York obtained a memo from the leaders of Mount Sinai Hospital, Mount Sinai Morningside and Mount Sinai West that makes clear most issues in the ongoing negotiations have been resolved — but not all, and the clock is ticking.

Nurses have said that there has been progress at some bargaining tables where hospitals are negotiating with their respective staffs, but not enough progress yet to avoid a strike. The nurses union said there has been at least one sign of progress: All of the hospitals on the list have agreed to not cut health benefits.

“The New York State Nurses Association will rescind a strike notice when we reach a tentative agreement at Mount Sinai that respects nurses and our patients. Not before,” said New York State Nurses Association president Nancy Hagans. “There has been some offers and progress but we are not there yet.”

According to a source familiar with Mount Sinai’s past talks, the hospital had previously offered nurses a deal that included 19.1 percent raises over three years. Management says they negotiated past midnight with the help of a mediator but are still at an impasse over wages. That deal was higher than the one extended by NY-Presbyterian over the weekend.

“It’s not reasonable for NYSNA to ask for a significant wage increase above and beyond these other sites.  It’s time for NYSNA to meet us back at the bargaining table and continue negotiating in good faith, so that Mount Sinai nurses can continue providing the exceptional patient care for which they’re known and respected,” a Mount Sinai statement said Friday afternoon.

That tentative deal, if accepted, would give nurses at NY-Presbyterian 18 percent raises over the next three years, with added incentives to retain experienced nurses. There was also a promise to address chronic understaffing, which was the union’s biggest complaint.

While it remains to be seen whether the nurses at NY-Presbyterian will accept the offer, Montefiore Hospital said Wednesday that nurse representatives at their hospital had rejected a deal that mirrored the one NY-Presbyterian offered. A spokesperson for the hospital said that nurses were offered “an 18 percent wage increase over three years, fully funded healthcare for life, and a significant increase in registered nurses in the emergency departments, among other benefits.”

That development may spell trouble for other hospitals given the financial landscape. According to the Montefiore spokesperson, NY-Presbyterian posted $200 million in profits in 2022 while Montefiore posted $200 million in losses. That sort of deal was considered potentially unattainable for other hospitals on the list, but now nurses at NY-Presbyterian may think twice about ratifying the deal they tentatively agreed to (voting began Tuesday night and concludes Saturday).

At least one hospital has ratified their new contract deal with nurses, assuring no strike will take place there: Nurses at Maimonides Hospital approved a new contract with 93 percent of the vote.

Why Are Nurses Threatening to Strike? What Are They Hoping to Get?

“Nurses feel abandoned and disrespected by their bosses,” Hagans said. “We held the hands of dying patients, set up last FaceTime calls so dying patients could say goodbye to their loved ones.”

Matt Allen, a labor and delivery nurse on the negotiating committee at Mount Sinai, told NBC New York on Monday that there are more than 700 vacancies for nursing positions at Mount Sinai hospitals — something they desperately want to be addressed.

“Staffing is the biggest issue that we’re fighting for right now,” said Allen. “We’re hopeful that we’re going to get something this week, before our strike is still on the table.”

The union says members are upset about staffing ratios at the local hospitals, contract proposals that they feel dramatically worsen their healthcare benefits (while paying big bonuses to executives), and Mayor Eric Adams’ recent move to forcibly hospitalize psychiatric patients. All of those elements have left workers overworked and burnt out.

“We’re not able to clean the patient on time, not able to give medicine on time, no breaks,” said Allen. “Burnout was real, so we leave the profession and go to work at a travel agency that’s going to pay us more.”

The average salary for nurses in New York is $93,000, and $98,000 in NYC, the nurses union and GNYHA confirmed. It isn’t clear just how much in terms of compensation and raises the union is hoping to get for its members, but it’s clear the numbers some of the hospitals have thrown out thus far have not met their standards.

“If Montefiore can afford to pay its executives so much, they can’t hardly cry broke when it comes to negotiate a contract with frontline nurses,” said Hagans.

Can the Government Step In and Force the Sides to Reach an Agreement?

In short, no. These are private hospitals negotiating with unions, and the government can’t do much officially to help avoid a strike.

However, that doesn’t mean nothing can be done.

Gov. Kathy Hochul’s office has said previously that they are “monitoring the situation.” Sources said that both Hochul and NYC Mayor Eric Adams are getting regular daily updates on the talks. While neither Hochul nor Adams have any formal role in the negotiations, some have wondered whether they would step in to apply pressure or try to broker a deal.

Aides to Gov. Hochul confirmed that she has been very engaged for many days, not directly at the bargaining table but speaking to both sides regularly and pushing both sides to get to yes. The state has also started to review the hospitals’ strike contingency plans.

“We have been working with all parties to help reach a fair resolution to keep New Yorkers and health care workers safe,” Hochul spokesperson Avi Small told NBC New York on Thursday.