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Republicans Are Downplaying Abortion, but It Keeps Coming Up

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Julie Rovner, KFF
Fri, 28 Jun 2024 09:00:00 +0000

For generations, the GOP campaigned on eliminating the right to an abortion in the United States. Now, torn between a base that wants more restrictions on reproductive health care and a moderate majority that does not, it seems many Republicans would rather take an off-ramp than a victory lap.

And yet, they just can't escape talking about it.

The policy high point for abortion opponents — the Supreme Court's 2022 decision to strike down Roe v. Wade — is proving a low point for public support for their cause. More American adults consider themselves “pro-choice” than at any time in the past 30 years, according to a recent survey from Gallup: 54%, compared with 41% who identify as “pro-life.”

The tide is turning even as some conservatives seek restrictions on birth control and fertility treatments. A new KFF survey of women voters found that Democrats are more likely than Republicans to say that abortion is the most important issue in their vote for president — a reversal from recent elections. One in 5 women under age 30 and 13% of those under age 50 said it is their top concern. Among independents, 81% said they believed abortion should be legal.

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Democrats are counting on the issue to help turn out their votes and ensure President Joe Biden's reelection, despite persistent dissatisfaction with his leadership. Abortion could prove particularly disruptive in battleground states expected to have initiatives on the ballot to enshrine access to abortion in state constitutions, including Arizona and Nevada.

Eight in 10 Democratic women in states with possible ballot measures said they were “absolutely certain” they would vote — and also said they were more likely to back Biden compared with Democratic women in other states, KFF found.

So far, abortion rights supporters have prevailed in each of the seven states that have put ballot initiatives before voters — including in states where Republicans control the legislatures, such as Kansas, Ohio, and Kentucky. About two-thirds of women in Arizona told KFF they support the state's proposed Right to Abortion Initiative, including 68% of independents.

On the campaign trail, Republicans are bobbing and weaving to avoid the subject, even when that means distancing themselves from — well, themselves. Former President Donald Trump, who has taken a few different stances since calling himself “pro-choice” in 1999, reportedly urged lawmakers during a recent closed-door visit to the Capitol not to shy away from the issue, but also to support exceptions to bans, including to protect the life of the pregnant person.

In pivotal Arizona, U.S. Senate Republican candidate Kari Lake, who embraced a near-complete abortion ban while running for governor two years ago, recently said “a full ban on abortion is not where the people are.” In Nevada, the GOP Senate nominee, Sam Brown, who as recently as 2022 headed up a branch of a conservative anti-abortion group, has said he will respect his state's permissive abortion law and would not vote for a nationwide ban if elected.

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The Supreme Court is keeping the issue on the front burner. In a decision June 27, the court left emergency abortions legal in Idaho, a state with a strict ban, though the issue remains unsettled nationally. Justice Ketanji Brown Jackson, who joined the majority in an unusual ruling that sent the case back to the lower court and declared it had been accepted prematurely, accused her colleagues of dawdling on the issue.

“Pregnant people experiencing emergency medical conditions remain in a precarious position, as their doctors are kept in the dark about what the law requires,” she wrote.

The KFF survey found broad, strong support for preserving access to abortion in cases of pregnancy-related emergencies: 86% of women voters — including 79% of Republican women — support laws protecting access in those circumstances.

In mid-June, the court rejected an effort to overturn the FDA's 24-year-old approval of the abortion pill mifepristone, but only on a technicality. With no actual ruling on the merits of the case, the justices left open the possibility that different plaintiffs could provoke a different outcome. Nevertheless, the push to redefine reproductive health care post-Roe v. Wade continues. The influential evangelical Southern Baptist Convention recently called for significant legislative restrictions on in vitro fertilization, which its members call morally incompatible with the belief that life begins at fertilization.

Abortion opposition groups are pressing Trump not to discard a main plank of the GOP's presidential platform since 1976: a federal abortion ban. Trump has recently said states should make their own decisions about whether to restrict abortion.

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Democrats and Democratic-aligned groups are exploiting Republicans' discomfort with the issue. On the day Senate Democrats forced a vote on legislation that would have guaranteed a federal right to contraception, a group called Americans for Contraception floated a giant balloon shaped like an IUD near the Capitol. (Republicans blocked the bill, as expected — and no doubt Democrats will frequently remind voters of that this year.)

A week later, Senate Democrats tried to bring up a bill to guarantee access to IVF, which Republicans also voted down. No giant balloon for that one, though.

Republicans still appear bent on dodging accountability for the unpopularity of their reproductive health positions, if only by highlighting other issues they hope voters care about even more — notably, the economy. But one thing they're unlikely to accomplish is keeping the issue out of the news.

HealthBent, a regular feature of KFF , offers insight into and analysis of policies and politics from KFF Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

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By: Julie Rovner, KFF Health News
Title: Republicans Are Downplaying Abortion, but It Keeps Coming Up
Sourced From: kffhealthnews.org/news/article/republicans-downplay-abortion-election-issue-voter-opinion/
Published Date: Fri, 28 Jun 2024 09:00:00 +0000

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Kaiser Health News

How to Find a Good, Well-Staffed Nursing Home

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Jordan Rau, KFF
Fri, 12 Jul 2024 09:45:00 +0000

Few people want to go into a nursing home, but doing so can be the right choice if you or a loved one is physically or cognitively disabled or recovering from surgery. Unfortunately, homes vary greatly in quality, and many don't have enough nurses and aides to give residents the care they need.

Q: How do I find nursing homes worth considering?

Start with Medicare's online comparison tool, which you can search by city, state, ZIP code, or home name. Ask for advice from people designated by your state to help people who are older or have disabilities search for a nursing home. Every state has a “no wrong door” contact for such inquiries.

You can also reach out to your local area agency on aging, a public or nonprofit resource, and your local long-term care ombudsman, who helps residents resolve problems with their nursing home.

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Find your area agency on aging and ombudsman through the federal government's Eldercare Locator website or by calling 1-800-677-1116. Identify your ombudsman through the National Consumer Voice for Quality Long-Term Care, an advocacy group. Some people use private placement agencies, but they may refer you only to homes that pay them a referral fee.

Q: What should I find out before visiting a home?

Search online for news coverage and for reviews posted by residents or their families.

Call the home to make sure beds are available. Well-regarded homes can have long waiting lists.

Figure out how you will pay for your stay. Most nursing home residents rely primarily on private long-term care insurance, Medicare (for rehabilitation stays) or Medicaid (for long-term stays if you have few assets). In some cases, the resident pays entirely out-of-pocket. If you're likely to run out of money or insurance coverage during your stay, make sure the home accepts Medicaid. Some won't admit Medicaid enrollees unless they start out paying for the care themselves.

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If the person needing care has dementia, make sure the home has a locked memory-care unit to ensure residents don't wander off.

Q: How can I tell if a home has adequate staffing?

Medicare's comparison tool gives each home a rating of one to five stars based on staffing, health inspection results, and measurements of resident care such as how many residents had pressure sores that worsened during their stay. Five is the highest rating. Below that overall rating is one specifically for staffing.

Be sure to study the annual staff turnover rate, at the bottom of the staffing page. Anything higher than the national rate — an appalling 52% — should give you pause.

You should also pay attention to the inspection star rating. The “quality” star rating is less reliable because homes self-report many of the results and have incentives to put a glossy spin on their performance.

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Q: Does a home with three, four, or five stars provide good care?

Not necessarily. Medicare's ratings compare the staffing of a home against that of other homes, not against an independent standard. The industry isn't as well staffed as many experts think it needs to be: About 80% of homes, even some with four and five stars, are staffed below the standards the Biden administration will be requiring homes to meet in the next five years.

Q: How many workers are enough?

There's no straightforward answer; it depends on how frail and sick a nursing home's residents are. Medicare requires homes to prominently post their staffing each day. The notices should show the number of residents, registered nurses, licensed vocational nurses, and nurse aides. RNs are the most skilled and manage the care. LVNs provide care for wounds and catheters and handle basic medical tasks. Nurse aides help residents eat, dress, and get to the bathroom.

Expert opinions vary on the ideal ratios of staffing. Sherry Perry, a Tennessee nursing assistant who is the chair of her profession's national association, said that preferably a nursing assistant should care for eight or fewer residents.

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Charlene Harrington, an emerita professor of nursing at the University of California-San Francisco, recommends that on the day shift there be one nurse aide for every seven residents who need help with physical functioning or have behavioral issues; one RN for every 28 residents; and one LVN for every 38 residents. Patients with complex medical needs will need higher staffing levels.

Staffing can be lower at night because most residents are sleeping, Harrington said.

Nursing home industry officials say that there's no one-size-fits-all ratio and that a study the federal government published last year found quality improved with higher staffing but didn't recommend a particular level.

Q: What should I look for when I visit a home?

Watch to see if residents are engaged in activities or if they are alone in their rooms or slumped over in wheelchairs in hallways. Are they still in sleeping gowns during the day? Do nurses and aides know the residents by name? Is food available only at mealtimes, or can residents get snacks when hungry? Watch a meal to see whether people are getting the help they need. You might visit at night or on weekends or holidays, when staffing is thinnest.

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Q: What should I ask residents and families in the home?

Are residents cared for by the same people or by a rotating cast of strangers? How long do they have to wait for help bathing or getting out of bed? Do they get their medications, physical therapy, and meals on time? Do aides come quickly if they turn on their call light? Delays are strong signs of understaffing.

Medicare requires homes to allow residents and families to form councils to address common issues. If there's a council, ask to speak to its president or an officer.

Ask what proportion of nurses and aides is on staff or from temporary staffing agencies; temp workers won't know the residents' needs and likes as well. A home that relies heavily on temporary staff most likely has trouble recruiting and keeping employees.

Q: What do I need to know about a home's leadership?

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Turnover at the top is a sign of trouble. Ask how long the home's administrator has been on the job; ideally it should be at least a year. (You can look up administrator turnover on the Medicare comparison tool: It's on the staffing page beneath staff turnover. But be aware the information may not be up to date.) You should also ask about the tenure of the director of nursing, the top clinical supervisor in a home.

During your tour, observe how admissions staff members treat the person who would be living there. “If you walk in to visit with your mom and they greeted you and didn't greet your mom or focused all their attention on you, go somewhere else,” advised Carol Silver Elliott, president of the Jewish Home Family, a nonprofit in Rockleigh, New Jersey.

Q: Does it matter who owns the home?

It often does. Generally, nonprofit nursing homes provide better care because they can reinvest revenue back into the home rather than paying some of it to owners and investors.

But there are some very good for-profit homes and some lousy nonprofits. Since most homes in this country are for-profit, you may not have a choice in your area. As a rule of thumb, the more local and present the owner, the more likely the home will be well run. Many owners live out of state and hide behind corporate shell companies to insulate themselves from accountability. If nursing home representatives can't give you a clear answer when you ask who owns it, think twice.

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Finally, ask if the home's ownership has changed in the past year or so or if a sale is pending. Stable, well-run nursing homes aren't usually the ones owners are trying to get rid of.

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By: Jordan Rau, KFF
Title: How to Find a Good, Well-Staffed Nursing Home
Sourced From: kffhealthnews.org/news/article/nursing-home-shopping-staffing-resources-red-flags/
Published Date: Fri, 12 Jul 2024 09:45:00 +0000

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Lifesaving Drugs and Police Projects Mark First Use of Opioid Settlement Cash in California

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Aneri Pattani and Don Thompson
Fri, 12 Jul 2024 09:00:00 +0000

SACRAMENTO — Sonja Verdugo lost her husband to an opioid overdose last year. She regularly delivers medical supplies to people using drugs who are living — and dying — on the streets of Los Angeles. And she advocates at Los Angeles City Hall for policies to address addiction and homelessness.

Yet Verdugo didn't know that hundreds of millions of dollars annually are flowing to California communities to combat the opioid crisis, a payout that began in 2022 and continues through 2038.

The money comes from pharmaceutical companies that made, distributed, or sold prescription opioid painkillers and that agreed to pay about $50 billion nationwide to settle lawsuits over their role in the overdose epidemic. Even though a recent Supreme Court decision upended a settlement with OxyContin maker Purdue Pharma, many other companies have already begun paying out and will continue doing so for years.

California, the most populous state, is in line for more than $4 billion.

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“You can walk down the street and you see someone addicted on every corner — I mean it's just everywhere,” Verdugo said. “And I've never even heard of the funds. And to me, that's crazy.”

Across the nation, much of this windfall has been shrouded in secrecy, with many jurisdictions offering little transparency on how they're spending the money, despite repeated queries from people in recovery and families who lost loved ones to addiction.

Meanwhile, there's plenty of jockeying over how the money should be used. Companies are lobbying for spending on products that range from medication bottles that lock to full-body scanners to screen people entering jails. Local officials are often advocating for the fields they represent, whether it's treatment, prevention, or harm reduction. And some governments are using it to plug budget gaps.

In California, local governments must report how they spend settlement funds to the state's Department of Health Care Services, but there's no requirement that the reports be made public.

KFF obtained copies of the documents via a public records request and is now making available for the first time 265 spending reports from local governments for fiscal year 2022-23, the most recent reports filed.

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The reports provide a snapshot of the early spending priorities, and tensions.

Naloxone an Early Winner

As of June 2023, the bulk of opioid settlement funds controlled by California cities and counties — more than $200 million — had yet to be spent, the reports show. It's a theme echoed nationwide as officials take time to deliberate.

The city and county of Los Angeles accounted for nearly one-fifth of that unspent total, nearly $39 million, though officials say that since the report was filed they've begun allocating the money to recovery housing and programs to connect people who are homeless with residential addiction treatment.

Among local governments that did use the cash in the first fiscal year, the most popular object of spending was naloxone, a medication that reverses opioid overdoses and is often known by the brand name Narcan. The medication accounted for more than $2 million in spending across 19 projects.

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One of those projects was in Union City, in the San Francisco Bay Area. The community of about 72,000 residents had five suspected fentanyl overdoses, two of them fatal, within 24 hours in September.

The opioid settlement money “was invaluable,” Corina Hahn, the city's director of community and recreation services, said in her report. “Having these resources available helped educate, train and distribute the Narcan kits to parents, youth and school staff.”

Union City bought 500 kits, each containing two doses of naloxone. The kits cost about $13,500, with an additional $56,000 set aside for similar projects, including backpacks containing Narcan kits and training materials for high school students.

Union City also plans to expand its outreach to homeless people to fund drug education and recovery services, including addiction counseling.

Those are the sorts of lifesaving services that Verdugo, the Los Angeles advocate, said are desperately needed as deaths of people living on the streets pile up.

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She lost her 46-year-old husband, Jesse Baumgartner, in June of last year to an addiction that started after he was prescribed pain medications for a high school wrestling injury. He tried kicking his habit for six years using methadone, but each time prescribers lowered his dosage the cravings drove him back to illicit drugs.

“It was just this horrible roller coaster of him not being able to get off of it,” Verdugo said.

By then the couple had survived 4½ years of being homeless and had been in stable housing for about two years.

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Fentanyl use, particularly among homeless people, “is just rampant,” she said. People sometimes are initially exposed to the cheap, highly addictive substance unknowingly when it is mixed with something else.

“Once they start using it, it's like they just can't backtrack,” said Verdugo, who works as a community organizer for Ground Game LA.

So she leaves boxes of naloxone at homeless encampments in the hope of saving lives.

“They definitely use it, because it's needed right then — they can't wait for an ambulance to come out,” she said.

Cities Backtrack on Spending for Law Enforcement

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By contrast, the cities of Irvine and Riverside, both in Greater Los Angeles, listed plans to prioritize law enforcement by buying portable drug analyzers, though neither city did so in the first fiscal year, 2022-23. Their inclination mirrored patterns elsewhere in the country, with millions in settlement funds flowing to police departments and jails.

But such uses of the money have stirred controversy, and both cities backed away from the drug analyzer purchase after the Department of Care Services issued rules that opioid settlement funds may not be used for certain law enforcement efforts. The rules specifically excluded “equipment for the purpose of evidence gathering for prosecution, such as the TruNarc Handheld Narcotics Analyzer.”

In Hawthorne, also near Los Angeles, the police department had already spent about $25,000 of settlement funds on an initial installment to buy 80 BolaWraps, devices that shoot Kevlar tethers to wrap around a person's limbs or torso.

After the state said BolaWraps were not an allowable expense, the city said it would find other funding sources to pay the remaining installments.

Santa Rosa, in California's wine country, spent nearly $30,000 on police officer wellness and support.

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The funds allowed the police department to boost its contracted wellness coordinator from a part-time to a full-time position, and to buy a mobile machine to measure electrical activity in the brain, said Sgt. Patricia Seffens, a spokesperson.

The goal is to use the technology on police officers to help “assess the traumatic impact of responding to the increasing overdose calls,” Seffens said in an email.

In Dublin, east of San Francisco, officials are using part of their $62,000 in settlement cash for a D.A.R.E. program.

D.A.R.E., which stands for Drug Abuse Resistance Education, is a series of classes taught by police officers in schools to encourage students to resist peer pressure and avoid drugs. It was initially developed during the “Just Say No” campaign in the 1980s.

Studies have found inconsistent results from the program and no long-term effects on drug use, leading many researchers to dismiss it as “ineffective.”

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But on its website, D.A.R.E. cites studies since the program was updated in 2009, which found “a positive effect” on fifth graders and “statistically significant reductions” in drinking and smoking about four months after completing the program.

“The D.A.R.E. program when it first came out looks a lot, lot different than what it looks like right now,” said Nate Schmidt, the Dublin police chief.

Schmidt said additional settlement money will be used to distribute naloxone to residents and stock it at schools and city facilities.

Other local governments in California spent modest sums on a wide range of addiction-related measures. Ukiah, in Mendocino County, north of San Francisco, spent $11,000 for a new heating and air conditioning system for a local drug treatment center. Orange and San Mateo counties spent settlement funds in part on medication-assisted treatment for people incarcerated in their jails. The city of Oceanside spent $16,000 to showcase drug prevention art and made by middle school students in local movie theaters, in public spaces, and on buses and taxis.

The Department of Health Care Services said it plans to release a statewide report on how the funds were spent, as well as the individual city and county reports, by year's end.

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This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

——————————
By: Aneri Pattani and Don Thompson
Title: Lifesaving Drugs and Police Projects Mark First Use of Opioid Settlement Cash in California
Sourced From: kffhealthnews.org//article/drugs-police-projects-first-california-opioid-settlement-spending/
Published Date: Fri, 12 Jul 2024 09:00:00 +0000

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KFF Health News’ ‘What the Health?’: GOP Platform Muddies Abortion Waters

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Thu, 11 Jul 2024 20:00:00 +0000

The Host

Julie Rovner
KFF


@jrovner


Read Julie's stories.

Julie Rovner is chief Washington correspondent and host of KFF ' weekly health policy news , “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

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Republicans released a draft party platform in advance of the GOP national convention next week, and while it is being described as softening the party's stance opposing abortion, support from major groups that oppose abortion suggests that claim may be something of a mirage.

Meanwhile, the Federal Trade Commission is taking on the pharmacy benefits management industry as it prepares to file suit charging that the largest PBMs engage in anticompetitive behavior that raises patients' drug costs.

This week's panelists are Julie Rovner of KFF Health News, Jessie Hellmann of CQ Roll Call, Shefali Luthra of The 19th News, and Sandhya Raman of CQ Roll Call.

Panelists

Jessie Hellmann
CQ Roll Call


@jessiehellmann

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Read Jessie's stories.

Shefali Luthra
The 19th


@shefalil


Read Shefali's stories.

Sandhya Raman
CQ Roll Call

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@SandhyaWrites


Read Sandhya's stories.

Among the takeaways from this week's episode:

  • For the first time in decades, the GOP presidential platform will not include a call for a national abortion ban. But Republicans are hardly soft-pedaling the issue: The new platform effectively asserts that abortion violates the 14th Amendment, which guarantees equal protection under the law for all citizens — including, under their reading, human embryos. Under that argument, abortion opponents may already have the constitutional justification they need to defend in court further restrictions on the procedure.
  • Lawmakers in Washington are making early progress on government spending bills, including for the Department of Health and Human Services. Some political issues, like access to gender-affirming care for service members and minors, are creating wrinkles. Congress will likely need to pass a stopgap spending measure to avoid a government shutdown this fall.
  • And a new report from the Federal Trade Commission illuminates the sweeping control of a handful of pharmacy benefits managers over most of the nation's prescription drugs. As the government eyes lawsuits against some of the major PBMs alleging anticompetitive behavior, the findings bolster the case that PBMs are inflating drug prices.

Also this week, Rovner interviews Jennifer Klein, director of the White House Gender Policy Council, about the Biden administration's policies to ensure access to reproductive health care.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: STAT News' “Troubled For-Profit Chains Are Stealthily Operating Dozens of Psychiatric Hospitals Under Nonprofits' Names,” by Tara Bannow.

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Jessie Hellmann: North Carolina Health News' “N.C. House Wants to Spend Opioid Money on Multiple Abstinence-Based Recovery Centers, While Experts Stress Access to Medication,” by Grace Vitaglione.

Shefali Luthra: The Washington Post's “These GOP Women Begged the Party to Abandon Abortion. Then Came Backlash,” by Caroline Kitchener.

Sandhya Raman: Roll Call's “For at Least One Abortion Clinic, Dobbs Eased Stressors,” by Sandhya Raman.

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Francis Ying
Audio producer

Emmarie Huetteman
Editor

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To hear all our click here.

And subscribe to KFF Health News' “What the Health?” on SpotifyApple PodcastsPocket Casts, or wherever you listen to podcasts.

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Title: KFF Health News' ‘What the Health?': GOP Platform Muddies Abortion Waters
Sourced From: kffhealthnews.org/news/podcast/what-the-health-355-gop-platform-abortion-gender-july-11-2024/
Published Date: Thu, 11 Jul 2024 20:00:00 +0000

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