The Host

Julie Rovner
KFF Health News

@jrovner

@julierovner.bsky.social

Read Julie's stories.

Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “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.

The Senate has passed — and sent back to the House — a bill that would allow the Trump administration to claw back some $9 billion in previously approved funding for foreign aid and public broadcasting. But first, senators removed from the bill a request to cut funding for the President’s Emergency Plan for AIDS Relief, President George W. Bush’s international AIDS/HIV program. The House has until Friday to approve the bill, or else the funding remains in place.

Meanwhile, a federal appeals court has ruled that West Virginia can ban the abortion pill mifepristone despite its approval by the Food and Drug Administration. If the ruling is upheld by the Supreme Court, it could allow states to limit access to other FDA-approved drugs.

This week’s panelists are Julie Rovner of KFF Health News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine, Shefali Luthra of The 19th, and Sandhya Raman of CQ Roll Call.

Panelists

Joanne Kenen
Johns Hopkins University and Politico

@JoanneKenen

@joannekenen.bsky.social

Read Joanne's bio.

Shefali Luthra
The 19th

@shefali.bsky.social

Read Shefali's stories.

Sandhya Raman
CQ Roll Call

@SandhyaWrites

@SandhyaWrites.bsky.social

Read Sandhya's stories.

Among the takeaways from this week’s episode:

• The Senate approved the Trump administration’s cuts to foreign aid and public broadcasting, a remarkable yielding of congressional spending power to the president. Before the vote, Senate GOP leaders removed President Donald Trump’s request to cut PEPFAR, sparing the funding for that global health effort, which has support from both parties.
• Next Congress will need to pass annual appropriations bills to keep the government funded, but that is expected to be a bigger challenge than the recent spending fights. Appropriations bills need 60 votes to pass in the Senate, meaning Republican leaders will have to make bipartisan compromises. House leaders are already delaying health spending bills until the fall, saying they need more time to work out deals — and those bills tend to attract culture-war issues that make it difficult to negotiate across the aisle.
• The Trump administration is planning to destroy — rather than distribute — food, medical supplies, contraceptives, and other items intended for foreign aid. The plan follows the removal of workers and dismantling of aid infrastructure around the world, but the waste of needed goods the U.S. government has already purchased is expected to further erode global trust.
• And soon after the passage of Trump’s tax and spending law, at least one Republican is proposing to reverse the cuts the party approved to health programs — specifically Medicaid. It’s hardly the first time lawmakers have tried to change course on their own policies, though time will tell whether it’s enough to mitigate any political (or actual) damage from the law.

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

Julie Rovner: The New York Times’ “UnitedHealth’s Campaign to Quiet Critics,” by David Enrich.

Joanne Kenen: The New Yorker’s “Can A.I. Find Cures for Untreatable Diseases — Using Drugs We Already Have?” by Dhruv Khullar.

Shefali Luthra: The New York Times’ “Trump Official Accused PEPFAR of Funding Abortions in Russia. It Wasn’t True,” by Apoorva Mandavilli.

Sandhya Raman: The Nation’s “‘We’re Creating Miscarriages With Medicine’: Abortion Lessons from Sweden,” by Cecilia Nowell.

Also mentioned in this week’s podcast:

• The Atlantic’s “The Trump Administration Is About To Incinerate 500 Tons of Emergency Food,” by Hana Kiros.
• KFF Health News’ “Vested Interests. Influence Muscle. At RFK Jr.’s HHS, It’s Not Pharma. It’s Wellness,” by Stephanie Armour.
• The Washington Post’s “A Clinic Blames Its Closing on Trump’s Medicaid Cuts. Patients Don’t Buy It,” by Hannah Knowles.

Click to open the transcript

Transcript: The Senate Saves PEPFAR Funding — For Now

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Julie Rovner: Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, July 17, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Sandhya Raman of CQ Roll Call. 

Sandhya Raman: Hello, everyone. 

Rovner: Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: And Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico Magazine. 

Joanne Kenen: Hi, everybody. 

Rovner: No interview this week, but more than enough news. So we will get right to it. 

We’re going to start on Capitol Hill, where in the very wee hours of Thursday morning, the Senate approved the $9 billion package of rescissions of money already appropriated. It was largely for foreign aid and the Corporation for Public Broadcasting, which oversees NPR and PBS. Now, this bill represents pennies compared to the entire federal budget and even to the total of dollars that are appropriated every year, but it’s still a big deal because it’s basically Congress ceding more of its spending power back to the president. And even this small package was controversial. Before even bringing it to the floor, senators took out the rescission of funds for PEPFAR [the President’s Emergency Plan for AIDS Relief], the bipartisanly popular international AIDS/HIV program begun under President George W. Bush. So now it has to go back to the House, and the clock on this whole process runs out on Friday. Sandhya, what’s likely to happen next? 

Raman: I think that the House has been more amenable. They got this through quicker, but if you look— 

Rovner: By one vote. 

Raman: Yeah. But I think if you look at what else has been happening in the House this week that isn’t in the health sphere, they’ve been having issues getting other things done, because of some pushback from the Freedom Caucus, who’s been kind of stalling the votes and having them to go back. And other things that should have been smoother are taking a lot longer and having a lot more issues. So it’s more difficult to say without seeing how all of that plays out, if those folks are going to make a stink again about something here because some of this money was taken out. It’s a work in progress this week in the House. 

Rovner: Yeah, that’s a very kind way to put it. The House has basically been stalled for the last 24 hours over, as you say, many things, completely unrelated, but there is actually a clock ticking on this. They had 45 days from when the administration sent up this rescission request, and we’re now on Day 43 because Congress is the world’s largest group of high school students that never do anything until the last minute. So Democrats warned that this bill represents yet another dangerous precedent. They reached a bipartisan agreement on this year of spending bills in the spring, and this basically rolls at least some of that back using a straight party-line vote. What does this bode for the rest of Congress’ appropriations work for the fiscal year that starts in just a couple of months? 

Raman: I think that the sense has been that once this goes through, I think a lot of people have just been assuming that it’ll take time but that things will get passed on rescissions. It really puts a damper on the bipartisan appropriations process, and it’s going to make it a lot harder to get people to come to the table. So earlier this week we had the chair of the Appropriations Committee and the chair of the Labor, HHS [Health and Human Services], Education subcommittee in the House say that the health appropriations they were going to do next week for the House are going to get pushed back until September because they’re not ready. And I think that health is also one of the hardest ones to get through. There’s a lot more controversial stuff. It’s setting us up to go, kind of like usual at this point, for another CR [continuing resolution], because it’s going to be a really short timeline before the end of the fiscal year. But if you look at some— 

Rovner: Every year they say they’re going to do the spending bills separately, and every year they don’t. 

Raman: Yeah, and I think if you look at how they’ve been approaching some of the things that have been generally a little bit less controversial and how much pushback and how much more difficulties they’ve been having with that, even this week, I think that it’s going to be much more difficult to get that done. And the rescissions, pulling back on Congress’ power of the purse, is not going to make that any easier. 

Rovner: I think what people don’t appreciate, and I don’t think I appreciated it either until this came up, is that the rescissions process is part of the budget act, which is one of these things that Congress can do on an expedited basis in the Senate with just a straight majority. But the regular appropriations bills, unlike the budget reconciliation bill that we just did, need 60 votes. They can be filibustered. So the only way to get appropriations done is on a bipartisan basis, and yet they’re using this rather partisan process to take back some of the deal that they made. The Democrats keep saying it, and everybody’s like, Oh, process, process. But that actually could be a gigantic roadblock, to stopping everything in its tracks, right? 

Raman: I really think so. And if you look at who are the two Republicans in the Senate that voted against the rescissions, one of them is the Senate Appropriations chair, Susan Collins. And throughout this, one of her main concerns was when we still had the PEPFAR in there. But it just takes back her power as the highest-ranking appropriator in the Senate to do it through this process, especially when she wasn’t in favor of the rescissions package. 

So it’s going to make things, I think, a lot more complicated, and one of her concerns throughout has just been that there wasn’t enough information. She was pulling out examples of rescissions in the past and how it was kind of a different process. They were really briefed on why this was necessary. And it was just different now. So I think what happens with appropriations and how long it’ll take this year is going to be interesting to watch. 

Rovner: And it’s worth remembering that it’s when the appropriations don’t happen that the government shuts down. So, but that doesn’t happen until October. Well, separately we learned that — oh, go ahead, Joanne. 

Kenen: There’s also sort of a whole new wrinkle, is that rescissions is, if you’re a Republican and you don’t like something and you end up, to avoid a government shutdown or whatever reason, you end up having to vote for a bill, you just have the president put out a statement saying, If this goes through, I’m going to cut it afterwards. And then the Republican who doesn’t like it can give a floor speech saying, I’m voting for it because I like this in it and I know that the president’s going to take care of that. It really — appropriations is always messy, but there’s this whole unknown. The constitutional balance of who does what in the American government is shifting. And at the end of the day, the only thing we do know after both the first term and what’s happened so far even more so in the second term, is what [President Donald] Trump wants, Trump tends to get. 

So, Labor-H [the appropriations for Labor, HHS, Education and related agencies], like Sandhya just pointed out, the health bill is one of the hardest because there’s so much culture-war stuff in it. But, although, the Supreme Court has put some of that off the table. But I just don’t know how things play out in the current dynamic, which is unprecedented. 

Rovner: And of course, Labor-HHS also has the Department of Education in it. 

Kenen: The former Department of Education. 

Rovner: To say, which is in the process of being dismantled. So that’s going to make that even more controversial this year. Moving back to the present, separately we learned this week that the administration plans to spend hundreds of thousands of dollars of taxpayer money to destroy stocks of food and contraceptives and other medical devices rather than distribute them through some of the international aid programs that they’re canceling. Now, in the case of an estimated 500 tons of high-energy biscuits bought by USAID [the U.S. Agency for International Development] at the end of the Biden administration, you can almost understand it because they’re literally about to expire next week. According to The Atlantic, which first reported this story, this is only a small part of 60,000 metric tons of food already purchased from U.S. farmers and sitting in warehouses around the world, where the personnel who’d be in charge of distributing them would’ve been fired or transferred or called back to the U.S. 

At the same time, there are apparently also plans to destroy an estimated $12 million worth of HIV prevention supplies and contraceptives originally purchased as part of foreign aid programs rather than turn them over or even sell them to other countries or nonprofits. This feels like maybe the not most efficient use of taxpayer dollars? 

Luthra: I think this is something we’ve talked about before, but it really bears repeating. As a media ecosphere, we’ve sort of moved on from the really rapid dismantling of USAID. And it was not only without precedent. It was incredibly wasteful with the sudden way it was done, all of these things that were already purchased no longer able to be used, leases literally broken. And people had to pay more to break leases for offices set up in other countries, all these sorts of things that really could have already been used because they had been paid for. And instead, the money is simply lost. 

And I think the important thing for us to remember here is not only the immense waste financially to taxpayers but the real trust that has been lost, because these were promises made, things purchased, programs initiated, and when other countries see us pulling back in such a, again, I keep saying wasteful, but truly wasteful manner, it’s just really hard to ever imagine that the U.S. will be a reliable partner moving forward. 

Rovner: Yeah, absolutely. I understand the food thing to some extent because the food’s going to expire, but the medical supplies that could be distributed by somebody else? I’m still sort of searching for why that would make any sense in any universe, but yeah I guess this is the continuation of, We’re going to get rid of this aid and pretend that it never happened. 

Well, meanwhile, it’s only been a couple of weeks, but we’re starting to see the politics of that big Trump tax and spending measure play out. One big question is: Why didn’t Republicans listen to the usually very powerful hospital industry that usually gets its way but did not this time? And relatedly, will those Republicans who voted with Trump but against those powerful hospital interests do an about-face between now and when these Medicaid cuts are supposed to take effect? We’ve already seen Sen. Josh Hawley, the Republican from Missouri who loudly proclaimed his opposition to those Medicaid cuts before he voted for them anyway, introduce legislation to rescind them. So is this the new normal? I think, Joanne, you were sort of alluding to this, that you can now sort of vote for something and then immediately say: Didn’t mean to vote for that. Let’s undo it. 

Kenen: You could even do it before you vote for it, if they play it right. If Congress passes these things, we’re not going to pay attention. We’re already in that moment. But also, when I was working on a Medicaid piece, the magazine piece like four or five months ago, one of the most cynical people I know in Washington told me, he said, Oh, they’ll pass these huge cuts because they need the budget score to get the taxes through, and then they’ll start repealing it. And it seemed so cynical at the time, only he might’ve been right. 

So I don’t think they’re going to cut all of it. Republicans ideologically want a smaller Medicaid program. They want less spending. They want work requirements. You’re not going to see the whole thing go away. Could you see some retroactive tinkering or postponement or something? Yeah, you could. It’s too soon to know. Hospitals are the biggest employer in many, many congressional districts. This is a power— 

Rovner: Most of them. 

Kenen: Most, yeah. I don’t think it’s quite all, but like a lot. It’s the biggest single employer, and Medicaid is a big part of their income. And they still by law have to stabilize people who come in sick, and there’s emergency care and all sorts of other things, right? They do charity care. They do uninsured people. They do all sorts. They still treat people under certain circumstances even when they can’t pay. But right now, the threat of a primary opponent is more powerful than the threat of your local hospital being mad at you and harming health care access in your community. So much in the Republican world revolves around not getting the president mad enough that he threatens to get you beaten in a primary. We’ve seen that time and again already. 

Rovner: Right. And I will also say there’s precedent for this, for passing something and then unpassing it. Joanne and I covered in 19— 

Kenen: But it wasn’t the plan. 

Rovner: Yeah, I know. But remember, back in 1997 when they passed the Balanced Budget Act, every year for the next — was it three or four years? They did what we came to call “give back” bills. 

Kenen: Or punting, right? 

Rovner: Yeah, where they basically undid, they unspooled, some of those cuts, mostly because they’d cut more deeply than they’d intended to. And then we know with the Affordable Care Act, I’ve said this several times, they passed all of these financing mechanisms for it and then one by one repealed them. 

Kenen: And the individual mandate — I mean everything- 

Rovner: And the individual mandate, right. 

Kenen: They kept the dessert and they gave away everything. They undid everything that paid for the dessert, basically. 

Rovner: Right. Right. 

Kenen: And so it was the Cadillac — because people don’t remember anymore — the Cadillac tax, the insurance tax, the device tax. They all were like, One at a time! And they were repealed because lobbying works. 

Rovner: The tanning tax just went. 

Kenen: Right, right. So that dynamic existed, passing something unpopular and then redoing it, but the dynamic now really just comes — basically this is Donald Trump’s town. He has had a remarkable success in not only getting Congress to do what he wants but getting Congress to surrender some of its own powers, which have been around since Congress began. This is the way our government was set up. So there’s a very, very different dynamic, and it’s still unpredictable. None of us thought that the biggest crisis would be the [Jeffrey] Epstein case, right? Which is not a health story, and we don’t have to spend any time on it except to acknowledge— 

Rovner: Please. 

Kenen: —that there’s stuff going on in the background that people who had been extremely loyal to the president are now mad. And we don’t know how long. He’s very good at neutralizing things, too. He’s blaming it on the Democrats. 

But there is a different dynamic. Congress has less power because Congress gave up some of its power. Are they going to want to reassert themselves? There is no sign of it right now, but who knows what happens. I thought they would cut Medicaid. I thought they would do work requirements. I thought they would let the enhanced ACA subsidies expire. But I did not think the cuts would go this deep and this extensive — really transformationally pretty historic cuts. 

Rovner: Shefali, you wanted to say something? 

Kenen: Not pretty historic cuts, very historic cuts. Unprecedented. 

Luthra: I was thinking Joanne made such a good point about how, for all of the talk now about trying to mitigate that backlash, a lot of this is in line ideologically with what Republicans want. They do want a smaller Medicaid program. And I think a really interesting and still open question is whether they are willing and able to actually create policy that does reverse some of these cuts or not, and even if they do, if it’s sufficient to change voters’ perception, because we know that these cuts are very unpopular. Democrats are talking about them a lot. Hospitals are talking about them a lot. And just the failed attempt to repeal the ACA led to the 2018 midterms. And I think there is a real chance that this is the dominant topic when we head into next year’s elections. And it’s hard to say if Josh Hawley putting out a bill can undo that damage, so—. 

Rovner: Well, I’m so glad you mentioned that, because The Washington Post has a really interesting story about a clinic closing in rural Nebraska, with its owners publicly blaming the impending Medicaid cuts. Yet its Trump-supporting patients are just not buying it. Now in 2010, Republicans managed to hang the Affordable Care Act around Democrats’ necks well before the vast majority of the changes took place. Are Democrats going to be able to do that now? There’s a lot of people saying, Oh, well, they’re not going to be able to blame this on the Republicans, because most of it won’t have happened yet. This is really going to be a who-manages-to-push-their-narrative, right? 

Kenen: This really striking thing about that story is that the people who were losing access, they’re not losing their Medicaid yet, but they’re losing access to the only clinic within several — they have to drive hours now to get medical care. And when they were told this was because the Republican Congress and President Trump, they said, Oh no, it can’t be. First of all, a lot of people just don’t pay attention to the news. We know that. And then if you’re paying attention to news that never says anything negative about the president, that blames everything on Joe Biden no matter — if it rains yesterday, it was his fault, right? 

So the sort of gap between — there are certain things that are matters of opinion and interpretation, and there are certain things that are matters of fact, but those facts are not getting through. And we do not know whether the Democrats will be able to get them through, because the resistance, it’s almost magical, right? My clinic closed because of a Republican Medicaid bill? Oh no, it’s hospital greed. They just don’t want to treat us anymore. They just, it doesn’t compute, because it doesn’t fit into what they have been reading and hearing, to the extent that they read and hear. 

Rovner: Sandhya, you want to add something? 

Raman: The one thing that as I’ve been asking around on Capitol Hill about the Hawley bill — and there was one from Sen. Rand Paul, and a House counterpart, from [Rep.] Greg Steube, does sort of the opposite — it wants to move up the timeline for one of the provisions. So one important thing to consider is neither of these bills have had a lot of buy-in from other members of Congress. They’ve been introduced, but the people that I’ve talked to have said, I’m not sure. 

And I think something interesting that Sen. Thom Tillis had said was: If Republicans had a problem with what some of the impacts would be, then why were they denying that there would be an effect on rural health or some of those things to begin with? And I think a lot of it will take some time to judge to see if people will move the needle, but if we’re going to change any of these deadlines through not reconciliation, you need 60 votes in the Senate and you’ll need Democrats on board as well as Republicans. And I think one interesting thing to watch there is that I think some of the Democrats are also looking at this in a political way. If there’s a Republican that has a bill that is trying to tamp down some of the effects of their signature reconciliation law, do they want to help them and sign on to that bill or kind of illustrate the effects of the bill before the midterms or whatever? 

Rovner: A lot more politics to come. 

Raman: Yeah. Yeah. 

Rovner: Meanwhile, over at HHS [the Department of Health and Human Services], there is also plenty of news. Many of the workers who’ve been basically in limbo since April when a judge temporarily halted the Trump administration’s efforts to downsize have now been formally let go after the Supreme Court last week lifted that injunction. What are we hearing about how things are going over at HHS? We’ve talked sort of every week about this sort of continuing chaos. I assume that the hammer falling is not helping. It’s not adding to things settling down. 

Kenen: No. And then Secretary [Robert F.] Kennedy [Jr.] just fired two top aides because — no one knows exactly the full story but it’s — and I certainly do not know the full story. But what I have read is that the personality conflict with his top aide — and that happens in offices, and he’s not the first person in the history of HHS to have people who don’t get along with one another. But it’s just more unsettled stuff in an agency already in flux, because now in addition to all these people being let go in all sorts of programs and programs being rolled back, you also have some leadership chaos at the top. 

Rovner: Well, meanwhile, HHS Secretary Kennedy took office with vows to eliminate the financial influence of Big Pharma, Big Food, and other industries with potential conflicts of interests. But shoutout here to my KFF Health News colleague Stephanie Armour, who has a story this week about how the new vested interests at HHS are the wellness industry. Kennedy and four top advisers, three of whom have been hired into the department, wrote Stephanie, quote, “earned at least $3.2 million in fees and salaries from their work opposing Big Pharma and promoting wellness in 2022 and 2023, according to a KFF Health News review of financial disclosure forms filed with the U.S. Office of Government Ethics and the Department of Health and Human Services; published media reports; and tax forms filed with the IRS. That total doesn’t include revenue from speaking fees, the sale of wellness products, or other income sources for which data is not publicly available.” Have we basically just traded one form of regulatory capture for another form of regulatory capture? 

Kenen: And one isn’t covered by insurance. Some of it is, but there’s a lot of stuff in the, quote, “wellness” industry that providers and so forth, certain services are covered if there’s licensed people and an evidence base for them, but a lot of it isn’t. And these providers charge a lot of money out-of-pocket, too. 

Rovner: And they make a lot of money. This is a totally — unlike Big Pharma, Big Food, and Big Medicine, which is regulated, Big Wellness is largely not regulated. 

Kenen: I think Stephanie — that was a really good piece — and I think Stephanie said it was, what, $6.3 trillion industry? Was that— 

Rovner: Yeah, it’s huge. 

Kenen: Am I remembering that number right? It’s largely unregulated. Many of the products have never gone through any review for safety or efficacy. And insurance doesn’t cover a lot of it. It doesn’t mean it’s all bad. There are certain things that are helpful, but as an industry overall, it leaves something for us to worry about. 

Rovner: Well, in HHS-adjacent breaking news that could turn out to be nothing or something really big, an appeals court in Richmond on Tuesday ruled 2-1 that West Virginia may in fact limit access to the abortion pill, even though it’s approved by the FDA [Food and Drug Administration]. It’s the first time a federal appeals court has basically said that states can effectively override the FDA’s nationwide drug approval authority. And it’s the question that the Supreme Court has already ducked once, in that case out of Texas last year where the justices ruled that the doctors who were suing didn’t have standing, so they didn’t have to get to that question. But, Shefali, this has implications well beyond abortion, right? 

Luthra: Oh, absolutely. We are seeing efforts across the country to restrict access to certain medications that are FDA-approved. Abortion pills are the obvious one, but, of course, we can think about gender-affirming care. We can think about access to all sorts of other therapeutics and even vaccines that are now sort of coming under political fire. And if FDA approval means less than state restrictions, as we are seeing in this case, as we very possibly could see as these kinds of arguments and challenges make their way to the Supreme Court. The case you alluded to earlier with the doctors who didn’t have standing is still alive, just with different plaintiffs now. And so these questions will probably come back. There are just such vast ramifications for any kind of medication that could be politicized, and it’s something that industry at large has been very worried about since this abortion pill became such a big question. And it is something that this decision is not going to alleviate. 

Rovner: Yes. Speaking of Big Pharma, they’re completely freaked out by this possibility because it does have implications for every FDA-approved drug. 

Luthra: And they invest so much money in trying to get products that have FDA approval. There’s a real promise that with this global gold standard, you will be able to keep a drug on the market and really make a lot of money on it. There’s also obviously concerns for birth control, which we aren’t seeing legally restricted in the same way as abortion yet, but it is something that is so deeply subject to politics and culture-war issues that that’s something that we could see coming down the line if trends continue the way they are. 

Rovner: Well, we will watch that space. Moving on. Wednesday was the third anniversary of the federal 988 federal crisis line, which has so far served an estimated 16 million people with mental health crises via call, text, or chat. An estimated 10% of those calls were routed through a special service for LGBTQ+ youth, which is being cut off today by the Trump administration, which accused the program, run by the Trevor Project, as, quote, “radical gender ideology.” Now, LGBTQ+ youth are among those at the highest risk for suicide, which is exactly what the 988 program was created to prevent. Yet there’s been very little coverage of this. I had to actually go searching to find out exactly what happened here. Is this just kind of another day in the Trump administration? 

Raman: I think a lot of it stems back to some of those initial executive orders related to gender ideology and DEI [diversity, equity, and inclusion] and things like that. The Trump administration’s kind of argument is that it shouldn’t be siloed. It should be all general. There shouldn’t be sort of special treatment, even though we do have specialized services for veterans who call in to these services and things. But I— 

Rovner: Although that was only saved when members of Congress complained. 

Raman: Yeah. But I do think that when we have so much happening in this space focused on LGBTQ issues, it’s easier for things to get missed. I think the one thing that I did notice was that California announced yesterday that they were going to step up to do a partnership with the Trevor Project to at least — the LGBTQ youth calling from California to any of those local 988 centers would be reaching people that have been trained a little bit more in cultural competency and dealing with LGBTQ youth. But that’s not going to be all the states and it’s going to take time. Yeah. 

Rovner: Yeah, we’re going to continue to see this cobbled together state by state. It feels like increasingly what services are available to you are going to be very much dependent on where you live. That’s always been true, but it feels like it’s getting more and more and more true. Shefali, I see you nodding. 

Luthra: Something you alluded to that I think bears making explicit is public health interventions are typically targeted toward people who are in greater danger or are at greater risk. That’s not discrimination — that’s public health efficiency. And suggesting that we shouldn’t have resources targeted toward people at higher risk of suicide is counter to what public health experts have been arguing for a very long time. And that’s just something that I think really bears noting and keeping in mind as we see what the impact of this is moving forward. 

Rovner: Yeah, I think that’s a very good point. Thank you. 

Well, speaking of popular things that are going away, a federal judge appointed by President Trump last week struck down the last-minute Biden administration rule from the Consumer Financial Protection Bureau that tried to bar medical debt from appearing on credit reports. This had been hailed as a major step for the 100 million Americans with medical debt, which is not exactly the same as buying a car or a TV that you really can’t afford. People don’t go into medical debt saying, Oh, I think I’m going to go run up a big medical bill that I can’t pay. But this strikes me as yet another way this administration is basically inflicting punishment on its own voters. Yes? 

Kenen: Yes, except we just don’t know. Some red states are so red that you don’t need every voter. We don’t know who actually votes, and we don’t know whether people make these connections, right? What we were talking about before with Medicaid — do they understand that this is something that President Trump not just urged but basically ordered Congress to do? So do people pay attention? How many people even know if their medical debt is or is not on their credit report? They know they have the medical debt, but I’m not sure everybody understands all the implication, particularly if you’re used to being in debt. You may be somebody who’s lost a job or couldn’t pay your mortgage or couldn’t pay your rent. Some of the people who have medical debt have so many other financial — not all — that it’s just part of a debt soup and it’s just one more ingredient. 

So how it plays out and how it’s perceived? It’s part of this unpredictable mix. Trump is openly talking about gerrymandering more, and so it won’t matter what voters do, because they’ll have more Republican seats. That’s just something he’s floating. We don’t know whether it’ll actually happen, but he floated it in public, so— 

Rovner: So much of this is flooding the zone, that people — there’s so much happening that people have no idea who’s responsible for what. There’s always the pollster question: Is your life better or worse than it was last year? Or four years ago, whatever. And I think that when you do so much so fast, it’s pretty hard to affix blame to anybody. 

Raman: And most people aren’t single-issue voters. They’re not going to the polls saying, My medical debt is back on my credit report. There’s so many other things, even if with the last election, health care was not the number one issue for most voters. So it’s difficult to say if it will be the top issue for the next election or the next one after that. 

And I guess just piggybacking that a lot of the times when there’s these big changes, they don’t take effect for a while. So it’s easier to rationalize, Oh, it may have been this person or that person or the senator then, or who was president at a different time, just because of how long it takes to see the effects in your daily life. 

Rovner: Politics is messy. All right, well, this is as much time for the news as we have this week? Now it’s time for our extra-credit segment. That’s where we each recognize a story we read this week we think you should read, too. Don’t worry if you miss it. We’ll put the links in our show notes on your phone or other mobile device. Shefali, why don’t you go first this week? 

Luthra: Sure. My piece is from The New York Times, by Apoorva Mandavilli. The headline is “Trump Official Accused PEPFAR of Funding Abortions in Russia. It Wasn’t True.” And she takes a look at when the head of the OMB [Office of Management and Budget] told the Senate that PEPFAR had spent almost $10 million advising Russian doctors on abortions and gender analysis. And she goes through and says this isn’t true. PEPFAR hasn’t been in Russia. They cannot fund abortions. And she talks with people who were there and can say this simply isn’t true and this is very easy to disprove. And I like this piece because it’s just a reminder that a lot of things are being said about government spending that are not true. And it is a public service to remind readers that they are very easily disproven. 

Rovner: Yeah, and to go ahead and do that. Sandhya. 

Raman: My extra credit is “‘We’re Creating Miscarriages With Medicine’: Abortion Lessons From Sweden,” and it’s from Cecilia Nowell for The Nation, my co-fellow through AHCJ [the Association of Health Care Journalists] this year. Cecilia went to Kiruna, which is an Arctic village in Sweden, to look at how they’re using mifepristone for abortions up to 22 weeks in pregnancy, compared to up to 10 weeks in the U.S. And it’s a really interesting look at how they’re navigating rural access to abortion in very remote areas. Almost all abortions in Sweden are done through medication abortion, and while the majority here are in the 60% versus high 90s. So just interesting how they’re taking their approach there as rural access is limited here. 

Rovner: Really interesting story. Joanne. 

Kenen: This is a piece in The New Yorker by Dhruv Khullar, and it’s “Can A.I. Find Cures for Untreatable Diseases — Using Drugs We Already Have?” And what I found interesting, we’ve been hearing about: Can AI do this? It’s sort of been in the air since AI came around. But what was so interesting about this article is there’s a nonprofit that is actually doing it, and they have this sort of whole sort of hierarchy of why a drug may be promising and why a disease may be a good target. And then the AI look at genetics and diseases, and they have four or five factors they look at. And then there’s this just sort of hierarchy of which are the ones we can make accessible. 

So A, it’s actually happening. B, it has promise. It’s not a panacea, but there’s promise. And C, it’s being done by a nonprofit. It’s not a cocktail for an individual patient. It’s trying to figure out: What are the smartest drugs to be looking at and what can they treat? And they give examples of people who have gone into remission from rare diseases. And also it says there are 18,000 diseases and only 9,000 have treatment. So this is huge, right? Rare diseases may only affect a few people, but there are lots of rare diseases. So cumulatively some of the people they strike are young. So for someone who doesn’t always read about AI, I found this one interesting. 

Rovner: Also, we read somebody’s story about how AI is terrible for this, that, and the other thing. It is very promising for an awful lot of things. 

Kenen: No. Right. 

Rovner: There’s a reason that everybody’s looking at it. 

All right, my extra credit this week is also from The New York Times. It’s called “UnitedHealth’s Campaign to Quiet Critics,” by David Enrich, who’s The Times’ deputy investigations editor and, notably, author of a book on attacks on press freedoms. That’s because the story chronicles how UnitedHealth, the mega health company we have talked about a lot on this show, is taking a cue from President Trump and increasingly taking its critics to court, in part by claiming that critical reporting about the company risks inciting further violence like the Midtown Manhattan murder of United executive Brian Thompson last year. 

I hasten to add, this isn’t a matter of publications making stuff up. United, as we have pointed out, is a subject of myriad civil and criminal investigations into potential Medicare fraud as well as antitrust violations. This is still another chapter unfolding in the big United story. 

OK, that is this week’s show. Thanks as always to our editor, Emmarie Huetteman, and our producer-engineer, Francis Ying. If you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us to review. That helps other people find us, too. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can find me on X, @jrovner, or on Bluesky, @julierovner. Where are you folks hanging these days? Shefali? 

Raman: I’m at Bluesky, @shefali. 

Rovner: Sandhya. 

Raman: I’m at X and at Bluesky, @SandhyaWrites. 

Rovner: Joanne? 

Kenen: I’m mostly at Bluesky, @joannekenen.bsky, and I’ve been posting things more on LinkedIn, and there are more health people hanging out there. 

Rovner: So we are hearing. We will be back in your feed next week. Until then, be healthy. 

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View the full post “Schizophrenic” soca song is Brendon Charles’ coping mechanism  on NOW Grenada.

The Ministry of Health on Wednesday launched its toll-free 915 suicide prevention hotline, saying the “crucial lifeline” was being supported by emergency responders. “If you call the hotline and they recognise that somebody is in crisis, then they have a rapid response team that would actually go out and get to that person and work ...

Ocurrió hace más de una década, pero el momento permanece en su memoria.

Sara Stewart conversaba con su madre, Barbara Cole, entonces de 86 años, en el comedor de su casa de Bar Harbor, en Maine. Stewart, abogada tenía en ese momento 59 años y estaba haciendo una de sus largas visitas desde fuera del estado.

Dos o tres años antes, Cole había comenzado a mostrar signos preocupantes de demencia, probablemente debido a una serie de pequeños derrames cerebrales. “No quería sacarla de su casa”, contó Stewart.

Así que, con un batallón de ayudantes —una empleada doméstica, visitas familiares frecuentes, un vecino atento y un servicio de entrega de comidas—, Cole pudo quedarse en la casa que ella y su difunto esposo habían construido 30 años atrás.

Se las arreglaba bien y solía parecer alegre y conversadora. Pero esta conversación en 2014 tuvo un dramático giro. “Me dijo: ‘¿De dónde nos conocemos? ¿de la escuela?’”, recordó su hija y primogénita. “Sentí como si me hubieran pateado”.

Stewart recuerda haber pensado: “En el curso natural de las cosas, se suponía que morirías antes que yo. Pero nunca se suponía que olvidaras quién soy”. Más tarde, sola, lloró.

Las personas con demencia avanzada suelen no reconocer a sus seres queridos, a sus parejas, hijos y hermanos. Para cuando Stewart y su hermano menor trasladaron a Cole a un centro de atención para la memoria un año después, la mujer ya había perdido casi por completo la capacidad de recordar sus nombres o vínculos.

“Es bastante común en las últimas etapas” de la enfermedad, dijo Alison Lynn, directora de trabajo social del Penn Memory Center, quien ha dirigido grupos de apoyo para cuidadores de personas con demencia por una década.

Ha escuchado muchas versiones de este relato, un momento descrito con dolor, ira, frustración, alivio o una combinación de estos sentimientos.

Estos cuidadores “ven muchas pérdidas, revierten hitos, y este es uno de esos momentos, un cambio fundamental” en una relación cercana, dijo. “Puede llevar a las personas a una crisis existencial”.

Es difícil determinar qué saben o sienten las personas con demencia —una categoría que incluye la enfermedad de Alzheimer y otros trastornos cognitivos—. “No tenemos forma de preguntarle a la persona ni de ver una resonancia magnética”, señaló Lynn. “Todo es pura deducción”.

Pero los investigadores están comenzando a investigar cómo reaccionan los familiares cuando un ser querido ya parece no reconocerlos. Un estudio cualitativo publicado recientemente en la revista Dementia analizó entrevistas en profundidad con hijos adultos que cuidaban de madres con demencia que, al menos en una ocasión, no los habían reconocido.

“Es muy desestabilizador”, dijo Kristie Wood, psicóloga clínica investigadora del Campus Médico Anschutz de la Universidad de Colorado y coautora del estudio. “El reconocimiento reafirma la identidad, y cuando desaparece, las personas sienten que han perdido parte de sí mismas”.

Aunque comprendían que no implicaba un rechazo sino un síntoma de la enfermedad de sus madres, algunos hijos adultos se culpaban a sí mismos, agregó.

“Se cuestionaban su papel. ‘¿Acaso no era lo suficientemente importante como para que me recuerde?'”, dijo Wood. Esto puede hacer que se alejen o que sus visitas se vuelvan menos frecuentes.

Pauline Boss, la terapeuta familiar que desarrolló hace décadas la teoría de la “pérdida ambigua”, señala que puede implicar ausencia física, como cuando un soldado desaparece en combate, o ausencia psicológica, incluyendo la falta de reconocimiento debido a la demencia.

La sociedad no tiene forma de reconocer la transición cuando “una persona está físicamente presente pero psicológicamente ausente”, dijo Boss. “No hay certificado de defunción, ni ritual donde amigos y vecinos vengan a sentarse contigo y te consuelen”.

“La gente se siente culpable si llora a alguien que aún está vivo”, continuó. “Pero si bien no es lo mismo que una muerte confirmada, es una pérdida real, que ocurre una y otra vez”.

La falta de reconocimiento adopta diferentes formas. Algunos familiares informan que, aunque un ser querido con demencia ya no puede recordar su nombre ni su parentesco exacto, todavía parecen felices de verlo.

“En un sentido narrativo, ya no sabe quién soy, que yo era su hija Janet”, contó Janet Keller, de 69 años, actriz de Port Townsend, Washington, hablando de su difunta madre, diagnosticada con Alzheimer en un correo electrónico. “Pero siempre supo que yo era alguien a quien apreciaba y con quien quería reír y a quien le agarraba la mano”.

A los cuidadores les reconforta seguir sintiendo una conexión. Sin embargo, una de las participantes en el estudio sobre demencia informó que ahora sentía a su madre como una extrañas, y que la relación ya no le proporcionaba ninguna recompensa emocional.

“Era como si estuviera visitando al cartero”, le dijo al entrevistador.

Larry Levine, de 67 años, administrador de atención médica jubilado de Rockville, Maryland, observó cómo la capacidad de su esposo para reconocerlo cambiaba de forma impredecible.

Levine y Arthur Windreich, pareja desde hacía 43 años, se habían casado en 2010, cuando Washington, DC, legalizó el matrimonio entre personas del mismo sexo. Al año siguiente, Windreich tuvo un diagnóstico de Alzheimer de inicio temprano.

Levine se convirtió en su cuidador hasta su fallecimiento a los 70 años, a finales de 2023.

“Su condición era zigzagueante”, dijo Levine. Windreich se había mudado a una unidad de cuidados de la memoria. “Un día, me llamaba ‘el hombre amable que viene de visita'”, dijo Levine. “Al día siguiente, me llamaba por mi nombre”.

Incluso en sus últimos años, cuando, como muchos pacientes con demencia, Windreich se volvió prácticamente silencioso, “había cierto reconocimiento”, dijo su esposo. “A veces se le veía en los ojos, ese brillo en lugar de la expresión vacía que solía tener”.

Sin embargo otras veces “no había ningún afecto”. Levine a menudo salía del centro llorando.

Buscó la ayuda de su terapeuta y sus hermanas, y recientemente se unió a un grupo de apoyo para cuidadores LGBTQ+ de personas con demencia, a pesar que su esposo ya había fallecido.

Los grupos de apoyo, en persona o por internet, “son medicina para el cuidador”, dijo Boss. “Es importante no aislarse”.

Lynn anima a los participantes de sus grupos a que también encuentren rituales personales para conmemorar la pérdida de reconocimiento y otros hitos que marcan un antes y un después. “Quizás enciendan una vela. Quizás recen una oración”, dijo.

Alguien que se sienta en shivá, parte del ritual de duelo judío, podría reunir a un pequeño grupo de amigos o familiares para recordar y compartir historias, aunque el ser querido con demencia no haya fallecido.

“Que alguien más participe puede ser muy reconfortante”, dijo Lynn. “Dice: ‘Veo el dolor que estás sintiendo'”.

De vez en cuando, la niebla de la demencia parece disiparse brevemente.

Investigadores de Penn y de otros centros han señalado un fenómeno sorprendente llamado “lucidez paradójica”. Alguien con demencia grave, luego de meses o años sin comunicarse, recupera repentinamente la lucidez y puede inventar un nombre, decir algunas palabras apropiadas, contar un chiste, hacer contacto visual o cantar con la radio.

Aunque comunes, estos episodios suelen durar solo unos segundos y no significan un cambio real en el deterioro de la persona. Los esfuerzos por recrear las experiencias tienden a fracasar.

“Es un instante”, dijo Lynn. Pero los cuidadores suelen reaccionar con sorpresa y alegría; algunos interpretan el episodio como evidencia de que, a pesar de la profundización de la demencia, no se les olvida del todo.

Stewart experimentó un pequeño incidente como esos unos meses antes de la muerte de su madre. Estaba en el apartamento de su madre cuando una enfermera le pidió que la acompañara al final del pasillo.

“Al salir de la habitación, mi madre me llamó por mi nombre”, dijo. Aunque Cole solía parecer contenta de verla, “no había usado mi nombre desde que tengo memoria”.

No volvió a ocurrir, pero eso no importó. “Fue maravilloso”, dijo Stewart.

La serie de columnas The New Old Age se producen a través de una alianza con The New York Times.

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Who’s on the couch here? The psychiatrist or the poet? The poem or the practice of psychiatry?

As a poet and a psychiatrist/therapist, I exist in both practices, and the worlds of each enrich the other. Each speaks with abandon, and each interrogates the other, and there are many ways in which each discipline supports the other, some obvious, some not so obvious.

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Si te adentras demasiado en la oscuridad, le decían, un gigantesco y monstruoso mono que vive en las sombras podría atraparte.

Ahora, cuando García-Ramírez mira por encima del hombro, no son los monos monstruosos a los que teme. Son los agentes del Servicio de Inmigración y Control de Aduanas de Estados Unidos (ICE).

“Hay un miedo constante de que vayas caminando por la calle y se te cruce un vehículo”, dijo García-Ramírez, de 57 años. “Te dicen: ‘Somos de ICE; estás arrestado’, o ‘Muéstrame tus papeles’”.

Silverthorne, una pequeña ciudad entre las mecas del esquí de Breckenridge y Vail, ha sido el hogar de García-Ramírez durante los últimos dos años. Trabaja como cajero en un supermercado y comparte un apartamento de dos habitaciones con cuatro compañeros.

La ciudad de casi 5.000 habitantes ha sido un refugio acogedor para el exiliado político, quien fue liberado de prisión en 2023 después que el gobierno autoritario de Nicaragua negociara un acuerdo con el gobierno estadounidense para transferir a más de 200 presos políticos a Estados Unidos.

A los exiliados se les ofreció residencia temporal en Estados Unidos bajo un programa de libertad condicional humanitaria (conocido como parole humanitario) de la administración Biden.

Este permiso humanitario de dos años de García-Ramírez expiró en febrero, apenas unas semanas después que el presidente Donald Trump emitiera una orden ejecutiva para poner fin al programa que había permitido la residencia legal temporal en Estados Unidos a cientos de miles de cubanos, haitianos, nicaragüenses y venezolanos. Esto lo que lo ponía en riesgo de deportación.

A García-Ramírez se le retiró la ciudadanía nicaragüense al llegar a Estados Unidos. Hace poco más de un año, solicitó asilo político. Sigue esperando una entrevista.

“No puedo decir con seguridad que estoy tranquilo o que estoy bien en este momento”, dijo García-Ramírez. “Uno se siente inseguro, pero también incapaz de hacer algo para mejorar la situación”.

Vail y Breckenridge son mundialmente famosos por sus pistas de esquí, que atraen a millones de personas cada año. Pero la vida para la fuerza laboral del sector turístico que atiende a los centros turísticos de montaña de Colorado es menos glamorosa.

Los residentes de los pueblos montañosos de Colorado experimentan altas tasas de suicidio y adicciones, impulsadas en parte por las fluctuaciones estacionales de los ingresos, que pueden causar estrés a muchos trabajadores locales.

Las comunidades latinas, que constituyen una proporción significativa de la población residente permanente en estos pueblos de montaña, son particularmente vulnerables.

Una encuesta reciente reveló que más de 4 de cada 5 latinos encuestados en la región de la Ladera Occidental, donde se encuentran muchas de las comunidades rurales de estaciones de esquí del estado, expresaron una preocupación “extrema o muy grave” por el consumo de sustancias.

Esta cifra es significativamente mayor que en el condado rural de Morgan, en el este de Colorado, que también cuenta con una considerable población latina, y en Denver y Colorado Springs.

A nivel estatal, la preocupación por la salud mental ha resurgido entre los latinos en los últimos años, pasando de menos de la mitad que la consideraba un problema extremada o muy grave en 2020 a más de tres cuartas partes en 2023.

Tanto profesionales de salud como investigadores y miembros de la comunidad afirman que factores como las diferencias lingüísticas, el estigma cultural y las barreras socioeconómicas pueden exacerbar los problemas de salud mental y limitar el acceso a la atención médica.

“No recibes atención médica regular. Trabajas muchas horas, lo que probablemente significa que no puedes cuidar de tu propia salud”, dijo Asad L. Asad, profesor adjunto de sociología de la Universidad de Stanford. “Todos estos factores agravan el estrés que todos podríamos experimentar en la vida diaria”.

Si a esto le sumamos los altísimos costos de vida y la escasez de centros de salud mental en los destinos turísticos rurales de Colorado, el problema se agrava.

Ahora, las amenazas de la administración Trump de redadas migratorias y la inminente deportación de cualquier persona sin residencia legal en el país han disparado los niveles de estrés.

Según estiman defensores, en las comunidades cercanas a Vail, la gran mayoría de los residentes latinos no tienen papeles. Las comunidades cercanas a Vail y Breckenridge no han sufrido redadas migratorias, pero en el vecino condado de Routt, donde se encuentra Steamboat Springs, al menos tres personas con antecedentes penales han sido detenidas por el ICE, según informes de prensa.

Las publicaciones en redes sociales que afirman falsamente haber visto a oficiales del ICE merodeando cerca de sus hogares han alimentado aún más la preocupación.

Yirka Díaz Platt, trabajadora social bilingüe de Silverthorne, originaria de Perú, afirmó que el temor generalizado a la deportación ha llevado a muchos trabajadores y residentes latinos a refugiarse en las sombras.

Según trabajadores de salud y defensores locales, las personas han comenzado a cancelar reuniones presenciales y a evitar solicitar servicios gubernamentales que requieren el envío de datos personales. A principios de febrero, algunos residentes locales no se presentaron a trabajar como parte de una huelga nacional convocada por el “día sin inmigrantes”. Los empleadores se preguntan si perderán empleados valiosos por las deportaciones.

Algunos inmigrantes han dejado de conducir por temor a ser detenidos por la policía. Paige Baker-Braxton, directora de salud conductual ambulatoria del sistema de salud de Vail, comentó que ha observado una disminución en las visitas de pacientes hispanohablantes en los últimos meses.

“Intentan mantenerse en casa. No socializan mucho. Si vas al supermercado, ya no ves a mucha gente de nuestra comunidad”, dijo Platt. “Existe ese miedo de: ‘No, ahora mismo no confío en nadie'”.

Juana Amaya no es ajena a la resistencia para sobrevivir. Amaya emigró a la zona de Vail desde Honduras en 1983 como madre soltera de un niño de 3 años y otro de 6 meses. Lleva más de 40 años trabajando como limpiadora de casas en condominios y residencias de lujo en los alrededores de Vail, a veces trabajando hasta 16 horas al día. Con apenas tiempo para terminar el trabajo y cuidar de una familia en casa, comentó, a menudo les cuesta a los latinos de su comunidad admitir que el estrés ya es demasiado.

“No nos gusta hablar de cómo nos sentimos”, dijo, “así que no nos damos cuenta de que estamos lidiando con un problema de salud mental”.

El clima político actual solo ha empeorado las cosas.

“Ha tenido un gran impacto”, dijo. “Hay personas que tienen niños pequeños y se preguntan qué harán si están en la escuela y se los llevan a algún lugar, pero los niños se quedan. ¿Qué hacen?”.

Asad ha estudiado el impacto de la retórica de la deportación en la salud mental de las comunidades latinas. Fue coautor de un estudio, publicado el año pasado en la revista Proceedings of the National Academy of Sciences, que concluyó que el aumento de esta retórica puede causar mayores niveles de angustia psicológica en los no ciudadanos latinos e incluso en los ciudadanos latinos.

Asad descubrió que ambos grupos pueden experimentar mayores niveles de estrés, y las investigaciones han confirmado las consecuencias negativas de la falta de documentación de los padres en la salud y el rendimiento educativo de sus hijos.

“Las desigualdades o las dificultades que imponemos hoy a sus padres son las dificultades o desigualdades que sus hijos heredarán mañana”, afirmó Asad.

A pesar de los altos niveles de miedo y ansiedad, los latinos que viven y trabajan cerca de Vail aún encuentran maneras de apoyarse mutuamente y buscar ayuda.

Grupos de apoyo en el condado de Summit, donde se encuentra Breckenridge y a menos de una hora en coche de Vail, han ofrecido talleres de salud mental para nuevos inmigrantes y mujeres latinas. Building Hope, en el condado de Summit y Olivia’s Fund en el condado de Eagle, donde se encuentra Vail, ayudan a quienes no tienen seguro médico a pagar un número determinado de sesiones de terapia.

Vail Health planea abrir un centro psiquiátrico regional para pacientes hospitalizados en mayo, y la Alianza de Recursos Interculturales Móviles ofrece servicios integrales, incluyendo recursos de salud conductual, directamente a las comunidades cercanas a Vail.

De vuelta en Silverthorne, García-Ramírez, el exiliado nicaragüense, vive el día a día.

“Si me deportan de aquí, iría directamente a Nicaragua”, dijo García-Ramírez, quien contó haber recibido una amenaza de muerte verbal de las autoridades de su país natal. “Sinceramente, no creo que aguante ni un día”.

Mientras tanto, continúa su rutinario viaje a casa desde su trabajo de cajero, a veces sorteando nieve resbaladiza y calles oscuras después de las 9 pm. Cuando surgen pensamientos de pesadilla sobre su propio destino en Estados Unidos, García-Ramírez se concentra en el suelo bajo sus pies.

“Llueva, truene o nieve”, dijo, “yo camino”.

Este artículo se publicó con el apoyo de Journalism & Women Symposium (JAWS) Health Journalism Fellowship, asistida por subvenciones de The Commonwealth Fund.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).

Adults, he recollects, would scare the kids with tales of the “Mona Bruja,” or “Monkey Witch.” Step too far into the dark, they told him, and you might just get snatched up by the giant monstrous monkey who lives in the shadows.

Now, when García-Ramírez looks over his shoulder, it’s not monster monkeys he is afraid of. It’s U.S. Immigration and Customs Enforcement officers.

“There’s this constant fear that you’ll be walking down the street and a vehicle rolls up,” García-Ramírez, 57, said in Spanish. “They tell you, ‘We’re from ICE; you’re arrested,’ or, ‘Show me your papers.’”

Silverthorne, a commuter town between the ski meccas of Breckenridge and Vail, has been García-Ramírez’s home for the past two years. He works as a cashier at the grocery and shares a two-bedroom apartment with four roommates.

The town of nearly 5,000 has proved a welcome haven for the political exile, who was released from prison in 2023 after Nicaragua’s authoritarian government brokered a deal with the U.S. government to transfer more than 200 political prisoners to the U.S. The exiles were offered temporary residency in the U.S. under a Biden administration humanitarian parole program.

García-Ramírez’s two-year humanitarian parole expired in February, just a few weeks after President Donald Trump issued an executive order to end the program that had permitted temporary legal residency in the U.S. for hundreds of thousands of Cubans, Haitians, Nicaraguans, and Venezuelans, putting him at risk of deportation. García-Ramírez was stripped of his Nicaraguan citizenship when he came to the U.S. Just over a year ago, he applied for political asylum. He is still waiting for an interview.

“I can’t safely say I’m calm, or I’m OK, right now,” García-Ramírez said. “You feel unsafe, but you also feel incapable of doing anything to make it better.”

Vail and Breckenridge are world famous for their ski slopes, which attract millions of people a year. But life for the tourism labor force that serves Colorado’s mountain resorts is less glamorous. Residents of Colorado’s mountain towns experience high rates of suicide and substance use disorders, fueled in part by seasonal fluctuations in income that can cause stress for many in the local workforce.

The Latino communities who make up significant proportions of year-round populations in Colorado’s mountain towns are particularly vulnerable. A recent poll found more than 4 in 5 Latino respondents in the Western Slope region, home to many of the state’s rural ski resort communities, expressed “extremely or very serious” concern about substance use. That’s significantly higher than in rural eastern Colorado’s Morgan County, which also has a sizable Latino population, and in Denver and Colorado Springs.

Statewide, concerns about mental health have surged among Latinos in recent years, rising from fewer than half calling it an extremely or very serious problem in 2020 to more than three-quarters in 2023. Health care workers, researchers, and community members all say factors such as language differences, cultural stigma, and socioeconomic barriers may exacerbate mental health issues and limit the ability to access care.

“You’re not getting regular medical care. You’re working long hours, which probably means that you can’t take care of your own health,” said Asad Asad, a Stanford University assistant professor of sociology. “All of these factors compound the stresses that we all might experience in daily life.”

Add sky-high costs of living and an inadequate supply of mental health facilities across Colorado’s rural tourist destinations, and the problem becomes acute.

Now, the Trump administration’s threats of immigration raids and imminent deportation of anyone without legal U.S. residency have caused stress levels to soar. In communities around Vail, advocates estimate, a vast majority of Latino residents do not have legal status. Communities near Vail and Breckenridge have not experienced immigration raids, but in neighboring Routt County, home to Steamboat Springs, at least three people with criminal records have been detained by ICE, according to news reports. Social media posts falsely claiming local ICE sightings have further fueled concerns.

Yirka Díaz Platt, a bilingual social worker in Silverthorne originally from Peru, said a pervasive fear of deportation has caused many Latino workers and residents to retreat into the shadows. People have begun to cancel in-person meetings and avoid applying for government services that require submitting personal data, according to local health workers and advocates. In early February, some locals didn’t show up to work as part of a nationwide “day without immigrants” strike. Employers wonder whether they will lose valuable employees to deportation.

Some immigrants have stopped driving out of fear they will be pulled over by police. Paige Baker-Braxton, director of outpatient behavioral health at the Vail Health system, said she has seen a decline in visits from Spanish-speaking patients over the last few months.

“They’re really trying to keep to themselves. They are not really socializing much. If you go to the grocery stores, you don’t see much of our community out there anymore,” Platt said. “There’s that fear of, ‘No, I’m not trusting anyone right now.’”

Juana Amaya is no stranger to digging in her heels to survive. Amaya immigrated to the Vail area from Honduras in 1983 as a single mother of a 3-year-old and a 6-month-old. She has spent more than 40 years working as a house cleaner in luxury condos and homes around Vail, sometimes working up to 16 hours a day. With barely enough time to finish work and care for a family at home, she said, it is often hard for Latinos in her community to admit when the stress has become too much.

“We don’t like to talk about how we’re feeling,” she said in Spanish, “so we don’t realize that we’re dealing with a mental health problem.”

The current political climate has only made things worse.

“It’s had a big impact,” she said. “There are people who have small children and wonder what they’ll do if they’re in school and they are taken away somewhere, but the children stay. What do you do?”

Asad has studied the mental health impacts of deportation rhetoric on Latino communities. He co-authored a study, published last year in the journal Proceedings of the National Academy of Sciences, that found escalated deportation rhetoric may cause heightened levels of psychological distress in Latino noncitizens and even in Latino citizens.

Asad found that both groups may experience increased stress levels, and research has borne out the negative consequences of a parent’s lack of documentation on the health and educational attainment of their children.

“The inequalities or the hardships we impose on their parents today are the hardships or inequalities their children inherit tomorrow,” Asad said.

Despite heightened levels of fear and anxiety, Latinos living and working near Vail still find ways to support one another and seek help. Support groups in Summit County, home to Breckenridge and less than an hour’s drive from Vail, have offered mental health workshops for new immigrants and Latina women. Building Hope Summit County and Olivia’s Fund in Eagle County, home to Vail, help those without insurance pay for a set number of therapy sessions.

Vail Health plans to open a regional inpatient psychiatric facility in May, and the Mobile Intercultural Resource Alliance provides wraparound services, including behavioral health resources, directly to communities near Vail.

Back in Silverthorne, García-Ramírez, the Nicaraguan exile, takes things one day at a time.

“If they deport me from here, I’d go directly to Nicaragua,” said García-Ramírez, who said he had received a verbal death threat from authorities in his native country. “Honestly, I don’t think I would last even a day.”

In the meantime, he continues to make the routine trek home from his cashier job, sometimes navigating slick snow and dark streets past 9 p.m. When nightmarish thoughts about his own fate in America surface, García-Ramírez focuses on the ground beneath his feet.

“Come rain, shine, or snow,” he said, “I walk.”

This article was published with the support of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, assisted by grants from The Commonwealth Fund.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Colorado families say their state was a haven for those health services for a long time, but following executive orders from the Trump administration, even hospitals in Colorado limited the care they offer for trans patients under age 19. KFF Health News Colorado correspondent Rae Ellen Bichell spoke with youth and their families.

GRAND JUNCTION, Colo. — On a Friday after school, 6-year-old Esa Rodrigues had unraveled a ball of yarn, spooked the pet cat, polled family members about their favorite colors, and tattled on a sibling for calling her a “butt-face mole rat.”

Next, she was laser-focused on prying open cherry-crisp-flavored lip gloss with her teeth.

“Yes!” she cried, twisting open the cap. Esa applied the gloopy, shimmery stuff in her bedroom, where a large transgender pride flag hung on the wall.

Esa said the flag makes her feel “important” and “happy.” She’d like to take it down from the wall and wear it as a cape.

Her parents questioned her identity at first, but not anymore. Before, their anxious child dreaded going to school, bawled at the barbershop when she got a boy’s haircut, and curled into a fetal position on the bathroom floor when she learned she would never get a period.

Now, that child is happily bounding up a hill, humming to herself, wondering aloud if fairies live in the little ceramic house she found perched on a stone.

Her mom, Brittni Packard Rodrigues, wants this joy and acceptance to stay. Depending on a combination of Esa’s desire, her doctors’ recommendations, and when puberty sets in, that might require puberty blockers, followed by estrogen, so that Esa can grow into the body that matches her being.

“In the long run, blockers help prevent all of those surgeries and procedures that could potentially become her reality if we don’t get that care,” Packard Rodrigues said.

The medications known as puberty blockers are widely used for conditions that include prostate cancer, endometriosis, infertility, and puberty that sets in too early. Now, the Trump administration is seeking to limit their use specifically for transgender youth.

Esa’s home state of Colorado has long been known as a haven for gender-affirming care, which the state considers legally protected and an essential health insurance benefit. Medical exiles have moved to Colorado for such treatment in the past few years. As early as the 1970s, the town of Trinidad became known as “the sex-change capital of the world” when a cowboy-hat-wearing former Army surgeon, Stanley Biber, made his mark performing gender-affirming surgeries for adults.

On his first day in office, President Donald Trump signed an executive order refuting the existence of transgender people by saying it is a “false claim that males can identify as and thus become women and vice versa.” The following week, he issued another order calling puberty blockers and hormones for anyone under age 19 a form of chemical “mutilation” and “a stain on our Nation’s history.” It directed agencies to take steps to ensure that recipients of federal research or education grants stop providing it.

Subsequently, health care organizations in Colorado; California; Washington, D.C.; and elsewhere announced they would preemptively comply. In Colorado, that included three major health care organizations: Children’s Hospital Colorado, Denver Health, and UCHealth. At the end of January and in early February, the three systems announced changes to the gender-affirming care they provide to patients under 19, effective immediately: no new hormone or puberty blocker prescriptions for patients who hadn’t had them before, limited or no prescription renewals for those who had, and no surgeries, though Children’s Hospital had never offered it, and such surgery is rare among teens: For every 100,000 trans minors, fewer than three undergo surgery.

Children’s Hospital and Denver Health resumed offering puberty blockers and hormones on Feb. 24 and Feb. 19, respectively, after Colorado joined a U.S. District Court lawsuit in Washington state. The court concluded that Trump’s orders relating to gender “discriminate on the basis of transgender status and sex.” It granted a preliminary injunction blocking them from taking effect in the four states involved in the lawsuit.

Surgeries, however, have not resumed. Denver Health said it will “continue its pause on gender-affirming surgeries for patients under 19 due to patient safety and given the uncertainty of the legal and regulatory landscape.”

UCHealth has resumed neither medication nor surgery for those under 19. “Our providers are awaiting a more permanent decision from federal courts that may resolve the uncertainty around providing this care,” spokesperson Kelli Christensen wrote.

Trans youth and their families said the court ruling and the two Colorado health systems’ decisions to resume treatments haven’t resolved matters. It has bought them time to stockpile prescriptions, to try to find private practice physicians with the right training to monitor blood work and adjust prescriptions accordingly, and, for some, to work out the logistics of moving to another state or country.

The Trump administration has continued to press health providers beyond the initial executive orders by threatening to withhold or cancel federal money awarded to them. In early March, the Health Resources and Services Administration said it would review funding for graduate medical education at children’s hospitals.

KFF Health News requested comment from White House deputy press secretary Kush Desai but did not receive a response. HHS deputy press secretary Emily Hilliard responded with links to two prior press releases.

Medical interventions are just one type of gender-affirming care, and the process to get treatment is long and thorough. Researchers have found that, even among those with private insurance, transgender youth aren’t likely to receive puberty blockers and hormones. Interestingly, most gender-affirming breast reduction surgeries performed on men and boys are done on cisgender — not transgender — patients.

Kai, 14, wishes he could have gone on puberty blockers. He lives in Centennial, a Denver suburb. KFF Health News is not using his full name because his family is worried about him being harassed or targeted.

Kai got his period when he was 8 years old. By the time he realized he was transgender, in middle school, it was too late to start puberty blockers.

His doctors prescribed birth control to suppress his periods, so he wouldn’t be reminded each month of his gender dysphoria. Then, once he turned 14, he started taking testosterone.

Kai said if he didn’t have hormone therapy now, he would be a danger to himself.

“Being able to say that I’m happy in my body, and I get to be happy out in public without thinking everyone’s staring at me, looking at me weird, is such a huge difference,” he said.

His mom, Sherry, said she is happy to see Kai relax into the person he is.

Sherry, who asked to use her middle name to prevent her family from being identified, said she started stockpiling testosterone the moment Trump got elected but hadn’t thought about what impact there would be on the availability of birth control. Yet after the executive orders, that prescription, too, became tenuous. Sherry said Kai’s doctor at UCHealth had to set up a special meeting to confirm the doctor could keep prescribing it.

So, for now, Kai has what he needs. But to Sherry, that is cold comfort.

“I don’t think that we are very safe,” she said. “These are just extensions.”

The family is coming up with a plan to leave the country. If Sherry and her husband can get jobs in New Zealand, they’ll move there. Sherry said such mobility is a privilege that many others don’t have.

For example, David, an 18-year-old student at Western Colorado University in the Rocky Mountain town of Gunnison. He asked to be identified only by his middle name because he worries he could be targeted in this conservative, rural town.

David doesn’t have a passport, but even if he did, he doesn’t want to leave Gunnison, he said. He is studying geology, is learning to play the bass, and has a good group of friends. He has plans to become a paleontologist.

His dorm room shelves are scattered with his essentials: fossils, Old Spice deodorant, microwave macaroni and cheese. But there are no mirrors. David said he got in the habit of avoiding them.

“For the longest time, I just had so much body dysphoria and dysmorphia that it can be kind of hard to look in the mirror,” David said. “But when I do, most of the time, I see something that I really like.”

He’s been taking testosterone for three years, and the hormone helped him grow a beard. In January, his doctor at Denver Health was told to stop prescribing it. His mom drove hours from her home to Gunnison to deliver the news in person.

That prescription is back on track now, but the mastectomy he’d planned for this summer isn’t. He’d hoped to have adequate recovery time before sophomore year. But he doesn’t know anyone in Colorado who would perform it until he is 19. He could easily get surgery to enhance his breasts, but he must seek surgical options in other states to reduce or remove them.

“Colorado as a state was supposed to be a safe haven,” said his mother, Louise, who asked to be identified by her middle name. “We have a law that makes it a right for trans people to have health care, and yet our health care systems are taking that away.”

It has taken eight years and about 10 medical providers and therapists to get David this close to the finish line. That’s a big deal after living through so many years of dysphoria and dysmorphia.

“I’m still going, and I’m going to keep going, and there’s almost nothing they can do to stop me — because this is who I am,” David said. “There have always been trans people, and there always will be trans people.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Along the way, she learned about her own family’s history with such trauma.

This formed the multimedia “Silence in Sikeston” project from KFF Health News, Retro Report, and WORLD as told through a documentary film, educational videos, digital articles, and a limited-series podcast. Hear about Anthony’s journey and join this conversation about the toll of racialized violence on our health and our communities.

Explore more of the “Silence in Sikeston”project:

LISTEN: The limited-series podcast is available on PRX, Apple Podcasts, Spotify, iHeart, or wherever you get your podcasts.

• Episode 1: “Racism Can Make You Sick”
• Episode 2: “Hush, Fix Your Face”
• Episode 3: “Trauma Lives in the Body”
• Episode 4: “Is There a Cure for Racism”

WATCH: The documentary film “Silence in Sikeston,” a co-production of KFF Health News and Retro Report, is now available to stream on WORLD’s YouTube channel, WORLDchannel.org, and the PBS app.

READ: KFF Health News Midwest correspondent Cara Anthony wrote an essay about what her reporting for this project helped her learn about her own family’s hidden past.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

In the series finale of the podcast, a confident, outspoken Sikeston teenager shares her feelings in an uncommonly frank conversation with Chief James McMillen, head of Sikeston’s Department of Public Safety, which includes Sikeston police. 

Host Cara Anthony asks what kind of systemic change is possible to reduce the burden of racism on the health of Black Americans. Health equity expert Gail Christopher says it starts with institutional leaders who recognize the problem, measure it, and take concrete steps to change things. 

“It is a process, and it’s not enough to march and get a victory,” Christopher said. “We have to transform the systems of inequity in this country.” 

Host

Cara Anthony
Midwest correspondent, KFF Health News

@CaraRAnthony

Read Cara's stories

Cara is an Edward R. Murrow and National Association of Black Journalists award-winning reporter from East St. Louis, Illinois. Her work has appeared in The New York Times, Time magazine, NPR, and other outlets nationwide. Her reporting trip to the Missouri Bootheel in August 2020 launched the “Silence in Sikeston” project. She is a producer on the documentary and the podcast’s host.

In Conversation With …

Gail Christopher
Public health leader and health equity expert 

click to open the transcript

Transcript: Is There a Cure for Racism?

Editor’s note: If you are able, we encourage you to listen to the audio of “Silence in Sikeston,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast. 

[Ambient sounds from Sikeston, Missouri’s 2021 Juneteenth celebration — a DJ making an announcement over funky music, people chatting — begin playing.] 

Cara Anthony: It’s 2021. It’s hot and humid. We’re at a park in the heart of Sunset — Sikeston, Missouri’s historically Black neighborhood. 

Emory: Today is Juneteenth, baby. 

Cara Anthony: The basketball courts are jumping. And old-school funk is blaring from the speakers. Kids are playing. 

Cara Anthony: [Laughter] Are you enjoying the water?  

Cara Anthony: People are lining up for barbecue. 

I’ve been here reporting on the toll racism and violence can take on a community’s health. But today, I’m hoping to capture a little bit of Sikeston’s joy.  

Taneshia Pulley: When I look out to the crowd of my people, I see strength. I see power. I just see all magic. 

Cara Anthony: I drift over to a tent where people are getting their blood pressure, weight, and height checked … health screenings for free. 

Cara Anthony: I’m a journalist. 

Community Health Worker: Ooooh! Hi! Hi! 

Cara Anthony: The ladies working the booth are excited I’m there to report on the event. 

Cara Anthony: OK, and I’m a health journalist. 

Community health worker: Baby, that’s what I told them. Yeah, she healthy. [Laughter] 

[Dramatic instrumental music plays.] 

Cara Anthony: This Juneteenth gathering is happening a little over a year after Sikeston police officers shot and killed 23-year-old Denzel Taylor. 

We made a documentary about Denzel’s death and the death of another young Black man — also killed in Sikeston. 

Denzel was shot by police. Nearly 80 years earlier, Cleo Wright was lynched by a white mob. 

Both were killed before they got their day in court. 

In these years of reporting, what I’ve found is that many Black families worry that their kids don’t have an equal chance of growing up healthy and safe in Sikeston. 

[Dramatic instrumental ends.] 

Rosemary Owens: Being Black in the Bootheel can get you killed at any age. 

Cara Anthony: That’s Rosemary Owens. She raised her children here in Southeast Missouri. 

Cara Anthony: About 10 Sikeston police officers showed up to Juneteenth — for security and to connect with the community. Some are in uniform; some are in plain clothes. 

Rosemary has her doubts about why they came today. 

Cara Anthony: You see the police chief talking to people. What’s going through your mind as you see them milling about? 

Rosemary Owens: I hope they are real and wanting to close the gap between the African Americans and the white people. 

Anybody can come out and shake hands. But at the end of the day, did you mean what you said? Because things are still going on here in Sikeston, Missouri. 

Cara Anthony: For Rosemary, this brings to mind an encounter with the police from years ago. 

[Slow, minor, instrumental music plays softly.] 

When her son was maybe 16 years old, she says, she and her sister gave their boys the keys to their new cars — told them they could hang out in them. 

Rosemary had gotten her new car for Mother’s Day. 

Rosemary Owens: A brand-new red Dodge Caravan. We, we knew the boys were just going from the van to the car. You know, just showing out — they were boys. They weren’t driving. 

Cara Anthony: Someone nearby saw the boys …  

Rosemary Owens: … called and told the police that two Black men were robbing cars. 

 When the boys saw the police come up, there was three police cars. So they were like, something’s going on. So their intention, they were like, they were trying to run to us. And my brother said, stop. When they looked back, when the police got out of the car, they already had their guns drawn on my son and my nephew.  Cara Anthony: That’s what Rosemary thinks about when she sees Sikeston police at Juneteenth. 

[Slow, minor, instrumental music ends.] 

[“Silence in Sikeston” theme song plays.]  Cara Anthony: In this podcast series, we’ve talked about some of the ways racism makes Black people sick. But Juneteenth has me thinking about how we get free — how we STOP racism from making us sick. 

The public health experts say it’s going to take systemwide, institutional change. 

In this episode, we’re going to examine what that community-level change looks like — or at least what it looks like to make a start. 

From WORLD Channel and KFF Health News, distributed by PRX, this is “Silence in Sikeston.” 

Episode 4 is our final episode: “Is There a Cure for Racism?” 

[“Silence in Sikeston” theme song ends.] 

James McMillen: How you doing? 

Juneteenth celebration attendee: Good. Good.  

James McMillen: Good to see you, man.  

Juneteenth celebration attendee: What’s up? How are you?   

Cara Anthony: When I spot Sikeston’s director of public safety in his cowboy hat, sipping soda from a can, I head over to talk.  James McMillen: Well, you know, I just, I, I’m glad to be … on the inside of this. 

Cara Anthony: James McMillen leads the police department. He says he made it a point to come to Juneteenth. And he encouraged his officers to come, too. 

James McMillen: I remember as being a young officer coming to work here, not knowing anybody, driving by a park and seeing several Black people out there. And I remember feeling, you know, somewhat intimidated by that. And I don’t really know why. 

I hadn’t always been, um, that active in the community. And, um, I, I have been the last several years and I’m just wanting to teach officers to do the same thing. 

Cara Anthony: The chief told me showing up was part of his department’s efforts to repair relations with Sikeston’s Black residents. 

James McMillen: What’s important about this is, being out here and actually knowing people, I think it builds that trust that we need to have to prevent and solve crimes. 

Cara Anthony: A few minutes into our conversation, I notice a teenager and her friend nearby, listening. 

Cara Anthony: Yeah, we have two people who are watching us pretty closely. Come over here. Come over here. Tell us your names. 

Lauren: My name is Lauren. 

Michaiahes: My name is Michaiahes. 

Cara Anthony: Yeah. And what are you all … ? 

James McMillen: I saw you over there. 

Cara Anthony: So, what do you think about all of this?  

Michaiahes: Personally, I don’t even know who this is because I don’t mess with police because, because of what’s happened in the past with the police. But, um … 

Cara Anthony: As she starts to trail off, I encourage her to keep going. 

Cara Anthony: He’s right here. He’s in charge of all of those people. 

Michaiahes: Well, in my opinion, y’all should start caring about the community more. 

Cara Anthony: What are you hearing? She’s speaking from the heart here, Chief. What are you hearing? 

James McMillen: Well, you know what? I agree with everything she said there. 

Cara Anthony: She’s confident now, looking the chief in the eye. 

Michaiahes: And let’s just be honest: Some of these police officers don’t even want to be here today. They’re just here to think they’re doing something for the community. 

James McMillen: Let’s be honest. Some of these are assumptions that y’all are making about police that y’all don’t really know. 

[Subtle propulsive music begins playing.] 

Michaiahes: If we seen you protecting community, if we seen you doing what you supposed to do, then we wouldn’t have these assumptions about you. 

James McMillen: I just want to say that people are individuals. We have supervisors that try to keep them to hold a standard. And you shouldn’t judge the whole department, but, but just don’t judge the whole department off of a few. No more than I should judge the whole community off of a few. 

Cara Anthony: But here’s the thing … in our conversations over the years, Chief McMillen has been candid with me about how, as a rookie cop, he had judged Sikeston’s Black residents based on interactions with just a few. 

James McMillen: Some of, um, my first calls in the Black community were dealing with, obviously, criminals, you know? So if first impressions mean anything, that one set a bad one. I had, um, really unfairly judging the whole community based on the few interactions that I had, again, with majority of criminals. 

Cara Anthony: The chief says he’s moved past that way of thinking and he’s trying to help his officers move past their assumptions. 

And he told me about other things he wants to do …  

Hire more Black officers. Invest in racial-bias awareness education for the department. And open up more lines of communication with the community. 

James McMillen: I know that we are not going to see progress or we’re not going to see success without a little bit of pain and discomfort on our part. 

Cara Anthony: I don’t think I’ve ever heard the chief use the term institutional change, but the promises and the plans he’s making sound like steps in that direction. 

Except … here’s something else the chief says he wants …  

[Subtle propulsive music ends with a flourish.] 

James McMillen: As a police officer, I would like to hear more people talk about, um, just complying with the officer. 

Cara Anthony: That phrase is chilling to me. 

[Quiet, dark music starts playing.] 

When I hear “just comply” … a litany of names cross my mind. 

Philando Castile. 

Sonya Massey. 

Tyre Nichols. 

Cara Anthony: After Denzel Taylor was killed, people felt unsafe. I talked to a lot of residents on the record about them feeling like they didn’t know if they could be next. 

One thing that you told me was, like, well, one thing that people can do is comply with the officers, you know, if they find themselves having an interaction with law enforcement. 

James McMillen: Well, I mean, I think that’s, that’s a good idea to do. 

And if the person is not complying, that officer has got to be thinking, is this person trying to hurt me? So, asking people to comply with the officer’s command — that’s a reasonable statement. 

Cara Anthony: But, it’s well documented: Black Americans are more likely than our white peers to be perceived as dangerous by police. 

That perception increases the chances we’ll be the victim of deadly force. Whether we comply — or not. 

[Quiet, dark music ends.] 

That’s all to say … even with the promise of more Black officers in Sikeston and all the chief’s other plans, I’m not sure institutional change in policing is coming soon to Sikeston. 

[Sparse electronic music starts playing.] 

Cara Anthony: I took that worry to Gail Christopher. She has spent her long career trying to address the causes of institutional racism. 

Cara Anthony: We’ve been calling most of our guests by their first name, but what’s your preference? I don’t want to get in trouble with my mom on this, you know? [Cara laughs.] 

Gail Christopher: If you don’t mind, Dr. Christopher is good. 

Cara Anthony: OK. All right. That sounds good. I’m glad I asked. 

Cara Anthony: Dr. Christopher thinks a lot about the connections between race and health. And she’s executive director of the National Collaborative for Health Equity. Her nonprofit designs strategies for social change. 

She says the way to think about starting to fix structural racism … is to think about the future. 

Gail Christopher: What do you want for your daughter? What do I want for my children? I want them not to have interactions with the police, No. 1, right? 

Uh, so I want them to have safe places to be, to play, to be educated … equal access to the opportunity to be healthy. 

Cara Anthony: But I wonder if that future is even possible. 

[Sparse electronic music ends.] 

Cara Anthony: Is there a cure for racism? And I know it’s not that simple, but is there a cure? 

Gail Christopher: I love the question, right? And my answer to you would be yes. It is a process, and it’s not enough to march and get a victory. We have to transform the systems of inequity in this country. 

Cara Anthony: And Dr. Christopher says it is possible. Because racism is a belief system. 

[Hopeful instrumental music plays.] 

Gail Christopher: There is a methodology that’s grounded in psychological research and social science for altering our beliefs and subsequently altering our behaviors that are driven by those beliefs. 

Cara Anthony: To get there, she says, institutions need a rigorous commitment to look closely at what they are doing — and the outcomes they’re creating. 

Gail Christopher: Data tracking and monitoring and being accountable for what’s going on. 

We can’t solve a problem if we don’t admit that it exists. 

Cara Anthony: One of her favorite examples of what it looks like to make a start toward systemic change comes from the health care world. 

I know we’ve been talking about policing so far, but — bear with me here — we’re going to pivot to another way institutional bias kills people. 

A few years ago, a team of researchers at the Brigham and Women’s Hospital in Boston reviewed admission records for patients with heart failure. They found that Black and Latinx people were less likely than white patients to be admitted to specialized cardiology units. 

Gail Christopher: Without calling people racist, they saw the absolute data that showed that, wait a minute, we’re sending the white people to get the specialty care and we’re not sending the people of color. 

Cara Anthony: So, Brigham and Women’s launched a pilot program. 

When a doctor requests a bed for a Black or Latinx patient with heart failure, the computer system notifies them that, historically, Black and Latinx patients haven’t had equal access to specialty care. 

The computer system then recommends the patient be admitted to the cardiology unit. It’s still up to the doctor to actually do that. 

The hard data’s not published yet, but we checked in with the hospital, and they say the program seems to be making a difference. 

Gail Christopher: It starts with leadership. Someone in that system has the authority and makes the decision to hold themselves accountable for new results. 

[Hopeful instrumental music ends.] 

Cara Anthony: OK, so it could be working at a hospital. Let’s shift back to policing now. 

Gail Christopher: There should be an accountability board in that community, a citizens’ accountability board, where they are setting measurable and achievable goals and they are holding that police department accountable for achieving those goals. 

Cara Anthony: But, like, do Black people have to participate in this? Because we’re tired. 

Gail Christopher: Listen, do I know that we’re tired! Am I tired? After 50 years? Uh, I think that there is work that all people have to do. This business of learning to see ourselves in one another, to be fully human — it’s all of our work. 

[Warm, optimistic instrumental music plays.] 

Now, does that preclude checking out at times and taking care of yourself? I can’t tell you how many people my age who are no longer alive today, who were my colleagues and friends in the movement. But they died prematurely because of this lack of permission to take care of ourselves. 

Cara Anthony: Rest when you need to, she says, but keep going. 

Gail Christopher: We have to do that because it is our injury. It is our pain. And I think we have the stamina and the desire to see it change. 

Cara Anthony: Yep. Heard. It’s all of our work. 

Dr. Christopher has me thinking about all the Black people in Sikeston who aren’t sitting around waiting for someone else to change the institutions that are hurting them. 

People protested when Denzel Taylor was killed even with all the pressure to stay quiet about it. 

Protesters: Justice for Denzel on 3. 1, 2, 3 … Justice for Denzel! Again! 1, 2, 3 …  Justice for Denzel! 

Cara Anthony: And I’m thinking about the people who were living in the Sunset neighborhood of Sikeston in 1942 when Cleo Wright was lynched. 

Harry Howard: They picked up rocks and bricks and crowbars and just anything to protect our community. 

Cara Anthony: And Sunset did not burn. 

[Warm, optimistic instrumental music begins fading out.] 

[Piano starts warming up.] 

Cara Anthony: After nearly 80 years of mostly staying quiet about Cleo’s lynching, Sikeston residents organized a service to mark what happened to him — and their community. 

Reverend: We are so honored and humbled to be the host church this evening for the remembrance and reconciliation service of Mr. Cleo Wright. 

[Piano plays along with Pershard singing.] 

Pershard Owens: [Singing] It’s been a long, long time coming, but I know a change gonna come, oh yes it will. It’s been too hard a-livin but I’m afraid to die and I don’t know what’s up next, beyond the sky … 

[Pershard singing and piano accompaniment fade out.] 

Cara Anthony: I want to introduce you to that guy who was just singing then. His name is Pershard Owens. 

Remember Rosemary Owens? The woman who told us about someone calling the police on her son and nephew when they were playing with their parents’ new cars? Pershard is Rosemary’s younger son. 

Pershard Owens: Yeah, I definitely remember that. 

Cara Anthony: Even after all this time, other people didn’t want to talk to us about it. We couldn’t find news coverage of the incident. But Pershard remembers. He was in his weekly karate practice when it happened. He was 10 or 11 years old. 

Pershard Owens: My brother and cousin were, like, they were teens. So what do you think people are going to feel about the police when they do that, no questions asked, just guns drawn? 

Cara Anthony: Pershard’s dad works as a police officer on a different police force in the Bootheel. Pershard knows police. But that didn’t make it any less scary for him. 

Pershard Owens: You know, my parents still had to sit us down and talk and be like, “Hey, this is, that’s not OK, but you can’t, you can’t be a victim. You can’t be upset.” That’s how I was taught. So we acknowledge the past. But we don’t, we don’t stay down. 

Cara Anthony: So years later, when Chief James McMillen started a program as a more formal way for people in Sikeston and the police to build better relationships, Pershard signed up. They started meeting in 2020. 

The group is called Police and Community Together, or PACT for short. 

  [Sparse, tentative music begins playing.] 

Pershard Owens: It was a little tense that first couple of meetings because nobody knew what it was going to be. 

Cara Anthony: This was only five months after Sikeston police killed Denzel Taylor. 

PACT is not a citizens’ accountability board. The police don’t have to answer to it. 

The committee met every month. For a while. But they haven’t met in over a year now. 

Pershard Owens: We would have steps forward and then we would have three steps back. 

Cara Anthony: People have different accounts for why that is. Busy schedules. Mutual suspicion. Other things police officers have done that shook the trust of Black residents in Sikeston. 

Pershard Owens: And people were like, bro, like, how can you work with these people? 

The community is like, I can’t fully get behind it because I know what you did to my little cousin and them. Like, I know what the department did back in, you know, 15 years ago, and it’s hard to get past that. 

So, I mean, I’m getting both sides, like, constantly, and listen, that is, that is tough. 

[Sparse, tentative music ends.] 

Cara Anthony: But Pershard says something important changed because he started working with PACT. 

Pershard Owens: Chief did not like me at first [Pershard laughs]. He did not. 

Chief didn’t … me and Chief did not see eye to eye. Because he had heard things about me and he — people had told him that I was, I was anti-police and hated police officers, and he came in with a defense up. 

So, it took a minute for me and him to, like, start seeing each other in a different way. But it all happened when we sat down and had a conversation. 

[Slow instrumental music begins playing.] 

Cara Anthony: Just have a conversation. It sounds so simple; you’re probably rolling your eyes right now hearing it. 

But Pershard says … it could be meaningful. 

Pershard Owens: I truly want and believe that we can be together and we can work together and we can have a positive relationship where you see police and y’all dap each other up and y’all legit mean it. I think that can happen, but a lot of people have to change their mindsets. 

Cara Anthony: That’s a challenge Pershard is offering to police AND community members: Have a conversation with someone different from you. See if that changes the way you think about the person you’re talking to. See if it changes your beliefs. 

The more people do that, the more systems can change. 

Pershard Owens: We got to look in the mirror and say, “Am I doing what I can to try and change the dynamic of Sikeston, even if it does hurt?” 

Cara Anthony: Pershard says he’s going to keep putting himself out there. He ran for City Council in 2021. And even though he lost, he says he doesn’t regret it. 

Pershard Owens: When you’re dealing with a place like Sikeston, it’s not going to change overnight. 

Cara Anthony: And he’s glad he worked with PACT. Even if the community dialogue has fizzled for now, he’s pleased with the new relationship he built with Chief McMillen. And all of this has broadened his view of what kind of change is possible. 

[Slow instrumental music ends.] 

Pershard Owens: If you want something that has never been done, you have to go places that you’ve never been. 

[“Silence in Sikeston” theme music plays.] 

Cara Anthony: Places that you’ve never been … stories that you’ve never told out loud … maybe all of that helps build a Sikeston where Black residents can feel safer. Where Black people can live healthier lives. 

A world you might not be able to imagine yet, but one that could exist for the next generation. 

[“Silence in Sikeston” theme music ends.] 

[Upbeat instrumental music plays.] 

Cara Anthony: Thanks for listening to “Silence in Sikeston.” 

Next, go watch the documentary — it’s a joint production from Retro Report and KFF Health News, presented in partnership with WORLD. 

Subscribe to WORLD Channel on YouTube. That’s where you can find the film “Silence in Sikeston,” a Local, USA special. 

If you made it this far, thank you. Let me know how you’re feeling. 

I’d love to hear more about the conversations this podcast has sparked in your life. Leave us a voicemail at (202) 654-1366. 

And thanks to everyone in Sikeston for sharing your stories with us. 

This podcast is a co-production of WORLD Channel and KFF Health News and distributed by PRX. 

It was produced with support from PRX and made possible in part by a grant from the John S. and James L. Knight Foundation. 

This audio series was reported and hosted by me, Cara Anthony. 

Audio production by me, Zach Dyer. And me, Taylor Cook. 

Editing by me, Simone Popperl. 

And me, managing editor Taunya English. 

Sound design, mixing, and original music by me, Lonnie Ro. 

Podcast art design by Colin Mahoney and Tania Castro-Daunais. 

Tarena Lofton and Hannah Norman are engagement and social media producers for the show. 

Oona Zenda and Lydia Zuraw are the landing page designers. 

Lynne Shallcross is the photo editor, with photography from Michael B. Thomas. 

Thank you to vocal coach Viki Merrick. 

And thank you to my parents for all their support over the four years of this project. 

Music in this episode is from Epidemic Sound and Blue Dot Sessions. 

Some of the audio you heard across the podcast is also in the film. 

For that, special thanks to Adam Zletz, Matt Gettemeier, Roger Herr, and Philip Geyelin. 

Kyra Darnton is executive producer at Retro Report. 

I was a producer on the film. 

Jill Rosenbaum directed the documentary. 

Kytja Weir is national editor at KFF Health News. 

WORLD Channel’s editor-in-chief and executive producer is Chris Hastings. 

Help us get the word out about “Silence in Sikeston.” Write a review or give us a quick rating wherever you listen to this podcast. 

Thank you! It makes a difference. 

Oh yeah! And tell your friends in real life too!  

[Upbeat instrumental music ends.] 

Credits

Taunya English
Managing editor

@TaunyaEnglish

Taunya is deputy managing editor for broadcast at KFF Health News, where she leads enterprise audio projects.

Simone Popperl
Line editor

@simoneppprl

Simone is broadcast editor at KFF Health News, where she shapes stories that air on Marketplace, NPR, and CBS News Radio, and she co-manages a national reporting collaborative.

Zach Dyer
Senior producer

@zkdyer

Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production.

Taylor Cook
Associate producer

@taylormcook7

Taylor is an independent producer who does research, books guests, contributes writing, and fact-checks episodes for several KFF Health News podcasts.

Lonnie Ro
Sound designer

@lonnielibrary

Lonnie Ro is an audio engineer and a composer who brings audio stories to life through original music and expert sound design for platforms like Spotify, Audible, and KFF Health News.

Additional Newsroom Support

Lynne Shallcross, photo editorOona Zenda, illustrator and web producerLydia Zuraw, web producerTarena Lofton, audience engagement producer Hannah Norman, video producer and visual reporter Chaseedaw Giles, audience engagement editor and digital strategistKytja Weir, national editor Mary Agnes Carey, managing editor Alex Wayne, executive editorDavid Rousseau, publisher Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chief Tammie Smith, communications officer 

The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.

Watch the accompanying documentary from WORLD, Retro Report, and KFF here.

To hear other KFF Health News podcasts, click here.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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