Josephine, 16, has been diagnosed with tetrasomy 8p mosaicism, severe autism, severe obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder, among other conditions, which will require constant assistance and supervision for the rest of her life.

Ortiz, 25, is Josephine’s caregiver. A Venezuelan immigrant, Ortiz helps Josephine eat, bathe, and perform other daily tasks that the teen cannot do alone at her home in West Orange, New Jersey. Over the past 2½ years, Ortiz said, she has developed an instinct for spotting potential triggers before they escalate. She closes doors and peels barcode stickers off apples to ease Josephine’s anxiety.

But Ortiz’s ability to work in the U.S. has been thrown into doubt by the Trump administration, which ordered an end to the temporary protected status program for some Venezuelans on April 7. On March 31, a federal judge paused the order, giving the administration a week to appeal. If the termination goes through, Ortiz would have to leave the country or risk detention and deportation.

“Our family would be gutted beyond belief,” said Krysta Senek, Josephine’s mother, who has been trying to win a reprieve for Ortiz.

Americans depend on many such foreign-born workers to help care for family members who are older, injured, or disabled and cannot care for themselves. Nearly 6 million people receive personal care in a private home or a group home, and about 2 million people use these services in a nursing home or other long-term care institution, according to a Congressional Budget Office analysis.

Increasingly, the workers who provide that care are immigrants such as Ortiz. The foreign-born share of nursing home workers rose three percentage points from 2007 to 2021, to about 18%, according to an analysis of census data by the Baker Institute for Public Policy at Rice University in Houston.

And foreign-born workers make up a high share of other direct care providers. More than 40% of home health aides, 28% of personal care workers, and 21% of nursing assistants were foreign-born in 2022, compared with 18% of workers overall that year, according to Bureau of Labor Statistics data.

That workforce is in jeopardy amid an immigration crackdown President Donald Trump launched on his first day back in office. He signed executive orders that expanded the use of deportations without a court hearing, suspended refugee resettlements, and more recently ended humanitarian parole programs for nationals of Cuba, Haiti, Nicaragua, and Venezuela.

In invoking the Alien Enemies Act to deport Venezuelans and attempting to revoke legal permanent residency for others, the Trump administration has sparked fear that even those who have followed the nation’s immigration rules could be targeted.

“There's just a general anxiety about what this could all mean, even if somebody is here legally,” said Katie Smith Sloan, president of LeadingAge, a nonprofit representing more than 5,000 nursing homes, assisted living facilities, and other services for aging patients. “There's concern about unfair targeting, unfair activity that could just create trauma, even if they don't ultimately end up being deported, and that's disruptive to a health care environment.”

Shutting down pathways for immigrants to work in the United States, Smith Sloan said, also means many other foreign workers may go instead to countries where they are welcomed and needed.

“We are in competition for the same pool of workers,” she said.

Growing Demand as Labor Pool Likely To Shrink

Demand for caregivers is predicted to surge in the U.S. as the youngest baby boomers reach retirement age, with the need for home health and personal care aides projected to grow about 21% over a decade, according to the Bureau of Labor Statistics. Those 820,000 additional positions represent the most of any occupation. The need for nursing assistants and orderlies also is projected to grow, by about 65,000 positions.

Caregiving is often low-paying and physically demanding work that doesn’t attract enough native-born Americans. The median pay ranges from about $34,000 to $38,000 a year, according to the Bureau of Labor Statistics.

Nursing homes, assisted living facilities, and home health agencies have long struggled with high turnover rates and staffing shortages, Smith Sloan said, and they now fear that Trump’s immigration policies will choke off a key source of workers, leaving many older and disabled Americans without someone to help them eat, dress, and perform daily activities.

With the Trump administration reorganizing the Administration for Community Living, which runs programs supporting older adults and people with disabilities, and Congress considering deep cuts to Medicaid, the largest payer for long-term care in the nation, the president’s anti-immigration policies are creating “a perfect storm” for a sector that has not recovered from the covid-19 pandemic, said Leslie Frane, an executive vice president of the Service Employees International Union, which represents nursing facility workers and home health aides.

The relationships caregivers build with their clients can take years to develop, Frane said, and replacements are already hard to find.

In September, LeadingAge called for the federal government to help the industry meet staffing needs by raising caps on work-related immigration visas, expanding refugee status to more people, and allowing immigrants to test for professional licenses in their native language, among other recommendations.

But, Smith Sloan said, “There's not a lot of appetite for our message right now.”

The White House did not respond to questions about how the administration would address the need for workers in long-term care. Spokesperson Kush Desai said the president was given “a resounding mandate from the American people to enforce our immigration laws and put Americans first” while building on the “progress made during the first Trump presidency to bolster our healthcare workforce and increase healthcare affordability.”

Refugees Fill Nursing Home Jobs in Wisconsin

Until Trump suspended the refugee resettlement program, some nursing homes in Wisconsin had partnered with local churches and job placement programs to hire foreign-born workers, said Robin Wolzenburg, a senior vice president for LeadingAge Wisconsin.

Many work in food service and housekeeping, roles that free up nurses and nursing assistants to work directly with patients. Wolzenburg said many immigrants are interested in direct care roles but take on ancillary roles because they cannot speak English fluently or lack U.S. certification.

Through a partnership with the Wisconsin health department and local schools, Wolzenburg said, nursing homes have begun to offer training in English, Spanish, and Hmong for immigrant workers to become direct care professionals. Wolzenburg said the group planned to roll out training in Swahili soon for Congolese women in the state.

Over the past 2½ years, she said, the partnership helped Wisconsin nursing homes fill more than two dozen jobs. Because refugee admissions are suspended, Wolzenburg said, resettlement agencies aren’t taking on new candidates and have paused job placements to nursing homes.

Many older and disabled immigrants who are permanent residents rely on foreign-born caregivers who speak their native language and know their customs. Frane with the SEIU noted that many members of San Francisco’s large Chinese American community want their aging parents to be cared for at home, preferably by someone who can speak the language.

“In California alone, we have members who speak 12 different languages,” Frane said. “That skill translates into a kind of care and connection with consumers that will be very difficult to replicate if the supply of immigrant caregivers is diminished.”

The Ecosystem a Caregiver Supports

Caregiving is the kind of work that makes other work possible, Frane said. Without outside caregivers, the lives of the patient and their loved ones become more difficult logistically and economically.

“Think of it like pulling out a Jenga stick from a Jenga pile, and the thing starts to topple,” she said.

Thanks to the one-on-one care from Ortiz, Josephine has learned to communicate when she’s hungry or needs help. She now picks up her clothes and is learning to do her own hair. With her anxiety more under control, the violent meltdowns that once marked her weeks have become far less frequent, Ortiz said.

“We live in Josephine’s world,” Ortiz said in Spanish. “I try to help her find her voice and communicate her feelings.”

Ortiz moved to New Jersey from Venezuela in 2022 as part of an au pair program that connects foreign-born workers with people who are older or children with disabilities who need a caregiver at home. Fearing political unrest and crime in her home country, she got temporary protected status when her visa expired last year to keep her authorization to work in the United States and stay with Josephine.

Losing Ortiz would upend Josephine’s progress, Senek said. The teen would lose not only a caregiver, but also a sister and her best friend. The emotional impact would be devastating.

“You have no way to explain to her, ‘Oh, Alanys is being kicked out of the country, and she can't come back,’” she said.

It’s not just Josephine: Senek and her husband depend on Ortiz so they can work full-time jobs and take care of themselves and their marriage. “She's not just an au pair,” Senek said.

The family has called its congressional representatives for help. Even a relative who voted for Trump sent a letter to the president asking him to reconsider his decision.

In the March 31 court decision, U.S. District Judge Edward Chen wrote that canceling the protection could “inflict irreparable harm on hundreds of thousands of persons whose lives, families, and livelihoods will be severely disrupted.”

‘Doing the Work That Their Own People Don’t Want To Do’

News of immigration dragnets that sweep up lawfully present immigrants and mass deportations are causing a lot of stress, even for those who have followed the rules, said Nelly Prieto, 62, who cares for an 88-year-old man with Alzheimer’s disease and a man in his 30s with Down syndrome in Yakima County, Washington.

Born in Mexico, she immigrated to the United States at age 12 and became a U.S. citizen under a law authorized by President Ronald Reagan that made any immigrant who entered the country before 1982 eligible for amnesty. So, she’s not worried for herself. But, she said, some of her co-workers working under H-2B visas are very afraid.

“It kills me to see them when they talk to me about things like that, the fear in their faces,” she said. “They even have letters, notarized letters, ready in case something like that happens, saying where their kids can go.”

Foreign-born home health workers feel they are contributing a valuable service to American society by caring for its most vulnerable, Prieto said. But their efforts are overshadowed by rhetoric and policies that make immigrants feel as if they don’t belong.

“If they cannot appreciate our work, if they cannot appreciate us taking care of their own parents, their own grandparents, their own children, then what else do they want?” she said. “We’re only doing the work that their own people don’t want to do.”

In New Jersey, Ortiz said life has not been the same since she received the news that her TPS authorization was slated to end soon. When she walks outside, she fears that immigration agents will detain her just because she’s from Venezuela.

She’s become extra cautious, always carrying proof that she’s authorized to work and live in the U.S.

Ortiz worries that she’ll end up in a detention center. But even if the U.S. now feels less welcoming, she said, going back to Venezuela is not a safe option.

“I might not mean anything to someone who supports deportations,” Ortiz said. “I know I'm important to three people who need me."

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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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As of Oct. 14, the state has had six confirmed and five possible human cases of bird flu, according to the California Department of Public Health (CDPH).

All of the affected individuals reportedly had direct contact with infected cattle at nine dairy farms, the department stated. 

FIRST CASE OF HUMAN BIRD FLU DIAGNOSED WITHOUT EXPOSURE TO INFECTED ANIMALS, CDC SAYS

The U.S. Centers for Disease Control and Prevention (CDC) is conducting tests to confirm the five possible cases.

All the individuals experienced "mild symptoms," including eye redness or discharge (conjunctivitis), the CDPH stated. None were hospitalized. 

There is not a concern at this point about human-to-human transmission, according to the agency.

"Given the amount of exposure to infected cows, evidence continues to suggest only animal-to-human spread of the virus in California," said the CDPH statement. 

"Additionally, based on CDC’s genomic sequencing of three California bird flu cases, there is no evidence to suggest an increased ability for the virus to infect or spread between people and no known reduced susceptibility to antiviral medications."

IN A POTENTIAL OUTBREAK, IS BIRD FLU TESTING AVAILABLE FOR HUMANS? WHAT TO KNOW

As of Oct. 15, there were a total of 20 confirmed human cases of bird flu in the U.S., according to the CDC.

Colorado and California have had the most cases, with others reported in Michigan, Missouri and Texas, the same source stated.

Roughly half of those were linked to exposure to infected cattle and the other half to infected poultry. 

"To a large extent, the higher numbers we are seeing in California, and previously in Colorado, are due to more aggressive monitoring and case finding efforts in those states, rather than necessarily reflecting a larger burden of disease," Shira Doron, M.D., chief infection control officer at Tufts Medicine Health System in Boston, told Fox News Digital.

"California has one of the more comprehensive programs to find avian influenza in its cattle herds, and when they find sick cows, they monitor exposed farm workers," she went on.

"The disease has been mostly very mild, so it will only be detected if looked for."

It’s not known whether the strain that is causing avian flu in cows will ever mutate into a strain that can be spread from human to human, according to Doron.

"Right now, with no evidence of human-to-human spread, it does not have the potential to become a human pandemic, but that could change," she told Fox News Digital.

"Obviously, scientists and public health officials should be concerned, and should take action to limit the spread of this disease in farm animals."

BIRD FLU PANDEMIC IN FUTURE? EU WARNS OF POTENTIAL SPREAD TO HUMANS DUE TO 'LACK OF IMMUNE DEFENSE’

Farm owners and farm workers should also be concerned, she said.

"They should be taking measures to protect those who work closely with animals, especially cows and chickens," Doron advised.

Sam Scarpino, PhD, director of AI and life sciences at Northeastern University in Boston, said he finds the rising number of human H5N1 cases "concerning."

"The more spillovers to humans, the more chances there are for the wrong variant to find itself in a person and spark an epidemic," he told Fox News Digital.

There's currently no evidence, however, that the virus has mutated to become more infectious in humans, Scarpino said.

"Most likely, we are seeing the impact of an increasing number of infected dairy farms leading to an increasing number of human infections," he said.

"California also has active efforts for both human and dairy cattle surveillance, so ascertainment may be higher than in other states."

Although experts say the risk for human-to-human transmission remains low, they recommend certain public health precautions. 

"People who have close contact with animals, particularly farm animals and wild birds, should be taking precautions," Doron advised. 

CDC, WEBMD GIVE UPDATE ON CURRENT BIRD FLU OUTBREAK

The CDC also recommends that farm workers wear personal protective equipment — such as gloves, goggles and face shields — and that farms follow guidance to prevent the spread of the virus between animals.

"Even if a large outbreak isn't sparked, the risk to farm workers is clearly higher, and we need to ensure they are protected," Scarpino told Fox News Digital.

"At this point, there's no excuse for a farm worker to die from an H5N1 infection."

It’s also important for people to get their seasonal flu shot, experts say.

"While it is not likely to protect against avian flu, it will help people avoid being infected with the seasonal and avian strain at the same time, which can lead to genetic mixing and emergence of a pandemic strain," said Doron.

Getting the flu vaccine also makes it less likely that someone will end up with a suspected case of avian flu as a result of having the seasonal flu and a history of animal exposure, she added.

Vaccines for bird flu are currently in development.

"It is not time to vaccinate more broadly yet, given the small number of cases, absence of proven human-to-human transmission and mostly mild infection," said Doron.

It is important for tests to be commercially available for avian flu, however.

"Seasonal flu cases will be rising soon, and we will need to distinguish quickly between regular flu and avian flu, especially in animal workers," Doron noted.

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"Right now, to test for avian flu, specimens have to go to special public health labs and the results take days to return. We are going to need answers more quickly if we want people to be able to properly isolate and prevent spread."

The CDPH recommends that California residents monitor for bird flu symptoms for 10 days after exposure.

Those include eye redness (conjunctivitis), sore throat, cough, runny or stuffy nose, vomiting, diarrhea, muscle or body aches, fatigue, headaches, trouble breathing and fever.

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"If they start to feel sick, they should immediately isolate, notify their local public health department, and work with public health and health care providers to get timely testing and treatment," the agency advises on its website.

Californians in November will weigh in on a ballot initiative to increase scrutiny over the use of health-care dollars — particularly money from a federal drug discount program — meant to support patient care largely for low-income or indigent people. The revenue is sometimes used to address housing instability and homelessness among vulnerable patient populations.

Voters are being asked whether California should increase accountability in the 340B drug discount program, which provides money for community clinics, safety net hospitals and other nonprofit health-care providers.

The program requires pharmaceutical companies to give drug discounts to these clinics and nonprofit entities, which can bank revenue by charging higher reimbursement rates.

Advocates pushing the measure, Proposition 34, say some entities are using the drug discount program as a slush fund, plowing money into housing and homelessness initiatives that don’t meet basic patient safety standards. Researchers and advocates have called for greater oversight.

“There are 340B entities that are misusing these public dollars,” said Nathan Click, a spokesperson for the pro-Proposition 34 campaign. “The whole point of this program is to use this money to get more low-income people health-care services.”

The initiative wouldn’t bar 340B providers from using health-care funds for housing or homelessness programs. Instead, it targets providers that spend more than $100 million on purposes other than direct patient care over 10 years. It would mandate that 98 percentof 340B revenues go to direct patient care. It also targets 340B providers with health insurer contracts and pharmacy licenses and those serving low-income Medicaid or Medicare patients that have been dinged with at least 500 high-severity housing violations for substandard or unsafe conditions.

That has placed a bull’s eye on the Los Angeles-based AIDS Healthcare Foundation, a nonprofit that provides direct patient care via clinics and pharmacies in California and other states, including Illinois, Texas and New York. It also owns housing for low-income and homeless people.

A Los Angeles Times investigation found that many residents of AIDS Healthcare Foundation properties are living in deplorable, unhealthy conditions.

Michael Weinstein, the foundation’s president, disputes those claims and argues that Proposition 34 proponents, including real estate interests, are going after him for another ballot initiative that seeks to implement rent control in more communities across California.

“It’s a revenge initiative,” Weinstein said, arguing that the deep-pocketed California Apartment Association is targeting his foundation — and its health and housing operations — because it has backed ballot measures pushing rent control across California. “This is a two-pronged attack against us to defeat rent control.”

Weinstein is locked in a feud with the apartment association, the chief sponsor of the initiative, which has contributed handsomely to pass Proposition 34. Opponents argue that the initiative is “a wolf in sheep’s clothing.”

Weinstein acknowledged to KFF Health News that his nonprofit uses money from 340B drug discounts to support its housing initiatives but argued they are helping treat and house some of the most vulnerable people, who would otherwise be homeless.

The apartment association declined several requests for comment. But Proposition 34 backers say they aren’t going after rent control — or Weinstein and his nonprofit.

Supporters argue that “rising health care costs are squeezing millions of Californians” and say that the initiative would “give California patients and taxpayers much needed relief, and lowers state drug costs, while saving California taxpayers billions.”

If the initiative passes and 340B providers do not spend 98 percent of the revenue on direct patient care, they could lose their license to practice health care and their nonprofit status.

This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.

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Health officials in Los Angeles County on Wednesday warned of an "unprecedented" rise in dengue fever among residents who have not traveled out of the country.

At least three cases of dengue have been reported in residents in the Baldwin Park neighborhood east of downtown Los Angeles after they were bitten by local mosquitoes, Los Angeles County public health officials said.

"This is an unprecedented cluster of locally acquired dengue for a region where dengue has not previously been transmitted by mosquitoes," said Barbara Ferrer, director of the Los Angeles County Department of Public Health.

Dengue is typically acquired after traveling abroad to a country where dengue is commonly spread. The first locally acquired case in California was reported a year ago.

CDC WARNS OF MOSQUITO-DRIVEN VIRUS AS CASES SPIKE

Dengue spread from mosquito bites within the U.S. has been reported this year in Florida, the U.S. Virgin Islands and Puerto Rico, where officials have declared a dengue epidemic.

There have been 3,085 such cases in the U.S. this year, of which 96% were in Puerto Rico, according to the U.S. Centers for Disease Control and Prevention.

Symptoms of dengue fever can include high fever, severe headache, pain behind the eyes, joint and muscle pain, rash and mild bleeding, according to public health officials. 

NORTHEASTERN TOWNS ISSUE VOLUNTARY LOCKDOWN TO PREVENT SPREAD OF MOSQUITO-BORNE DISEASE

Symptoms may mimic other viruses such as the flu, though officials say the most serious cases can result in shock, severe bleeding and severe organ impairment which require immediate medical attention.

Los Angeles County Public Health said it is working with other agencies and the city of Baldwin Park to go door-to-door and speak to residents about the risk of dengue and mosquito bite prevention.

Meanwhile, officials are increasing mosquito trapping to identify and test mosquitoes to reduce the risk of any additional spread in the neighborhood.

The Associated Press contributed to this report.

Christina Kashiwada was traveling for work during the summer of 2018 when she noticed a small, itchy lump in her left breast.

She thought little of it at first. She did routine self-checks and kept up with medical appointments. But a relative urged her to get a mammogram. She took the advice and learned she had stage 3 breast cancer, a revelation that stunned her.

“I’m 36 years old, right?” said Kashiwada, a civil engineer in Sacramento, California. “No one’s thinking about cancer.”

About 11,000 Asian American and Pacific Islander women were diagnosed with breast cancer in 2021 and about 1,500 died. The latest federal data shows the rate of new breast cancer diagnoses in Asian American and Pacific Islander women — a group that once had relatively low rates of diagnosis — is rising much faster than that of many other racial and ethnic groups. The trend is especially sharp among young women such as Kashiwada.

About 55 of every 100,000 Asian American and Pacific Islander women under 50 were diagnosed with breast cancer in 2021, surpassing the rate for Black and Hispanic women and on par with the rate for white women, according to age-adjusted data from the National Institutes of Health. (Hispanic people can be of any race or combination of races but are grouped separately in this data.)

The rate of new breast cancer cases among Asian American and Pacific Islander women under 50 grew by about 52% from 2000 through 2021. Rates for AAPI women 50 to 64 grew 33% and rates for AAPI women 65 and older grew by 43% during that period. By comparison, the rate for women of all ages, races, and ethnicities grew by 3%.

Researchers have picked up on this trend and are racing to find out why it is occuring within this ethnically diverse group. They suspect the answer is complex, ranging from cultural shifts to pressure-filled lifestyles — yet they concede it remains a mystery and difficult for patients and their families to discuss because of cultural differences.

Helen Chew, director of the Clinical Breast Cancer Program at UC Davis Health, said the Asian American diaspora is so broad and diverse that simple explanations for the increase in breast cancer aren’t obvious.

“It’s a real trend,” Chew said, adding that “it is just difficult to tease out exactly why it is. Is it because we’re seeing an influx of people who have less access to care? Is it because of many things culturally where they may not want to come in if they see something on their breast?”

There’s urgency to solve this mystery because it’s costing lives. While women in most ethnic and racial groups are experiencing sharp declines in breast cancer death rates, about 12 of every 100,000 Asian American and Pacific Islander women of any age died from breast cancer in 2023, essentially the same death rate as in 2000, according to age-adjusted, provisional data from the Centers for Disease Control and Prevention. The breast cancer death rate among all women during that period dropped 30%.

The CDC does not break out breast cancer death rates for many different groups of Asian American women, such as those of Chinese or Korean descent. It has, though, begun distinguishing between Asian American women and Pacific Islander women.

Nearly 9,000 Asian American women died from breast cancer from 2018 through 2023, compared with about 500 Native Hawaiian and Pacific Islander women. However, breast cancer death rates were 116% higher among Native Hawaiian and Pacific Islander women than among Asian American women during that period.

Rates of pancreatic, thyroid, colon, and endometrial cancer, along with non-Hodgkin lymphoma rates, have also recently risen significantly among Asian American and Pacific Islander women under 50, NIH data show. Yet breast cancer is much more common among young AAPI women than any of those other types of cancer — especially concerning because young women are more likely to face more aggressive forms of the disease, with high mortality rates.

“We’re seeing somewhere almost around a 4% per-year increase,” said Scarlett Gomez, a professor and epidemiologist at the University of California-San Francisco’s Helen Diller Family Comprehensive Cancer Center. “We’re seeing even more than the 4% per-year increase in Asian/Pacific Islander women less than age 50.”

Gomez is a lead investigator on a large study exploring the causes of cancer in Asian Americans. She said there is not yet enough research to know what is causing the recent spike in breast cancer. The answer may involve multiple risk factors over a long period of time.

“One of the hypotheses that we're exploring there is the role of stress,” she said. “We're asking all sorts of questions about different sources of stress, different coping styles throughout the lifetime.”

It’s likely not just that there’s more screening. “We looked at trends by stage at diagnosis and we are seeing similar rates of increase across all stages of disease,” Gomez said.

Veronica Setiawan, a professor and epidemiologist at the Keck School of Medicine of the University of Southern California, said the trend may be related to Asian immigrants adopting some lifestyles that put them at higher risk. Setiawan is a breast cancer survivor who was diagnosed a few years ago at the age of 49.

“Asian women, American women, they become more westernized so they have their puberty younger now — having earlier age at [the first menstrual cycle] is associated with increased risk,” said Setiawan, who is working with Gomez on the cancer study. “Maybe giving birth later, we delay childbearing, we don't breastfeed — those are all associated with breast cancer risks.”

Moon Chen, a professor at the University of California-Davis and an expert on cancer health disparities, added that only a tiny fraction of NIH funding is devoted to researching cancer among Asian Americans.

Whatever its cause, the trend has created years of anguish for many patients.

Kashiwada underwent a mastectomy following her breast cancer diagnosis. During surgery, doctors at UC Davis Health discovered the cancer had spread to lymph nodes in her underarm. She underwent eight rounds of chemotherapy and 20 sessions of radiation treatment.

Throughout her treatments, Kashiwada kept her ordeal a secret from her grandmother, who had helped raise her. Her grandmother never knew about the diagnosis. “I didn't want her to worry about me or add stress to her,” Kashiwada said. “She just would probably never sleep if she knew that was happening. It was very important to me to protect her.”

Kashiwada moved in with her parents. Her mom took a leave from work to help take care of her.

Kashiwada’s two young children, who were 3 and 6 at the time, stayed with their dad so she could focus on her recovery.

“The kids would come over after school,” she said. “My dad would pick them up and bring them over to see me almost every day while their dad was at work.”

Kashiwada spent months regaining strength after the radiation treatments. She returned to work but with a doctor’s instruction to avoid lifting heavy objects.

Kashiwada had her final reconstructive surgery a few weeks before covid lockdowns began in 2020. But her treatment was not finished.

Her doctors had told her that estrogen fed her cancer, so they gave her medicine to put her through early menopause. The treatment was not as effective as they had hoped. Her doctor performed surgery in 2021 to remove her ovaries.

More recently, she was diagnosed with osteopenia and will start injections to stop bone loss.

Kashiwada said she has moved past many of the negative emotions she felt about her illness and wants other young women, including Asian American women like her, to be aware of their elevated risk.

“No matter how healthy you think you are, or you're exercising, or whatever you're doing, eating well, which is all the things I was doing — I would say it does not make you invincible or immune,” she said. “Not to say that you should be afraid of everything, but just be very in tune with your body and what your body's telling you.”

Phillip Reese is a data reporting specialist and an associate professor of journalism at California State University-Sacramento.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Supplemental support comes from the Asian American Journalists Association-Los Angeles through The California Endowment.

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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Julie Rovner
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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.

As Vice President Kamala Harris appears poised to become the Democratic Party’s presidential nominee, health policy in general and reproductive health issues in particular are likely to have a higher profile. Harris has long been the Biden administration’s point person on abortion rights and reproductive health and was active on other health issues while serving as California’s attorney general.

Meanwhile, Congress is back for a brief session between presidential conventions, but efforts in the GOP-led House to pass the annual spending bills, due by Oct. 1, have run into the usual roadblocks over abortion-related issues.

This week’s panelists are Julie Rovner of KFF Health News, Stephanie Armour of KFF Health News, Rachel Cohrs Zhang of Stat, and Alice Miranda Ollstein of Politico.

Panelists

Stephanie Armour
KFF Health News

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Rachel Cohrs Zhang
Stat News

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Alice Miranda Ollstein
Politico

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Among the takeaways from this week’s episode:

• President Joe Biden’s decision to drop out of the presidential race has turned attention to his likely successor on the Democratic ticket, Vice President Kamala Harris. At this late hour in the campaign, she is expected to adopt Biden’s health policies, though many anticipate she’ll take a firmer stance on restoring Roe v. Wade. And while abortion rights supporters are enthusiastic about Harris’ candidacy, opponents are eager to frame her views as extreme.
• As he transitions from incumbent candidate to outgoing president, Biden is working to frame his legacy, including on health policy. The president has expressed pride that his signature domestic achievement, the Inflation Reduction Act, took on the pharmaceutical industry, including by forcing the makers of the most expensive drugs into negotiations with Medicare. Yet, as with the Affordable Care Act’s delayed implementation and results, most Americans have yet to see the IRA’s potential effect on drug prices.
• Lawmakers continue to be hung up on federal government spending, leaving appropriations work undone as they prepare to leave for summer recess. Fights over abortion are, once again, gumming up the works.
• In abortion news, Iowa’s six-week limit is scheduled to take effect next week, causing rippling problems of abortion access throughout the region. In Louisiana, which added the two drugs used in medication abortions to its list of controlled substances, doctors are having difficulty using the pills for other indications. And doctors who oppose abortion are pushing higher-risk procedures, like cesarean sections, in lieu of pregnancy termination when the mother’s life is in danger — as states with strict bans, like Texas and Louisiana, are reporting a rise in the use of surgeries, including hysterectomies, to end pregnancies.
• The Government Accountability Office reports that many states incorrectly removed hundreds of thousands of eligible people from the Medicaid rolls during the “unwinding” of the covid-19 public health emergency’s coverage protections. The Biden administration has been reluctant to call out those states publicly in an attempt to keep the process as apolitical as possible.

Also this week, Rovner interviews Anthony Wright, the new executive director of the consumer health advocacy group Families USA. Wright spent the past two decades in California, working with, among others, now-Vice President Kamala Harris on various health issues.

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

Julie Rovner: NPR’s “A Study Finds That Dogs Can Smell Your Stress — And Make Decisions Accordingly,” by Rachel Treisman.  

Alice Miranda Ollstein: Stat’s “A Pricey Gilead HIV Drug Could Be Made for Dramatically Less Than the Company Charges,” by Ed Silverman, and Politico’s “Federal HIV Program Set To Wind Down,” by Alice Miranda Ollstein and David Lim. 

Stephanie Armour: Vox’s “Free Medical School Won’t Solve the Doctor Shortage,” by Dylan Scott.  

Rachel Cohrs Zhang: Stat’s “How UnitedHealth Harnesses Its Physician Empire To Squeeze Profits out of Patients,” by Bob Herman, Tara Bannow, Casey Ross, and Lizzy Lawrence. 

Also mentioned on this week’s podcast:

• States Newsroom’s “Anti-Abortion Researchers Back Riskier Procedures When Pregnancy Termination Is Needed, Experts Say,” by Sofia Resnick.
• KFF Health News’ “Louisiana Reclassifies Drugs Used in Abortions as Controlled Dangerous Substances,” by Rosemary Westwood, WWNO.
• The New York Times’ “Biden and Georgia Are Waging a Fight Over Medicaid and the Future of Obamacare,” by Noah Weiland.

click to open the transcript

Transcript: Harris in the Spotlight

KFF Health News’ ‘What the Health?’Episode Title: ‘Harris in the Spotlight’Episode Number: 357Published: July 25, 2024

[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 25, at 10 a.m. As always, news happens fast and things might have changed by the time you hear this, so here we go. We are joined today via video conference by Alice Miranda Ollstein of Politico.

Alice Miranda Ollstein: Hello.

Rovner: Rachel Cohrs Zhang of Stat News.

Rachel Cohrs Zhang: Hi, everybody.

Rovner: And we welcome back to the podcast one of our original panelists, Stephanie Armour, who I am pleased to say has now officially joined us here at KFF Health News. Stephanie, so great to have you back.

Stephanie Armour: Great to be back.

Rovner: Later in this episode, we will have my interview with Anthony Wright, the new executive director of the consumer health advocacy group Families USA. Anthony previously spent two decades working on health issues in California so he’s pretty familiar with the health work of the current vice president and soon-to-be Democratic presidential nominee, Kamala Harris, and he’ll share some of that knowledge with us. But first, this week’s news.

So it’s safe to say a lot has changed since the last time we met. In fact, it may be fair to say that just about everything has changed. President Joe Biden announced he would not seek reelection after all, he endorsed his vice president, Kamala Harris, and she proceeded to all but lock up the nomination in less than 48 hours. Obviously, this will be a huge deal for the fight over abortion and reproductive health care, which we will get to in a moment. But how is this going to impact health care, in general, as a campaign issue?

Ollstein: Yeah, it’s interesting because Kamala Harris has been a public figure for a while and has held a bunch of different offices, and so we can glean some clues as to where she is on various health care issues. But she’s been a bit hard to pin down. And when my colleagues and I were talking to a lot of folks throughout the health care industry over the past week, there were a lot of question marks on their end, so we know a few things. We know that she used the powers of the AG [attorney general] office to go after monopolies and consolidation and anticompetitive practices in California.

She did that in the insurance space, in the provider space, in the drug space, and so people are expecting that she would be maybe more aggressive on that front. We know that she did co-sponsor [Sen. Bernie Sanders’] “Medicare for All” bill, but then she also introduced her own, arguably more moderate, one that preserved private health insurance. And then, of course, abortion rights. She’s been very vocal on that front, but since becoming the presumptive nominee, she hasn’t really laid out what, if anything, she would do differently than Joe Biden. So like I said, a lot of question marks.

Rovner: Stephanie, you led our coverage of Harris’ health record. What did you learn?

Armour: Well, I think a number of the people that I’ve talked with really expect that she’ll be a standard-bearer to what Biden has already done, and I think that’s probably true. I don’t think she’s going to go back stumping for Medicare for All right now, for example. What I did find really interesting is, yes, she’s very much made abortion and reproductive rights a cornerstone of her vice presidency and, I assume, will be of her campaign. But based on where abortion is polling right now, a number of the strategists I spoke to said she really needs to do something pretty major on it in order to get a real uptick in terms of galvanizing voters, just because economy and immigration are so high. They’re saying that she really needs to do something like say that she’ll bring back legislation to restore Roe v. Wade, for example, to really make a difference. So I think it’ll be interesting to see how much that can really motivate voters when there’s so much competing for interest right now.

Cohrs Zhang: Oh, there is one other issue that I wanted to bring up. And I think especially from her time in the Senate, she didn’t sit on health care committees, but she did go out of her way to take ownership over concerns about maternal mortality. She was lead Senate sponsor of the Momnibus Act, which included a whole slew of different policies and programs that could help support mothers, especially Black mothers. And I think she has continued that interest in the White House and really championed health equity, which does, again, just draw a very stark contrast. So we haven’t seen a lot of passion or interest in the traditional health policy sense from her outside of abortion, but that is one issue she really has owned.

Rovner: Yeah, I mean, it has not been part of her quote-unquote “portfolio” as vice president, anything except, as I mentioned, reproductive rights, which will obviously be the biggest change from Biden to Harris. The president, as we all know, does not even like to say the word “abortion.” She, on the other hand, has been all over the issue since well before Roe got overturned and obviously particularly since then. Alice, how are advocates on both sides of this issue reacting to this switch at the top of the ticket?

Ollstein: Yeah, honestly, it’s been this interesting convergence because the pro-abortion-rights side is really jazzed. They’ve basically all rushed to endorse her and talk about how they’ve been working with her for years and really know her and trust her, and they believe she’ll be more aggressive than Biden was. But you also have the anti-abortion side being excited to have her as the villain, basically. They’ve had a hard time portraying Biden as extreme on this issue and they think they’ll have an easier time portraying Kamala Harris as extreme on abortion rights. One other thing from her record and background is her fight with the conservatives who recorded sting videos at Planned Parenthood that the anti-abortion movement still brings that up a lot. So yeah, it’ll be really interesting to see for which side this really lights a fire more because we’re hearing claims from both that it will fuel them.

Rovner: And, actually, I think it will actually fuel both sides of this. I would think that the abortion-rights groups were very — I mean everybody was pretty quick to endorse her — but the abortion-rights groups were right there right away, as were the anti-abortion groups saying she is extreme on abortion, which in some ways will fuel the abortion-right side. It’s like, “Oh good. The more the antis don’t like her, the stronger that means she is for us.” I mean, I literally could see this fueling both sides of this issue and …

Armour: Whereas you see Republicans backing away increasingly from abortion like the RNC [Republican National Committee] platform. And so it’s turning out to be still very much a hot-button issue and difficult issue for Republicans.

Rovner: So they say that the vice presidency is not very good for much, and I definitely agree with that. I mean, everybody always says, “The vice president hasn’t done anything.” Because the vice president doesn’t really have a job to do anything. Often the only time the vice president is on TV is when he or she sits behind the president at the State of the Union. But I feel like, in Harris’ case, it’s made her a much more confident and natural and comfortable campaigner. I watched her a lot when she was running for president in 2019 and 2020, and she was, to be kind, a little bit awkward; I mean she was just not one of those natural, had-that-rapport with a crowd, and I feel like that has changed a lot having watched her crisscross the country, particularly on reproductive health. Am I the only one that feels that way? I feel like people are going to see a very different vice president than they think they saw, while she was doing her due diligence as vice president.

Ollstein: Definitely, and I’ve found it interesting that it’s only been a few days since all of this went down, but I have noticed that while she has brought up abortion rights in pretty much every speech and appearance she’s given, she has not given specifics. She has not indicated if she is in the Biden camp of let’s restore Roe v. Wade, or with a lot of the rest of the movement that says Roe was never good enough, we need to aim for something much more expansive. So we didn’t know where she is on that. I mean, largely she’s been just saying, “Oh, I will stop Donald Trump from banning abortion nationally.” And using him as the foil and pledging to stop him. And so we haven’t really seen her make an affirmative case of what she would do on this front.

Rovner: Well, I think that would probably be as difficult for her as it is for the Republicans to try and figure out how far they want to go banning. Because yeah, as you mentioned, I mean, there’s a lot of the abortion-rights movement that think that restoring Roe, even if they could, is not enough because obviously under Roe, many, many types of restrictions were allowed and were in place. That is obviously not where the abortion-rights side wants to end up. And on the other side, as we’ve talked about ad nauseum, do anti-abortion forces, are they OK with state-by-state bans? Do they want a national ban? If so, what would it look like? So that will obviously continue.

Now that we have, relatively, mostly settled who’s going to be at the top of the ticket, we are once again, back to the “Who will be the VP pick?” sweepstakes. Now that we’ve finished the Republican side, we’re back to the Democratic side of the short list. We’ve all been hearing Kentucky Gov. Andy Beshear, North Carolina Gov. Roy Cooper, Arizona Sen. Mark Kelly, and Pennsylvania Gov. Josh Shapiro. They all have significant health records, but mostly on different issues. Who do you think of the people who are being mentioned would make the biggest splash on the health care scene?

Ollstein: I’ve been hearing a lot of people talk about Gov. Beshear’s record on Medicaid expansion and pushing back against work requirements, and also opposing legislation to restrict trans care. And so there’s definitely a lot there. Really, a lot of them have something there, but I’ve been hearing the most about him.

Rovner: And Mark Kelly, of course, is married to Gabrielle Giffords, who was shot at a campaign event and is now a leading voice in the gun control movement. So they all seem to have slightly different major health issues. Roy Cooper in North Carolina got North Carolina to expand Medicaid, which was a very, very, very big deal with a very, very, very Republican legislature. I’m not going to ask anybody to guess who it’s going to be because I can’t imagine that any of us have any major insight into this. Whoever it turns out to be, and I imagine we’ll know in the next week or two, we will go in and examine their health care record. One of the advantages that Vice President Harris will have on the campaign trail is she gets to campaign on the Biden administration’s record, which is fairly accomplished on the health care front without the drag of being in her 80s. Somebody remind us of all the health policies the Biden administration has gotten done. Start with the Inflation Reduction Act.

Cohrs Zhang: The name of the legislation is very general, but I think President Biden, in his goodbye speech last night, did mention the drug pricing portion of that bill. He’s described it as beating Big Pharma. And I think that’s definitely something that he talked about in his State of the Union, that he wanted to expand some of those pricing mechanisms to more people, not just people in Medicare, but people in commercial health plans, too. So I think that’s been something that he has really felt passionate about and Vice President Harris now could certainly use on the campaign trail. It’s a really popular issue and, again, not a huge policy departure, but, certainly, there’s more work to be done there on Democrats’ side.

Armour: And also I think the ACA [Affordable Care Act] extensions in terms of how many more people have been eligible for coverage is something that will definitely be part of Biden’s legacy as well. And the record-low uninsurance that we saw is something I bet that will be remembered, too.

Rovner: Yeah, I mean I’ve been personally surprised at some of the things that he’s gotten done in a Congress with virtually minuscule majority. I mean, one vote in the Senate and, when the Democrats were controlling the House, it was, what, four votes in the House. That takes, I think, a certain kind of legislator to get things passed. I know people walk around and say, “Oh, the Biden administration hasn’t done anything.” And you want to pull your hair out because that’s all we’ve spent the last six years talking about, things that have actually gotten done and not gotten done.

Cohrs Zhang: Right. Well, I mean doing things and communicating well about doing things are different issues, and I think that’s going to be Vice President Harris’ challenge over the next few months.

Rovner: Yeah, and so we’ve seen, and I think the Biden administration has prevented a lot of things from happening, which is always very hard to campaign on. It’s like, “Well, if we hadn’t done this, then this might’ve happened.” I mean, I think that’s true about the pandemic. Things could have gone much, much worse and didn’t and that’s tricky to say, “Hey, we prevented things from getting even more terrible than they were.”

Ollstein: And on the drug pricing front, I mean it just always reminds me of the Affordable Care Act where the payoff is years down the road, and so selling it to voters in the moment when they’re not feeling the effects yet is really hard. So it makes sense that people aren’t aware that they got this major legal change that’s been decades in the making over the finish line because the drugs aren’t cheaper yet for a lot of people.

Rovner: That’s true. And the caps on spending haven’t really kicked in yet. It is a lot like the Affordable Care Act, which took four years from the time of passage to the time it was fully implemented.

Well, in other news, and there is some other news, Congress is back after a break for the Republican [National] Convention, although they’re about to leave again. At the top of the House’s list was passing the spending bills that they didn’t manage to pass last year. So how’s that all going, Rachel?

Cohrs Zhang: I think they’ve just thrown in the towel this week, given up a bit. I think there’s been an attitude of just apathy on the Hill and especially on health care issues that the sense has been, “We’ll return to this in December when we all have a little bit more information about the dynamics going to the lame-duck session.” And I think that clearly has bled over into any will that remains to pass appropriations bills before August recess. I think they’re ready to get out there, ready to be on the campaign trail and put this on the back burner.

Rovner: Yeah, and in an election year, you basically have the six months leading up to the first convention and then almost nothing until they come back after the election. They were going gangbusters on some of these spending bills. They were getting them out of committee even though they were obviously not in the kind of shape that they were going to become law. We talked at some length about all of the riders and all of the funding cuts that the Republicans have put in some of these bills, but they couldn’t even get them through the floor. I mean, Alice we’re hung up on abortion, again!

Ollstein: Oh, as always. And it’s the exact same policy fights as last time. The fight’s going to happen in the ag[riculture] bill, around FDA [Food and Drug Administration] regulation of abortion pills. There’s going to be fights about the provisions helping veterans and active-duty service members access abortion, knowing that these appropriations bills are the only real legislation that has any chance of going anywhere. People are putting all of their policy priorities in as riders. And last round of this, there were anti-abortion provisions tacked onto basically every single spending bill, and almost all of them got stripped out in the end and did not become law. Obviously, they kept long-standing things like the Hyde Amendment, but they didn’t add the new restrictions Republicans wanted to add. That is likely to happen again. We’ll see. This could drag past the election potentially. So the dynamics, depending on the outcome of the election, could be really different than they are today.

Rovner: Yeah, I mean, I guess the House is going out and they won’t be back until September. It used to be there would be an August recess in an election year, and they would come back in September, and they would actually work until the beginning or even the middle of October. And even that seems to have gone away. Now, once they’re gone for the quote-unquote “August recess,” it’s like, bye-bye getting much of anything done.

Well, there’s also some more news on the abortion front: The on-again off-again, on-again, off-again, six-week abortion ban in Iowa appears to be on again, possibly to start as soon as next week. Alice, I think we’ve mentioned this before, but this is going to affect a lot more than just people in Iowa.

Ollstein: Yeah, definitely. I mean, we’re seeing a big erosion of access across the Midwest Great Plains, like that whole area, that whole swath, the Dakotas, et cetera. And there’s already a lot of pressure on Illinois as the destination and clinics there are already overwhelmed with folks coming in from all over. And so this will add to that. As we’ve seen when this has happened in other states, wait times can go up, shortages of providers needed to care for everyone. Telemedicine does relieve some of that, and there are these groups that mail abortion pills into any state regardless of restrictions. But not everyone is comfortable doing that or knows how to do that or wants to do that or can afford to do that. And so this is said to have a big impact, and we’ll have to see what happens.

Rovner: There were two other pieces about abortion that caught my eye this week, and they’re both about things that we’ve talked about before. One is the push by anti-abortion doctors to change medical practice. In Louisiana, the abortion drugs mifepristone and misoprostol, both of which are used for many more things than just abortion, are now on the state’s list of controlled substances. And then from States Newsroom, there’s a piece about how anti-abortion OB-GYNs are trying to get medically necessary abortions that happen later in pregnancy, switched instead to C-sections or having the pregnant person go through and induce labor and delivery. I’ve been covering this issue, as I like to say, for nearly 40 years. This is the most intense effort I’ve ever seen from inside the medical profession to actually change how medicine is practiced in terms of what’s considered the standard of care, both for things like — not even so much mifepristone the abortion pill, but misoprostol, which is used for a lot of things other than abortion.

Armour: Was it initially an ulcer medication?

Rovner: Yes, yes, misoprostol.

Armour: That’s what I thought. Yeah.

Rovner: Cytotec. It was for a long time one of the go-to ulcer medicine. And in fact, the only reason it stopped becoming the go-to ulcer medicine because, if you were pregnant and wanted to be, it could help end your pregnancy. It is known to have that as a side effect, but yes, it’s an ulcer medication.

Armour: Yeah, this is the first I had seen anywhere, and I could be wrong, but of a real push to try and change the management of late-term medical miscarriages to how it would actually be carried out, which was just very interesting and to see what they were recommending instead.

Rovner: ACOG, the American College of Obstetricians and Gynecologists, has put out guidelines — forever, that’s what they do — about how to handle pregnancy problems later in pregnancy. Generally using the least invasive procedure is considered the safest and, therefore, best for the patient. And that’s not necessarily having a C-section, which is major surgery, or going through labor and delivery. People forget that it’s really dangerous to be pregnant. I mean, it’s amazing that we have all of these kids and happy parents because if you go back and look in history, a lot of women used to die in childbirth. They still do. It’s obviously not as bad as it used to be, but it is not everything-goes-fine-99%-of-the-time thing that I think a lot of people think it is.

Armour: That’s right. Yeah.

Rovner: All right, well, meanwhile, before we bid Congress goodbye for the rest of the summer, the House Oversight Committee, which is usually as partisan a place as there is in this Congress, held a hearing this week on PBMs [pharmacy benefit managers] and there seems to be pretty bipartisan support that something needs to be done. Rachel, I keep asking this question: It seems that just about everybody on Capitol Hill wants to do something to rein in PBM drug price abuse, and yet no one ever does. So are we getting closer yet?

Cohrs Zhang: We are getting closer, I think, as we approach December. My understanding was that lawmakers were pretty close on a deal on PBMs back in March. But I think it was just a symptom of “Appropriations Bill Has to Move.” They want it to be clean. If they add one committee’s extra stuff, they have to let other committees add extra stuff, too, and it gets too complicated on deadline. But it’s wild to me that we’re still seeing new PBM reform bills at this point. But there’s just a huge, huge pile of bills at this point, everyone wants their name on it. And so I really do believe that we’re going to see something in December. I think the big question is how far some of these reforms will reach: whether they’ll be limited to the Medicare program or whether some of these will start to touch private insurance as well. I think that’s what the larger industry is waiting to see. But I think there’s a lot of appetite. I mean with congresswoman Cathy McMorris Rodgers retiring, she’s led a package on this issue …

Rovner: She’s chairman of the House Energy and Commerce Committee, which obviously has the main jurisdiction over this in the House.

Cohrs Zhang: Right. So if we’re thinking about legacy, getting some of these things across the finish line, it does depend how dynamics change in the lame duck. But I think there is a very good chance that we’re going to see some sort of action here.

Rovner: Congressman Jamie Raskin, at that hearing, had maybe my favorite line ever about PBMs, which is, he said, “The more I hear about this, the less I understand it.” It’s like you could put that on a T-shirt.

Ollstein: That’s great. Yeah.

Cohrs Zhang: Yes.

Rovner: The PBM debate in one sentence. All right. Finally, this week we have some Medicaid news, a new report from the GAO [Government Accountability Office] finds pretty much what we already knew: that states have been wrongly kicking eligible people off of their Medicaid coverage as they were, quote, “unwinding from the public health emergency.” According to the report, more than 400,000 people lost coverage because the state looked at the household’s eligibility instead of individual eligibility. Even though Medicaid income thresholds are much higher for many people, like children and pregnant women. So if the household wasn’t eligible, possibly, even probably, the children still were. It’s a pretty scathing report. Is anybody going to do anything about it? I mean, the GAO’s recommendation was that the administration act a little more strongly and the administration says, “We already are.”

Cohrs Zhang: Yeah, I actually had the chance to talk with a White House official about this dynamic, and just, I think there’s only so far that they’re willing to go, and I think might talk about, in a while. I think there’s been clashes between the Biden administration and conservative states, especially on Medicaid programs, and there’s really only so much influence they can exert. And I think without provoking an all-out war, I’m personally expecting them to get much more aggressive in the last six months of their administration, if they weren’t going to do it before, when they really could have potentially made a difference and really made it a calling card in some of these states. So I’m not expecting much change from the White House on this issue.

Rovner: Yeah, I remember the administration was so sensitive about this that when we were first learning about how states were cutting people off who they shouldn’t have been, the administration said, “We’re working with the states.” And we all said, “Which states?” And they said, “We’re not going to tell you.” I mean, that’s literally how sensitive it was. They would not give us the list of the states who they said were incorrectly knocking people off the roll. So yeah, clearly this has been politically sensitive for the administration, but I’m …

Armour: And the Medicaid directors, too. They really pushed back, especially initially, about not wanting it to be too adversarial. I think the administration really took that to heart. Whether that was the right call or not remains to be seen, but there was a lot of tension around that from the get-go.

Rovner: Yeah. Well, also this week, The New York Times has a deep dive into the one remaining Medicaid work requirement in the country, Georgia’s Pathways to Coverage. In case you don’t remember, this was the program that Georgia said would enroll up to 100,000 people, except, so far it’s only managed to sign up about 4,500. It feels relevant again though, because the Heritage Foundation’s Project 2025, which is now all over the campaign trail, would go even further than previous Republican efforts to rein in Medicaid by possibly imposing lifetime caps on coverage. Cutting Medicaid didn’t go very well in 2017 when the Republicans tried to repeal and replace the Affordable Care Act. What makes them think an even bigger cutback would be more popular now?

Armour: Well, the study’s authors say to me that if they’re not cutting Medicaid, which goes back to the original debate back when they were talking about …

Rovner: The Project 2025 authors.

Armour: Yes, authors. Right. And that goes back to the original debate of how do you define it? A little bit of sleight of hand. And the other thing is that would definitely bring back the Medicaid work requirements and some premiums for some, which also turned out not to be super-popular as well. So it does dive right into an issue. But it’s also an issue that conservatives have been, boy, working on for years and years now to try and get this accomplished.

Rovner: Oh yeah, block-granting Medicaid goes back decades.

Armour: Exactly. Yeah.

Rovner: And there’ve been various ways to do it. And then work requirements, obviously Alice, you were the queen of our work requirement coverage in Arkansas because they put in a work requirement and it didn’t go well. Remind us.

Ollstein: Yeah. So this is what a lot of experts and advocates predicted, which is that we know from years of data that pretty much everybody on Medicaid who can work is already working and those who aren’t working are not working because they are a student or they have to care for a relative or they have a disability or there are all these reasons. And so when these work requirements actually went into effect, just a lot of people who should have been eligible fell through the cracks. It was hard to navigate the bureaucracy of it all. And so even people who were working struggled to prove it and to get their benefits. And so people really point to that as a cautionary tale for other states. But this is something conservatives really believe in ideologically, and so I don’t expect it to be going away anytime soon.

Rovner: To swing back to where we started. I imagine we will see more talk about health care on the presidential campaign trail as we go forward.

All right, well that’s as much news for this week as we can fit in. Now we will play my interview with Families USA’s Anthony Wright, and then we’ll come back and do our extra credits.

I am so pleased to welcome to the podcast Anthony Wright, the brand-new executive director of Families USA, one of the nation’s leading consumer health advocacy groups. And a big part of why we even have the ACA. Anthony is no stranger to health care battles. He spent more than 20 years heading up the group Health Access California, where he worked on a variety of health issues, large and small, and encountered someone who is suddenly very much in the news: Vice President Kamala Harris. Anthony Wright, welcome to “What the Health?”

Anthony Wright: Thank you so much for having me. I’m a longtime listener, but first-time caller.

Rovner: Awesome. So, for those who are not familiar with Families USA, tell us about the group and tell us what your immediate priorities are.

Wright: So, Families USA has been a longtime voice for health care consumers in Congress, at the administration, working nationally for the goal of quality, affordable, equitable health care for all Americans. I’m pleased to take on that legacy and to try to uplift those goals. I’m also particularly interested in continuing to uplift and amplify the voices of patients in the public in health policy debates. It’s opaque to try to figure out how normal people engage in the federal health policy discussions so that health reforms actually matter to them. I would like families to do more to provide pathways so that they have an effective voice in those policy discussion tables. There’s so many policy debates where it’s the fight between various parts of the industry, when, in fact, the point of the health care system is patients, is the public, and they should be at the center of these discussions.

Rovner: Yes, and I’m embarrassed to admit that we spend an enormous amount of time talking about the players in the health care debate that are not patients. They are basically the people who stand to make money from it. What’s your biggest priority for this year and next?

Wright: Yeah, I want to take some of the lessons that I’ve learned over the 22 years of working in California, where we had the biggest drop of the uninsured rate of all 50 states, mostly working to implement and improve the Affordable Care Act. And I recognize that some of those lessons will have to be adopted and changed for the different context of [Washington,] D.C., or the 49 other states. But there is work that we can do, and we should do, moving forward. There are things on the plate right now. For example, in the next year, the additional affordability assistance that people have in the exchanges is set to expire. And so we can either have a system where everybody has a guarantee that their premiums are capped at 8.5% of their income or less on a sliding scale, or we can let those enhanced tax credits expire and to have premiums go up by hundreds, or for many people, thousands of dollars literally in the next year or so.

So that’s a very important thing that will be on the ballot this fall, along with a number of other issues and we want to highlight that. But frankly, I’m also interested in the work around expanding coverage, including in those 10 states that haven’t expanded Medicaid yet. In California, we’ve done a lot of work on health equity dealing with racial and ethnic disparities and just meeting the specific needs of specific communities. That was an imperative in California with the diversity and the size and scale of that state. But there’s more we can do both in California, but nationally, with regard to that. And then I think there’s more to work on costs with regard to just how darn expensive health care is and how do we fix the market failures that lead to, not just high, but irrational and inflated health prices.

Rovner: So obviously a big part of what you will or won’t be able to do next year depends on who occupies the White House and who controls Congress. You’re from California and so is Vice President Harris. Tell us about her record on health care.

Wright: Yeah, she actually has a significant record, mostly from her time as attorney general of California. She didn’t have much of a portfolio as district attorney, but when she did become the attorney general — attorney generals have choices about where they focus their time and she made a point to focus more on health care and start an evolution of the attorney general being more involved in health care issues — on issues like reviewing mergers of hospitals and putting conditions to make sure that emergency rooms stayed open, that hospitals continued their commitments to charity care. She worked on broader issues of consolidation, for example, joining the [U.S.] Justice Department in opposing the merger of Anthem and Cigna.

And she took on, whether it’s the insurers or the drug companies or the hospital chains, on issues of pricing and anticompetitive practices, whether it was Bayer and Cipro and other drug companies with regard to pay-for-delay practices, basically schemes to keep the price of drugs inflated. Or on the issue of high hospital prices. She began the investigations that led to a landmark Sutter settlement where that hospital chain paid $575 million in fines, but also agreed to a series of conditions with regard to no longer engaging in anticompetitive contracting practices. And that kind of work is something that we worked on with her, and I think is really relevant to the moment we’re in now where we really do see that consolidation is one of the major drivers of why health care prices are so high. And that kind of experience that she could talk about as she talks about health care costs broadly, medical debt, and some of the issues that are on the campaign trail today.

Rovner: So, obviously, with the exception of reproductive health, health in general has not been a big part of the campaign this year. Do you think it’s going to get bigger now that Harris is at the head of the ticket?

Wright: One of the things that I’m happy with is that, after several weeks where the conversation has much been about the campaign processes, we can maybe focus back on policy and the very real issues that are at stake. Our health care is on the ballot, whether it is reproductive health and abortion care, but also there’s a very easy leap to also talk about the threats, not just to reproductive health, but also to the Affordable Care Act, to Medicaid, to Medicare. There’s very different visions and records of the last two administrations with regard to the Affordable Care Act, whether to repeal it or build upon it, on Medicaid and whether to bolster it or to block-grant it. And even on the question of something like prescription drug negotiation, whether we took some important steps under the Inflation Reduction Act. Do we now expand that authority to cover more drugs for more discounts for more people? Or do we give up that authority to negotiate for the best possible price?

Those are very key issues that are at stake in this election. We are a nonpartisan, non-endorsing organization, but we do want to make sure that health care issues are on people’s minds, and also, frankly, policymakers to make some commitments, including on something like what I was talking about earlier with those enhanced tax credits. Again, at a time when people are screaming about affordability, but we know that they’ve been actually screaming about health care affordability for not just years but decades. And that’s a very specific, concrete thing that literally means hundreds or thousands of dollars in people’s pockets.

Rovner: So then-presidential candidate Kamala Harris was a supporter of Medicare for All in 2020 when she ran. Do you expect that that may have changed, as she’s learned how hard it is even to make incremental change? I haven’t seen anybody ask her yet what her feeling is on systemic health reform.

Wright: I mean, she had a modified proposal that I think was trying to both take seriously the question of how do we get to universal coverage while also recognizing the politics and procedural barriers that exist. And so I think there’s a practical streak of how do we get the most help to the most people and help change, frankly, the financial incentives in our system, which are right now just to get bigger, not to get better. And so I think that there’s some very practical questions on the table right now, like these tax credits, this cap on how much a percentage of your income should go for premium. That’s something that’s front of mind because it literally expires next year. So it’s something that maybe gets dealt with in a lame duck, but hopefully early in the next year, since rates need to be decided early. And so those are the immediate things.

But I do think she’s also, in her record — I’m not going to talk about what may be — but in her record, she’s been supportive of the Affordable Care Act. I mean our biggest actual engagement with then-U.S. Sen. Harris was at a time when we all thought that the Affordable Care Act was a goner. It would be repealed and replaced. She was willing to be loud and proud at our rallies, in front of a thousand people, in front of a Los Angeles public hospital, talking about the need to defend the Affordable Care Act and protections for people with preexisting conditions. And she came again in July and just at a time where we needed that forceful defense of the Affordable Care Act. She was there and we very much appreciated that. I think she would continue to do that as well as want to work to build upon that financing and framework to make additional gains forward.

Rovner: This being Washington, everybody’s favorite parlor game this week is handicapping the vice presidential sweepstakes. And who about-to-be-candidate Harris is going to choose to be her running mate. Are any of the big names in contention more or less important in terms of their health care backgrounds?

Wright: I have my credentials to talk about the Californian on the ticket. I probably have less there. I do know that some of those governors and others have their own records of trying to take the framework of the ACA and adapt it to their state. And I think that would be a useful thing to continue to move forward on the trail. I’m not in a position, again, as a non-endorsing organization, we’re focused on the issues.

Rovner: You’re agnostic about the vice presidential candidate.

Wright: You’re right, I think the point is how can we make sure that people recognize what is at stake for the health care that they depend on and, frankly, the financial piece of it. Affordability has been something that has been talked about a lot and there is no greater source of economic anxiety and insecurity than the health care bill. A hospital bill is the biggest bill that anybody will get in their entire life. So how do you deal with it? And whether it’s a conversation about medical debt and how you deal with it, or what kind of tax credits we can provide to provide some security that you don’t pay more than the percentage of your income. Or how do you deal with the root causes of the market failures in our health care system, whether it’s consolidations and mergers or anticompetitive practices. Those are the things that I think we should have a bigger conversation in this campaign cycle about.

Rovner: Hopefully we’ll be able to do this again as it happens. Anthony Wright, thank you so much.

Wright: Thank you.

Rovner: OK, we are back. It’s time for our extra-credit segment. That’s when we each recommend a story we read this week we think you should read, too. As always, don’t worry if you miss it. We will post the links on the podcast page at kffhealthnews.org and in our show notes on your phone or other mobile device. Rachel, why don’t you go first this week?

Cohrs Zhang: Sure. There’s a lot of good health journalism out there, but I have to highlight a new project from my colleagues. Bob Herman, Tara Bannow, Casey Ross, and Lizzy Lawrence are looking into UnitedHealth’s business practices, and there’s been a lot of buzz about UnitedHealthcare on the Hill, and the first part of their investigation is headlined “How UnitedHealth Harnesses Its Physician Empire To Squeeze Profits out of Patients.” It focuses on the trend that UnitedHealth has been acquiring so many physician practices and looks at the incentives of what actually happens when an insurer owns a physician practice.

What pressures are they putting on? What’s the patient experience? What’s the physician experience? Their physicians on the record were telling them about their experiences: having to turn through patients; feeling pressure to make patients look sicker on paper so UnitedHealth could get more money from the federal government to pay for them. And just, I mean, the documentation here is just really superb reporting. It’s part one of a series. And I think reporting like this really helps inform Washington about how these things are actually playing out and what’s next in terms of whether action should be taken to rein these practices in.

Rovner: I feel like the behemoth that is UnitedHealthcare is going to keep a lot of health reporters busy for a very long time to come. Alice.

Ollstein: Yeah. So there’s been a lot of news on the PrEP front recently. That’s the drug that prevents transmission of HIV. And so basically two steps forward, one step back. I chose this piece from Stat News [“A Pricey Gilead HIV Drug Could Be Made for Dramatically Less Than the Company Charges”], about a new form of PrEP that is an injection that you get just twice a year that has proven wildly effective in clinical trials. And so folks are really excited about that, and I think it could really make a difference because, as with birth control and as with lots of other medication, the effectiveness rate is only if you use it perfectly, which, you know, we’re humans. And humans don’t always adhere perfectly. And so something like just a couple injections a year that you could get from your doctor would go a long way towards compliance and making sure people are safe with their medications.

But my colleague and I also scooped this week that HHS [the Department of Health and Human Services] is ending one of its big PrEP distribution programs [“Federal HIV Program Set To Wind Down”]. It’s called Ready, Set, PrEP. It debuted under the Trump administration in 2019. And the reason given by HHS for it ending — which, by the way, they were very quiet about and didn’t even tell a lot of providers that it was ending — they said it was because there are all these other ways people can get PrEP now, that didn’t exist back then, like generic versions. And while that’s true, we also heard from a lot of advocates who said the program was just really flawed from the start and didn’t reach even a fraction of the people it should have reached. And so we’ll continue to dig on that front.

Rovner: Good stories. Stephanie.

Armour: Yes. I picked the story by Dylan Scott on Vox about “Free Medical School Won’t Solve the Doctor Shortage.” And it looks at Michael Bloomberg, who is donating a billion dollars to Johns Hopkins to try to pay for medical school for students there. The idea being that, “Look, there’s this doctor shortage and what can we do to help?” And what’s really interesting about the story is it goes beyond just the donation to look at the fact that it’s not really that there’s a doctor shortage, it’s that we don’t have the right kind of doctors and it’s the distribution. Where you don’t have nearly what we need when it comes to psychiatrists, for example. And there’s a real dearth of physicians in areas that are rural or in the Midwest. So I think what it raises is what resources do we want to spend and where? What other steps can we do that would really help drive doctors to where they’re most needed? So it’s a good story. It’s worth a read.

Rovner: Yeah, it is a good story. It is a continuing problem that I continue to harp on. But we now have quote-unquote “free medical school,” mostly in really urban, really expensive places.

Armour: Yes.

Rovner: New York, Los Angeles, Baltimore. That’s nice for the doctors who will now graduate without $200,000 in medical debt. But yeah, as Dylan points out, it’s not exactly solving the problem that we have. Well, I went cute this week. My extra credit this week is from NPR. It’s called “A Study Finds That Dogs Can Smell Your Stress — And Make Decisions Accordingly,” by Rachel Treisman. Now, we’ve known for a fairly long time that dogs’ sensitive noses can detect physical changes in their humans. That’s how alert dogs for epilepsy and diabetes and other ailments actually work.

But what we didn’t know until now is that if a dog smells a person’s stress, it can change the dog’s emotional reaction. It was a complicated experiment that you can read about if you want, but as somebody who competes with my dogs, and who knows how differently they act when I am nervous, this study explains a lot.

All right, that is our show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review; that helps other people find us too. Special thanks, as always, to our technical guru, Francis Ying, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me at X, @jrovner. Alice, where are you?

Ollstein: @AliceOllstein on X.

Rovner: Rachel.

Cohrs Zhang: @rachelcohrs on X.

Rovner: Stephanie.

Armour: @StephArmour1.

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

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The head of Health Access California, one of the state’s most influential consumer groups, changed course only after he and his allies extracted a deal to increase subsidies for people in need.

The plan was ultimately blocked by Democrats who wanted the state to adopt a single-payer health care system instead. Yet the moment encapsulates classic Anthony Wright: independent-minded and willing to compromise if it could help Californians live healthier lives without going broke.

This summer, Wright will assume the helm of the health consumer group Families USA, taking his campaign for more affordable and accessible health care to the national level and a deeply divided Congress. In his 23 years in Sacramento, Wright has successfully lobbied to outlaw surprise medical billing, require companies to report drug price increases, and cap hospital bills for uninsured patients — policies that have spread nationwide.

“He pushed the envelope and gave people aspirational leadership,” said Jennifer Kent, who served as Schwarzenegger’s head of the Department of Health Care Services, which administers the state Medicaid program. The two were often on opposing sides on health policy issues. “There was always, like, one more thing, one more goal, one more thing to achieve.”

Recently, Wright co-led a coalition of labor and immigrant rights activists to provide comprehensive Medicaid benefits to all eligible California residents regardless of immigration status. The state funds this coverage because the federal government doesn’t allow it.

His wins have come mostly under Democratic governors and legislatures and when Republican support hasn’t been needed. That will not be the case in Washington, D.C., where Republicans currently control the House and the Senate Democratic Caucus has a razor-thin majority, which has made it extremely difficult to pass substantive legislation. November’s elections are not expected to ease the partisan impasse.

Though both Health Access and Families USA are technically nonpartisan, they tend to align with Democrats and lobby for Democratic policies, including abortion rights. But “Anthony doesn’t just talk to his own people,” said David Panush, a veteran Sacramento health policy consultant. “He has an ability to connect with people who don’t agree with you on everything.”

Wright, who interned for Vice President Al Gore and worked as a consumer advocate at the Federal Communications Commission in his 20s, acknowledges his job will be tougher in the nation’s capital, and said he is “wide-eyed about the dysfunction” there. He said he also plans to work directly with state lawmakers, including encouraging those in the 10, mostly Republican states that have not yet expanded Medicaid under the Affordable Care Act to do so.

In an interview with California Healthline senior correspondent Samantha Young, Wright, 53, discussed his accomplishments in Sacramento and the challenges he will face leading a national consumer advocacy group. His remarks have been edited for length and clarity.

Q: Is there something California has done that you’d like to see other states or the federal government adopt?

Just saying “We did this in California” is not going to get me very far in 49 other states. But stuff that has already gone national, like the additional assistance to buy health care coverage with state subsidies, that became something that was a model for what the federal government did in the American Rescue Plan [Act] and the Inflation Reduction Act. Those additional tax credits have had a huge impact. About 5 million Americans have coverage because of them. Yet, those additional tax credits expire in 2025. If those tax credits expire, the average premium will spike $400 a month.

Q: You said you will find yourself playing defense if former President Donald Trump is elected in November. What do you mean?

Our health is on the ballot. I worry about the Affordable Care Act and the protections for preexisting conditions, the help for people to afford coverage, and all the other consumer patient protections. I think reproductive health is obviously front and center, but that’s not the only thing that could be taken away. It could also be something like Medicare’s authority to negotiate prices on prescription drugs.

Q: But Trump has said he doesn’t want to repeal the ACA this time, rather “make it better.”

We just need to look at the record of what was proposed during his first term, which would have left millions more people uninsured, which would have spiked premiums, which would have gotten rid of key patient protections.

Q: What’s on your agenda if President Joe Biden wins reelection?

It partially depends on the makeup of Congress and other elected officials. Do you extend this guarantee that nobody has to spend more than 8.5% of their income on coverage? Are there benefits that we can actually improve in Medicare and Medicaid with regard to vision and dental? What are the cost drivers in our health system?

There is a lot we can do at both the state and the federal level to get people both access to health care and also financial security, so that their health emergency doesn’t become a financial emergency as well.

Q: Will it be harder to get things done in a polarized Washington?

The dysfunction of D.C. is a real thing. I don’t have delusions that I have any special powers, but we will try to do our best to make progress. There are still very stark differences, whether it’s about the Affordable Care Act or, more broadly, about the social safety net. But there’s always opportunities for advancing an agenda.

There could be a lot of common ground on areas like health care costs and having greater oversight and accountability for quality in cost and quality in value, for fixing market failures in our health system.

Q: What would happen in California if the ACA were repealed?

When there was the big threat to the ACA, a lot of people thought, “Can’t California just do its own thing?” Without the tens of billions of dollars that the Affordable Care Act provides, it would have been very hard to sustain. If you get rid of those subsidies, and 5 million Californians lose their coverage, it becomes a smaller and sicker risk pool. Then premiums spike up for everybody, and, basically, the market becomes a death spiral that will cover nobody, healthy or sick.

Q: California expanded Medicaid to qualified immigrants living in the state without authorization. Do you think that could happen at the federal level?

Not at the moment. I would probably be more focused on the states that are not providing Medicaid to American citizens [who] just happen to be low-income. They are turning away precious dollars that are available for them.

Q: What do you take away from your time at Health Access that will help you in Washington?

It’s very rare that anything of consequence is done in a year. In many cases, we’ve had to run a bill or pursue a policy for multiple years or sessions. So, the power of persistence is that if you never give up, you’re never defeated, only delayed. Prescription drug price transparency took three years, surprise medical bills took three years, the hospital fair-pricing act took five years.

Having a coalition of consumer voices is important. Patients and the public are not just another stakeholder. Patients and the public are the point of the health care system.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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).

The Centers for Disease Control and Prevention has issued a fresh warning about an increased risk of dengue virus infections as a "record-breaking number" of cases are being reported in the Americas. 

From January 1 to June 24 of this year, more than 9.7 million dengue cases were recorded among countries in the Americas, which is more than double the 4.6 million infections recorded throughout 2023, according to the CDC. 

"Global incidence of dengue in 2024 has been the highest on record for this calendar year; many countries are reporting higher-than-usual dengue case numbers," it also said. "In 2024, countries in the Americas have reported a record-breaking number of dengue cases, exceeding the highest number ever recorded in a single year." 

The CDC describes the dengue virus as the "most common" mosquito-borne disease in the world. In the U.S., Florida has reported the most cases so far this year with 197, followed by New York with 134, Massachusetts with 50 and California with 40. 

TIGER MOSQUITOES BLAMED FOR SPREAD OF DENGUE FEVER 

"Six U.S. territories and freely associated states are classified as areas with frequent or continuous dengue transmission: Puerto Rico, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau," the CDC adds. 

The health agency says one in every four dengue infections are symptomatic, with effects including fever and "nausea, vomiting, rash, muscle aches, joint pain, bone pain, pain behind the eyes, headache, or low white blood cell counts." 

"Severe disease, with associated severe bleeding, shock or respiratory distress caused by plasma leakage, or end-organ impairment, develops in 1 in 20 people with symptomatic dengue," according to the CDC. 

PUERTO RICO HEALTH OFFICIALS DECLARE DENGUE FEVER A PUBLIC HEALTH EMERGENCY 

It said infants under the age of one, pregnant women and adults over the age of 65 carry an "increased risk of severe dengue" and that "transmission peaks during the warmer and wetter months in many tropical and subtropical regions." 

There is not currently a medication to treat dengue, the CDC says. 

Infected people are advised to rest, take acetaminophen for pain and fever, stay hydrated and see a doctor. 

Fox News’ Melissa Rudy contributed to this report. 

Charlotte, Carolina del Norte. — Cuatro meses después de buscar asilo en Estados Unidos, Fernando Hermida comenzó a toser y a sentirse cansado. Primero pensó que estaba resfriado. Luego aparecieron llagas en su ingle y empezó a empapar su cama de sudor. Se hizo una prueba.

El día de Año Nuevo de 2022, a los 31 años, supo que tenía VIH.

“Pensé que me iba a morir”, dijo, recordando el escalofrío que le recorrió el cuerpo cuando revisaba sus resultados. Luchó por navegar un nuevo y complicado sistema de atención médica. A través de una organización de VIH que encontró en internet, recibió una lista de proveedores médicos en Washington, DC, donde estaba en ese momento. Pero no le devolvieron las llamadas durante semanas.

Hermida, que solo habla español, no sabía a dónde ir.

Para cuando Hermida recibió su diagnóstico, el Departamento de Salud y Servicios Humanos de Estados Unidos (HHS) llevaba adelante desde hacía unos tres años una iniciativa federal para acabar con la epidemia de VIH en la nación, invirtiendo cada año cientos de millones de dólares en ciertos estados, condados y territorios con las tasas de infección más altas.  

El objetivo era llegar a las aproximadamente 1.2 millones de personas que viven con VIH, incluidas algunas que ni siquiera lo saben.

En general, las tasas estimadas de nuevas infecciones por VIH han disminuido un 23% desde 2012 hasta 2022. Pero un análisis de KFF Health News y Associated Press comprobó que la tasa no ha bajado para los latinos (que pueden ser de cualquier raza) tanto como para otros grupos raciales y étnicos.

Si bien en general los afroamericanos continúan teniendo las tasas más altas de VIH en el país, los latinos representaron la mayor parte de los nuevos diagnósticos e infecciones de VIH entre hombres gays y bisexuales en 2022, según los datos disponibles más recientes, en comparación con otros grupos raciales y étnicos.

Los latinos, que constituyen aproximadamente el 19% de la población de Estados Unidos, representaron alrededor del 33% de las nuevas infecciones por VIH, según los Centros para el Control y Prevención de Enfermedades (CDC). El análisis halló que los latinos están experimentando un número desproporcionado de nuevas infecciones y diagnósticos en todo el país, con las tasas de diagnóstico más altas en el sureste.

Oficiales de salud pública en el condado de Mecklenburg, en Carolina del Norte, y el condado de Shelby, en Tennessee, donde los datos muestran que las tasas de diagnóstico han aumentado entre los latinos, dijeron a KFF Health News y AP que no tienen planes específicos para abordar el problema del VIH en esta población, o que éstos aún no se han finalizado.

Incluso en lugares con buena cantidad de recursos como San Francisco, en California, las tasas de diagnóstico de VIH aumentaron entre los latinos en los últimos años mientras disminuían entre otros grupos raciales y étnicos, a pesar de los objetivos del condado de reducir las infecciones entre los latinos.

“Las disparidades de VIH no son inevitables”, dijo en un comunicado Robyn Neblett Fanfair, directora de la División de Prevención del VIH de los CDC. Señaló las inequidades sistémicas, culturales y económicas, como el racismo, las diferencias de idioma y la desconfianza en los médicos.

Y aunque los CDC proporcionan algunos fondos para grupos minoritarios, defensores de las políticas de salud para los latinos quieren que el HHS declare una emergencia de salud pública con la esperanza de dirigir más dinero a las comunidades latinas, argumentando que los esfuerzos actuales no son suficientes.

“Nuestra invisibilidad ya no es tolerable”, dijo Vincent Guilamo-Ramos, co-presidente del Consejo Asesor Presidencial sobre VIH/SIDA.

Perdido sin un intérprete

Hermida sospecha que contrajo el virus mientras estaba en una relación abierta con un compañero masculino antes de llegar a Estados Unidos. A fines de enero de 2022, meses después que comenzaran sus síntomas, fue a una clínica en la ciudad de Nueva York que un amigo lo ayudó a encontrar para finalmente recibir tratamiento para el VIH.

Demasiado enfermo para cuidarse solo, Hermida finalmente se mudó a Charlotte, Carolina del Norte, para estar más cerca de su familia y con la esperanza de recibir atención médica más constante. Se inscribió en una clínica de Amity Medical Group que recibe fondos del Programa Ryan White de VIH/SIDA, un plan de la red de seguridad federal que atiende a más de la mitad de los diagnosticados con VIH en la nación, independientemente de su estatus migratorio.

Después que se conectó con gestores de casos, su VIH se volvió indetectable. Pero dijo que, con el tiempo, la comunicación con la clínica se volvió menos frecuente y no recibía ayuda regular de un intérprete durante las visitas con su médico, que hablaba inglés.

Un representante de Amity confirmó que Hermida fue cliente, pero no respondió preguntas sobre su experiencia en la clínica.

Hermida dijo que tuvo dificultades para completar el papeleo para mantenerse inscrito en el programa Ryan White, y cuando su elegibilidad expiró, en septiembre de 2023, no pudo obtener su medicación.

Dejó la clínica y se inscribió en un plan de salud a través del mercado de seguros de la Ley de Cuidado de Salud a Bajo Precio (ACA). Pero Hermida no se dio cuenta que la aseguradora le exigía pagar una parte de su tratamiento para el VIH.

En enero, el conductor de Lyft recibió una factura de $1,275 por su antirretroviral, el equivalente a 120 viajes, dijo. Pagó la factura con un cupón que encontró en línea. En abril, recibió una segunda cuenta que no pudo pagar. Durante dos semanas, dejó de tomar la medicación que mantiene al virus indetectable, y por ende no transmisible.

“Estoy que colapso”, dijo. “Tengo que vivir para pagar la medicación”. Una forma de prevenir el VIH es la profilaxis previa a la exposición, o PrEP, que se toma regularmente para reducir el riesgo de contraer el VIH a través del sexo o el uso de drogas intravenosas. Fue aprobada por el gobierno federal en 2012, pero la adopción no ha sido uniforme entre los diferentes grupos raciales y étnicos: los datos de los CDC muestran tasas de cobertura de PrEP mucho más bajas entre los latinos que entre los estadounidenses blancos no hispanos.

Los epidemiólogos dicen que el buen uso de PrEP y el acceso constante al tratamiento son necesarios para construir resistencia a nivel comunitario.

Carlos Saldana, especialista en enfermedades infecciosas y ex asesor médico del Departamento de Salud de Georgia, ayudó a identificar cinco grupos de transmisión rápida de VIH que involucró a unos 40 latinos gay y hombres que tienen sexo con hombres desde febrero de 2021 hasta junio de 2022. Muchas personas en el grupo dijeron a los investigadores que no habían tomado PrEP y que les resultaba difícil entender el sistema de salud.

Saldana dijo que también experimentaron otras barreras, incluida la falta de transporte y el miedo a la deportación si buscaban tratamiento.

Defensores de políticas de salud para los latinos quieren que el gobierno federal redistribuya los fondos para la prevención del VIH, incluyendo pruebas y acceso a PrEP. De los casi $30 mil millones en dinero federal que se destinaron a servicios de atención médica para el VIH, tratamiento y prevención en 2022, solo el 4% se dirigió a la prevención, según un análisis de KFF.

Los defensores sugieren que más dinero podría ayudar a llegar a las comunidades latinas a través de esfuerzos como la divulgación basada en la fe en iglesias, pruebas en clubes durante fiestas latinas, y en capacitar a personal bilingüe para que realice las pruebas.

Aumentan las tasas latinas

El Congreso ha asignado $2.3 mil millones a lo largo de cinco años para la iniciativa Ending the HIV Epidemic, y las jurisdicciones que reciben el dinero deben invertir el 25% en organizaciones comunitarias.

Pero esta iniciativa no requiere dirigirse a determinados grupos, incluidos los latinos: delega en las ciudades, condados y estados la tarea de idear estrategias específicas.

En 34 de las 57 áreas que reciben dinero, los casos van en la dirección equivocada: las tasas de diagnóstico entre los latinos aumentaron de 2019 a 2022 mientras que disminuían en otros grupos raciales y étnicos, halló el análisis de KFF Health News-AP.

A partir del 1 de agosto, los departamentos de salud estatales y locales deberán presentar informes anuales de gastos sobre el financiamiento en lugares que representan el 30% o más de los diagnósticos de VIH, dijeron los CDC. Antes, solo se requería esto en un pequeño número de estados.

En algunos estados y condados, el financiamiento de la iniciativa no ha sido suficiente para cubrir las necesidades de los latinos. Carolina del Sur, que vio las tasas entre latinos casi duplicarse de 2012 a 2022, no ha expandido las pruebas móviles de VIH en áreas rurales, donde la necesidad es alta entre los latinos, dijo Tony Price, gerente del programa de VIH en el departamento de salud del estado.

Carolina del Sur solo puede pagar a cuatro trabajadores comunitarios de salud enfocados en la divulgación sobre el VIH, y no todos son bilingües.

En el condado de Shelby, Tennessee, hogar de Memphis, la tasa de diagnóstico de VIH entre los latinos aumentó un 86% de 2012 a 2022. El Departamento de Salud dijo que recibió $2 millones en financiamiento de la iniciativa en 2023 y, aunque el plan del condado reconoce que los latinos son un grupo objeto, la directora del departamento, Michelle Taylor, dijo: “No hay campañas específicas solo entre los latinos”.

Hasta ahora, el condado de Mecklenburg, en Carolina del Norte, no incluyó objetivos específicos para abordar el VIH en la población latina, donde las tasas de nuevos diagnósticos se han más que duplicado en una década, pero disminuyeron ligeramente entre otros grupos raciales y étnicos.

El departamento de salud ha utilizado fondos para campañas de marketing bilingües y concientización sobre la PrEP.

Mudarse por la medicina

Cuando llegó el momento para Hermida de empacar y mudarse a la tercera ciudad en dos años, su prometido, que está tomando PrEP, sugirió buscar atención en Orlando, Florida.

La pareja, que eran amigos en la escuela secundaria en Venezuela, tenía algunos familiares y amigos en Florida, y habían escuchado sobre Pineapple Healthcare, una clínica de atención primaria sin fines de lucro dedicada a apoyar a los latinos que viven con VIH.

La clínica está en un consultorio al sur del centro de Orlando. El personal, mayoritariamente latino, viste camisetas turquesa con estampado de piñas, y se escucha con más frecuencia español que inglés en los cuartos de atención y en los pasillos.

“En su esencia, si la organización no es dirigida por y para personas de color, entonces solo somos una idea de último momento”, dijo Andres Acosta Ardila, director de divulgación comunitaria en Pineapple Healthcare, quien fue diagnosticado con VIH en 2013.

“¿Te mudaste reciente [mente], ya por fin?”, preguntó la enfermera Eliza Otero, quien comenzó a tratar a Hermida cuando todavía vivía en Charlotte. “Hace un mes desde la última vez que nos vimos”.

Todavía necesitan trabajar en bajar su colesterol y presión arterial, le dijo. Aunque su carga viral sigue siendo alta, Otero dijo que debería mejorar con atención regular y constante.

Pineapple Healthcare, que no recibe dinero de la iniciativa federal, ofrece atención primaria completa principalmente a hombres latinos. Allí, Hermida obtiene su medicación para el VIH sin costo porque la clínica es parte de un programa federal de descuento de medicamentos.

En muchos sentidos, la clínica es un oasis. La tasa de nuevos diagnósticos para los latinos en el condado de Orange, Florida, que incluye Orlando, aumentó alrededor de un tercio desde 2012 hasta 2022, mientras que disminuyó un tercio para otros. Florida tiene la tercera población latina más grande de Estados Unidos y tuvo la séptima tasa más alta de nuevos diagnósticos de VIH entre latinos en la nación en 2022.

Hermida, que tiene pendiente su caso de asilo, nunca imaginó que obtener medicación sería tan difícil, dijo durante el viaje de 500 millas de Carolina del Norte a Florida. Después de habitaciones de hotel, trabajos perdidos y despedidas familiares, espera que su búsqueda de tratamiento consistente para el VIH, que ha definido su vida en los últimos dos años, finalmente pueda llegar a su fin.

“Soy un nómade a la fuerza, pero bueno, como dicen mi prometido y mis familiares, yo tengo que estar donde me den buenos servicios médicos”, dijo.

Esa es la prioridad ahora, agregó.

KFF Health News y The Associated Press analizaron datos de los Centros para el Control y Prevención de Enfermedades de Estado Unidos sobre el número de nuevos diagnósticos e infecciones de VIH entre estadounidenses de 13 años y más a nivel local, estatal y nacional.

Esta historia utiliza principalmente datos de tasas de incidencia —estimaciones de nuevas infecciones— a nivel nacional y datos de tasas de diagnóstico a nivel estatal y de condados.

Bose produjo esta historia desde Orlando, Florida. Reese, desde Sacramento, California. La periodista de video Laura Bargfeld colaboró con este informe.

The Associated Press Health and Science Department recibe apoyo de la Fundación Robert Wood Johnson. AP es responsable de todo el contenido.

Esta historia fue producida por KFF Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation. 

Un proyecto de KFF Health News y The Associated PressCo-publicado por Univisión Noticias

CRÉDITOS

Reporteros:Vanessa G. SánchezDevna BosePhillip ReeseCinematografía:Laura BargfeldFotografía:Laura BargfeldPhelan M. EbenhackEdición de video:Federica NarancioKathy YoungEsther PovedaVideo adicional:Federica NarancioEsther PovedaProducción de video:Eric HarkleroadLydia Zuraw

Editores:Judy LinErica HunzingerEditor de datos:Holly HackerRedes sociales:Patricia VélezFederica NarancioEsther PovedaCarolina AstuyaNatalia BravoJuan Pablo VargasKyle ViterboSophia EppolitoHannah NormanChaseedaw GilesTarena LoftonTraducción:Paula Andalo Corrección:Gabe Brison-Trezise

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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En el campamento que habían montado los estudiantes dentro del campus de la Universidad de California en Los Ángeles (UCLA), de repente la ginecóloga y obstetra residente Elaine Chan se sintió como una médica en un campo de batalla.

La policía avanzó hacia el campamento luego de horas de enfrentamiento y tensión.

Chan, de 31 años, voluntaria en el puesto de atención médica, dijo que los manifestantes llegaban con dificultades para caminar y con graves heridas punzantes. Pero, por el caos que reinaba afuera, había pocas posibilidades de trasladarlos a un hospital donde se les pudiera brindar otro tipo de cuidados.

Chan expresó su sospecha de que esas lesiones habían sido causadas por balas de goma u otros proyectiles “menos letales”. Después del desalojo del campamento, la policía confirmó que había usado estos dispositivos.

“Los proyectiles atravesaron la piel y se clavaron profundamente en el cuerpo de las personas”, explicó Chan. “Todos sangraban profusamente. Los médicos que nos especializamos en obstetricia y ginecología no hemos sido capacitados para atender heridos por balas de goma… No podía creer que se permitiera atacar de ese modo a civiles, a estudiantes, que tenían ningún equipo de protección”.

La protesta de la UCLA, que reunió a miles de personas que se oponen a los continuos bombardeos de Israel sobre la Franja de Gaza, comenzó en abril y alcanzó un peligroso crescendo en mayo, cuando manifestantes pro Israel y la policía se enfrentaron a los activistas y a los que los apoyaban.

En entrevistas con KFF Health News, Chan y otros tres médicos voluntarios describieron cómo debieron atender a manifestantes con heridas sangrantes, lesiones en la cabeza y huesos presuntamente fracturados en una clínica improvisada en tiendas de campaña, sin electricidad ni agua corriente.

En los puestos sanitarios del campamento hubo día y noche médicos, enfermeras, estudiantes de medicina, paramédicos y voluntarios sin formación médica formal.

En muchos momentos, la escalada de la violencia fuera de la carpa sanitaria fue de tal magnitud que impedía que los manifestantes heridos llegaran hasta las ambulancias, explicaron los médicos. Esto obligó a que los heridos fueran caminando por sus propios medios hasta algún hospital cercano. A otros los llevaron más allá de los límites de la protesta para trasladarlos a una sala de emergencias.

“Nunca había estado en una situación en la que se nos impidiera ofrecer una atención de mayor nivel”, dijo Chan. “Y eso me aterrorizó”.

Tres de los médicos entrevistados por KFF Health News dijeron que estaban presentes el 2 de mayo, cuando la policía arrasó el campamento, y describieron que debieron ocuparse de múltiples lesiones que parecían haber sido causadas por proyectiles “menos letales”.

Estos proyectiles “menos letales” incluyen balas llenas de perdigones de metales pesados o plomo; y municiones comúnmente conocidas como balas de goma. Los utiliza la policía para controlar a sospechosos o para dispersar multitudes y protestas.

La policía recibió una condena generalizada por haber utilizado estas armas contra las manifestaciones del movimiento Black Lives Matter, que se extendieron por todo el país tras el asesinato de George Floyd en 2020.

Aunque el nombre de estas armas parece minimizar su peligrosidad, los proyectiles menos letales pueden viajar a más de 200 mph y está comprobada su capacidad de herir, mutilar o matar.   

Las entrevistas a los médicos que atendieron en la posta sanitaria contradicen directamente la versión del Departamento de Policía de Los Ángeles (LAPD). Después que los agentes desalojaran el campamento, el jefe de Policía, Dominic Choi, afirmó en una publicación en la plataforma social X que “no hubo heridos graves entre los agentes ni entre los manifestantes” durante el operativo en el hubo más de 200 arrestos.

En las respuestas enviadas por correo electrónico a las preguntas de KFF Health News, tanto el Departamento de Policía de Los Ángeles como la Patrulla de Carreteras de California afirmaron que investigarían cómo habían actuado sus agentes durante la protesta en la UCLA. Esas indagaciones, dijeron, darán lugar a un “informe detallado”.

La declaración de la Patrulla de Carreteras asegura que los oficiales advirtieron previamente a los manifestantes que si no se dispersaban podrían utilizar “municiones no letales”.

Después que algunos manifestantes se convirtieran en una “amenaza inmediata” porque “lanzaban objetos y armas”, algunos oficiales utilizaron “balas cinéticas especiales para protegerse a sí mismos, a otros oficiales y a los miembros del público”. Un agente resultó con heridas leves, según el comunicado.

Las imágenes de un video que circuló por Internet después del desalojo del campamento parecían mostrar a un oficial de la Patrulla de Carreteras disparando con una escopeta estos proyectiles de menor letalidad contra los manifestantes.

“El uso de la fuerza y cualquier incidente que implique el uso de un arma por parte del personal de la CHP es un asunto serio, y la CHP llevará a cabo una investigación justa e imparcial para garantizar que las acciones fueron coherentes con la política y la ley”, respondió la Patrulla de Carreteras en su declaración.

El Departamento de Policía de la UCLA, que también participó en el operativo vinculado a la protesta, no respondió al pedido de testimonio de KFF Health News.

Jack Fukushima, de 28 años, estudiante de medicina de la UCLA y socorrista voluntario, contó que presenció cómo un agente de policía les disparó a por lo menos dos manifestantes con proyectiles de menor letalidad.

Entre ellos, a un hombre que se desplomó tras recibir un impacto “justo en el pecho”. Fukushima explicó que, junto con otros médicos, acompañaron al hombre, aturdido, a la carpa sanitaria. Luego volvieron a la zona de los enfrentamientos para buscar más heridos.

“Realmente lo sentí como una guerra”, aseguró Fukushima. “Encontrarse con semejante brutalidad policial fue muy descorazonador”.

Cuando los médicos estuvieron de regreso en la primera línea, la Policía ya había traspasado los límites del campamento y se encontraba forcejeando directamente con los manifestantes, recordó Fukushima.

En esa situación, el socorrista vio como el mismo policía que antes le había disparado al herido que habían llevado al puesto sanitario ahora le disparaba a otro manifestante en el cuello. El muchacho cayó al suelo. Fukushima supuso lo peor y corrió a su lado.

“Cuando logré acercarme le pregunté: ‘Oye, ¿estás bien?’”, contó Fukushima. “Y él, con una valentía impresionante, me respondió: ‘Sí, no es mi primera vez’. Y volvió de inmediato a la acción”.

Sonia Raghuram, de 27 años, otra estudiante de medicina que colaboró en la carpa sanitaria dijo que durante el operativo policial atendió a un manifestante que tenía una herida punzante abierta en la espalda, a otro con un moretón del tamaño de una moneda en el centro del pecho y a un tercero con un corte que sangraba “a borbotones” sobre el ojo derecho y que probablemente tenía una costilla rota.

Raghuram contó que los pacientes le dijeron que las heridas habían sido causadas por los proyectiles policiales, lo que, según ella, coincidía con la gravedad de sus lesiones.

Los pacientes les advirtieron claramente que los agentes de policía se estaban acercando a la posta sanitaria, dijo Raghuram, pero ella no se movió.

“Nunca abandonaremos a un paciente”, aseguró, aludiendo al mantra de la carpa médica. “No me importa que nos detengan. Si estoy atendiendo a un paciente, eso es lo prioritario”, concluyó.

La protesta de la UCLA es una de las muchas que se han organizado en campus universitarios de todo el país. Los estudiantes que se oponen a la guerra que Israel mantiene en Gaza exigen que la universidad apoye un alto el fuego y que se retiren las inversiones que pueda tener en empresas vinculadas a Israel.

La Policía utilizó la fuerza para desalojar a los manifestantes de campamentos en la Universidad de Columbia, la Universidad de Emory y las universidades de Arizona, Utah y el sur de Florida, entre otras.

En el campus de la UCLA, el 25 de abril los estudiantes que protestaban instalaron tiendas de campaña en una plaza cubierta de césped frente al teatro Royce Hall.

El asentamiento atrajo a miles de simpatizantes, según Los Angeles Times. Días más tarde, una “violenta turba” de manifestantes de signo contrario “atacó el campamento”, informó el Times, e intentó derribar las barricadas que protegían sus límites, arrojando fuegos artificiales contra las carpas que había en su interior.

La noche siguiente, la Policía declaró ilegal la demostración y luego desalojó el campamento en las primeras horas del 2 de mayo. Hubo cientos de arrestos.

La Policía ha sido muy criticada por no haber intervenido durante el enfrentamiento entre los manifestantes que acampaban y los que fueron a atacarlos, una confrontación que se prolongó durante horas.

La red de Universidades de California anunció que había contratado a un consultor independiente en materia policial para que investigara los actos de violencia y para “resolver las preguntas sin respuesta sobre la planificación y los protocolos de la UCLA, así como sobre el trabajo de colaboración interinstitucional”.

Charlotte Austin, de 34 años, residente de cirugía, dijo que cuando los manifestantes opositores atacaron el campamento de protesta, vio a unos 10 agentes de seguridad privada del campus de pie, “con las manos en los bolsillos”, mientras los estudiantes eran golpeados y ensangrentados.

Austin asegura que atendió a pacientes con cortes en la cara y posibles fracturas de cráneo. La posta médica envió al menos a 20 personas al hospital esa noche, agregó.

“Cualquier profesional de la medicina calificaría esas lesiones de graves”, dijo Austin. “Hubo personas que debieron ser internadas, no se limitó solo a una visita a la sala de emergencias, sino que necesitaron una hospitalización real”.

Tácticas policiales: “lícitas pero horribles”

Los manifestantes de la UCLA no son los primeros heridos por proyectiles de menor letalidad, ni mucho menos.

En los últimos años, la policía de todo Estados Unidos ha disparado cientos de veces estas armas contra manifestantes, sin que prácticamente exista una normativa general que regule su uso o su seguridad. Algunos de los heridos nunca han vuelto a ser los mismos y las ciudades han gastado millones para responder a las demandas de los damnificados.

Durante las protestas que se produjeron en todo el país tras la muerte de George Floyd a manos de la policía en 2020, al menos 60 manifestantes sufrieron lesiones graves —incluso ceguera y fractura de mandíbula— por disparos de estos proyectiles, a veces en aparente violación de las políticas de los departamentos de policía, según una investigación conjunta de KFF Health News y USA Today.

En 2004, en Boston, una estudiante universitaria que celebraba la victoria de los Red Sox murió por el impacto de un proyectil lleno de gas pimienta, que le atravesó el ojo y le llegó al cerebro.

“Se llaman ‘menos letales’ por una razón”, sentenció Jim Bueermann, ex jefe de policía de Redlands, en California, que ahora lidera el Future Policing Institute. “Pueden matarte”.

Bueermann, que a petición de KFF Health News revisó las imágenes de video de la intervención de la policía en la UCLA, dijo que muestran a agentes de la Patrulla de Carreteras de California disparando balas de salva con una escopeta.

Bueermann opinó que las imágenes no proporcionaban suficiente contexto como para determinar si los proyectiles se estaban utilizando “razonablemente”, según indica la norma establecida por los tribunales federales, o se estaban disparando “indiscriminadamente”, lo que fue prohibido por una ley de California en 2021.

“Hay un dicho en la Policía — “legal pero horrible”— lo que significa que es razonable bajo los estándares legales, pero se ve terrible”, explicó Bueermann. “Y creo que un policía cargando múltiples balas en una escopeta y disparando contra los manifestantes, no es algo que se vea muy bien”.

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).