Anna Claire Vollers, Author at Missouri Independent https://missouriindependent.com/author/annaclairevollers/ We show you the state Tue, 01 Oct 2024 18:41:46 +0000 en-US hourly 1 https://wordpress.org/?v=6.6.2 https://missouriindependent.com/wp-content/uploads/2020/09/cropped-Social-square-Missouri-Independent-32x32.png Anna Claire Vollers, Author at Missouri Independent https://missouriindependent.com/author/annaclairevollers/ 32 32 200+ women faced criminal charges over pregnancy in year after Dobbs, report finds https://missouriindependent.com/2024/10/01/200-women-faced-criminal-charges-over-pregnancy-in-year-after-dobbs-report-finds/ https://missouriindependent.com/2024/10/01/200-women-faced-criminal-charges-over-pregnancy-in-year-after-dobbs-report-finds/#respond Tue, 01 Oct 2024 18:41:46 +0000 https://missouriindependent.com/?p=22163

A new report details more than 200 cases of women charged criminally for their behavior while pregnant in the year after the 2022 U.S. Supreme Court decision that dismantled the constitutional right to abortion (John Moore/Getty Images).

In the year after the U.S. Supreme Court dismantled the constitutional right to abortion in June 2022, more than 200 pregnant women faced criminal charges for conduct associated with their pregnancy, pregnancy loss or birth, according to a new report.

The report was produced by Pregnancy Justice, a nonprofit that advocates for the rights of pregnant people, including the right to abortion. Researchers in multiple states documented 210 cases of women being charged for pregnancy-related conduct in 12 states from June 24, 2022, to June 23, 2023, the first year after the U.S. Supreme Court eliminated the constitutional right to an abortion, throwing the issue to the states.

The majority of charges alleged substance use during pregnancy; in two-thirds of cases, it was the only allegation made against the defendant. Six states — Alabama, Mississippi, Ohio, Oklahoma, South Carolina and Texas — accounted for the majority of cases documented by researchers.

The new report utilizes improved data collection, making comparisons with previous versions difficult. But “what we found was even more of an acceleration in pregnancy criminalization as compared to before” the Supreme Court’s ruling, said Lourdes Rivera, president of Pregnancy Justice. Rivera said she thinks that in states with abortion bans or new restrictions, there is more scrutiny of pregnancy loss.

However, almost none of the prosecutions documented by researchers were brought under state abortion laws. Instead, researchers found that law enforcement most often charged pregnant women with crimes such as child neglect or endangerment, interpreting the definition of “child” to include a fetus. In doing so, authorities relied on a legal concept called fetal personhood — the idea that a fetus, embryo or fertilized egg has the same legal rights as a person who has been born.

“If we focus only on abortion laws, we miss a crucial part of the picture in the fact that pregnant individuals are being criminalized for allegedly endangering their own pregnancies, for pregnancy loss and, in some cases, for conduct related to abortion,” Rivera said. “What’s driving pregnancy criminalization is the expansion of fetal personhood.”

Charges of child abuse or endangerment carry stiffer penalties — higher fines and lengthier prison sentences — than the low-level drug charges the women likely would have faced had they not been pregnant.

“Pregnancy-related prosecutions don’t generally charge crimes that, on the face of the criminal statute, have anything whatsoever to do with pregnancy,” said Wendy Bach, a professor at the University of Tennessee College of Law and the report’s principal investigator. “Instead, using the idea of fetal personhood, or more specifically the idea that the fetus can be the victim of a crime perpetrated by the pregnant person, they use that theory to charge general crimes.”

The push for charges

Conservative lawmakers in Alaska, Illinois, Missouri, South Carolina and West Virginia introduced fetal personhood bills in the most recent legislative session, though none made it out of committee. In Nebraska, dueling amendments will appear on the ballot. One would codify the right to abortion until “fetal viability,” about 24 weeks. The other would amend the state constitution to restrict abortion to 12 weeks and protect “unborn children” in the second and third trimesters of pregnancy.

Proponents of charging pregnant women for conduct that could harm a fetus argue that the threat of prosecution incentivizes the women to get care or treatment for substance use disorders.

Jody Willoughby, the Republican district attorney in Etowah County, Alabama, which has long had some of the highest numbers of pregnancy-related arrests in the country, has said publicly that his office prosecutes cases because doing nothing would make his office “an enabler of a deadly addiction, complicit in the abuse of a child, and ultimately lead to the death of a mother,” local news outlet AL.com reported in 2022. Willoughby did not respond to Stateline’s requests for comment.

But critics say the arrests and prosecutions deter people from seeking care for fear they’ll be arrested or lose custody of their children. The majority of defendants identified in the report had low incomes; most were white.

All six of the states that accounted for most of the cases cited in the study have fetal personhood language baked into their laws. Seventeen states have laws with broad fetal personhood language that could apply to all criminal laws, according to an analysis by Pregnancy Justice.

When it comes to prosecuting pregnant women, Alabama leads the nation: The state accounts for nearly half of the prosecutions documented in the report. Alabama has a constitutional amendment, approved by voters in 2018, that explicitly confers personhood on fetuses and affirms the state’s responsibility to protect “the rights of unborn children.” All the cases documented in Alabama were brought under its chemical endangerment law, which the Alabama Supreme Court ruled in 2013 can include fetuses.

Most of Alabama’s cases come from just a few counties. They were long considered outliers, places where a handful of overzealous officials liberally applied the state’s chemical endangerment law to hundreds of pregnant women.

But Brittany VandeBerg, who led the research in Alabama, said that chemical endangerment charges have popped up in a dozen more Alabama counties since the Dobbs ruling.

“In each county the district attorney really steers the ship as far as what type of priorities they have in their office for prosecutions,” said VandeBerg, who is associate chair of the department of criminology and criminal justice at the University of Alabama. “I don’t know if the elected district attorneys feel this is what the community wants, or if it’s their own personal feelings. But the system is in place to move those cases forward.”

VandeBerg said Alabama provides relatively meager resources for people struggling with addiction. That leaves law enforcement feeling like they have no options other than to arrest and jail women with substance use disorders, she said.

“There just aren’t enough inpatient treatment facilities to help these women,” VandeBerg told Stateline.

One of the things that stuck out to VandeBerg in reviewing cases was the large share of incidents in which a pregnant woman was charged with chemical endangerment even though her baby exhibited no signs of harm after it was born.

“I found that incredibly shocking,” said VandeBerg, who noted that Alabama’s chemical endangerment law can result in a 10-year prison sentence — much longer than some domestic violence crimes carry. “Here, they’re charging the mother before we know harm has been done.”

Defendant exonerated

In July, an Oklahoma court exonerated a woman who’d been charged with felony child neglect in 2020 after her son tested positive for marijuana at birth. Prosecutors pursued the case even though her baby was born healthy, and she’d had a doctor-approved state license to legally use medical marijuana to treat severe morning sickness during the pregnancy.

Brian Hermanson, an Oklahoma Republican district attorney who’s prosecuted dozens of women in his district in similar circumstances, used fetal personhood language in his legal argument.

“Marijuana is an illegal drug under Oklahoma law unless the person consuming the marijuana holds a medical marijuana license. Unborn babies cannot hold such a license,” Hermanson wrote in a court filing.

“[The defendant] admitted to smoking marijuana throughout her pregnancy, knowing that her unborn baby was being exposed to the possible harmful effects of the marijuana smoke.”

The Pregnancy Justice report also documented five cases in which allegations specifically mentioned abortion. One was brought under a state abortion statute that has since been repealed. The other four cases were charged as homicide, child neglect or abuse of a corpse. In the two cases in which homicide was charged, the defendants allegedly visited an abortion clinic or took pills and the abortion was successful, Rivera said.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

]]>
https://missouriindependent.com/2024/10/01/200-women-faced-criminal-charges-over-pregnancy-in-year-after-dobbs-report-finds/feed/ 0
Helping a minor travel for an abortion? Some states have made it a crime https://missouriindependent.com/2024/08/23/helping-a-minor-travel-for-an-abortion-some-states-have-made-it-a-crime/ https://missouriindependent.com/2024/08/23/helping-a-minor-travel-for-an-abortion-some-states-have-made-it-a-crime/#respond Fri, 23 Aug 2024 17:00:43 +0000 https://missouriindependent.com/?p=21607

Helping a pregnant minor travel to get a legal abortion without parental consent is now a crime in two Republican-led states, and lawmakers in other states have considered similar legislation (Oscar Wong/Getty Images)

Helping a pregnant minor travel to get a legal abortion without parental consent is now a crime in at least two Republican-led states, prompting legal action by abortion-rights advocates and copycat legislation from conservative lawmakers in a handful of other states.

Last year, Idaho became the first state to outlaw “abortion trafficking,” which it defined as “recruiting, harboring or transporting” a pregnant minor to get an abortion or abortion medication without parental permission. In May, Tennessee enacted a similar law. And Republican lawmakers in Alabama, Mississippi and Oklahoma introduced abortion trafficking bills during their most recent legislative sessions, although those bills failed to advance before the sessions ended.

Those five states are among the 14 that enacted strict abortion bans following the U.S. Supreme Court’s June 2022 Dobbs decision, which dismantled the federal right to abortion. Now, conservative state lawmakers are pushing additional measures to try to restrict their residents from getting them in states where it remains legal.

“A lot of folks thought Dobbs was the floor and it’s really not,” said Tennessee state Rep. Aftyn Behn, a Nashville Democrat who’s challenging Tennessee’s trafficking law in court. “[Anti-abortion lawmakers] are coming for state travel and the ability to even talk about abortion.”

Abortion-rights advocates have filed lawsuits in Alabama, Idaho and Tennessee, arguing the laws are vague and violate constitutional rights to free speech and travel between states. A federal judge has temporarily blocked Idaho’s law from being enforced while the case is ongoing.

Proponents of the laws argue they’re needed to protect parental rights and to prevent other adults from persuading adolescents to get abortions.

“This is a parental rights piece of legislation,” Idaho Republican state Rep. Barbara Ehardt told Stateline. “We can’t control someone getting an abortion in Oregon. But you cannot take a child to get an abortion without the parent’s knowledge because, at least in the past, we would have called that kidnapping.”

But critics warn that abortion trafficking laws could have grave implications not only for interstate travel, but also for personal speech and communication between friends, or between children and adults they trust.

“If courts go down this road, it could change the scope of the First Amendment,” Mary Ziegler, a legal historian and law professor at the University of California, Davis School of Law, told Stateline. “It could have an effect on what else qualifies as crime-facilitating speech, and that could limit the kinds of things people can say and do online and in other contexts.”

Opponents also question whether states should be permitted to interfere in the business of other states. Criminalizing travel within an abortion-ban state to reach another state for a legal abortion would “allow prosecutors to project power across state lines,” said Ziegler.

“We haven’t seen states try to interfere in what’s happening in other states in quite the same way in a long time,” she said. “That’s why there is legal uncertainty — because we’re not talking about something where we have a lot of legal precedent.”

‘Parental rights’

Tennessee state Rep. Jason Zachary, a Knoxville Republican, defended Tennessee’s legislation as “a parental rights bill” that “reinforces a parent’s right to do what’s best for their child,” in remarks he made to the Tennessee General Assembly before the bill passed. Republican Gov. Bill Lee signed it into law in May.

The following month, Behn joined with Nashville attorney and longtime abortion access activist Rachel Welty to file a lawsuit challenging the new law.

Behn and Welty sued nearly a dozen district attorneys in Tennessee, alleging they ignored Welty’s requests to define what behavior would be deemed illegal under the new law. The Tennessee law says that abortion trafficking occurs when an adult “intentionally recruits, harbors, or transports” a pregnant minor within the state to get an abortion or an abortion-inducing drug without parental consent, “regardless of where the abortion is to be procured.”

A hearing to determine whether the court will grant a temporary injunction blocking the Tennessee law, which is currently in effect, is scheduled for Aug. 30.

After Idaho passed its law in April 2023, two advocacy groups and an attorney who works with sexual assault victims sued the state attorney general. The plaintiffs claim Idaho’s law is vague and violates the First Amendment right to free speech, as well as the right to travel freely between states. The right to interstate travel isn’t spelled out in the U.S. Constitution but it’s implied, legal experts say. The Idaho law directly applies to travel within the state, but it also notes that defendants are not immune from liability if “the abortion provider or the abortion-inducing drug provider is located in another state.”

Megan Kovacs, a board member with the Northwest Abortion Access Fund, which is a plaintiff in the case along with the Indigenous Idaho Alliance, said it is “so clearly unconstitutional to disallow people from accessing health care from within or outside their state.” Kovacs added that her group also wants to protect its volunteers from legal liability.

Neither the Idaho nor the Tennessee law exempts minors who become pregnant after being raped by a parent.

“If that person had to go to a parent who didn’t believe them or wanted to defend that family member who was the abuser, that only impedes healing even more,” said Kovacs, who has spent a decade working with survivors of domestic and sexual violence.

Ehardt, who sponsored the Idaho bill, said any adult who is told by a child about an incident of incest should call authorities rather than helping the minor obtain an abortion without parental consent.

“You have to call the police and they will be the ones to help protect the child’s safety,” she said.

The 9th U.S. Circuit Court of Appeals held a hearing in May in Seattle, and Kovacs said she expects to learn in the next few weeks whether the court will uphold the temporary injunction blocking Idaho’s law while the lawsuit rolls on.

In July 2023, a group of health care providers sued Alabama Republican Attorney General Steve Marshall and district attorneys, asking the court to prevent the state from prosecuting people who help Alabamians travel to get abortion care in states where it’s legal.

The providers filed the lawsuit in response to remarks that Marshall made on a radio show in 2022, when he suggested that some people who aid a pregnant person in planning or traveling to get an abortion in another state could be prosecuted under the state’s criminal conspiracy laws. A judge denied Marshall’s motion to dismiss the lawsuit earlier this year, and the case is ongoing.

A coordinated effort

The Tennessee and Idaho laws mirror language in model legislation that was published in 2022 by the National Right to Life Committee, which bills itself as the nation’s oldest and largest grassroots pro-life organization.

“With this model law, we [are] laying out a roadmap for the right-to-life movement so that, in a post-Roe society, we can protect many mothers and their children from the tragedy of abortion,” said Carol Tobias, president of National Right to Life Committee, in a June 2022 statement introducing the model anti-abortion law.

Anti-abortion-rights organizations, like other interest groups, have long coordinated strategies to promote their preferred legislation to state and federal lawmakers.

The Idaho and Tennessee laws focus specifically on minors, even though they comprise a small fraction of people who get abortions. Those under 19 accounted for 8.1% of abortions, and those under age 15 accounted for just 0.2% of abortions in 2021, the most recent year for which the federal Centers for Disease Control and Prevention has published data.

Kovacs and Ziegler say the bills zero in on minors’ access to abortion because policies that regulate children and teens tend to be more politically acceptable than broader restrictions that affect adults. Such bills also tend to be more likely to survive legal challenges in court.

A chilling effect

Nobody in Tennessee or Idaho has yet been prosecuted under the abortion trafficking laws, but an Idaho woman and her son were charged with kidnapping last fall for allegedly taking the son’s girlfriend, a minor, out of state to get an abortion.

One main goal of a law such as Tennessee’s, Behn believes, is to create a chilling effect so that average people are scared to help anyone who might need an abortion, for fear of breaking the law.

“These bills create an environment of suspicion, fear and misinformation,” said Behn. “But I do think we will see more aggressive district attorneys start to prosecute these cases. [The law] widens the permission structure to start prosecuting people.”

Laws criminalizing abortion travel and imposing other abortion restrictions may be designed to provoke a legal challenge, Ziegler said. With a 6-3 conservative majority, the U.S. Supreme Court might be inclined to support them.

Abortion-rights advocates argue that restrictive abortion laws end up harming even those people who live in states where abortion is still legal.

Oregon, for example, has some of the strongest abortion protection laws in the nation. And yet the strict abortion ban next door in Idaho has made it more difficult for Oregonians to access care, said Kovacs, who lives in Oregon.

Before Idaho’s ban, many people in Eastern Oregon traveled to Idaho for abortion care, she said, because its clinics were closer than Oregon’s clinics, most of which are concentrated on the western side of the state. Last year, in response to increasing abortion restrictions in other states, Oregon passed a sweeping health care omnibus bill that strengthens protections for abortion providers and explicitly allows minors to seek abortions without parental consent. It was signed into law and took effect in January.

Ziegler said it’s not hard to imagine that if abortion trafficking laws are upheld in abortion-ban states, at some point prosecutors in those states could file charges against providers in “safe” states for providing abortion help, such as mailing abortion pills.

“I think it’s not intended to just stop with the people who are in the ban states,” Ziegler said.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

]]>
https://missouriindependent.com/2024/08/23/helping-a-minor-travel-for-an-abortion-some-states-have-made-it-a-crime/feed/ 0
Conservatives push to declare fetuses as people, with far-reaching consequences https://missouriindependent.com/2024/08/05/conservatives-push-to-declare-fetuses-as-people-with-far-reaching-consequences/ https://missouriindependent.com/2024/08/05/conservatives-push-to-declare-fetuses-as-people-with-far-reaching-consequences/#respond Mon, 05 Aug 2024 17:00:41 +0000 https://missouriindependent.com/?p=21339

In vitro fertilization process close up (Getty Images).

When Missourians head to the polls in November, they may get to vote on whether to overturn their state’s near-total abortion ban and legalize abortions up to the point of fetal viability.

But one lawmaker says the results of that vote may not matter if his colleagues approve his bill declaring that fetuses are people.

Missouri state Rep. Brian Seitz, a Republican, plans to reintroduce a bill in January that would grant “unborn children” the same rights as newborns, building on a similar Missouri law that has been on the books since the 1980s.

Seitz said the bill would provide protections for embryos and fetuses “regardless of that vote in November.”

Absolute abortion bans remain unpopular, even in conservative-led states and among Republican women. So during this legislative session, many GOP state lawmakers pivoted to protecting the rights of fertilized eggs, embryos and fetuses. And when the national Republican Party released its official platform in July, it made no mention of a federal abortion ban. Instead, the GOP affirmed states’ prerogative to pass laws protecting life under the Constitution’s 14th Amendment, which has been used in legal arguments to support fetal personhood.

Fetal personhood, a longtime cornerstone of the anti-abortion movement, is the idea that a fetus, embryo or fertilized egg has the same legal rights as a person who has been born. If the law considers fetuses to be people, the thinking goes, then abortion would legally be considered murder.

Can a fetus be an employee? States are testing the boundaries of personhood after ‘Dobbs’

At least 19 states — either through state law, criminal statutes or case law — have declared that fetuses at some stage of pregnancy are people, according to a 2023 report from Pregnancy Justice, a nonprofit that conducts research and advocates for the rights of pregnant people, including the right to abortion.

Missouri is one of several Republican-led states where lawmakers have taken a renewed interest in fetal personhood legislation in the two years since the U.S. Supreme Court’s Dobbs decision overturned Roe v. Wade and dismantled the federal constitutional right to abortion.

“If you elevate a fetus to the status of a person and grant it citizenship rights equal to that of a pregnant person, then now you have a clash of rights,” said Rebecca Kluchin, a history professor at California State University, Sacramento, who is writing a book on the history of efforts to establish fetal personhood in the United States.

Kluchin said one goal of the recent fetal personhood bills is to get a case before the U.S. Supreme Court. The Dobbs decision, and the conservative bent of the current court, have created an environment where lawmakers are saying, “Let’s try it,” she said. “If one of them gets it right, then others can pass identical laws.”

Seitz thinks his bill could fulfill that purpose.

“If it does get to the Supreme Court, due to the makeup of the court right now, I think they would see this commonsense legislation is, in fact, truth,” he said.

Critics, meanwhile, warn of legal chaos. The possible implications of fetal personhood bills extend far beyond abortion — to fertility treatments, birth control and even child tax credits. In states that have enacted such laws, pregnant women have faced criminal charges for actions that might harm their pregnancies.

“When a pregnant person’s rights conflict with fetal rights,” Kluchin said, “fetal rights tend to trump them.”

IVF’s chilling effect

Seitz’s bill didn’t make it out of committee before Missouri’s legislative session ended in May.

He attributed that failure to the GOP’s reluctance to push an anti-abortion bill in an election year, a concern that might have been justified: Missouri abortion rights supporters gathered more than double the number of signatures needed to get their constitutional amendment on the ballot. As of press time, the ballot petition signatures were still being reviewed by local and state officials.

But Seitz said the bill will be the first he introduces when the legislature returns in January. With election season behind them, he said, “I think it will be very easy for my Republican colleagues to come on board and support this.”

Conservative lawmakers in Alaska, Illinois, South Carolina and West Virginia introduced similar fetal personhood bills in their most recent legislative sessions, though none made it out of committee.

Then in February, the Alabama Supreme Court ruled that embryos created through in vitro fertilization are children under state law, and that people can be held liable for destroying them. The court cited Alabama’s constitutional amendment, passed by voters in 2018, that confers personhood on fetuses and affirms the state’s responsibility to protect “the rights of unborn children.”

The court’s decision generated a national uproar, ignited bipartisan ire and halted fertility treatments statewide until Alabama’s Republican supermajority legislature hastily passed a law protecting fertility service providers.

The backlash underscored how many lawmakers hadn’t fully considered the far-reaching implications and legal bedlam that can be created by fetal personhood laws.

And it had a chilling effect on fetal personhood bills.

In February, a Florida Republican state senator sidelined her bill that would have covered fetuses under wrongful death lawsuits after some lawmakers worried it would hurt IVF providers.

In March, the Iowa House passed a bill to criminalize “the death of an unborn person,” but Republicans in the Senate declined to take up the bill over concerns it could criminalize IVF.

Similarly, the Kentucky House refused to hear a bill that the Senate passed that would have granted the right to retroactively collect child support for costs incurred during pregnancy.

Through the back door

Last year, Arizona Republican state Rep. Matt Gress introduced five pregnancy-related bills that he said were inspired by his experience growing up in a family headed by a single mother.

“I’m the youngest of four and raised by a single mom in a single-wide trailer house in rural Oklahoma. We grew up very poor,” Gress said in an interview with Stateline. “These bills, to me, represented a policy approach that helps women and families.”

One of the bills would have allowed families to retroactively claim child tax credits in the year before a baby is born; another would have allowed pregnant women to drive alone in a highway car pool lane, their fetus counting as a separate passenger.

Yet another bill would have allowed a woman, after having a baby, to collect child support backdated to the date of her positive pregnancy test.

Arizona’s Democratic state legislators accused Gress of taking a back-door approach to inserting fetal personhood language into state law. But Gress denies that codifying fetal personhood was his intent.

“That didn’t even cross my mind,” he said. “The way I read the bills, there were no rights being afforded to anybody besides women and families.”

Gress noted that he was the first Republican, and one of the few, who supported Democratic state legislators’ bid to repeal Arizona’s near-total abortion ban, which dated to 1864. The repeal effort eventually succeeded in early May.

Arizona’s legislature passed two of Gress’ pregnancy bills, but Democratic Gov. Katie Hobbs vetoed both. Gress said he doesn’t intend to reintroduce the bills unless a new governor is elected who might support them.

Republican and Democratic lawmakers in Alabama, Kansas, Kentucky, Mississippi and Missouri tried but failed to pass similar fetal child support laws this year. Georgia’s 2019 “heartbeat law,” which went into effect in 2022, grants child support benefits for fetuses.

Republican U.S. Rep. Mike Johnson of Louisiana, now the speaker of the House, introduced a similar bill in Congress in 2022, and was explicit about its purpose. In a statement, he called it a “first step” toward updating federal laws to reflect that “life begins at conception.”

Beyond abortion

Fetal personhood laws, like abortion bans, end up having broader effects on all pregnant people and pregnancy-related care, said Dr. Daniel Grossman, an OB-GYN and the director of Advancing New Standards in Reproductive Health, a research program at the University of California, San Francisco, which focuses on abortion and reproductive health.

Grossman points to cases in which pregnant patients experiencing obstetric emergencies had to be airlifted out of states with strict abortion bans, such as Idaho, because doctors were afraid of violating the law.

In states such as Florida, North Carolina and Texas, pregnant women who weren’t seeking abortions but who experienced possible miscarriages or other emergencies have been turned away from hospitals. Stories of pregnant women being turned away from emergency rooms spiked after Roe was overturned, a recent Associated Press investigation found.

Fetal personhood has implications for birth control, too.

Hormonal contraceptive methods such as IUDs and birth control pills typically work by preventing an egg from being fertilized, but there’s a small chance that some forms can also prevent a fertilized egg from being implanted in the uterus, said Grossman. So, if state law considers a fertilized egg a person, that could create a legal basis for banning any contraception that could possibly prevent implantation.

Grossman also worries about increased scrutiny these laws create for people who experience miscarriage or stillbirth.

“Before Dobbs, people were arrested and criminally prosecuted for allegedly trying to end a pregnancy on their own,” he said. “I’m already concerned that’s going to become more common, especially in places with fetal personhood laws.”

The laws also have resulted in women being criminally charged for actions that might harm their pregnancies, said Lourdes Rivera, president of Pregnancy Justice.

Rivera’s organization documented nearly 1,400 instances of pregnant women being charged, often for substance use, in the 16 years leading up to the June 2022 Dobbs decision. Most of the cases occurred in a handful of Southern states — including Alabama, South Carolina and Tennessee — that have expanded their definitions of child abuse to include fetuses, fertilized eggs and embryos.

Nearly 85% of pregnancy criminalization cases in the Pregnancy Justice report involved charges against a pregnant person who was legally indigent, and the laws were disproportionately applied to poor women and women of color, Rivera said.

“These laws are forcing pregnant people to give up their bodily autonomy, their health and well-being,” she said, “and to be surveilled and criminalized for actions that would not be criminal if they were done by people who were not pregnant.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

]]>
https://missouriindependent.com/2024/08/05/conservatives-push-to-declare-fetuses-as-people-with-far-reaching-consequences/feed/ 0
‘Compounded’ weight-loss drugs are a growing problem for state regulators https://missouriindependent.com/2024/07/08/compounded-weight-loss-drugs-are-a-growing-problem-for-state-regulators/ https://missouriindependent.com/2024/07/08/compounded-weight-loss-drugs-are-a-growing-problem-for-state-regulators/#respond Mon, 08 Jul 2024 15:14:52 +0000 https://missouriindependent.com/?p=20919

Wegovy and other injectable weight-loss medications have soared in popularity in the past two years. Supply issues and spotty insurance coverage have driven some patients to seek out compounded versions of the drug, which tend to be less expensive (Amanda Andrade-Rhoades/The Associated Press).

Anna Wysock’s “aha” moment arrived in an Ohio amusement park, as she got ready to ride a roller coaster with her 7-year-old son: The safety bar across her lap would only click into place once. The attendant told her it had to click twice, or she couldn’t ride. She was mortified.

“I had to do the walk of shame and get off the roller coaster and let my 7-year-old ride it with his cousin,” Wysock, an elementary school teacher and married mother of two, said of the 2022 incident. “I thought, ‘Anna, you’ve got to get yourself together.’”

Three months after the roller coaster incident, Wysock got a prescription for Mounjaro, an injectable diabetes drug that can be used for weight loss. Her insurance didn’t cover it, but a manufacturer’s coupon cut the cost to $25 per month. In six months, combined with diet and exercise changes, it helped her shed nearly 60 pounds.

Then the discount ended, raising the price to about $1,000 per month. Friends told her about a local clinic that offered cheaper, compounded versions of weight-loss drugs, and she got a prescription costing $150 per month. She began losing weight again.

To create a compounded drug, pharmacists reformulate the active ingredients in a commercial drug to customize it for an individual patient. Wysock was concerned about making the switch, fearing that the compounded version would cause unfamiliar side effects, “but it was worth it to me to try.”

Drugs prescribed for weight loss such as Mounjaro, Ozempic, Wegovy and Zepbound are popular, expensive, and in short supply. To meet the demand, many physicians, medical spas, IV infusion clinics, telehealth entrepreneurs and pharmacies are jumping on the opportunity to provide compounded versions of the weight-loss medications, which haven’t been on the market long enough to have generic equivalents.

State regulators are having trouble keeping up.

The U.S. Food and Drug Administration regulates commercial drugs, but the licensing and oversight of compounding pharmacies falls to states. States including Idaho and Tennessee have announced investigations into illegal dispensing by medical spas and other providers, while states such as California are looking to beef up their oversight.

“It’s not a normal situation that a blockbuster drug immediately goes on shortage and meets criteria for compounding pharmacies to compound it,” said Tenille Davis, an Arizona pharmacist and the chief advocacy officer for the Alliance of Pharmacy Compounding, an industry group representing compounding pharmacists.

“I don’t think we’ve ever seen anything like this.”

A cheaper alternative

Compounding pharmacies are allowed to make a medication that’s essentially a copy of a commercially available drug if its active ingredients are listed on the FDA’s drug shortage list. The active ingredient in weight-loss drugs such as Wegovy and Zepbound is either semaglutide or tirzepatide, and both are on the list.

“As the demand continues to grow, there continues to be a shortage of conventionally manufactured product, and compounding pharmacies are filling that need,” said Davis. “Compounding pharmacies have been able to step in and fill some of those gaps in the marketplace.”

Most states have similar compounding rules, though some states — including California and Texas — are stricter than others. Enforcement also varies.

In Mississippi, regulators have told doctors and other providers to stop prescribing compounded medications for weight loss — period. The state medical board has a rule that only medications that have been FDA-approved for weight loss can be prescribed for weight loss — meaning compounded drugs don’t qualify.

But many states and compounding pharmacies aren’t sure where the lines are. States including Kansas and New Jersey have had to issue statements clarifying their regulations. Last spring, North Carolina and West Virginia issued warnings that compounding weight-loss drugs wasn’t allowed — only to amend their statements after determining they had misinterpreted FDA guidance.

Federal law requires most U.S. compounding pharmacies to make medications for specific patients. They aren’t supposed to bulk manufacture medications unless they’re registered with the FDA as “outsourcing facilities,” which follow a stricter set of federal regulations.

But some states have found compounders breaking those rules.

In May, for example, Idaho’s licensing agency announced that regulators had discovered videos of health professionals filling syringes of weight-loss medications that weren’t compounded for specific patients, and then sending those syringes to patients, which is illegal under state law.

A compounding pharmacy in Nashville, Tennessee, that was producing tens of thousands of doses of compounded weight-loss medications shut down last year. It had been shipping its drugs nationwide. After state regulators inspected the facility and issued a disciplinary order requiring the company to make several changes before it could resume compounding, an executive died by suicide and the pharmacy’s owner chose to close.

And in Florida, a physician told the state pharmacy board he’d been approached by representatives from a multistate compounding pharmacy that wanted him to write prescriptions for their specific compounded semaglutide product — a form of prescription solicitation that’s likely illegal, Carter said.

Compounders generally don’t have to register with the FDA, and they aren’t required to report which drugs they’re compounding. That means there’s no way to know exactly how much semaglutide or tirzepatide they are dispensing, said Davis.

‘Like Whac-A-Mole’

To protect patients, the FDA enforces strict safety and quality requirements for drug manufacturers and for the small subset of compounding pharmacies registered as outsourcing facilities. The idea is that companies that are bulk manufacturing drugs need closer oversight than smaller compounding pharmacies that are merely customizing drugs for individual patients.

Compound pharmacies that bulk produce weight-loss drugs without FDA approval are doing so without that oversight.  And because compounding pharmacies aren’t required to report instances of patient harm involving their medications, problems may go undetected.

“It’s kind of like ‘Whac-A-Mole,’” said Al Carter, a pharmacist and executive director at the National Association of Boards of Pharmacy. He said state boards will only investigate when they receive a complaint.

“There are bad actors out there, purporting to be compounding pharmacies that are licensed in specific states or have the credentials to be able to compound when in actuality they don’t,” said Carter. “My understanding is most licensed, legitimate pharmacies aren’t compounding” weight-loss medications.

Most of the complaints that state regulators are hearing, he said, come from patients who tried to purchase their medications online. The National Association of Boards of Pharmacy recently released a report that found illegal online pharmacies — many operating outside the United States — sell substandard or fake weight-loss medications, or misrepresent the products they sell.

But even some domestic, legally operating clinics misrepresent the products they offer. Some clinics and online pharmacies advertise a “generic” form of semaglutide, even though the FDA hasn’t approved a generic form of semaglutide or tirzepatide.

Meanwhile, pharmaceutical giants Novo Nordisk and Eli Lilly have gone on the offensive, filing dozens of lawsuits in multiple states against medical spas, weight-loss clinics and pharmacies. Many of the suits allege the companies falsely marketed their compounded products as commercial medications.

An Eli Lilly spokesperson told Stateline in a statement that “Lilly will continue to pursue legal remedies against those who falsely claim their products are Mounjaro, Zepbound, or ‘FDA-approved’ tirzepatide, including certain med-spas, wellness centers, online retailers, and compounding pharmacies.”

Some states are focusing their investigations specifically on medical spas and IV infusion clinics that offer compounded weight-loss medications. The California State Board of Pharmacy recently discussed expanding its oversight of IV hydration clinics, noting that even when their drug products are from licensed compounding pharmacies, clinic staff may not be giving them to consumers legally.

And in Texas, some physicians are pushing for legislation to tighten state oversight of medical spas following the death last July of a woman who died after receiving an IV infusion treatment.

But ultimately the burden rests on patients to figure out whether the medications they’re taking were made by a licensed and reputable compounder.

For patients like Wysock, compounded versions of weight-loss medications have been life- changing. Wysock said her compounded tirzepatide has enabled her to continue to lose weight, to maintain a healthier lifestyle and to be present for her family and students.

“As a teacher you’re on your feet all day long, and then coming home to two kids, I was exhausted by the weekend,” she said. “I used to take naps every weekend. That was a ‘nonnegotiable.’ Now it’s not a necessity anymore.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

]]>
https://missouriindependent.com/2024/07/08/compounded-weight-loss-drugs-are-a-growing-problem-for-state-regulators/feed/ 0
Despite GOP headwinds, citizen-led abortion measures could be on the ballot in 9 states https://missouriindependent.com/2024/06/21/despite-gop-headwinds-citizen-led-abortion-measures-could-be-on-the-ballot-in-9-states/ https://missouriindependent.com/2024/06/21/despite-gop-headwinds-citizen-led-abortion-measures-could-be-on-the-ballot-in-9-states/#respond Fri, 21 Jun 2024 17:00:19 +0000 https://missouriindependent.com/?p=20730

Supporters of a proposed ballot measure to legalize abortion up until the point of fetal viability gathered at a rally hosted by Missourians for Constitutional Freedom on Feb. 6 in Kansas City (Anna Spoerre/Missouri Independent).

For abortion rights supporters in Florida, it was a tumultuous day of highs and lows.

On April 1, the Florida Supreme Court paved the way for the state to ban nearly all abortions after six weeks of pregnancy. But it also OK’d a ballot measure that would allow Florida voters to overturn the ban this November.

“I was elated and devastated,” said Natasha Sutherland, the communications director for Floridians Protecting Freedom, a coalition of state and national organizations that gathered nearly 1 million signatures for a proposed constitutional amendment enshrining the right to abortion.

“Many women don’t even know they’re pregnant by the time they’re outside of the six-week window for abortion care,” said Sutherland, who lives in Tallahassee. “Considering the stakes are so high with the abortion ban we’re now under, it was really important for us to ensure we gave it all we’ve got.”

This November, voters in as many as nine states could sidestep their legislators and directly decide whether to expand access to abortion through citizen-led ballot initiatives. Constitutional amendments in Colorado, Florida and South Dakota already have qualified for the ballot, while coalitions in Arizona, Arkansas, Missouri, Montana, Nebraska and Nevada are still collecting signatures or awaiting state approval on their measures.

Two more states, Maryland and New York, have abortion rights ballot measures that were referred by their state legislatures, though New York’s is currently tied up in litigation.

In June 2022, the U.S. Supreme Court dismantled the constitutional right to an abortion, kicking the issue back to the states. Fourteen states have outlawed abortion with almost no exceptions, while another seven states ban abortions at or before 18 weeks of pregnancy, according to the Guttmacher Institute, a pro-abortion rights research organization.

Yet access to abortion remains popular, even in conservative states. Since the high court’s 2022 decision, voters in six states have approved abortion access via ballot measure, including in red states such as Kansas and Kentucky.

“The whole idea of the initiative process is to put pressure on state lawmakers when there appears to be support for an issue that the median voter in the electorate might want but the median lawmaker doesn’t want,” said Daniel Smith, a professor and chair of the political science department at the University of Florida, who has authored books and papers on ballot initiatives.

In several states, Republican lawmakers opposed to abortion rights have tightened signature requirements or raised the percentage of the vote required for ballot initiatives to pass. Proponents of stricter rules say they want to prevent out-of-state interests from manipulating the process by funneling money to initiative campaigns. They say they also want to ensure that populous urban centers don’t have too much power. But in several cases, GOP backers have acknowledged that their goal is to thwart abortion rights measures that are broadly popular.

Mat Staver, an attorney based in Orlando, Florida, said it should be harder to get constitutional amendments passed because organizations from outside the state are funneling money into ballot initiatives such as the ones expanding reproductive rights. Staver is the co-founder of Liberty Counsel, a Florida-based nonprofit that opposes abortion-related ballot measures in Florida and other states.

“Even though we have a 60% threshold [in Florida], if you have the financial resources, you can get pretty much anything on the ballot you want,” he said. “That’s not good for Floridians because that doesn’t allow for debate.”

Critics argue that legislators’ attempts to impose new restrictions subvert one of the purest forms of direct democracy available to citizens.

“Democracy requires compromise,” said Alice Clapman, senior counsel at the Brennan Center for Justice at New York University School of Law, a progressive law and policy nonprofit. “I am concerned that there seems to be a resistance to leaving these issues to the democratic process. Some people in power in these states feel certain issues shouldn’t be up for democratic debate.”

‘Monopoly power’

For decades, legislators on both sides of the political aisle have tried to make it harder for citizens to get various proposals on the ballot, said Smith. It just depends on who’s controlling the state’s levers of power.

“The ballot initiative takes away the monopoly power of lawmakers,” he said. “We can look at restrictions by Republicans right now on the initiative process, but doing so is myopic. It happens on both sides.”

In today’s polarized political climate, voter support for a ballot measure doesn’t necessarily translate into support for a political candidate who backs it. Smith’s research has found that many people may vote for a ballot measure while also voting for candidates from the political party that opposes it.

“And they’re fine with that,” Smith said. “There’s no cognitive dissonance in the voter’s mind. [The ballot measure] is a one-off.”

Ballot measures typically don’t boost voter turnout in presidential election years like they do in midterms and special elections. But 2024 could be different, Smith said, thanks to tepid public enthusiasm for the repeat matchup between President Joe Biden and former President Donald Trump. A ballot measure might prod more people to head to the polls.

‘Not unlike gerrymandering’

Last month, the Missourians for Constitutional Freedom campaign turned in more than twice the likely number of signatures needed for its measure to qualify for Missouri’s ballot in November. The proposed constitutional amendment, like Florida’s, would legalize abortion up to fetal viability — the point at which a fetus can survive outside the uterus, often considered around 24 or 25 weeks of pregnancy.

“The signature-gathering piece of this campaign was the most incredible thing I’ve ever been a part of,” said Mallory Schwarz, executive director at Abortion Action Missouri, one of the organizations participating in the campaign. “I have never seen the level of enthusiasm about the issue that I saw this year.”

Coalition organizations trained more than a thousand volunteers who canvassed in their communities, held house parties, and knocked on tens of thousands of doors in less than three months, Schwarz said, eventually gathering more than 380,000 signatures. The state must now certify the petition for it to appear on the ballot.

Missouri voters of all political stripes have a deep attachment to the ballot initiative process that dates back more than a century, Schwarz said: “We’ve seen issues that may be presented as partisan really appeal to people across the board, year in and year out.”

In recent years, ballot measures in Republican-controlled Missouri have raised the state minimum wage, expanded Medicaid, overturned a so-called right-to-work law and decriminalized cannabis use.

This year, Missouri Republicans put forth several proposals designed to defeat abortion rights initiatives, including one that would require ballot measures to win not just a majority of votes statewide, but also a majority of votes in Missouri’s congressional districts.

After heated debate, the bill passed the Senate, but the House couldn’t reconcile different versions of the bill before the session ended.

“It’s not unlike gerrymandering,” Schwarz said. “The only way they can stop the will of the people is to change the rules of the game.”

Florida lawmakers filed a similar bill last year. They proposed a constitutional amendment to increase the percentage of votes a ballot measure needs to pass, from 60% to a two-thirds supermajority. The bill passed the House but died in the Senate.

In 2023, ballot initiatives in eight states attracted more than $205 million in donations, according to OpenSecrets, a nonprofit that tracks campaign financing and lobbying. Sutherland, with Floridians Protecting Freedom, pointed out that the campaign raised nearly $12 million in April and May, but about 70% of contributions coming from within Florida.

An array of tactics

Students hold up anti-abortion signs at the Midwest March for Life on May 1 at the Missouri State Capitol (Anna Spoerre/Missouri Independent).

After abortion rights advocates gathered nearly 500,000 signatures in Ohio to get a reproductive rights amendment on the November 2023 ballot, the Republican secretary of state and the Ohio Ballot Board changed the wording of the amendment’s summary in a way that opponents said was incomplete and inaccurate. Ohio voters approved the ballot measure anyway, enshrining abortion access in the state constitution last November.

A similar scenario unfolded In Missouri, where Republican Secretary of State Jay Ashcroft attempted to change the wording of a proposed abortion rights ballot measure so that it would ask voters whether they were in favor of “dangerous and unregulated abortions until live birth.” A Missouri court later struck down the language.

In Arizona, GOP lawmakers have put their own constitutional amendment on the November 2024 ballot that would require organizers to gather a certain percentage of signatures from every one of Arizona’s 30 legislative districts rather than in the state as a whole. They’ve also considered a strategy to introduce their own abortion-related ballot measures to compete with the abortion rights measure.

If reproductive rights ballot amendments pass, they’ll likely face legal challenges that stretch far beyond the election.

Staver, of the Liberty Counsel, said his organization would investigate legal channels for blocking implementation of Florida’s amendment.

“There may be litigation that would be necessary to argue that preexisting constitutional rights override this amendment,” said Staver, who believes the amendment is overly broad.

Clapman, with the Brennan Center, said she also expects lawmakers to continue pushing back against ballot measures: “It’s not a fight that’s going to go away even if initiatives pass.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and X.

]]>
https://missouriindependent.com/2024/06/21/despite-gop-headwinds-citizen-led-abortion-measures-could-be-on-the-ballot-in-9-states/feed/ 0
New rules protect pregnant workers, but red states sue over abortion provisions https://missouriindependent.com/2024/06/01/new-rules-protect-pregnant-workers-but-red-states-sue-over-abortion-provisions/ https://missouriindependent.com/2024/06/01/new-rules-protect-pregnant-workers-but-red-states-sue-over-abortion-provisions/#respond Sat, 01 Jun 2024 10:45:35 +0000 https://missouriindependent.com/?p=20338

The Pregnant Workers Fairness Act, a new workplace anti-discrimination law that was passed by Congress with wide bipartisan support, has become fodder in the abortion rights battle between Republican-led states and the federal government (Getty Images).

Natasha Jackson was four months pregnant when she told her supervisor she was expecting. It was 2008, and Jackson was an account executive at a rental furniture store in Charleston, South Carolina — the only female employee there.

“I actually hid my pregnancy as long as I could because I was scared about what could happen,” she said.

When her doctor recommended that she not lift more than 25 pounds, her employer wouldn’t let her move temporarily to a role where she didn’t need to lift furniture, even though those roles were available, she said. She was forced to go on leave and then lost her job. Her marriage unraveled and she spent time after the birth in emergency housing.

“That hardship affected me years on, and it took away the joy of being pregnant,” said Jackson. “They made me feel guilty and ashamed for having a baby.”

Jackson, now 41 and a mother of four who owns her own cleaning company, has spent years working with advocacy groups to fight for better laws to protect pregnant workers. Last year, she was invited to speak at a White House event celebrating the passage of the Pregnant Workers Fairness Act, a new workplace anti-discrimination law for which she had advocated.

But now this law, passed with wide bipartisan support, has become fodder in the bitter battle over abortion rights between Republican-led states and the federal government.

The act fills gaps in state and federal protections by requiring employers with 15 or more employees to provide “reasonable accommodations” for pregnant workers and those who have recently given birth or have related medical conditions — unless the employer can prove it would cause “undue hardship” on the business.

Accommodations can include allowing an employee to take additional bathroom breaks, carry a water bottle, or sit instead of stand while on the job. After years of lobbying by nonprofit organizations and business groups, the federal law passed in December 2022. It went into effect last June.

In its rulemaking process, the Biden administration included abortion as a “related medical condition” covered by the law. That means employees seeking abortion care can ask for accommodations from their employers, such as time off work for an appointment or recovery.

This year, 19 Republican attorneys general — including from Jackson’s home state of South Carolina — have sued the administration over that interpretation.

The AGs argue the Biden administration is forcing abortion accommodations even in states where abortions are illegal.

“Under this radical interpretation of the PWFA, business owners will face federal lawsuits if they don’t accommodate employees’ abortions, even if those abortions are illegal under state law,” Arkansas Republican Attorney General Tim Griffin said in a statement last month announcing the lawsuit filed by Arkansas and 16 other Republican-led states.

But some advocates say the lawsuit threatens protections for all pregnant workers covered under the new law — not just the small subset who need abortion care.

“These states are cutting off their noses to spite their faces,” said Elizabeth Gedmark, an attorney and vice president of A Better Balance, a national nonprofit advocacy organization that provides legal services and has long pushed for a national Pregnant Workers Fairness Act.

“These attacks have very real consequences for peoples’ lives and for their economic security and health,” she said.

Jackson fears the lawsuit could lead to fewer workers accessing the care they need to be healthy.

“[Workers] should have the right to proper medical care during pregnancy, after childbirth, after having a miscarriage, or having an abortion,” she said. “It seems quite ridiculous to me that some employers want so much control over employees to the point that they feel like they have the right to threaten their job security because of pregnancy or anything associated with it.”

Into the fray

After Congress passed the Pregnant Workers Fairness Act, the U.S. Equal Employment Opportunity Commission, a federal agency known as the EEOC, had to hammer out a set of rules that clarify what employers can and can’t do under the law.

So last summer, the EEOC sought public comment on its proposed rules for how the new law would work. More than 100,000 comments were submitted over a two-month period.

The flood of comments stemmed from opinions about whether the EEOC should include abortion in its definition of “pregnancy, childbirth or related medical conditions” that are covered under the new law.

The vast majority were nearly identical form comments, according to the EEOC. About 54,000 of the comments urged the EEOC to exclude abortion, while about 40,000 supported its inclusion.

In a 3-2 vote, the EEOC ultimately adopted new rules that included abortion care in its definition of conditions covered under the law. The rules are set to go into effect June 18.

But in April, a week after the EEOC announced its final rules, the 17-state coalition of GOP attorneys general argued in its lawsuit that the agency’s “erroneous interpretation” of the Pregnant Workers Fairness Act creates an “abortion accommodation mandate.”

“When the law was passed by Congress, it was explicitly understood not to address abortion at all, and the text of the statute does not address abortion,” said Tennessee Attorney General Jonathan Skrmetti, who is co-leading the lawsuit with Arkansas’ Griffin.

Skrmetti and the other Republican attorneys general point to comments made by lawmakers during debate on the measure that appear to signal Congress’ intent was not to impose abortion-related requirements in states where those abortions would be illegal.

Pennsylvania Democratic U.S. Sen. Bob Casey, who sponsored the pregnant workers bill, said during debate that the EEOC “could not issue any regulation that requires abortion leave, nor does the act permit the EEOC to require employers to provide abortions in violation of state law.”

The 15 other states joining the lawsuit are Alabama, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Missouri, Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota, Utah and West Virginia.

More states have jumped into the fray. In mid-May, Louisiana’s and Mississippi’s attorneys general, both Republicans, filed their own lawsuit challenging the same provision.

And in February, a federal judge in Texas blocked the EEOC from accepting complaints filed by Texas state employees under the Pregnant Workers Fairness Act. It was a win for Texas Republican Attorney General Ken Paxton, who had sued the Biden administration last year.

Protections at risk

Skrmetti, the Tennessee attorney general, believes the Pregnant Workers Fairness Act is a good law.

“It was passed with a degree of bipartisanship that you rarely see,” he told Stateline, “and it undermines the efforts of Congress and the popular will when agencies take laws and change them without the authority of the people’s representatives.”

But Gedmark, of A Better Balance, said decades of legal precedent support including abortion as a related medical condition for pregnant workers. The Pregnancy Discrimination Act, a federal law passed in 1978, prohibits sex discrimination based on pregnancy, childbirth or related medical conditions — a definition that the EEOC has long interpreted to include abortion.

Proponents of the new Pregnant Workers Fairness Act and the EEOC’s rules worry the lawsuits will sow confusion among employers and employees. There’s concern, Gedmark said, that a court could render more of the regulations invalid, beyond those that mention abortion.

Skrmetti doesn’t think the 17-state lawsuit will hurt the law’s protections for pregnant, postpartum and lactating workers.

“The optimal outcome would be for the abortion-related pieces of the rule that aren’t supported by the statute to be vacated,” he said. “But the law remains the law regardless of what the [EEOC’s] rules are.”

While states and the feds clash in court, Jackson said she’s focused on making sure as many women as possible know about their new rights.

Whenever she’s out shopping and spots a pregnant store employee, she asks how they’re doing. She asks if they know about their workplace rights, and how to ask their employers for the accommodations they need.

“Whether a mother decides to have an abortion or not, she still needs medical care after the procedure, the same as she would need medical care if she had a miscarriage or regular childbirth,” Jackson said. “I believe that employers need to know the difference between personal [ideology] and business.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

]]>
https://missouriindependent.com/2024/06/01/new-rules-protect-pregnant-workers-but-red-states-sue-over-abortion-provisions/feed/ 0
More addiction patients can take methadone at home, but some states lag behind https://missouriindependent.com/2024/05/13/more-addiction-patients-can-take-methadone-at-home-but-some-states-lag-behind/ https://missouriindependent.com/2024/05/13/more-addiction-patients-can-take-methadone-at-home-but-some-states-lag-behind/#respond Mon, 13 May 2024 15:03:26 +0000 https://missouriindependent.com/?p=20162

People wait in line for a methadone clinic to open in Hoquiam, Wash., in 2017. As a chorus of physicians and advocates calls for loosening methadone restrictions, states have been slower to adopt new relaxed federal rules (David Goldman/The Associated Press).

Matt Haney’s home in San Francisco isn’t far from a methadone clinic.

The 42-year-old state lawmaker has watched people line up early each morning outside the clinic in the Tenderloin, a community long considered the epicenter of the city’s substance use epidemic. His neighbors wait for the daily dose of methadone that relieves their cravings and minimizes opioid withdrawal symptoms.

Despite methadone’s effectiveness, a labyrinth of state and federal rules — meant to guard against its misuse — keeps it inaccessible to many people who desperately need it, Haney said.

“What kind of normal person with a job, a life and a family can line up for medication every morning, sometimes far from where they live?”

The Democratic assemblymember and majority whip noted that California is one of many states with rules that are stricter than federal regulations on when, where and how people can access opioid treatments like methadone.

“It’s almost comical how difficult it is to get this medication and stay on it,” he said.

Yet addiction treatment in the United States is poised for change. This year, the federal Substance Abuse and Mental Health Services Administration, known as SAMHSA, made permanent a set of pandemic-era rules that loosened several restrictions, including those on take-home doses of methadone.

It’s a move that a broad consensus of academics, advocates and providers says will improve treatment access and success rates. Having the flexibility to take medication at home can mean patients can get to work or get their kids to school on time. They can deal with family emergencies and unexpected travel. And they avoid the stigma of waiting in line at a clinic.

In theory, the new federal rules make more take-home methadone doses available to a wider subset of patients. But what’s less clear is how the rules will trickle down to states. There’s concern states that didn’t preserve the relaxed regulations they had during the pandemic might be slow to adopt them now.

“A number of states will have to revise their regulations if they’re going to be in alignment with what SAMHSA has released,” Mark Parrino, founder and president of the American Association for the Treatment of Opioid Dependence Inc., a national trade group that supports the new federal regulations. “What could delay implementation would be the state regulators.”

Later this month at his group’s annual conference, SAMHSA will convene a closed-door meeting of regulators from all 50 states to discuss the new federal rules and how states might bring their own standards into compliance, Parrino said.

It’s all happening as the opioid crisis, driven by rising fentanyl overdoses, has prompted a chorus of physicians and advocates to call for loosening methadone restrictions even further — a move that leaders at many opioid treatment programs oppose.

‘Liquid handcuffs’

Medications that treat opioid use disorder — such as methadone, buprenorphine and naltrexone — are rigorously regulated by the government. They block the effects of opioids or halt withdrawal symptoms and reduce cravings without causing the same feelings of euphoria.

But while medications like buprenorphine can be prescribed by a physician and taken at home, methadone can only be prescribed and dispensed in the United States through federally certified clinics called opioid treatment programs. Methadone can be taken as a liquid, a pill or an injectable.

Currently, about 1,800 certified opioid treatment programs operate in the United States, giving methadone treatment to about 400,000 people.

That’s just 19% of the estimated 2.1 million people in the United States who have opioid use disorder.

Until the pandemic, most methadone patients had to visit a clinic daily to take their doses while a provider watched. Restrictions stem from concern that methadone can be abused or resold. Even though it does not produce an intense high, it’s possible to overdose if it’s not taken as prescribed.

But the tight regulation created a system that keeps patients tethered to the nearest methadone clinic with what some have called “liquid handcuffs.” Long clinic lines, varying hours, counseling requirements and inflexible rules around rescheduling appointments make it difficult for patients to juggle job and family responsibilities.

One pregnant patient in a 2021 study reported being required to remain in line at her methadone clinic even after her water broke. Other patients said they were refused take-home doses for family emergency situations or were randomly required to make additional clinic visits. Ten states require methadone providers to observe patients during urine sample collection, according to a 2021 analysis by The Pew Charitable Trusts.

“There’s no other medical condition where we feel like patients need to earn the right to treatment,” said Ximena Levander, an addiction medicine physician and researcher at Oregon Health & Science University. “What SAMHSA has done with these new rules is to try to shift that paradigm from a punitive, ‘you need to earn this’ model to a patient-centered, individualized treatment plan.

“But it’s going to take time for that culture change to happen.”

A power imbalance

At the outset of the COVID-19 pandemic, federal officials allowed states to give more methadone patients up to 28 days of take-home doses. In February of this year, SAMHSA made these new, looser rules permanent. They went into effect last month, and opioid treatment programs have until October to comply.

“That’s an ambitious timeline,” said Parrino, of the trade group. His association represents more than 1,300 opioid treatment clinics.

At least 10 states had “stability criteria” for take-home doses that were stricter than federal rules as of June 2021. Individual opioid treatment programs might be more conservative still. Some, for example, won’t allow take-home doses for patients who drink alcohol or use cannabis. Even individual clinicians might have their own views about what patients must do before being allowed take-home doses.

The requirements help keep patients safe, Parrino said: “Methadone is an incredibly successful medication and it’s extremely effective, but it’s deadly if used unwisely.”

Yet for patients, opioid treatment programs’ monopoly on methadone treatment represents a power imbalance that’s not as apparent in other areas of medicine.

Levander recalled one patient who said her treatment program had increased her required clinic visits from once a month to once every two weeks, and she felt like she had no recourse to challenge that decision.

“Patients know if they lose access to their medication, they may not have another methadone program nearby and they could return to use [of illicit drugs],” Levander said. “The opioid treatment programs have all the power and control. There’s not a lot of desire from patients to rock the boat.”

Haney, the California state lawmaker, has introduced a bill that would remove several barriers to methadone access, including allowing physicians outside of opioid treatment clinics to temporarily prescribe take-home doses. The bill passed out of committee late last month with bipartisan support.

Minnesota lawmakers introduced a bill this year, still in committee, that would bring the state’s rules for dispensing take-home doses in line with federal rules. Some states, such as Massachusetts, issued executive orders adopting many of the new federal guidelines. State agencies in places including Minnesota and Colorado have shifted their rules to adopt a more patient-centered approach to addiction medicine.

But other states haven’t yet followed suit.

“It’s so highly variable as far as where states are on this issue,” said Bobby Mukkamala, a physician in Flint, Michigan, who is on the board of trustees at the American Medical Association. “Some states are way ahead at truly looking at substance use disorder as a medical condition, not something to be punished.”

Methadone monopoly

Meanwhile, a bipartisan bill in Congress could further deregulate the opioid treatment industry and open methadone treatment nationally to physicians outside of clinics. U.S. Sen. Edward Markey, a Democrat from Massachusetts, and U.S. Sen. Rand Paul, a Republican from Kentucky, have introduced legislation that would allow physicians trained in addiction treatment to prescribe methadone outside of a clinic.

It’s a move supported by several national organizations, including the American Medical Association.

“If it’s the restriction that’s stopping patients with these issues from seeing a physician to help, then we need to remove it,” said Mukkamala.

But the opioid treatment program industry is pushing back. Parrino noted that many opioid use disorder patients have other associated conditions, from HIV to emotional trauma, that require the kind of comprehensive and regimented treatment available from a certified clinic.

Earlier this year, Markey suggested opioid treatment clinics have more financially driven motivations for their opposition to expanding methadone to non-clinic settings.

“Ultimately, tethering methadone exclusively to opioid treatment programs is less about access, or health and safety, but about control, and for many investors in those programs, it is about profit,” he said in a February statement about the new rules.

Nearly two-thirds of opioid treatment programs are operated by for-profit companies. At least 562 of those are financed by private equity firms, according to a STAT News analysis. Private equity’s involvement in health care has been the subject of an avalanche of scrutiny from lawmakers, advocates and researchers in recent years.

A growing body of research supports methadone’s deregulation. A 2022 survey of opioid treatment patients in a Midwest community found more than half reported travel and work conflicts kept them from treatment. Last year, researchers found that flexible methadone take-home policies were associated with fewer overdose deaths among Black and Hispanic men. Another recent study found that take-home flexibility of methadone did not lead to more methadone-involved deaths.

Haney, the California lawmaker, thinks moving methadone beyond clinic walls would benefit not just people with opioid use disorder, but also their surrounding communities, such as the Tenderloin.

“These outdated policies come from a fear of these patients and a fear of this medication that’s misguided,” he said. “It’s fueling the crisis that we are now facing.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

]]>
https://missouriindependent.com/2024/05/13/more-addiction-patients-can-take-methadone-at-home-but-some-states-lag-behind/feed/ 0
Vets fret as private equity snaps up clinics, pet care companies https://missouriindependent.com/2024/03/29/vets-fret-as-private-equity-snaps-up-clinics-pet-care-companies/ https://missouriindependent.com/2024/03/29/vets-fret-as-private-equity-snaps-up-clinics-pet-care-companies/#respond Fri, 29 Mar 2024 13:35:18 +0000 https://missouriindependent.com/?p=19579

Veterinary personnel keep a cat named Miller calm as he has blood drawn at a veterinary hospital in Florida. Some veterinarians and advocates warn that private equity’s involvement in veterinary care could lead to higher costs for consumers and the closure of independent practices (Wilfredo Lee/The Associated Press).

HUNTSVILLE, Ala. — About a year ago, veterinarian Melissa Ezell started noticing subtle changes at the midsized animal clinic in Huntsville, Alabama, where she works.

She said she and other vets were feeling pressure from management to make a certain amount of money from every appointment. If a pet owner wasn’t going to spend enough, the message from management was to offer more services. She was urged to pack in more patients outside of normal business hours.

“Before, I never felt any pressure to be making a certain amount of money in a day,” Ezell, who started working at the clinic in 2021, told Stateline. “It was just, ‘Fill your schedule, practice good medicine, everything else will come.’”

The clinic is owned by National Veterinary Associates, one of the largest veterinary chains in the nation. In 2020 the company was acquired by JAB Consumer Partners, a global private equity firm based in Luxembourg. By early 2023, Ezell said, she felt a shift in atmosphere at the clinic and a greater focus on increasing profits.

Private equity’s foray into the human health care industry in recent years has drawn public outrage and legislative scrutiny as firms have been blamed for increasing prices, slashing services and shuttering hospitals to maximize shareholder profits.

Now, some veterinarians and advocates are sounding the alarm that private equity’s entry into the pet health care industry could lead to similar results.

Some states already have laws that prohibit non-veterinarians from owning veterinary practices, and some consumer advocates want states to review large-scale acquisitions in the industry.

“A large number of these funds are seeing veterinary medicine as a good profit center,” said Dr. Grant Jacobson, an Iowa veterinarian who serves on the board of the Independent Veterinary Practitioners Association. He said he’s seen corporate-owned chains in his region drive up prices for consumers, suppress market competition and skirt state laws that ostensibly prohibit veterinary practices from being owned by non-veterinarians.

Private equity firms such as Shore Capital Partners, KKR, TSG Consumer and JAB Consumer Partners have spent billions over the past few years on veterinary practices, specialty animal hospitals, pet insurance services and pet food companies. Among the companies owned by private equity are PetSmart, PetVet Care Centers, FIGO, Thrive Pet Healthcare and ASPCA Pet Health Insurance.

Private equity firms say those investments are giving clinics and other providers the capital they need to buy better technology, and that they are improving efficiency. And in many cases, corporate chains can offer their employees better workplace benefits, such as health insurance.

In a statement to Stateline, National Veterinary Associates said its corporate philosophy is “grounded in vets making medical decisions and not a corporate office,” and that its program of shared ownership by veterinarians is “the industry’s largest such program and unique among our peers.”

“Our vision is to build a community of hospitals that pet owners trust, are easy to access, and provide the best possible care,” National Veterinary Associates said in the statement.

JAB Consumer Partners did not respond to Stateline’s request for comment.

More pets, more money

Private equity uses pooled investment money from pension funds, endowments and wealthy individuals to buy controlling stakes in companies. The firms typically look for a quick return on their investment before selling it within a few years. They have been gobbling up small businesses in myriad industries in recent years — from nursing homes to car washes.

As pet ownership soared during the COVID-19 pandemic, private equity followed close behind. The pandemic years of 2020-2022 were “the peak years for private equity acquisitions of veterinary services and practices,” said Michael Fenne, senior coordinator for health care at the Private Equity Stakeholder Project, a nonprofit watchdog group that advocates for communities affected by private equity ownership.

Americans spent a record $147 billion on pet products and services last year. From 2017 to 2022, private equity spent $45 billion on deals in the veterinary sector, according to PitchBook, which tracks investment data.

The vet industry is attractive because it’s mostly made up of small, privately owned businesses that corporations can buy and consolidate into larger chains. And it’s mainly a cash-based business: Unlike in human health care, veterinary customers typically pay out of pocket, rather than rely on third-party payers such as insurance companies.

In some cases, private equity firms and other corporations buy community clinics from the veterinarians who own them for two, five or even 10 times their value. Then the firms roll them up into a larger chain of clinics that can corner a regional market.

It’s a strategy that can push other private owners out of the business, said Jacobson, the Iowa veterinarian. He spent nearly 20 years working at a privately owned practice in Iowa and had hoped to buy it when the original founder retired.

But the founder sold the practice to a large veterinary chain owned by Mars Inc. — the private company best known for owning candy brands that include M&Ms — for more than $1 million above his offer, Jacobson said. Mars, while not a private equity firm, is the biggest consolidator of pet care companies in the United States, owning pet food companies, pet pharmacies and veterinary care clinic chains such as Banfield Pet Hospitals and BluePearl.

About a quarter of general veterinary practices and about three-quarters of specialty practices, such as emergency and surgery care, are now owned by large corporations, according to John Volk of Brakke Consulting, a veterinary management consulting firm.

Some private equity-backed chains, such as National Veterinary Associates, buy community-based veterinary practices like Ezell’s without rebranding them under the chain’s name. As a result, clients might not be aware of the ownership change.

“It can appear you’re getting community-oriented care when there’s actually this set of big-box incentives underlying [the clinic] that comes from their private equity owners,” Fenne said.

Where vets want to work

Lori Kogan, a clinical sciences professor at Colorado State University’s College of Veterinary Medicine and Biomedical Sciences, surveyed nearly 900 veterinarians in 2022 about their experiences and perceptions of corporate vs. privately owned veterinary clinics.

Even though most of the veterinarians surveyed reported working for corporate-owned clinics, Kogan found more than half said they would prefer to work in privately owned clinics. The benefits offered by corporate chains, such as health insurance, didn’t seem strong enough to override other preferences, Kogan told Stateline.

“Feeling like they have a voice in decision-making, feeling like they’re recognized as an individual, those are things that are really important to people,” she said. “I think corporate ownership could accomplish those things, but it will take paying attention.”

Ezell, the veterinarian who left National Veterinary Associates, said the pressure has an impact on patients and their humans as well.

“Either you’re getting talked into additional services that may or may not actually be necessary, or your feel like you’re being rushed,” Ezell said. “You feel like you don’t have the time with the doctor, and you leave not fully understanding what was done to your pet or what is wrong with your pet if they’re sick.”

In its statement to Stateline, National Veterinary Associates noted that it has made “continued investment in technology and infrastructure, pioneering clinical research, industry-leading continuing education programs and wellbeing initiatives.”

Could states step in?

Last August, Thrive Pet Healthcare announced it would be closing the only 24-hour emergency veterinary clinic in the Rochester, New York, metro area. Thrive is a chain of more than 500 veterinary clinics and hospitals based in Austin, Texas, that is owned by private equity firm TSG Consumer.

“The thought of having the only 24-hour emergency pet care center in our entire metro area close was really scary,” said Rachel Barnhart, a Democratic member of the Monroe County Legislature in New York who has taken her dogs to the clinic. “We are a community of more than a million people. The idea that we can’t support a 24-hour pet facility is outrageous.”

Barnhart wrote a letter to the Federal Trade Commission, asking it to look into Thrive, which operates more than a dozen clinics in Rochester. She said she’d seen the FTC act against anticompetitive practices in the veterinary industry elsewhere, and she felt Thrive deserved similar scrutiny.

Thrive leadership said in a letter to Barnhart and in media reports that a shortage of ER veterinarians made it impossible to hire enough workers to keep the 24-hour clinic open. But Barnhart suspected the company wanted to shutter the clinic because its staff recently voted to unionize. CEO Tad Stahel said in the letter to Barnhart that the closure was unrelated to the staff unionization.

In 2022, the FTC took action against JAB Consumer Partners, which recently acquired an array of veterinary and pet service companies. The FTC required the firm to divest some of its vet clinics in California, Colorado, Texas, Virginia and Washington, D.C., as a condition of approving its multibillion-dollar purchases of two other multistate veterinary care chains.

If states were to authorize officials or agencies to review similar large-scale mergers and acquisitions in the veterinary industry, that “would be a good first step” toward protecting consumers, said Fenne, of the advocacy group.

Many states already have laws that prohibit non-veterinarians from owning veterinary practices, including Iowa, Minnesota, New Jersey, New York and North Carolina. The idea is to prevent corporate interests from guiding veterinarians’ medical judgment.

Experts and advocates expect to see further corporatization in veterinary care as more companies acquire not just vet clinics, but also other businesses across the pet care spectrum.

In February, asset management behemoth Blackstone Inc. acquired Rover, the nation’s largest online platform for pet sitting, dog walking and other services. In the past two years, JAB has acquired several of the largest pet insurance companies in the United States and Europe.

Ezell, the Alabama veterinarian, eventually decided to take a job at another clinic in town that’s privately owned. She will start there in a few weeks.

“Not all corporate medicine is horrible, and you can find amazing veterinarians and caring support staff anywhere,” she told Stateline.

“But it’s easy to lose sight of your values. The whole reason we’re doing this is we want to make a difference in animals’ and people’s lives. If we’re unable to do that, shouldn’t we try to fix that?”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

]]>
https://missouriindependent.com/2024/03/29/vets-fret-as-private-equity-snaps-up-clinics-pet-care-companies/feed/ 0
Facing public backlash, some health care companies are abandoning hospital deals https://missouriindependent.com/2024/03/19/facing-public-backlash-some-health-care-companies-are-abandoning-hospital-deals/ https://missouriindependent.com/2024/03/19/facing-public-backlash-some-health-care-companies-are-abandoning-hospital-deals/#respond Tue, 19 Mar 2024 11:30:48 +0000 https://missouriindependent.com/?p=19408

Connecticut residents stage a protest outside Day Kimball Hospital in Putnam, Conn., in July 2022 amid the hospital’s discussions to be acquired by Covenant Healthcare, worried that a takeover by the Catholic health system would lead to cuts in reproductive care and other services. Proposed hospital deals in some states have fizzled as lawmakers turn up the regulatory heat amid intense pushback from organized labor and grassroots organizations (Susan Haigh/The Associated Press).

Worried about hospitals closing and higher costs for patients, state lawmakers are increasingly tangling with hospitals over potential health care mergers, in some cases derailing deals they think don’t serve the public interest.

Financially strapped hospitals often look to merge with or be acquired by other systems. After a pandemic-era slowdown, health care mergers and acquisitions have risen steadily over the past two years. But some proposed hospital deals in Connecticut, Louisiana, Minnesota and elsewhere have fizzled amid heavy pushback from lawmakers, organized labor and grassroots organizations.

At least 10 health care “megadeals” were called off or unwound just last year, due in part to increased oversight, reported Becker’s Hospital Review, an industry publication.

“We have seen situations nationally in certain health care transactions where a lot of promises were made, but when you look into it, clinics are closing, prices are going up, access is down,” Minnesota Attorney General Keith Ellison, a Democrat, told Stateline.

Ellison was in the middle of campaigning for reelection in late 2022 when he learned that Minnesota-based Fairview Health Services intended to merge with Sanford Health, a larger South Dakota-based health care system.

The proposed deal drew intense criticism from Minnesota’s Democratic legislators, from nurses unions, University of Minnesota leaders and community groups. Fairview owns the University of Minnesota Medical Center, which is funded by state taxpayers. If the systems merged, Minnesota tax dollars might be spent across state lines. Some legislators also argued the resulting system would create a local health care monopoly that could lead to fewer services and higher costs for patients.

As the Fairview-Sanford deal chugged along, Ellison’s office held public listening sessions across the state. And while Fairview and Sanford officials said the merger would allow the systems to expand care and some residents expressed support for the deal, the overall sentiment from stakeholders was negative, Ellison recalled.

Meanwhile, Democratic lawmakers passed a bill in May 2023 that bans anti-competitive health care mergers and strengthens state oversight of potential deals. It was signed into law that month.

Two months later, Sanford Health called off the merger due to lack of support from “certain Minnesota stakeholders.”

Financially struggling hospitals

In March 2023, Massachusetts-based Covenant Health called off its plan to purchase a smaller, struggling health care system in the rural northeast corner of Connecticut. More than a quarter of announced health care deals in the United States last year involved a financially distressed partner, according to consultancy KaufmanHall.

Community groups rallied against the deal, concerned that Covenant’s takeover would lead to cuts in reproductive care and other services. Covenant is a Catholic system and follows a set of rules called the Ethical and Religious Directives for Catholic Health Care Services, which forbids the system from providing some types of health care. Those include emergency contraception, fertility services, gender-affirming care, abortion and some end-of-life care.

“My concerns were really rooted in the fact that it was a Catholic-affiliated health care institution that follows Catholic directives,” Connecticut state Rep. Jillian Gilchrest, a Democrat, told Stateline. “That region of the state already has limited health care options, and one of the Planned Parenthood clinics in that area had recently closed.

“There was a concern that women in the northeast corner of Connecticut wouldn’t have access to reproductive health care.”

Some area residents worried they’d lose their hospital without Covenant’s takeover, but others formed a coalition that called on the state to deny the proposed acquisition. Gilchrest joined 15 other Democratic state legislators in signing a letter opposing the deal.

It fell through a few months later.

Covenant President/CEO Steve Grubbs said in a statement announcing the deal’s cancellation that “the affiliation was no longer financially viable.”

Day Kimball Healthcare CEO R. Kyle Kramer said the system’s leadership was “disappointed” by Covenant’s decision not to acquire it, in a statement he released shortly after it was announced.

“We are immediately pursuing the best path forward for Day Kimball and look forward to working with local and state officials as well as exploring discussions with other potential future partners to preserve essential hospital services in the northeastern Connecticut community,” Kramer’s statement read.

Gilchrest said she hopes Connecticut lawmakers will do more to protect services being eliminated following some hospital mergers, particularly women’s health services.

“Unfortunately, I feel like we have not been able to go far enough yet,” she told Stateline. “As a result of many of these mergers, when it comes to women’s reproductive health care, we continue to see the closure of services like labor and delivery units across Connecticut.”

More pushback

This year in Louisiana, pushback from state lawmakers and community groups paused a proposed $2.5 billion sale of the nonprofit Blue Cross and Blue Shield of Louisiana to for-profit insurance giant Elevance Health. Blue Cross had defended the proposed sale by saying it would help the nonprofit insurer slow rising health care costs and better compete with its national rivals.

Last month, Louisiana state senators sent a report to the state insurance commissioner outlining dozens of concerns over the fairness of the deal, alleged attempts by Blue Cross to influence policyholders’ votes, and Elevance’s “troubled” history of fines, penalties, lawsuits and premium increases. The Louisiana Hospital Association, other medical groups and the state treasurer also opposed the deal.

Louisiana state Sen. Jeremy Stine, a Republican, said he plans to introduce a bill this legislative session that would prevent deals like the proposed Blue Cross sale from taking effect without meeting certain consumer protection standards.

“The proposed Blue Cross Blue Shield sale to Elevance Health has raised concerns about the potential consequences for Louisiana’s healthcare landscape,” Stine said in a statement sent to Stateline.

“By implementing these safeguards, we aim to prevent any undue influence, personal gain, or hasty decision-making that may compromise the health and well-being of our community.”

Back in Minnesota, the attorney general’s office has reviewed nearly a dozen proposed health care transactions since the new law passed less than a year ago.

“Before this law was passed, we did not get advance notice [of a merger or other transaction] unless the parties told us,” said Elizabeth Odette, manager of the antitrust division at the Minnesota AG’s office.

“Sometimes that meant there was not a whole lot we could do, meaningfully, before the parties completed the transaction.”

But the stronger law has allowed “not only our office but the public and the [involved] parties to take a little more time to consider the implications of a proposed large merger,” she said.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

]]>
https://missouriindependent.com/2024/03/19/facing-public-backlash-some-health-care-companies-are-abandoning-hospital-deals/feed/ 0
More places install drop-off boxes for surrendered babies. Critics say they’re a gimmick https://missouriindependent.com/2024/02/28/more-places-install-drop-off-boxes-for-surrendered-babies-critics-say-theyre-a-gimmick/ https://missouriindependent.com/2024/02/28/more-places-install-drop-off-boxes-for-surrendered-babies-critics-say-theyre-a-gimmick/#respond Wed, 28 Feb 2024 15:02:36 +0000 https://missouriindependent.com/?p=19121

Since it was installed in January, the Safe Haven Baby Box at a fire station in Madison, Ala., has received a surrendered infant on two separate occasions. Both babies were taken to a local hospital for evaluation and then put in the care of state child services (Anna Claire Vollers/Stateline).

The pitch feels noble, visceral: Prevent newborns from being discarded in dumpsters, and do it in a way that shields the mother and protects her anonymity while safeguarding the baby’s health and future.

In a growing number of states, the answer to the rare occurrence of illegal infant abandonment is a baby drop-off box. It’s an infant incubator secured behind a small door in the exterior wall of a public facility such as a hospital or fire station. A person can walk up to the box, open the door, place an infant into the bassinet inside, close the door and walk away.

The bassinet is temperature controlled, ventilated and equipped with alarms that alert emergency responders, who arrive within minutes. The baby is placed into foster care or for adoption, and the parent is not prosecuted for abandonment.

Installing baby boxes has become increasingly popular as lawmakers, including those in states with the most restrictive abortion laws, look for ways to show support for pregnant women and new parents.

But a growing chorus of experts and adoption advocates argue that however well-intended, baby boxes are a gimmick, unsupported by scientific research, that won’t address the real problems facing parents and newborns. They also worry about the inability to establish informed consent or medical histories.

“I think what legislators hear is, ‘If you don’t do this, there will be dead babies abandoned on the streets of your city,’” said Gregory Luce, a Minnesota attorney and founder of the Adoptee Rights Law Center who has been a vocal opponent of baby boxes.

“They don’t want that to happen on their watch,” he said, “whether they’re Republicans or Democrats, so they pass it without further investment in prenatal or postnatal services for women, or mental health services, or services for women in crisis.”

At least 19 states now allow the use of newborn drop-off boxes, though more than half the incubators that have been installed are in Indiana, the home state of the company that makes them. Lawmakers have introduced bills this legislative session in 15 more states: Colorado, Georgia, Idaho, Indiana, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New Mexico, South Carolina, Tennessee, Washington and Wyoming.

In Missouri, a newborn girl was anonymously surrendered to a drop-off box two weeks ago at a Mehlville Fire Protection District station in St. Louis County. Paramedics retrieved the baby within a minute and took her to a hospital.

It was the first time a drop-off box was used in Missouri since a law legalizing them was passed in 2021. The bill’s sponsor, Republican Rep. Jim Murphy, posted on social media that after the news broke that, “Today we celebrate a life saved and I can think of nothing greater.”

Baby boxes have proven surprisingly bipartisan, despite their ties to the conservative anti-abortion movement. And they’re media-friendly: The surrender of infants into the boxes regularly makes the local news, and cities often hold ribbon-cutting-style ceremonies when a box is installed.

“We know [baby boxes] work because we’ve seen it,” said Tennessee Republican state Rep. Ed Butler, the sponsor of a baby box bill in his state. “My objective is to save a baby’s life, end of discussion.”

But Lori Bruce, a bioethicist at Yale School of Medicine, described baby boxes as a poor solution to infant abandonment, “because we know things like prenatal care are more integral to the health of an infant, as well as to the birthing parent.”

She would like to see states consider allowing women to labor and deliver at hospitals anonymously — as Jane Does — so they can relinquish their newborns in a safer setting.

Babies in boxes

The overwhelming majority of the more than 200 active baby boxes currently in place in at least 15 states are provided by one company: a nonprofit called Safe Haven Baby Boxes Inc.

Monica Kelsey is the founder. An adoptee herself, she is closely aligned with the anti-abortion rights movement and travels around the country, speaking at news conferences when infants are surrendered, holding “blessing” ceremonies to dedicate new boxes, and spreading baby box awareness to more than 800,000 followers on her popular TikTok account.

“I do think women and men are scared when they get into a moment of crisis and they freak out, not knowing what to do,” she told Stateline. “We’re out there in the public every single day, educating and bringing awareness that they have options, so when they do have a crisis, they will come to us.”

The nonprofit says 42 babies have been surrendered to its baby boxes since the first one opened in Indiana in 2016. There’s no national database of infant abandonments — legal or illegal — and many states don’t track those numbers.

The National Safe Haven Alliance, another nonprofit dedicated to infant abandonment prevention, estimates that more than 4,500 babies have been relinquished under safe haven laws since 1999. Those laws allow parents to surrender newborns to safe spaces such as hospitals and fire stations, placing the infant in a recipient’s arms, without risk of prosecution for abandonment. The group estimates that another 1,610 babies were illegally abandoned; fewer than half of those were found alive.

States began passing so-called safe haven laws more than two decades ago. Texas passed the first safe haven law in 1999, and soon every state had its own version. For some in the anti-abortion rights movement, safe haven laws — and by extension baby boxes — are an answer to critics who say restricting abortion rights will lead to more unwanted babies. U.S. Supreme Court Justices Amy Coney Barrett and Samuel Alito both cited safe haven laws during the landmark Dobbs v. Jackson case that ended the constitutional right to abortion.

Michelle Oberman, a law professor at Santa Clara University in California who has studied state safe haven policies, said states have different rules for drop-off locations and how old a surrendered infant can be, and varying protections for parents when an infant tests positive for illegal substances. Some laws require surrendered infants to be placed into foster care, while others fast-track them into adoptions. Few, if any, require the kind of oversight that would ensure the infant surrenders are truly voluntary and not coerced, she said.

“It feels to me like such a limited and heartless response to say, ‘We don’t care that you’re unhoused, addicted or mentally ill — just drop off your baby and we’ll let you go on your way,’” Oberman said. She wants states to gather better data on newborns who are surrendered, including where and under what circumstances, and use that data to write bills that would support parents in crisis.

Safe haven laws aren’t tailored for the communities most likely to use them, nor designed for people who don’t feel comfortable walking into a hospital, Bruce said. People with low incomes and communities of color are disproportionately affected by the kinds of crises — housing instability, domestic violence, lack of access to treatment for mental illness or substance use — that might influence a person to surrender their infant.

A 2019 study from the University of Southern California’s Keck School of Medicine and Children’s Hospital Los Angeles looked at infants who had been safely surrendered in Los Angeles County and found the majority were surrendered in lower-income communities. More than half of the infants had medical issues requiring monitoring or specialized care.

Using taxpayer dollars

The initial cost of a baby box is about $20,000. That price includes the leasing of the box from Safe Haven Baby Boxes, which owns the patent and contracts with a manufacturer, as well as costs for installation, electrical and alarm system hookups, and staff training on how to use it. There’s also a $500 annual service fee, paid to Safe Haven Baby Boxes, to ensure the box continues working properly.

Safe Haven Baby Boxes are typically paid for through private donations and nonprofit organizations, though local municipalities may be on the hook for continuing annual maintenance and fees.

Most state baby box laws simply allow the boxes, but some legislators are pushing their states to spend taxpayer money to fund them.

In Tennessee, lawmakers this year introduced a bill that would require a “newborn safety device” such as a baby box to be installed at a safe haven location in each of the state’s 95 counties. As currently amended, the bill would create a $2 million grant program to help each county pay for leasing and installation — about $21,000 per box.

An average of six or seven newborns are surrendered each year under Tennessee’s safe haven law, according to Tennessee’s Department of Children Services. The state currently has three baby boxes, one of which has received a surrendered infant; the rest have gone to hospitals, fire stations or other safe havens.

“I support face-to-face handoff because that’s likely the best option,” said Butler, the Tennessee lawmaker who sponsored the bill. “But what I don’t want to happen is that because the mother is in a bad place, she’s leaving her baby in a dumpster or behind a shopping center somewhere.

“I believe Safe Haven Baby Boxes provide an anonymous, private moment for that mother to surrender that child with nobody asking why they’re doing it, with no shame,” he said.

Lawmakers in Nebraska sponsored a bill that would set aside $15,000 in grants to help safe haven locations install baby boxes, plus another $50,000 for the next fiscal year and $10,000 per year after that for a public awareness campaign about the state’s safe haven law.

Wyoming lawmakers filed a bill that would allocate $300,000 for a one-year grant program to help safe havens such as police and fire departments purchase and manage baby boxes.

And a bill in New Jersey sponsored by a Democrat would require all newly constructed police stations, fire stations and hospitals to provide a baby box.

Marley Greiner, a co-founder of the adoptee rights organization Bastard Nation who also runs a site dedicated to tracking and opposing baby box legislation, argues that baby boxes can create a parallel child welfare system that doesn’t allow for informed consent for the birth parents nor a full record of identifying information and social and medical histories for the newborn.

In contrast, Greiner said, when a parent surrenders an infant to a worker at a hospital or fire station, there is direct interaction with a professional who can ask for medical information about the infant and can assess whether the parent needs medical care or other supports.

A parallel system

With 115 baby boxes, Indiana accounts for more than half of the nation’s 205 baby boxes. The home base for Safe Haven Baby Boxes Inc., is Woodburn, Indiana, where Kelsey’s husband, Joseph Kelsey, the company’s chief operating officer, is the town mayor.

In 2022, Indiana legislators approved $1 million to help communities install and promote Safe Haven Baby Boxes.

In April 2023, they passed another law that, among other things, allows baby box operators to place surrendered babies directly with a private adoption agency, skipping state child protective services. Last August, officials at a fire station in Carmel, Indiana, placed a baby that had been surrendered in their baby box with an adoptive family within 12 hours. Officials said it cuts out a layer of bureaucracy and gets the baby to a family more quickly.

“This creates an avenue of off-the-record surrenders, a problematic issue that could obviously lead to corruption,” said Luce, the attorney with Adoptee Rights Law Center.

Even Kelsey is concerned about the intersection between private adoption agencies and her baby boxes. She cut ties recently with an Alabama nonprofit that had provided funding for the lease and installation of several baby boxes in that state, after learning the nonprofit also facilitates adoptions.

“Some of the adoption agencies might get ticked off at us, but we’re not here to supply babies for them,” Kelsey said. “We’re here to help moms.”

In New Mexico, lawmakers are scrambling to change the state’s safe haven law after learning officials there tried to find the parents of each of the four infants surrendered in New Mexico baby boxes, as directed by that law. State officials also noted that the Federal Indian Child Welfare Act requires the state to attempt to identify any infants with Indigenous heritage and return them to their tribes, a further challenge to baby boxes’ promise of anonymity.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

]]>
https://missouriindependent.com/2024/02/28/more-places-install-drop-off-boxes-for-surrendered-babies-critics-say-theyre-a-gimmick/feed/ 0
Governments can erase your medical debt for pennies on the dollar — and some are https://missouriindependent.com/2024/02/15/governments-can-erase-your-medical-debt-for-pennies-on-the-dollar-and-some-are/ https://missouriindependent.com/2024/02/15/governments-can-erase-your-medical-debt-for-pennies-on-the-dollar-and-some-are/#respond Thu, 15 Feb 2024 16:01:42 +0000 https://missouriindependent.com/?p=18945

Some states, counties and cities are looking to use public money to purchase and forgive millions of dollars of their residents’ medical debt, which disproportionately affects Black patients, people with low incomes and those who live in Southern states (Getty Images).

Medical debt is the leading cause of bankruptcies in the United States, and more than 2 in 5 American adults have some.

In many cases, the money people owe to health care providers forces them to cut spending on food or utilities, forgo other medical care or take on even more debt. Medical debt can make it impossible to buy a home, pay for college or save for retirement.

To address the problem, Connecticut, New Jersey and a growing list of counties and cities are using public money to purchase and forgive millions of dollars of their residents’ medical debt. Earlier this month, Pennsylvania Democratic Gov. Josh Shapiro, unveiled a budget proposal that would set aside $4 million to purchase and pay off the debt of Pennsylvanians with low incomes. A disproportionate number of the 1 million state residents who owe money to health care providers live in rural areas, according to Shapiro.

“Combined with higher prices at the stores, this debt is an anchor holding those families and communities back,” Shapiro told lawmakers during his budget address. He noted that a relatively small state investment can make a huge difference, because hospitals will sell the debt for pennies on the dollar.

Such programs “can be truly life-changing,” said Gabriela Elizondo-Craig, a project lead at Innovation for Justice, a research program at the University of Arizona and the University of Utah. Her research has focused on state policies that impact medical debt.

“They didn’t choose to get sick, [and] didn’t choose to incur these expenses that can have these devastating effects on their lives,” she said.

Americans owe at least $195 billion in unpaid health care bills, according to a 2022 analysis of U.S. Census Bureau data by KFF, a health policy research organization. Black residents, residents of Southern states — many of which have not expanded Medicaid — and people with chronic conditions or low incomes are most likely to owe money to medical providers. Nearly a quarter of households with children have unpaid health care bills, compared with 17% of those without children.

Berneta Haynes, a senior attorney at the National Consumer Law Center, noted that even people with health insurance can fall into medical debt when they can’t afford to pay deductibles or copayments or they receive care outside of their insurer’s network of providers. About half of adults with medical debt say they owe less than $2,500, according to KFF.

Unlike with other kinds of consumer debt, people rarely plan to take on debt from medical care. A one-time or short-term expense such as a hospital stay causes about two-thirds of all medical debt, according to the Consumer Financial Protection Bureau. Even people who might want to shop around for the best health care value are thwarted by opaque pricing, restrictive insurance networks, too few providers or a lack of options in an emergency situation.

“Medical debt is a systemic problem, which is what the government is situated and expected to address,” said Allison Sesso, president and CEO of RIP Medical Debt, a national nonprofit that takes donor money and uses it to purchase medical debt from providers and collection agencies at a steep discount and then forgive it. The organization has been a popular partner for state and local governments looking to cancel medical debt.

“This is an area that is ripe for public involvement and public-funded solutions,” Sesso said, “because the fact is that medical debt is not an individual choice. It is the result of a broken system.”

A 2022 poll from YouGov found two-thirds of Americans support government relief for medical debt, making it more popular than relief for other types of debt, including for student loans.

In May, New Orleans set aside $1.3 million from the federal American Rescue Plan Act to establish a medical debt forgiveness program with RIP Medical Debt.

New Orleans will use the $1.3 million to purchase and cancel an estimated $130 million in debt for residents with incomes below 400% of the federal poverty level (about $124,000 for a family of four) and those who have medical debt that’s equal to at least 5% of their household income.

The novel use of one-time pandemic funds made sense, said Jeanie Donovan, deputy director of the New Orleans Health Department. More than 1 in 5 adults in Louisiana have medical debt, one of the highest rates in the nation. City leaders figured that erasing medical debt could help as many as 80,000 New Orleans residents.

“Not accessing medical care can be costly and deadly,” said Donovan, who noted that New Orleans acted after hearing about a similar effort in Cook County, Illinois, which includes Chicago. “We also know there are inequity issues, that nationwide, Black and brown people are more impacted by medical debt and more likely to owe money for care, and it’s particularly problematic in the South.”

New Orleans residents don’t have to sign up for the program; those who qualify will receive letters in the mail informing them their debt has been paid.

Last month, New York City entered a similar partnership with RIP Medical Debt, following cities and counties in Michigan, Ohio and Pennsylvania. New York City plans to spend $18 million to erase $2 billion worth of city residents’ medical debt.

Connecticut, New Jersey and Pennsylvania also are looking to partner with RIP Medical Debt. In Connecticut, Gov. Ned Lamont, a Democrat, announced this month that the state would spend $6.5 million in federal pandemic aid to erase as much as $1 billion in medical debt for residents.

In response, Connecticut House Republican leader Rep. Vincent Candelora shared on social media his concern that medical debt relief might draw attention from other budget issues and disappoint those who don’t qualify for debt relief.

New Jersey’s current state budget allocates $10 million to cancel medical debt in partnership with RIP Medical Debt. Last month New Jersey Gov. Phil Murphy, a Democrat, urged legislators to increase that amount for the coming year.

Like New Orleans and Cook County, many localities have used federal pandemic relief money to pay for their programs. With the end of that money, Sesso said, it remains to be seen whether local and state officials will find other funding to pay down residents’ medical debt.

“This is not a permanent solution to the issue of medical debt. It is something [state and local governments] can do today,” Sesso said. “But they should be thinking about broader solutions they can get behind” and starting conversations with stakeholders about how to address medical debt.

State-level consumer protections for medical debt are patchy. Elizondo-Craig studied the issue for the Medical Debt Policy Scorecard, a research project from the University of Arizona and the University of Utah.

Erasing medical debt, she said, “really is a Band-Aid solution because the root cause of the problem is that a part of the population is un- or underinsured, and providers can essentially charge whatever they want in different amounts to different payers.”

“Across all health care services, the pricing is just way too high for people to afford, and we need transparency on pricing to make informed health care decisions,” she said.

Democrats have pushed the debt erasure efforts. But in some places, other medical debt relief measures have been bipartisan.

North Carolina State Treasurer Dale Folwell, a Republican, championed a bill in North Carolina last year called the Medical Debt De-Weaponization Act that would cap the interest allowed on medical debt, require transparency in medical billing and add additional consumer protections. The bipartisan bill stalled in committee, but its primary sponsors were Republicans.

Illinois and Oregon enacted laws last year that require hospitals to take on a more active role in limiting medical debt by screening patients to determine if they’re eligible for financial assistance. And in August, Colorado became the first state in the country to enact a law that prohibits medical debt information from being included on consumer credit reports. Its primary sponsors were two Democrats and one Republican.

Haynes, of the National Consumer Law Center, said she and her colleagues have seen much more interest in medical debt relief at the state level. She predicted upcoming state action to remove medical debt from credit reports and to increase eligibility for financial assistance.

Other changes might include bans on aggressive medical debt collection tactics such as wage garnishment or liens; increased transparency in pricing; and requirements that health care providers inform people who might qualify for charity care or debt relief.

But Elizondo-Craig emphasized that universal health care insurance “would be the single most effective thing to do.”

Expanding Medicaid under the Affordable Care Act would significantly reduce medical debt in the 10 states that still have not done so, she said. People who live in states that haven’t expanded Medicaid are 40% more likely to have medical debt than those living in expansion states, according to a 2022 study.

Not only does Medicaid expansion extend insurance coverage to more people, Elizondo-Craig said, but it also gives the government more leverage to negotiate with health care providers on pricing, “reducing how much medical bills even are in the first place.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

]]>
https://missouriindependent.com/2024/02/15/governments-can-erase-your-medical-debt-for-pennies-on-the-dollar-and-some-are/feed/ 0
States strive to get opioid overdose drug to more people https://missouriindependent.com/2023/12/08/states-strive-to-get-opioid-overdose-drug-to-more-people/ https://missouriindependent.com/2023/12/08/states-strive-to-get-opioid-overdose-drug-to-more-people/#respond Fri, 08 Dec 2023 17:18:53 +0000 https://missouriindependent.com/?p=18079

A nonprofit worker prepares items for the first Appalachian Save a Life Day naloxone distribution event at the Unitarian Universalist Congregation of Charleston in Charleston, W.Va., in September (Leah Willingham/The Associated Press).

Posing as shoppers, a team of researchers from the University of Mississippi called nearly 600 pharmacies across the state and asked a simple, yes-or-no question: “Do you have naloxone that I can pick up today?”

Mississippi enacted a law authorizing pharmacists to sell the opioid overdose reversal drug naloxone — often sold under the brand name Narcan — in 2017. The drug, which can be administered via nasal spray or injection, can prevent death from overdose by blocking the effect of opioids in the body.

The results of the survey, conducted last year, were disheartening: Despite the Mississippi law, 41% of the pharmacies the researchers called refused to dispense naloxone. Only 37% had naloxone available for same-day pickup. Most of the pharmacies saying they could not immediately provide naloxone said it required a prescription, which was false.

“It seems like that refusal might have been driven by a lack of education about the state’s naloxone policy,” said Emily Gravlee, a pharmacist and a doctoral candidate at the University of Mississippi who conceived of and directed the secret-shopper study.

Earlier this year, the U.S. Food and Drug Administration approved Narcan to be sold over the counter. That means that residents in every state can buy it at their local pharmacy without a prescription — at least in theory.

In reality, access remains patchy.

As the Mississippi researchers and other studies have found, pharmacies don’t always keep the drug in stock. And naloxone spray can be pricey for people paying out of pocket; a two-dose pack of Narcan typically retails for about $45-$50. As an over-the-counter medicine, it may not be covered by insurance.

In the past year, more states and municipalities have launched programs to distribute hundreds of thousands of doses of naloxone for free in a myriad of ways: by mail, vending machines, community groups, telehealth, first responders and more.

“We need to normalize that it is not only the humane thing but the appropriate thing to treat people with substance use disorders just like we do people with other diseases,” said Dr. Steven Stack, Kentucky’s commissioner for public health and president of the Association of State and Territorial Health Officials.

“We don’t tell diabetics, ‘I can’t believe you need to have insulin every day,’” Stack said. “We need to recognize people [with substance use issues] as someone with a medical problem. And there are resources available.”

A changing adversary

Drug overdose deaths in the United States have risen fivefold over the past two decades, claiming nearly 107,000 lives from last June to this June, according to the most recent estimates from the federal Centers for Disease Control and Prevention.

Twenty years ago, overdose deaths involving opioids mostly were from prescription drugs such as oxycodone and hydrocodone. In 2010, a new version of the prescription painkiller OxyContin was introduced that was harder to misuse, leading to a rise in the use of illicit opioids such as heroin.

The opioid epidemic continues to mutate. Today, overdose deaths are overwhelmingly caused by fentanyl and other synthetic opioids. They accounted for nearly 88% of opioid overdose deaths in 2021, the latest year for which final CDC data is available.

“In years past, many people who were chronic users of things like heroin or morphine or hydrocodone were experienced and knew their limits, so they didn’t overdose as often,” Stack said. But over the past decade, illicit drugs have increasingly been mixed with fentanyl to make them cheaper and 50-100 times more potent.

“When you get a drug on the street that’s laced with fentanyl, for most people it doesn’t matter what their tolerance already is,” he said. “One experimentation could be deadly, because fentanyl is that powerful.”

Enlisting bystanders

Naloxone is highly effective at reversing overdoses. It typically restores breathing within two to three minutes, and it’s safe even if given to someone without opioids in their system. It’s also non-addictive and doesn’t create a high.

Experts now say it’s vital for family members, coaches, business owners and community members to have naloxone on hand so they can administer it quickly if they encounter someone experiencing overdose, which can cause difficulty breathing and a loss of consciousness. Studies have shown bystanders are present in about one-third of all overdoses, Stack said.

“If you are in the midst of an overdose, you don’t have the capacity to treat yourself,” said Stack. “That’s why we have to make sure it’s in the hands of bystanders or witnesses.”

Last year, the Biden administration directed $1.5 billion to states to help them address the opioid and overdose epidemic, including funding for health departments to buy and distribute naloxone. Through State Opioid Response grants, 6.6 million naloxone kits were distributed and nearly 400,000 overdose reversals reported, according to the National Association of State Alcohol and Drug Abuse Directors.

Most states direct federal and state funding to community groups, local health departments, first responders, needle exchanges and other organizations to help them offer free or low-cost naloxone.

Increasingly, states also are trying to get the overdose reversal drug to individuals. Last December, the Mississippi State Department of Health launched a service that mails free naloxone kits to residents who request them. The naloxone mailing program is part of a larger statewide substance use program initiated a few years ago to tackle Mississippi’s overdose crisis. And the state’s overdose rates have shown improvement: Mississippi’s total number of suspected drug overdose deaths decreased by more than 35% from 2021 to 2022, and the number of opioid-related deaths decreased by more than 25%, according to the most recent data from the Mississippi Opioid and Heroin Data Collaborative.

Other states, including Delaware and Kentucky, also have embraced mail-based delivery programs, offering residents free naloxone through the mail. The nonprofit Harm Reduction Ohio, which mails free naloxone to Ohioans on request, reports having distributed 42,000 naloxone kits last year. Iowa’s Naloxone Iowa initiative offers free naloxone from a pharmacy or by mail for individuals who set up a telehealth appointment with a pharmacist through the University of Iowa’s Tele-Naloxone program.

In Kentucky, Stack’s department is placing boxes filled with free naloxone near high-traffic areas such as shopping centers, sporting events and common areas on college campuses.

States, cities and districts including KansasLas VegasMichigan, New York CityNorthern Idaho, Philadelphia and San Diego County also have launched vending machine programs in the past year that offer free naloxone kits.

Dr. Karen Scott, president of the Foundation for Opioid Response Efforts and a physician in preventive medicine, said the recent spike in youth overdose death rates means more middle and high schools should look at making naloxone easily available.

Experts have attributed the increase in the adolescent overdose death rate almost entirely to fentanyl, which is increasingly found in counterfeit pills.

“I appreciate that some school districts will be very hesitant and say, ‘This doesn’t happen here,’” Scott said, “but the data is telling us that we need to be paying more attention to this population and their risk of unintentional overdose.”

Most teens don’t have an opioid use disorder or a long history of drug use, she said. But that doesn’t mean they have no need for naloxone.

“Given the prevalence of [counterfeit] pills in schools, a kid might think they’re getting a valium off their friends or an attention-deficit medication and it’s really fentanyl,” she said. “You don’t have to have a long history of using opioids to be at risk of having an overdose.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

]]>
https://missouriindependent.com/2023/12/08/states-strive-to-get-opioid-overdose-drug-to-more-people/feed/ 0
Faith-based maternity homes ‘create a haven’ in states with strict abortion laws https://missouriindependent.com/2023/10/03/faith-based-maternity-homes-create-a-haven-in-states-with-strict-abortion-laws/ https://missouriindependent.com/2023/10/03/faith-based-maternity-homes-create-a-haven-in-states-with-strict-abortion-laws/#respond Tue, 03 Oct 2023 16:43:16 +0000 https://missouriindependent.com/?p=17244

Ashley Liveoak folds donated baby clothing during a tour of the rooms at Selah’s Oasis, a new maternity home in Chilton County, Ala. A rise in the number of maternity homes, which provide free housing and services for pregnant clients, comes as some states are directing more funding toward anti-abortion pregnancy resource organizations (Anna Claire Vollers/Stateline).

CHILTON COUNTY, Ala. — At the end of a gravel road that runs through a wooded property in Chilton County, Alabama, a plain white two-story house sits overlooking a small pond.

Outside the house, everything is tranquil: The swings on the new playground nearby are quiet, the pond is still, the rocking chairs lined up on the covered front porch rest vacant.

Inside, the house is a hive of activity on a sunny morning in mid-September. Volunteers mop floors and carry plastic tubs of supplies to the upstairs bedrooms while contractors install stair railings and touch up paint in the hallways.

In the middle of it all is Ashley Liveoak, executive director of an anti-abortion pregnancy resource center in nearby Clanton, a small town known mainly for its peach farms, nestled along Interstate 65 between Birmingham and Montgomery.

Liveoak’s center has been renovating the 11-bedroom house to open it this month as a maternity home, a type of group housing for pregnant and new single mothers. She named the home Selah’s Oasis. Selah is a Hebrew word found in the Bible, at the end of verses in the Psalms, usually interpreted to mean rest, pause or reset.

“Just because abortion is now illegal in the state of Alabama, people think we’ve won,” said Liveoak, whose Christian-based pregnancy resource center offers free pregnancy tests, ultrasounds, parenting classes, Bible study, baby supplies and other services for pregnant women, while counseling against abortion.

“That was a great victory that God provided, but there’s still work to be done,” she said. “And the next step for us is offering maternity housing to these women who need it.”

Many states with the nation’s strictest anti-abortion laws, such as Alabama, also tend to be states where families face high maternal and infant mortality rates, high rates of poverty, and poor access to obstetrical providers, health insurance and child care.

In places where the social safety net is threadbare, maternity homes can offer a soft place to land.

And their numbers are growing.

“In the last 12 months we’ve seen a 21% increase in new maternity homes opening. As far as I can find, that is the largest concentrated jump in numbers that we’ve ever seen,” said Valerie Harkins, director of the Maternity Housing Coalition, a nonprofit that provides support to maternity home operators. It’s part of Heartbeat International, a network that trains and equips pregnancy resource centers around the world in how to dissuade people from having abortions.

Harkins said she initially assumed the rise in numbers of maternity homes was due to new state abortion restrictions. The increase was particularly marked in the Midwest. But after talking with maternity home operators around the country, she said, the reality is less clear-cut.

Many told her their expansion has had less to do with lack of abortion access and more to do with addressing the waves of crises —a shortage of affordable housing and child care, paychecks shrunken by inflation — that have hit parents particularly hard since the pandemic.

“Our moms find that it’s difficult to find a job that pays a livable wage, impossible to find a home they can afford and impossible to find child care, never mind child care that’s affordable,” said Harkins. “This is where these maternity homes are stepping in. Many are expanding with services that haven’t broadly existed in the past.”

As conservative state lawmakers look for ways to support pregnant women after championing anti-abortion legislation, some have turned to pregnancy resource centers, many of them Christian-based, funneling public dollars toward them and, in some cases, to the maternity homes they operate.

But critics caution that the free help maternity homes provide comes with strings attached.

They usually require residents to participate in classes and multi-step programs and obey house rules around curfews and cellphone use. They also may require residents to attend Bible study or church services to continue living there.

Andrea Swartzendruber is a public health researcher and epidemiologist at the University of Georgia who studies crisis pregnancy centers. She has noticed a rise in maternity homes aligned with pregnancy centers too.

“Some of the concerns have always been around who gets housing and how they are using it,” she said. “I worry they use the opportunity of attaining housing to potentially coerce people into childbirth.”

‘God will provide’

Each bedroom at Selah’s Oasis is named after a name given to God, such as “Adonai” or “El Shaddai.” Local churches and community groups decorated the bedrooms, providing furniture, baby supplies and art. A welcome basket sits at the foot of the bed in each bedroom, filled with items such as blankets, diaper bags, mugs, toiletries, books and a Bible.

Communal living spaces include a classroom, a large kitchen, a laundry room and a living room with computer stations. All the funding for Selah’s Oasis comes from private donations, Liveoak said.

“We do not use federal grants because a lot of times they try to put stipulations on sharing the gospel, and we are not willing to sacrifice that in order to have funds,” she said. “But God has been faithful. We still need some monthly financial support, but I believe God will provide it.”

Earlier this year, Alabama lawmakers attempted to pass a state tax credit that might have helped pregnancy resource centers like hers. It passed the House but stalled in the Senate; supporters expect it to be brought back in next year’s session. The credit was similar to ones recently passed in Mississippi and Louisiana, which use millions in taxpayer dollars to subsidize tax breaks for people and corporations that donate to pregnancy resource centers.

Aside from tax credits, at least 18 states directly fund pregnancy resource centers through state grants and by funneling federal welfare dollars to them, according to Equity Forward, a research and watchdog group focused on reproductive rights.

States including Arizona, Minnesota, Missouri, Pennsylvania and Texas have directed public money toward nonprofit maternity homes directed by anti-abortion pregnancy centers. State regulations vary when it comes to prohibiting organizations from having religious discussions with pregnant clients.

Swartzendruber, the University of Georgia researcher, said she’s concerned about state reliance on programs that don’t offer clients the full scope of reproductive options. She worries that women in need of assistance might base decisions about remaining pregnant — which could impact their health, career and finances — on being able to access stable housing.

“This is about who gets housing and who doesn’t,” she said. “Will [maternity homes] turn away people who need help but aren’t aligned with the crisis pregnancy center’s anti-abortion goals?”

Maternity homes differ from domestic violence shelters, which typically offer emergency housing for a short period of time. Maternity homes often are structured to allow a pregnant woman to live at the home during and after her pregnancy, in some cases for months or even years after the baby is born. Some allow a pregnant person’s other children to live there with her.

They also tend to be lightly regulated, aside from having to follow typical building codes and local ordinances. In states such as Alabama, if the pregnant residents and new moms are over 18, the maternity home does not have to be registered with the state’s family services agency.

In Georgia last year, lawmakers passed a law designed to make it easier to open maternity homes. Supported by the anti-abortion Georgia Life Alliance, the law created a new category of homes for pregnant women over age 18, calling them “maternity supportive housing residences” and exempting them from the kind of state regulation that governs maternity homes for pregnant teens.

“All we’re attempting to do is create a haven for pregnant ladies who need a safe place to go, have their child, have an opportunity to bond with their child, have an opportunity to build an offramp back into communities so they can be productive and happy citizens,” said Republican state Sen. Randy Robertson, who sponsored the bill, in an address to the state House’s Health and Human Services committee.

More to come

At Heartbeat International’s annual Pregnancy Help Conference this year, maternity housing was one of the main programming topics, according to Heartbeat International’s news outlet, Pregnancy Help News.

About 450 maternity homes currently operate in the United States, according to the Maternity Housing Coalition. Harkins said about 180 of those are affiliated with Heartbeat International.

“What we’re finding with housing is that this is the next chapter” for pregnancy resource organizations, she said. “After we see [a client] through her pregnancy, what does it look like as she’s raising and loving that child, if that’s what she’s chosen? While other affiliates are on the front lines working on more immediate crises, maternity homes are working on the long-term, perpetual crisis.”

Liveoak said she received training and advice on launching her maternity home at Heartbeat International conferences, from how to set up the client intake process to how to structure the application and other forms. A consultant from a maternity home in Texas even came out to meet with her and her board.

Liveoak said the need for pregnancy services in her area, and especially for housing, has been overwhelming. Her resource center typically serves about 400 clients per year but had already reached that number by September. She expects to see 500-600 clients by the end of the year.

Selah’s Oasis will open with four residents. Liveoak employs a “house mom” who stays with the residents each night, as well as an activities coordinator and a case manager. Residents must be at least 19 years old and are required to participate in parenting and pregnancy classes, as well as attend church services each Wednesday and Sunday at a local church. The house has a curfew. A local organization donated an SUV to transport residents to doctor’s appointments, work and other places.

Harkins expects to see the number of maternity homes continue to increase because they fill an urgent need — especially for women who are struggling to stay sober, have aged out of foster care or are fleeing domestic violence.

“There’s this picture of [a maternity home resident] as a down-on-her-luck woman who can pull herself up by her bootstraps and live a happy life, just her and her baby,” said Harkins. But that image doesn’t account for the economic, educational, psychological and emotional barriers many of these women face, she said.

“Those that are providing housing for them are doing the hard work every day that often goes overlooked.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

]]>
https://missouriindependent.com/2023/10/03/faith-based-maternity-homes-create-a-haven-in-states-with-strict-abortion-laws/feed/ 0
As child poverty doubles, states launch or expand their own tax credits https://missouriindependent.com/2023/09/22/as-child-poverty-doubles-states-launch-or-expand-their-own-tax-credits/ https://missouriindependent.com/2023/09/22/as-child-poverty-doubles-states-launch-or-expand-their-own-tax-credits/#respond Fri, 22 Sep 2023 15:24:57 +0000 https://missouriindependent.com/?p=17114

Six states have created new child tax credits — New Jersey, New Mexico and Vermont in 2022, and Minnesota, Oregon and Utah this year — while five more have expanded their existing credits (Spencer Platt/Getty Images).

The federal pandemic-era child tax credit expansion lifted millions of children out of poverty in the second half of 2021. But Congress allowed it to expire at the end of that year, and new U.S. census data shows the child poverty rate more than doubled in 2022, erasing the record gains that were made.

“It wasn’t surprising because we knew this was coming,” said Megan Curran, policy director at Columbia University’s Center on Poverty and Social Policy. “But still, when you see the magnitude of the change, and you know how many kids that represents, it’s still shocking.”

Now states are stepping in. Since the federal enhancement ended, several states have launched or expanded their own child tax credits.

Six states have created new child tax credits — New Jersey, New Mexico and Vermont in 2022, and Minnesota, Oregon and Utah this year — while five more have expanded their existing credits, according to the Institute on Taxation and Economic Policy, a nonpartisan tax policy nonprofit. Currently 14 states offer child tax credits, and several others saw bills introduced this year.

“Child poverty has often been thought of as this status quo that can’t change,” said Curran. “But one of the most powerful lessons to take out of the horrible pandemic is that our policy decisions really matter, and we can make a huge difference in a short amount of time.

“We know what works and we know how to do it. This is a solvable problem.”

A new approach

In 2021, the American Rescue Plan Act temporarily expanded the federal child tax credit, increasing the maximum credit to $3,000 per child ages 6-17 and $3,600 per child under age 6. It was a significant bump from the previous $2,000-per-child credit.

The temporary expansion gave the credit in monthly cash payouts to about 6 in 10 U.S. households with children, rather than as one lump sum after taxes. And it made the full credit available to all low- and middle-income families making less than $150,000 for married couples ($112,500 for single parents). The previous credit excluded income earners at the lowest end of the spectrum.

After the payments began, the nation’s child poverty rate dropped by half in 2021 to a historic low of 5%, primarily thanks to the expanded child tax credit, according to researchers at the Annie E. Casey Foundation, a charitable organization focused on child well-being. The expansion helped lift 3 million children out of poverty, according to the U.S. Census Bureau, which found that most parents said they used the credit payments on child care, rent, utilities, food and school expenses.

“You saw this whole host of data coming from all sorts of places, showing these payments were having a positive and immediate effect on families’ basic needs, and how they were able to care for their children,” Curran said. “You were seeing particularly significant gains for families with lower incomes.”

While the federal tax credit expansion did lift children out of poverty in the short term, some analysts argue it could have had negative long-term effects if made permanent.

“What we worry about, with good reason given the evidence, is that a lot of families will receive that extra money and it will cause them to work less or to not work at all,” said Scott Winship, senior fellow and director at the Center on Opportunity and Social Mobility at the American Enterprise Institute, a center-right public policy think tank. Winship said a permanent expanded child tax credit also might discourage marriage and result in more families headed by single parents.

Two pieces of 2021 research from economists at the University of Chicago concluded that if the expanded child tax credit were made permanent, between 1.3 million and 1.5 million workers would exit the labor force. A 2021 analysis of census data from Columbia University researchers found that the temporary expanded benefits during the pandemic didn’t discourage parents from working, but Winship said the results might have been different if people thought the expanded credit was going to be permanent.

“It takes time for a lot of these behavioral changes to develop,” he said. “I don’t think 2021 is a very good test of what would happen in the long run.”

Winship added that he doesn’t think state-level child tax credits are a good idea, but that he’d rather see states experiment with different approaches to reducing child poverty than the federal government.

Who’s left out?

Now that eligibility for the federal credit has reverted to its pre-pandemic rules, low-income families are no longer receiving the full tax credit afforded to middle-income families.

For example, a married couple with two children must earn at least $35,900 per year to qualify for the maximum $2,000 child tax credit; a single parent with two children would have to earn $29,400 to qualify, according to the Center on Poverty and Social Policy. That means children whose parents get paid at or near the federal minimum wage of $7.25 an hour don’t qualify for the maximum credit.

About a quarter of children nationwide do not qualify for the maximum $2,000 credit because of their parents’ income. That includes a third of rural children; half of kids with a single parent; 40% of Black and Hispanic kids; and 90% of kids in households below the federal poverty level, which is about $30,000 per year for a family of four.

“We have programs for folks who struggle financially, but nothing replaces having your own funds to solve your own problems,” said Mercedes Elizalde, director of advocacy at Latino Network, a Latino-led advocacy organization based in Portland, Oregon.

Her organization advocated for Oregon’s new child tax credit, which gives an annual benefit of up to $1,000 per child up to age 5 for families who earn up to $30,000 per year. She said the Latino communities her organization supports tend to have a high proportion of families with young children.

“Having a tax credit that is specific to lower-income families and specifically helps families with multiple children is really beneficial when we know a two-kiddo household in our community is still pretty common,” Elizalde said.

She said she expects to see families use the funds for basic needs like food, clothes for school and utility bills.

“This is a way of buying shoes when their kiddos outgrow them or being able to cover a copay for a doctor’s visit,” she said. “It’s those little bits of money that are hard to plan for because you’re not always sure when you’re going to need them.”

Helping low-income families

Several states creating or expanding child tax credits have specifically targeted low-income families that fall through the gap in federal eligibility requirements.

“It’s a proven intervention,” said Minnesota Democratic state Rep. Aisha Gomez, who chairs the House Taxes Committee. Her committee put forward the child tax credit bill that became law earlier this year. “Poor people aren’t poor because they don’t work hard. Giving a little bit of extra money to folks who are experiencing poverty and aren’t being taken care of in our economy works, so we were happy to pick up where the feds unfortunately left off.”

Minnesota now offers a tax credit of $1,750 per child under 18 for single parents with incomes below $29,500 per year and married parents making below $35,000. The credit was passed as part of an omnibus tax bill that received no Republican support, but Gomez said she’d like to think if the tax credit had been a stand-alone bill that it would have received some GOP votes.

“Child poverty is one of those issues where I think there’s pretty widespread agreement that we have a role as the government to intervene when our system is failing families so acutely,” she said.

“What we’ve noticed is not only is there a huge explosion of interest [from states] in creating child tax credits in the last two years,” said the Center on Poverty and Social Policy’s Curran, “but there’s been interest in trying to craft them in a way that fixes some of the gaps the federal credit has historically had.”

Curran said her organization has been contacted by lawmakers in several states who said they were interested in child tax credits because they saw the significant poverty reduction that came from the federal expansion: “That really caught peoples’ attention.”

In nearly every state, a combination of the existing federal tax credit and a state credit up to $2,000 would slash child poverty rates by at least a quarter, according to an analysis from the Institute on Taxation and Economic Policy.

Elizalde said Latino Network will focus its efforts now on making sure people know about the new tax credit so they can take full advantage.

“This is going to be very impactful,” Elizalde said. “In a couple of years, we hope we can go back to the legislature and say, ‘Let’s increase that income cap and help more families.’”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

]]>
https://missouriindependent.com/2023/09/22/as-child-poverty-doubles-states-launch-or-expand-their-own-tax-credits/feed/ 0
Some states back hospital mergers despite record of service cuts, price hikes https://missouriindependent.com/2023/09/07/some-states-back-hospital-mergers-despite-record-of-service-cuts-price-hikes/ https://missouriindependent.com/2023/09/07/some-states-back-hospital-mergers-despite-record-of-service-cuts-price-hikes/#respond Thu, 07 Sep 2023 13:30:45 +0000 https://missouriindependent.com/?p=16881

Registered nurses rally outside Mission Hospital in Asheville, N.C., in January to highlight concerns including safe staffing levels and workplace violence. HCA Healthcare, the nation’s largest health system, bought Mission four years ago, prompting multiple antitrust lawsuits (Courtesy of National Nurses United).

Some illnesses and injuries — say, a broken ankle — can send you to numerous health care providers. You might start at urgent care but end up in the emergency room. Referred to an orthopedist, you might eventually land in an outpatient surgery center.

Four different stops on your road to recovery. But as supersized health care systems gobble up smaller hospitals and clinics, it’s increasingly likely that all those facilities will be owned by the same corporation.

Hospital trade groups say mergers can save failing hospitals, especially rural ones. But research shows that a lack of competition often leads to fewer services at higher costs. In recent years, federal regulators have been taking a harder look at health care consolidation.

Yet some states, notably those in the South, are paving the way for more mergers.

Mississippi passed a law this year that exempts hospital acquisitions from state antitrust laws, while North Carolina considered legislation to do the same for the University of North Carolina’s health system. Louisiana officials approved a $150 million hospital acquisition late last year that has ignited a legal battle with the Federal Trade Commission over whether they allowed a monopoly.

States including South Carolina, Tennessee, Texas and Virginia have certificate of public advantage (COPA) laws that let state agencies determine whether hospitals can merge, circumventing federal antitrust laws. And large hospital systems wield significant political power in many state capitals.

‘A tool in the tool belt’

Nearly half of Mississippi’s rural hospitals are at risk of closing, according to a report from the Center for Healthcare Quality & Payment Reform, a nonprofit policy research center.

Mississippi leaders hope easing restrictions on hospital mergers could be a solution. A new law exempts all hospital acquisitions and mergers from state antitrust laws and classifies community hospitals as government entities, making them immune from antitrust enforcement.

Mississippi, one of the poorest states in the nation, is also one of the least healthy, with high rates of chronic conditions like heart disease and diabetes. It is one of 10 states that haven’t expanded Medicaid under the Affordable Care Act, and has one of the nation’s highest percentages of people without health insurance.

“Like many states in a similar socioeconomic status, Mississippi has difficulties with patients that are either not insured or underinsured,” said Ryan Kelly, executive director of the nonprofit Mississippi Rural Health Association. Food insecurity and lack of reliable transportation mean rural residents tend to be sicker and more expensive to treat.

That’s part of the reason why so many Mississippi hospitals operate in the red. The largest hospital in the Mississippi Delta region, Greenwood Leflore, is at immediate risk of closure even after hospital leaders shuttered unit after unit — including labor and delivery, and intensive care — in an effort to remain solvent.

A deal for the University of Mississippi Medical Center to purchase Greenwood Leflore fell through last year. Now, with the new law in effect, the hospital’s owners — the city and county — are soliciting new bidders and offering them the option to buy the hospital outright.

Kelly said he expects to see more Mississippi hospitals consolidate over the coming decade. Some have already had conversations around merger possibilities after the new law went into effect, though talks are in early days.

“It’s a tool in the tool belt,” he said of the new law. “I think it could be a saving grace for some of our hospitals that are perennially struggling but still serve with good purpose. They could be part of a larger system that could help offset their costs so they’re able to be a little leaner but still provide services in their community.”

Leaders in some states think consolidation could solve their health care woes, but studies indicate it has a negative impact.

“There’s a large body of research showing that health care consolidation leads to increases in prices without clear evidence it improves quality,” said Zachary Levinson, a project director at KFF, a nonprofit health care policy research organization, who analyzes the business practices of hospitals and other providers and their impact on costs.

When researchers studied how affiliation with a larger health system affected the number of services a rural hospital offered, they found most of the losses in service occurred in hospitals that joined larger systems, according to a 2023 study from the Rural Policy Research Institute at the University of Iowa.

Even when an acquisition by a larger health system helps a struggling hospital keep its doors open, “there can be potential tradeoffs,” Levinson said.

“There’s some concern that, for example, when a larger health system buys up a smaller independent hospital in a different region, that hospital will become less attentive to the specific needs of the community it serves,” and may cut services the community wants because they’re not deemed profitable enough, he said.

Most research suggests hospital consolidation does lead to higher prices, according to a sweeping 2020 report from MedPAC, an independent congressional agency that advises Congress on issues affecting Medicare. The report found that patients with private insurance pay higher prices for care and for insurance in markets that are dominated by one health care system. And when hospitals acquire physician practices, taxpayer and patient costs can double for some services provided in a physician’s office, the report found.

Kelly said he’s not as concerned with consolidation raising costs for Mississippi’s rural residents because so many qualify for subsidized care, but he does think mergers could eliminate some jobs in the health care sector.

“It’s hard to say for sure,” he said. “It is a risk, no question. But I still think it’s a net positive.”

A ‘hospital cartel’

When HCA Healthcare purchased a North Carolina hospital system in 2019, registered nurse Kerri Wilson wasn’t prepared for how much would change — and how quickly — at her hospital in Asheville.

“Once the sale was final in 2019, that’s when it was like the ball dropped and we started seeing staffing cuts,” said Wilson, an Asheville native who has worked in the cardiology stepdown unit at Mission Hospital since 2016.

“We saw our nurse-patient ratios change,” Wilson said. “We saw primary care offices get shut down. We’ve seen our specialists leave for out of state. Several of the outlying hospitals saw services cut even though they were told it wouldn’t happen.”

In the four years since HCA Healthcare bought Mission Health, North Carolinians have hit the nation’s largest health system with multiple antitrust lawsuits, including one that asserts HCA operates an unlawful health care monopoly through Mission Health, and another filed by city and county governments that says HCA’s corporate practices have decimated local health care options and raised costs.

HCA Healthcare did not immediately respond to a request for comment. However, when the second lawsuit was filed, HCA/Mission Health spokesperson Nancy Lindell called it “meritless.”

“Mission Health has been caring for Western North Carolina for more than 130 years and our dedication to providing excellent health care to our community will not waiver [sic] as we vigorously defend against this meritless litigation,” Lindell said in a statement to the Mountain Xpress newspaper. “We are disappointed in this action and we continue to be proud of the heroic work our team does daily.”

Mission’s nurses voted in 2020 to join National Nurses Organizing Committee, an affiliate of National Nurses United, the nation’s largest nursing union, to advocate for higher pay and safer working conditions.

Meanwhile, North Carolina leaders such as Republican State Treasurer Dale Folwell and Democratic Attorney General Josh Stein have spoken out against HCA’s practices. Folwell likened the merger to a “hospital cartel” and both officials filed amicus briefs supporting the plaintiffs in the antitrust lawsuits.

“We have a situation with the cartel-ization of health care in North Carolina where people have to drive miles just to get basic services, and this is unacceptable,” Folwell told Stateline. He said many North Carolinians, particularly those with low incomes, fear seeking medical help because of sky-high medical bills that he said are a result of massive health care systems with little state oversight.

Folwell has publicly criticized the power that the North Carolina Health Care Association, the state’s hospital trade group, wields in the legislature. He calls the group the “leader of the [hospital] cartel.”

Industry groups spent more than $141 million lobbying state officials on health issues in 2021. And out of that $141 million, the hospital and nursing home industry spent the most, accounting for nearly 1 out of every 4 dollars spent on lobbying state lawmakers over health issues.

“This is not a Republican or Democrat issue,” said Folwell, who has lent his support to a bipartisan bill that would limit the power of large hospitals to charge interest rates and rein in medical debt collection tactics. “It’s a moral issue.”

North Carolina Democratic state Sen. Julie Mayfield, who was on the Asheville City Council when HCA acquired Mission Health, sponsored a bill earlier this year that would have curbed hospital consolidations.

In a social media post introducing the bill, Mayfield said she hoped it would “prevent other communities from suffering what we have suffered in the wake of the Mission sale — loss of nursing and other staff, loss of physicians, closure of facilities, and the resulting lower quality of care many people have experienced in Mission hospitals over the last four years.”

Even the Federal Trade Commission jumped in, urging legislators to “reconsider” a bill that would have greenlighted UNC Health’s expansion, saying it could “lead to patient harm in the form of higher health care costs, lower quality, reduced innovation and reduced access to care.” That bill ultimately failed in the state House, as sentiment among some North Carolina leaders had already soured on hospital mergers.

In most U.S. markets, a single hospital system now accounts for more than half of hospital inpatient admissions. Federal regulators have been scrutinizing health care mergers more carefully in recent years, said KFF’s Levinson. The FTC has both sued and been sued by health care systems in Louisiana this year, and recently released a draft version of new guidelines on anti-competitive practices.

“People have viewed those guidelines as indicating the FTC and [the U.S. Department of Justice] will be more interested in aggressively challenging anti-competitive practices than in the past,” Levinson said.

Both the Trump and Biden administrations issued executive orders directing federal agencies to focus on promoting competition in health care markets. President Joe Biden’s order noted that “hospital consolidation has left many areas, particularly rural communities, with inadequate or more expensive healthcare options.”

In Mississippi, the hospital mergers law received widespread support from most of the state’s GOP leaders. But the state’s far-right Freedom Caucus came out against it, with Republican state Rep. Dana Criswell, the chair of the caucus, calling it “an attempt at a complete government takeover” of Mississippi’s hospitals.

Criswell said allowing the University of Mississippi Medical Center to buy smaller hospitals “will create a huge government protected monopoly, driving out competition and ultimately putting private hospitals out of business.”

‘Trying something different’

Wilson, the Asheville nurse, said she used to have three or four patients per shift before the merger; now she typically has five. That gives her an average of 10 minutes per patient per hour. It’s not enough time, she said, to give patients their medication, answer questions and perform other tasks that she said nurses often take on because other departments are short-staffed.

Sometimes, she said, those tasks include helping patients go to the bathroom because there aren’t enough nursing assistants or taking out the trash because of a shortage of cleaning staff. Meanwhile, the waiting rooms are overflowing.

Wilson joined the new Mission Hospital nurses union, which was able to negotiate raises for its members. The union continues to protest working conditions, including staff-patient ratios.

But Kelly, of the Mississippi Rural Health Association, said that in his state, mergers are an opportunity for positive change.

“It’s not like health care in Mississippi is at the top of the list for good things,” he said. “I think this is an example of trying something different and seeing if it works.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

]]>
https://missouriindependent.com/2023/09/07/some-states-back-hospital-mergers-despite-record-of-service-cuts-price-hikes/feed/ 0
Abortion-ban states pour millions into pregnancy centers with little medical care https://missouriindependent.com/2023/08/24/abortion-ban-states-pour-millions-into-pregnancy-centers-with-little-medical-care/ https://missouriindependent.com/2023/08/24/abortion-ban-states-pour-millions-into-pregnancy-centers-with-little-medical-care/#respond Thu, 24 Aug 2023 19:54:28 +0000 https://missouriindependent.com/?p=16685

A Portico Crisis Pregnancy Center nurse straightens baby clothes in the baby boutique room in 2022 in Murfreesboro, Tenn. States that have passed strict abortion bans have been funneling millions of taxpayer dollars into privately operated clinics that steer women away from abortions but provide little if any health care services. (Mark Zaleski/The Associated Press)

After the U.S. Supreme Court overturned Roe v. Wade last year, Louisiana Republican state Sen. Beth Mizell looked for a way to address her state’s abysmal record on infant and maternal mortality, preterm births and low birth weight. Louisiana has one of the nation’s strictest abortion bans, with no exceptions for rape or incest.

Mizell and her colleagues borrowed an idea from neighboring Mississippi: a state tax credit program that sends millions each year to nonprofit pregnancy resource centers, also called crisis pregnancy centers. They’re private anti-abortion organizations, often religiously affiliated, that typically offer free pregnancy tests, parenting classes and baby supplies. They are not usually staffed by doctors or nurses, though some offer limited ultrasounds or testing for sexually transmitted infections.

“I see [pregnancy resource centers] as a touchpoint for pregnant women who may not know where to go for services or where to begin,” Mizell said. Louisiana has roughly 30-40 pregnancy resource centers scattered across the state. “If we don’t use everything with an open mind to give women the services they need, we’re only hurting women in our state.”

Legislators in states with some of the strictest abortion bans are pouring millions into pregnancy resource centers, painting them as solutions to poor birth outcomes and the lack of access to adequate prenatal and postpartum care. But while Republican lawmakers have increasingly positioned pregnancy resource centers as a backstop for maternal health care, critics say those taxpayer dollars should be used to shore up more comprehensive medical and social services.

Mizell’s bill, which was signed into law in June and went into effect Aug. 1, allows both individuals and corporations to claim an income tax break for donations made to pregnancy resource centers, which the law calls “maternal wellness centers.” The tax credits are capped at $5 million per year. Mississippi passed a similar tax credit law last year and expanded its cap this year to $10 million annually.

In 2017, Missouri became the first state to issue tax credits for donations to pregnancy resource centers and it recently removed its limit on how many tax credits the state can issue. Alabama, Kansas and Nebraska considered their own tax credits in this year’s legislative sessions.

The tax breaks are much larger than those awarded for donations to most other types of charities.

Some critics of Louisiana’s new law question its cost, when so many residents struggle to get prenatal care.

“We have many areas around the state where there are no obstetricians, no birthing centers and it’s very difficult for people to get access to prenatal care,” said Michelle Erenberg, executive director of Lift Louisiana, a reproductive rights advocacy organization.

“I think these centers are trying to rebrand as being maternal care centers. But they’re not providing any actual medical services. They’re not licensed. They’re not regulated. Is that a good value for $5 million a year of Louisiana’s tax dollars?”

‘What could be bad?’

Matt Mitchell, the CEO of Oasis Medical Center in Corinth, Mississippi, calls his center “the best first stop for pregnancy concerns.”

Located in the rural northeast corner of the state, Oasis is a pregnancy resource center that does not offer comprehensive medical care, but does provide pregnancy tests, non-diagnostic ultrasounds, testing for sexually transmitted infections, adoption referrals, parenting classes and community resource referrals, all for free.

Mitchell doesn’t think his center’s role has changed since the U.S. Supreme Court overturned Roe v. Wade, he told Stateline in a written statement, “but I think more people are aware of the important role we play.”

The Southeast is home to about 900 pregnancy resource centers, more than a third of the national total, according to the Crisis Pregnancy Center Map created by University of Georgia researchers Andrea Swartzendruber and Danielle Lambert.

“From a public health perspective, I think awareness about what crisis pregnancy centers are, their mission and goals, is really low,” said Lambert. Her work with Swartzendruber has focused on the public health impact of pregnancy resource centers, which they found tend to be more common in states with abortion bans.

“When we talk to policymakers and advocacy groups,” Lambert said, “the narrative is, ‘What could be bad about helping women who are in need and pregnant?’ They have images on their websites of people in white coats.”

Swartzendruber has noticed a “significant increase” recently in the number of pregnancy resource centers that offer limited, non-diagnostic ultrasounds or have changed their names in ways that suggest they provide health care. “But we’ve found on the whole, the services they’re offering aren’t in line with national medical standards,” she said.

Louisiana’s new tax credit law requires “maternal wellness centers” to provide certain resources to their clients, including a list of the closest OB-GYNs, as well as information on applying for Medicaid and federal food assistance programs. And, as with the Mississippi and Missouri laws, the centers can’t be associated with abortion providers or refer clients for abortions.

“If I had put a requirement on the bill that they had to have a licensed medical provider there, I wouldn’t have had buy-in from the pregnancy resource centers because that’s too much of a financial burden on them and that’s not the role of the center,” Mizell said.

Critics of pregnancy resource centers say they often use a bait-and-switch approach, targeting vulnerable women by offering “abortion consultations” or “pre-abortion screenings” that spread false claims about the dangers of abortion. Swartzendruber and Lambert said they’ve documented instances of centers providing misinformation about reproductive health, including about contraceptives.

From a public health perspective, I think awareness about what crisis pregnancy centers are, their mission and goals, is really low.

– Danielle Lambert, University of Georgia researcher

Some centers, such as Oasis in Mississippi, offer “abortion reversal” treatment. It’s a controversial practice that uses doses of the hormone progesterone to stop a medication abortion after a patient has completed the first part of the two-step abortion process. The American College of Obstetricians and Gynecologists says the treatment is not supported by science and does not meet clinical standards.

A small 2019 study designed to test the effectiveness of abortion reversal was halted after three of the 12 participants required a trip via ambulance to the hospital to be treated for severe bleeding.

But Mizell said she hasn’t seen evidence of danger or misinformation from the centers.

“I just think it’s a paper tiger of an argument,” she said. “We have 40-something of these centers all over the state, including in the rural areas. They’re not intimidating, and they have all of these buckets of information available and can point the pregnant person in the right direction.”

More bang for your buck

The tax credit programs are structured to make donations to pregnancy resource centers far more lucrative for donors than contributions to other types of charities, said Lillian Hunter, a research assistant at the Urban-Brookings Tax Policy Center who has studied how states have amended their tax policies in the wake of the Dobbs v. Jackson Women’s Health Organization ruling that struck down constitutional protections for abortion.

This is because a tax credit allows filers to reduce their taxes owed, as opposed to reducing their taxable income.

If you’re a Louisiana resident and you donate $500 to a pregnancy resource center and apply for a state tax credit, you’ll reduce the total amount of state taxes you owe by $250, because the tax credit for that donation is 50% of the donated amount. If you donated that same $500 to any other charitable organization, you’d save yourself just $21.25. This is because your donation would reduce your taxable income by $500, and Louisiana’s top state tax rate is 4.25%.

“It really privileges this type of donation over donations to every other charity,” Hunter said. And while a handful of states have tax credits for other types of charitable donations, “they’re not typical.”

For example, Missouri offers a 50% tax credit for donations of $100 or more to diaper banks. Its tax credit for donations to pregnancy resource centers is 70%, which means a donation of $100 to a diaper bank would result in a $50 reduction in state taxes, but the same donation to a pregnancy resource center means a $70 reduction.

After Missouri lawmakers removed the limit on how many tax credits the state could issue for donations to pregnancy resource centers, Missouri authorized more than $7 million in tax credits for the centers in the first quarter of 2022, according to an analysis by ProPublica. That jump was more than three times higher than in any other quarter.

In Mississippi, Mitchell said donations to his center increased after the state passed its tax credit law last year, and he hopes more businesses and individual taxpayers will take advantage of the expanded tax credit this year.

Transparency and oversight

It’s hard to say what the impact of the tax credits will be on birth outcomes. States with strict abortion bans and high numbers of pregnancy resource centers, mostly in the Southeast and Midwest, already tend to be states with some of the worst birth outcomes.

“My biggest concern is that states enact these tax credits and don’t invest in programs that we know work, like expanding earned income or child tax credits,” said Hunter, the research assistant at the Urban-Brookings Tax Policy Center. They might spend less on maternal health or food assistance programs, she said, “because they already have something they can point to that they’re doing to help families.”

The principal author of Mississippi’s tax credit expansion this year was Republican House Speaker Philip Gunn, a vocal opponent of abortion rights. Last year, he twice blocked bipartisan efforts to expand Medicaid coverage in Mississippi for mothers up to 12 months postpartum.

Aside from the new tax credit programs, at least 18 states directly fund pregnancy resource centers through state grants and by funneling federal welfare dollars to them — and many have bumped up their funding, according to Equity Forward, a research and watchdog group focused on reproductive rights.

Some notable increases in state spending on pregnancy resource centers from 2022 to 2023 include Florida’s increase from $4.5 million to $25 million and Tennessee’s from $3 million to $20 million, according to Ashley Underwood, director of Equity Forward.

The cascade of funding is thanks, in part, to organized national pregnancy center groups that “shop tactics across state lines,” she said. She pointed out that Louisiana’s law even requires pregnancy resource centers to be affiliated with a national pregnancy center organization before they can go on the state-approved donation list.

The Louisiana law also requires pregnancy resource centers to self-report that they meet the criteria to be eligible for tax-credit donations, including that they offer information about local obstetricians and how to apply for government assistance programs. But the law does not give the state department of health regulatory authority over the centers.

“I just think that if our tax dollars are being put towards this, whether it’s a direct program or a tax credit program, there needs to be more requirements that they show they’re actually doing something to improve maternal health outcomes,” Lift Louisiana’s Erenberg said.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

]]>
https://missouriindependent.com/2023/08/24/abortion-ban-states-pour-millions-into-pregnancy-centers-with-little-medical-care/feed/ 0
Laws banning gender-affirming treatments can block trans youth from receiving other care https://missouriindependent.com/2023/07/27/laws-banning-gender-affirming-treatments-can-block-trans-youth-from-receiving-other-care/ https://missouriindependent.com/2023/07/27/laws-banning-gender-affirming-treatments-can-block-trans-youth-from-receiving-other-care/#respond Thu, 27 Jul 2023 15:54:17 +0000 https://missouriindependent.com/?p=16251

Sean Woolley, 15, right, and his mother Ashley Moore, hold hands as they attend a protest of transgender youth, their families and supporters on Feb. 15 at the Mississippi Capitol in Jackson, Mississippi. (AP Photo/Rogelio V. Solis)

In some states, new laws banning gender-affirming care for transgender youth are dissuading health care providers from offering mental health services and other medical care that isn’t explicitly banned by those laws.

In the first few weeks after Mississippi’s law went into effect in February, nurse practitioner Stacie Pace said she was fielding calls and emails from parents of trans youth who said their children’s pediatricians would no longer see them for routine care. Pace offers gender-affirming care at a clinic in Hattiesburg.

“[Parents] weren’t able to bring their kids to the pediatrician they were seeing before because the ban scared the pediatrician,” said Pace. She said the vague language in Mississippi’s law scared primary, mental health and other providers from seeing trans youth and even adults. One parent told her their child needed a refill on asthma medication and their doctor refused to see them.

In Texas, a new law banning gender-affirming care for minors is pushing some providers, including the pediatrician who led a program that offered mental health services and hormone treatments to transgender children, to leave the state. Dr. Ximena Lopez, a pediatric endocrinologist, has said publicly she is leaving Texas out of concern for the safety of herself and her family.

And in Arizona and Missouri, advocates worry that new state laws barring medical practitioners from referring transgender youth to other providers for “gender transition procedures” might curb access to counseling and therapy.

The new laws do not focus on mental health services. In fact, some state lawmakers who have sponsored bans on surgery or hormone therapy have stressed their support for mental health care.

Stacie Pace talks about gender-affirming care at her clinic, Spectrum: The Other Clinic, in Hattiesburg, Miss., in February. (Eric J. Shelton/Mississippi Today)

Indiana state Rep. Michelle Davis, a Republican who sponsored Indiana’s new law prohibiting gender-affirming care for minors, told Stateline earlier this year: “We should continue to support children who may be struggling by ensuring they have access to compassionate mental health care.”

But state bans on services such as hormone therapies and surgery can create a climate of fear and confusion for trans youth, families and care providers that can have a chilling effect on all types of care, said Elana Redfield, federal policy director at UCLA School of Law’s Williams Institute, a public policy think tank focused on sexual orientation and gender identity issues.

“If you’re a young person who is trans or a parent of that young person, you might feel concerned about asking for any kind of care for fear it might come back to hurt you or your family,” Redfield said.

Heather Stone, a licensed counselor in Huntsville, Alabama, who sees trans patients, saw that chilling effect after Alabama passed its law last year, even though a court order is currently preventing it from taking effect.

“Mental health treatment for trans youth is not illegal in Alabama,” said Stone, “but the law is so vague that it makes parents and children more hesitant to even seek mental health treatment because they’re confused whether” that treatment has been banned.

Across the country, legislators in at least 21 Republican-led states have passed laws banning or restricting gender-affirming care for minors, according to the Movement Advancement Project, a nonprofit think tank that tracks LGBTQ+ state policies. Similar laws have been considered in at least seven other states this year.

The raft of new legislation is part of a recent nationwide effort by GOP-led state legislatures to place new restrictions on transgender people. Multiple states have enacted laws that bar transgender girls from competing on girls sports teams, prohibit discussions of gender identity in classrooms and outlaw drag shows when minors are present.

The laws restricting gender-affirming health care vary by state, but mainly prohibit hormone therapy and gender-affirming surgery for transgender minors. Implementation has been patchy, as many of the laws face court challenges and some aren’t scheduled to go into effect until later this year.

Legislators sponsoring the bills have cited a lack of information on the long-term effects of hormone therapy on adolescents. Republican state Rep. Jim Olsen of Oklahoma, who voted for his state’s law banning gender-affirming care, said that he hoped to spare teens from undergoing “irreversible procedures” they might later regret.

“Even one child who undergoes a life-altering procedure and later laments their decision is one too many,” Olsen said.

The U.S. Department of Health and Human Services describes gender-affirming care as a spectrum of medical and non-medical services that can include social affirmation, hormone therapy, mental health services and surgery.

Gender-affirming surgery is rarely performed on patients under 18. Puberty-blocking drugs and hormone treatments are prescribed by physicians to some children and adolescents struggling with gender dysphoria, a condition in which a person’s gender identity doesn’t align with their sex assigned at birth.

Major U.S. medical organizations — including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association — oppose bans on gender-affirming care and support care for minors when administered appropriately.

These are people who deserve to have their basic health care needs met, just like anyone else.

– Stacie Pace, a nurse practitioner in Hattiesburg, Mississippi

However, some European countries, including Norway and the United Kingdom, recently changed or have considered changing medical guidelines on gender-affirming care for minors. Data analyzed by public health officials in England, Finland and Sweden found long-term studies failed to show improvements in mental health and suggested puberty blockers could hinder bone development.

A ‘chilling effect’

Johnathan Gooch of Equality Texas, a statewide organization that advocates for LGBTQ+ rights, said rhetoric and legislation from Texas lawmakers on transgender issues already have eroded health care options for both trans youth and adults.

“Because we’ve seen such a sustained attack on trans youth, there are a lot of trans-focused health providers that have closed up shop over time,” he said, citing the closure of gender-affirming services for adolescents at Texas Children’s Hospital in Houston. “The options have been consistently narrowing since February 2022.”

That’s when Texas Republican Gov. Greg Abbott directed the Texas Department of Family and Protective Services to investigate reports of children undergoing gender-affirming care as potential child abuse. Gooch said some mental health providers at the time were concerned that they’d be required as mandatory reporters to turn in parents who brought their children in for mental health visits related to gender-affirming care.

“We did see a chilling effect among mental health providers, who would prefer to end their client relationship rather than being forced to report them to authorities, even though that was a misunderstanding of the law.”

Stone, the licensed counselor in Alabama, said she knows providers who are afraid to treat trans youth and adults since the state law passed last year.

“We have to ask [ourselves], am I providing gender-affirming care, and is that illegal?” she said. “My reading of it, and I’m not an attorney, is that supportive mental health is not illegal. But you never know. But I’m not going to stop providing it at this point because I think that would be ethically wrong and there’s a huge need in the community.”

Oliver Hall is the trans health director at the Kentucky Health Justice Network, which connects trans clients with gender-affirming health resources and provides guidance on insurance coverage. A federal judge recently lifted an injunction on Kentucky’s ban on gender-affirming care for trans youth, allowing it to take effect.

“There is a lot of misunderstanding about what the law does with regard to mental health care,” Hall said in a statement to Stateline. While the current law does not ban mental health services, a different bill, which did not pass, would have explicitly banned gender-affirming mental health care for minors.

“This has also obviously added to the chilling effect for mental health care providers treating trans youth,” Hall said.

Issues with affordability

Some states, including Arizona, Arkansas, Mississippi and Missouri, prohibit the use of public funds, such as Medicaid, to cover gender-affirming care for minors and in some instances, for all trans people regardless of age.

The state laws don’t explicitly prohibit coverage of mental health services, but they create legal uncertainty for providers, said Redfield, of the Williams Institute.

For example: A mental health visit that’s linked to a prohibited treatment might also not be covered by public insurance, she said.

Gender-affirming care, even when prescribed and overseen by medical professionals, can be expensive. And trans people are more likely to be uninsured and report cost-related barriers to care than cisgender adults, according to a KFF analysis from 2020.

Medicaid policies that exclude transgender-specific care were associated with less use of therapy and counseling, according to a 2020 analysis, while trans-inclusive Medicaid policies were associated with more use of therapy/counseling.

In Texas, Gooch said Equality Texas has partnered with Campaign for Southern Equality to offer small grants to families who ask for financial assistance in accessing gender-affirming care.

“Texas is a big state, and most of the places out of state [that offer gender-affirming care] are going to take you a five- to seven-hour drive or a flight,” said Gooch. “There’s a financial burden, a time cost, and making all of that simpler for the families is something important to us.”

The Campaign for Southern Equality, which advocates for LGBTQ+ rights across the South, recently launched the Southern Trans Youth Emergency Project, a regional effort to provide emergency grants and guidance to families of trans youth impacted by the gender-affirming care laws.

“As bans are passing and laws are changing, we’re working to do town halls and partnering with folks on the ground to make sure we’re getting out good, accurate information on what the law does and doesn’t say,” said Ivy Hill, director of gender justice for the group. The organization’s directory lists more than 500 trans-affirming health and legal service providers located across the South, about half of which see adolescents.

Pace also keeps a list of trans-affirming providers — from counselors to neurologists — available for people who call her clinic in Mississippi.

“These are people who deserve to have their basic health care needs met, just like anyone else,” Pace said.

Stateline is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott Greenberger for questions: info@stateline.org. Follow Stateline on Facebook and Twitter.

GET THE MORNING HEADLINES.

]]>
https://missouriindependent.com/2023/07/27/laws-banning-gender-affirming-treatments-can-block-trans-youth-from-receiving-other-care/feed/ 0