Rise of syphilis in the U.S reflects neglect of long-term public health funding : Shots

Mai Yang, a communicable disease specialist, searches for Angelica, a 27 year-old pregnant woman who tested positive for syphilis, in order to get her treated before she delivers her baby.

Talia Herman for ProPublica


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Talia Herman for ProPublica


Mai Yang, a communicable disease specialist, searches for Angelica, a 27 year-old pregnant woman who tested positive for syphilis, in order to get her treated before she delivers her baby.

Talia Herman for ProPublica

When Mai Yang is looking for a patient, she travels light. She dresses deliberately — not too formal, so she won’t be mistaken for a police officer; not too casual, so people will look past her tiny 4-foot-10 stature and youthful face and trust her with sensitive health information. Always, she wears closed-toed shoes, “just in case I need to run.”

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Yang carries a stack of cards issued by the Centers for Disease Control and Prevention that show what happens when the Treponema pallidum bacteria invades a patient’s body. There’s a photo of an angry red sore on a penis. There’s one of a tongue, marred by mucus-lined lesions. And there’s one of a newborn baby, its belly, torso and thighs dotted in a rash, its mouth open, as if caught midcry.

It was because of the prospect of one such baby that Yang found herself walking through a homeless encampment on a blazing July day in Huron, Calif., an hour’s drive southwest of her office at the Fresno County Department of Public Health.

She was looking for a pregnant woman named Angelica, whose visit to a community clinic had triggered a report to the health department’s sexually transmitted disease program. Angelica had tested positive for syphilis. If she was not treated, her baby could end up like the one in the picture or worse — there was a 40% chance the baby would die.

Yang knew, though, that if she helped Angelica get treated with three weekly shots of penicillin at least 30 days before she gave birth, it was likely that the infection would be wiped out and her baby would be born without any symptoms at all. Every case of congenital syphilis, when a baby is born with the disease, is avoidable. Each is considered a

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Medicaid expands funding for home and community-based care : Shots

Expanded funds for in-home care can help seniors and disabled Americans stay in their homes. Here, Lidia Vilorio, a home health aide, gives her patient Martina Negron her medicine and crackers for her tea in May in Haverstraw, N.Y.

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Michael M. Santiago/Getty Images


Expanded funds for in-home care can help seniors and disabled Americans stay in their homes. Here, Lidia Vilorio, a home health aide, gives her patient Martina Negron her medicine and crackers for her tea in May in Haverstraw, N.Y.

Michael M. Santiago/Getty Images

For older people and people with disabilities, solving everyday practical problems can be the difference between being able to live at home or being forced to move to an institution. Sometimes people need help getting dressed or making meals. Sometimes they need help managing medications or shopping for groceries.

Originally, these things weren’t paid for by Medicaid, the federal health care program that many low-income and disabled Americans rely on. In recent years, the program has worked to expand coverage of home-based care but it’s still optional for states. Some states have adopted it widely, while in others, more care still happens in nursing homes and other institutions.

In April, the Biden administration rolled out funding from the American Rescue Plan to help states boost these services. And Thursday, the federal Department of Health and Human Services unveiled every state’s plan for how they’ll use the funds. An estimated $12.7 billion dollars in federal matching funds are available to “encourage states to expand home and community-based services and strengthen their programs,” according to an agency press release.

“More and more people are saying, if I need care, I’d like it to be done at home or here in my community versus an institution or a hospital or a nursing home,” says Health Secretary Xavier Becerra. “In the 21st century, we’re moving closer to a care model that’s based on giving people services in their home.”

Becerra adds that his own father spent his last few months in hospice at home. “When he passed, he was in my home, he was surrounded by family,” he says.

Medicaid recently surpassed 80 million beneficiaries — the most ever since the program was created in the 1960s. It is the primary provider of long-term care services for older people, since these are not covered by Medicare or private insurance.

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