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

October 28, 2021 Vera

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

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.

There's A Shortage Of Home Health Aides For The Elderly, And It's Getting Worse

“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.

Short home workouts can boost your mood and reduce stress : Shots

October 17, 2021 Vera

Add five-minute stints of fun and easy exercise to your day at home by working with what’s around you, says trainer Molly McDonald.

Cha Pornea for NPR

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Cha Pornea for NPR

Add five-minute stints of fun and easy exercise to your day at home by working with what’s around you, says trainer Molly McDonald.

Cha Pornea for NPR

Of all the ways in which the pandemic has affected Americans’ well-being, perhaps the one we’ve noticed least is how much we’re sitting. And it’s not just bad for our waistlines — it’s hurting our mental health.

More than a year and a half of social distancing and work-from-home policies have led to less time moving around and more time sitting and looking at screens — it’s a potentially toxic combination that’s linked with poorer mental health.

“The sneaky effects of the pandemic that we might not even notice [is] that we’ve changed our sitting patterns,” says Jacob Meyer, director of the Wellbeing and Exercise lab at Iowa State University.

His own research showed that in the early weeks of the pandemic, people who exercised less and had more screen time were likely to be stressed, depressed and lonely.

And though most people saw their mental health gradually improve as they adapted to a new reality, people who stayed mostly sedentary didn’t see get the same improvement, according to a follow-up study by Meyer. “People who continued to have really high levels of sitting, their depression didn’t improve” as much, says Meyer.

The good news is that something as simple as some very light movement around the house to break up all that couch surfing time can make a difference in mood, as Meyer’s earlier research has found.

Scores of previous studies confirm that being physically active boosts mood, lowers anxiety and improves sleep quality.

“We know consistently that the more people are active, the more that they exercise, the better their mental health is,” says Meyer.

For many office workers like me, working from home means we’ve fallen into a routine of spending hours at our desk. With another pandemic winter about to hit us and much of the country and the world still dealing with COVID-19, we are often stuck at home more than we’d like, so it’s time to start sitting less and moving around more.

Meyer and other exercise experts shared some tips

The pandemic has driven many Americans to delay health care : Shots

October 16, 2021 Vera

Hospitals in Idaho, like St. Luke’s Boise Medical Center in Boise, remain full after the summer delta surge pushed many to their limits.

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Kyle Green/AP

Hospitals in Idaho, like St. Luke’s Boise Medical Center in Boise, remain full after the summer delta surge pushed many to their limits.

Kyle Green/AP

Last month, Chelsea Titus, a 40-year-old mother of one in Boise, Idaho, needed surgery to relieve severe pain from endometriosis. But hospitals there are so full of unvaccinated COVID-19 patients that doctors told her she’d have to wait.

Nearly 1 in 5 American households has had to delay care for serious illnesses in the past few months, according to a new poll from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

Titus, who works for a tech company from the home she shares with her husband, her daughter and a labradoodle named Winston, previously had surgery for endometriosis in which doctors removed her uterus and one ovary. When the condition flared again in September, the pain was severe.

“Sometimes it feels like I am in active labor,” she says.

Endometriosis affects millions of women in the U.S. when tissue that typically grows inside the uterus also grows outside it.

When the initial medication that Titus received didn’t help, she reached out to her on-call doctor.

“He said, ‘If the hospitals weren’t in the situation they were in, I would have you in for surgery today,’ ” she recalls.

The safety net is gone

The situation in Idaho’s hospitals has become dire. The facilities are so full of mostly unvaccinated COVID-19 patients that many can no longer operate normally. Several hospitals have had to ration care.

Chelsea Titus

Chelsea Titus/Boise State Public Radio

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Chelsea Titus/Boise State Public Radio

Chelsea Titus

Chelsea Titus/Boise State Public Radio

Jim Souza, chief physician executive at the largest of Boise’s hospitals, St. Luke’s, describes his institution’s typical high standards of care as the net that allows doctors to perform high-wire medical acts every day.

But now, “the net is gone and the people will fall from the wire,” Souza says.

Idaho has one of the lowest COVID-19 vaccination rates in the United States.

“As cancer clinicians, we’re really frustrated,” says Dr. Dan Zuckerman, medical director for St. Luke’s Cancer Institute.

Zuckerman says his staff has delayed surgery

Poll: Financial distress worsens for Americans during delta surge : Shots

October 15, 2021 Vera

Americans have fallen way behind.

The rent’s overdue and evictions are looming. Two-thirds of parents say their kids have fallen behind in school. And one in five households say someone in the home has been unable to get medical care for a serious condition.

These are some of the main takeaways from a new national poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

Despite billions of dollars in relief money from federal and state governments, “what we have here is a lot of people who are still one step from drowning financially,” says Robert Blendon, emeritus professor of health policy and political analysis at the Harvard Chan School.

Thirty-eight percent of households across the nation report facing serious financial problems in the past few months. Among Latino, Black and Native American households, more than 50% had serious financial problems, while 29% of white households did. This disparity is echoed in many other poll findings, with the minority families bearing a disproportionate share of the pandemics’ socio-economic impact.

Brittany Mitchell’s family is among those that are struggling. She lives in Gaston, S.C. and she’s a full-time cake decorator at the local Food Lion grocery store — her husband is a butcher. They were weathering the pandemic well enough, until her husband lost his job.

“There was a good two months where we really couldn’t pay rent, we couldn’t pay electric, we couldn’t pay for our internet,” she says. “We were basically borrowing from friends and family members just to make ends meet.”

Mitchell was able to enroll in rental assistance, and she says her landlord was very understanding. Her husband got a new job, but now they’re behind on utility and car payments.

“We’re still struggling real hard just to get through,” she says.

A sharp income divide

The poll showed a sharp income divide, with 59% of those with annual incomes below $50,000 reporting serious financial problems in the past few months, compared with 18% of households with annual incomes of $50,000 or more.

All this, despite the fact that around two-thirds of households report that they have received financial assistance from the government in the past few months during the delta variant surge.

It appears that the funding from COVID-19 relief bills, Blendon says, “did not provide a floor to protect people who are of moderate and low incomes.”

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Surprise medical bills are the target of a new law. Here’s how it works : Shots

October 15, 2021 Vera

The No Surprises Act is intended to stop surprise medical bills. It could also slow the growth of health insurance premiums.

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J. Scott Applewhite/AP

The No Surprises Act is intended to stop surprise medical bills. It could also slow the growth of health insurance premiums.

J. Scott Applewhite/AP

Patients are months away from not having to worry about most surprise medical bills — those extra costs that can amount to hundreds or thousands of dollars when people are unknowingly treated by an out-of-network doctor or hospital.

The No Surprises Act — which takes effect Jan. 1 — generally forbids insurers from dropping such bills on patients and, instead, requires health care providers and insurers to work out a deal between themselves.

Some observers have speculated that the law will have the unintended consequence of shifting costs and leading to higher insurance premiums.

Many policy experts told KHN that, in fact, the opposite may happen: It may slightly slow premium growth.

The reason, said Katie Keith, a research faculty member at the Center on Health Insurance Reforms at Georgetown University, is that a new rule released Sept. 30 by the Biden administration appears to “put a thumb on the scale” to discourage settlements at amounts higher than most insurers generally pay for in-network care.

That rule, which provides more details on the way such out of network disputes will be settled under the No Surprises Act, drew immediate opposition from hospital and physician groups. The American Medical Association called it “an undeserved gift to the insurance industry,” while the American College of Radiology said it “does not reflect real-world payment rates” and warned that relying on it so heavily “will cause large imaging cuts and reduce patient access to care.”

Such tough talk echoes comments made while Congress was hammering out the law.

Here’s how the law will work and how it might affect insurance premiums and the health care industry.

Sending unsettled bills to arbitration

The No Surprises Act takes aim at a common practice: large, unexpected “balance bills” being sent to insured patients for services such as emergency treatment at out-of-network hospitals or via air ambulance companies. Some patients get bills even after using in-network facilities because they receive care from a doctor there who has not signed on with an insurer’s network.

Patients were caught in the middle and liable for

What the latest COVID research says about breakthrough cases and transmission : Shots

October 14, 2021 Vera

Gloria Clemons gives a COVID-19 vaccine to Navy veteran Perry Johnson at the Edward Hines, Jr. VA Hospital in Hines, Ill., in September.

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Gloria Clemons gives a COVID-19 vaccine to Navy veteran Perry Johnson at the Edward Hines, Jr. VA Hospital in Hines, Ill., in September.

Scott Olson/Getty Images

Conventional wisdom says that if you’re vaccinated and you get a breakthrough infection with the coronavirus, you can transmit that infection to someone else and make that person sick.

But new evidence suggests that even though that may happen on occasion, breakthrough infections might not represent the threat to others that scientists originally thought.

Ross Kedl, an immunologist at the University of Colorado School of Medicine, will point out to anyone who cares to listen that basic immunology suggests the virus of a vaccinated person who gets infected will be different from the virus of an infected unvaccinated person.

That’s because vaccinated people have already made antibodies to the coronavirus. Even if those antibodies don’t prevent infection, they still “should be coating that virus with antibody and therefore helping prevent excessive downstream transmission,” Kedl says. And a virus coated with antibodies won’t be as infectious as a virus not coated in antibodies.

Scant evidence for easy transmission of breakthrough infections

In Provincetown, Mass., this summer, a lot of vaccinated people got infected with the coronavirus, leading many to assume that this was an example of vaccinated people with breakthrough infections giving their infection to other vaccinated people.

Kedl isn’t convinced.

“In all these cases where you have these big breakthrough infections, there’s always unvaccinated people in the room,” he says.

In a recent study from Israel of breakthrough infections among health care workers, the researchers report that in “all 37 case patients for whom data were available regarding the source of infection, the suspected source was an unvaccinated person.”

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It’s hard to prove that an infected vaccinated person actually was responsible for transmitting their infection to someone else.

“I have seen no one report actually trying to trace whether or not the people who were vaccinated who got infected are downstream — and certainly only could be downstream — of another vaccinated person,” Kedl says.

There’s new laboratory evidence supporting Kedl’s supposition. Initially, most vaccine experts predicted that mRNA vaccines like the ones made by Pfizer and Moderna that are