Celebrity hotel heiress Paris Hilton is backing California lawmakers’ push to increase the transparency of residential teen therapeutic centers by requiring these programs to report the use of restraints or seclusion rooms in disciplining minors.
“We shouldn’t be placing youth in facilities without knowing what these children will be subjected to,” Hilton testified Monday to the Senate Human Services Committee in Sacramento. “The Accountability in Children’s Treatment Act is a simple transparency measure that would make a lasting impact and show the world what truly happens behind closed doors.”
Hilton, 43, has become a high-profile advocate for getting tough on what she describes as the “troubled teen industry,” which promises to rehabilitate teenagers struggling with substance abuse, mental illness, and problematic behavior. Such programs lack federal oversight and have been exposed for riots, assaults, and even deaths of minors, prompting a pushback to protect the rights of young people.
Last year, Hilton went to Washington, D.C., to advocate for the federal Stop Institutional Child Abuse Act, which would establish best practices and transparency in youth residential care programs. But national efforts have failed for more than a decade and the latest proposal has been stalled for a year.
Now, Hilton and others are eyeing the most populous state as an opportunity for change.
Senate Bill 1043 is a bipartisan bill by Republican state Sen. Shannon Grove and authored also by Democratic Sens. Aisha Wahab and Angelique Ashby. The bill aims to protect young people housed in short-term residential therapeutic programs licensed by the California Department of Social Services by requiring the agency to produce a public dashboard by 2026 on the use of restraint and seclusion rooms, and when it results in serious injuries or death. It would also require foster parents and guardians to be notified when restraints and seclusion rooms are used on minors.
“There are complaints of broken arms, slammed hands in doors,” said Grove, who noted that these facilities typically house vulnerable populations, including foster youth. “There’s no data to show what happened and what caused that. And so, the goal is to go after the data.”
There was no formal opposition. The National Association of Therapeutic Schools and Programs, the nation’s largest such member organization, told California Healthline that it supports the California bill.
During Monday’s hearing, Hilton shared that while she was housed at facilities in California, Utah, and Montana, she was subjected to abuse disguised as therapy. She said if she tried to tell her parents about the abuse, facility staff would rip the phone from her hand, restrain her, and force her into solitary confinement.
“When I close my eyes at night, I still have nightmares about solitary confinement 20 years later,” Hilton said. “The sounds of my peers screaming as they were physically restrained by numerous staff members and injected with sedatives will also never leave me.”
Zoe Schreiber, another survivor, said she was sent at age 13 to a Utah facility, where she was restrained face down in the mud by six adults for hours in the rain. Schreiber described enduring seclusion, hard labor, and humiliation for four years.
Democratic state Sen. Marie Alvarado-Gil, who chairs the Human Services Committee, said she had worked in such residential treatment facilities and noticed that staff often didn’t have proper training.
“I don’t think they’re all bad, but I do think the ones that are bad, that impact the trauma of our children, that are unregulated, that are unstructured, that do not have evidence-based programming — I wonder how we get away with that here in California,” Alvarado-Gil said.
Wahab said it’s important for California to act in the absence of a federal bill. California enacted related legislation in 2021 to prevent the state from sending foster children to out-of-state facilities.
“I’m hoping that we do some justice to the kids here,” Wahab said.
The Senate Human Services Committee passed SB 1043 on a 5-0 vote. The bill now goes to the Appropriations Committee.
A wide-ranging lawsuit filed Friday outlines a moneymaking scheme by which large insurance sales agency call centers enrolled people into Affordable Care Act plans or switched their coverage, all without their permission.
According to the lawsuit, filed in U.S. District Court for the Southern District of Florida, two such call centers paid tens of thousands of dollars a day to buy names of people who responded to misleading advertisements touting free government “subsidies” and other rewards. In turn, sales agents used the information to either enroll them in ACA plans or switch their existing policies without their consent.
As a result, the lawsuit alleges, consumers lost access to their doctors or medications and faced financial costs, such as owing money toward medical care or having to repay tax credits that were paid toward the unauthorized coverage.
Some consumers were switched multiple times or had duplicative policies.
“We allege there was a plan that targeted the poorest of Americans into enrolling in health insurance through deceptive ads and unauthorized switching,” to gain compensation for the sign-ups or capture the commissions that would have been paid to legitimate insurance agents, said Jason Doss, one of two lawyers who filed the case following a four-month investigation.
Doss and Jason Kellogg, the other lawyer on the case, which was filed on behalf of several affected policyholders and agents, are seeking class action status.
Named as defendants are TrueCoverage and Enhance Health, which operate insurance call centers in Florida and other states; Speridian Technologies, a New Mexico-based limited liability company that owns and controls TrueCoverage; and Number One Prospecting, doing business as Minerva Marketing, which is also a lead-generating company. The lawsuit also names two people: Brandon Bowsky, founder and CEO of Minerva; and Matthew Herman, CEO of Enhance Health. Attempts to reach the companies for comment were unsuccessful.
According to the lawsuit, the call centers had access to policyholder accounts through “enhanced direct enrollment” platforms, including one called Benefitalign, owned by Speridian.
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Such private sector platforms, which must be approved by the Centers for Medicare & Medicaid Services, streamline enrollment by integrating with the federal ACA marketplace, called healthcare.gov. The ones included in this case were not open to the public, but only to those call center agencies granted permission by the platforms.
One of the plaintiffs, Texas resident Conswallo Turner, signed up for ACA coverage in December through an agent she knew, and expected it to go into effect on Jan. 1, according to the lawsuit. Not long after, Turner saw an ad on Facebook promising a monthly cash card to help with household expenses.
She called the number on the ad and provided her name, date of birth, and state, the lawsuit says. Armed with that information, sales agents then changed her ACA coverage and the agent listed on it five times in just a few weeks, dropping coverage of her son along with way, all without her consent.
She ended up with a higher-deductible plan along with medical bills for her now-uninsured son, the lawsuit alleges. Her actual agent also lost the commission.
The lawsuit contains similar stories from other plaintiffs.
The routine worked, it alleges, by collecting names of people responding to online and social media ads claiming to offer monthly subsidies to help with rent or groceries. Those calls were recorded, the suit alleges, and the callers’ information obtained by TrueCoverage and Enhance Health.
The companies knew people were calling on the promise “of cash benefits that do not exist,” the lawsuit said. Instead, call center agents were encouraged to be “vague” about the money mentioned in the ads, which was actually the subsidies paid by the government to insurers toward the ACA plans.
The effort targeted people with low enough incomes to qualify for large subsidies that fully offset the monthly cost of their premium, the lawsuit alleges. The push began after March 2022, when a special enrollment period for low-income people became available, opening up a year-round opportunity to enroll in an ACA plan.
The suit asserts that those involved did not meet the privacy and security rules required for participation in the ACA marketplace. The lawsuit also alleges violations of the federal Racketeer Influenced and Corrupt Organizations Act, known as RICO.
“Health insurance is important for people to have, but it’s also important to be sold properly,” said Doss, who said both consumers and legitimate agents can suffer when it’s not.
“It’s not a victimless crime to get zero-dollar health insurance if you don’t qualify for it and it ends up causing you tax or other problems down the road,” he said. “Unfortunately, there’s so much fraud that legitimate agents who are really trying to help people are also being pushed out.”
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Newswise — People with a nonfatal opioid overdose who have access to a peer support program while in the emergency department are more likely to initiate treatment and less likely to have repeated overdoses, according to a Rutgers Health study.
The study is the largest study on outcomes associated with emergency department-based peer support for opioid use disorders and was published in JAMA Network Open.
According to the Centers for Disease Control and Prevention, nonfatal drug overdoses are treated in emergency departments, which historically have stabilized and then discharged patients without linking them to treatment options.
The study analyzed the outcomes of the Opioid Overdose Recovery Program, a New Jersey Division of Mental Health and Addiction Services–supported program that connect patients admitted for opioid overdose to emergency departments with peer recovery specialists—people who have lived experiences with substance use disorders who provide nonclinical assistance, recovery support and referrals for assessment and substance use disorder treatment.
“People who themselves are in recovery can relate to someone who is going through the same experience,” said Nina Cooperman, associate professor of psychiatry at Rutgers Robert Wood Johnson Medical School, a member of the Addiction Research Center at Rutgers and an author of the study. “If a patient is ready to enter treatment, the peers will facilitate the transfer; if they are not, the peers maintain a relationship with the patient after discharge for eight weeks to provide support and facilitate linkage to treatment if they later become motivated.”
Researchers looked at 12,046 adults on Medicaid between ages 18 to 64 who were treated for nonfatal opioid overdose from 2015, when New Jersey launched the program, to June 2020 at 70 acute care hospitals. They compared the 180-day outcomes with those treated in hospitals that offered a peer intervention and those at hospitals that didn’t.
They found an increase in the probability that a patient treated for opioid overdose in hospitals that were affiliated with the peer recovery program would initiate medication for opioid use disorder treatment within 60 days of discharge and a decrease in the probability of repeat overdoses as compared to patients treated in hospitals that did not offer the program.
“However, we found a lot of variability among hospitals in achieving those outcomes,” Cooperman said. “Our findings suggest that emergency department-based peer recovery support programs are associated with increased initiation of medication for opioid use disorder, but that outcome likely depended on additional factors, such as program characteristics, program implementation success and availability of other substance use disorder services either in the hospital or in the community. Evaluating these factors is the focus of our ongoing research.”
“Peer recovery support can help reduce repeat overdoses, but it may be more effective when implemented alongside other hospital-based interventions, like emergency department buprenorphine initiation and naloxone distribution,” said lead author Peter Treitler, an assistant professor at Boston University School of Social Work who performed this research as a research program manager at the Rutgers Institute for Health, Health Care Policy and Aging Research.
Other authors include Rutgers faculty, Stephen Crystal, Joel Cantor, Sujoy Chakravarty, Anna Kline, Cory Morton and Kristen Gilmore Powell and Suzanne Borys at the New Jersey Division of Mental Health and Addiction Services.
Tax season is never fun. But some tax filers this year face an added complication: Their returns are being rejected because they failed to provide information about Affordable Care Act coverage they didn’t even know they had.
While the concern about unscrupulous brokers enrolling unsuspecting people in ACA coverage has simmered for years, complaints have risen in recent months as consumers discover their health insurance coverage isn’t what they thought it was.
Now such unauthorized enrollments are also causing tax headaches. Returns are getting rejected by the IRS and some people will have to pay more in taxes.
“It’s definitely gotten worse over the past year. We’ve helped three to four dozen people this year already,” said Erin Kinard, director of systems and intake for the Health and Economic Opportunity Program at Pisgah Legal Services in North Carolina, which helps low-income families enroll in ACA plans and get tax help.
Neither the IRS nor the Centers for Medicare & Medicaid Services, which oversees the federal Obamacare marketplace, responded to questions about the problem.
The IRS did, however, issue an FAQ in February instructing consumers on what to do if their electronically filed returns are rejected because of ACA issues.
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Unauthorized sign-ups can happen in several ways, Kinard and others said. Some rogue agents troll online enrollment portals that are accessible only to brokers but are integrated with the healthcare.gov website. When those agents open a new policy or switch an already enrolled policyholder to a different plan, they garner the associated monthly commissions. Other consumers unwittingly sign up when they respond to advertisements touting gift cards or government subsidies then are transferred to agents who enroll them in health coverage. It’s happening even after new rules were put in place requiring agents to get written or recorded consent from clients before making changes.
CMS has not released details on how many consumers have been affected or how many agents have been sanctioned for participating in such schemes.
There’s also no public tally of how many taxpayers are facing problems as a result. And the tax consequences can come as a surprise.
“Many people are finding out when they go to e-file their taxes and it bounces back and the IRS says it can’t accept your return,” said Christine Speidel, an associate professor and the director of the Federal Tax Clinic at Villanova University’s Charles Widger School of Law.
Returns are rejected if the IRS has information indicating the taxpayer has ACA coverage but the returns don’t include forms that help determine whether premium tax credits paid on the policyholder’s behalf to insurers were correct. If their income was misstated by the rogue broker who enrolled them, for example, they might not have qualified for the full amount paid. Or, if they had affordable employer coverage, they would not have been eligible for ACA subsidies at all.
Ashley Zukoski, an ultrasound technologist in Charlotte, North Carolina, had employer coverage but now faces a tax bill for an ACA plan she said she never signed up for. She reached out to KFF Health News after it reported on such unauthorized plan enrollments.
Unbeknownst to her, she said, a broker in Florida enrolled her family in an ACA plan in late February 2023, even though Zukoski had coverage starting that January through her job. The broker listed an income that qualified the household for a full subsidy, so Zukoski never received a premium bill.
Her first inkling that something was amiss came early in 2024 when she received a special form, called a 1095-A, which showed she had an ACA plan. After reporting the problem to the federal marketplace, she sought to get the 1095-A voided so she would not be liable for the plan’s premium subsidies paid by the government to the insurer.
But, because Zukoski’s pharmacy had billed the ACA plan instead of her job-based coverage, her request was denied. She plans to appeal.
In the meantime, the family has filed an extension on their taxes.
“Instead of getting a $4,100 refund, we now owe almost $700 in taxes based on the 1095-A and premium tax credit applied,” Zukoski said.
With the April 15 federal tax filing deadline upon us, there are some important steps for affected consumers to take, tax and insurance experts said.
First, because it could take weeks to get corrected forms, experts recommend filing for an extension to buy more time. When consumers file for that extension, they should also pay any taxes owed to avoid penalties and interest.
In general, consumers who at any point in the year think they are victims of an unauthorized enrollment or plan switch should report it immediately to the relevant federal or state ACA marketplace and request a corrected Form 1095-A. But move fast. Appeals to cancel coverage retroactively must be made within 60 days of discovering the fraudulent enrollment, Speidel said.
Consumers can ask for help filing a complaint with federal or state regulators by contacting their own insurance agents or seeking help from assisters or “navigator” programs, which are government-funded nonprofit groups that help people enroll or deal with insurance problems.
Navigators and assisters are fielding many such cases this year and can submit what are called “complex case forms,” which help federal officials investigate such complaints, said Lynn Cowles, program manager for Prosper Health Coverage, a navigator program in Texas.
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
State and local governments are receiving billions of dollars in opioid settlements to address the drug crisis that has ravaged America for decades. But instead of spending the money on new addiction treatment and prevention services they couldn’t afford before, some jurisdictions are using it to replace existing funding and stretch tight budgets.
Scott County, Indiana, for example, has spent more than $250,000 of opioid settlement dollars on salaries for its health director and emergency medical services staff. The money usually budgeted for those salaries was freed to buy an ambulance and create a financial cushion for the health department.
In Blair County, Pennsylvania, about $320,000 went to a drug court the county has been operating with other sources of money for more than two decades.
And in New York, some lawmakers and treatment advocates say the governor’s proposed budget substitutes millions of opioid settlement dollars for a portion of the state addiction agency’s normal funding.
The national opioid settlements don’t prohibit the use of money for initiatives already supported by other means. But families affected by addiction, recovery advocates, and legal and public health experts say doing so squanders a rare opportunity to direct additional resources toward saving lives.
“To think that replacing what you’re already spending with settlement funds is going to make things better — it’s not,” said Robert Kent, former general counsel for the Office of National Drug Control Policy. “Certainly, the spirit of the settlements wasn’t to keep doing what you’re doing. It was to do more.”
Settlement money is a new funding stream, separate from tax dollars. It comes from more than a dozen companies that were accused of aggressively marketing and distributing prescription painkillers. States are required to spend at least 85% of the funds on addressing the opioid crisis. Now, with illicit fentanyl flooding the drug market and killing tens of thousands of Americans annually, the need for treatment and social services is more urgent.
Scott County, Indiana — a small, rural place known nationally as the site of an HIV outbreak in 2015 sparked by intravenous drug use — received more than $570,000 in opioid settlement funds in 2022.
From August 2022 to July 2023, the county reported using roughly $191,000 for the salaries of its EMS director, deputy director, and training officer/clinical coordinator, as well as about $60,000 for its health administrator. The county also awarded about $151,000 total to three community organizations that address addiction and related issues.
In a public meeting discussing the settlement dollars, county attorney Zachary Stewart voiced concerns. “I don’t know whether or not we’re supposed to be using that money to add, rather than supplement, already existing resources,” he said.
Susan Ousterman, of Bucks County, Pennsylvania, lost her 24-year-old son, Tyler Cordeiro, to a drug overdose in 2020. She has been fighting to ensure the opioid settlement funds are used effectively since.(Steven Ousterman)
Council President Lyndi Hughbanks did not respond to repeated requests to explain this decision. But council members and county commissioners said in public meetings that they hoped to compensate county departments for resources expended during the HIV outbreak.
Their conversations echoed the struggles of many rural counties nationwide, which have tight budgets, in part because they poured money into addressing the opioid crisis for years. Now as they receive settlement funds, they want to recoup some of those expenses.
The Scott County Health Department did not respond to questions about how the funds typically allocated for salary were used instead. But at the public meeting, it was suggested they could be used at the department’s discretion.
EMS Chief Nick Oleck told California Healthline the money saved on salaries was put toward loan payments for a new ambulance, purchased in spring 2023.
Unlike other departments, which are funded from local tax dollars and start each year with a full budget, the county EMS is mostly funded through insurance reimbursements for transporting patients, Oleck said. The opioid settlement funds provided enough cash flow to make payments on the new ambulance while his department waited for reimbursements.
Oleck said this use of settlement dollars will save lives. His staff needs vehicles to respond to overdose calls, and his department regularly trains area emergency responders on overdose response.
“It can be played that it was just money used to buy an ambulance, but there’s a lot more behind the scenes,” Oleck said.
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Still, Jonathan White — the only council member to vote against using settlement funds for EMS salaries — said he felt the expense did not fit the money’s intended purpose.
The settlement “was written to pay for certain things: helping people get off drugs,” White told California Healthline. “We got drug rehab facilities and stuff like that that I believe could have used that money more.”
Phil Stucky, executive director of a local nonprofit called Thrive, said his organization could have used the money too. Founded in the wake of the HIV outbreak, Thrive employs people in recovery to provide support to peers with mental health and substance use disorders.
Phil Stucky is executive director of a nonprofit called Thrive, which began in Scott County, Indiana, in the wake of a large HIV outbreak in 2015. Thrive employs people in recovery to provide peer support to others with mental health and substance use disorders.(Jake Zaepfel)
Stucky, who is in recovery himself, asked Scott County for $300,000 in opioid settlement funds to hire three peer specialists and purchase a vehicle to transport people to treatment. He ultimately received one-sixth of that amount — enough to hire one person.
In Blair County, Pennsylvania, Marianne Sinisi was frustrated to learn her county used about $322,000 of opioid settlement funds to pay for a drug court that has existed for decades.
“This is an opioid epidemic, which is not being treated enough as it is now,” said Sinisi, who lost her 26-year-old son to an overdose in 2018. The county received extra money to help people, but instead it pulled back its own money, she said. “How do you expect that to change? Isn’t that the definition of insanity?”
Blair County Commissioner Laura Burke told California Healthline that salaries for drug court probation officers and aides were previously covered by a state grant and parole fees. But in recent years that funding has been inadequate, and the county general fund has picked up the slack. Using opioid settlement funds provides a small reprieve since the general fund is overburdened, she said. The county’s most recent budget faces a $2 million deficit.
Forfeited Federal Dollars
Supplantation can take many forms, said Shelly Weizman, project director of the addiction and public policy initiative at Georgetown University’s O’Neill Institute. Replacing general funds with opioid settlement dollars is an obvious one, but there are subtler approaches.
If those jurisdictions then use opioid settlement funds for activities that could have been covered with federal money, Weizman considers it supplantation.
“It’s really letting down the citizens of their state,” she said.
Officials in Bucks County, Pennsylvania, forfeited more than $1 million in federal funds from September 2022 to September 2023, the bulk of which was meant to support the construction of a behavioral health crisis stabilization center.
“We were probably overly optimistic” about spending the money by the grant deadline, said Diane Rosati, executive director of the Bucks County Drug and Alcohol Commission.
In a September 2022 email to other committee members, she expressed disappointment in the suggested uses: “Please keep in mind, the settlement funds are not meant to fund existing programs or programs that can be funded by other sources, such as federal grants.”
But Rosati said the county is maximizing its resources. Settlement funds will create a host of services, including grief groups for families and transportation to treatment facilities.
“We’re determined to utilize every bit of funding that’s available to Bucks County, using every funding source, every stream, and frankly every grant opportunity that comes our way,” Rosati said.
The county’s guiding principles for settlement funds demand as much. They say, “Whenever possible, use existing resources in order that Opioid Settlement funds can be directed to addressing gaps in services.”
Ed Mahon of Spotlight PA contributed to this report.
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
SACRAMENTO — Nearly a half-million health workers who stand to benefit from California’s nation-leading $25 minimum wage law could be in for a rude awakening if hospitals and other health care providers follow through on potential cuts to hours and benefits.
A medical industry challenge to a new minimum wage ordinance in one Southern California city suggests layoffs and reductions in hours and benefits, including cuts to premium pay and vacation time, could be one result of a state law set to begin phasing in in June. However, some experts are skeptical of that possibility.
The California Hospital Association brought a partly successful legal challenge to Inglewood’s $25 minimum wage ordinance, which barred employers from taking those sorts of steps to offset their higher costs.
“Layoffs, reductions in premium pay rates, reductions in non-wage benefits, reductions in hours, and increased charges are consequences of an employer having less money to spend—which will necessarily be the case given the significant increase in spending on wages due to the minimum wage,” the association said in its lawsuit. Additional examples include reducing health coverage and charging for parking or work-related equipment.
Inglewood voters approved the ordinance in November 2022, nearly a year before California legislators enacted a $25 minimum wage for health workers. Those statewide higher wages are to be phased in starting in June under California’s first-in-the-nation law, but Gov. Gavin Newsom has since said they are too expensive as the state faces a deficit estimated between $38 billion and $73 billion. It’s unclear if lawmakers will agree to a delay or take other steps to reduce the cost.
U.S. District Judge Dale S. Fischer agreed with the hospital industry in a March 11 tentative ruling when he shot down the portion of Inglewood’s ordinance banning layoffs and clawbacks by employers, while allowing the rest of the ordinance to remain in effect. He gave the sides time to object to his preliminary decision, though none did.
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The California Hospital Association represents more than 400 hospitals and was a key backer of the state’s carefully crafted compromise law, which notably contains none of the employee safeguards included in the Inglewood ordinance.
Spokesperson Jan Emerson-Shea said the association doesn’t know how providers will react once the state law takes effect. “We don’t have any insights,” she said.
“The challenge for any health care organization is figuring out how to pay for the higher wages,” said Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at the University of California-San Francisco. “Since labor costs are the largest part of any health care organization’s costs, it’s hard to figure out how to reduce spending without looking at labor costs.”
Providers can try to increase revenues by bargaining for higher reimbursements from commercial insurers, she said. Public hospitals, nursing homes, and community clinics get most of their money through Medi-Cal, the state’s Medicaid program.
Providers could reduce the services they offer, pare back charity care, and cut or delay capital investments, Spetz said. In the long term, she expects some combination of spending cuts and revenue increases.
Both the state law and local ordinance cover far more than doctors and nurses, with a definition of health worker that includes janitors, housekeepers, groundskeepers, security guards, food service workers, laundry workers, and clerical staff.
The most recent estimate by the Health Care Program at the University of California-Berkeley Labor Center is that as many as 426,000 health workers would make an average of $6,400 extra in the law’s first year, a 19% average pay bump mainly benefiting lower-income workers of color and women. State finance officials project that well over 500,000 workers will benefit.
Researchers didn’t include layoffs and other potential staffing and benefit reductions when they projected the state law’s costs and benefits, said Laurel Lucia, the program’s director. But she pointed to initial projections by hospitals, doctors, and business and taxpayer groups that the wage hike would cost $8 billion annually, thereby imperiling services and resulting in higher premiums and higher costs for state and local governments.
“It seems like a contradiction to say this law’s going to cost billions of dollars while at the same time saying it’s going to reduce workers’ total compensation,” said Lucia, who projects a far lower price tag.
She added that state finance officials had anticipated that Medi-Cal reimbursements would reflect the increased labor costs, while Medicare would eventually at least partially compensate for the higher labor costs.
Michael Reich, chair of the Center on Wage and Employment Dynamics at UC Berkeley’s Institute for Research on Labor and Employment, and affiliated economist Justin Wiltshire recently argued that California’s new $20 minimum wage law for fast-food workers won’t result in mass layoffs and price increases, as some have predicted.
Health care is much different than fast food, Reich acknowledged, but he argued for much the same positive result.
“A higher minimum wage will make it easier and cheaper for hospitals to recruit and retain these workers. The cost savings, and the productivity benefits of more experienced workers, could offset much of the labor cost increase,” Reich said.
The hospital association filed its lawsuit against Inglewood’s ordinance in July, while it was still opposing early versions of the statewide minimum wage legislation. Among many other provisions, the statewide law put on hold an initiative to cap hospital executives’ salaries in Los Angeles.
The hospital association’s legal challenge referenced in part layoffs and reduced working hours imposed by Centinela Hospital Medical Center after Inglewood’s ordinance took effect.
But Centinela said the reduction was entirely unrelated to the ordinance and that all staff were offered alternate positions, which many accepted.
“Centinela Hospital also has since added many more jobs in new clinical positions above minimum wage scale,” the hospital said in a statement.
Service Employees International Union-United Healthcare Workers West, the prime backer of both the local ordinance and the statewide law, sued the hospital in April 2023 alleging that it cut workers’ hours to offset the higher minimum wage. The case is still pending.
The union did not respond to repeated requests for comment.
In a court filing, however, the union and city of Inglewood said similar employer restrictions in previous minimum wage laws have survived.
The ordinance “merely sets the backdrop for collective bargaining negotiations,” and does not bar employers from locking out employees or hiring replacement workers during a strike. Employers can still lay off workers or reduce their hours, they said, so long as they don’t do so to fund the higher minimum wage.
But Fischer agreed with the hospital association that layoffs and reductions in employees’ total compensation packages are “obvious responses by an employer to rising compensation costs.”
Restricting employers’ options would violate federal labor relations rules, he said.
“The minimum wage an employer has to pay its employees will invariably affect the total amount of compensation it is able or willing to pay,” he wrote “This will then invariably affect the number of employees it can retain and the number of hours those employees will be scheduled to work.”
Nearly a quarter of adults disenrolled from Medicaid in the past year say they are now uninsured, according to a survey released Friday that details how tens of millions of Americans struggled to retain coverage in the government insurance program for low-income people after pandemic-era protections began expiring last spring.
The first national survey of adults whose Medicaid eligibility was reviewed during the unwinding found nearly half of people who lost their government coverage signed back up weeks or months later — suggesting they should never have been dropped in the first place.
While 23% reported being uninsured, an additional 28% found other coverage — through an employer, Medicare, the Affordable Care Act’s insurance marketplace, or health care for members of the military, the survey by KFF found.
“Twenty-three percent is a striking number especially when you think about the number of people who lost Medicaid coverage,” said Chima Ndumele, an associate professor of health policy at the Yale University School of Public Health.
Going without insurance even for a short period of time can lead people to delay seeking care and leave them at financial risk when they do.
Seven in 10 adults who were disenrolled during the unwinding process say they became uninsured at least temporarily when they lost their Medicaid coverage.
Adrienne Hamar, of Plymouth Meeting, Pennsylvania, lost her Medicaid coverage in February but was able to sign up for an Obamacare marketplace insurance plan in April. She was uninsured in March. Hamar had been enrolled in Medicaid since 2020. (Adrienne Hamar)
Adrienne Hamar, 49, of Plymouth Meeting, Pennsylvania, said she struggled to enroll in an Affordable Care Act marketplace plan this winter after the state informed her that she and her two children no longer qualified for Medicaid. They had been enrolled since 2020. She said phone lines were busy at the state’s marketplace and she couldn’t complete the process online.
Hamar, who works as a home health aide, and her children were uninsured in March. But since April 1, they’ve been enrolled in a marketplace plan that, with the help of government subsidies, costs $50 a month for the family.
“I was very relieved,” she said. Unsure of their insurance status, Hamar said, her 23-year-old daughter delayed getting a dental checkup.
Hamar’s struggles were common, the survey found.
Of adults enrolled in Medicaid before the unwinding, about 35% who tried to renew their coverage described the process as difficult, and about 48% said it was at least somewhat stressful.
About 56% of those disenrolled say they skipped or delayed care or prescriptions while attempting to renew their Medicaid coverage.
“People’s current insurance status is likely to be very much in flux, and we would expect at least some of the people who say they are currently uninsured to reenroll in Medicaid — many say they are still trying — or enroll in other coverage within a short period of time,” said Jennifer Tolbert, a co-author of the KFF report and the director of KFF’s State Health Reform and Data Program.
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The survey didn’t include children, and the KFF researchers said their findings therefore couldn’t be extrapolated to determine how the Medicaid unwinding has affected the overall U.S. uninsured rate, which hit a record low of 7.7% in early 2023. Nearly half of enrollees in Medicaid and the related Children’s Health Insurance Program are children.
The unwinding, in which states are reassessing eligibility for Medicaid among millions of Americans who enrolled before or during the pandemic and dropping those who no longer qualify or did not complete the renewal process, won’t be completed until later this year. Enrollment in Medicaid and CHIP grew to a record of nearly 94.5 million in April of last year, three years after the federal government prohibited states from cutting people from their rolls during the covid-19 public health emergency.
Nationally, states have disenrolled about 20 million people from Medicaid in the past year, most of them for procedural reasons such as failure to submit required paperwork. That number is expected to grow, as states have a few more months to redetermine enrollees’ eligibility.
Among adults who had Medicaid prior to the start of the unwinding, 83% retained their coverage or reenrolled, while 8% found other insurance and 8% were uninsured. The share left uninsured was larger in states that have not expanded Medicaid under the ACA (17%) than in states that have (6%). Forty states have expanded Medicaid to cover everyone with an income under 138% of the federal poverty rate, or $31,200 for a family of four this year.
The KFF survey found that nearly 1 in 3 disenrolled adults discovered only when they sought health care — such as going to a doctor or a pharmacy — that they had been dropped from Medicaid.
In March, Indira Navas (center), of Miami, learned that her 6-year-old son, Andres (below center), had been disenrolled from Florida’s Medicaid program but that her 12-year-old daughter, Camila (left), remained covered even though the children live in the same household with their parents. (Javier Ojeda)
Indira Navas of Miami found out that her 6-year-old son, Andres, had been disenrolled from Florida’s Medicaid program when she took him to a doctor appointment in March. She had scheduled Andres’ appointment months in advance and is frustrated that he remains uninsured and his therapy for anxiety and hyperactivity has been disrupted.
Navas said the state could not explain why her 12-year-old daughter, Camila, remained covered by Medicaid even though the children live in the same household with their parents.
“It doesn’t make sense that they would cover one of my children and not the other,” she said.
Kate McEvoy, executive director of the National Association of Medicaid Directors, said the sheer volume of millions of people being redetermined for eligibility has overwhelmed some state call centers trying to support enrollees.
She said states have tried many ways to communicate with enrollees, including through public outreach campaigns, text, email, and apps. “Until the moment your coverage is at stake, it’s hard to penetrate people’s busy lives,” she said.
The KFF survey, of 1,227 adults who had Medicaid coverage in early 2023 prior to the start of the unwinding on April 1, 2023, was conducted between Feb. 15, 2024, and March 11, 2024. The margin of sampling error was plus or minus 4 percentage points.
KFF Health News correspondent Daniel Chang contributed to this article.
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
MONROE, N.C. — Regina Barrett, a 69-year-old retiree who lives in this small North Carolina city southeast of Charlotte, has not been happy with her tap water for a while.
“Our water has been cloudy and bubbly and looks milky,” said Barrett, who blames fluoride, a mineral that communities across the nation have for decades added to the water supply to help prevent cavities and improve dental health.
“I don’t want fluoride in my nothing!” said Barrett, echoing a growing number of people who not only doubt the mineral’s effectiveness but also believe it may be harmful despite decades of data pointing to public health and economic benefits.
In February, the Board of County Commissioners in Union County, whose seat is Monroe, voted 3-2 to stop adding fluoride to drinking water at the Yadkin River Water Treatment Plant, the only water source wholly owned and operated by the county. But the decision came after heated discussions among residents and county officials.
“My children had the blessing of growing up with fluoride in their water and … they have very little dental issues,” said Commissioner Richard Helms ahead of the vote. A fellow commissioner saw it differently: “Let’s stop putting something in the water that’s meant to treat us, and give people the freedom to choose,” said David Williams.
Barrett’s water comes from the city of Monroe, not the Yadkin facility. So, for now, she will continue to drink water enhanced with fluoride. “I’m suspicious as to why they add that to our water,” she told California Healthline.
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It is a scenario playing out nationwide. From Oregon to Pennsylvania, hundreds of communities have in recent years either stopped adding fluoride to their water supplies or voted to prevent its addition. Supporters of such bans argue that people should be given the freedom of choice. The broad availability of over-the-counter dental products containing the mineral makes it no longer necessary to add to public water supplies, they say. The Centers for Disease Control and Prevention says that while store-bought products reduce tooth decay, the greatest protection comes when they are used in combination with water fluoridation.
The outcome of an ongoing federal case in California could force the Environmental Protection Agency to create a rule regulating or banning the use of fluoride in drinking water nationwide. In the meantime, the trend is raising alarm bells for public health researchers who worry that, much like vaccines, fluoride may have become a victim of its own success.
The CDC maintains that community water fluoridation is not only safe and effective but also yields significant cost savings in dental treatment. Public health officials say removing fluoride could be particularly harmful to low-income families — for whom drinking water may be the only source of preventive dental care.
“If you have to go out and get care on your own, it’s a whole different ballgame,” said Myron Allukian Jr., a dentist and past president of the American Public Health Association. Millions of people have lived with fluoridated water for years, “and we’ve had no major health problems,” he said. “It’s much easier to prevent a disease than to treat it.”
According to the anti-fluoride group Fluoride Action Network, since 2010, over 240 communities around the world have removed fluoride from their drinking water or decided not to add it.
One needs only to look to Union County to see just how intense discussions can be. Usually when the commissioners meet on the first floor of the Government Center in downtown Monroe, there are more vacant seats than attendees. But sessions about the prohibition of fluoride in public water supplies were packed, and residents who signed up to speak were divided.
One person who came to the microphone on Feb. 5 compared water fluoridation to a seat belt. It does not “prevent the car crash, but it limits the harm done,” he said. Another argued that there is no proof fluoride is safe or effective. “It’s a significant potential milestone to reverse 60-plus years of poisoning the public,” he said, using an unproven claim often made by opponents of fluoridation.
Fluoride opponents claim the mineral is responsible for everything from acne to high blood pressure and thyroid dysfunction to bone cancer.
The National Institutes of Health acknowledges that, when ingested in extremely large amounts, fluoride from dental products or dietary supplements can cause nausea, vomiting, abdominal pain, diarrhea, bone pain, and even death in extremely rare cases.
Infants and children who receive too much fluoride can develop discoloration or small dents in their teeth. In adults, consumption of excessive fluoride for extended periods can lead to skeletal fluorosis, a very rare condition that causes joint pain and stiffness, weak bones, muscle loss, and nerve problems.
However, the recommended dosage in drinking water has always been small. In 2015, the Department of Health and Human Services lowered the optimal fluoride concentration from 1.2 milligrams per liter to 0.7 mg/L.
Juneau, Alaska, voted to remove fluoride from its drinking water in 2007. A study published in the journal BMC Oral Health in 2018 compared the dental records of children and adolescents who received dental care for decaying teeth four years before and five years after the city stopped adding fluoride to the water. Cavity-related procedures and treatment costs were significantly higher in the latter group, the study found.
Portland, Oregon, is the largest city in the nation that has consistently refused to fluoridate its drinking water. Voters have repeatedly rejected measures to add it, first in 1956 and the latest time in 2013.
Despite the strong recommendation of local doctors and dentists, voters in Wichita, Kansas, have rejected adding fluoride to the water several times, most recently in 2012.
The Brushy Creek Municipal Utility District in Williamson County, Texas, had been adding fluoride to its water system since 2007 but ended the practice in December.
In 2016, Collier County, Florida, commissioners opted not to remove fluoride from the water system. But they unanimously reversed that decision following a 2023 Health Freedom Bill of Rights county ordinance in response to covid-19 “to safeguard the healthcare rights and freedoms of Collier County residents.”
The State College Borough Water Authority in Pennsylvania stopped adding fluoride to the water of its 75,000 customers in March 2023. Officials used claims often cited by fluoride opponents, such as potential environmental contamination, concerns about medical freedom, and possible adverse health effects, like the potential for the appearance of faint white lines on the teeth and lowered IQ for babies.
A study published in JAMA Pediatrics in 2019, conducted in six Canadian cities, associated fluoride exposure during pregnancy with lower IQ scores in children. But the study was based on self-reporting and has been criticized for its perceived methodological shortcomings.
In 2016, several consumer advocacy groups, including the Fluoride Action Network, Food & Water Watch, and Moms Against Fluoridation, petitioned the EPA to end water fluoridation under the Toxic Substances Control Act, alleging that significant research showed fluoride was neurotoxic at the doses now used. The same group filed a federal lawsuit against the EPA the following year, after the agency denied their citizen petition.
During a 10-day bench trial in San Francisco that concluded in mid-February, the two sides debated the risks and areas of uncertainty. If Senior U.S. District Judge Edward Chen determines water fluoridation presents an “unreasonable risk” to human health, the EPA will be forced to create a rule regulating or banning water fluoridation in the U.S. A decision is expected soon.
For the time being, decisions about whether to fluoridate community water systems are still made primarily at the local level, which Barrett hopes will change.
“Of all things, they want our teeth healthy when basic needs of housing and food are lacking.”
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Newswise — Worldwide, someone dies from drug or alcohol addiction every four minutes. Now, researchers at Huntsman Mental Health Institute at the University of Utah have been selected by Wellcome Leap to research a new treatment for substance use disorder as part of a $50 million commitment to develop innovative treatments.
The research will be funded by the Untangling Addiction program, which is a $50 million program founded by Wellcome Leap to develop scalable measures to assess addiction susceptibility, quantify the risks stemming from addiction, and develop innovative treatments.
“Substance use disorder is a significant global health problem, and yet the treatment options are limited,” Mickey said. “We’re developing a non-invasive intervention for preventing and treating addiction, chronic pain, and depression. This funding will help us validate and generate the data to support the next critical step: an efficacy trial to determine the effectiveness of the intervention.”
Mickey’s team will use a novel ultrasound-based device to modulate deep brain regions and behaviors associated with opioid addiction. The goal will be to ultimately develop this approach into an individually targeted therapeutic intervention for a range of addictions.
“Addictions are brain illnesses that have enormous negative impact on individuals, families, and society,” Mickey said. “A major reason that addictions have been difficult to prevent—and treat—is that they are driven by dysfunction of deep brain regions that are challenging to access. Many psychiatric problems such as depression, anxiety, and addiction are caused by malfunction of brain circuits. This project is an example of our mission to understand how these neural circuits are dysregulated and to develop novel, circuit-targeted interventions that return the brain to a healthy state.”
“We are proud to bring Wellcome Leap’s innovative problem-solving and funding approach to our research enterprise at the University of Utah,” said Taylor Randall, President, University of Utah. “To have our mental health researchers contributing to pioneering work on addiction treatment reaffirms our commitment to improving lives through discovery.”
“What makes research like this so impactful is that it brings together a variety of disciplines to help solve complex problems in mental health,” said Mark Hyman Rapaport, MD, CEO of Huntsman Mental Health Institute. “This is particularly timely news given the groundbreaking of a new translational research building on campus focused on mental health and the brain. Our nation is in a mental health crisis, but there is hope if we can think differently and work together to change this trajectory.”
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About Huntsman Mental Health Institute
Huntsman Mental Health Institute at University of Utah Health brings together 75 years of patient care, research, and education into one of the nation’s leading academic medical centers focused on mental health. Nestled in the campus of University of Utah, Huntsman Mental Health Institute serves the community with 1,600 faculty and staff in 20 locations providing inpatient and outpatient services for youth, teens, and adults as well as a comprehensive crisis care model which includes the nationally recognized SafeUT app and the 988 Crisis hotline for Utah. Our mission is to advance mental health knowledge, hope, and healing for all. Learn more at: HMHI.utah.edu and join the conversation on Instagram, Facebook, TikTok, X and LinkedIn.
The Arizona Supreme Court shook up the national abortion debate this week, ruling that a ban originally passed in 1864 — before the end of the Civil War and decades before Arizona became a state — could be enforced. As in some other states, including Florida, voters will likely have the chance to decide whether to enshrine abortion rights in the state constitution in November.
The Arizona ruling came just one day after former President Donald Trump declared that abortion should remain a state issue, although he then criticized the ruling as having gone “too far.”
This week’s panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Rachel Roubein of The Washington Post, and Rachel Cohrs Zhang of Stat.
Among the takeaways from this week’s episode:
Former President Donald Trump’s remarks this week reflect only the latest public shift in his views on abortion access. During an appearance on NBC’s “Meet the Press” in 1999, he described himself as “very pro-choice,” but by the 2016 presidential campaign, he had committed to nominating conservative Supreme Court justices likely to overturn the constitutional right to an abortion. Trump later blamed Republican losses in the 2022 elections on the overturning of that right.
Arizona officials, as well as doctors and patients, are untangling the ramifications of a state Supreme Court ruling this week allowing the enforcement of a near-total abortion ban dating to the Civil War. Yet any ban — even one that doesn’t last long — can have lasting effects. Abortion clinics may not survive such restrictions, and doctors and residents may factor them into their decisions about where to practice medicine.
Also in abortion news, an appeals court panel in Indiana unanimously ruled that the state cannot enforce its abortion ban against a group of non-Christians who sued, siding with mostly Jewish plaintiffs who charged that the ban violates their religious freedom rights.
A discouraging new study finds that paying off an individual’s medical debt once it has reached collections doesn’t offer them much financial — or mental health — benefit. One factor could be that the failure to pay medical debt is only a symptom of larger financial difficulties.
Also this week, Rovner interviews KFF Health News’ Molly Castle Work, who reported and wrote the latest KFF Health News-NPR “Bill of the Month” feature about an air-ambulance ride for an infant with RSV that his insurer deemed not to be medically necessary. If you have an outrageous or baffling medical bill you’d like to send us, you can do that here.
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
