Category: Rehab News

New Report: Life Expectancy Years Shorter in the United States Compared to the United Kingdom

Original post: Newswise - Substance Abuse New Report: Life Expectancy Years Shorter in the United States Compared to the United Kingdom

Newswise — A new report from the Bloomberg American Health Initiative at the Johns Hopkins Bloomberg School of Public Health finds that life expectancy in the United States is, on average, 78.6 years versus 81.3 years in England and Wales, an overall 2.7-year difference.  

The analysis, which reviewed causes of death based on newly released 2023 data, found that preventable causes—heart disease, overdose, firearm violence, and motor vehicle crashes—explain the almost three-year gap in life expectancy.

The report, A Tale of Two Countries: The Life Expectancy Gap Between the United States and the United Kingdom, offers evidence-based solutions from Johns Hopkins public health experts to close this gap and to increase lifespans in the U.S. 

The report is set to be announced by Michael R. Bloomberg, founder of Bloomberg L.P. and Bloomberg Philanthropies and WHO Global Ambassador for Noncommunicable Diseases and Injuries, at the seventh annual Bloomberg American Health Summit in Washington, D.C. The Summit convened public health leaders, government officials, community organizations, researchers, and students to discuss the urgent need to uphold evidence-based health policies to improve life expectancy in a politically divided country.

“There is simply no good reason why people in the U.S. can expect to die nearly three years earlier than their counterparts across the Atlantic,” says Joshua M. Sharfstein, MD, director of the Bloomberg American Health Initiative and vice dean for Public Health Practice and Community Engagement at the Bloomberg School. “If we choose programmatic and policy solutions based on evidence, we will close this gap.”

In 1984, life expectancy in the U.S. and the U.K. was the same. But the gap has widened over time, peaking in 2022 during the pandemic with a difference of 4.7 years, as the two countries have taken different directions on health and social policy on issues that include dietary sodium, firearm policy, addiction treatment, injury prevention, COVID-19, and health care. The U.S. health care system is particularly unable to deliver needed preventive services equitably and at scale.

The report found the life expectancy gap is due to the following:

  • Cardiovascular disease: Cardiovascular disease, which is linked to environmental factors, structural conditions, and lifestyle choices, represents the largest contributor to the life expectancy gap. The U.S. death rate due to cardiovascular health issues is 38% greater than that of England and Wales.
  • Overdose deaths: Overdose is the second leading contributor to the gap. The U.S. overdose death rate is more than three times greater than England and Wales—31.6 per 100,000 versus 9.3 per 100,000. 
  • Gun-related deaths: The death rate for firearm-related homicides and suicides is 13.3 deaths per 100,000 in the U.S. compared to 0.1 per 100,000 in England and Wales. Ninety individuals died from firearm-related causes in England and Wales in 2023 compared to more than 45,000 in the United States. 
  • Motor vehicle crashes: The death rate from motor vehicle crashes in the U.S. is six times greater than the rate in England and Wales—13.3 per 100,000 versus 2.2 per 100,000 in England and Wales. 

COVID-19 and cancer offset some of the life expectancy gap between the two countries. The death rate for COVID-19 in the U.S. was 12 per 100,000 compared to 13.8 per 100,000 in England and Wales. For cancer-related deaths, the U.S. had a lower rate of 147.2 per 100,000 compared to 186.1 in England and Wales.

The new report is a follow-up to a 2022 report from the Bloomberg American Health Initiative, which detailed actions the U.S. can take to address declining life expectancy.

The new report draws from preliminary 2023 mortality data from the U.S. National Center for Health Statistics and the Centers for Disease Control and Prevention, and final 2023 data from the United Kingdom Office for National Statistics. Available U.K. data includes England and Wales, which represent about 90% of the population, but not Scotland or Northern Ireland. While the U.S. has about five times more people than the U.K. and greater per capita income, the age distributions and several other demographic factors are similar.

Younger Americans, Men Die Before U.K. Counterparts

For younger Americans, the researchers found even larger gaps in life expectancy between the U.S. and the U.K. Firearm-related homicide and suicide rates are 485.9 times higher for people under age 25 in the U.S. compared to England and Wales. Drug overdose rates are 4.5 times higher in the U.S. for people under age 25. 

Men overall had the largest age gap in life expectancy, a difference of 3.4 years, and lower life expectancy overall. Men living in the U.S. have a life expectancy of 75.9 years, while those in England and Wales have a life expectancy of 79.3 years. Women have a difference of 1.9 years, with the U.S. having a life expectancy of 81.3 years compared with 83.2 years in England and Wales. 

In the new report, researchers also highlight health policies, some in place in the U.K., that can address the key areas they found to be responsible for the life expectancy gap between the two countries. These include:

  • Reducing cardiovascular disease by prioritizing clinical and population-based solutions including increasing access to treatment for hypertension, increasing access to more nutritious food, reducing sodium through food policy, and providing more opportunities for physical activity.
  • Reducing overdose-related deaths by expanding access to treatment for opioid use disorder, such as methadone, in the U.S. through community pharmacies and correctional facilities.
  • Reducing gun homicides and gun-related suicides by limiting access to gun ownership through Firearm Purchaser Licensing and Extreme Risk Protection Orders, both popular policies that have been shown to reduce violence or self-harm.
  • Reducing teen suicides by building a national community mental health infrastructure that allows for ongoing investment in mental health care services, especially in rural and historically underserved areas.
  • Reducing motor vehicle crashes by incorporating intelligent speed technology that alerts drivers when they are over the speed limit, enforcing penalties for impaired driving, and including a hazard perception test as part of driver licensing requirements.

“This analysis tells a story of how preventable disease is responsible for the U.S. falling behind in life expectancy,” says Alison Gemmill, PhD, MPH, assistant professor in the Department of Population, Family and Reproductive Health at the Bloomberg School and lead researcher on the analysis of the study. “What we do with this information will determine whether this gap grows or shrinks over time.”

Contributors to A Tale of Two Countries: The Life Expectancy Gap Between the United States and the United Kingdominclude Joshua Sharfstein, Alison Gemmill, Lawrence Appel, Sonia Angell, Brendan Saloner, Josh Horwitz, Silvia Villareal, Kiara Alvarez, and Johnathan Ehsani.

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Nursing Home Industry Wants Trump To Rescind Staffing Mandate

Covid’s rampage through the country’s nursing homes killed more than 172,000 residents and spurred the biggest industry reform in decades: a mandate that homes employ a minimum number of nurses.

But with President-elect Donald Trump’s return to the White House, the industry is ramping up pressure to kill that requirement before it takes effect, leaving thousands of residents in homes too short-staffed to provide proper care.

The nursing home industry has been marshaling opposition for months among congressional Republicans — and some Democrats — to overrule the Biden administration’s mandate. Two industry groups, the American Health Care Association and LeadingAge, have sued to overturn the regulation, and 20 Republican state attorneys general have filed their own challenge.

Consumer advocates, industry officials and independent researchers agree that the incoming administration is likely to rescind the rule, given the first Trump administration’s “patients over paperwork” campaign to remove “unnecessary, obsolete, or excessively burdensome health regulations on hospitals and other healthcare providers.” Among other things, Trump aided the industry by easing fines against homes that had been cited for poor care.

“The Trump administration has proven itself really eager to reverse overreaching regulations,” said Linda Couch, senior vice president for policy and advocacy at LeadingAge, which represents nonprofit elder care providers. “We think it’s got a pretty good chance of being repealed, and hope so.”

Issued in April, the staffing regulation requires nursing homes to have registered nurses on-site around the clock — something that the industry has endorsed — and to maintain minimum numbers of nurses and aides. Four in 5 homes would have to increase staffing. The requirements would be phased in, starting in May 2026.

Even before the election, many experts and activists had doubts that the rule would be effectively enforced, given the poor results in states that have imposed their own minimums. In New York, California, Rhode Island, and Massachusetts — states with the most robust requirements — many homes remain below the legal staffing levels. Governors have given many homes reprieves, and other homes have found that paying penalties costs less than the increase in payroll for additional staff.

The federal government estimates the average annual cost over a decade to meet the Biden mandate would be $4.3 billion a year, a 2% increase in expenses, though the changes do not include increases in federal Medicare or Medicaid payments.

“Staffing is everything in terms of nursing-home quality,” said R. Tamara Konetzka, a professor of public health sciences at the University of Chicago.

While the rule’s effectiveness was uncertain, she worried that repealing it would send the wrong message. “We would be losing that signal that nursing homes should try really hard to improve their staffing,” she said.

Advocate groups for nursing home residents, who had criticized the Biden administration rule for not requiring even higher staffing levels, have since pivoted and are trying to protect it.

“We’re hoping the president-elect will come in and take a look at the science and data behind it and see this really is a modest reform,” said Sam Brooks, the director for public policy for the National Consumer Voice for Quality Long-Term Care, a Washington, D.C.-based nonprofit. “We’d be devastated to see it fall.”

The Trump transition team did not respond to a request for comment. The Department of Health and Human Services did not respond to requests for comment, but in a court filing it argued that nursing homes should be able to reach the required staffing levels.

“There is more than enough time to identify, train and hire additional staff,” the Biden administration wrote.

The quality of care in the nation’s 15,000 nursing homes and the lack of adequate staffing for their 1.2 million residents has been a concern for decades. Inspection reports continue to find homes leaving residents lying in their own feces, suffering severe bedsores and falls, contracting infections, choking on food while unattended, or ending up back in a hospital for preventable reasons. Some nursing homes overuse psychotropic medications to pacify residents because they do not have enough workers to attend to them.

Leslie Frane, executive vice president of the SEIU, the Service Employees International Union, which represents health care workers, said in a statement that “far too many nursing home owners will not do the right thing and invest in workers without oversight and binding regulation.”

The nursing home industry says many homes cannot afford to increase their workforces, and that, even if they could, there is a scarcity of trained nurses, and not enough people willing to work as aides for an average $19 an hour. A registered nurse earns $40 an hour on average in a nursing home, less than what they could make at a hospital, according to the Bureau of Labor Statistics.

The Biden administration noted in its court filing it was planning to spend $75 million to recruit and train more workers, and that there were more than 100,000 workers who left nursing homes during the pandemic and could be lured back if salaries and working conditions were better.

How many nursing homes could afford the increased cost remains a mystery because of weaknesses in the government’s requirements for financial transparency. About half of homes lose money, according to their reports to Medicare, but some nursing home owners grow rich through clandestine maneuvers to siphon profits into their own pockets.

Last month, owners of Centers Health Care, one of New York state’s largest nursing home chains, agreed to pay $45 million to settle allegations by Attorney General Letitia James that they diverted $83 million intended for resident care to themselves during the pandemic.

Maryellen Mooney, a spokesperson for the Centers Health Care chain, which denied the allegations, said in a statement that Centers was “committed to fully implementing the settlement terms, including a significant investment in resident care.”

About three-quarters of nursing homes are for-profit. The industry, though, highlights the most sympathetic examples: rural nonprofit nursing homes like Kimball County Manor & Assisted Living in Kimball, Nebraska. Its staffing levels for registered nurses are 40% below what the new rule would require, federal data shows.

Sarah Stull, Kimball’s administrator, said recruitment had always been challenging and that temporary nursing staffing agencies charged more than double what she paid her own staff.

“We had to pay $65 for a nurse aide during covid, and that’s insane,” she said.

The government estimated that about a fourth of the nation’s nursing homes would be eligible to apply for hardship exemptions if there were a documented shortage of nurses and aides in their communities compared with the national average.

But Nate Schema, the chief executive of the Good Samaritan Society, which runs 133 nonprofit homes mainly in the rural Midwest, estimated that only seven would be likely to qualify for a hardship waiver.

“Philosophically, they sound great,” he said. “But in practicality and how they’re put together, they won’t do much for us.”

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. 

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With Trump on the Way, Advocates Look to States To Pick Up Medical Debt Fight

Worried that President-elect Donald Trump will curtail federal efforts to take on the nation’s medical debt problem, patient and consumer advocates are looking to states to help people who can’t afford their medical bills or pay down their debts.

“The election simply shifts our focus,” said Eva Stahl, who oversees public policy at Undue Medical Debt, a nonprofit that has worked closely with the Biden administration and state leaders on medical debt. “States are going to be the epicenter of policy change to mitigate the harms of medical debt.”

New state initiatives may not be enough to protect Americans from medical debt if the incoming Trump administration and congressional Republicans move forward with plans to scale back federal aid that has helped millions gain health insurance or reduce the cost of their plans in recent years.

Comprehensive health coverage that limits patients’ out-of-pocket costs remains the best defense against medical debt.

But in the face of federal retrenchment, advocates are eyeing new initiatives in state legislatures to keep medical bills off people’s credit reports, a consumer protection that can boost credit scores and make it easier to buy a car, rent an apartment, or even get a job.

Several states are looking to strengthen oversight of medical credit cards and other financial products that can leave patients paying high interest rates on top of their medical debt.

Some states are also exploring new ways to compel hospitals to bolster financial aid programs to help their patients avoid sinking into debt.

“There’s an enormous amount that states can do,” said Elisabeth Benjamin, who leads health care initiatives at the nonprofit Community Service Society of New York. “Look at what’s happened here.”

New York state has enacted several laws in recent years to rein in hospital debt collections and to expand financial aid for patients, often with support from both Democrats and Republicans in the legislature. “It doesn’t matter the party. No one likes medical debt,” Benjamin said.

Other states that have enacted protections in recent years include Arizona, California, Colorado, Connecticut, Florida, Illinois, Minnesota, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, and Washington. Many measures picked up bipartisan support.

President Joe Biden’s administration has proved to be an ally in state efforts to control health care debt. Such debt burdens 100 million people in the United States, a KFF Health News investigation found.

Led by Biden appointee Rohit Chopra, the Consumer Financial Protection Bureau has made medical debt a priority, going after aggressive collectors and exposing problematic practices across the medical debt industry. Earlier this year, the agency proposed landmark regulations to remove medical bills from consumer credit scores.

The White House also championed legislation to boost access to government-subsidized health insurance and to cap out-of-pocket drug costs for seniors, both key bulwarks against medical debt.

Trump hasn’t indicated whether his administration will move ahead with the CFPB credit reporting rule, which was slated to be finalized early next year. Congressional Republicans, who will control the House and Senate next year, have blasted the proposal as regulatory overreach that will compromise the value of credit reports.

And Elon Musk, the billionaire whom Trump has tapped to lead his initiative to shrink government, last week called for the elimination of the watchdog agency. “Delete CFPB,” Musk posted on X.

If the CFPB withdraws the proposed regulation, states could enact their own rules, following the lead of Colorado, New York, and other states that have passed credit reporting bans since 2023. Advocates in Massachusetts are pushing the legislature there to take up a ban when it reconvenes in January.

“There are a lot of different levers that states have to take on medical debt,” said April Kuehnhoff, a senior attorney at the National Consumer Law Center, which has helped lead national efforts to expand debt protections for patients.

Kuehnhoff said she expects more states to crack down on medical credit card providers and other companies that lend money to patients to pay off medical bills, sometimes at double-digit interest rates.

Under the Biden administration, the CFPB has been investigating patient financing companies amid warnings that many people may not understand that signing up for a medical credit card such as CareCredit or enrolling in a payment plan through a financial services company can pile on more debt.

If the CFPB efforts stall under Trump, states could follow the lead of California, New York, and Illinois, which have all tightened rules governing patient lending in recent years.

Consumer advocates say states are also likely to continue expanding efforts to get hospitals to provide more financial assistance to reduce or eliminate bills for low- and middle-income patients, a key protection that can keep people from slipping into debt.

Hospitals historically have not made this aid readily available, prompting states such as California, Colorado, and Washington to set stronger standards to ensure more patients get help with bills they can’t afford. This year, North Carolina also won approval from the Biden administration to withhold federal funding from hospitals in the state unless they agreed to expand financial assistance.

In Georgia, where state government is entirely in Republican control, officials have been discussing new measures to get hospitals to provide more assistance to patients.

“When we talk about hospitals putting profits over patients, we get lots of nodding in the legislature from Democrats and Republicans,” said Liz Coyle, executive director of Georgia Watch, a consumer advocacy nonprofit.

Many advocates caution, however, that state efforts to bolster patient protections will be critically undermined if the Trump administration cuts federal funding for health insurance programs such as Medicaid and the insurance marketplaces established through the Affordable Care Act.

Trump and congressional Republicans have signaled their intent to roll back federal subsidies passed under Biden that make health plans purchased on ACA marketplaces more affordable. That could hike annual premiums by hundreds or even thousands of dollars for many enrollees, according to estimates by the Center on Budget and Policy Priorities, a think tank.

And during Trump’s first term, he backed efforts in Republican-led states to restrict enrollment in their Medicaid safety net programs through rules that would require people to work in order to receive benefits. GOP state leaders in Idaho, Louisiana, and other states have expressed a desire to renew such efforts.

“That’s all a recipe for more medical debt,” said Stahl, of Undue Medical Debt.

Jessica Altman, who heads the Covered California insurance marketplace, warned that federal cuts will imperil initiatives in her state that have limited copays and deductibles and curtailed debt for many state residents.

“States like California that have invested in critical affordable programs for our residents will face tough decisions,” she said.

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. 

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2024 Bloomberg American Health Summit in Washington, D.C., to Spotlight Concrete Ways to Advance Public Health Amid Political Division

The seventh Bloomberg American Health Summit organized by the Bloomberg American Health Initiative will bring together public health leaders, government officials, community organizations, researchers, and students to discuss evidence-based health policies that remain critical to advancing health in a politically divided country. The Summit will take place on December 3 in Washington, D.C.

Following the recent U.S. election, this year’s event, “Advancing Public Health in Uncertain Political Times,” will underscore the essential role of evidence and policy to address preventable illness that is holding back American life expectancy and progress. The Summit will also emphasize how fostering bipartisan collaboration, reforming policies that drive health disparities, and using innovative methods to enhance policy impact are essential to safeguard public health.

Keynote discussions will cover urgent topics including:

  • Building bipartisan support for public health initiatives in 2025 and beyond
  • Protecting reproductive health
  • Defending the role of science in uncertain political times

Featured speakers include:

  • Jerome Adams, Former U.S. Surgeon General & Director of Health Equity, Purdue University
  • Xavier Becerra, Secretary, U.S. Department of Health and Human Services
  • Michael R. Bloomberg, Founder of Bloomberg L.P. and Bloomberg Philanthropies, WHO Global Ambassador for Noncommunicable Diseases and Injuries, and 108th mayor of New York City
  • Cory Booker, U.S. Senator (D-NJ)
  • Muriel Bowser, Mayor, Washington, D.C.
  • Jonathan Capehart, Associate Editor, The Washington Post 
  • Francis S. Collins, Distinguished Investigator, National Institutes of Health
  • Ron Daniels, President, Johns Hopkins University
  • Madlen Davies, Senior Editor, The Examination
  • Rosa DeLauro, Congresswoman, U.S. House of Representatives, Connecticut
  • Thomas Dobbs, Former Mississippi State Health Officer
  • Jamie Ducharme, Health Correspondent, TIME Magazine
  • John Feinblatt, President, Everytown for Gun Safety
  • Brian Fitzpatrick, U.S. Representative, Pennsylvania 
  • Cynthia Bissett Germanotta, President and Co-Founder, Born This Way Foundation
  • Riley Griffin, Health Care Reporter, Bloomberg News
  • Ellen J. MacKenzie, Dean, Johns Hopkins Bloomberg School of Public Health
  • Marion Nestle, Paulette Goddard Professor of Nutrition, Food Studies, and Public Health, Emerita, New York University
  • Joshua M. Sharfstein, Director, Bloomberg American Health Initiative
  • Michelle Spencer, Deputy Director, Bloomberg American Health Initiative
  • Sheryl Gay Stolberg, Washington Correspondent, The New York Times
  • Yasmin Tayag, Staff Writer, The Atlantic

Additional speakers will be announced and posted on the Summit’s website.

Members of the media are invited to attend the plenary from 9 a.m. to 1:30 p.m. in person or view the event’s livestream. Apply for credentials here. For more information, please contact [email protected].

“Science and data should drive U.S. public health research and policy​—not partisan politics or baseless conspiracy theories,” says Michael R. Bloomberg, founder of Bloomberg L.P. and Bloomberg Philanthropies, WHO Global Ambassador for Noncommunicable Diseases and Injuries, and 108th mayor of New York City. “This year’s Bloomberg American Health Summit brings leading experts to Washington to share evidence-based approaches that can improve the health of the American people.”

Through a series of on-stage conversations, keynote speakers, and videos, the event will highlight successful public health efforts and explore implications for national and state policy across the Initiative’s five focus areas: addiction and overdose; adolescent health; environmental challenges; food systems for health; and violence.

The Bloomberg American Health Initiative was created in 2016 to address the nation’s most pressing health challenges and works to improve health and life expectancy in the United States in ways that advance equity, use evidence, and change policy. The Initiative was established with a $300 million gift from Bloomberg Philanthropies to the Johns Hopkins Bloomberg School of Public Health, the world’s leading school of public health.

The Summit will also feature the work of Bloomberg Fellows, a program of the Initiative that provides world-class public health training to individuals in organizations tackling critical challenges facing the United States. Each year, the Initiative supports 60 Fellows with full scholarships to earn an MPH or DrPH degree from the Bloomberg School. Each Fellow represents an organization working on one of the Initiative’s five focus areas. The growing network of 388 Fellows and 318 collaborating organizations from 43 states, Washington, D.C., and two territories, is using the tools of public health to positively impact their own communities.

“I am thrilled that this year’s summit is bringing leading thinkers and changemakers together in our nation’s capital to discuss the future of public health policy, especially in a new administration,” says Ellen J. MacKenzie, dean of the Bloomberg School. “This is an extraordinary opportunity to spark new ideas and forge new partnerships as we work to pursue practical, achievable solutions to some of our greatest health challenges in such a historic time.”

The main plenary session on December 3 will be available to the public via livestream.

To learn more about the Bloomberg American Health Summit, please visit the Summit website.

About the Bloomberg American Health InitiativeThe Bloomberg American Health Initiative at the Johns Hopkins Bloomberg School of Public Health was developed to tackle five core issues that deeply challenge the nation’s health: addiction and overdose; adolescent health; environmental challenges; food systems for health; and violence. The Initiative’s work with faculty, Bloomberg Fellows, and collaborating organizations is building a dynamic nationwide network committed to harnessing data and developing new approaches to public health that will ensure a healthier future for all Americans. Learn more here: Bloomberg American Health Initiative.

About Bloomberg Philanthropies

Bloomberg Philanthropies invests in 700 cities and 150 countries around the world to ensure better, longer lives for the greatest number of people. The organization focuses on creating lasting change in five key areas: the Arts, Education, Environment, Government Innovation, and Public Health. Bloomberg Philanthropies encompasses all of Michael R. Bloomberg’s giving, including his foundation, corporate, and personal philanthropy as well as Bloomberg Associates, a philanthropic consultancy that advises cities around the world. In 2023, Bloomberg Philanthropies distributed $3 billion. For more information, please visit bloomberg.org, sign up for our newsletter, or follow us on Instagram, LinkedIn, YouTube, Threads, Facebook, and X.

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‘I Don’t Feel Your Pain’: How Alcohol Increases Aggression

COLUMBUS, Ohio – Alcohol’s ability to increase people’s pain threshold is one reason that drinking also leads to more aggressive behavior, a new study suggests.

Researchers found that the less pain that study participants felt after drinking an alcoholic beverage, the more pain they were willing to inflict on someone else.

“We’ve all heard the idiom ‘I feel your pain,’” said study co-author Brad Bushman, professor of communication at The Ohio State University.

“But if intoxicated people can’t feel their own pain, they might be less likely to feel empathy when others feel pain, and that could lead them to be more aggressive.”

The study was published recently in the Journal of Studies on Alcohol and Drugs.

This study used an experimental design that has been used in research studies since 1967 and has been approved for use in humans in this study and others.

This new research involved two independent laboratory experiments, one with 543 participants and the other with 327 participants, all of whom reported consuming 3-4 alcoholic beverages per occasion at least once a month. They were recruited by newspaper advertisements and paid $75. The methods for the two experiments were identical.

After giving informed consent, participants were given 20 minutes to drink an alcohol or placebo beverage. The orange juice beverages looked identical so participants wouldn’t know which one they got.  For the placebo drinks, the researchers put a small amount of alcohol on the top of the orange juice and sprayed the rim of the glass with alcohol so that it tasted like an alcoholic beverage.

After drinking the beverage, each participant received one-second electrical shocks to two fingers on one hand. The researchers increased shocks in intensity until the participant described the shock as “painful.” That was labeled the participant’s pain threshold.

They then participated in an online competitive reaction time task in which the winner could deliver a shock to the loser. The shocks ranged from 1 (low) to 10, which was the level the participant rated as “painful.”  Participants could also choose how long the shocks lasted.

In reality, there was no opponent and the researchers randomly declared the participant the “winner” in half of the reaction time tasks. The purpose was simply to see if those who drank the alcoholic beverage would be willing to deliver stronger and longer shocks – and whether a higher pain threshold had an impact.

Results showed that for those drinking alcohol, the alcohol increased the level at which the shocks became painful to them. And the greater their tolerance for physical pain, the greater their level of aggression in terms of the intensity and length of shocks they were willing to deliver to the opponent.

Those who drank the placebo drinks weren’t as aggressive in their response, partly because their pain threshold was generally lower than those drinking alcohol, Bushman said.

“In other words, they were still able to feel their own pain – and didn’t want to inflict pain on others,” he said.

“There are many reasons that intoxicated people are more likely to intentionally hurt others, but this research suggests pain tolerance is one possible reason.”

Bushman noted that the people who drank alcohol in this study had blood alcohol concentrations averaging between 0.095% and 0.11%.  That’s slightly above the legal limit in most states, which is 0.08%.

“The effects of alcohol on pain tolerance may be higher for those who drink more than what they did in these experiments,” Bushman said. “That may make them even more willing to be aggressive against others.”

Co-authors on the study were C. Nathan DeWall of the University of Kentucky, and Peter Giancola, a licensed clinical psychologist in Montreal.

The research was supported by the National Institute on Alcohol Abuse and Alcoholism and the National Center for Research Resources.

Homebound Seniors Living Alone Often Slip Through Health System’s Cracks

Carolyn Dickens, 76, was sitting at her dining room table, struggling to catch her breath as her physician looked on with concern.

“What’s going on with your breathing?” asked Peter Gliatto, director of Mount Sinai’s Visiting Doctors Program.

“I don’t know,” she answered, so softly it was hard to hear. “Going from here to the bathroom or the door, I get really winded. I don’t know when it’s going to be my last breath.”

Dickens, a lung cancer survivor, lives in central Harlem, barely getting by. She has serious lung disease and high blood pressure and suffers regular fainting spells. In the past year, she’s fallen several times and dropped to 85 pounds, a dangerously low weight.

And she lives alone, without any help — a highly perilous situation.

Across the country, about 2 million adults 65 and older are completely or mostly homebound, while an additional 5.5 million seniors can get out only with significant difficulty or assistance. This is almost surely an undercount, since the data is from more than a dozen years ago.

It’s a population whose numbers far exceed those living in nursing homes — about 1.2 million — and yet it receives much less attention from policymakers, legislators, and academics who study aging.

Consider some eye-opening statistics about completely homebound seniors from a study published in 2020 in JAMA Internal Medicine: Nearly 40% have five or more chronic medical conditions, such as heart or lung disease. Almost 30% are believed to have “probable dementia.” Seventy-seven percent have difficulty with at least one daily task such as bathing or dressing.

Almost 40% live by themselves.

That “on my own” status magnifies these individuals’ already considerable vulnerability, something that became acutely obvious during the covid-19 outbreak, when the number of sick and disabled seniors confined to their homes doubled.

“People who are homebound, like other individuals who are seriously ill, rely on other people for so much,” said Katherine Ornstein, director of the Center for Equity in Aging at the Johns Hopkins School of Nursing. “If they don’t have someone there with them, they’re at risk of not having food, not having access to health care, not living in a safe environment.”

Research has shown that older homebound adults are less likely to receive regular primary care than other seniors. They’re also more likely to end up in the hospital with medical crises that might have been prevented if someone had been checking on them.

To better understand the experiences of these seniors, I accompanied Gliatto on some home visits in New York City. Mount Sinai’s Visiting Doctors Program, established in 1995, is one of the oldest in the nation. Only 12% of older U.S. adults who rarely or never leave home have access to this kind of home-based primary care.

Gliatto and his staff — seven part-time doctors, three nurse practitioners, two nurses, two social workers, and three administrative staffers — serve about 1,000 patients in Manhattan each year.

These patients have complicated needs and require high levels of assistance. In recent years, Gliatto has had to cut staff as Mount Sinai has reduced its financial contribution to the program. It doesn’t turn a profit, because reimbursement for services is low and expenses are high.

First, Gliatto stopped in to see Sandra Pettway, 79, who never married or had children and has lived by herself in a two-bedroom Harlem apartment for 30 years.

Pettway has severe spinal problems and back pain, as well as Type 2 diabetes and depression. She has difficulty moving around and rarely leaves her apartment. “Since the pandemic, it’s been awfully lonely,” she told me.

When I asked who checks in on her, Pettway mentioned her next-door neighbor. There’s no one else she sees regularly.

Pettway told the doctor she was increasingly apprehensive about an upcoming spinal surgery. He reassured her that Medicare would cover in-home nursing care, aides, and physical therapy services.

“Someone will be with you, at least for six weeks,” he said. Left unsaid: Afterward, she would be on her own. (The surgery in April went well, Gliatto reported later.)

The doctor listened carefully as Pettway talked about her memory lapses.

“I can remember when I was a year old, but I can’t remember 10 minutes ago,” she said. He told her that he thought she was managing well but that he would arrange testing if there was further evidence of cognitive decline. For now, he said, he’s not particularly worried about her ability to manage on her own.

A doctor performs a visual exam on a senior female patient
Physician Peter Gliatto visits Marianne Gluck Morrison in her cluttered Greenwich Village apartment. Morrison said she’d been feeling dizzy over the past few weeks, and Gliatto gave her a basic neurological exam, asking her to follow his fingers with her eyes and touch her fingers to her nose. “I think your problem is with your ear, not your brain,” he tells her, describing symptoms of vertigo. (Judith Graham for KFF Health News)

A doctor performs at home medical assessment of a senior female.
Sandra Pettway never married or had children. She’s lived by herself in a two-bedroom Harlem apartment for 30 years. Pettway has severe spinal problems, back pain, Type 2 diabetes, and depression. She has difficulty moving around and rarely leaves her apartment. “Since the pandemic, it’s been awfully lonely,” she says. (Judith Graham for KFF Health News)

Several blocks away, Gliatto visited Dickens, who has lived in her one-bedroom Harlem apartment for 31 years. Dickens told me she hasn’t seen other people regularly since her sister, who used to help her out, had a stroke. Most of the neighbors she knew well have died. Her only other close relative is a niece in the Bronx whom she sees about once a month.

Dickens worked with special-education students for decades in New York City’s public schools. Now she lives on a small pension and Social Security — too much to qualify for Medicaid. (Medicaid, the program for low-income people, will pay for aides in the home. Medicare, which covers people over age 65, does not.) Like Pettway, she has only a small fixed income, so she can’t afford in-home help.

Every Friday, God’s Love We Deliver, an organization that prepares medically tailored meals for sick people, delivers a week’s worth of frozen breakfasts and dinners that Dickens reheats in the microwave. She almost never goes out. When she has energy, she tries to do a bit of cleaning.

Without the ongoing attention from Gliatto, Dickens doesn’t know what she’d do. “Having to get up and go out, you know, putting on your clothes, it’s a task,” she said. “And I have the fear of falling.”

The next day, Gliatto visited Marianne Gluck Morrison, 73, a former survey researcher for New York City’s personnel department, in her cluttered Greenwich Village apartment. Morrison, who doesn’t have any siblings or children, was widowed in 2010 and has lived alone since.

Morrison said she’d been feeling dizzy over the past few weeks, and Gliatto gave her a basic neurological exam, asking her to follow his fingers with her eyes and touch her fingers to her nose.

“I think your problem is with your ear, not your brain,” he told her, describing symptoms of vertigo.

Because she had severe wounds on her feet related to Type 2 diabetes, Morrison had been getting home health care for several weeks through Medicare. But those services — help from aides, nurses, and physical therapists — were due to expire in two weeks.

“I don’t know what I’ll do then, probably just spend a lot of time in bed,” Morrison told me. Among her other medical conditions: congestive heart failure, osteoarthritis, an irregular heartbeat, chronic kidney disease, and depression.

Morrison hasn’t left her apartment since November 2023, when she returned home after a hospitalization and several months at a rehabilitation center. Climbing the three steps that lead up into her apartment building is simply too hard.

“It’s hard to be by myself so much of the time. It’s lonely,” she told me. “I would love to have people see me in the house. But at this point, because of the clutter, I can’t do it.”

When I asked Morrison who she feels she can count on, she listed Gliatto and a mental health therapist from Henry Street Settlement, a social services organization. She has one close friend she speaks with on the phone most nights.

“The problem is I’ve lost eight to nine friends in the last 15 years,” she said, sighing heavily. “They’ve died or moved away.”

Bruce Leff, director of the Center for Transformative Geriatric Research at the Johns Hopkins School of Medicine, is a leading advocate of home-based medical care. “It’s kind of amazing how people find ways to get by,” he said when I asked him about homebound older adults who live alone. “There’s a significant degree of frailty and vulnerability, but there is also substantial resilience.”

With the rapid expansion of the aging population in the years ahead, Leff is convinced that more kinds of care will move into the home, everything from rehab services to palliative care to hospital-level services.

“It will simply be impossible to build enough hospitals and health facilities to meet the demand from an aging population,” he said.

But that will be challenging for homebound older adults who are on their own. Without on-site family caregivers, there may be no one around to help manage this home-based care.

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. 

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Medicated Nasal Spray Will Slash Opioid-Related Hospital Admissions

Original post: Newswise - Substance Abuse Medicated Nasal Spray Will Slash Opioid-Related Hospital Admissions

Australian researchers say access to a free medicated nasal spray which temporarily reverses the effects of opioid toxicity while waiting for an ambulance to arrive, will save lives and reduce opioid-related hospital admissions.

The Federal Government is funding a national Take Home Naloxone (THN) program which makes the life-saving medication available for free and without prescription in pharmacies across Australia.

Naloxone reverses the effects of opioid toxicity and, under the THN program, is available from pharmacies for anyone at risk of either experiencing or witnessing an opioid overdose or adverse reaction.

Initially introduced on a trial basis, the THN program has expanded to now include more than 384 participating pharmacies across South Australia.

Dr Victoria Cock, Statewide Clinical Director, Drug and Alcohol Services SA, says demand for free naloxone is growing as more people become aware of its availability, with 8377 units being supplied across South Australia (SA) alone in 2022-23 and 16,171 in 2023-24.

A recent paper co-authored by SA Health experts and University of South Australia pharmacist Dr Jacinta Johnson found there were 2046 hospital admissions in SA involving opioid toxicity between 2017 and 2020, costing the State approximately $18 million.

Almost 20% of the patients admitted stayed in hospital for more than five days, 22% required intensive care and around 10% required mechanical ventilation.

Of the 2046 opioid toxicity-related admissions in SA hospitals, 6% involved children who were accidentally poisoned, prompting health officials to remind South Australians about the importance of safe medication storage and disposal of opioids to protect children.

Families also may wish to consider having naloxone on hand in case of an accidental poisoning at home.

Members of the public can locate their nearest registered pharmacy using the user-friendly map available on www.sahealth.sa.gov.au/naloxone. They do not need to provide any identifying details when requesting naloxone at a pharmacy. The webpage also includes a range of resources consumers may find useful.

Dr Maria Sarantou from Flinders Medical Centre says a 2019 trial of the Take Home Naloxone (THN) program, providing free access to the opioid blocker, found that it saved an estimated three lives a day.

“Research evaluating the pilot program showed that expanding THN supply to include the majority of patients prescribed medium to high doses of opioids would save hundreds of lives over the next five years,” Dr Sarantou says.

Dr Johnson, the UniSA senior lecturer who is responsible for driving all pharmacy research across SA Health, says a history of opioid toxicity is a major risk factor for future overdoses, yet many patients were not referred to drug and alcohol services or specialist pain services for help after discharge.

“There are things within the system we can improve,” Dr Johnson says.

In addition to the now implemented THN program, which is expanding to include an increasing number of public hospitals, the authors have made the following recommendations:

  • Improved discharge referrals to external healthcare services; and
  • Parental/carer education around safe storage and disposal of opioids to protect children.

Organisations involved in the study included local health networks in Adelaide, South Australian Statewide Chronic Pain Clinical Network, University of South Australia, University of Adelaide, and SA Pharmacy Statewide Clinical Support Services.

“A 3-year retrospective review of hospital admissions involving opioid toxicity in South Australia” is published in Drug and Alcohol Review. DOI: 10.1111/dar.13913

Background

Naloxone is a drug that can temporarily reverse the effects of opioid toxicity, which may be referred to as an opioid overdose or adverse reaction. If someone is experiencing severe opioid toxicity, they may be unconscious or awake, but unable to talk. It’s unlikely they will be able to administer naloxone themselves.  

Naloxone can be administered by injection into a muscle or delivery through a nasal spray. It works by blocking opioid drugs, such as heroin and oxycodone, from attaching to opioid receptors in the brain. 

It is vital to call an ambulance (000) as naloxone’s effect only lasts about 30-90 minutes and the person can experience toxicity again once it wears off. 

Opioids include pharmaceutical opioids, that is, medicines used for pain, and non-pharmaceutical opioids, such as heroin. The average Australian drug-related death last year involved a middle-aged person who was taking prescribed pharmaceutical opioids in combination with other prescribed pharmaceutical drugs.

Rutgers Startup Seeks to Design Safer Prescription Opiates

Rutgers startup Zena Therapeutics strives to create narcotic medications that will minimize or even eliminate overdoses from prescription drugs.

Co-founded by Eileen Carry, PhD, and Ariane Vasilatis, PhD, the company is based on an innovation developed at Rutgers, The State University of New Jersey: a novel compound that does not increase the risk of overdose if taken with other central nervous system depressing substances such as opioids and alcohol.

“What we want to do is design medication so that even if it is misused, death is not the consequence,” said Carry. “Right now, when it comes to narcotics drugs, the onus is on the patient to take the medication as prescribed, but that is not a guarantee. We hope to shift the paradigm to substantially reduce overdose risk without compromising efficacy.”

“We believe that it is feasible and possible to design drugs and medications where death is not the end result of misuse, whether it’s accidental or on purpose as recreationally,” said Vasilatis. “We both have had family and friends succumbing to addiction and overdose, unfortunately, so we share a passion for this self-started project.”

The partnership between Carry and Vasilatis began at the lab of James Simon, PhD, a Distinguished Professor in the Department of Plant Biology at Rutgers School of Environmental and Biological Sciences. Carry’s research was focusing on safer medications for addiction and mental health, which led her to develop a proprietary compositional molecule. She asked Vasilatis to join her in entrepreneurial training with the I-Corps program at Rutgers, and from there, Zena Therapeutics was formed.

Said Vasilatis, “The I-Corps training, both at Rutgers and the national program, was paramount for us because we needed to understand: is there an end user? Is there a market for this? Or is it so niche that it would never get to that end user? I-Corps helped us realize that we had a little bit more of a niche market, but there was a broader application. Programs like I-Corps or the Yale Innovation Impact have been invaluable with all the knowledge we’ve gained and the people we’ve met through them.”

“We were able to hone our business model through participation in two National Science Foundation (NSF) I-Corps programs, the regional here at Rutgers and the national,” said Carry. “Doing the I-Corps training, where we interviewed prescribers and people from the patient demographic, we realized what a huge issue this is and that there’s a gap; nobody’s really focusing on this issue. So that motivated us to keep moving forward.”

According to the National Institute on Drug Abuse, drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to over 17,000 in 2017, and has hovered around 15,000 per year since. Carry and Vasilatis believe that people with addictive tendencies may become hooked on their prescription medication, and because over 40% of U.S. adults drink alcohol while using medications, their innovation could be life-changing to many people and families.

The company’s website states that early studies with its novel compound show “favorable pharmacokinetics, robust anxiolytic activity…and favorable safety characteristics.” Carry and Vasilatis hope the compound will help both individuals suffering from general anxiety and panic disorders as well as those dealing with withdrawal symptoms.

“We’re starting with anxiety medications, specifically hoping to create alternatives for benzodiazepines, which are the current standard treatment for general anxiety and panic disorder and are commonly involved in overdoses with opiates,” said Carry. “Previously, companies have focused on the addictive potential of drugs. We understand that any psychoactive medication has addictive potential in the sense that it also has a mental component. However, none of the current medications were optimized to reduce overdose risk, and we believe we can do that without compromising efficacy. Essentially, we are creating medication with a ceiling effect, so if somebody takes the whole bottle, it won’t raise past the level of mild sedation but will still help with the anxiety.”

Vasilatis and Carry will continue to work together to lead Zena Therapeutics, which is named after the Slavic word for ‘woman’ (žena), serving as Chief Executive Officer and Chief Scientific Officer, respectively. The company has so far received funding through the New Jersey Health Foundation, the I-Corps program, $1 million in seed funding from Foundation Venture Capital Group, LLC, and a Phase I National Institutes of Health STTR (Small Business Technology Transfer) grant, the latter through which they are able to use Rutgers core services. The next step, according to Carry, is to move the compounds to clinical trials.

“It seems like whoever jumps onto the Zena Therapeutics bandwagon doesn’t leave,” laughed Vasilatis. “And everyone who has helped us has been invaluable, from Dr. Simon, who helped push us into the I-Corps program, to Dr. Nicholas Bello (at the Department of Animal Sciences) who helped us obtain our Phase I STTR, to Dr. Jacques Roberge at the Rutgers Biomolecular Innovation Cores, to Rutgers Office for Research’s Technology Transfer and New Ventures teams, who have been keeping tabs on us and sending us grant opportunities or anything they feel that can help us. Our passion is what created Zena, and Eileen’s ideas are what created the foundation for the company, but we wouldn’t have been able to move forward without this support.”

“Zena Therapeutics is another example of how Rutgers researchers focus their work on issues and questions facing the world,” said Deborah Perez Fernandez, PhD, MBA, executive director of Technology Transfer, and Vince Smeraglia, JD, executive director of New Ventures. “The opiate crisis is personal to both Drs. Carry and Vasilatis, as it is to so many people, and the Technology Transfer and New Ventures teams are proud to support them in their endeavors to solve this issue.”

A Toddler Got a Nasal Swab Test but Left Before Seeing a Doctor. The Bill was $445.

Ryan Wettstein Nauman was inconsolable one evening last December. After being put down for bed, the 3-year-old from Peoria, Illinois, just kept crying and crying and crying, and nothing would calm her down.

Her mother, Maggi Wettstein, remembered fearing it could be a yeast or urinary tract infection, something they had been dealing with during potty training. The urgent care centers around them were closed for the night, so around 10:30 p.m. she decided to take Ryan to the emergency room at Carle Health.

The Medical Procedure

The ER wasn’t very busy when they arrived at 10:48 p.m., Wettstein recalled. Medical records indicate they checked in and she explained Ryan’s symptoms, including an intermittent fever. The toddler was triaged and given a nasal swab test to check for covid-19 and influenza A and B.

Wettstein said they sat down and waited to be called. And they waited.

As Wettstein watched Ryan in the waiting room’s play area, she noticed her daughter had stopped crying.

In fact, she seemed fine.

So Wettstein decided to drive them home. Ryan had preschool the next day, and she figured there was no point keeping her awake for who knew how much longer and getting stuck with a big ER bill.

There was no one at the check-in desk to inform that they were leaving, Wettstein said, so they just headed home to go to bed.

Ryan went to her preschool the next day, and Wettstein said they forgot all about the ER trip for eight months.

Then the bill came.

The Final Bill

$445 for the combined covid and flu test — from an ER visit in which the patient never made it beyond the waiting room.

The Billing Problem: A Healthy Hospital Markup and Standard Insurance Rules

Even though Ryan and her mother left without seeing a doctor, the family ended up owing $298.15 after an insurance discount.

At first, Wettstein said, she couldn’t recall Ryan being tested at all. It wasn’t until she received the bill and requested her daughter’s medical records that she learned the results. (Ryan tested negative for covid and both types of flu.)

While Wettstein said the bill isn’t going to break the bank, it seemed high to her, considering Walgreens sells an at-home covid and flu combination test for $30 and can do higher-quality PCR testing for $145.

A photo of Ryan Wettstein Nauman.
Maggi Wettstein was charged $445 for the combined covid and flu test — from an ER visit in which her daughter never made it beyond the waiting room.(Ron Johnson for KFF Health News)

Under the public health emergency declared in 2020 for the covid pandemic, insurance companies were required to pay for covid tests without copayments or cost sharing for patients.

That requirement ended when the emergency declaration expired in May 2023. Now, it is often patients who foot the bill — and ER bills are notoriously high.

“That’s a pretty healthy markup the hospital is making on it,” Loren Adler, associate director of the Brookings Institution Center on Health Policy, told KFF Health News when contacted about Ryan’s case.

The rates the insurance companies negotiate with hospitals for various procedures are often based on multipliers of what Medicare pays, Adler said.

Lab tests are one of the few areas in which insurance companies can often pay less than Medicare, he said — the exception being when the test is performed by the hospital laboratory, which is often what happens during ER visits.

Medicare pays $142.63 for the joint test that Ryan received, but the family is on the hook for more than twice that amount, and the initial hospital charge was over three times as much.

The hospital is “utilizing their market power to make as much money as possible, and the insurance companies are not all that good at pushing back,” Adler said. A markup of a few hundred dollars is a drop in the bucket for big insurers. But for the patients who get unexpected bills, it can be a big burden.

Brittany Simon, a public relations manager for Carle Health, did not respond to specific questions but said in a statement, “We follow policies that support the safety and wellbeing of our patients, which includes the initial triage of symptomatic patients to the Emergency Department.”

While Ryan’s family would not have had to pay for a covid test during the public health emergency, it was the family’s insurer, Cigna, that did not have to pay this time, since the family had not yet met a $3,000 yearly deductible.

A Cigna representative did not respond to requests for comment.

The Resolution

Wettstein said she knew she could just pay the bill and be done with it, “but the fact that I never saw a provider, and the fact that it was just for a covid test, is mind-blowing to me.”

She contacted the hospital’s billing department to make sure the bill was correct. She explained what happened and said the hospital representative was also surprised by the size of the bill and sent it up for further review.

“‘Don’t pay this until you hear from me,’” Wettstein remembered being told.

Soon, though, she received a letter from the hospital explaining that the charge was correct and supported by documentation.

Wettstein thought she was avoiding any charges by taking Ryan home without being seen. Instead, she got a bill “that they have verified that I have to pay.”

“Like I said, it’s mind-blowing to me.”

A photo of Maggi Wettstein with her daughter.
(Ron Johnson for KFF Health News)

The Takeaway

ERs are among the most expensive options for care in the nation’s health system, and the meter can start running as soon as you check in — even if you check out before receiving care.

If your issue isn’t life-threatening, consider an urgent care facility, which is often cheaper (and look for posted notices to confirm whether it’s actually an urgent care clinic). The urgent care centers near Ryan’s home were closed that evening, but some facilities stay open late or around the clock.

In some ways, Wettstein was lucky. KFF Health News’ “Bill of the Month” has received tips from other patients who left an ER after a long wait without seeing a doctor — and got slapped with a facility fee of over $1,000.

Making the decision about where to go is tough, especially in a stressful situation — such as when the patient is too young to communicate what’s wrong. Trying to figure out what’s going on physically with a 3-year-old can feel impossible.

If you decide to leave an ER without treatment, don’t just walk out. Tell the triage nurse you’re leaving. You might get lucky and avoid some charges.

Wettstein won’t think twice about taking Ryan to the pediatrician or an urgent care center the next time she’s ailing. But, Wettstein said, after getting this bill, “I’m not going to create a habit out of going to the emergency room.”

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it!

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. 

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Trump Doesn’t Need Congress To Make Abortion Effectively Unavailable

On the campaign trail, Donald Trump tried mightily to reassure abortion rights supporters, vowing he would not sign into law a nationwide abortion ban even if Congress sent him one.

But once he returns to the White House in January, Trump can make abortions difficult — or illegal —across the United States without Congress taking action at all.

The president-elect will have a variety of tools to restrict reproductive rights in general and abortion rights in particular, both directly from 1600 Pennsylvania Ave. and from the executive agencies he’ll oversee. They include strategies he used during his first term, but also new ones that emerged in the wake of the Supreme Court’s overturn of Roe v. Wade in 2022.

The Trump transition team did not respond to a request for comment on this topic.

By far the most sweeping thing Trump could do without Congress would be to order the Justice Department to enforce the Comstock Act, an 1873 anti-vice law that bars the mailing of “obscene matter and articles used to produce abortion.”

While Roe was in effect, the law was presumed unconstitutional, but many legal scholars say it could be resurrected. “And it is so broad that it would ban abortion nationwide from the beginning of a pregnancy without exception. Procedural abortion, pills, everything,” Greer Donley, an associate professor and abortion policy researcher at the University of Pittsburgh Law School, said on KFF Health News’ “What the Health?” podcast early this year.

Even if he does not turn to Comstock, Trump is expected to quickly reimpose restrictions embraced by every GOP president for the past four decades. When Trump took office in 2017, he reinstituted the “Mexico City Policy” (also known as the “global gag rule”), a Ronald Reagan-era rule that banned U.S. aid to international organizations that support abortion rights. He also pulled U.S. funding for the United Nations Population Fund. Both actions were undone when President Joe Biden took office in 2021.

Those aren’t the only policies Trump could resurrect. Others that Trump imposed and Biden overturned include:

  • Barring providers who perform abortions and entities that provide referrals for abortion (such as Planned Parenthood) from the federal family planning program, Title X. The Trump administration imposed the rules in 2019; Biden formally overturned them in 2021.
  • Banning the use of human fetal tissue in research funded by the National Institutes of Health. The Trump administration issued guidance barring the practice in 2019; the Biden administration overturned it in 2021.
  • Requiring health plans under the Affordable Care Act to collect separate premiums if they offer coverage for abortion. The 2019 Trump administration regulation was overturned by Biden officials in 2021.
  • Allowing health providers to refuse to offer any service that violates their conscience. The 2019 Trump administration regulation — a revision of one originally implemented by President George W. Bush — had already been blocked by several appeals courts before being rescinded and rewritten by the Biden administration. The new, narrower rule was issued in January.

Anti-abortion groups say those changes are the minimum they expect. “The commonsense policies of President Trump’s first term become the baseline for the second, along with reversing Biden-Harris administration’s unprecedented violation of longstanding federal laws,” Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said in a statement to KFF Health News.

Dannenfelser was referring to the expectation that Trump will overturn actions that Biden took toward protecting abortion rights after the Supreme Court’s decision. Some included:

Even easier than formal changes of policy, though, Trump could simply order the Justice Department to drop several cases being heard in federal court in which the federal government is effectively arguing to preserve abortion rights. Those cases include:

  • FDA v. The Alliance for Hippocratic Medicine. This case out of Texas challenges the FDA’s approval of the abortion pill mifepristone. The Supreme Court in June ruled that the original plaintiffs lacked standing to sue, but attorneys general in three states (Missouri, Idaho, and Kansas) have stepped in as plaintiffs. The case has been revived at the U.S. District Court for the Northern District of Texas.
  • Texas v. Becerra. In this case, the state of Texas is suing the Department of Health and Human Services, charging that the Biden administration’s interpretation of a law requiring emergency abortions to protect the health of the pregnant woman oversteps its authority. The Supreme Court denied a petition to hear the case in October, but that left the possibility that the court would have to step in later — depending on the outcome of a similar case from Idaho that the justices sent back to the Court of Appeals.

Whether Trump will take any or all of these actions is anyone’s guess. Whether he can take these actions, however, is unquestioned.

HealthBent, a regular feature of KFF Health News, offers insight into and analysis of policies and politics from KFF Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

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. 

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