KFF Health News Midwest correspondent Cara Anthony appeared in a two-part special of Nine PBS’ “Listen, St. Louis with Carol Daniel” to discuss her reporting for the “Silence in Sikeston” project.
The first conversation, which aired Oct. 9, explores the connections between a 1942 lynching and a 2020 police shooting in a rural Missouri community — and what those killings say about the nation’s silencing of racial trauma. The second episode, which premiered Oct. 16, explores the health effects of such trauma with mental health counselor Lekesha Davis.
These conversations stem from the “Silence in Sikeston” multimedia project by KFF Health News, Retro Report, and WORLD, which includes a documentary film, educational videos, digital articles, and a limited-series podcast.
READ: KFF Health News Midwest correspondent Cara Anthony wrote an essay about what her reporting for this project helped her learn about her own family’s hidden past.
Cuando Pam McClure se enteró que el próximo año ahorraría casi $4,000 en sus medicamentos recetados dijo: “parece demasiado bueno para ser verdad”.
Para finales de 2024, habrá gastado casi $6,000 en estos fármacos, incluido uno para controlar su diabetes.
McClure, de 70 años, es una de las aproximadamente 3.2 millones de personas con un plan de medicamentos recetados de Medicare cuyos costos de bolsillo se limitarán a $2,000 en 2025 gracias a la Ley de Reducción de la Inflación (IRA, por sus siglas en inglés) de 2022 promulgada por la administración Biden, según un estudio de Avalere/AARP.
La IRA, una ley de atención médica y clima que el presidente Joe Biden y la vicepresidenta Kamala Harris promueven en la campaña como uno de los mayores logros de su administración, rediseñó radicalmente el beneficio de medicamentos de Medicare, conocido como Parte D, que sirve a unas 53 millones de personas de 65 años o más, o que viven con ciertas discapacidades.
Gracias a este nuevo límite en el gasto de bolsillo y otros cambios importantes, pero menos conocidos, la administración estima que alrededor de 18.7 millones de personas ahorrarán aproximadamente $7.4 mil millones solo el próximo año.
El período de inscripción anual para que los beneficiarios de Medicare renueven o cambien su cobertura de medicamentos, o elijan un plan Medicare Advantage, comenzó el 15 de octubre y se extiende hasta el 7 de diciembre. Medicare Advantage es la alternativa comercial al Medicare tradicional administrado por el gobierno y cubre atención médica y, a menudo, medicamentos recetados.
Los planes de medicamentos independientes de Medicare, que cubren medicamentos que normalmente se toman en casa, también son administrados por compañías de seguros privadas.
“Siempre alentamos a los beneficiarios a que realmente revisen los planes y elijan la mejor opción para ellos”, dijo Chiquita Brooks-LaSure, quien dirige los Centros de Servicios de Medicare y Medicaid (CMS, por sus siglas en inglés), a KFF Health News. “Y este año, en particular, es importante hacerlo porque el beneficio ha cambiado mucho”.
Las mejoras a la cobertura de medicamentos de Medicare requeridas por la IRA son los cambios más importantes desde que el Congreso agregó el beneficio en 2003, pero la mayoría de los votantes no los conocen, según encuestas de KFF, una organización sin fines de lucro de información sobre salud que incluye a KFF Health News. Y algunos beneficiarios pueden sorprenderse por un inconveniente: algunos planes aumentarán sus primas.
El 27 de septiembre, los CMS dijeron que, a nivel nacional, la prima promedio de los planes de medicamentos de Medicare disminuyó alrededor de $1.63 al mes —aproximadamente un 4%— respecto al año pasado.
“Las personas inscritas en un plan de la Parte D de Medicare seguirán viendo primas estables y tendrán amplias opciones de planes asequibles”, dijeron los CMS en un comunicado.
Sin embargo, un análisis de KFF encontró que “muchas aseguradoras están aumentando las primas” y que grandes aseguradoras como UnitedHealthcare y Aetna también redujeron la cantidad de planes que ofrecen.
Las propuestas iniciales de primas de muchas aseguradoras de la Parte D para 2025 fueron aún más altas. Para amortiguar el impacto del precio, la administración Biden creó lo que llama un programa de demostración para pagar a las aseguradoras $15 adicionales al mes por beneficiario si aceptaban limitar los aumentos de primas a no más de $35.
“En ausencia de esta demostración, los aumentos de primas ciertamente habrían sido mayores”, escribió Juliette Cubanski, subdirectora del Programa de Políticas de Medicare en KFF, en su análisis del 3 de octubre.
Casi todas las aseguradoras de la Parte D aceptaron el acuerdo. Los republicanos lo han criticado, cuestionando la autoridad de los CMS para hacer los pagos adicionales y llamándolos una maniobra política en un año electoral.
Sea cual sea la razón, las primas están subiendo dramáticamente para algunos planes.
En el estado de Nueva York, por ejemplo, la prima del popular plan Value Script de Wellcare pasó de $3.70 mensuales a $38.70 el próximo año, un aumento de $35, más de diez veces que el costo actual.
Una página de un “aviso de cambios” que Wellcare envió a los clientes de su plan de medicamentos de Medicare Value Script en Nueva York. El folleto de 28 páginas no explica por qué se aumentó la prima ni cómo se calculó. “Esperamos mantenerlo como miembro el año que viene”, dice el folleto, antes de explicar cómo cambiar de plan.(Susan Jaffe for KFF Health News)
Cubanski identificó ocho planes en California que aumentaron sus primas exactamente $35 al mes. KFF Health News encontró que las primas aumentaron en al menos el 70% de los planes de medicamentos ofrecidos en California, Texas y Nueva York, y en alrededor de la mitad de los planes en Florida y Pennsylvania, los cinco estados con más beneficiarios de Medicare.
Voceros de Wellcare y de su empresa matriz, Centene Corp., no respondieron a las solicitudes de comentarios. En una declaración este mes, la vicepresidenta senior de servicios clínicos y especializados de Centene, Sarah Baiocchi, dijo que Wellcare ofrecería el plan Value Script sin prima en 43 estados.
Además del límite de $2,000 en el gasto de medicamentos, la IRA limita los copagos de Medicare para la mayoría de los productos de insulina a no más de $35 al mes y permite que Medicare negocie directamente los precios de algunos de los medicamentos más caros directamente con las farmacéuticas.
También eliminará una de las características más frustrantes del beneficio de medicamentos, una brecha conocida como el “agujero de dona (doughnut hole)” que suspende la cobertura justo cuando las personas enfrentan crecientes costos de medicamentos, obligándolas a pagar el precio completo de las drogas de su plan de su bolsillo hasta que alcancen un umbral de gasto que cambia de un año a otro.
La ley también amplía la elegibilidad para los subsidios de “ayuda adicional” para aproximadamente 17 millones de personas de bajos ingresos en los planes de medicamentos de Medicare y aumenta el monto del subsidio. Las farmacéuticas deberán contribuir para ayudar a pagarlo.
A partir del 1 de enero, el beneficio de medicamentos rediseñado funcionará más como otras pólizas de seguro privado. La cobertura comienza después que los pacientes paguen un deducible, que no será mayor de $590 el próximo año. Algunos planes ofrecen un deducible menor o ninguno, o excluyen ciertos medicamentos, generalmente genéricos baratos, del deducible.
Después que los beneficiarios gasten $2,000 en deducibles y copagos, el resto de sus medicamentos de la Parte D serán gratuitos.
Eso se debe a que la IRA aumenta la parte de la factura asumida por las aseguradoras y las compañías farmacéuticas. La ley también intenta frenar futuros aumentos de precios de medicamentos al limitar los aumentos a la tasa de inflación al consumidor, que fue del 3.4% en 2023. Si los precios suben más rápido que la inflación, las farmacéuticas deben pagar a Medicare la diferencia.
“Antes del rediseño, la Parte D incentivaba los aumentos de precios de los medicamentos”, dijo Gina Upchurch, farmacéutica y directora ejecutiva de Senior PharmAssist, una organización sin fines de lucro en Durham, Carolina del Norte, que asesora a beneficiarios de Medicare. “La forma en que está diseñada ahora coloca más obligaciones financieras en los planes y los fabricantes, presionándolos para que ayuden a controlar los precios”.
Otra disposición de la ley permite a los beneficiarios pagar los medicamentos en un plan de pago a plazos, en lugar de tener que pagar una factura abultada en un corto período de tiempo.
Las aseguradoras deben hacer los cálculos y enviar una factura mensual a los titulares de pólizas, que se ajustará si se agregan o eliminan medicamentos.
Junto con los grandes cambios introducidos por la IRA, los beneficiarios de Medicare deben prepararse para las sorpresas inevitables que surgen cuando las aseguradoras revisan sus planes para un nuevo año. Además de aumentar las primas, las aseguradoras pueden eliminar medicamentos cubiertos y eliminar farmacias, médicos u otros servicios de las redes de proveedores que los beneficiarios deben usar.
Perder la oportunidad de cambiar de plan significa que la cobertura se renovará automáticamente, incluso si cuesta más o ya no cubre los medicamentos que el afiliado necesito o sus farmacias preferidas.
La mayoría de los beneficiarios no pueden realizar ningún cambio en sus planes, o pasar a otros por fuera del período de inscripción annual, a menos que los CMS les otorgue un “período de inscripción especial”.
Sin embargo, muchos no se toman el tiempo para comparar docenas de planes que pueden cubrir diferentes medicamentos a diferentes precios en diferentes farmacias, incluso cuando el esfuerzo podría ahorrarles dinero.
En 2021, solo el 18% de los inscritos en planes de medicamentos de Medicare Advantage y el 31% de los miembros de planes de medicamentos independientes compararon los beneficios y costos de su plan con los de los competidores, según encontraron investigadores de KFF.
Para obtener ayuda gratuita e imparcial para elegir un plan de medicamentos, los beneficiarios pueden comunicarse con el Programa de Asistencia Estatal de Seguros de Salud (SHIP) de su estado en shiphelp.org o en la línea de ayuda 1-877-839-2675.
When Pam McClure learned she’d save nearly $4,000 on her prescription drugs next year, she said, “it sounded too good to be true.” She and her husband are both retired and live on a “very strict” budget in central North Dakota.
By the end of this year, she will have spent almost $6,000 for her medications, including a drug to control her diabetes.
McClure, 70, is one of about 3.2 million people with Medicare prescription drug insurance whose out-of-pocket medication costs will be capped at $2,000 in 2025 because of the Biden administration’s 2022 Inflation Reduction Act, according to an Avalere/AARP study.
“It’s wonderful — oh my gosh. We would actually be able to live,” McClure said. “I might be able to afford fresh fruit in the wintertime.”
The IRA, a climate and health care law that President Joe Biden and Vice President Kamala Harris promote on the campaign trail as one of their administration’s greatest accomplishments, radically redesigned Medicare’s drug benefit, called Part D, which serves about 53 million people 65 and older or with disabilities. The administration estimates that about 18.7 million people will save about $7.4 billion next year alone due to the cap on out-of-pocket spending and less publicized changes.
The annual enrollment period for Medicare beneficiaries to renew or switch drug coverage or to choose a Medicare Advantage plan began Oct. 15 and runs through Dec. 7. Medicare Advantage is the commercial alternative to traditional government-run Medicare and covers medical care and often prescription drugs. Medicare’s stand-alone drug plans, which cover medicines typically taken at home, are also administered by private insurance companies.
“We always encourage beneficiaries to really look at the plans and choose the best option for them,” Chiquita Brooks-LaSure, who heads the Centers for Medicare & Medicaid Services, told California Healthline. “And this year in particular it’s important to do that because the benefit has changed so much.”
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Improvements to Medicare drug coverage required by the IRA are the most sweeping changes since Congress added the benefit in 2003, but most voters don’t know about them, KFF surveys have found. And some beneficiaries may be surprised by a downside: premium increases for some plans.
CMS said Sept. 27 that nationwide the average Medicare drug plan premium fell about $1.63 a month — about 4% — from last year. “People enrolled in a Medicare Part D plan will continue to see stable premiums and will have ample choices of affordable Part D plans,” CMS said in a statement.
However, an analysis by KFF, a health information nonprofit that includes KFF Health News, the publisher of California Healthline, found that “many insurers are increasing premiums” and that large insurers including UnitedHealthcare and Aetna also reduced the number of plans they offer.
Many Part D insurers’ initial 2025 premium proposals were even higher. To cushion the price shock, the Biden administration created what it calls a demonstration program to pay insurers $15 extra a month per beneficiary if they agreed to limit premium increases to no more than $35.
“In the absence of this demonstration, premium increases would certainly have been larger,” Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF, wrote in her Oct. 3 analysis.
Nearly every Part D insurer agreed to the arrangement. Republicans have criticized it, questioning CMS’ authority to make the extra payments and calling them a political ploy in an election year. CMS officials say the government has taken similar measures when implementing other Medicare changes, including under President George W. Bush, a Republican.
In California, for example, Wellcare’s popular Value Script plan went from 40 cents a month to $17.40. The Value Script plan in New York went from $3.70 a month to $38.70, a more than tenfold hike — and precisely a $35 increase.
A page from a “notice of changes” that Wellcare sent to customers of its Value Script Medicare drug plan in New York. The 28-page booklet does not explain why the premium was increased or how it was calculated. “We hope to keep you as a member next year,” the booklet says, before explaining how to change plans.(Susan Jaffe for KFF Health News)
Cubanski identified eight plans in California that raised their premiums exactly $35 a month. California Healthline found that premiums went up for at least 70% of drug plans offered in California, Texas, and New York and for about half of plans in Florida and Pennsylvania — the five states with the most Medicare beneficiaries.
Spokespeople for Wellcare and its parent company, Centene Corp., did not respond to requests for comment. In a statement this month, Centene’s senior vice president of clinical and specialty services, Sarah Baiocchi, said Wellcare would offer the Value Script plan with no premium in 43 states.
In addition to the $2,000 drug spending limit, the IRA caps Medicare copayments for most insulin products at no more than $35 a month and allows Medicare to negotiate prices of some of the most expensive drugs directly with pharmaceutical companies.
It will also eliminate one of the drug benefit’s most frustrating features, a gap known as the “donut hole,” which suspends coverage just as people face growing drug costs, forcing them to pay the plan’s full price for drugs out-of-pocket until they reach a spending threshold that changes from year to year.
The law also expands eligibility for “extra help” subsidies for about 17 million low-income people in Medicare drug plans and increases the amount of the subsidy. Drug companies will be required to chip in to help pay for it.
Starting Jan. 1, the redesigned drug benefit will operate more like other private insurance policies. Coverage begins after patients pay a deductible, which will be no more than $590 next year. Some plans offer a smaller or no deductible, or exclude certain drugs, usually inexpensive generics, from the deductible.
After beneficiaries spend $2,000 on deductibles and copayments, the rest of their Part D drugs are free.
That’s because the IRA raises the share of the bill picked up by insurers and pharmaceutical companies. The law also attempts to tamp down future drug price hikes by limiting increases to the consumer price inflation rate, which was 3.4% in 2023. If prices rise faster than inflation, drugmakers have to pay Medicare the difference.
“Before the redesign, Part D incentivized drug price increases,” said Gina Upchurch, a pharmacist and the executive director of Senior PharmAssist, a Durham, North Carolina, nonprofit that counsels Medicare beneficiaries. “The way it is designed now places more financial obligations on the plans and manufacturers, pressuring them to help control prices.”
Another provision of the law allows beneficiaries to pay for drugs on an installment plan, instead of having to pay a hefty bill over a short period of time. Insurers are supposed to do the math and send policyholders a monthly bill, which will be adjusted if drugs are added or dropped.
Along with big changes brought by the IRA, Medicare beneficiaries should prepare for the inevitable surprises that come when insurers revise their plans for a new year. In addition to raising premiums, insurers can drop covered drugs and eliminate pharmacies, doctors, or other services from the provider networks beneficiaries must use.
Missing the opportunity to switch plans means coverage will renew automatically, even if it costs more or no longer covers needed drugs or preferred pharmacies. Most beneficiaries are locked into Medicare drug and Advantage plans for the year unless CMS gives them a “special enrollment period.”
“We do have a system that is run through private health plans,” CMS chief Brooks-LaSure said. But she noted that beneficiaries “have the ability to change their plans.”
But many don’t take the time to compare dozens of plans that can cover different drugs at different prices from different pharmacies — even when the effort could save them money. In 2021, only 18% of Medicare Advantage drug plan enrollees and 31% of stand-alone drug plan members checked their plan’s benefits and costs against competitors’, KFF researchers found.
For free, unbiased help selecting drug coverage, contact the State Health Insurance Assistance Program at shiphelp.org or 1-877-839-2675.
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.
The CVS representative popped into Lisa Trumble’s third-floor Berkshire Medical Center hospital room in Pittsfield, Massachusetts, to announce that everything was arranged for Trumble to return home, where she relies on IV nutrition because of severe intestinal problems that leave her unable to eat.
That was on Tuesday, Oct. 8. The next morning a social worker and a doctor woke Trumble to say her discharge was canceled. CVS would no longer provide her home nutrition, and she had to stay in the hospital. A week later, “I’m still here,” she said by telephone Wednesday. “I was dropped between Tuesday night and Wednesday morning with no care for my life or my health.”
Trumble is not the only one in crisis. She’s among 25,000 U.S. patients who depend on parenteral nutrition, or PN — IV bags containing life-sustaining amino acids, sugars, fats, vitamins, and electrolytes. Hurricane Helene wrecked a factory in North Carolina that produced 60% of the fluids their sustenance is mixed from. About two weeks later, CVS announced that its Coram division, a leading infusion pharmacy, was exiting the PN and IV antibiotics business.
Lisa Trumble’s discharge from a Massachusetts hospital was canceled after CVS said it would no longer provide the IV nutrition at home that she requires to stay alive.(Lisa Trumble)
The hurricane led Baxter International to ration its dwindling supplies. Pharmacies that supply Trumble and other patients like her were already plagued by shortages, and the rationing means the remaining infusion pharmacies can’t take on the customers cut off by CVS, said David Seres, director of medical nutrition at Columbia University Medical Center in New York.
At the Mayo Clinic in Rochester, Minnesota, seven or eight patients were ready to go home Tuesday but couldn’t be discharged because no infusion company would accept them, said Manpreet Mundi, a Mayo endocrinologist. The patients would fall ill within a day or two without this nutrition, he said.
Although the FDA is allowing emergency imports of IV fluids wiped out by Helene, as well as production of some of the fluids by U.S. compounding pharmacies, it’s unclear how long it will take to replenish supplies, said Mundi, who is a board member of the American Society for Parenteral and Enteral Nutrition and medical adviser to the Oley Foundation, which advocates for PN patients. “We’re trying to raise awareness that this could get worse before it gets better,” he said.
The patients who rely on PN have a variety of conditions that render them unable to digest food. Some have congenital abnormalities or disorders like Crohn’s disease that led to surgical removal of bowel sections. Others were scarred by cancer, car accidents, or gunfire, or are preemies born with underdeveloped intestines. In most patients, the fluid is pumped through a catheter into a large vein near the heart.
A crisis hit this community two years ago when CVS Health announced that it was shutting half of the 71 Coram pharmacies.
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CVS, which recently announced nearly 3,000 layoffs amid reports of a possible restructuring, on Oct. 8 began telling its remaining 800 to 1,000 PN customers that they would have to find other infusion pharmacies. A news release provided to California Healthline suggested the phaseout would last into January, but for patients like Trumble, the impact was immediate.
Highly specialized infusion medicine is “a challenging environment” for all companies “and Coram has not been immune to these challenges,” the CVS release said. “As such, we have reevaluated our service offerings.”
As far as Trumble, CVS Health spokesperson Mike DeAngelis said, “We’ll look into this matter and try to resolve it.”
Trumble has relied on IV nutrition for more than a year because of colon cancer and severe intestinal issues. While she has been held at the hospital, she says, she has missed her grandson Jordan Wood, as well as her mother and son, who have helped with her care.(Lisa Trumble)
It’s hard enough normally for such patients to find new suppliers for their materials, which can include 120 pounds of IV fluid per week.
Coram’s departure “made a big crisis that much worse,” Mundi said. “It’s become kind of a double whammy.”
The Baxter International North Cove plant produced most of the country’s high-concentration dextrose, a major source of energy for PN patients, as well as saline solution and sterile water, also vital supplies. A week after Helene hit, Hurricane Milton threatened sterile IV fluid supplier B. Braun Medical’s facility in Daytona Beach, Florida. The federal government helped truck 60 loads of the company’s inventory to a safe location, but the plant was spared the storm’s worst. It restarted production on Oct. 11.
That was a huge relief for Beth Gore, CEO of the Oley Foundation. She, her husband, and their six adopted children braved the storm’s seven hours of lashing wind in their home near Ruskin, Florida. Milton wrecked a car and part of the roof, but the family prayed through it all and somehow never lost power, though their neighbors did, Gore said. That kept the IV fluids fresh and the internet on, which calmed the kids.
Coram has supplied her youngest son, 15-year-old Manny, with PN for 13 years, and the family will need to find another supplier, she said.
“There’s been no relief” since Coram reduced its services in 2022, Gore said. “Now there’s this new twist.”
Her son gets care through Medicaid, whose reimbursement provides barely break-even margins for many infusion pharmacies, she said. Insurance limits, state licensing differences, and highly specific nutritional needs pose challenges for patients seeking new IV suppliers in the best of times, she said.
The FDA announced Oct. 9 that it would allow Baxter to import emergency supplies from Canada, China, Ireland, and the U.K. In the meantime, Baxter is prioritizing hospital patients over the home infusion companies — which lack backup supplies, Mundi said.
“We’re all on the phone 24/7,” said Kathleen Gura, president-elect of the American Society for Parenteral and Enteral Nutrition and pharmacy clinical research program manager at Boston Children’s Hospital. Her team is struggling to find new suppliers of IV nutrition at home for the 20 Coram patients among the 150 she sees.
“Some kids have a situation where they can’t absorb at all through their intestines and will die of dehydration if they can’t get IV,” Gura said.
The IV fluids lost in the Baxter disaster are key to all kinds of inpatient care. Many U.S. hospitals are conserving fluid by giving some patients oral hydration instead of IVs, or by delaying surgeries, said Soumi Saha, senior vice president of government affairs at Premier, which negotiates group hospital purchases.
President Joe Biden has invoked the Defense Production Act, which will enable the government to order companies to prioritize rebuilding the Baxter plant.
The military is flying in supplies from Baxter plants overseas, Saha said. Premier has also asked the FDA to put several more PN ingredients on its shortage list, which would allow large compounding facilities to produce the materials.
Ellie Rogers, 17, of Simpsonville, South Carolina, fears the worst if she can’t get her supplies. She suffers from a host of immunological and neurological ailments that require her to get four liters of IV fluid daily to stay alive, she said.
Her supplier, an Option Care Health pharmacy in South Carolina, informed the family Oct. 14 that instead of her weekly supply it was sending her enough bags for a day or two. “They really don’t know when they’re going to get what they need,” she said. Reducing the infusions in the past has led to dizziness, nausea, and pooling of her blood that “felt like my veins were going to explode.”
On Oct. 7, Crohn’s disease patient Hannah Hale’s infusion pharmacy called and said it couldn’t fill her standing weekly order of IV bags, urging her to find a new pharmacy.
Trumble and her grandson Jordan.(Lisa Trumble)
“I called 14 infusion pharmacies and haven’t been able to find anyone to take me,” said the Dallas 37-year-old. She suffers from weight loss and low blood sugar, and rationing her supplies raises dangers of seizures or coma, she said.
Trumble, 52, who started on PN 13 months ago because of colon cancer and severe intestinal issues, said she’s grateful to the hospital and gets excellent care but misses her mother, son, and 8-year-old grandson, Jordan — and her cats.
What’s worse, Trumble said, her mother and son, who get Medicaid payments to care for her, haven’t been paid the two weeks she has been in the hospital.
But without IV nutrition at home, she said, “I’d starve.”
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.
The 2024 campaign — particularly the one for president — has been notably vague on policy. But health issues, especially those surrounding abortion and other reproductive health care, have nonetheless played a key role. And while the Affordable Care Act has not been the focus of debate the way it was over the previous three presidential campaigns, who becomes the next president will have a major impact on the fate of the 2010 health law.
The panelists for this week’s special election preview, taped before a live audience at KFF’s offices in Washington, are Julie Rovner of KFF Health News, Tamara Keith of NPR, Alice Miranda Ollstein of Politico, and Cynthia Cox and Ashley Kirzinger of KFF.
Among the takeaways from this week’s episode:
As Election Day nears, who will emerge victorious from the presidential race is anyone’s guess. Enthusiasm among Democratic women has grown with the elevation of Vice President Kamala Harris to the top of the ticket, with more saying they are likely to turn out to vote. But broadly, polling reveals a margin-of-error race — too close to call.
Several states have abortion measures on the ballot. Proponents of abortion rights are striving to frame the issue as nonpartisan, acknowledging that recent measures have passed thanks in part to Republican support. For some voters, resisting government control of women’s health is a conservative value. Many are willing to split their votes, supporting both an abortion rights measure and also candidates who oppose abortion rights.
While policy debates have been noticeably lacking from this presidential election, the future of Medicaid and the Affordable Care Act hinges on its outcome. Republicans want to undermine the federal funding behind Medicaid expansion, and former President Donald Trump has a record of opposition to the ACA. Potentially on the chopping block are the federal subsidies expiring next year that have transformed the ACA by boosting enrollment and lowering premium costs.
And as misinformation and disinformation proliferate, one area of concern is the “malleable middle”: people who are uncertain of whom or what to trust and therefore especially susceptible to misleading or downright false information. Could a second Trump administration embed misinformation in federal policy? The push to soften or even eliminate school vaccination mandates shows the public health consequences of falsehood creep.
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.
KANSAS CITY, Mo. – Veinticuatro minutos antes del tiroteo masivo en el desfile del Super Bowl de los Kansas City Chiefs, en febrero, que dejó un muerto y al menos 24 heridos, Jenipher Cabrera sintió cómo una bala le perforaba la parte posterior del muslo derecho.
La joven de 20 años y su familia estaban a solo cuatro cuadras de Union Station, en medio de una multitud de fanáticos de los Chiefs que, con camisetas rojas, caminaban hacia la multitudinaria concentración después del desfile en ese cálido Día de San Valentín.
La bala, disparada por unos adolescentes que se peleaban en la calle, lanzó el cuerpo de Cabrera hacia adelante.
Ella tomó a su madre por el hombro y, en pánico, sin decirle una sola palabra, con sus grandes ojos marrones le señaló la pierna que sangraba. Cuando Cabrera estaba siendo atendida en una ambulancia escuchó los informes que resonaban en la radio de la policía.
“Mi madre intentaba subir conmigo a la ambulancia”, contó Cabrera. “Recuerdo que se lo impidieron, le dijeron algo así como: ‘No puedes subir. Puede que haya otras víctimas que tengamos que recoger’”.
El tiroteo que hirió a Cabrera ocurrió minutos antes del que acaparó los grandes titulares ese día y forma parte de los cientos de disparos de armas de fuego que, cada año, hieren o matan a residentes del área de Kansas City.
Esa incesante oleada de violencia con armas de fuego —desde incidentes puntuales hasta tiroteos masivos— ha terminado aniquilando la sensación de seguridad de quienes sobreviven.
Mientras las víctimas y sus familias intentan superar la experiencia y seguir adelante, las referencias a los hechos de violencia armada son inevitables en los medios de comunicación, en sus comunidades y en su propia vida cotidiana.
“Miro a la gente de otra manera”, afirma James Lemons, que también recibió un disparo en el muslo durante el desfile. Ahora, cuando está rodeado de desconocidos, no puede evitar preguntarse si alguno tendrá un arma y si sus hijos están a salvo.
La nueva temporada de la NFL se inauguró aquí con un minuto de silencio por Lisa López-Galván, la única persona asesinada en el desfile del Super Bowl.
Kansas City ha registrado al menos 124 homicidios este año. La policía local afirma que ha habido otras 476 “víctimas heridas con armas de fuego”, es decir, personas que recibieron disparos y sobrevivieron. Y hasta mediados de septiembre habían ocurrido por lo menos 50 tiroteos en escuelas de todo el país.
Desde que le dispararon en el desfile del Super Bowl de los Kansas City Chiefs en febrero, James Lemons (izq.) se ha enfocado en proteger a su familia: su hijo Jaxson, su hija Kensley y su esposa Brandie.(Bram Sable-Smith/KFF Health News)
Toda esta situación está dejando huellas colectivas.
Quienes han sobrevivido a situaciones de este tipo sufren ataques de pánico, tienen una mayor sensación de peligro en grandes aglomeraciones y padecen una profunda ansiedad ante la posibilidad de que irrumpa la violencia en cualquier lugar de Kansas City.
Cada sobreviviente de un tiroteo responde de manera diferente a la violencia armada e incluso a la amenaza de que surja, explicó LJ Punch, cirujano traumatólogo y el fundador de la Bullet Related Injury Clinic en St. Louis.
Para algunos, haber sido baleados significa que siempre se mantendrán alerta, tal vez incluso armados. Otros prefieren alejarse de las armas de fuego para siempre.
“¿Pero qué es lo que todos tienen en común? Que esas personas quieren desesperadamente sentirse seguras”, afirma Punch.
El intento de Cabrera por entender lo que le sucedió la impulsó a colaborar con un legislador local frustrado que busca cambiar las leyes sobre armas, algo que parece casi imposible, ya que la legislación del estado de Missouri prácticamente prohíbe cualquier restricción local sobre armas de fuego.
Enterarse de otros tiroteos por teléfono
Jenipher Cabrera muestra la herida de bala que recibió de camino al desfile de los Kansas City Chiefs por el Super Bowl.(Christopher Smith for KFF Health News)
En la mente de Cabrera,el 14 de febrero es una película en cámara lenta, que avanza fotograma por fotograma. Y la banda sonora es su propia voz, que habla y habla. Ve a un grupo de adolescentes revoltosos, que corren alrededor de ella y de su familia. Luego, dos estallidos: ¿son fuegos artificiales? Otro estallido. Finalmente, un cuarto.
“Creo que fue entonces cuando entré en shock y agarré a mi madre”, recordó Cabrera. “No le dije nada. Simplemente la miré y sentí los ojos muy abiertos. Recuerdo que le hice una especie de señal con los ojos para que me mirara la pierna”.
Cabrera cayó al suelo y otros aficionados corrieron a socorrerla, llamaron al 911 y empezaron a cortarle las calzas. Cuatro hombres se quitaron el cinturón para hacerle un torniquete. Recordó que en ese momento pensó que, si perdía el conocimiento, podría morir. Así que habló y habló sin parar. O eso creía.
Uno de los rescatistas le contó más tarde que en realidad ella no dijo ni una sola palabra, ni siquiera cuando él le preguntó cuántos dedos tenía levantados.
“Me dijo que yo tenía los ojos enormes, como naranjas, y que todo lo que hice fue mirar hacia arriba y hacia abajo cuatro veces, porque él tenía cuatro dedos levantados”, dijo Cabrera.
Cabrera recuerda que después la sacaron del servicio de urgencias de University Health para hacerles sitio a otras 12 personas que habían llegado desde el tiroteo que había ocurrido en la manifestación. Ocho de esas personas tenían heridas de bala. En ese momento miró las redes sociales en su teléfono: ¿había otro tiroteo? Era increíble. Finalmente, sus padres la encontraron. Pasó siete días en el hospital.
Cabrera agradece estar viva. Pero ahora se siente inquieta cuando se cruza con grupos de adolescentes insultando y jugando, o cuando ve camisetas rojas de los Chiefs. Oír cuatro estallidos seguidos —algo habitual en su barrio del noreste de Kansas City— hace que a Cabrera se le oprima el pecho y sepa que está por tener un ataque de pánico.
Cuando Jenipher Cabrera (izq.) estaba siendo atendida en una ambulancia tras recibir un disparo de camino al desfile del Super Bowl de los Kansas City Chiefs, su madre, Josefina, intentó estar con ella. Pero los paramédicos le dijeron que necesitaban el espacio por si había más víctimas.(Christopher Smith for KFF Health News)
“En mi mente, lo sucedido se repite una y otra vez”, dijo.
¿Una creciente sensación de amenaza?
Aunque el cirujano general de EE.UU. declaró en junio que la violencia con armas de fuego es una crisis de salud pública, en Missouri casi cualquier intento de regular el uso de armas es un fracaso político.
De hecho, hubo una ley estatal de 2021 —firmada en la misma armería de Kansas City donde se compró una de las armas utilizadas en el tiroteo del desfile— que tenía como objetivo prohibir que la policía local aplicara las leyes federales sobre armas de fuego.
Esa ley fue anulada por un tribunal federal de apelaciones en agosto.
Missouri no tiene restricciones respecto de la edad para el uso y la posesión de armas, aunque la ley federal prohíbe en gran medida que los menores lleven pistolas.
Las encuestas realizadas entre los votantes de Missouri muestran su apoyo a que se exijan certificados de antecedentes y se establezcan límites de edad para la compra de armas, pero también revelan que casi la mitad de los encuestados está en contra de que los condados y las ciudades tengan facultades para aprobar sus propias normas sobre armas.
En una comparación por cantidad de habitantes, Kansas City, Missouri, se encuentra entre los lugares más violentos de la nación. En esta ciudad de 510.000 habitantes, entre 2014 y 2023 se produjeron al menos 2.175 tiroteos, que dejaron 1.275 muertos y 1.624 heridos.
Jason Barton was worried about a mass shooting before he drove his family to the Kansas City Chiefs Super Bowl parade in February. The shooting, which left one person dead and at least 24 more injured, happened right in front of them. His wife, Bridget Barton, found a bullet in her backpack, and his stepdaughter, Gabriella Magers-Darger, was burned by sparks from a bullet ricochet. (Christopher Smith for KFF Health News)
Punch, del Bullet Related Injury Clinic, comparó la violencia con armas de fuego con un brote de una enfermedad que no se enfrenta y se propaga. Según Punch, la postura permisiva del estado hacia las armas de fuego podría agravar la situación en Kansas City, aunque no haya sido el origen del problema.
“Entonces, ¿está pasando algo? ¿La gente se siente cada vez más amenazada?”, se preguntó Punch.
Jason Barton, que creció en Kansas City, está familiarizado con ese tipo de violencia. Ahora, que vive en Osawatomie, Kansas, consideró detenidamente si debía llevar su propia pistola al desfile del Super Bowl como una forma de proteger a su familia.
Al final decidió no hacerlo, suponiendo que si ocurría algo y sacaba un arma, lo detendrían o le dispararían.
Barton reaccionó rápidamente ante el tiroteo, que se produjo justo delante de él y de su familia. Su mujer encontró una bala en su mochila. Su hijastra sufrió quemaduras en las piernas por las chispas de un rebote de bala.
A pesar de que sus peores temores se hicieron realidad, Barton opina que no llevar su arma ese día fue la decisión correcta.
“No es necesario llevar armas a lugares como ése”, afirmó.
Una peligrosa escopeta calibre 12
Los tiroteos masivos pueden deteriorar gravemente la sensación de seguridad de los sobrevivientes, según Heather Martin, ella misma sobreviviente del tiroteo en la secundaria Columbine en 1999.
Martin es cofundadora de The Rebels Project, una organización que brinda apoyo entre pares a quienes han sobrevivido a experiencias traumáticas masivas.
“En los años posteriores al evento es muy común que se intente encontrar la manera de volver a sentirse seguro”, explicó Martin.
James Lemons siempre había sentido recelo de volver a Kansas City, donde había crecido. Incluso llevó su pistola al desfile, pero, a instancias de su esposa, la dejó en el auto. Tenía a su hija de 5 años sobre los hombros cuando una bala le atravesó la parte posterior del muslo. Él impidió que se golpeara contra el suelo cuando caía.
¿Qué iba a hacer realmente con una pistola?
James Lemons dice que recibir un disparo en el muslo en el desfile de los Kansas City Chiefs ha cambiado su forma de ver a los extraños. No puede evitar preguntarse si tienen un arma o si sus hijos estarán seguros cerca de ellos.(Bram Sable-Smith/KFF Health News)
Y, sin embargo, no puede evitar preguntarse “qué hubiera pasado si…”. No puede quitarse de encima la sensación de que no protegió a su familia. Cuando sueña con el desfile, al despertarse, cuenta: “simplemente empiezo a llorar”.
Sabe que aún no lo ha procesado, pero no sabe cómo empezar a hacerlo. Ha puesto toda su energía en la seguridad de su familia.
Este verano compraron dos bulldogs americanos, por lo que ahora hay tres en casa, uno para cada niño. Lemons los describe como “tener un arma sin tener un arma”.
“Tengo un calibre 12 con dientes”, bromea Lemons, “un protector grande y suave”.
La mayoría de las noches sólo logra dormir unas horas de corrido porque se despierta para ver cómo están los niños. Por lo general, suele echarse en el sofá porque es más cómodo para su pierna, que aún se está curando. También porque lo ayuda a evitar las nerviosas patadas de su hija de 5 años, que se acuesta con sus padres desde el desfile.
Estar en el sofá también le asegura que sería él quien interceptara a cualquier intruso que irrumpiera en la casa.
Emily Tavis, que recibió un disparo en la pierna, encontró consuelo en su iglesia y en el terapeuta de una congregación hermana.
Pero el domingo por la mañana después del tiroteo en el mitín de Donald Trump, en julio, el sermón del predicador giró en torno a la violencia armada, y eso desató el pánico en su interior.
“Me sentí tan abrumada que me fui al baño”, dijo Tavis, “y me quedé allí durante el resto del sermón”. Ahora, incluso duda de ir a la iglesia.
Tavis se ha mudado recientemente a una nueva casa en Leavenworth, Kansas, que le alquiló a una amiga.
El marido de la amiga le advirtió que si Tavis iba a estar sola necesitaba un arma para protegerse. Ella le contestó que no podía lidiar con armas de fuego en ese momento.
“Y él le dijo: ‘OK, bueno, toma esto’. Y sacó un machete gigante”, recuerda Tavis riendo.
“Así que ahora tengo un machete”.
En busca de algo bueno
Cabrera, la joven que no podía hablar después de que la hirieron, intenta ahora utilizar su voz en la lucha contra la violencia armada.
Manny Abarca, legislador del condado de Jackson, Missouri, vive calle abajo. Una tarde fue a visitarla. Los padres de Cabrera tomaron la palabra; ella es tímida por naturaleza. Pero entonces él se volvió hacia ella y le preguntó directamente a Cabrera qué quería.
“Sólo quiero algo de justicia para mi caso”, dijo, “o que pase algo bueno”.
Antes del desfile, a la joven le habían ofrecido un puesto en la fábrica donde trabajaba su hermana, pero no pudo tomarlo porque su pierna aún estaba curándose. Así que Abarca le ofreció una pasantía y la ayudó a establecer una Oficina de Prevención de la Violencia Armada en el condado de Jackson, un plan que presentó en julio en respuesta a los tiroteos del desfile.
Abarca participó en el desfile de la victoria de los Chiefs con su hija Camila, de 5 años. Estaban en Union Station cuando se produjeron los disparos, y se acurrucaron en un baño de la planta baja.
Emily Tavis había encontrado consuelo en su iglesia tras recibir un disparo en la pierna durante el desfile de los Kansas City Chiefs. Pero en julio un sermón se refirió a la violencia con armas de fuego y eso desató el pánico en su interior.(Christopher Smith for KFF Health News)
“Solo dije: ‘Oye, ya sabes, solo mantén la calma. Solo estate quieta. Vamos a averiguar qué está pasando. Algo ha sucedido,’”, contó Abarca. “Y ella me contestó: ‘Esto es un simulacro.’ Y, oye, eso me desgarró el corazón por dentro, porque pensé que hacía alusión a su entrenamiento en la escuela”.
Finalmente salieron temblando pero a salvo, sólo para enterarse de que López-Galván había muerto. Abarca conocía a la popular DJ tejana, una madre de 43 años, a través de la unida comunidad hispana de la zona.
Abarca ha aprovechado la conmoción de este tiempo tenso tras los tiroteos del desfile del Super Bowl para trabajar en medidas contra la violencia, a pesar de que conoce las severas limitaciones que impone la ley estatal.
En junio, la asamblea legislativa del condado de Jackson aprobó una norma que da fuerza local a una ley federal contra la violencia doméstica que permite a los jueces retirar las armas de fuego a los delincuentes.
Pero Abarca no ha podido conseguir que se apruebe la creación de una oficina para la violencia armada, y los funcionarios del condado han rechazado considerar otra medida que establecería límites de edad para comprar o poseer armas, temiendo una demanda del fiscal general del estado, que es bastante agresivo.
Sin embargo, contrató a Cabrera, explicó, porque es bilingüe y quiere su ayuda como sobreviviente.
En cierto sentido, este trabajo hace que Cabrera se sienta más fuerte en su lucha por salir adelante tras el tiroteo. Aún así, la percepción de seguridad de su familia se ha hecho añicos, y nadie tiene pensado ir a los partidos o a un potencial desfile por ganar el Super Bowl en el futuro.
“Nunca esperamos que fuera a ocurrir algo así”, afirma. “Y por eso creo que ahora vamos a ser más precavidos y quizá nos limitemos a ver el desfile por la tele”.
KFF Health News and KCUR are following the stories of people injured during the Feb. 14 mass shooting at the Kansas City Chiefs Super Bowl celebration. Listen to how survivors are seeking a sense of safety.
KANSAS CITY, Mo. — Twenty-four minutes before the mass shooting at the Kansas City Chiefs Super Bowl victory parade in February left one person dead and at least 24 people injured, Jenipher Cabrera felt a bullet pierce the back of her right thigh.
The 20-year-old and her family were just four blocks from Union Station, in a river of red-shirted Chiefs fans walking toward the massive rally after the parade that warm Valentine’s Day. The bullet — fired by teen boys fighting in the street — thrust Cabrera forward.
She grabbed her mom by the shoulder and signaled in panic to her bleeding leg with her large brown eyes, not saying a word. Cabrera was being treated in an ambulance when she heard reports blasting from the police radio.
“My mom was trying to get on the ambulance,” Cabrera said. “I remember them saying, like, ‘You can’t get on. There might be other victims that we need to pick up.’”
Cabrera’s shooting happened before the one that garnered the big headlines that day and is one of hundreds that kill or injure Kansas City-area residents each year. That endless drumbeat of gun violence — from one-off incidents to mass shootings — has shattered the sense of safety for those who survive. As victims and their families try to move forward, reminders of gun violence are inescapable in the media, in their communities, in their daily lives.
“I look at people differently,” said James Lemons, who was shot in the thigh at the rally. Now when he’s around strangers he can’t help but wonder if they have a gun and if his kids are safe.
The new NFL season opened here with a moment of silence for Lisa Lopez-Galvan, the only person killed at the parade. Kansas City has recorded at least 124 homicides this year. Local police say there have been an additional 476 “bullet-to-skin victims” — people who were shot and survived. And there were at least 50 school shootings nationwide by mid-September.
Collectively it is all taking a toll.
Survivors suffer panic attacks and feel a heightened sense of danger in crowds and deep anxieties about the threat of violence anywhere in Kansas City.
Since being shot at the Kansas City Chiefs Super Bowl parade in February, James Lemons (left) has focused much of his attention on protecting his family, including son Jaxson, daughter Kensley, and wife Brandie. (Bram Sable-Smith/KFF Health News)
Every shooting survivor responds in their own way to gun violence and even the threat of it, according to LJ Punch, a trauma surgeon by training and founder of the Bullet Related Injury Clinic in St. Louis.
For some, getting shot ensures they will always be on guard, perhaps even armed. Others want nothing to do with guns ever again.
“But what’s the common ground? That people desperately want to be safe,” Punch said.
Cabrera’s search to make meaning out of what happened has led her to work with a frustrated local lawmaker seeking new gun laws — something akin to impossible given Missouri state law, which prohibits nearly any local restrictions on firearms.
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Learning of Other Shootings on the Phone
Feb. 14 is a movie in Cabrera’s mind, in slow motion, frame by frame, and the soundtrack is her voice, talking and talking. She sees a group of rowdy teenage boys running around her and her family. Then two pops — fireworks? Another pop. Finally, a fourth.
“I think that’s where the shock kicked in, and I grabbed my mom,” Cabrera remembered. “I didn’t say anything to her. I just, like, looked at her, and I had, like, my eyes were widened, and I kind of signaled with my eyes to look down at my leg.”
Jenipher Cabrera shows her bullet wound from being shot on the way to the Kansas City Chiefs Super Bowl parade.(Christopher Smith for KFF Health News)
Cabrera fell and other fans rushed to her rescue, calling 911, and began cutting off her leggings. Four men instantly pulled off their belts when asked for a tourniquet. She remembers thinking that if she lost consciousness, she could die. So she talked and talked. Or so she thought.
One of her rescuers later said she actually didn’t say a word even when he asked how many fingers he was holding up.
“He told me [that] my eyes were huge, like oranges, and that all I was basically doing was, like, looking up and down four times since he had four fingers up,” Cabrera said.
Cabrera remembers being moved out of the emergency room at University Health to make room for 12 people who came in from the shooting at the rally, including eight with gunshot wounds. She checked social media on her phone — another shooting? Unreal. Finally her parents found her. She spent seven days in the hospital.
When Jenipher Cabrera (left) was being treated in an ambulance after being shot on the way to the Kansas City Chiefs Super Bowl parade, her mother, Josefina, tried to get onboard also. But paramedics said they needed the space in case there were other victims to pick up. (Christopher Smith for KFF Health News)
Cabrera is grateful to be alive. But she is triggered now when she sees groups of teenage boys cursing and playing, or when she sees red Chiefs shirts. Hearing four pops in a row — a regular occurrence in her northeast Kansas City neighborhood — makes Cabrera’s chest swell and she braces for a panic attack.
“It runs over and over and over and over in my mind,” she said.
‘An Increasing Sense of Threat?’
The U.S. surgeon general declared gun violence a public health crisis in June, but nearly any new regulation on guns is a political nonstarter in Missouri. In fact, a 2021 state law — signed at the Kansas City-area gun store where one of the weapons used in the parade shooting was purchased — would have barred local police from enforcing federal gun laws. The law was struck down by a federal appeals court in August.
Missouri has no age restrictions on gun use and possession, although federal law largely prohibits juveniles from carrying handguns.
Polling of Missouri voters shows support for requiring background checks and instituting age restrictions for gun purchases, but also nearly half were opposed to allowing counties and cities to pass their own gun rules.
Per capita, Kansas City, Missouri, is among the more violent places in the nation. From 2014 to 2023, there were at least 2,175 shootings in this city of 510,000, leaving 1,275 people dead and 1,624 injured. And while murder rates fell in more than 100 cities across the country last year, Kansas City recorded its deadliest year on record.
Punch, of the Bullet Related Injury Clinic, likened the violence to a disease outbreak that goes unaddressed and spreads. The state’s permissive posture toward guns might supercharge the reality in Kansas City, Punch said, but it didn’t start it.
“So is there something going on? Is there an increasing sense of threat?” Punch asked.
Jason Barton was familiar with that violence growing up in Kansas City. Now settled in Osawatomie, Kansas, he thought long and hard about bringing his own gun for protection when he drove his family to the Super Bowl parade.
Ultimately he decided against it, surmising that if something happened and he pulled out a gun, he would be arrested or shot.
Barton responded quickly to the shooting, which happened right in front of him and his family. His wife found a bullet in her backpack. His stepdaughter’s legs were burned by sparks from a bullet ricochet.
Despite his worst fears coming true, Barton said not bringing his gun that day was the right decision.
“Guns don’t need to be brought into places like that,” he said.
Jason Barton was worried about a mass shooting before he drove his family to the Kansas City Chiefs Super Bowl parade in February. The shooting, which left one person dead and at least 24 more injured, happened right in front of them. His wife, Bridget Barton, found a bullet in her backpack, and his stepdaughter, Gabriella Magers-Darger, was burned by sparks from a bullet ricochet. (Christopher Smith for KFF Health News)
‘A 12-Gauge With Teeth’
Mass shootings can derail survivors’ sense of safety, according to Heather Martin, a survivor of the Columbine High School shooting in 1999 and co-founder of The Rebels Project, which provides peer support to survivors of mass trauma.
“Trying to find a way to feel safe again is very common,” Martin said, “in the years following it.”
James Lemons had always felt trepidation about returning to Kansas City, where he grew up. He even brought his gun with him to the parade but left it in the car at the urging of his wife. His 5-year-old daughter was on his shoulders when a bullet entered the back of his thigh. He shielded her from the ground as he fell. What was he realistically going to do with a gun?
And yet he can’t help but wonder “what if.” He can’t shake the feeling that he failed to protect his family. Waking up from dreams about the parade, “I just start crying,” he said. He knows he hasn’t processed it yet but he doesn’t know how to start. He has focused on his family’s safety.
They got two American bulldogs this summer, making three total in the house now — one for each kid. Lemons described them as “like having a gun without having a gun.”
“I’ve got a 12-gauge with teeth,” Lemons joked, “just a big, softy protector.”
James Lemons says being shot in the thigh at the Kansas City Chiefs Super Bowl parade has changed the way he views strangers. He can’t help but wonder if they have a gun or if his children will be safe around them.(Bram Sable-Smith/KFF Health News)
Most nights he sleeps only a few hours at a time before waking up to check on the kids. Usually he’s on the couch. It’s more comfortable for his leg that is still healing, and it helps him avoid the restless kicks of his 5-year-old, who has slept with her parents since the parade.
It also ensures he’ll be the one to intercept an intruder who breaks into the house.
Emily Tavis, who was shot through the leg, found solace at her church and from a sister congregation’s in-house therapist.
But then, the Sunday morning after the Donald Trump rally shooting in July, the preacher’s sermon turned to gun violence — triggering panic inside her.
“And it just, like, overwhelmed me so much, where I just went to the bathroom,” Tavis said, “and I just stayed in the bathroom for the rest of the sermon.” Now even attending church gives her pause.
Tavis recently moved into a new house in Leavenworth, Kansas, that she is renting from a friend. The friend’s husband cautioned that if Tavis was going to be alone she needed a gun for protection. She told him she just can’t deal with guns right now.
“And he’s like, ‘OK, well, take this.’ And he pulls out this giant machete,” Tavis recalled, laughing.
“So I have a machete now.”
Emily Tavis had been finding solace in her church after being shot through the leg at the Kansas City Chiefs Super Bowl parade in February. But when a sermon in July addressed gun violence, it triggered panic inside her.(Christopher Smith for KFF Health News)
A Search for Something Good
Cabrera, the young woman who couldn’t speak after being shot, is now trying to use her voice in the fight against gun violence.
Manny Abarca, a Jackson County, Missouri, legislator, lives down the street. One evening, he came to visit. Cabrera’s parents did most of the talking; she’s shy by nature. But then he turned and asked her directly: What did she want?
“I just want, like, some justice for my case,” she said, “or something good to happen.”
Before the parade, Cabrera was offered a factory job where her sister worked, but she hadn’t started because her leg was still healing. So Abarca offered her an internship, helping him establish a Jackson County Office of Gun Violence Prevention, a plan he introduced in July in response to the parade shootings.
Abarca was in the Chiefs victory parade with his 5-year-old daughter, Camila. They were in Union Station when shots were fired — and they huddled in a downstairs bathroom.
“I just said, ‘Hey, you know, just be calm. Just be quiet. Let’s just find out what’s going on. Something’s happened,’” Abarca said. “And then she said, ‘This is a drill.’ And hey, it tore everything out of me, because I was like, she’s referring to her training” at school.
They emerged shaken but safe, only to learn that Lopez-Galvan had died. Abarca knew the 43-year-old mother and popular Tejano DJ through the area’s tight-knit Hispanic community.
Abarca has taken advantage of this heated time after the Super Bowl parade shootings to work on anti-violence measures, despite knowing the severe limitations posed by state law.
In June, the Jackson County Legislature passed a measure that gives local teeth to a federal domestic violence law that allows judges to remove firearms from offenders.
But Abarca hasn’t been able to get the gun violence office approved, and county officials have refused to take up another measure that would establish age limits for purchasing or possessing firearms, fearing a lawsuit from a combative state attorney general. He hired Cabrera, he said, because she is bilingual and he wants her help as a survivor.
In a sense, the work makes Cabrera feel stronger in her fight to move forward from the shooting. Still, her family’s perception of safety has been shattered, and no one will be attending games or a possible Super Bowl victory parade anytime soon.
“We just never expected something like that to happen,” she said. “And so I think we’re gonna be more cautious now and maybe just watch it through TV.”
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.
When Lyft driver Tramaine Carr transports seniors and sick patients to hospitals in Atlanta, she feels like both a friend and a social worker.
“When the ride is an hour or an hour and a half of mostly freeway driving, people tend to tell you what they’re going through,” she said.
Drivers such as Carr have become a critical part of the medical transportation system in Georgia, as well as in Washington, D.C., Mississippi, Arizona, and elsewhere. While some patients use transportation companies solely dedicated to medical rides or nonemergency ambulance rides to get to their appointments, the San Francisco-based ride-hailing companies Uber and Lyft are also ferrying people to emergency rooms, kidney dialysis, cancer care, physical therapy, and other medical visits.
But Georgia ride-hail drivers aren’t only serving patients living in Atlanta or its sprawling suburbs. When rural Georgians are too sick to drive themselves, Uber or Lyft is often one of the only ways to reach medical care in the state capital.
Rural hospital closures in Georgia have meant people battling cancer and other serious illnesses must now commute two or more hours to treatment facilities in Atlanta, said Bryan Miller, director of psychosocial support services at the Atlanta Cancer Care Foundation, a medical practice offshoot that seeks to alleviate financial burdens for cancer patients and their families.
From April 2022 to April 2024, Lyft drivers completed thousands of rides that were greater than 50 miles each way and that began or ended at Atlanta-area medical treatment centers, including the Winship Cancer Institute of Emory University and Emory University Hospital Midtown, according to Lyft.
While 75% of those trips were under 100 miles, the company said, 21% of them were between 100 and 200 miles and 4% were over 200, showing that even Georgians who live hours away from metro Atlanta rely on the ride-hail platform to reach medical care there.
Uber Health global head Zachary Clark declined to provide comparable ridership data. Uber Health is a division of Uber that organizes medical transportation for some Medicaid and Medicare recipients, health care workers, prescription drug delivery, and others seeking reimbursement for medical-related Uber rides, according to Uber’s website.
Lyft also has a health care division, offering programs such as Lyft Assisted and Lyft Concierge to coordinate rides for patients.
Nationwide, some insurance companies and cancer treatment centers, plus Medicare Advantage and state Medicaid plans, pay for such ride-hailing services, often with the goal of reducing missed appointments, according to Krisda Chaiyachati, an adjunct assistant professor at the University of Pennsylvania medical school.
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In 2024, 36% of individual Medicare Advantage plans and 88% of special needs plans offered transportation services, said Jeannie Fuglesten Biniek, associate director of Medicare policy at KFF, the health policy research, polling, and news organization that publishes California Healthline. A special needs plan provides extra benefits to Medicare recipients who have severe and chronic diseases or certain other health care needs, or who also have Medicaid.
And Medicaid — the federal-state government safety net insurance plan for those with low incomes or disabilities — paid for up to 4 million beneficiaries to use nonemergency medical transportation services annually from 2018 through 2021, according to a Department of Health and Human Services report. Patients residing in rural areas used ride-hailing and other nonemergency transportation providers at the highest rates, the report said.
The estimated total federal and state investment in nonemergency medical transportation was approximately $5 billion in 2019, according to a study by the Texas A&M University Transportation Institute.
Even with some insurance covering trips or charities offering ride credits, social workers say, many ailing patients are still left without a ride. Nationwide, 21% of adults without access to a vehicle or public transit went without needed medical care in 2022, according to a study by the Robert Wood Johnson Foundation. People who lacked access to a vehicle but had access to public transit were less likely to skip needed care.
The data analytics company Geotab ranked Atlanta as tied for second worst in the nation when it comes to the accessibility of its public transportation network.
“The ability to get to a doctor’s appointment can be a barrier to care,” said Rochelle Schube, a cancer support group facilitator in Atlanta. “If I give a patient $250 in Uber cards and they live far away, that gets spent quickly.”
The fact that Uber and Lyft are harder to come by in rural America compounds the lack of medical access in those areas. “When you move to rural areas — which you could argue have a higher need — you see fewer services,” Chaiyachati said.
Finding drivers who are able and willing to provide medical transportation can be a challenge. The Atlanta-based start-up MedTrans Go connects patients and health care providers with vetted drivers, many offering wheelchair or stretcher rides, in Georgia and 16 other states. Many of its drivers have medical training, walk patients to and from medical facilities or their homes, and can handle complex situations for vulnerable patients, said Dana Weeks, the company’s co-founder and CEO.
The company’s app can also dispatch directly to Uber or Lyft for patients who do not need specialized assistance, she said.
Uber and Lyft trips can save patients and insurers money, costing a fraction of the typical fee for an ambulance ride, said David Slusky, an economics professor at the University of Kansas who has studied the impact of ride-hailing services on medicine.
But instead of all of that, argued Timothy Crimmins, a history professor emeritus at Georgia State University and a former director of the school’s neighborhood-studies center, the best solution would be for Georgia to expand Medicaid, so more rural hospitals would be able to remain open and Georgians could seek medical care close to home.
The decision by Georgia lawmakers to not accept a federally funded expansion of Medicaid has left more than 1.4 million Georgians without health insurance, according to KFF — and that hurts rural hospitals when those patients use the medical facilities and cannot pay their bills. In Georgia, 10 rural hospitals have either closed or ceased their inpatient care operations since 2010, according to a 2024 report from health care consultant Chartis, and 18 more are in danger of shuttering.
Until more patients are insured, Crimmins said, the state should subsidize Uber and Lyft trips for less prosperous Georgians who need help reaching medical care in Atlanta. “We might be talking about $100 to $150 round-trip,” he said. “That can be subsidized.”
Still, ferrying around patients is not for every ride-hail driver. Damian Durand said his Chevrolet Equinox SUV is large enough to accommodate a medical passenger requiring a wheelchair, but he isn’t paid extra to transport those with medical needs. He said some of his recent passengers in Atlanta have been Medicaid recipients with mental health conditions or disabilities.
“It can be stressful,” he said. “I do feel like Uber and Lyft are trying to catch me off guard. When I can see that the ride is going to the hospital, I try to avoid or cancel the ride.”
While Durand’s experience with medical transport has been mostly negative, Carr loves the work and appreciates being able to help older Georgians, who she said often tip her well. For her, ride-hail work remains a good option even when it entails medical calls.
“It’s not stressful for me,” she said. “I worked a good 20 years in customer service. For me, human connection is important. I tried to work from home, and I really didn’t like it. I prefer this because I can connect with people.”
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.
STONY BROOK, NY, October 16, 2024 – A study that used a specialized type of magnetic resonance imaging (MRI), named neuromelanin-sensitive MRI, showed that this type of MRI signal was increased in regions of the midbrain in young adults ages 20 to 24 who had an extensive alcohol and drug use history. The research was conducted by a team of investigators in the Department of Psychiatry and Behavioral Health in the Renaissance School of Medicine at Stony Brook University. The findings are published early online in the American Journal of Psychiatry.
The research involved 135 individuals, 105 women and 30 men. Neuromelanin accumulates naturally in areas of the midbrain where the neurotransmitter dopamine is produced. Dopamine plays important roles in many cognitive and bodily functions and is central to the reward/motivation system in the brain. Dopamine can be difficult to study in young people. This has hindered researchers’ understanding of early stages of certain neurological diseases and mental health conditions, such as adolescent-onset addictive behavior. However, neuromelanin accumulation in young people can be safely and easily studied using neuromelanin-sensitive MRI.
“Young adults who regularly engage in substance use appear to show greater than normal levels of neuromelanin accumulation on this type of MRI scan, especially young women,” says Greg Perlman, PhD, Assistant Professor of Psychiatry and Behavioral Health and Lead Author.
“This is important because much of the biomedical research on the effects of drug and alcohol use on the dopamine system has examined older adults after years or decades of chronic substance use. In contrast, there is very little information about the dopamine system in adolescent or young adult populations after just a few years of habitual alcohol and drug use. The potential of neuromelanin-sensitive MRI to provide new insights about the health of the dopamine system in young people was a key motivation for our study.”
Perlman indicated that the association between substance use and neuromelanin MRI signal was especially strong in certain midbrain regions of young women, such as the ventral tegmental area. In addition, increased neuromelanin was associated with substance use generally, but not with use of one type of drug.
The research team is currently conducting a new study using neuromelanin-sensitive MRI in teenagers ages 14 to 17 to better understand neuromelanin accumulation over those three years of life. The study will use yearly MRI scans to evaluate the effect of life experiences reported by teenagers, such as alcohol use, social media use, and stressful events, on neuromelanin accumulation measured by neuromelanin-sensitive MRI.
The work is supported in part with funding from the National Institute of Health’s National Institute on Drug Abuse.
Newswise — In a new study evaluating meditation for chronic lower back pain, researchers at University of California San Diego School of Medicine have discovered that men and women utilize different biological systems to relieve pain. While men relieve pain by releasing endogenous opioids, the body’s natural painkillers, women rely instead on other, non-opioid based pathways.
Synthetic opioid drugs, such as morphine and fentanyl, are the most powerful class of painkilling drugs available. Women are known to respond poorly to opioid therapies, which use synthetic opioid molecules to bind to the same receptors as naturally-occurring endogenous opioids. This aspect of opioid drugs helps explain why they are so powerful as painkillers, but also why they carry a significant risk of dependence and addiction.
“Dependence develops because people start taking more opioids when their original dosage stops working,” said Fadel Zeidan, Ph.D., professor of anesthesiology and Endowed Professor in Empathy and Compassion Research at UC San Diego Sanford Institute for Empathy and Compassion. “Although speculative, our findings suggest that maybe one reason that females are more likely to become addicted to opioids is that they’re biologically less responsive to them and need to take more to experience any pain relief.”
The study combined data from two clinical trials involving a total of 98 participants, including both healthy individuals and those diagnosed with chronic lower back pain. Participants underwent a meditation training program, then practiced meditation while receiving either placebo or a high-dose of naloxone, a drug that stops both synthetic and endogenous opioids from working. At the same time, they experienced a very painful but harmless heat stimulus to the back of the leg. The researchers measured and compared how much pain relief was experienced from meditation when the opioid system was blocked versus when it was intact.
The study found:
Blocking the opioid system with naloxone inhibited meditation-based pain relief in men, suggesting that men rely on endogenous opioids to reduce pain.
Naloxone increased meditation-based pain relief in women, suggesting that women rely on non-opioid mechanisms to reduce pain.
In both men and women, people with chronic pain experienced more pain relief from meditation than healthy participants.
“These results underscore the need for more sex-specific pain therapies, because many of the treatments we use don’t work nearly as well for women as they do for men,” said Zeidan.
The researchers conclude that by tailoring pain treatment to an individual’s sex, it may be possible to improve patient outcomes and reduce the reliance on and misuse of opioids.
“There are clear disparities in how pain is managed between men and women, but we haven’t seen a clear biological difference in the use of their endogenous systems before now,” said Zeidan. “This study provides the first clear evidence that sex-based differences in pain processing are real and need to be taken more seriously when developing and prescribing treatment for pain.”
Co-authors on the study include Jon Dean, Mikaila Reyes, Lora Khatib, Gabriel Riegner, Nailea Gonzalez, Julia Birenbaum and Krishan Chakravarthy at UC San Diego, Valeria Oliva at Istituto Superiore di Sanità, Grace Posey at Tulane University School of Medicine, Jason Collier and Rebecca Wells at Wake Forest University School of Medicine, Burel Goodin at Washington University in St Louis and Roger Fillingim at University of Florida.
This study was funded, in part, by the National Center for Complementary and Integrative Health (grants R21-AT010352, R01-AT009693, R01AT011502) and the National Center for Advancing Translational Sciences (UL1TR001442).
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Disclosures: The authors declare no competing interests.
