There’s a new morning ritual in Pinedale, Wyoming, a town of about 2,000 nestled against the Wind River Mountains.
Friends and neighbors in the oil- and gas-rich community “take their morning coffee and pull up” to watch workers building the county’s first hospital, said Kari DeWitt, the project’s public relations director.
“I think it’s just gratitude,” DeWitt said.
Sublette County is the only one in Wyoming — where counties span thousands of square miles — without a hospital. The 10-bed, 40,000-square-foot hospital, with a similarly sized attached long-term care facility, is slated to open by the summer of 2025.
DeWitt, who also is executive director of the Sublette County Health Foundation, has an office at the town’s health clinic with a window view of the construction.
Pinedale’s residents have good reason to be excited. New full-service hospitals with inpatient beds are rare in rural America, where declining population has spurred decades of downsizing and closures. Yet, a few communities in Wyoming and others in Kansas and Georgia are defying the trend.
“To be honest with you, it even seems strange to me,” said Wyoming Hospital Association President Eric Boley. Small rural “hospitals are really struggling all across the country,” he said.
A June 2024 drone view of a hospital being constructed in Pinedale, Wyoming. The new 10-bed hospital counters the national trend of downsizing and closures.
There is no official tally of new hospitals being built in rural America, but industry experts such as Boley said they’re rare. Typically, health-related construction projects in rural areas are for smaller urgent care centers or stand-alone emergency facilities or are replacements for old hospitals.
About half of rural hospitals lost money in the prior year, according to Chartis, a health analytics and consulting firm. And nearly 150 rural hospitals have closed or converted to smaller operations since 2010, according to data collected by the University of North Carolina’s Cecil G. Sheps Center for Health Services Research.
To stem the tide of closures, Congress created a new rural emergency hospital designation that allowed struggling hospitals to close their inpatient units and provide only outpatient and emergency services. Since January 2023, when the program took effect, 32 of the more than 1,700 eligible rural hospitals — from Georgia to New Mexico — have joined the program, according to data from the Centers for Medicare & Medicaid Services.
Tony Breitlow is health care studio director for EUA, which has extensive experience working for rural health care systems. Breitlow said his national architecture and engineering firm’s work expands, replaces, or revamps older buildings, many of which were constructed during the middle of the last century.
The work, Breitlow said, is part of health care “systems figuring out how to remain robust and viable.”
Freeman Health System, based in Joplin, Missouri, announced plans last year to build a new 50-bed hospital across the state line in Kansas. Paula Baker, Freeman’s president and chief executive, said the system is building for patients in the southeastern corner of the state who travel 45 minutes or more to its bigger Joplin facilities for care.
Paula Baker, president and chief executive of Freeman Health System, announces a new 50-bed hospital in southeastern Kansas.
Freeman’s new hospital, with construction on the building expected to begin in the spring, will be less than 10 miles away from an older, 64-bed hospital that has existed for decades. Kansas is one of more than a dozen states with no “certificate of need” law that would require health providers to obtain approval from the state before offering new services or building or expanding facilities.
Baker also said Freeman plans to operate emergency services and a small 10-bed outpost in Fort Scott, Kansas, opening early next year in a corner of a hospital that closed in late 2018. Residents there “cried, they cheered, they hugged me,” Baker said, adding that the “level of appreciation and gratitude that they felt and they displayed was overwhelming to me.”
Michael Topchik, executive director of the Chartis Center for Rural Health, said regional health care systems in the Upper Midwest have been particularly active in competing for patients by, among other things, building new hospitals.
And while private corporate money can drive construction, many rural hospital projects tap government programs, especially those supported by the U.S. Department of Agriculture, Topchik said. That, he said, “surprises a lot of people.”
Since 2021, the USDA’s rural Community Facilities Programs have awarded $2.24 billion in loans and grants to 68 rural hospitals for work that was not related to an emergency or disaster, according to data analyzed by California Healthline and confirmed by the agency. The federal program is funded through what is often known as the farm bill, which faces a September congressional renewal deadline.
Nearly all the projects are replacements or expansions and updates of older facilities.
The USDA confirmed that three new or planned Wyoming hospitals received federal funding. Hospital projects in Riverton and Saratoga received loans of $37.2 million and $18.3 million, respectively. Pinedale’s hospital received a $29.2 million loan from the agency.
Wyoming’s new construction is rare in a state where more than 80% of rural hospitals reported losses in the third quarter of 2023, according to Chartis. The state association’s Boley said he worries about several hospitals that have less than 10 days’ cash on hand “day and night.”
A 10-bed hospital construction site in remote Pinedale, Wyoming, a community comprising about 2,000 residents, who voted to raise taxes in support of the project.
Pinedale’s project loan was approved after the community submitted a feasibility study to the USDA that included local clinics and a long-term care facility. “It’s pretty remote and right up in the mountains,” Boley said.
Pinedale’s DeWitt said the community was missing key services, such as blood transfusions, which are often necessary when there is a trauma like a car crash or if a pregnant woman faces severe complications. Local ambulances drove 94,000 miles last year, she said.
DeWitt began working to raise support for the new hospital after her own pregnancy-related trauma in 2014. She was bleeding heavily and arrived at the local health clinic believing it operated like a hospital.
“It was shocking to hear, ‘No, we’re not a hospital. We can’t do blood transfusions. We’re just going to have to pray you live for the next 45 minutes,’” DeWitt said.
DeWitt had to be airlifted to Idaho, where she delivered a few minutes after landing. When the hospital financing went on the ballot in 2020, DeWitt — fully recovered, with healthy grade-schoolers at home — began making five calls a night to rally support for a county tax increase to help fund the hospital.
“By improving health care, I think we improve everybody’s chances of survival. You know, it’s pretty basic,” DeWitt 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.
Congress has left Washington for the campaign trail, but after the Nov. 5 general election lawmakers will have to complete work on the annual spending bills for the fiscal year that starts Oct. 1. While the GOP had hoped to push spending decisions into 2025, Democrats forced a short-term spending patch that’s set to expire before Christmas.
Meanwhile, on the campaign trail, abortion continues to be among the hottest issues. Democrats are pressing their advantage with women voters while Republicans struggle — with apparently mixed effects — to neutralize it.
This week’s panelists are Julie Rovner of KFF Health News, Joanne Kenen of Politico and the Johns Hopkins schools of nursing and public health, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.
Among the takeaways from this week’s episode:
When Congress returns after the election, there’s a chance lawmakers could then make progress on government spending and more consensus health priorities, like expanding telehealth access. After all, after the midterm elections in 2022, Congress passed federal patient protections against surprise medical billing.
As Election Day approaches, Democrats are banging the drum on health care — which polls show is a winning issue for the party with voters. This week, Democrats made a last push to extend Affordable Care Act subsidies expanded during the pandemic — an issue that will likely drag into next year in the face of Republican opposition.
The outcry over the first reported deaths tied to state abortion bans seems to be resonating on the campaign trail. With some states offering the chance to weigh in on abortion access via ballot measures, advocates are telling voters: These tragedies are examples of what happens when you leave abortion access to the states.
And Sen. Bernie Sanders of Vermont summoned the chief executive of Novo Nordisk before the health committee he chairs this week to demand accountability for high drug prices. Despite centering on a campaign issue, the hearing — like other examples of pharmaceutical executives being thrust into the congressional hot seat — yielded no concessions.
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.
One evening in May, nursing assistant Debra Ragoonanan’s vision blurred during her shift at a state-run Massachusetts veterans home. As her head spun, she said, she called her husband. He picked her up and drove her to the emergency room, where she was diagnosed with a brain aneurysm.
It was the latest in a drumbeat of health issues that she traces to the first months of 2020, when dozens of veterans died at the Soldiers’ Home in Holyoke, in one of the country’s deadliest covid-19 outbreaks at a long-term nursing facility. Ragoonanan has worked at the home for nearly 30 years. Now, she said, the sights, sounds, and smells there trigger her trauma. Among her ailments, she lists panic attacks, brain fog, and other symptoms of post-traumatic stress disorder, a condition linked to aneurysms and strokes.
Scrutiny of the outbreak prompted the state to change the facility’s name to the Massachusetts Veterans Home at Holyoke, replace its leadership, sponsor a $480 million renovation of the premises, and agree to a $56 million settlement for veterans and families. But the front-line caregivers have received little relief as they grapple with the outbreak’s toll.
“I am retraumatized all the time,” Ragoonanan said, sitting on her back porch before her evening shift. “How am I supposed to move forward?”
Covid killed more than 3,600 U.S. health care workers in the first year of the pandemic. It left many more with physical and mental illnesses — and a gutting sense of abandonment.
What workers experienced has been detailed in state investigations, surveys of nurses, and published studies. These found that many health care workers weren’t given masks in 2020. Many got covid and worked while sick. More than a dozen lawsuits filed on behalf of residents or workers at nursing facilities detail such experiences. And others allege that accommodations weren’t made for workers facing depression and PTSD triggered by their pandemic duties. Some of the lawsuits have been dismissed, and others are pending.
Health care workers and unions reported risky conditions to state and federal agencies. But the federal Occupational Safety and Health Administration had fewer inspectors in 2020 to investigate complaints than at any point in a half-century. It investigated only about 1 in 5 covid-related complaints that were filed officially, and just 4% of more than 16,000 informal reports made by phone or email.
Nursing assistants, health aides, and other lower-wage health care workers were particularly vulnerable during outbreaks, and many remain burdened now. About 80% of lower-wage workers who provide long-term care are women, and these workers are more likely to be immigrants, to be people of color, and to live in poverty than doctors or nurses.
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Some of these factors increased a person’s covid risk. They also help explain why these workers had limited power to avoid or protest hazardous conditions, said Eric Frumin, formerly the safety and health director for the Strategic Organizing Center, a coalition of labor unions.
He also cited decreasing membership in unions, which negotiate for higher wages and safer workplaces. One-third of the U.S. labor force was unionized in the 1950s, but the level has fallen to 10% in recent years.
Like essential workers in meatpacking plants and warehouses, nursing assistants were at risk because of their status, Frumin said: “The powerlessness of workers in this country condemns them to be treated as disposable.”
In interviews, essential workers in various industries told KFF Health News they felt duped by a system that asked them to risk their lives in the nation’s moment of need but that now offers little assistance for harm incurred in the line of duty.
“The state doesn’t care. The justice system doesn’t care. Nobody cares,” Ragoonanan said. “All of us have to go right back to work where this started, so that’s a double whammy.”
‘A War Zone’
The plight of health care workers is a problem for the United States as the population ages and the threat of future pandemics looms. Surgeon General Vivek Murthy called their burnout “an urgent public health issue” leading to diminished care for patients. That’s on top of a predicted shortage of more than 3.2 million lower-wage health care workers by 2026, according to the Mercer consulting firm.
The veterans home in Holyoke illustrates how labor conditions can jeopardize the health of employees. The facility is not unique, but its situation has been vividly described in a state investigative report and in a report from a joint oversight committee of the Massachusetts Legislature.
The Soldiers’ Home made headlines in March 2020 when The Boston Globe got a tip about refrigerator trucks packed with the bodies of dead veterans outside the facility. About 80 residents died within a few months.
The state-run Soldiers’ Home in Holyoke, Massachusetts, was the scene of one of the country’s deadliest covid outbreaks at a long-term nursing facility. Scrutiny of the outbreak prompted the state to change the home’s name, replace its leadership, and agree to a $56 million settlement for veterans and their families. But front-line caregivers have received little relief as they continue to grapple with the trauma.(Amy Maxmen/KFF Health News)
The state investigation placed blame on the home’s leadership, starting with Superintendent Bennett Walsh. “Mr. Walsh and his team created close to an optimal environment for the spread of COVID-19,” the report said. He resigned under pressure at the end of 2020.
Investigators said that “at least 80 staff members” tested positive for covid, citing “at least in part” the management’s “failure to provide and require the use of proper protective equipment,” even restricting the use of masks. They included a disciplinary letter sent to one nursing assistant who had donned a mask as he cared for a sick veteran overnight in March. “Your actions are disruptive, extremely inappropriate,” it said.
To avoid hiring more caretakers, the home’s leadership combined infected and uninfected veterans in the same unit, fueling the spread of the virus, the report found. It said veterans didn’t receive sufficient hydration or pain-relief drugs as they approached death, and it included testimonies from employees who described the situation as “total pandemonium,” “a nightmare,” and “a war zone.”
Because his wife was immunocompromised, Walsh didn’t enter the care units during this period, according to his lawyer’s statement in a deposition obtained by KFF Health News. “He never observed the merged unit,” it said.
In contrast, nursing assistants told KFF Health News that they worked overtime, even with covid, because they were afraid of being fired if they stayed home. “I kept telling my supervisor, ‘I am very, very sick,’” said Sophia Darkowaa, a nursing assistant who said she now suffers from PTSD and symptoms of long covid. “I had like four people die in my arms while I was sick.”
Nursing assistants recounted how overwhelmed and devasted they felt by the pace of death among veterans whom they had known for years — years of helping them dress, shave, and shower, and of listening to their memories of war.
“They were in pain. They were hollering. They were calling on God for help,” Ragoonanan said. “They were vomiting, their teeth showing. They’re pooping on themselves, pooping on your shoes.”
Nursing assistant Kwesi Ablordeppey said the veterans were like family to him. “One night I put five of them in body bags,” he said. “That will never leave my mind.”
Four years have passed, but he said he still has trouble sleeping and sometimes cries in his bedroom after work. “I wipe the tears away so that my kids don’t know.”
High Demands, Low Autonomy
A third of health care workers reported symptoms of PTSD related to the pandemic, according to surveys between January 2020 and May 2022 covering 24,000 workers worldwide. The disorder predisposes people to dementia and Alzheimer’s. It can lead to substance use and self-harm.
Since covid began, Laura van Dernoot Lipsky, director of the Trauma Stewardship Institute, has been inundated by emails from health care workers considering suicide. “More than I have ever received in my career,” she said. Their cries for help have not diminished, she said, because trauma often creeps up long after the acute emergency has quieted.
Another factor contributing to these workers’ trauma is “moral injury,” a term first applied to soldiers who experienced intense guilt after carrying out orders that betrayed their values. It became common among health care workers in the pandemic who weren’t given ample resources to provide care.
“Folks who don’t make as much money in health care deal with high job demands and low autonomy at work, both of which make their positions even more stressful,” said Rachel Hoopsick, a public health researcher at the University of Illinois at Urbana-Champaign. “They also have fewer resources to cope with that stress,” she added.
People in lower income brackets have less access to mental health treatment. And health care workers with less education and financial security are less able to take extended time off, to relocate for jobs elsewhere, or to shift careers to avoid retriggering their traumas.
Such memories can feel as intense as the original event. “If there’s not a change in circumstances, it can be really, really, really hard for the brain and nervous system to recalibrate,” van Dernoot Lipsky said. Rather than focusing on self-care alone, she pushes for policies to ensure adequate staffing at health facilities and accommodations for mental health issues.
In 2021, Massachusetts legislators acknowledged the plight of the Soldiers’ Home residents and staff in a joint committee report saying the events would “impact their well-being for many years.”
But only veterans have received compensation. “Their sacrifices for our freedom should never be forgotten or taken for granted,” the state’s veterans services director, Jon Santiago, said at an event announcing a memorial for veterans who died in the Soldiers’ Home outbreak. The state’s $56 million settlement followed a class-action lawsuit brought by about 80 veterans who were sickened by covid and a roughly equal number of families of veterans who died.
The state’s attorney general also brought criminal charges against Walsh and the home’s former medical director, David Clinton, in connection with their handling of the crisis. The two averted a trial and possible jail time this March by changing their not-guilty pleas, instead acknowledging that the facts of the case were sufficient to warrant a guilty finding.
An attorney representing Walsh and Clinton, Michael Jennings, declined to comment on queries from KFF Health News. He instead referred to legal proceedings in March, in which Jennings argued that “many nursing homes proved inadequate in the nascent days of the pandemic” and that “criminalizing blame will do nothing to prevent further tragedy.”
Nursing assistants sued the home’s leadership, too. The lawsuit alleged that, in addition to their symptoms of long covid, what the aides witnessed “left them emotionally traumatized, and they continue to suffer from post-traumatic stress disorder.”
The case was dismissed before trial, with courts ruling that the caretakers could have simply left their jobs. “Plaintiff could have resigned his employment at any time,” Judge Mark Mastroianni wrote, referring to Ablordeppey, the nursing assistants’ named representative in the case.
But the choice was never that simple, said Erica Brody, a lawyer who represented the nursing assistants. “What makes this so heartbreaking is that they couldn’t have quit, because they needed this job to provide for their families.”
‘Help Us To Retire’
Brody didn’t know of any cases in which staff at long-term nursing facilities successfully held their employers accountable for labor conditions in covid outbreaks that left them with mental and physical ailments. KFF Health News pored through lawsuits and called about a dozen lawyers but could not identify any such cases in which workers prevailed.
A Massachusetts chapter of the Service Employees International Union, SEIU Local 888, is looking outside the justice system for help. It has pushed for a bill — proposed last year by Judith García, a Democratic state representative — to allow workers at the state veterans home in Holyoke, along with its sister facility in Chelsea, to receive their retirement benefits five to 10 years earlier than usual. The bill’s fate will be decided in December.
Retirement benefits for Massachusetts state employees amount to 80% of a person’s salary. Workers qualify at different times, depending on the job. Police officers get theirs at age 55. Nursing assistants qualify once the sum of their time working at a government facility and their age comes to around 100 years. The state stalls the clock if these workers take off more than their allotted days for sickness or vacation.
Several nursing assistants at the Holyoke veterans home exceeded their allotments because of long-lasting covid symptoms, post-traumatic stress, and, in Ragoonanan’s case, a brain aneurysm. Even five years would make a difference, Ragoonanan said, because, at age 56, she fears her life is being shortened. “Help us to retire,” she said, staring at the slippers covering her swollen feet. “We have bad PTSD. We’re crying, contemplating suicide.”
(Amy Maxmen/KFF Health News)
I got my funeral dress out because the way everybody was dying, I knew I was going to die.
Debra Ragoonanan
Certain careers are linked with shorter life spans. Similarly, economists have shown that, on average, people with lower incomes in the United States die earlier than those with more. Nearly 60% of long-term care workers are among the bottom earners in the country, paid less than $30,000 — or about $15 per hour — in 2018, according to analyses by the Department of Health and Human Services and KFF, a health policy research, polling, and news organization that includes KFF Health News.
Fair pay was among the solutions listed in the surgeon general’s report on burnout. Another was “hazard compensation during public health emergencies.”
If employers offer disability benefits, that generally entails a pay cut. Nursing assistants at the Holyoke veterans home said it would halve their wages, a loss they couldn’t afford.
“Low-wage workers are in an impossible position, because they’re scraping by with their full salaries,” said John Magner, SEIU Local 888’s legal director.
Despite some public displays of gratitude for health care workers early in the pandemic, essential workers haven’t received the financial support given to veterans or to emergency personnel who risked their lives to save others in the aftermath of 9/11. Talk show host Jon Stewart, for example, has lobbied for this group for over a decade, successfully pushing Congress to compensate them for their sacrifices.
“People need to understand how high the stakes are,” van Dernoot Lipsky said. “It’s so important that society doesn’t put this on individual workers and then walk away.”
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.
In a campaign ad this month, Derek Tran, a Democrat from Orange County, California, blasted his opponent, Republican U.S. Rep. Michelle Steel, for supporting a national abortion ban and voting to limit access to birth control.
Democratic challenger Will Rollins also called out his rival, Rep. Ken Calvert, and “MAGA extremists” in an ad last week for their backing of a bill that could criminalize medical practitioners who provide abortions.
A few blocks from state Route 14 in Lancaster, about 70 miles north of downtown Los Angeles, Rep. Mike Garcia’s Democratic opponent, George Whitesides, planted two billboards promising to protect reproductive health care, a jab at the Republican congressman, who has voted to cut taxpayer funding of abortions for service members and other Americans.
As Election Day approaches, Democratic hopefuls are doing all they can to tie Republican opponents in contested congressional districts to their anti-abortion records. Aggressive ads are going up in California, Arizona, Nebraska, New Jersey, New York, and Oregon, as Democrats see an opportunity to take control of the House by engaging voters who might not vote straight-ticket — or at all. Republicans currently control the House by a slim margin.
“What we all need to do is to make sure we look at her record, and that record is contrary to what she’s putting out there in her ads,” Tran said in an interview about Steel. “We’re making sure that we educate and remind the voters of who she really is.”
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Democrats are also linking Republican incumbents to former President Donald Trump, who has taken credit for the 2022 Supreme Court decision overturning Roe v. Wade. Democrats are warning voters that more restrictions could come. During the Sept. 10 presidential debate, Trump dodged a question about whether he would veto a national abortion ban if elected.
A majority of voters support restoring a federal right to abortion, according to a recent KFF poll. And 1 in 14 voters say abortion is the most important issue in determining their choice. Those voters have the potential to make a difference in the close races, said David McCuan, a political science professor at Sonoma State University.
“The politics of abortion and reproductive health can get voters to participate at higher rates,” McCuan said. “It’s going to be a defining issue.”
Democrats are hoping the issue plays to their favor in California. Voters two years ago codified abortion rights into state law. In May, Planned Parenthood Affiliates of California launched a seven-figure campaign targeting seven Republican seats and Democrat Katie Porter’s open seat.
As a result, political analysts say, Republicans have shied away from their votes on abortion and some incumbents — such as Steel, Garcia, and Central Valley U.S. Rep. David Valadao — have moderated their stances to appeal to voters.
Steel, like Garcia and Valadao, has said she supports exceptions to abortion bans in cases of rape, incest, or threats to the life of the mother. All three co-sponsored a bill amounting to a blanket abortion ban in the previous Congress. Garcia and Valadao left their names off the bill last year, but Steel signed on again as a co-sponsor — briefly.
Rep. Michelle Steel (R-Calif.) attends a congressional hearing on May 23 in Washington.(Michael A. McCoy/Getty Images)
She withdrew her support after she won her March primary, explaining that it could create confusion because the three-page bill could threaten in vitro fertilization. In a September campaign ad, Steel shared that she had used IVF to have children and reiterated her support for the procedure. Steel spokesperson Lance Trover said she opposes a national abortion ban.
None of the Republican incumbents who represent a California “toss-up” district, as determined by the nonpartisan Cook Political Report, granted California Healthline an interview. Those who did respond said they do not support a national abortion ban.
Rep. John Duarte added that he opposes a ban because he’s “pro-choice,” and Calvert said “the issue is best decided with the states and their voters directly.” Both voted for a bill to limit medication abortion and supported a measure that would have authorized prison time for medical providers who don’t resuscitate babies born after an attempted abortion.
Tim Rosales, a political strategist who has represented Republican candidates, said these incumbents shouldn’t get heat for changing their minds over time, noting that Democratic former Presidents Bill Clinton and Barack Obama reversed their positions on same-sex marriage.
“There has to be some allowance for evolution on a variety of issues,” Rosales said.
Ben Petersen, a spokesperson for the National Republican Congressional Committee, said Democrats who have called out Republicans for inconsistencies want to move the conversation away from other topics, such as the “disastrous cost of living crisis hurting women and families caused by their one-party control of Sacramento.”
This political dance is playing out on the national stage, especially in battleground races where Republicans find themselves on defense in states where abortion is on the ballot. Roughly two dozen races are considered toss-ups.
In a March post on the social platform X, Republican Nebraska Rep. Don Bacon wrote, “I’ve always defended the life of the mother,” after his Democratic rival, Tony Vargas, called him out for supporting a national abortion ban, which makes no exceptions for cases in which the mother’s life is at risk. That same month, Rolling Stone reported that the Omaha-area congressman had deleted some anti-abortion endorsements from his website. Nebraskans will vote this November on competing abortion ballot measures.
In Arizona, where voters will also be asked whether to enshrine abortion rights into the state constitution, Republican incumbent David Schweikert this year did not support a national abortion ban, which he had co-sponsored at least six times from 2012 to 2021. In April, he wrote on X that he opposed an abortion ban in Arizona, calling on the state legislature to “address this issue immediately.”
On the airwaves, on their websites, and on the campaign trail, Republican candidates are pivoting to convince voters that they have voted to protect women. For example, Steel this month released an ad titled “Champion,” in which the Orange County sheriff says Steel has “worked tirelessly to protect victims of domestic violence and sexual abuse.”
Trover, the Steel spokesperson, said she voted two years ago to reauthorize the Violence Against Women Act. That vote was on a larger $1.5 trillion government spending bill, which included the measure.
Tim Sheehy “would let politicians like him ban abortion, with no exceptions for rape or to save a woman’s life, and criminalize women.”
A Facebook ad from the campaign of Sen. Jon Tester (D-Mont.), launched on Sept. 6, 2024
In a race that could decide control of the U.S. Senate, Sen. Jon Tester (D-Mont.) is attacking his challenger, Republican Tim Sheehy, for his stance on abortion.
Montana’s Senate race is one of a half-dozen tight contests around the country in which Democrats are defending seats needed to keep their one-seat majority. If Republicans flip Tester’s seat, they could take over the chamber even if they fail to oust Democrats in any other key races.
In a series of Facebook ads launched in early September, Tester’s campaign said Sheehy supports banning abortion with no exceptions.
An ad launched on Sept. 6 said, “Tim Sheehy wants to take away the freedom to choose what happens with your own body, and give that power to politicians. Sheehy would let politicians like him ban abortion, with no exceptions for rape or to save a woman’s life, and criminalize women. We can’t let Tim Sheehy take our freedom away.”
Sheehy’s Anti-Abortion Stance Allows for Rape, Health Exceptions
Sheehy’s website calls him “proudly pro-life,” and he’s campaigning against abortion. He opposes a measure on Montana’s November ballot that would amend the Montana Constitution to provide the right to “make and carry out decisions about one’s own pregnancy, including the right to abortion.”
In July, we rated False Sheehy’s statement that Tester and other Democrats have voted for “elective abortions up to and including the moment of birth. Healthy, 9-month-year-old baby killed at the moment of birth.”
But contrary to the new ad’s message, Sheehy has voiced support for exceptions.
In a Montana Public Radio interview in May, Sheehy was asked, “Yes or no, do you support a federal ban on abortion?”
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Sheehy said, “I am proudly pro-life and support commonsense protections for when a baby can feel pain, as well as exceptions for rape, incest, and the life of the mother, and I believe any further limits must be left to each state.”
And in a June debate with Tester, Sheehy said, “I’ll always protect the three rights for women: rape, incest, life of the mother.”
The issues section of Sheehy’s campaign website does not say that he has a no-exceptions stance, nor does it say he would “criminalize women” who have abortions.
In a statement, the Sheehy campaign told PolitiFact that the ad mischaracterizes Sheehy’s abortion position. Allowing no exceptions “has never been Tim’s position,” the campaign said.
Our Ruling
The Tester campaign’s ad says Sheehy “would let politicians like him ban abortion, with no exceptions for rape or to save a woman’s life, and criminalize women.”
Sheehy has said he supports abortion ban exceptions for rape or to save a pregnant woman’s life. We found no instances of him saying he would be OK with states criminalizing women who receive abortions in violation of state laws.
What gives the ad a kernel of truth is that Sheehy has voiced support for letting states decide abortion parameters within their borders. The Tester campaign argues that this means Sheehy would effectively enable legislators to pass abortion restrictions that don’t include exceptions or that criminalize women.
The Tester campaign’s argument relies on hypotheticals and ignores Sheehy’s stated support for exceptions, giving a misleading impression of Sheehy’s position.
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.
A dog’s pain medication, a grandparent’s pill organizer, even a discarded tissue: Rutgers Health research reveals they’re all potential sources of opioid poisoning for young children.
Researchers at the New Jersey Poison Control Center examined 230 cases of opioid exposure in children ages 1 month to 6 years over a five-year period. Their findings in the Journal of Pediatrics show how children access these dangerous drugs.
“We’re seeing this in our clinical practice,” said Diane Calello, the medical director of the poison control center and senior author of the study. “I’ve seen too many kids in my practice at University Hospital who have gotten severely poisoned because they got opioids in their house.”
An overwhelming majority of exposures (97 percent) were unintentional. More than 91 percent occurred in the child’s home, and 84.3 percent resulted in the child being admitted to a health care facility.
While many cases involved a child accessing a parent’s medication, the study uncovered several unexpected sources of exposure. Grandparents’ medications were implicated in 17.4 percent of cases, highlighting what the researchers described as an often-overlooked risk factor: exposure to older adults who may not be as vigilant as parents about securing their medications.
Another significant risk came from pet medications, which were involved in 4.3 percent of cases. Children sometimes accessed these opioids directly and sometimes accessed pet medication that had been mixed with food, such as peanut butter, and then left out.
Children ages 2 and under accounted for 80 percent of all exposures. Kids in this age group face particularly high risk because of their exploratory behavior and inability to distinguish between safe and dangerous substances.
The study drew data from reports to the New Jersey Poison Control Center between January 2018 and December 2022. Researchers manually extracted and analyzed information from the center’s database, focusing on single opioid exposures in young children.
While prescription opioid pills were the most common source of danger, the study uncovered other scenarios. Children accessed used fentanyl patches, illicit drug paraphernalia and even opioid residue left on discarded items such as tissue paper and cotton balls.
The study highlights the importance of proper medication storage and disposal, Calello said.
“One opioid pill could actually kill a 2-year-old,” she said. “And yet, a parent who may take that opioid pill every day may not realize that even though it’s very familiar to them, it is deadly.”
The study authors said there is a need for more comprehensive education about the dangers of opioids in the home. Calello suggested it should include grandparents and anyone who might bring medications into a home where children are present.
One potential solution is increasing access for parents and caregivers to naloxone, a medication that can reverse opioid overdoses, Calello said.
“I’ve seen several cases of young children where I thought that if this mom or dad had naloxone with them, they could have given it, and this child may have had a better outcome,” she said.
Looking forward, the study team is preparing to publish data on how children nationwide are exposed to opioids. Those figures show more pediatric exposures to illicit opioids and medications for treating opioid addiction.
Calello added that she hopes to study the effects of distributing naloxone more widely to parents.
“That would be a good next step,” she said. “It could make a big difference.”
When Preston Nafz was 12, he asked his dad for permission to play lacrosse.
“First practice, he came back, he said, ‘Dad, I love it,’” recalled his father, Lothar Nafz, of Hoover, Alabama. “He lives for lacrosse.”
But years of youth sports took a toll on Preston’s body. By the time the teenager limped off the field during a lacrosse tournament last year, the pain in his left hip had become so intense that he had trouble with simple activities, such as getting out of a car or turning over in bed. Months of physical therapy and anti-inflammatory drugs didn’t help.
Not only did he have to give up sports, but “I could barely do anything,” said Preston, now 17.
The Medical Procedure
A doctor recommended Preston undergo a procedure called a sports hernia repair to mend damaged tissue in his pelvis, believed to be causing his pain.
The sports medicine clinic treating Preston told Lothar that the procedure had no medical billing code — an identifier that providers use to charge insurers and other payers. It likely would be a struggle to persuade their insurer to cover it, Lothar was told, which is why he needed to pay upfront.
With his son suffering, Lothar said, the surgery “needed to be done.” He paid more than $7,000 to the clinic and the surgery center with a personal credit card and a medical credit card with a zero-interest rate.
Preston underwent surgery in November, and his father filed a claim with their insurer, hoping for a full reimbursement. It didn’t come.
The Final Bill
$7,105, which broke down as $480 for anesthesia, a $625 facility fee, and $6,000 for the surgery.
The Billing Problem: No CPT Code
Before the surgery, Lothar said, he called Blue Cross and Blue Shield of Alabama and was encouraged to learn that his policy typically covers most medical, non-cosmetic procedures.
But during follow-up phone calls, he said, insurance representatives were “deflecting, trying to wiggle out.” He said he called several times, getting a denial just before the surgery.
By the time Preston limped off the field during a lacrosse tournament last year, he was experiencing hip pain so intense that he had trouble with simple activities, such as getting out of a car. Months of physical therapy and anti-inflammatory drugs didn’t help.(Charity Rachelle for KFF Health News)
Lothar said he trusted his son’s doctor, who showed him research indicating the surgery works. The clinic, Andrews Sports Medicine and Orthopaedic Center, has a good reputation in Alabama, he said.
Other medical providers not involved in the case called the surgery a legitimate treatment.
A sports hernia — also known as an “athletic pubalgia” — is a catchall phrase to describe pain that athletes may experience in the lower groin or upper thigh area, said David Geier, an orthopedic surgeon and sports medicine specialist in Mount Pleasant, South Carolina.
“There’s a number of underlying things that can cause it,” Geier said. Because of that, there isn’t “one accepted surgery for that problem. That’s why I suspect there’s not a uniform CPT.”
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CPT stands for “Current Procedural Terminology” and refers to the numerical or alphanumeric codes for procedures and services performed in a clinical or outpatient setting. There’s a CPT code for a rapid strep test, for example, and different codes for various X-rays.
The lack of a CPT code can cause reimbursement headaches, since insurers determine how much to pay based on the CPT codes providers use on claims forms.
More than 10,000 CPT codes exist. Several hundred are added each year by a special committee of the American Medical Association, explained Leonta Williams, director of education at AAPC, previously known as the American Academy of Professional Coders.
Codes are more likely to be proposed if the procedure in question is highly utilized, she said.
Not many orthopedic surgeons in the U.S. perform sports hernia repairs, Geier said. He said some insurers consider the surgery experimental.
Preston said his pain improved since his surgery, though recovery was much longer and more painful than he expected.
By the end of April, Lothar said, he’d finished paying off the surgery.
The Resolution: A billing statement from the surgery center shows that the CPT code assigned to Preston’s sports hernia repair was “27299,” which stands for “a pelvis or hip joint procedure that does not have a specific code.”
After submitting more documentation to appeal the insurance denial, Lothar received a check from the insurer for $620.26. Blue Cross and Blue Shield didn’t say how it came up with that number or which costs it was reimbursing.
Lothar said he has continued to receive confusing messages from the insurer about his claim.
Both the insurer and the sports medicine clinic declined to comment.
Preston with his father, Lothar Nafz, at their home near Birmingham, Alabama.(Charity Rachelle for KFF Health News)
The Takeaway
Before you undergo a medical procedure, try to check whether your insurer will cover the cost and confirm it has a billing code.
Williams of the AAPC suggests asking your insurer: “Do you reimburse this code? What types of services fall under this code? What is the likelihood of this being reimbursed?”
Persuading an insurer to pay for care that doesn’t have its own billing code is difficult but not impossible, Williams said. Your doctor can bill insurance using an “unlisted code” along with documentation explaining what procedure was performed.
“Anytime you’re dealing with an unlisted code, there’s additional work needed to explain what service was rendered and why it was needed,” she said.
Some patients undergoing procedures without CPT codes may be asked to pay upfront. You can also offer a partial upfront payment, which may motivate your provider to team up to get insurance to pay.
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, 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.
KFF Health News Midwest correspondent Cara Anthony sat down with WORLD executive producer Chris Hastings to discuss the origins of the “Silence in Sikeston” project, which explores the impact of a 1942 lynching and a 2020 police shooting on a rural Missouri community. The collaboration with Retro Report includes a documentary film, educational videos, digital articles, and a limited-series podcast on the toll racism has on health.
The 1942 lynching of Cleo Wright in Sikeston, Missouri, and conversations with one of the few remaining witnesses launch a discussion about the health consequences of racism and violence in the United States. Host Cara Anthony speaks with history scholar Eddie R. Cole and racial equity scholar Keisha Bentley-Edwards about the physical, mental, and emotional burdens on Sikeston residents and Black Americans in general.
Racial violence is an experience shared by residents of Sikeston, Missouri, and many Black Americans. Staying silent in the face of this threat is a survival tradition families have passed down to their children to keep them safe. After host Cara Anthony uncovers details of a police killing in her family, she and psychologist Aiesha Lee discuss the silence that surrounds racism and its effects on health across generations — including the reverberations Anthony and her family live with today.
READ: KFF Health News Midwest correspondent Cara Anthony wrote an essay about what her reporting on this project helped her learn about her own family’s hidden past.
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.
Sara McGinnis was pregnant with her second child and something felt off. Her body was swollen. She was tired and dizzy.
Her husband, Bradley McGinnis, said she had told her doctor and nurses about her symptoms and even went to the emergency room when they worsened. But, Bradley said, what his wife was told in response was, “‘It’s summertime and you’re pregnant.’ That haunts me.”
Two days later, Sara had a massive stroke followed by a seizure. It happened on the way to the hospital, where she was headed again due to a splitting headache.
Sara, from Kalispell, Montana, never met her son, Owen, who survived through an emergency delivery and has her oval eyes and thick dark hair. She died the day after he was born.
Sara had eclampsia, a sometimes deadly pregnancy complication caused by persistent high blood pressure, also known as hypertension. High blood pressure makes the heart work in overdrive, which can damage organs.
Sara died in 2018. Today, more pregnant people are being diagnosed with dangerously high blood pressure, a finding that could save their lives. Recent studies show the rates of newly developed and chronic maternal high blood pressure have roughly doubled since 2007. Researchers say the jump in cases is likely due in part to more testing that discovers the conditions.
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But that’s not the whole story. Data shows that the overall maternal mortality rate in the U.S. is also climbing, with high blood pressure one of the leading causes.
Medical experts are trying to stem the tide. In 2022, the American College of Obstetricians and Gynecologists lowered the threshold for when doctors should treat pregnant and postpartum patients for high blood pressure. And federal agencies offer training in best practices for screening and care. Federal data shows that maternal deaths from high blood pressure declined in Alaska and West Virginia after implementation of those guidelines. But applying those standards to everyday care takes time, and hospitals are still working to incorporate practices that might have saved Sara’s life.
In Montana, which last year became one of 35 states to implement the federal patient safety guidelines, more than two-thirds of hospitals provided patients with timely care, said Annie Glover, a senior research scientist with the Montana Perinatal Quality Collaborative. Starting in 2022, just over half of hospitals met that threshold.
“It just takes some time in a hospital to implement a change,” Glover said.
Mary Collins felt something was wrong in her pregnancy earlier this year when her body started to swell while her baby’s growth slowed drastically. Collins is among the growing number of people diagnosed with severe high blood pressure in pregnancy, which threatens the life of parent and child. (Thom Bridge for KFF Health News)
High blood pressure can damage a person’s eyes, lungs, kidneys, or heart, with consequences long after pregnancy. Preeclampsia — consistent high blood pressure in pregnancy — can also lead to a heart attack. The problem can develop from inherited or lifestyle factors: For example, being overweight predisposes people to high blood pressure. So does older age, and more people are having babies later in life.
Black and Indigenous people are far more likely to develop and die from high blood pressure in pregnancy than the general population.
“Pregnancy is a natural stress test,” said Natalie Cameron, a physician and an epidemiologist with Northwestern University’s Feinberg School of Medicine, who has studied the rise in high blood pressure diagnoses. “It’s unmasking this risk that was there all the time.”
But pregnant women who don’t fit the typical risk profile are also getting sick, and Cameron said more research is needed to understand why.
Mary Collins, 31, of Helena, Montana, developed high blood pressure while pregnant this year. Halfway through her pregnancy, Collins still hiked and attended strength training classes. Yet, she felt sluggish and was gaining weight too rapidly while her baby’s growth slowed drastically.
Collins said she was diagnosed with preeclampsia after she asked an obstetrician about her symptoms. Just before that, she said, the doctor had said all was going well as he checked her baby’s development.
“He pulled up my blood pressure readings, did a physical assessment, and just looked at me,” Collins said. “He was like, ‘Actually, I’ll take back what I said. I can easily guarantee that you’ll be diagnosed with preeclampsia during this pregnancy, and you should buy life flight insurance.’”
Indeed, Collins was airlifted to Missoula, Montana, for the delivery and her daughter, Rory, was born two months early. The baby had to spend 45 days in a neonatal intensive care unit. Both Rory, now about 3 months old, and Collins are still recovering.
Mary Collins holds her daughter, Rory, who at 2 months old was still catching up to a newborn’s weight after an emergency delivery months before her due date. Preeclampsia is one of the leading causes of premature births and a major contributor to maternal deaths and illnesses in the U.S.(Thom Bridge for KFF Health News)
The typical cure for preeclampsia is delivering the baby. Medication can help prevent seizures and speed up the baby’s growth to shorten pregnancy if the health of the mother or fetus warrants a premature delivery. In rare cases, preeclampsia can develop soon after delivery, a condition researchers still don’t fully understand.
Wanda Nicholson, chair of the U.S. Preventive Services Task Force, an independent panel of experts in disease prevention, said steady monitoring is needed during and after a pregnancy to truly protect patients. Blood pressure “can change in a matter of days, or in a 24-hour period,” Nicholson said.
And symptoms aren’t always clear-cut.
That was the case for Emma Trotter. Days after she had her first child in 2020 in San Francisco, she felt her heartbeat slow. Trotter said she called her doctor and a nurse helpline and both told her she could go to an emergency room if she was worried but advised her that it wasn’t needed. So she stayed home.
In 2022, about four days after she delivered her second child, her heart slowed again. That time, the care team in her new home of Missoula checked her vitals. Her blood pressure was so high the nurse thought the monitor was broken.
“‘You could have a stroke at any second,’” Trotter recalled her midwife telling her before sending her to the hospital.
Trotter was due to have her third child in September, and her doctors planned to send her and the new baby home with a blood pressure monitor.
Stephanie Leonard, an epidemiologist at Stanford University School of Medicine who studies high blood pressure in pregnancy, said more monitoring could help with complex maternal health problems.
“Blood pressure is one component that we could really have an impact on,” she said. “It’s measurable. It’s treatable.”
More monitoring has long been the goal. In 2015, the federal Health Resources and Services Administration worked with the American College of Obstetricians and Gynecologists to roll out best practices to make birth safer, including a specific guide to scan for and treat high blood pressure. Last year the federal government boosted funding for such efforts to expand implementation of those guides.
“So much of the disparity in this space is about women’s voices not being heard,” said Carole Johnson, head of the health resources agency.
The Montana Perinatal Quality Collaborative spent a year providing that high blood pressure training to hospitals across the state. In doing so, Melissa Wolf, the head of women’s services at Bozeman Health, said her hospital system learned that doctors’ use of its treatment plan for high blood pressure in pregnancy was “hit or miss.” Even how nurses checked pregnant patients’ blood pressure varied.
“We just assumed everyone knew how to take a blood pressure,” Wolf said.
Now, Bozeman Health is tracking treatment with the goal that any pregnant person with high blood pressure receives appropriate care within an hour. Posters dot the hospitals’ clinic walls and bathroom doors listing the warning signs for preeclampsia. Patients are discharged with a list of red flags to watch for.
Katlin Tonkin is one of the nurses training Montana medical providers on how to make birth safer. She knows how important it is from experience: In 2018, Tonkin was diagnosed with severe preeclampsia when she was 36 weeks pregnant, weeks after she had developed symptoms. Her emergency delivery came too late and her son Dawson, who hadn’t been getting enough oxygen, died soon after his birth.
Tonkin has since had two more sons, both born healthy, and she keeps photos of Dawson, taken during his short life, throughout her family’s home.
“I wish I knew then what I know now,” Tonkin said. “We have the current evidence-based practices. We just need to make sure that they’re in place.”
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.
Californians with medical debt will no longer have to worry about unpaid medical bills showing up on their credit reports under legislation signed Tuesday by Gov. Gavin Newsom, adding the nation’s most populous state to a growing effort to protect consumers squeezed by unaffordable medical bills.
The bill, by Sen. Monique Limón (D-Santa Barbara) and backed by Democratic Attorney General Rob Bonta, will block health care providers, as well as any contracted collection agency, from sharing a patient’s medical debt with credit reporting agencies. At least eight states have banned medical bills from consumer credit reports in the past two years. In June, the Biden administration proposed similar federal protections, but it’s unclear when the rules will be enacted — or, if former President Donald Trump is elected again, if they will be at all.
“Nobody chooses to get sick, and then your credit gets ruined,” said Chi Chi Wu, a senior attorney with the National Consumer Law Center. “That’s why we encourage states to keep adopting laws. In case something goes wrong at the federal level, the states could protect their own consumers.”
When California’s new law goes into effect in January, it will extend these protections to credit reports used for employment and tenant screening, Wu said. This is in addition to the proposed federal ban on reporting to credit agencies that inform credit card companies and mortgage lenders.
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California lawmakers noted that medical debt — unlike other kinds of debt — isn’t an accurate reflection of credit risk, and its inclusion can depress credit scores and make it hard for people to get a job, rent an apartment, or secure a car loan.
But California lawmakers have left a glaring loophole. Patients who pay hospital bills using medical credit cards or medical specialty loans — which can come with interest rates as high as 36% — won’t get that debt taken off their credit report, as residents of Colorado, Minnesota, and New York do. It’s a concession the financial industry won through late-in-the-game “hostile” amendments, which “influential entities opposed to the measure prevailed” in including, Limón said. In a 2022 KFF poll on medical debt, 15% of adults said they had used a medical credit card.
Kelly Parsons-O’Brien, legislative chair of the California Association of Collectors, which represents collection agencies, said the exemptions were essential because medical credit card holders can buy nonmedical items and medical loans can be refinanced with nonmedical debt, making it “impossible” for creditors to know what’s actually a medical charge.
“More consumers will get into situations where they cannot afford to pay, and lenders will be operating in the dark,” Parsons-O’Brien said.
The three largest U.S. credit agencies — Equifax, Experian, and TransUnion — said they would stop listing some medical debt, including paid-off debts and those less than $500, but millions of patients were left with bigger medical bills on their credit reports. The Consumer Financial Protection Bureau reported in April that 15 million Americans still had medical bills on their credit reports.
About 4 in 10 Californians report carrying some type of medical debt, which disproportionately affects low-income, Black, and Latino patients, according to the California Health Care Foundation.
Dozens of states have enacted legislation to protect consumers from surprise billing and medical debt, according to the National Conference of State Legislatures. Newsom, a Democrat, also signed legislation on Tuesday banning hospitals from using liens on all real property owned by Californians who typically earn less than 400% of the federal poverty level. It expands current state law that protects a patient’s home from debt collectors.
A KFF Health News analysis found that credit reporting is the most common collection tactic used by hospitals to get patients to pay their bills. A credit score ban might make it more difficult for hospitals to collect.
When Sacramento resident Sonia Hayden and her boyfriend applied for a home loan last year, she discovered her credit score had dropped about a hundred points. It had been downgraded because of an approximately $200 emergency room charge after a car accident years ago.
The 44-year-old said her insurance covered tens of thousands of dollars in medical bills but that the hospital miscoded the $200 charge and she never received a bill for it. That, she said, should also have been charged to insurance.
Hayden tried unsuccessfully for over a year to resolve the issue with her health insurer. It’s still on her credit report. She was eventually able to get a home loan, but her interest rates were higher because of her credit score.
“Medical bills, they’re not on purpose, you know?” said Hayden, who testified in support of the legislation. “It was already a super traumatic accident. I almost died. And then to have this super stressful medical bill — nobody’s asking for that. It shouldn’t affect your credit.”
