Rehab News – Page 38

Patients with Alcohol Use Disorder at Risk of Liver Disease May be Less Commonly Referred for Liver Treatment if they are primarily seen for Mental Health Disorders

Newswise — People with alcohol use disorder (AUD) who are at risk of advanced liver disease are less likely to be referred for liver evaluation and care if they present primarily with alcohol-related mental health issues or a mental health diagnosis, according to a study of referral practices in Virginia’s largest health system. The findings point to the possibility of widespread missed opportunities for treating three conditions that commonly co-occur: AUD, mental health disorders, and liver disease. Recent years have seen notable increases in the USA in alcohol-related deaths, mental health disorders, and hospital admissions relating to alcohol use and concurrent mental health conditions. AUD is a significant cause of liver disease, and both addiction and co-occurring mental illness can be barriers to successful liver treatment. Integrating AUD treatment, mental health care, and hepatology (liver care) is necessary to improve outcomes, but data suggests this approach is not the norm. For the study in Alcohol: Clinical & Experimental Research, investigators evaluated which patients with excessive alcohol use and potentially advanced liver disease were referred to hepatology for evaluation and treatment.

Researchers worked with data representing 316 patients experiencing excessive alcohol use who were treated between 2013 and 2023. All the patients in the study had results from FIB-4—a blood test included in routine lab work—correlating to a high risk of advanced liver fibrosis. The researchers collected information on the participants’ demographics, alcohol-related hospital admissions, predicted mortality, referral patterns, and mental health diagnoses and hospitalizations. They used statistical analysis to explore factors associated with referral to hepatology.

Most patients were men, and the average age was 60. Six in 10 were Caucasian, and nearly 4 in 10 African American. Only 37% of patients with excessive alcohol use and a high risk of advanced liver disease were referred for liver care. Referrals to hepatology were associated with higher FIB-4 scores, more co-occurring health conditions, and hospitalization due to AUD-related liver issues or gastrointestinal concerns. Patients less likely to be referred for liver care included those admitted to the hospital for physical injury or alcohol-related mental health concerns, who presented with mental health disorders, or who were older. Of these, patients with depression or suicidal ideation were more frequently referred to hepatology than patients with other mental health diagnoses.

The study identified an opportunity to increase integration of care across specialties serving patients with alcohol-related liver disease and mental health conditions. People presenting with primarily mental health or addiction issues were especially unlikely to be referred for appropriate liver care. The findings highlight the need for healthcare providers to be educated about the importance of multispecialty care, including hepatology and GI referrals. Managing liver disease is necessary for reducing the risk of cirrhosis, cancer, and other conditions and for liver transplant evaluation. Similarly, early identification of AUD in patients with liver disease is essential for improving outcomes.

Referral to hepatology is lower in patients with excessive alcohol use who have mental health disorders despite a high FIB-4 index. K. Houston, S. Harris, A.Teklezghi, S. Silvey, A. D. Snyder, A. J. Arias, J. S. Bajaj.

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KFF Health News’ ‘What the Health?’: American Health Under Trump — Past, Present, and Future

The Host

Recent comments from former President Donald Trump and Republican lawmakers preview potential health policy pursuits under a second Trump administration. Trump is yet again eyeing changes to the Affordable Care Act, while key lawmakers want to repeal Medicare drug price negotiations.

Also, this week brought news of the first publicly reported death attributed to delayed care under a state abortion ban. Vice President Kamala Harris said the death shows the consequences of Trump’s actions to block abortion access.

This week’s panelists are Emmarie Huetteman of KFF Health News, Joanne Kenen of Politico and the Johns Hopkins University’s schools of nursing and public health, Tami Luhby of CNN, and Shefali Luthra of The 19th.

Among the takeaways from this week’s episode:

Sen. JD Vance (R-Ohio), Trump’s running mate, says Trump is interested in loosening ACA rules to make cheaper policies available. While the campaign has said little about what Trump would do or how it would work, the changes could include eliminating protections against higher premiums for those with preexisting conditions. Republicans would also likely let enhanced subsidies for ACA premiums expire.
Key Republican lawmakers said this week that they’re interested in repealing the Inflation Reduction Act’s provisions enabling Medicare drug pricing negotiations. Should Trump win, that stance could create intraparty tensions with the former president, who has vowed to “take on Big Pharma.”
A state review board in Georgia ruled that the death in 2022 of a 28-year-old mother, after her doctors delayed performing a dilatation and curettage procedure, was preventable. Harris tied the death to Trump’s efforts to overturn Roe v. Wade, which included appointing three Supreme Court justices who voted to eliminate the constitutional right to an abortion.
And in health tech news, the FDA has separately green-lighted two new Apple product functions: an Apple Watch feature that assesses the wearer’s risk of sleep apnea, and an AirPods feature that turns the earbuds into hearing aids.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Emmarie Huetteman: The Washington Post’s “What Warning Labels Could Look Like on Your Favorite Foods,” by Lauren Weber and Rachel Roubein.

Shefali Luthra: KFF Health News’ “At Catholic Hospitals, a Mission of Charity Runs Up Against High Care Costs for Patients,” by Rachana Pradhan.

Tami Luhby: Politico Magazine’s “Doctors Are Leaving Conservative States To Learn To Perform Abortions. We Followed One,” by Alice Miranda Ollstein.

Joanne Kenen: The New York Times’ “This Chatbot Pulls People Away From Conspiracy Theories,” by Teddy Rosenbluth, and The Atlantic’s “When Fact-Checks Backfire,” by Jerusalem Demsas.

Also mentioned on this week’s podcast:

ProPublica’s “Abortion Bans Have Delayed Emergency Medical Care. In Georgia, Experts Say This Mother’s Death Was Preventable,” by Kavitha Surana.

To hear all our podcasts, click here.

And subscribe to KFF Health News’ “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.

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.

These Alabama Workers Were Swamped by Medical Debt. Then Their Employer Stepped In.

TUSCALOOSA, Ala. — Like most medical offices, the small suite of exam rooms at the PhiferCares Clinic fills daily with patients seeking help with bumps and bruises, sore throats, and stuffy noses.

But there’s an important difference about this clinic in central Alabama: No one gets a bill, including for prescriptions.

That’s because the clinic is owned by a manufacturing company with a specific agenda. “We don’t want you to spend money on health care,” said Russell DuBose, vice president of human resources at Phifer.

Phifer, a global manufacturer of window screens, opened the clinic five years ago in a bid to control its health care costs and stop big medical bills from driving its workers into debt. The strategy has paid big dividends. Phifer has saved so much on health care that the company was able to open a free summer camp for the children of employees.

Workers have dramatically boosted retirement savings, too. And Phifer is now adding chiropractic care and orthotics, all at no cost to workers.

Benefits like these remain out of reach for most U.S. workers, millions of whom drain savings, take out second mortgages, or cut back on food and other essentials to stay ahead of health care debt. Overall, about 100 million people in the U.S. are burdened by some form of this debt, KFF Health News has found.

Many of those people have health plans through employers who, unable to control their health care costs, now force workers to pay thousands of dollars out-of-pocket when they go to a doctor. Phifer has shown there’s another way. The company not only saved itself money, it’s sharing the benefits with workers and shielding them from debt.

“It’s really remarkable,” said Shawn Gremminger, president of the National Alliance of Healthcare Purchaser Coalitions, which works with employers on improving health benefits.

“If I had to point to a single employer in our network that’s been the most aggressive tackling this problem and coming up with the most innovative solutions,” he said, “it’s a relatively small, privately owned manufacturer in a small town in the South.”

Two medical professionals inside a health clinic — Julie Hass (left) and Deanna Morrison work at the PhiferCares Clinic outside Tuscaloosa, Alabama. At no cost, Phifer employees and their families can visit and get basic primary care, including checkups, vaccinations, and help managing chronic illnesses. (Charity Rachelle for KFF Health News)

‘Unacceptable’ Health Costs

Phifer is a family-owned company founded after World War II by a former pilot. J. Reese Phifer saw an opportunity to turn aluminum produced for the war effort into window screens for America’s booming suburbs.

Today Phifer still makes screens at a cavernous plant outside Tuscaloosa that stretches over more than 34 acres of factory floor. Inside, massive rolls of aluminum coil are unwound, stretched, and spun on rows of spools and looms. Elsewhere, fiberglass is woven into material for window shades, patio furniture, and other products.

Business has been good for the company, which employs about 2,000 people and operates plants in Alabama and overseas. A few years ago, though, Phifer noticed its workers weren’t saving enough for retirement. The culprit was medical bills.

“Copays, coinsurance, cost sharing. All these things were taking money away from our plan members,” DuBose said. “The amount of money employees were having to spend on health care was unacceptable.”

That’s not unusual. Most U.S. workers and their families are in a health plan with significant cost sharing, requiring they pay thousands of dollars out-of-pocket before coverage kicks in.

The average deductible for an employer-provided health plan now exceeds $1,500, data shows. And for family plans, deductibles can be several times that. That’s a big reason health care debt is such a big problem, even for people with health coverage.

For Phifer, which relies on skilled workers to operate its machines, reducing employees’ financial stress became a priority, DuBose said. “When you have somebody who wants to be here every day, wants to be here every year,” he said, “they can do some pretty awesome stuff.”

Removing Barriers

Phifer landed on a deceptively simple idea: Make it easier — and cheaper — for workers to see a doctor and fill a prescription. That, the company reasoned, could improve employee health and control costly complications.

The cornerstone of this plan was the PhiferCares Clinic and pharmacy.

A man in a blue polo shirt stands in front of a window — Russell DuBose, vice president of human resources at Phifer, says, “We don’t want you to spend money on health care.” DuBose led efforts to establish a workplace clinic for basic primary care where workers and their families can go at no cost. (Charity Rachelle for KFF Health News)

A woman in a purple t-shirt undertakes a task in a factory — Alexandra Vazquez works in the Phifer factory outside Tuscaloosa, Alabama. (Charity Rachelle for KFF Health News)

The company set up the clinic in a small park and recreation space Phifer owned down the road from the factory. It contracted with a local health system to provide the physician and nurses. Inside is a small pharmacy.

At no cost, employees and their families can go in for basic primary care, including checkups, vaccinations, and help managing chronic illnesses like diabetes. “It’s almost a concierge service,” DuBose said.

Phifer did something else, too. It directs patients to specialists and hospitals with the highest quality ratings. That can save money for patients and the company. Workers who choose one of these providers typically don’t get a bill.

That kind of no-cost access makes a huge difference, said Ronald Lewis, who visited the PhiferCares Clinic recently for a checkup.

“I’m saving thousands of dollars, easy. Easy $3,000,” said Lewis, whose wife works at the plant. “All you’ve got to do is come in, make an appointment, and they come in and see you. … It is a life-changer.”

The clinic has helped Lewis lose weight and keep his blood pressure in check. A doctor also caught early signs of prostate cancer.

Cherry Wilson, who has worked on a production line at Phifer since 2017, said she still has medical debt from a gallbladder surgery she had before she joined the company. But when she broke her foot more recently and got surgery from a preferred specialist, there were no medical bills. “I don’t pay anything here,” she said.

Big Dividends

Other companies have experimented with workplace clinics with mixed results.

Running a medical office can be expensive. The strategy may not work if employees aren’t centrally located or if employee turnover is high. And savings can take a while to materialize. But research on employer health benefits has shown that reducing how much workers pay for primary care and prescription drugs yields better outcomes for workers and can save everybody money.

Phifer is reaping rewards.

Despite years of high inflation nationally, the company’s net spending on health care was lower in 2023 than in 2019, declining from $15.8 million to $14.9 million in constant dollars, according to data provided by DuBose.

A drive-thru window for a pharmacy — The pharmacy drive-thru window at the PhiferCares Clinic outside Tuscaloosa, Alabama.(Charity Rachelle for KFF Health News)

The cost of the company’s most popular health plan — which comes with no deductible and includes dental benefits — is lower, as well. Phifer workers pay $394 a month for this family plan. By comparison, workers nationally contribute $548 monthly on average for family coverage that typically comes with a sizable deductible.

“We’ve seen the power of prevention,” DuBose said.

With savings from its health care strategy, Phifer opened the summer camp last year. And the company is offering college scholarships to workers’ children.

Workers are saving more, too. About 90% are hitting their retirement goals, DuBose said, up from around 75% five years ago.

The protections from big medical bills have had another benefit, said Jerry Wheat, who has worked for Phifer for 38 years and runs a production line for fiberglass screens.

“It makes you want to take care of yourself and do better for the company,” Wheat said. “If somebody’s going to take care of you, don’t you want to take care of them? That’s the way I look at it. But I’m old-school.”

Cyberattacks Plague the Health Industry. Critics Call Feds’ Response Feeble and Fractured.

Central Oregon Pathology Consultants has been in business for nearly 60 years, offering molecular testing and other diagnostic services east of the Cascade Range.

Beginning last winter, it operated for months without being paid, surviving on cash on hand, practice manager Julie Tracewell said. The practice is caught up in the aftermath of one of the most significant digital attacks in American history: the February hack of payments manager Change Healthcare.

COPC recently learned Change has started processing some of the outstanding claims, which numbered roughly 20,000 as of July, but Tracewell doesn’t know which ones, she said. The patient payment portal remains down, meaning customers are unable to settle their accounts.

“It will take months to be able to calculate the total loss of this downtime,” she said.

Health care is the most frequent target for ransomware attacks: In 2023, the FBI says, 249 of them targeted health institutions — the most of any sector.

And health executives, lawyers, and those in the halls of Congress are worried that the federal government’s response is underpowered, underfunded, and overly focused on protecting hospitals — even as Change proved that weaknesses are widespread.

The Health and Human Services Department’s “current approach to healthcare cybersecurity — self-regulation and voluntary best practices — is woefully inadequate and has left the health care system vulnerable to criminals and foreign government hackers,” Sen. Ron Wyden (D-Ore.), chair of the Senate Finance Committee, wrote in a recent letter to the agency.

The money isn’t there, said Mark Montgomery, senior director at the Foundation for Defense of Democracies’ Center on Cyber and Technology Innovation. “We’ve seen extremely incremental to almost nonexistent efforts” to invest more in security, he said.

The task is urgent — 2024 has been a year of health care hacks. Hundreds of hospitals across the Southeast faced disruptions to their ability to obtain blood for transfusions after nonprofit OneBlood, a donation service, fell victim to a ransomware attack.

Cyberattacks complicate mundane and complex tasks alike, said Nate Couture, chief information security officer at the University of Vermont Health Network, which was struck by a ransomware attack in 2020. “We can’t mix a chemo cocktail by eye,” he said, referring to cancer treatments, at a June event in Washington, D.C.

In December, HHS put out a cybersecurity strategy meant to support the sector. Several proposals focused on hospitals, including a carrot-and-stick program to reward providers that adopted certain “essential” security practices and penalize those that didn’t.

Even that narrow focus could take years to materialize: Under the department’s budget proposal, money would start flowing to “high-needs” hospitals in fiscal year 2027.

The focus on hospitals is “not appropriate,” Iliana Peters, a former enforcement lawyer at HHS’ Office for Civil Rights, said in an interview. “The federal government needs to go further” by also investing in the organizations that supply and contract with providers, she said.

The department’s interest in protecting patient health and safety “does put hospitals near the top of our priority partners list,” Brian Mazanec, a deputy director at the Administration for Strategic Preparedness and Response at HHS, said in an interview.

Responsibility for the nation’s health cybersecurity is shared by three offices within two different agencies. The health department’s civil rights office is a sort of cop on the beat, monitoring whether hospitals and other health groups have adequate defenses for patient privacy and, if not, potentially fining them.

The health department’s preparedness office and the Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency help build defenses — such as mandating that medical software developers use auditing technology to check their security.

Both of the latter are required to create a list of “systemically important entities” whose operations are critical to the smooth functioning of the health system. These entities could get special attention, such as inclusion in government threat briefings, Josh Corman, a co-founder of the cyber advocacy group I Am The Cavalry, said in an interview.

Federal officials had been working on the list when news of the Change hack broke — but Change Healthcare was not on it, Jen Easterly, leader of Homeland Security’s cybersecurity agency, said at an event in March.

Nitin Natarajan, the cybersecurity agency’s deputy director, told California Healthline that the list was just a draft. The agency previously estimated it would finish the entities list — across sectors — last September.

The health department’s preparedness office is supposed to coordinate with Homeland Security’s cybersecurity agency and across the health department, but congressional staffers said the office’s efforts fall short. There are “silos of excellence” in HHS, “where teams were not talking to each other, [where it] wasn’t clear who people should be going to,” said Matt McMurray, chief of staff for Rep. Robin Kelly (D-Ill.), at a June conference.

Is the health department’s preparedness office “the right home for cybersecurity? I’m not sure,” he said.

Historically, the office focused on physical-world disasters — earthquakes, hurricanes, anthrax attacks, pandemics. It inherited cybersecurity when Trump-era department leadership made a grab for more money and authority, said Chris Meekins, who worked for the preparedness office under Trump and is now an analyst with the investment bank Raymond James.

But since then, Meekins said, the agency has shown it’s “not qualified to do it. There isn’t the funding there, there isn’t the engagement, there isn’t the expertise there.”

The preparedness office has only a “small handful” of employees focused on cybersecurity, said Annie Fixler, director at the FDD’s Center on Cyber and Technology Innovation. Mazanec acknowledges the number isn’t high but hopes additional funding will allow for more hires.

The office has been slow to react to outside feedback. When an industry clearinghouse for cyberthreats tried to coordinate with it to create an incident response process, “it took probably three years to identify anyone willing to support” the effort, said Jim Routh, the then-board chair of the group, Health Information Sharing and Analysis Center.

During the NotPetya attack in 2017 — a hack that caused major damage to hospitals and the drugmaker Merck — Health-ISAC ended up disseminating information to its members itself, including the best method to contain the attack, Routh said.

Advocates look at the Change hack — reportedly caused by a lack of multifactor authentication, a technology very familiar in America’s workplaces — and say HHS needs to use mandates and incentives to get the health care sector to adopt better defenses. The department’s strategy released in December proposed a relatively restricted list of goals for the health care sector, which are mostly voluntary at this point. The agency is “exploring” creating “new enforceable” standards, Mazanec said.

Much of the HHS strategy is due to be rolled out over the coming months. The department has already requested more funding. The preparedness office, for example, wants an additional $12 million for cybersecurity. The civil rights office, with a flat budget and declining enforcement staff, is due to release an update to its privacy and security rules.

“There’s still significant challenges that the industry as a whole faces,” Routh said. “I don’t see anything on the horizon that’s necessarily going to change that.”

Abortion Clinics — And Patients — Are on the Move, as State Laws Keep Shifting

Soon after a series of state laws left a Planned Parenthood clinic in Columbia, Missouri, unable to provide abortions in 2018, it shipped some of its equipment to states where abortion remained accessible.

Recovery chairs, surgical equipment, and lighting from the Missouri clinic — all expensive and perfectly good — could still be useful to other health centers run by the same affiliate, Planned Parenthood Great Plains, in its three other states. Much of it went to Oklahoma, where the organization was expanding, CEO Emily Wales said.

When Oklahoma banned abortion a few years later, it was time for that equipment to move again. Some likely ended up in Kansas, Wales said, where her group has opened two new clinics within just over two years because abortion access there is protected in the state constitution — and demand is soaring.

Her Kansas clinics regularly see patients from Texas, Missouri, Oklahoma, Arkansas, and even Louisiana, as Kansas is now the nearest place to get a legal abortion for many people in the southern U.S.

Like the shuffling of equipment, America’s abortion patients are traveling around the nation to navigate the patchwork of laws created by the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision, which left policies on abortion to the states.

Since that ruling, 14 states have enacted bans with few exceptions, while other states have limited access. But states that do not have an abortion ban in place have seen an 11% increase in clinician-provided abortions since 2020, according to the Guttmacher Institute, a national nonprofit that supports abortion rights. Over 170,000 people traveled out of their own state to receive abortion care in 2023, according to the institute.

Not all of the increase in abortions comes from interstate travel. Telehealth has made medication abortions easier to obtain without traveling. The number of self-managed abortions, including those done with the medication mifepristone, has risen.

And Guttmacher data scientist Isaac Maddow-Zimet said the majority of the overall abortion increase in recent years came from in-state residents in places without total bans, as resources expanded to improve access.

“That speaks, in a lot of ways, to the way in which abortion access really wasn’t perfect pre-Dobbs,” Maddow-Zimet said. “There were a lot of obstacles to getting care, and one of the biggest ones was cost.”

Last year, the estimated number of abortions provided in the U.S. rose to over 1 million, the highest number in a decade, according to the institute.

Still, abortion opponents hailed an estimated drop in the procedure in the 14 states with near-total bans.

“It’s encouraging that pro-life states continue to show massive declines in their in-state abortion totals, with a drop of over 200,000 abortions since Dobbs,” Kelsey Pritchard, a spokesperson for Susan B. Anthony Pro-Life America, wrote in a statement.

Organizations in states where abortion remains legal feel the ripples of every new ban almost instantly. One Planned Parenthood affiliate with a clinic in southern Illinois, for example, reported a roughly 10% increase in call volume in the two weeks following the enactment of Florida’s six-week abortion ban in May. And an Illinois-based abortion fund, Midwest Access Coalition, experienced a similar pattern the day the Dobbs decision was announced in June 2022.

“Our hotline was insane,” said Alison Dreith, the coalition’s director of strategic partnerships.

People didn’t know what the decision meant for their ability to access abortions, Dreith said, including whether already scheduled appointments would still happen. The coalition helps people travel for abortions throughout 12 Midwestern states, four of which now have total bans with few exceptions.

After serving 800 people in 2021, the Midwest Access Coalition went on to help 1,620 in 2022 and 1,795 in 2023. Some of that increase can be attributed to the natural growth of the organization, which is only about a decade old, Dreith said, but it’s also a testament to its work. It pays for any mode of transportation that will get clients to a clinic, including partnering with another Illinois nonprofit with volunteer pilots who fly patients across state lines on private flights to get abortions.

“We also book and pay for hotel rooms,” Dreith said. “We give cash for food, and for child care.”

The National Network of Abortion Funds, a coalition of groups that offer logistical and financial assistance to people seeking abortions, said donations increased after the Dobbs decision, and its members reported a 39% increase in requests for help in the following year. They financially supported 102,855 people that year, including both in-state and out-of-state patients, but have also seen a “staggering drop off” in donations since then.

Increased awareness about the options for abortion care, spurred on by an increase in news stories about abortion since the Dobbs decision, may have fueled the rise in abortions overall, Maddow-Zimet said.

Both sides now await the next round of policy decisions on abortion, which voters will make in November. Ballot initiatives in at least 10 states could enshrine abortion rights, expanding access to abortions, including in two states with comprehensive bans.

“Lives will be lost with the elimination of laws that protect more than 52,000 unborn children annually,” wrote Pritchard of Susan B. Anthony Pro-Life America, citing an analysis on the group’s website.

In the meantime, Wales said her clinics in Kansas don’t have enough appointments to accommodate everyone who reaches out about scheduling an abortion. In the early days after the Dobbs decision, Wales estimated, only 20% of people who called the clinic were able to schedule an abortion appointment.

The organization has expanded and renovated its facilities across the state, including in Wichita, Overland Park, and Kansas City, Kansas. Its newest clinic opened in August in Pittsburg, just 30 miles from Oklahoma. But even with all that extra capacity, Wales said her group still expects to be able to schedule only just over 50% of people who inquire.

“We’ve done what we can to increase appointments,” Wales said. “But it hasn’t replaced what were many states providing care to their local communities.”

Las clínicas de abortos, y sus pacientes, se movilizan a medida que cambian las leyes estatales

En 2018, una serie de leyes estatales impidieron que una clínica de Planned Parenthood en Columbia, Missouri, siguiera practicando abortos. Poco después, la clínica envió parte de su equipamiento a otros estados donde el aborto seguía siendo accesible.

Las sillas especiales, los equipos quirúrgicos y la iluminación de la clínica de Missouri —equipo costoso y en perfectas condiciones— todavía podían ser útiles en otros centros de salud administrados por la misma filial, Planned Parenthood Great Plains, en sus otros tres estados.

Gran parte del equipo viajó a Oklahoma, donde la organización estaba en proceso de expansión, según explicó la directora ejecutiva, Emily Wales.

Cuando, unos años más tarde, Oklahoma prohibió el aborto, llegó el momento de reubicar de nuevo esos equipos. Es probable que una parte terminara en Kansas, reflexiona Wales, porque allí la organización había abierto dos nuevas clínicas en poco más de dos años. El acceso al aborto está protegido en la Constitución del estado y la demanda ha aumentado muchísimo.

Las clínicas de Kansas atienden regularmente a pacientes provenientes de Texas, Misuri, Oklahoma, Arkansas e incluso Luisiana, ya que, para muchas personas del sur de Estados Unidos, Kansas es ahora el estado más cercano donde pueden obtener un aborto legal.

Al igual que los equipos que debieron ser trasladados de estado en estado, también las pacientes que necesitan interrumpir un embarazo viajan por todo Estados Unidos para sortear el mosaico de leyes que prohibieron el aborto a partir de la sentencia de la Corte Suprema en el caso Dobbs contra Jackson Women’s Health Organization.

El fallo de la Corte dejó en manos de los estados las políticas sobre el aborto. Desde entonces, 14 estados promulgaron prohibiciones a la práctica que contemplan unas pocas excepciones, mientras que otros han restringido el acceso.

Por el contrario, desde 2020, los estados que no adoptaron prohibiciones han visto un aumento del 11% en los abortos asistidos por médicos, según el Instituto Guttmacher, una organización nacional sin fines de lucro que apoya el derecho al aborto.

Este instituto informa que, en 2023, más de 170,000 personas viajaron fuera de su estado para realizar el procedimiento.

El aumento en el número de abortos no se atribuye únicamente a los desplazamientos de un estado a otro. También influyó la expansión de la telesalud, que ha permitido realizar abortos farmacológicos sin que sea necesario viajar. Esto ha favorecido el aumento de los abortos autogestionados, especialmente aquellos en los que se utiliza el medicamento mifepristona.

Isaac Maddow-Zimet, analista de datos del Instituto Guttmacher, destacó que el aumento en los índices de abortos en los últimos años se explica por personas que viven en estados donde no hay prohibiciones absolutas. Este fenómeno se dio a medida que se expandieron los recursos disponibles y se facilitó el acceso.

“Esto refleja, en muchos sentidos, que el acceso al aborto tampoco era perfecto antes del fallo Dobbs”, afirmó Maddow-Zimet. “Había muchos obstáculos para recibir la atención, y uno de los mayores obstáculos era su costo”.

El año pasado, el número estimado de abortos realizados en el país superó el millón, la cifra más alta en una década, según el instituto.

De todos modos, los opositores al aborto celebraron una reducción significativa del procedimiento en los 14 estados que tienen prohibiciones casi totales.

“Es alentador que los estados pro-vida continúen mostrando descensos masivos en la práctica del aborto, con una caída de más de 200.000 procedimientos desde el fallo Dobbs”, escribió en un comunicado Kelsey Pritchard, vocera de Susan B. Anthony Pro-Life America.

Las organizaciones que trabajan en los estados donde el aborto sigue siendo legal perciben casi de inmediato las repercusiones de cada nueva prohibición. Por ejemplo, una filial de Planned Parenthood que tiene una clínica en el sur de Illinois, informó que hubo un aumento de aproximadamente el 10% en el volumen de llamadas en mayo, durante las dos semanas posteriores a la promulgación de la prohibición del aborto a las seis semanas en Florida.

Midwest Access Coalition, un fondo con sede en Illinois que proporciona asistencia financiera y otro tipo de colaboración a personas que necesitan practicarse un aborto, experimentó una situación similar el día en que se anunció el fallo Dobbs, en junio de 2022.

“Nuestra línea telefónica estaba desbordada”, afirmó Alison Dreith, directora de alianzas estratégicas de esa organización.

Las personas que llamaban no sabían qué significaba exactamente el fallo de la Corte Suprema ni tampoco cómo afectaba sus posibilidades de interrumpir el embarazo, explicó Dreith. Ni siquiera entendían si se iban a mantener las citas que ya tenían programadas.

Midwest Access Coalition ayuda a las personas a viajar para acceder a abortos en 12 estados del Medio Oeste, cuatro de los cuales ahora tienen prohibiciones totales que contemplan muy pocas excepciones.

En 2021, Midwest Access Coalition ayudó a unas 800 personas. El año siguiente, el número subió a 1.620 y en 2023 llegó a 1.795. Parte de ese aumento puede atribuirse al crecimiento natural de la organización, que existe solo desde hace alrededor de una década, argumentó Dreith. Pero también es un testimonio de la calidad de su trabajo.

Esta entidad cubre cualquier medio de transporte que sea necesario para llevar a las pacientes hasta las clínicas. Esto incluye una colaboración con otra organización sin fines de lucro en Illinois, que cuenta con pilotos voluntarios dispuestos a transportar a las pacientes en vuelos privados a través de las fronteras estatales para que puedan tener un aborto.

“También reservamos y pagamos habitaciones de hotel”, dijo Dreith. “Y damos dinero en efectivo para los gastos de alimentación y para cuidado infantil”, agregó.

La National Network of Abortion Funds, una coalición de grupos que ofrecen asistencia logística y financiera a las personas que quieren tener un aborto, informó que las donaciones aumentaron después del fallo Dobbs.

Los miembros de esta red registraron un aumento del 39% en las solicitudes de ayuda en 2023, el año posterior al fallo. En ese período pudieron ayudar económicamente a 102.855 pacientes, que residían tanto en el propio estado como en otros lugares. Sin embargo, desde entonces se ha producido un “asombroso descenso” de las donaciones.

El aumento en la conciencia sobre las opciones para abortar, impulsado por la catarata de noticias sobre el tema desde la decisión en el caso Dobbs, puede haber contribuido al aumento general en los abortos, opinó Maddow-Zimet.

Ambas partes esperan la próxima ronda de resoluciones políticas sobre el aborto, que los votantes decidirán en noviembre. Las iniciativas electorales en por lo menos una decena de estados podrían consagrar el derecho al aborto, ampliando el acceso, incluso en dos estados que hoy tienen prohibiciones integrales.

“Se perderán vidas con la eliminación de las leyes que protegen anualmente a más de 52.000 niños no nacidos”, escribió Pritchard, de Susan B. Anthony Pro-Life America, citando un análisis en la página web del grupo.

Mientras tanto, Wales dijo que sus clínicas en Kansas no tienen suficientes turnos para atender a todas las personas que se acercan para solicitar un aborto.

En los primeros días tras el fallo sobre Dobbs, recordó Wales, sólo el 20% de las personas que llamaron a la clínica pudieron hacer una cita.

La organización ha ampliado y renovado sus instalaciones en todo el estado, incluidas las de Wichita, Overland Park y Kansas City, Kansas. La clínica más reciente se inauguró en agosto en Pittsburg, a sólo 30 millas de Oklahoma.

Pero incluso considerando toda la capacidad que han agregado, Wales sostiene que su organización sólo podrá responder a la demanda de la mitad de las personas que solicitan ayuda.

“Hemos hecho todo lo que pudimos para aumentar nuestra capacidad de atención”, explicó Wales. “Pero aun así resulta insuficiente porque no ha sido posible reemplazar los recursos de muchos estados que prestaban atención a sus comunidades y han dejado de hacerlo”, concluyó.

Esta historia fue producida por KFF Health News, conocido antes como Kaiser Health News (KHN), una redacción nacional que produce periodismo en profundidad sobre temas de salud y es uno de los principales programas operativos de KFF, la fuente independiente de investigación de políticas de salud, encuestas y periodismo.

Ballot Measure on New Medi-Cal Spending Has Broad Support, But Opponents Flag Pitfalls

The proponents of Proposition 35, a November ballot initiative that would create a dedicated stream of funding to provide health care for California’s low-income residents, have assembled an impressive coalition: doctors, hospitals, community clinics, dentists, ambulance companies, several county governments, numerous advocacy groups, big business, and both major political parties.

The Yes on Prop 35 campaign has raised over $48 million as of Sept. 9, according to campaign filings with the secretary of state. The measure would use money from a tax on managed-care health plans mainly to hike the pay of physicians, hospitals, community clinics, and other providers in Medi-Cal, the state’s version of Medicaid.

For many months, there was no organized opposition. But shortly after Labor Day, a small group of community advocates, including the League of Women Voters of California, California Pan-Ethnic Health Network, and The Children’s Partnership, announced they were united against it.

“We do not have the deep pockets that the proponents of the initiative do,” said Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network. No fundraising has been recorded from opposition groups thus far.

Gov. Gavin Newsom hasn’t taken a public stance, but he has warned that the proposal to lock in how proceeds from the managed-care tax are used would hamstring his administration’s ability to address the state’s yawning budget gap.

The people represented by some of the opposition groups include Medi-Cal patients who are among the state’s most vulnerable — children, seniors, people with disabilities, and the chronically ill — as well as some workers who provide ancillary care to them.

The opponents say that if Proposition 35 passes, the patients, workers, and programs they care about could lose millions of dollars included for them in this year’s state budget. That’s because the ballot measure would supersede the budget, and it leaves them out of the health tax proceeds.

The budget currently provides tens of millions of dollars a year to raise the pay of community health workers, nonemergency medical transport drivers, and private-duty nurses, among other personnel. It also funds the cost of a new program, scheduled to start Jan. 1, that allows children through age 4 to stay on Medi-Cal without requiring their families to prove eligibility every year. Child health advocates say that will help avoid potentially harmful gaps in coverage.

Mayra Alvarez, president of The Children’s Partnership, estimates the program would bring coverage stability to about 1.2 million California kids. But funding for it will be at risk if Proposition 35 passes, she warns.

It’s not that the money for that program, or the pay increases for ancillary health care workers, would necessarily go away forever. But advocates would have to fight for it in subsequent budget rounds.

Dustin Corcoran, CEO of the California Medical Association, told me that in addition to the Medi-Cal pay hikes, and some funding for medical education and extra residency slots, the initiative would provide $2 billion a year in 2025 and 2026 to the state’s general fund, “which the legislature can appropriate as they see fit, which vastly exceeds the cost of the programs you mentioned.” CMA and Planned Parenthood Affiliates of California are leading the charge on Proposition 35.

Corcoran’s comments suggest that the groups worried about losing funding if Proposition 35 passes should be able to get it restored in future budgets. Given the current fiscal crisis, however, not everyone is buying it.

“We’re short tens of billions of dollars,” says Ramon Castellblanch, vice president of the California Alliance for Retired Americans, which opposes the measure. “For these people to say, ‘Wait, the general fund is going to cover it’ — is that called gaslighting?”

Proposition 35 proponents say that children, seniors, and disabled or chronically ill people also use doctors, hospitals, and community clinics, for which the measure does provide extra money.

They argue the initiative will go a long way toward addressing Medi-Cal’s historically low pay rates, enticing more providers to participate in the program and enabling those who already do to take more Medi-Cal patients.

“This will be the most significant investment in the Medi-Cal system since the Affordable Care Act,” Corcoran says. “I think it holds great promise for improved access to care, improved quality of care, shorter wait times for all Californians in our ERs, and elimination of health care deserts that are popping up in too many parts of our state.”

Another concern raised by Proposition 35 skeptics is that a long-threatened change in federal rules governing how states collect managed-care taxes to fund Medicaid could torpedo the plans of California — and some of the other 18 states with such a tax.

Proposition 35 sets specific dollar amounts through 2026, which are based on the managed-care tax approved by the federal government last year. But the tax, which California has had in some form since 2009, must be renewed and federally approved every three years. That means that the tax requires another federal approval starting in 2027, the year the ballot measure would make funding permanent.

California’s managed-care tax comes from a levy imposed on health plans, based on monthly numbers of both Medi-Cal and commercial insurance enrollees. The money raised is matched by the federal government, doubling the spending power.

Federal rules require that the health plans be reimbursed for the tax they pay on their Medi-Cal membership. Since the Medi-Cal rate is around 100 times as much as the rate on commercial membership, 99% of the revenue from the tax is on the Medi-Cal side, thus holding many of the health plans almost entirely harmless and minimizing any impact on premiums.

But the federal government has been warning California for years, most recently in a letter it sent in late 2023 accompanying its approval of the managed-care tax, that it will require more balance between the commercial and Medi-Cal levies. Were it to change the rules in that direction, it could cause a major headache in California for a couple of reasons.

First, as proponents of Proposition 35 readily acknowledge, there is no political appetite for an increase in the amount of tax raised on commercial health plan memberships. That’s because it would likely lead to a rebellion by health plans or a jump in premiums that would anger employers, privately insured individuals, and plenty of other people. In that case, the only way to comply would be to lower the tax rate on Medi-Cal enrollment, which would significantly reduce revenue.

Second, though the ballot measure contains flexibility for small changes, it requires a three-fourths majority vote in the legislature for any major changes. That would be a tall order.

“Say the federal administration comes back and says, ‘You can’t do this anymore,’ which seems likely,” says Savage-Sangwan, who is also a spokesperson for the opposing coalition. “We’re going to be stuck with a whole lot less money.”

So far, however, the feds have not followed through on repeated warnings, and Proposition 35 proponents seem to be betting the threat of changes will prove nothing more than bluster.

We’ll see.

Tennessee Tries To Rein In Ballad’s Hospital Monopoly After Years of Problems

Ballad Health, an Appalachian company with the nation’s largest state-sanctioned hospital monopoly, may soon be required to improve its quality of care or face the possibility of being broken up.

Government documents obtained by California Healthline reveal that Tennessee officials, in closed-door negotiations, are attempting to hold the monopoly more accountable after years of complaints and protests from patients and their families.

Ballad, a 20-hospital system in northeastern Tennessee and southwestern Virginia, was created six years ago through monopoly agreements negotiated with both states. Since then, Ballad has consistently fallen short of the quality-of-care goals, according to annual reports released by the Tennessee Department of Health.

Despite these failures, Tennessee has given “A” grades and annual stamps of approval to Ballad that allow the monopoly to continue. This has occurred, at least in part, because Ballad is graded against a scoring rubric that largely ignores how its hospitals actually perform.

Now that may change. In an ongoing renegotiation of Tennessee’s monopoly agreement, the state health department has pushed for an eightfold increase in the importance of hospital performance, making it “the most heavily weighted” issue on which Ballad would be judged, according to state documents obtained through a public records request. The negotiations appear to be the state’s most substantial response to residents who sound alarms about Ballad hospitals.

Dani Cook, a community organizer who has led efforts against Ballad for years, including an eight-month protest outside a Ballad hospital in 2019, said a renegotiated monopoly agreement could be a first step toward progress that locals have long sought, but only if it is enforced by the state.

Cook also questioned why Tennessee took years to prioritize something as fundamental as good care.

“That’s what baffles me about this entire relationship: Ballad seems to never be held to account,” Cook said. “And that’s why, when I look at this, I say, ‘Oh that sounds great.’ But let’s see what happens.”

A photo of a group of people protesting outside of a hospital. — Protesters gather in opposition to the closure of the neonatal intensive care unit at Holston Valley Medical Center, a Ballad Health hospital, in 2019.(Dani Cook)

Ballad Health was created in 2018 after Tennessee and Virginia officials waived federal anti-monopoly laws and approved the nation’s biggest hospital merger based on what’s called a Certificate of Public Advantage, or COPA, agreement. Despite the warnings of the Federal Trade Commission, the region’s rival hospital systems became a single system without competition. Ballad is now the only option for hospital care for most of about 1.1 million people in a 29-county region at the nexus of Tennessee, Virginia, Kentucky, and North Carolina.

In an effort to offset the perils of the monopoly, Ballad was required to enter agreements with the states that set expectations for the company and limited its ability to raise prices or close hospitals. Each year, Tennessee grades Ballad against this agreement on a 100-point scale. If the company performs poorly, Tennessee could in theory revoke the COPA, and then enforce a plan to split Ballad into separate companies, according to the monopoly agreement.

The new negotiation documents offer a snapshot of how Tennessee hopes to reshape this agreement, detailing more than a dozen changes the health department proposed in February and a counterproposal from Ballad in May. It is unclear if or how these proposals may have changed in the subsequent months.

Tennessee Department of Health spokesperson Dean Flener said the agency would not comment on Ballad or the ongoing negotiations.

In a written statement, Ballad did not comment directly on the negotiations but said the company “enthusiastically agrees that the most important thing to our patients is the quality of care they receive.” The company said in 2023 that its hospital quality slipped due to the pressure of the coronavirus pandemic and that it was in the process of rebounding.

“We strongly support a shared focus on quality of care as it relates to the COPA,” Molly Luton, a Ballad spokesperson, said in the statement.

Historically, quality of care has been just a small part of how Ballad is held accountable. Twenty percent of Ballad’s annual COPA score comes from measurements of hospital quality, but the company gets full credit on three-fourths of those measurements if it reports any value — even a terrible one. Only 5% of the annual score is determined by real-world hospital performance.

If quality was weighted more, Ballad would have scored much worse in past years. Annual reports released by the Tennessee Department of Health over the last two years show that Ballad failed to meet more than 74% of the state’s quality-of-care benchmarks, including some about mortality rates, readmission rates, emergency room speed, surgery-related infections, and patient satisfaction.

Under Tennessee’s proposed changes, all these metrics would matter much more. But Tennessee would also lower the overall standards for Ballad’s monopoly and ease a charity care obligation that Ballad has repeatedly not met, according to the negotiation documents. Ballad has said it hasn’t met the charity care obligation because changes to Medicaid programs have left fewer patients uninsured and in need of charity.

The documents show that:

Tennessee has proposed increasing the share of Ballad’s annual score that is attributable to real-world quality of care from 5% to 40% and no longer giving Ballad any points for merely reporting quality statistics. In a counteroffer, Ballad proposed raising this percentage to 34%, with some points still awarded to the company just for reporting.
Tennessee proposed lowering the minimum overall score that Ballad needs to obtain each year for its monopoly to be considered a “clear and convincing public advantage.” If Ballad falls below this threshold, the COPA agreement could be modified or “terminated.” Tennessee wants to lower the threshold from 85 out of 100 to 75. In its counteroffer, Ballad proposed 70.
Tennessee would reduce or weaken a requirement for Ballad charity care spending that is largely moot. Ballad has been required to provide more than $100 million in free or discounted charity care to low-income patients each year under the current monopoly agreement, but it has failed to do so five years in a row, falling short by about $194 million in total. Tennessee has waived the requirement each year.

Cook, who described the new documents as a rare glimpse into closed-door dealings that Ballad patients never get to see, said it was striking to witness the company push for lower standards.

“Why would they be pushing back on improving the quality of care that people receive?” Cook said. “If they are really among the nation’s best — because that’s what they tell the entire region — why do you need the standards lowered?”

Ultra-Low-Dose Ketamine Can Curb Opioid Withdrawal

Newswise — Drug overdose is the leading cause of injury deaths in young adults in the United States, with fentanyl causing over 70,000 deaths annually.

Many people who use fentanyl become trapped in their addiction out of fear and a low tolerance for the withdrawal symptoms, which include muscle cramps, nausea, chills, sweats and intense cravings.

They can’t stop using fentanyl, and they also have trouble starting either of the two medications, methadone and buprenorphine, that can dramatically reduce their risk of overdose death.

Research findings published Aug. 29 in Addiction Science & Clinical Practice may offer hope. A pilot study showed that a small amount of ketamine can reduce or eliminate the withdrawal symptoms associated with quitting fentanyl.

“The main takeaway is that we have found an easier way for people trapped in the grip of fentanyl addiction to get started in treatment,” said Dr. Lucinda Grande, a clinical assistant professor of family medicine at the University of Washington School of Medicine. She was the study’s lead author.

“Methadone can be difficult to access due to strict federal regulations, and starting buprenorphine can cause severe withdrawal symptoms before those who start it become stabilized,” added study co-author Dr. Tom Hutch. He is the medical director of the opioid treatment program at We Care Daily Clinics in Auburn, Wash. “Ketamine, at an imperceptibly low dose, helps bridge that gap.”

Over 14 months, Grande and colleagues in Auburn and Olympia prescribed ketamine to 37 fentanyl-addicted patients whose fear of withdrawal symptoms had deterred them from trying buprenorphine. Twenty-four patients actually tried the drug, and 16 completed the transition to buprenorphine.

Most patients reported a reduction or elimination of withdrawal symptoms after each ketamine dose, the effect of which lasted for hours. Of the last 12 who completed the transition, 92% remained in treatment for at least 30 days.

Patients placed a ketamine lozenge or syrup under the tongue. The 16 mg dose is a small fraction of that typically used for anesthesia, the main clinical role of ketamine for 50 years, according to Grande. That dosage also is less than half of the smallest ketamine dose prescribed for depression treatment, an increasingly common use of this medication.

Researchers monitored patients daily or almost daily, and refined the treatment strategy based on patient response and prescriber experience.

Grande developed the concept after she learned that emergency-medicine physician and coauthor Dr. Andrew Herring of Oakland, California, used a higher, sedating dose of ketamine successfully in his emergency department to resolve a patient’s severe case of withdrawal from fentanyl addiction.

Grande is a primary-care and addiction doctor in practice near Olympia who, in the past dozen years, has used low-dose ketamine to treat more than 600 patients for chronic pain and depression.

Ketamine has gained prominence in the news since actor Matthew Perry of the sitcom “Friends” overdosed on the drug and drowned. Perry had undergone high-dose ketamine treatment for depression, news reports have suggested.

“Our study underscores the enormous potential of this medication for addressing important health problems such as depression, chronic pain and now fentanyl-use disorder,” said Grande. Ketamine’s positive attributes have been overshadowed by Perry’s death, she said.

Grande hopes this pilot study’s results will be confirmed by larger studies. “I am excited about these results,” she said. “This is a wonderful opportunity to save lives.”

Silence in Sikeston: Hush, Fix Your Face

SIKESTON, Mo. — For residents of Sikeston, as for Black Americans around the country, speaking openly about experiences with racial violence can be taboo and, in some cases, forbidden.

As a child, Larry McClellon’s mother told him not to ask too many questions about the 1942 lynching of Cleo Wright in their hometown of Sikeston. McClellon, now an outspoken activist, wants his community to acknowledge the city’s painful past, as well as the racism and violence.

“They do not want to talk about that subject,” McClellon said. “That’s a hush-hush.”

Also in this episode, host Cara Anthony uncovers details of a police killing in her own family. Anthony unpacks her family’s story with Aiesha Lee, a licensed professional counselor and an assistant professor at Penn State.

“This pain has compounded over generations,” Lee said. “We’re going to have to deconstruct it or heal it over generations.”

Host

In Conversation With …

click to open the transcript

Transcript: Hush, Fix Your Face

Editor’s note: If you are able, we encourage you to listen to the audio of “Silence in Sikeston,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Cara Anthony: A lynching isn’t an isolated, singular act.

The violence — and the silence around it — was a deliberate, community-wide lesson meant to be passed on.

And passed down.

[BEAT]

Cara Anthony: In Sikeston, Missouri, a 25-year-old soon-to-be father named Cleo Wright was lynched by a white mob.

It happened in 1942. But you didn’t have to be there, or even born yet, to get the message.

Larry McClellon: I grew up here in Sikeston, Missouri. My age … 77.

Cara Anthony: That’s community elder Larry McClellon.

He was born two years after Cleo Wright’s body was dragged across the railroad tracks to the Black side of town.

Larry McClellon: Back in the old days, when dark comes, you don’t want to be caught over here after 6 o’clock. You want to be on this side of the tracks.

I didn’t cross the line. Because I knew what was waiting. I knew what time it was here in Sikeston, Missouri.

[BEAT]

Cara Anthony: I’m Cara Anthony. I’m a journalist. I’ve been visiting Sikeston for years to work on a documentary film and podcast about the lynching of Cleo Wright.

And the police killing in 2020 of another young, Black father, Denzel Taylor.

Larry McClellon: All these Black men are getting shot down, losing their life.

Cara Anthony: Cleo and Denzel, killed some 80 years apart. In the same city.

Larry McClellon: They do not want to talk about that subject. That’s a hush-hush.

Cara Anthony: In this episode of the podcast, we’re exploring how that “hush” hurts the community. And the way it hurts people’s health.

Here’s an example: Larry says it’s hard to feel safe in your hometown when Black men are killed and nearly everyone looks the other way.

Growing up, Larry had a lot of questions about Cleo.

Larry McClellon: I used to ask Mom. You know, “What is this with this man that supposedly, uh, got lynched?” And she told me, “Hey, you stay away from that. … Don’t you be asking no questions about Cleo Wright because that was just a no-no.”

Cara Anthony: Why was that a no-no?

Larry McClellon: Because she’s afraid for me that they would probably take me out and do something to me. Maybe bodily harm or something like that.

Cara Anthony: “They” being white neighbors.

Despite those lessons, Larry became an outspoken activist for racial justice and police reform in Sikeston. He founded an organization here called And Justice for All.

Being vocal has come at a price, he says.

Larry McClellon: Somebody called me and said, “Uh, Mr. Larry, your building is on fire.”

So, I didn’t even really hang the phone up real good. I just jumped up and come up the highway.

Cara Anthony: It was April 2019 — Larry rushed to the headquarters of And Justice for All.

Larry McClellon: I could see the flame was high as anything in Sikeston, might as well say. So, I gets up there and, uh, fire burning. So, all the fire department get out there pouring water and everything.

Cara Anthony: The building was a total loss.

Larry McClellon: The building was set on fire. That’s what, that’s what happened.

Who would come in and destroy something like that?

Cara Anthony: The police report says it was arson, but nothing really came of the investigation. Larry suspects it was a targeted attack — retaliation for his activism, for speaking out. Retaliation that could continue.

Larry McClellon: I got 4 acres over there. A lot of trees and so forth. And some of my own people, they make jokes out of it sometime, like, “Man, you going to be hanging from one of those trees down there, or somebody’s going to set over in those bushes with a high-powered rifle and going to shoot you when you walk out the door or shoot you when you pull up.”

Cara Anthony: And still, Larry’s decided he’s not going to hold his tongue.

Because keeping quiet causes its own trouble, its own hurt and pain.

This is “Silence in Sikeston.” The podcast all about finding the words to say the things that go unsaid.

From WORLD Channel and KFF Health News and distributed by PRX.

Episode 2: “Hush, Fix Your Face.”

[BEAT]

Cara Anthony: Larry’s keeping on with his work in Sikeston. But all those warnings from his mother decades ago to keep quiet about Cleo’s lynching left a mark.

I called up Aiesha Lee to talk about this. She’s a licensed mental health professional and also an assistant professor at Penn State.

One of the first things she wanted me to know is that silence has been used as a tool of systemic oppression in America for a very long time.

Aiesha Lee says lynching — and the community terror it caused — was part of a wider effort to impose white supremacy.

Aiesha Lee: This is a design. Let me be clear, this is, it was very much designed for us to be these subservient, submissive people who do not ask questions, who do not say anything, and just do as they’re told.

Cara Anthony: One of Aiesha’s areas of expertise is how racism can impact physical and mental health — across generations. She sees signs of it in her clients every day.

Aiesha Lee: No one actually comes in and says, “Hey, I’m dealing with intergenerational trauma. Can you help me?” Right?

Cara Anthony: I will have to admit, I’ve been very skeptical about that term, what that means, because, in my family, it was always this thing of like, “We’re good over here. Everything’s OK.”

Aiesha Lee: I love what you just said. And, and for me, as a mental [health] professional, I get really cautious when using, even using the word “trauma.”

Part of the, the generational legacy of Black families is we don’t talk about our problems, we just kind of roll through them, we deal with them, we’re strong, and we just keep it moving forward, right?

It’s protection. It is “Let me teach you the ways of the world according to us” or for us, right? And for us, we need to keep our mouth shut. We can’t ask any questions. We can’t make any noise, because if we do, you’re going to get the same, or worse than, you know, others.

Cara Anthony: My parents. Grandparents. My great-grandparents. Their experiences with racial violence — and what they had to do to stay safe — shaped me.

Stuffing down injustice and pain is a tried-and-true way to cope. But Aiesha says holding hurt in hurts.

Aiesha Lee: It’s almost like every time we’re silent, it’s like a little pinprick that we, we do to our bodies internally.

Cara Anthony: She says over time those wounds add up.

Aiesha Lee: After so long, um, those little pinpricks turn up as heart disease, as cancer, as, you know, all these other ailments.

Cara Anthony: Feeling unsafe, being that vigilant all the time. What can that do to someone’s body?

Aiesha Lee: Imagine every time you walk out of the door, you’re tightening your body, you’re tensing up your body, right? And you’re holding on to it for the entire day until you come home at night. What do we think would happen to our bodies as a result?

Cara Anthony: A study from UCLA found experiences with racism and discrimination correlated with higher levels of inflammation in the bodies of Black and Hispanic people. It affected their immune system, their gut.

Aiesha says always being on edge can rewire how the brain deals with stress.

Aiesha Lee: That’s what that hypervigilance does. That hypervigilance causes our bodies to tense up so that we can’t fully breathe.

Cara Anthony: Yeah, that’s exhausting. And as you were talking about it, like, I even feel my body just being tight as you are speaking about these things.

Cara Anthony: If you don’t deal with the emotional stuff, Aiesha says, it can live in your body.

Aiesha Lee: Arthritis, fibromyalgia, high blood pressure …

Cara Anthony: … and ripple through families as intergenerational trauma.

That makes me wonder about my dad’s high blood pressure.

My mom’s chronic pain.

About my own trouble sleeping.

[BEAT]

Cara Anthony: Despite endless conversations with my parents about this work — somehow, I was months and months into reporting on racial violence in Sikeston before I learned new details about a death in my own family.

Wilbon Anthony: I enjoy reading about history where, you know, my people come from.

Cara Anthony: My dad, Wilbon Anthony, knew the story for nearly a decade, but kept it to himself.

Really, I shouldn’t have been surprised. My whole life I was taught in big and small ways that usually it’s better to stay silent.

There’s a risk — to self — when you speak out.

I’m 37 years old — plenty grown now — but it feels like the “adults” have always tiptoed around the story of Leemon Anthony, my great-uncle on my father’s side.

Leemon served in the military during World War II. Family members remember him as fun-loving and outgoing.

I was told that Leemon died in a wagon-and-mule accident in 1946. But at family reunions, sometimes I’d overhear details that were different.

Wilbon Anthony: There was a hint there was something to do with it about the police, but it wasn’t much.

Cara Anthony: My dad knew that the stories he’d heard about Uncle Leemon’s death were incomplete. That missing piece left him feeling undone.

Wilbon Anthony: Later in life, I started researching it. I just thought about it one day and, uh, just said, “Oh, see if it was something about this.”

Cara Anthony: He called up family members, dug through newspaper archives online, and searched ancestry websites. Eventually, he found Leemon’s death certificate.

To show me what he found, Dad and I sat in his home office. He pulled up the death certificate on his computer. Leemon was 29.

Wilbon Anthony: It says, “Shot by police, resisting arrest.”

Well, no one ever, I never heard this in my, uh, whole life.

Then item 21, it lists the causes of death: accident or suicide or homicide, and the list says that item is homicide.

Cara Anthony: OK, OK, um, that’s a lot. I need to pause.

[BEAT]

Cara Anthony: Shot by police.

Even now, I only have bits and pieces of the story, mostly from whispers from my family.

There was a wagon accident.

One of my older cousins says a local white woman saw it and called the police. An article published in The Jackson Sun quoted Leemon’s father saying that Leemon had been “restless” and “all out of shape” since he returned home from the war.

What we do know is that the police showed up. And they killed Leemon.

[BEAT]

Cara Anthony: When I learned about my Uncle Leemon’s death, when I got slammed by that grief and anger, I called my Aunt B — my dad’s sister Bernice Spann — and told her what my dad had found.

Cara Anthony: OK, I just sent you the death certificate, um, just so you can …

Bernice Spann: What does it say, his death, how he died?

Cara Anthony: It says homicide, and that he was shot by the police.

Bernice Spann: Wow.

Cara Anthony: Yeah. Yeah.

Bernice Spann: And they said “homicide”?

Cara Anthony: Right.

Bernice Spann: And nobody was charged?

Cara Anthony: No charges.

So, what are you thinking right now?

Bernice Spann: I’m heartbroken.

Cara Anthony: Yeah. Yeah.

Bernice Spann: I mean, that’s close. That is not … it’s an uncle.

Cara Anthony: That’s your uncle. That’s my great-uncle. That’s your uncle. Yeah.

Bernice Spann: Well, that’s my uncle. And he died and nobody fought.

Cara Anthony: Yeah.

Bernice Spann: Nobody fought for a resolution ’cause nobody … everybody felt powerless.

Cara Anthony: Even now there’s so much silence in our family around Leemon’s death.

Bernice Spann: I think there’s something in our DNA that still makes us scared to talk about it. I need for us to look at it. I don’t know. Does it make sense? And maybe you’re the one who, it’s time for you to look at it.

Cara Anthony: So, that’s what I’m doing.

[BEAT]

Cara Anthony: This storytelling — this journalism — is about what’s at stake for our health, and our community, and loved ones when we’re silent in the face of racial violence — and the systemic racism that allows it to exist.

So on one reporting trip to Sikeston, I asked my family to take the ride with me.

We loaded into a van.

[Cara’s mom hums in the background.]

And during the drive from Illinois to southeastern Missouri, my mom hummed hymns, while my daughter, Lily, napped and inhaled snacks.

Cotton is still king in Sikeston. It’s a huge part of the town’s economy, and culture, and history. So just before we got to town, we stopped at a cotton field.

[Car door shuts.]

Cara Anthony: OK, Lily, come here.

Cara Anthony: Lily was just 5 back then.

Cara Anthony: What is this? What are we looking at right now?

Lily: Cotton.

Cara Anthony: Lily was excited, but when I turned around, my dad, Wilbon, looked watchful.

Wary.

As for lots of Black Americans, cotton’s a part of our family’s history.

Cara Anthony: OK, Dad. Come over here. So, Dad, Lily just said that cotton looks like cotton candy and potatoes ’cause it looks fluffy. When you look out at this field, what do you see?

Wilbon Anthony: Well, I see. First, I see a lot of memories. I remember … picking cotton as a kid. Actually, I can remember waiting on my parents while they were in the fields picking cotton. And then I remember a lot of days of hard work.

So, yeah, I … yeah, I have a lot, a lot of memories about cotton.

Cara Anthony: My mom has memories, too. As a little girl in Tennessee, around Lily’s age, my mom was already working in a field like this.

Days and days hunched over. Carrying heavy bales, working until her hands were sore.

My mom’s still in grief about the violence and punishing labor — and lost opportunity — so tightly woven into all this cotton.

As a child, she hid that pain. She’d lie face down in the dirt when the school bus drove past, hoping the other kids wouldn’t see.

[BEAT]

Cara Anthony: Standing in that cotton — three generations together — I worried I was dredging up old wounds or causing new hurt.

Still, I want to try to have these conversations without passing the pain and stress down to the next generation — to my daughter.

Cara Anthony: Why did we come down here to Sikeston?

Lily: Because there’s important work here.

Cara Anthony: Yeah, there is important work here.

[BEAT]

Cara Anthony: Someday I need to tell Lily about lynching in America. About Cleo Wright and our Uncle Leemon. I want her to know their names. I need to tell Lily about her personal risk of encountering that kind of violence.

But, truthfully, I’m not quite ready yet.

Here’s some advice I got from psychologist Aiesha Lee.

Aiesha Lee: This pain has compounded over generations, and so we’re going to have to deconstruct it or heal it over generations, right? And so, you know, our generation and the generations that come behind us will have little pieces of the work to do.

[BEAT]

As we put mental health more so at the forefront, and as we start to communicate more and more within our families, that’s how we engage in, in this healing.

Cara Anthony: I was told to keep quiet a lot when I was a kid, but I want to nurture Lily’s curiosity and teach her what she needs to know to stay safe.

My parents did what they thought was best. Now it’s my turn to try to find that balance.

Sometimes when Lily’s jumpy and restless, having a hard time falling asleep, we’ll sing together.

Cara Anthony and Lily [singing]: Hush. Hush, hush, somebody’s calling my name. Hush, hush, somebody’s calling my name.

Cara Anthony: At first listen, that might sound like a message to stay silent.

Actually, it’s a song enslaved people sang as they worked in cotton fields. As they dreamed and planned. It’s a call to be acknowledged. Named. And counted.

Lily has grown up a lot since we visited that cotton field in Sikeston. She’s 7 now. I want her to know that she can speak out more freely than her ancestors could.

More than I have.

Cara Anthony: Sit over, come over here. Come over here. Seriously. Do you remember a couple of weeks ago when you were crying? And I told you to fix your what?

Lily: Face.

Cara Anthony: That wasn’t very nice. I want you to know that we can talk about things. Because when we talk about things, we often feel better, right?

Lily: Yes.

Cara Anthony: Can we keep talking to each other while you grow up in life about stuff? Even hard stuff?

Lily: Like doing 100 math facts?

Cara Anthony: Sure. That’s the biggest thing in your life right now. But yes, all of that. We’re just going to keep talking to each other. So, can we make a promise?

Lily: Yeah.

Cara Anthony: All right, cool.

Cara Anthony: Talking just might help us start to heal.

[BEAT]

Cara Anthony: Next time on “Silence in Sikeston” …

Mikela Jackson: The Bootheel knows what happened to him. The world — they have no idea who Denzel Taylor is.

CREDITS

Cara Anthony: Thanks for listening to “Silence in Sikeston.”

Next, go watch the documentary. It’s a joint production from Retro Report and KFF Health News, presented in partnership with WORLD.

Subscribe to WORLD Channel on YouTube. That’s where you can find the film “Silence in Sikeston,” a Local, USA special.

This podcast is a co-production of WORLD Channel and KFF Health News and distributed by PRX.

It was produced with support from PRX and made possible in part by a grant from the John S. and James L. Knight Foundation.

The audio series was reported and hosted by me, Cara Anthony.

Zach Dyer and Taylor Cook are the producers.

Editing by Simone Popperl.

Taunya English is the managing editor of the podcast.

Sound design, mixing, and original music by Lonnie Ro.

Podcast art design by Colin Mahoney and Tania Castro-Daunais.

Oona Zenda was the lead on the landing page design.

Julio Ricardo Varela consulted on the script.

Sending a shoutout to my vocal coach, Viki Merrick, for helping me tap into my voice.

Music in this episode is from BlueDot Sessions and Epidemic Sound.

Some of the audio you’ll hear across the podcast is also in the film.

For that, special thanks to Adam Zletz, Matt Gettemeier, Roger Herr, and Philip Geyelin, who worked with us and colleagues from Retro Report.

Kyra Darnton is executive producer at Retro Report.

I was a producer on the film.

Jill Rosenbaum directed the documentary.

Kytja Weir is national editor at KFF Health News.

WORLD Channel’s editor-in-chief and executive producer is Chris Hastings.

If “Silence in Sikeston” has been meaningful to you, help us get the word out!

Write a review or give us a quick rating on Apple, Spotify, Amazon Music, iHeart, or wherever you listen to this podcast. It shows the powers that be that this is the kind of journalism you want.

Thank you. It makes a difference.

Oh, yeah, and tell your friends in real life, too!

Additional Newsroom Support

Lynne Shallcross, photo editor
Oona Zenda, illustrator and web producer
Lydia Zuraw, web producer
Tarena Lofton, audience engagement producer
Hannah Norman, visual producer and visual reporter
Chaseedaw Giles, audience engagement editor and digital strategist
Kytja Weir, national editor
Mary Agnes Carey, managing editor
Alex Wayne, executive editor
David Rousseau, publisher
Terry Byrne, copy chief
Gabe Brison-Trezise, deputy copy chief
Tammie Smith, communications officer

The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.

Watch the accompanying documentary from WORLD, Retro Report, and KFF starting Sept. 16, here.

To hear other KFF Health News podcasts, click here.

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