Homicides Surge in California Amid COVID Shutdowns of Schools, Youth Programs

KFF Health News, May 17, 2021

After more than a decade of fairly steady decreases, California's homicide rate surged in 2020.

This article was published on Monday, May 17, 2021 in Kaiser Health News.

By Phillip Reese

Amid a pandemic that left law enforcement agencies stretched thin and forced shutdowns that left young men with little to do, California registered a devastating surge in homicides in 2020 that hit especially hard in Black and Latino communities.

The number of homicide victims in California jumped 27% from 2019 to 2020, to about 2,300, marking the largest year-over-year increase in three decades, according to preliminary death certificate data from the California Department of Public Health.

There were 5.8 homicides per 100,000 residents in 2020, the highest rate in California since 2008.

Similar increases were seen nationwide. The number of homicides in a sampling of large cities grew 32% from 2019 to 2020, according to preliminary FBI data. The data encompasses over 200 cities with more than 100,000 people but does not include some big cities, like New York, Chicago and Philadelphia, that did not report.

The California death certificate data reveals striking disparities in who fell victim to homicide in 2020.

The number of homicides that took the lives of Black Californians rose 36% from 2019 to 2020, while homicides that took Hispanic lives rose 30%. By comparison, the number of white homicide victims rose 15% and the number of Asian victims rose 10%.

Most victims of homicide in 2020 were young, between 15 and 34 years old; the number of homicide victims in this age group rose from about 900 in 2019 to 1,175 in 2020, a 31% rise.

Firearms were the most common instrument of death, and the number of homicides involving guns rose 35% last year, the state data shows. Extending another long-standing trend: Males were five times as likely to be the victims of homicide as females. The number of male victims rose 30% in 2020, compared with a 14% rise in female victims.

The increase in deadly violence played out across large swaths of the state, urban and rural, and was keenly felt in the San Francisco Bay Area. Among California's 10 most populous counties, the sharpest increases were reported in Alameda County, where homicides rose 57%, followed by Fresno (44%), Sacramento (36%) and Los Angeles (32%). Only one of the 10 most populous counties — Contra Costa — saw a decline in homicides last year.

Law enforcement officials and criminologists said an increase in conflict among young adults, particularly those in street gangs, was a significant factor in the violence. They noted that schools and sports programs shut down as COVID-19 surged, as did large numbers of community and nonprofit programs that provide support, recreational outlets and intervention services for at-risk youth.

"They were bored," said Reynaldo Reaser, executive director of Reclaiming America's Communities Through Empowerment (R.A.C.E.), which offers sports leagues, gang mediation and youth development in impoverished neighborhoods of South Los Angeles. "And so, having nothing to do — no programs, no sports, no facilities open — the only thing they could focus on is each other."

Reaser runs a dynamic youth softball league that typically would draw more than 600 players and spectators during Sunday play, he said, many of them young gang members. But those games and other programs were curtailed during the COVID pandemic.

Terrell Williams, an 18-year-old who lives in the West Athens area of South Los Angeles, said he spent many nights doing "delinquent stuff" before Reaser's program changed his life. He said many of his peers felt cooped up and restless during the pandemic lockdowns, which contributed to an increase in violence.

"COVID tended to, I guess, make people not want to stay inside the house, and drove them outside more towards each other," he said.

Jorja Leap, a UCLA anthropologist and expert in gangs, violence and trauma, echoed that theme, saying the restrictions on youth intervention programs and other healthy activities played "a huge role" in the rise in violence.

"The sports after school — football, basketball, whatever it might be — all that is stopped," said Leap, a faculty member at UCLA's Luskin School of Public Affairs. "So, frankly, you got a lot of adolescent and young adult energies out there."

Leap said young adults were particularly vulnerable to the mental toll of the pandemic. "They finally get programs; they have people interested in them. And then, it's all of a sudden withdrawn," she said.

Pandemic-fueled anxiety and isolation corresponded with a huge increase in gun sales, which Leap said may also explain some of the increase in homicides. "I am worried about how easy it has been to get a gun during such a crisis time in America," she said.

"It's not 'Pick one factor,'" she added. "All of these factors reinforce each other."

David Robinson is the sheriff in Kings County, a largely rural county in Southern California that registered 15 homicides in 2020, up from four in 2019. He is also president of the California State Sheriffs' Association, giving him a wide lens on a difficult year.

Robinson agreed that an increase in gang activity and the "mental impact" of telling young adults they had to stay indoors likely contributed to the violence. But separately, he cited the toll the pandemic took on police agencies. Many officers fell ill with COVID, forcing their agencies to reduce patrols and other crime prevention efforts.

The mass protests that followed George Floyd's murder by a Minneapolis police officer last May also diverted resources, said Robinson. And the anger directed at police made it tougher for some officers to do their jobs.

"When there's this call to defund police, it has an impact on the mentality of the men and women doing the job," he said, adding that constant criticism can cause officers to "become more reactive than proactive."

Robinson echoed other law enforcement officers in noting that thousands of inmates were released early from state prisons and county jails during the pandemic to stem COVID outbreaks. He said he thinks research eventually will show a correlation with the surge in homicides.

Leap disagreed. "If you get two shoplifting charges, it's a felony," she said. "That's who they're releasing. They're not releasing people from death row."

With mass vaccinations taking place across the state and nation, more places are reopening and young adults have more options to engage in something positive. But Leap said it will take a broad effort to bolster jobs and education, along with short-term intervention aimed at those still hurting from the pandemic, to improve the social conditions that contributed to the increase in homicides.

"As much as we've never dealt with a global pandemic in modern times, we've never dealt with the aftermath of a global pandemic," she said.

Reaser, in Los Angeles, is nonetheless optimistic. After a year of shutdowns, his youth softball league is starting up again. Finally, instead of trying to work out conflicts over the phone or online, Reaser can get young adult rivals to talk, face to face, and bond in a positive way.

"I really think that a lot of programs will open up," he said. "A lot of violence will slow down."

Methodology

This story draws on data from three sources. The data from these sources matches closely, but not precisely. Cause of death and population figures for 1979 through 2018 come from the federal Centers for Disease Control and Prevention. Cause of death figures for 2019 and 2020 come primarily from the California Department of Public Health and are based on death certificates. The exception is 2019 data for eight largely rural counties with few homicides. CDPH did not publish specific 2019 homicide figures for those counties due to data privacy rules. For those counties, 2019 homicide data comes from the California Department of Justice. 

Phillip Reese is a data reporting specialist and an assistant professor of journalism at California State University-Sacramento.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Healthcare Foundation.

'Kicking You When You're Down': Many Cancer Patients Pay Dearly for Parking

KFF Health News, May 17, 2021

The costs of parking while in cancer treatment is finally drawing national scrutiny from oncology researchers and even some hospital administrators.

This article was published on Monday, May 17, 2021 in Kaiser Health News.

By Rebecca J. Ritzel

For cancer patients, the road from diagnosis to survivorship feels like a never-ending parade of medical appointments: surgeries, bloodwork, chemotherapy, radiation treatments, scans. The routine is time-consuming and costly. So, when hospitals charge patients double-digit parking fees, patients often leave the garage demoralized.

Iram Leon vividly remembers the first time he went for a follow-up MRI appointment at Dell Seton Medical Center in Austin, Texas, after he had been treated at another hospital for a brain tumor.

The medical news was good: His stage 2 tumor was stable. The financial news was not. When he sat down at the receptionist's desk to check out, Leon was confronted by a bold, red-lettered sign on the back of her computer that read: "WE DO NOT VALIDATE PARKING."

Below that all-caps statement was a list of parking rates, starting with $2 for a 30-minute visit and maxing out at $28 a day. Lose your ticket? Then you could pay $27 for an hour.

"To this day, I remember that sign," Leon, 40, said of the 2017 appointment, which he posted about on Facebook. "These patients were people who were coming in for various types of cancer treatment. These were people who were keenly aware of their own mortality, and yet the sign was screaming at them, 'We do not validate parking.'" (Hospital officials did not respond to requests for comment about their parking policy.)

JulieAnn Villa, who was diagnosed in March with her third bout of cancer, estimates she has spent "thousands of dollars" on parking fees during her years of treatment and follow-up care. She faces a transportation dilemma every time she commutes 6 miles to Chicago's Northwestern Memorial Hospital from her apartment. Should she take public transit? Call a pandemic surge-rate Uber? Ask a friend to drive her? Or pay $12 to $26 (with validation) to park in a garage where each floor is named after singers like Dolly Parton and Frank Sinatra?

She was hospitalized for multiple days in April after spending 23 hours alone in an overburdened ER, because she didn't want friends to pay to wait with her. "I almost drove myself, and I'm so glad I didn't," Villa said. "That would have been expensive."

Long a source of frustration for patients, the costs of parking while in cancer treatment is finally drawing national scrutiny from oncology researchers and even some hospital administrators.

"If you want to rile up patients or caregivers or family members, just bring up parking costs," said Dr. Fumiko Chino, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York who studies the "financial toxicity" of cancer treatment, including costs not covered by insurance, such as parking fees.

Chino, who enrolled in medical school after her husband died of a rare neuroendocrine cancer in 2007, added, "For people who have to pay $15 to $18 every single time, which is what I remember paying, it really feels like the last straw, frankly — like kicking you when you're down."

Public transit is possible for some cancer patients in larger cities, but not for those too ill or immunocompromised. Others have accessibility issues. Many must travel to get care, making driving the best option.

Parking fees can have implications for more than just the patient. "Some patients say, 'This is the reason I didn't participate in a clinical trial, because I couldn't afford the parking,'" Chino said.

At a time when hospitals and drug companies are under increasing pressure to diversify clinical trial populations, testing only patients who can afford high parking fees is problematic, Chino said.

There are some pilot programs to improve access to drug trials, and some charities, such as the Leukemia & Lymphoma Society, offer travel grants, but accessibility remains a substantial barrier to cancer care, said Elizabeth Franklin, president of the nonprofit Cancer Support Community, which offers financial aid to patients and advocates in Washington, D.C., for "patient-centered" health policies.

"The true definition of a patient-centered healthcare system," Franklin said, is one that allows patients to choose the best means of transportation. "It's not making them go into debt because they've had to pay a ton of money for parking each time they go to the clinic or the hospital."

Chino and colleagues published a short study in July showing that some cancer patients pay $1,680 over the course of treatment.

According to readership statistics released in late March, the study was the most read and downloaded article in JAMA Oncology last year, and it continues to prompt a lively social media response. A thread on Reddit has logged more than 1,100 comments, including many from patients in other countries voicing surprise at U.S. parking policies.

The researchers calculated the cost to park at 63 National Cancer Institute-designated cancer centers while receiving the standard number of treatments for each of three types of cancers: node-positive breast cancer, head and neck cancers, and acute myeloid leukemia, or AML. They did not calculate costs for follow-up appointments, blood draws, routine scans and immune-boosting injections.

They found that, while 20 of the hospitals provided free parking for all cancer patients, the other 43 had widely varying fees.

"The range was $0 to $800 for breast cancer," Chino said. "That's huge, and it's not like the person who's paying $800 is necessarily getting any better treatment." The maximum charges for a standard course of therapy for head and neck cancer were $665 and for AML, $1,680.

Practices should change, Chino said, "to alleviate this strain for our patients."

Of the 63 hospitals, including those where parking is free for cancer patients, 54% offered free parking for chemotherapy and 68% for radiation treatment.

The top daily parking rate, according to the researchers, is $40 at New York's Mount Sinai Hospital. (A spokesperson for Mount Sinai declined to comment.) Chino's own institution, Memorial Sloan Kettering, is not far behind; parking at one of its main garages begins at $12 an hour and maxes out at $36 a day. A spokesperson for the hospital said some locations do offer free parking, and all patients can apply for aid to cover parking costs.

A few colleagues scoffed when Chino said she was researching parking charges, she said, but a growing number of mostly younger oncologists are concerned about indirect costs that contribute to the financial toxicity of cancer.

"It seems ethically incorrect to nickel-and-dime patients for parking charges," a trio of doctors wrote last year in an editorial published by the American Society of Clinical Oncologists. They acknowledge that most top cancer hospitals are in urban centers, where parking costs are often high and third-party agencies may operate the garages. "Nevertheless, in 2020, with our multibillion-dollar cancer center budgets, we as healthcare systems should do everything we can to help patients and caregivers," the editorial said.

City of Hope National Medical Center in Los Angeles is one of the 20 NCI-designated hospitals that do not charge patients for parking. Dr. Vijay Trisal, a surgical oncologist who serves as City of Hope's chief medical officer, takes pride in that distinction.

"Charging cancer patients for parking is like a knife in the back," he said. "We can't control copays, but we can control what patients pay for parking."

While Trisal would never want a patient to choose City of Hope for the free parking alone, he acknowledges the policy gives his hospital a competitive advantage.

"You would not believe how many patients have said to me, 'Thank you for not charging for parking,'" he said.

What Does Approval of the Pfizer Vaccine for Teens and Preteens Mean for My Child?

KFF Health News, May 15, 2021

Though kids have been less likely to develop severe illness, they still can pose a risk to vulnerable people around them because they may not even know they are carrying the virus.

This article was published on Friday, May 14, 2021 in Kaiser Health News. This story also ran on PolitiFact.

By Carmen Heredia Rodriguez

Q: The federal government approved the Pfizer vaccine for 12- to 15-year-olds. What does this mean for my child?

Extending the emergency use of the Pfizer-BioNTech vaccine to preteens and young adolescents adds nearly 17 million more Americans to the pool of those eligible to be immunized against covid-19, helping to build a vaccinated population closer to herd immunity. Moderna and Johnson & Johnson are also testing the efficacy of their vaccines in teens and children.

Although children appear to catch covid less often and develop milder symptoms than adults, they can develop a rare, severe inflammatory response or “long-haul covid” symptoms. It also remains to be seen what, if any, long-term effects these younger patients may experience from covid.

The share of covid cases in children and teens is increasing — nearly a quarter of the new weekly covid cases were found in this age group, as reported May 6 by the American Academy of Pediatrics and the Children’s Hospital Association.

And, though kids have been less likely to develop severe illness, they still can pose a risk to vulnerable people around them because they may not even know they are carrying the virus, as documented by the Centers for Disease Control and Prevention.

Dr. Margaret Stager, a pediatrician and the division director of adolescent medicine at MetroHealth Medical Center in Cleveland, said she has had to explain to her young patients that getting immunized would help their community curb the spread, cut the risk of variants and help society reopen.

“I talk about them doing their part,” Stager said. “That this is all part of them contributing to the greater good.”

The Fine Print

The CDC this week recommended use of the Pfizer vaccine for children ages 12 to 15 after the Food and Drug Administration extended its emergency use authorization to include these preteens and young adolescents. That means this age group now can receive the same shots in the same time frame — 21 days apart — as adults do.

In a reversal of its previous guidance, teens and adults do not need to wait 14 days before or after getting the covid shot to receive a vaccine for another condition. This could be a boon for health care providers who have child patients lagging on other, routine vaccines, which has been a persistent problem during the pandemic.

“It’s a tremendous opportunity to play catch-up,” said Stager.

CDC officials noted in the May 12 Advisory Committee on Immunization Practices’ recommendation that they do not have data specifically looking at potential side effects in patients immunized against covid and other illnesses at the same time. However, the agency made the decision given the strong safety data of the Pfizer-BioNTech shot and previous experience with other immunizations.

This question will become more important as covid vaccines are studied in younger children. Trials are planned to test the vaccine in children as young as 6 months old.

As in adults, the question of how long the immunity lasts in children remains unknown, said Dr. Rebecca Wurtz, an associate professor of infectious diseases at the University of Minnesota. However, she said, it’s likely that any waning immunity detected in adults will also be seen among the young.

“Whatever we learn in adults,” Wurtz said, “kids will be not far behind.”

Whether this approval will prompt schools to require vaccination against covid for K-12 students returning to the classroom this fall is a pending question, said Stager. It is unclear whether federal law allows state authorities to mandate a vaccine that has not yet been fully approved. That said, the government’s approval will also likely play into parents’ decisions about sending their children to summer camp.

What Did the Trial Find?

Pfizer tested the vaccine in 2,260 preteens and young adolescents living in the United States. Researchers followed participants for two months or more, the FDA said. Pfizer’s clinical protocol says the company will continue to follow participants for two years after the second dose.

Results show the vaccine is safe to use in this age group, causing side effects similar to those seen in young adult populations for whom it had already been cleared, according to the FDA in a press release. Those vaccinated also produced a strong immune response — the level of antibodies recorded in this age group was even stronger than what was seen in 16- to 25-year-olds.

The vaccinated group also had no covid cases when tested seven days after their second dose. Sixteen participants out of 978 who did not get the shot but were followed as part of the study as a control group tested positive for the virus. In short, the vaccine was 100% effective in preventing covid, according to the FDA.

Why So Few Kids?

One data point that may give parents pause is the trial’s number of participants. The relatively low number — especially when compared with the tens of thousands enrolled in adult trials — is a reflection of what the researchers were trying to accomplish, said Dr. Kawsar Talaat, an assistant professor of international health at Johns Hopkins University School of Public Health.

Gauging whether the shot was safe for children and if it generated a strong immune response did not require a large study group, she said. Statisticians can calculate how many people a trial needs to generate meaningful results without unnecessarily exposing people to dangerous pathogens like the coronavirus.

In addition, the findings pertaining to the younger age group built on what has already been learned in earlier studies.

“It’s just not practical to do 30,000-person trials over and over with the same vaccine,” Talaat said. Large trials are expensive, she added. Including minors also poses extra challenges, said Stager, such as getting parental consent.

Jerica Pitts, a Pfizer spokesperson, said in an email the company is using a “careful, stepwise approach” to including minors in clinical trials.

Stager said physiological similarities among 12- to 15-year-olds in response to vaccines have previously been documented. Studies related to a vaccine for the human papillomavirus have shown kids at this age generated similar, strong immune responses, too.

Administering the vaccine to preteens and young adolescents in large numbers may reveal additional effects that weren’t detected in the clinical trials, said A. Oveta Fuller, associate professor of microbiology and immunology at the University of Michigan Medical School.

That said, when weighing the threat of the virus versus the vaccine’s proven safety, she said, the choice is clear.

“The thing is the danger is really not so much the vaccines as it is what it protects against,” Fuller said, “and that’s covid disease.”

Latinos Are the Most Eager to Get Vaccinated, Survey Shows — But Face Obstacles

KFF Health News, May 14, 2021

One-third of unvaccinated Hispanics say they want the shots, compared with 17% of Blacks and 16% of whites.

This article was published on Thursday, May 13, 2021 in Kaiser Health News.

By Anna Almendrala

Hispanics who have yet to receive a COVID shot are about twice as likely as non-Hispanic whites or Blacks to say they'd like to get vaccinated as soon as possible, according to a survey released Thursday. The findings hint at fixable, though difficult, vaccine access problems for the population.

One-third of unvaccinated Hispanics say they want the shots, compared with 17% of Blacks and 16% of whites, according to the survey released Thursday by KFF. (KHN is an editorially independent program of KFF.)

The results reflect an opportunity for public health departments and local governments to reach out to Hispanics with information and vaccinating teams, said Liz Hamel, vice president and director of public opinion and survey research at KFF and director of the organization's monthly COVID vaccine surveys.

"There definitely is a large chunk of the Hispanic population that's eager to get it, but they just have either not been able to fit it into their schedule, or they have some concerns or questions or they haven't been able to access it," Hamel said.

According to the Centers for Disease Control and Prevention, only about 13% of people in the U.S. who have received at least one vaccine dose are Hispanics, though they make up about 17% of the overall population. (Only about half of the CDC's data includes the race or ethnicity of vaccinated individuals.)

Among unvaccinated Hispanics, 64% were worried about missing work because of vaccine side effects, and 52% were concerned about having to pay for the shots — although the shots are offered at no cost. These numbers are even higher for Hispanics who lacked lawful permanent resident status.

"It's hard for somebody who lives day-to-day to take off half a day to come to a clinic and try to get a vaccination," said Dr. José Pérez, chief medical officer of the South Central Family Health Center, a nonprofit health organization with clinic locations throughout South Los Angeles. "If they don't work that day, they don't earn a living and they don't eat."

Those facing immigration issues were more likely to be worried about being asked to show government-issued ID or a Social Security number, according to the KFF survey.

The Trump administration's anti-immigrant policies scared people away from seeking any public health services, for fear it could jeopardize their immigration status, Pérez said.

"For Americans who are used to having order in their life, and don't have to be fearful of this or that, this may seem a little bit foreign," he said. "But for the immigrant community in South L.A., these are factors that they deal with on an everyday basis."

Despite the survey's hopeful message, Pérez's organization has administered only a fraction of the doses it has on hand, although it has expanded vaccination sites and now offers a shot to anyone who walks into one of its clinics, Pérez said.

"All we can do is continue to push, educate and continue to put our name out there," he said. "Hopefully, we'll catch up."

The Biden administration recently announced tax credits for small businesses that give their workers paid time off to get the shot and recover in case of side effects. Providers are not allowed to charge people for the COVID vaccine, and must give out shots regardless of immigration status or health insurance coverage.

In California, where Hispanics make up nearly 40% of the population, 48% of COVID deaths and 63% of COVID infections, about 32% have received vaccinations. Cases and deaths are especially concentrated in dense, low-income neighborhoods that are majority Latino.

Community health clinics and organizations throughout the state are taking the case for vaccinations to sidewalks, supermarkets and anywhere else people gather, seeking to ensure people know how to sign up for a shot.

In the ZIP code around South Central Family Health Center's main site, only 16% of eligible residents had at least one shot as of May 7, according to the California Department of Public Health's vaccine tracker. Five months into the nation's vaccination campaign, as the CDC relaxes mask recommendations, the clinic is still pushing the importance of masks because of how few people have been vaccinated, Pérez said.

"Vaccine hesitancy" has become a catch-all excuse to explain low rates of vaccinations among minority populations, but the problem is complex, said Nancy Mejía, chief program officer of Latino Health Access in Santa Ana, California, a nonprofit that contracts with Orange County to bring COVID vaccine to Latinos.

Her group's community health workers, or promotoras, encounter people who face a wide variety of obstacles to get the shot, she said.

"We hear all of these questions about, 'Well, I don't have health insurance,' or 'Do I have to pay?' or 'I don't have email, how do I register?'" Mejía said. "When folks talk about hesitancy, we really have to ask what it is that we're talking about, and not continue to place blame on individuals who actually have really good questions."

Now that demand for vaccine appointments has plunged, Mejía and her group are focusing more on mobile vaccine events at condominium buildings, swap meets and parking lots where pedestrians and residents can simply walk up. The events are happening in the evenings after work or on the weekends to make the decision to get vaccinated as easy as possible.

"We're seeing other places that have been open the entire day and gotten only five people in," she said. "So, for us being open just a few hours in the evening, and getting over 100 people — that's a success story."

Carmelo Morales, a 35-year-old Los Angeles resident, used to count himself among the vaccine skeptical. After talking to friends and seeing posts on Instagram, he feared the shots might be a plot to make people sick. He didn't see the urgency of getting a shot.

But Morales, who works in a meatpacking plant, has been deeply affected by the cases and deaths he has seen among colleagues and their families over the past year. One day in late April, as he was walking home from work, he noticed healthcare workers at a church near his house packing up after a COVID vaccine event.

He asked if there were any leftover doses, and because his house was nearby, nurses waited for him to run home to get his ID so he could get his first shot.

"I just thought about it and was like, hey, it'd be better just to be maybe on the safer side."

Anna Almendrala: aalmendrala@kff.org, @annaalmendrala

Podcast: KHN's 'What the Health?': Drug Price Effort Hits a Snag

KFF Health News, May 14, 2021

Concerns raised by a group of moderate Democrats threaten to derail a bill being pushed by House Democratic leaders.

This podcast was published on Friday, May 14, 2021 in Kaiser Health News.

The high cost of prescription drugs is a top health issue for the public and politicians, but concerns raised by a group of moderate Democrats threaten to derail a bill being pushed by House Democratic leaders.

Meanwhile, the Food and Drug Administration has authorized the use of the Pfizer COVID-19 vaccine for everyone age 12 and up, and Pfizer is applying for full licensure of that vaccine. It is currently being distributed under emergency authorization. Full approval could open the door to vaccine requirements in some workplaces, schools or other gathering spots, which will likely touch off more controversy.

And the Biden administration reinstated an Obama-era policy barring discrimination in healthcare for LGBTQ individuals, even as more states pass anti-LGBTQ legislation.

This week's panelists are Julie Rovner of KHN, Joanne Kenen of Politico, Sarah Karlin-Smith of the Pink Sheet and Rachel Cohrs of Stat.

Among the takeaways from this week's podcast:

  • Opposition by a handful of conservative and moderate Democrats to House Speaker Nancy Pelosi's proposal to drive down prescription drug prices was a bit of a surprise since some of the members had voted for very similar legislation in the previous Congress. Back then, though, it was clear the bill had no chance of survival in a Republican-controlled Senate. Now the stakes are much higher because Democrats control Congress and the White House.
     
  • In addition to drugmakers' clout on Capitol Hill, some resistance to Pelosi's plan reflects the fact it was written by leadership behind closed doors and didn't go through the typical committee process, in which members of the House would have had a chance to debate and amend the legislation.
     
  • Another factor in the dispute is that several of the representatives who signed the letter to the speaker come from areas where drugmakers have large operations and argue that measures to lower prices could cost jobs.
     
  • The administration announced that more than 1 million people have signed up for health coverage on the Affordable Care Act's marketplaces during the special enrollment period established by the Biden administration. The enrollment boost is attributed to enhanced subsidies passed by Congress earlier this year and a strong messaging campaign about the need for insurance by the administration.
     
  • Democrats in the Senate are pushing forward the nomination of Chiquita Brooks-LaSure to head the Centers for Medicare & Medicaid Services, despite efforts by Sen. John Cornyn (R-Texas) to block her nomination as a protest against Biden administration policies that could cut Medicaid payments to Texas hospitals.
     
  • If Brooks-LaSure is confirmed, nominations for other key posts at HHS will likely quickly follow, such as the heads of Medicaid and the Health Resources & Services Administration. But there has been no movement on a new commissioner for the Food and Drug Administration.
     
  • The vaccine advisory committee for the Centers for Disease Control and Prevention is recommending that children 12 and older not only can safely get the Pfizer COVID-19 vaccine, but that it can be given with other vaccines. Health officials had previously recommended that vaccines be spaced apart. Pediatricians, however, are concerned about how many children missed other important vaccinations over the course of the pandemic.
     
  • Equipping pediatricians to give the vaccine to youngsters may prove vital in getting this age group protected. But the vaccine that has been approved requires the most stringent cold storage, so that may be a hurdle in getting it into doctors' offices. The administration is looking for ways to make it easier for pediatricians to deliver the shot.Bottom of Form

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: HBO's "The Crime of the Century" by Alex Gibney

Joanne Kenen: Grist's "There's Federal Money Available to House the Homeless. No One's Taking It," by Adam Mahoney

Rachel Cohrs: Stat's "CDC's Slow, Cautious Messaging on COVID-19 Seems out of Step with the Moment, Public Health Experts Say," by Nicholas Florko

Sarah Karlin-Smith: KHN's "The Making of Reluctant Activists: A Police Shooting in a Hospital Forces One Family to Rethink American Justice," by Sarah Varney

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunes, Stitcher, Google Play, Spotify, or Pocket Casts.

Listen: Pandemics, Patents and Profits

KFF Health News, May 14, 2021

The Atlantic's "Social Distance" podcast discusses the current patent controversy.

This podcast was published on Friday, May 14, 2021 in Kaiser Health News.

Julie Rovner, KHN's chief Washington correspondent, joins The Atlantic's "Social Distance" podcast, hosted by Dr. James Hamblin and Maeve Higgins, to talk about the current patent controversy and how the drug industry has protected itself over the years with vibrant campaigns about the needs for high profits to support drug development.

Another Pandemic 'To Do' on the List for Schools: Contact Tracing

KFF Health News, May 13, 2021

Public health officials and educators are teaming up to track students who may have been exposed to the coronavirus.

This article was published on Thursday, May 13, 2021 in Kaiser Health News.

By Brett Dahlberg, WCMU

Chris Hodges, the principal of Gaylord High School in Otsego County, Michigan, never thought he'd be a contact tracer.

"I definitely thought, you know, 'Why — why am I doing this?'" he said with a laugh. "That's not what I went to school for."

In what has become a regular part of his school day, Hodges fields reports on his charges such as hearing from the Health Department of Northwest Michigan that a student had tested positive for the novel coronavirus and was in school for three days when she might have been contagious.

One Tuesday in April, after the school day was over, he found himself walking the almost-empty halls with a laptop and a tape measure, making a list of other students who sat close enough to their sick classmate that they would need to quarantine.

Lisa Peacock, health officer for the department, said that without the school district's help it would be "literally impossible" to keep up with contact tracing.

The school-age population has accounted for a growing share of recent coronavirus cases across northern Michigan, and Peacock said quickly identifying people exposed to those cases and telling them how to quarantine is crucial to protecting communities and containing spread.

When Hodges first started helping the health department with contact tracing, he found himself calling teachers on weekends, holidays and late in the day after they'd gone home, asking them where a particular student sat and struggling to orient himself in the classroom as they described the student's position over the phone.

It happened so often that he's now requiring each teacher to keep an up-to-date seating chart in a bright-yellow folder on top of their desk so he can find it easily.

But in this case, the teacher, Hannah Romel, was still at school. The student Hodges was tracing is in her yearbook class, which has different seating arrangements every day. Romel handed Hodges the three charts, and he got to work.

In each place Romel had marked the student, Hodges extended his tape measure to the surrounding desks.

Teachers have spaced their seats out as much as they can, he said, but sometimes they can't quite get to the 6-foot distance required to avoid counting as close contact.

(The federal Centers for Disease Control and Prevention updated its guidance last month to allow for 3-foot distancing between desks, but only in communities where transmission is low. In this district, Superintendent Brian Pearson said, during Michigan's recent surge in cases, 6-foot separation is the standard.)

Hodges moved quickly, both because if he didn't complete the contact tracing the same day, the school can't open the next, and because he wanted to get in touch with the families of students exposed to the virus right away.

"We want to make those phone calls as soon as we can, so that those students aren't at work, aren't at church, aren't going to other people's houses. We want to prevent the spread of COVID not only inside our walls, but in our community," he said.

Hodges will then pass on information about who was in close contact with the student to the local health department. Other nearby school districts run similar operations.

Nationally, this kind of relationship between schools and health departments is not typical in normal times, but it is happening with some regularity during the pandemic, said Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials.

Public health funding has declined over the past few decades, she said, forcing local departments to cut staff members who could have boosted their contact-tracing capacity.

Still, getting schools and health departments to work together can greatly help communities, Casalotti said.

Peacock, the local health officer, said that once her staffers get word of exposures at local schools, they will also get in touch with the families to talk them through the details.

"People always have questions," she said. "They have questions about 'What does this mean? What does it mean that I'm quarantined for 14 days?' We recognize that."

And, in some cases, the health department needs more information than Hodges can give, Peacock said. They might want to find out whether a coronavirus variant is at play, or do a more detailed investigation of how students got sick and where they were when contagious.

Back in Romel's yearbook classroom, Hodges found two students sat just shy of 6 feet from their classmate who tested positive. They'll need to quarantine for two weeks from the date of their last exposure.

Romel said she's still surprised to hear the news that a student is sick.

"I worry about the kid," she said. "I hope that it's a mild case, and they get to just be OK and get back to school after their quarantine period and come back and be learning with us again."

After a quick chat with Romel about whether the class did any group work on the days in question (they didn't, which Hodges said is a relief, because it complicates his process), he headed off to the next classroom.

In all, 14 students will be quarantined as a result of exposure to this coronavirus case.

It's a lot, Hodges said, but it's a far cry from the number of quarantines stemming from a single day last month when 15 students tested positive, and each of them had several close contacts.

Making phone calls to families informing them their child will need to stay home from school for up to two weeks is not an enjoyable part of the day, for him or the families, said Hodges, but he's gratified to play a role in mitigating the extent of the pandemic.

This story is from a reporting partnership that includes WCMU, NPR and KHN.

You've Added Your Kids to Your Health Plan. What About Mom?

KFF Health News, May 13, 2021

California would be the first state to extend commercial health insurance benefits to dependent parents.

This article was published on Thursday, May 13, 2021 in Kaiser Health News.

By Samantha Young

SACRAMENTO — When Laura Chavez's 74-year-old mom needed eye surgery last month, Chavez paid cash for the procedure.

The cost? $15,000 — and that was for just one eye. She couldn't afford both.

Her mom, Esperanza Chavez, doesn't qualify for Medicare because of her immigration status. And she can't find a private health insurance plan under $1,000 a month.

"We're constantly having to make decisions based on costs rather than 'Is this medication really going to help keep you alive and healthy?'" said Laura Chavez, 41, a San Franciscan whose mother has diabetes. "It's just unfair to have to think about it that way."

Now a California lawmaker is pushing a bill that would require private health plans regulated by the state to extend coverage to some subscribers' parents. Business groups and others fear the legislation could jack up insurance premiums, but the bill has strong backing from health advocacy and immigrants' rights organizations, as immigrants make up a sizable portion of California's uninsured population.

Policyholders can already add children up to age 26 to their health plans — a benefit available nationally under the Affordable Care Act. But California would be the first state to extend the benefit to dependent parents, who are expensive to cover because they are older and sicker than the overall population, health experts say.

"This is groundbreaking and, quite frankly, a shift in the paradigm about the way we think about people getting healthcare," said Assembly member Miguel Santiago (D-Los Angeles), author of AB 570. "The bottom line is we want everybody to get healthcare, and we will fight every angle to ensure that people get adequate healthcare."

Many states have experimented with how to cover America's roughly 33.2 million uninsured people, about 400,000 of whom are 65 or older. California's income-eligible children can receive public health insurance regardless of their immigration status, New Jersey parents can cover a dependent child up to age 31, and Floridians can cover their kids up to age 30 so long as they aren't married or don't have dependents of their own.

One group that would benefit from California's legislation, backers say, would be green card holders who haven't met the five-year waiting period to qualify for Medicare and Medicaid, and those here without legal permission.

While striving to cover parents is a laudable goal, said Sherry Glied, a former assistant secretary at the U.S. Department of Health and Human Services during the Obama administration, employers could face higher insurance premiums.

"This is an expensive population, and it's also susceptible to real risks," said Glied, now dean of New York University's Robert F. Wagner Graduate School of Public Service.

Glied fears some people would abuse the coverage. For instance, she said, someone could bring an ailing parent into the country on a tourist visa, sign them up on their employer's health plan and arrange for the treatment they need.

California already gives income-eligible unauthorized immigrants up to age 26 full benefits from Medi-Cal, the state's version of Medicaid for low-income people. Lawmakers are considering separate proposals to further broaden Medi-Cal eligibility. One bill targets undocumented immigrants age 65 and up, and another would make all Californians eligible regardless of age or immigration status. Similar efforts have failed repeatedly over the past several years because of cost concerns, but California now has a $75.7 billion budget surplus.

Unlike the Medi-Cal measures, which rely on state funding, the bill authored by Santiago, working with California Insurance Commissioner Ricardo Lara, would transfer the cost onto employers and insurance companies. It would allow parents or stepparents — regardless of age — whose children claim them as dependents on their taxes to be added to private health plans regulated by the state. They include job-based plans and those purchased on the open market or through Covered California.

Employer-sponsored plans regulated by the federal government would not be subject to the bill.

The Assembly Health Committee has approved the bill, which needs to clear the Assembly Appropriations Committee before heading to the full Assembly for a vote.

It's hard to pinpoint how many Californians could benefit from the measure. Nationwide, about 3.4 million people were claimed as dependents on their children's tax returns in 2019, and an estimated 400,000 of them lived in California, according to an analysis by the California Health Benefits Review Program.

The overwhelming majority of those parents already have health coverage through Medicare or Medicaid, the analysis concluded, leaving 20,000 to 80,000 Californians who could benefit.

Despite the relatively small number, California employers say this mandate would raise premiums by $200 million to $800 million a year, depending on how many people signed up.

"Small employers will be forced to reassess how much they can contribute to employees' dependent premiums," Preston Young, a policy advocate at the California Chamber of Commerce, told lawmakers at a recent Assembly Health Committee hearing.

Lara, California's insurance commissioner — whose parents were once undocumented immigrants — said the bill would help the poorest of the Golden State's families, giving those with no other options "substantial peace of mind."

"When we needed care as children, our parents were always there for us," Lara said. "As our parents age, a lot of us in turn have become their caretakers."

Chavez finds herself in the role of caretaker to her children and her mother. She has insurance for herself and her two daughters through her employer, the nonprofit organization Challenge Day.

But she can't afford to buy a comprehensive insurance plan for her mom on the open market. A bare-bones policy, Chavez said, costs more than $1,000 a month because her mom has preexisting conditions. She doesn't qualify for Medicare or Medicaid because she is in the United States without authorization.

If Chavez could add her mom to her job-based policy, she wouldn't have to pay cash for her mom's needs, and the whole family could share one deductible and one cap for out-of-pocket costs, she said.

"It would bring significant financial relief," Chavez said. "Every month, there are charges we have to budget for and pay for. God forbid she has to go to the emergency room."

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Healthcare Foundation.

Samantha Young: syoung@kff.org, @youngsamantha

Don't Eat the Yellowstone Snow: Elite Ski Resort Aims to Turn Sewage Into Powder

KFF Health News, May 12, 2021

The Yellowstone Club, a ski and golf resort just north of Yellowstone National Park, has asked the Montana Department of Environmental Quality for a permit to allow it to use wastewater for snowmaking operations on its ski slopes. 

This article was published on Wednesday, May 12, 2021 in Kaiser Health News.

By Justin Franz

An exclusive Montana resort wants to turn sewage into snow so that its rich and famous members can ski its slopes in a winter season that’s shrinking because of climate change.

The Yellowstone Club — a ski and golf resort just north of Yellowstone National Park that counts Bill Gates, Justin Timberlake and Jessica Biel among its members — has asked the Montana Department of Environmental Quality for a permit to allow it to use wastewater for snowmaking operations on its ski slopes.

About a dozen other ski areas across the U.S. have used wastewater to make artificial snow before, but the Yellowstone Club would be the first in Montana. The technique has also been used in Europe and Australia.

Officials at the club say the program would not only ensure the slopes can open on time, usually in late November and early December, but also replenish the area’s watershed and keep streams running longer into the season. And it would allow the growing Big Sky resort area to handle its increasing wastewater volumes.

“It’s an outside-the-box-idea,” said Rich Chandler, environmental manager for the club. “But it also checks a lot of boxes.”

Is it a safe plan for the rich and famous who will occasionally ingest it when they wipe out on the slopes? The short answer from state officials is yes. The method is safe for people and the environment as long as there is close monitoring to ensure contamination levels stay within standards, according to an environmental analysis.

But, the state officials said, that analysis did not study potential pollutants for which there are no environmental standards in wastewater, such as traces of prescription drugs.

A similar effort to turn wastewater into snow was controversial at the Arizona Snowbowl ski resort near Flagstaff. To combat snowless winters there, the resort in the early 2000s purchased wastewater from Flagstaff and pumped it from the treatment plant to the ski area, where it would be turned into snow and sprayed onto the San Francisco Peaks.

That drew protests from the Hopi Tribe, which said the artificial snow posed risks to public health and the environment and would desecrate a mountain it considers sacred. The tribe lost a legal challenge to prevent the Arizona ski area from moving ahead with the plan. In December 2012, the ski area fired up its snow guns and started making powder.

During the legal fight, environmental groups, including the Center for Biological Diversity, raised specific concerns about how wastewater can reduce local aquatic populations and cause some male fish to take on female appearances and reproductive traits.

Wastewater’s effect on human health also raises concerns. Although modern water treatment can eliminate many pollutants — and, in some instances, prepare that water for human consumption — some elements still escape the process, specifically pharmaceuticals. The research is in its infancy, but a 2017 study by the United Nations Educational, Scientific and Cultural Organization found that only half of the pharmaceutical compounds were removed in the water treatment process. It noted that evidence suggests some of the chemicals could affect human reproductive systems, too, just as studies have shown on aquatic life.

“Modern wastewater treatment plants mostly reduce solids and bacteria by oxidizing the water. They were not designed to deal with complex chemical compounds,” said Birguy Lamizana-Diallo, program management officer at the United Nations Environment Program and an expert on wastewater treatment.

Officials in Montana are quick to point out differences between their plan and what happened in Arizona. For one, the ski area near Flagstaff often makes all its snow from treated wastewater, whereas the Yellowstone Club will use it, at least initially, on only about 10% of the 2,700 acres of skiable terrain and usually only in October and November to create a base layer for its ski runs. Come December, most of the snow people would be skiing and riding on would be natural.

But perhaps the biggest difference between the two projects is the level of support the Yellowstone Club has for its plan, which is backed by environmental and conservation groups including the Gallatin River Task Force, the Association of Gallatin Agricultural Irrigators and Trout Unlimited.

The idea to turn Big Sky’s wastewater into snow has been brewing for more than a decade and emerged from a collaboration between the Yellowstone Club and other local groups concerned about depleted snowpack due to climate change, which could starve area creeks and streams of water later in the season.

Yellowstone already uses treated wastewater to hydrate its golf courses, and in 2011 it teamed up with the Montana DEQ and the Gallatin River Task Force to see if they could safely turn the same water into snow. Chandler, the club’s environmental manager, said they successfully turned a half-million gallons of wastewater into 2 acres of snow about 18 inches deep.

Kristin Gardner, executive director of the Gallatin River Task Force, said the snowmaking process effectively re-treats the wastewater by blasting it out of a filtered snowmaking gun that atomizes the water.

“It’s an added layer of security for the human health side of things,” Chandler said.

Chandler said the information gathered from the pilot study forms the core of the ski club’s application with the Montana DEQ. A draft permit tentatively approving the project has been issued by the state agency, and a final decision is expected later this year.

Officials at DEQ said that the wastewater used to make snow will be treated to the highest standards possible and that they can issue permits only to projects that will not pollute state waters. But the effect of pharmaceuticals remains uncharted territory. Amy Steinmetz, public water supply bureau chief, said that neither the DEQ nor the U.S. Environmental Protection Agency has standards to specifically treat wastewater for pharmaceuticals.

“The science is still emerging on that,” she said.

If the DEQ does issue its final permit this year, the Yellowstone Club will most likely begin turning wastewater into snow in late 2022. It would then be required to post signage advising skiers not to consume the snow. Similar signage can be found at Arizona Snowbowl.

Chandler said that the Yellowstone Club is proud of the collaborative work and that, ultimately, the process will benefit the community and watershed. Making more snow and increasing the snowpack during the winter, Chandler estimates, will increase the summer runoff in area creeks by about 19 days, a big win in the increasingly arid West. It’s also better than the alternative, he said: treating the wastewater and then just pushing it directly into the Gallatin River.

“It’s not like the Earth is producing more water, so we have to use what we have effectively,” he said.

COVID Fears Keep Many Latino Kids Out of Classrooms

KFF Health News, May 12, 2021

Latinos have been hit disproportionately hard by COVID, and many families are opting out of in-person learning.

This article was posted on Wednesday, May 12, 2021 in Kaiser Health News.

By Heidi de Marco  

EAST LOS ANGELES — For the past year, 13-year-old twins Ariel Jr. and Abraham Osorio have logged on to their online classes from their parents' flower shop. Ariel nestles in a corner among flowers, bows and stuffed animals. Abraham sets up on a small table in the back, where his dad used to work trimming flowers and keeping the books.

It's not ideal for learning: It's loud. It's cramped. It's bustling with people. Still, when the twins' mother, Graciela Osorio, recently had the chance to send her kids back to Brightwood Elementary in Monterey Park, California, she decided against it.

"After what we went through with their father, I'd rather keep them at home where I know they are safe," said Graciela, 51. "There's only a month left. It doesn't make sense that they return for such a short time."

The boys' father, Ariel Osorio Sr., 51, died of COVID-19 in January, four weeks after a trip to Mexico to visit his mother. He fell ill quickly and wasn't able to say goodbye to his children.

"I miss his presence," Abraham said. "I'm used to seeing him sit in his chair working, but not anymore."

Latinos have been hit disproportionately hard by COVID, and many families are opting out of in-person learning.

In California, Latinos make up 39% of the state's population but account for 47% of COVID deaths, according to the state Department of Public Health. Nationally, their risk of death from COVID is 2.3 times higher than that of whites.

Latinos are vulnerable to the highly transmissible coronavirus because they are more likely than non-Hispanic whites to work essential jobs that expose them to the public, said David Hayes-Bautista, a professor of public health and medicine at UCLA and co-author of a January study on this topic. They are more likely to lack health insurance, which may make them less likely to seek medical care, he said. And they are more likely to live in multigenerational households, which means the virus can spread quickly and easily within families.

"Many of them are essential workers and the breadwinners for their families and don't have the luxury of telework, of physical distancing and self-isolation," said Alberto González, a senior health strategist at UnidosUS, a Latino advocacy group in Washington, D.C.

The Osorio family has lived in a multigenerational household since Ariel died, and Graciela had to keep other family members in mind when deciding whether to send her boys back into the classroom.

In February, Graciela and the twins moved in with her 74-year-old mother, Cleotilde Servin, in East Los Angeles. Ten people now share the roughly 1,000-square-foot home, squeezing by one another in the kitchen every morning.

Graciela's mother and the other adults in the home have been vaccinated, but the children haven't. Even though she instructs her sons to wear their masks and doesn't allow them to visit friends, she's terrified of what could happen if her kids caught the virus at school and brought it home.

"My mother is active and takes vitamins, but it still worries me," Graciela said. She got COVID from her husband and gave it to her sister and niece. "I don't want anyone else to get sick," she said.

State and local education officials don't have recent data on in-person attendance by race, but an EdSource analysis of California Public Health Department data from February shows that white students were more likely to attend school in person than other students. The analysis showed that 12% of Latinos were attending in-person classes at least some of the time, compared with 32% of whites and 18% of all students.

The Los Angeles Unified School District, the second-largest in the country, serves more than 600,000 students and reopened for in-person learning in mid-April. Only some campuses are open, mostly elementary schools, and are running on hybrid schedules, combining on-campus classes with distance learning.

"We've upgraded the air filtration systems in every classroom, reconfigured school facilities to keep all at a school appropriately distanced, doubled the custodial staff, and we'll provide weekly COVID testing at school for every student and staff member," district superintendent Austin Beutner said in his weekly recorded video update on March 22.

In a statement released May 4, Beutner said 40% to 50% of elementary school students are now back in schools in "more affluent" communities compared with roughly 20% in low-income communities.

"We see the greatest reluctance for children to be back in schools from families who live in some of the highest-needs communities we serve," he said.

Brightwood Elementary is a K-8 school with 870 students, about half of whom are Asian American and 40% Latino, said principal Robby Jung. Just 15% of students are back on campus, he said, and, of those, about one-third are Latino.

For the Osorio family, the overriding reason the eighth grade twins are not back at Brightwood is fear.

Like so many other Latino families — roughly 28,000 Latinos have died of COVID in California — they are reeling from the grief and trauma that the disease has already wrought, and the fear of what it could do if it struck again.

"The boys are seeing a therapist to deal with their dad's death," Graciela said. "I know I should probably talk to someone, too."

With the memory of her husband's death still so fresh that she can't speak of him without crying, Graciela is still adjusting to the emotional toll, and to the day-to-day realities of running a flower shop by herself.

Originally from Guerrero, Mexico, she started Gracy's Flower Shop with her husband in 1997. Ariel took care of the finances at home and at the shop and was the better English speaker of the two.

"Now being alone with the boys, it's more difficult to keep up," she said.

During the COVID lockdowns, the boys joined the couple at the shop. Her husband sat next to their children while they attended school online, helping with their homework and acting as the main contact for the school.

"They were always with us," Graciela said. "They grew up in the flower shop, so they didn't have a problem setting up their school stations there."

Brightwood reopened its doors April 12, offering in-person learning two days a week for a few hours a day, with the rest of the sessions online. Graciela said the limited schedule doesn't work with her role as the family breadwinner.

"I would have to take them to school, pick them up for lunch and then bring them back," she said. "I can't do that. I have to work."

But mostly she's keeping them off campus because she doesn't want to lose another family member. She said she knows online classes aren't the same as in-person instruction "but they have been keeping their grades up," she said. "I thank God I have good boys. They listen. They understand why I kept them home."

The last day of school is May 28. Ariel and Abraham said they're looking forward to high school in the fall. Still dealing with their father's death, the boys, who are shy and reserved by nature, are torn between returning to school in person or continuing their classes online.

"We might go back," Abraham said. "For now, we keep each other company."

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Healthcare Foundation.

Heidi de Marco: heidid@kff.org, @Heidi_deMarco

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