By Gretchen McKay, Pittsburgh Post-Gazette

PITTSBURGH — Sarah Tuthill has a pretty straightforward philosophy to assemble a food board for parties: Keep things simple, but also make your spread memorable by arranging the food and drinks thoughtfully.

The made-to-order cheese and charcuterie boards crafted at her tiny storefront and commercial kitchen, EZPZ Gatherings in Aspinwall, Pennsylvania, are a case in point.

Not only are the cured meats, seasonal fruits, homemade spreads and various cheeses drool worthy, but they’re also artfully designed to make a table look pretty.

Richly layered and vibrant, they boast a contrasting mix of colors and textures. Some are traditionally arranged on wooden boards, but depending on the theme or season, Tuhill also might add a touch of whimsy by using woven harvest baskets or wooden bowls. Or she might opt for modern and minimalistic by placing pieces on acrylic or melamine boards.

As she details in her recently released how-to book, “Gathering Boards: Seasonal Cheese and Charcuterie Spreads” (Rowman & Littlefield, $27.95), the Aspinwall native and Penn State University grad also has been known to line up crackers on the vintage shirt-sleeve ironing board she found in an antique store. Big on repurposing, she also likes to tuck candles, jars of olives or flowers into a primitive wooden tool caddy.

“A lot of it comes down to social media,” Tuthill says of her distinctive displays. “Everyone is posting these beautiful pictures, and the bar is raised. You can’t just slap things on a [plain] board.”

Though she has always been a foodie and has dabbled in floral and interior design, Tuthill didn’t set out to be a food entrepreneur after graduating from college with a degree in advertising. Most of her career has been in communications, including many years as a freelance writer.

She only started toying with the idea of EZPZ Gatherings around 2018 because she longed to write a book and wanted to do something to “get my hands dirty” by doing it professionally.

“I love writing, but was drawn to doing something more hands-on, creating something tangible, but still creative,” she says.

While she has always loved to entertain and was known among family and friends for making beautiful hors d’oeuvres and other spreads, Tuthill knew she didn’t want to be a full-service caterer.

“So I zeroed in on appetizers,” she says, officially opening EZPZ Gathering in December 2019, just before the charcuterie craze took off during the COVID-19 pandemic.

Initially, Tuthill worked out of the food incubator kitchen her friend, Josephine Caminos Oria, opened in 2013. Then the pandemic hit “and I was done before I even started,” she says with a rueful laugh.

Back to the drawing board

No one would have blamed her if she threw in the towel. But Tuthill dug in, using the downtime to continue honing her packaging skills and further educate herself about cheese varieties, flavors, textures and production methods.

“It was a blessing in disguise,” she says.

Because so many were stuck at home and in search of hobbies, it also allowed her to start teaching online classes. “So many Zoom book clubs wanted cute snacks,” she remembers. “People wanted to learn and experience something rather than just sitting around.”

The public’s desire to create beautiful gathering boards at home only grew once pandemic restrictions were lifted and the charcuterie board craze exploded.

Today, the one-room storefront Tuthill took over in 2022 — one of the first local niche businesses focused on creating boards for dinner parties, graduation parties and other celebrations — now doubles as a “boarding school” in which fellow Pittsburghers can take workshops to learn the art of cheese and charcuterie styling.

As she notes in her book, “The truth is, you don’t have to be a culinary genius to throw a good party. In fact, you don’t have to know how to cook at all. By merely presenting food and drinks in an inventive, beautiful or whimsical way, you can turn the ordinary into the extraordinary.”

Many of her ingredients are sourced locally at specialty shops (Pennsylvania Macaroni Co. is a favorite haunt) but she also fills her boards with items from chain grocery stores like Trader Joe’s. “It’s a little bit of everything, depending on the season.”

Tuthill was approached to write her book on boards in 2022 in the most Pittsburgh manner. A woman saw a story about Tuthill’s shop and her background as a writer in a local paper. “And lo and behold, she cut it out like grandmas do and sent it to her son,” who works for Rowman & Littlefield Publishing. And the rest, she says, “is history.”

She closed her shop at the beginning of 2023 to focus on the project, and did most of the writing last summer. The tome hit bookshelves on May 13, and can be found on Amazon and in Barnes & Noble.

Meant as a “how-to-do-it” for people who like to entertain, the book — beautifully photographed by Kari Hilton and sprinkled throughout with family stories — includes specific suggestions for each season, along with styling tips. The section on summer gathering boards, for instance, includes “Picnic in the Park” and “Lakeside Snackle Box” boards while fall features a “Game Day Tailgate Box” and a Halloween-inspired “CharBOOterie.”

Along with a handful of recipes for go-to dips and sides, Tuthill offers tips on serving temperatures, knife selection and serving sizes. She also includes suggestions for wine pairings and decor, along with tips on glassware, lighting, party flow and post-party clean-up.

For an end-of-summer picnic, Tuthill recommends focusing on foods that are easy to pack and eat, and can withstand some heat, such as the skewers and Chautauqua Salad featured below.

“And of course a [pre-made] cocktail or fancy drink is always fun,” she says. She suggests using mason jars for a summer sangria because they’re super cute and close tightly.

“You just pour ice and vodka over the top,” she says, “and it’s all self contained.”

Summer on a Stick

Serves 6, PG tested

Skewers make for stress-free (and mess-free) picnicking, and take the guesswork out of what goes with what. This summer spin on Caprese salad swaps out the tomato for slices of juicy peach.

6 slices chilled prosciutto (slightly thicker slices work best)

1 ripe peach, sliced

6 small mozzarella balls (cherry-sized)

6 fresh basil leaves

Skewers or toothpicks

1. Fold prosciutto into ribbons: Fold a single slice in half longways, then gently fold it back and forth like an accordion. Pinch the bottom while fanning out the folds.
2. Thread a piece of peach onto a toothpick, followed by mozzarella ball, basil leaf (folded in half or into quarters if large). Finish with a prosciutto ribbon, then place onto a serving platter. Repeat with remaining ingredients.

— Sarah Tuthill

Mason Jar Sangria

Serves 2, PG tested

Mason jars make the perfect vessel for individual cocktails-to-go and can be found in just about any supermarket or craft store.

1 ripe peaches, sliced

1 ripe plumb, sliced

1/2 cup berries

3 ounces vodka

6 ounces dry white wine

6 ounces lemonade

1 12-ounce can sparkling water or club soda

1. Fill 2 half pint jars with seasonal fruit (You can use the same ones you’re serving for your picnic!)
2. Top each with a shot of vodka and 2 shots of white wine. (I prefer a dry white like sauvignon blanc in the summertime.) Add a couple ounces of something sweet like lemonade or lemonade concentrate.
3. Screw on the lids, give them a shake and let the jars sit in the refrigerator for a few hours or overnight.
4. Pack them up and when you’re ready to enjoy, top off with chilled soda water and add a festive straw.

— Sarah Tuthill

Chautauqua Salad

Serves 2-4, PG tested

“This salad is a key component of our family’s favorite summer meal” in Chautauqua, N.Y., writes Tuthill.

There, it’s almost always served alongside nothing more than corn on the cob and a crusty loaf of bread on nights when it’s too hot for the oven or grill. But it’s also a refreshing salad that’s perfect for a picnic.

3/4 cup red wine vinegar

1/2 cup granulated sugar

1/4 cup virgin olive oil

1 large cucumber, peeled and sliced thinly

2 large tomatoes, sliced

1. Prepare dressing: In a shallow bowl, dissolve sugar in the red wine vinegar. Whisk in the oil.
2. Gently fold in tomatoes and cucumbers and allow to sit, at room temp, for at least 20 minutes.

— Sarah Tuthill

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©2024 PG Publishing Co. Visit at post-gazette.com. Distributed by Tribune Content Agency, LLC.

By Aaron Bolton, MTPR and KFF Health News

Missoula is one of Montana’s largest cities but is surrounded by rural mountain communities where cattle ranching is king. Despite the latitude and altitude, in recent years this region has experienced punishing summer heat waves.

It has been difficult for residents to adapt to the warming climate and new seasonal swings. Many don’t have air conditioning and are unprepared for the new pattern of daytime temperatures hovering in the 90s — for days or even weeks on end. Dehydration, heat exhaustion, heatstroke, and abnormalities in heart rate and blood pressure are among the many health complications that can develop from excessive exposure to high temperatures.

It can happen anywhere and to anyone, said Missoula firefighter Andrew Drobeck. He remembers a recent 911 call. The temperature that day had risen to over 90 degrees and a worker at a local dollar store had fainted. “She’s sensitive to the heat. Their AC wasn’t working super good,” Drobeck said. “I guess they only get a 15-minute break.”

Drobeck said many of the heat calls his department receives are from seniors who struggle to stay cool inside their older homes. Montana’s population is among the oldest in the country. About 1 in 4 residents are over 60. Those over 65 are especially vulnerable to heat-related illness, according to the Centers for Disease Control and Prevention. As people age, their bodies don’t acclimate to heat as well as they did when they were younger, including not producing as much sweat.

In July, a heat dome that settled over much of the western U.S. baked the region and shattered two types of temperature records: daily highs, and number of consecutive days over 90 degrees. Although the Northwest, including western Montana, is typically cooler, the region experienced record-breaking heat this summer.

Emergency responders like Drobeck have noticed. Drobeck says 911 calls during heat waves have ticked up over the last few summers. But Missoula County officials wanted to know more: They wanted better data on the residents who were calling and the communities that had been hardest hit by the heat. So the county teamed up with researchers at the University of Montana to comb through the data and create a map of 911 calls during heat waves.

The team paired call data from 2020 with census data to see who lived in the areas generating high rates of emergency calls when it was hot. The analysis found that for every 1 degree Celsius increase in the average daily temperature, 911 calls increased by 1%, according to researcher Christina Barsky, who co-authored the study.

Though that may sound like a small increase, Barsky explained that a 5-degree jump in the daily average temperature can prompt hundreds of additional calls to 911 over the course of a month. Those call loads can be taxing on ambulance crews and local hospitals.

The Missoula study also found that some of the highest rates of emergency calls during extreme heat events came from rural areas, outside Missoula’s urban core. That shows that rural communities are struggling with heat, even if they get less media attention, Barsky said. “What about those people, right? What about those places that are experiencing heat at a rate that we’ve never been prepared for?” she said.

Barsky’s work showed that communities with more residents over 65 tend to generate more 911 calls during heat waves. That could be one reason so many 911 calls are coming from rural residents in Missoula County: Barsky said people living in Montana’s countryside and its small towns tend to be older and more vulnerable to serious heat-related illness.

And aging in rural communities can pose extra problems during heat waves. Even if it cools off at night, an older person living without air conditioning might not be able to cope with hours of high temperatures inside their home during the day. It’s not uncommon for rural residents to have to drive an hour or more to reach a library that might have air conditioning, a community center with a cooling-off room, or medical care. Such isolation and scattered resources are not unique to Montana. “I grew up in the Upper Peninsula of Michigan,” Barsky said. “There are no air-conditioned spaces in at least 50 miles. The hospital is 100 miles away.”

Heat research like the Missoula study has focused mostly on large cities, which are often hotter than outlying areas, due to the “heat island” effect. This phenomenon explains why cities tend to get hotter during the day and cool off less at night: It’s because pavement, buildings, and other structures absorb and retain heat. Urban residents may experience higher temperatures during the day and get less relief at night.

By contrast, researchers are only just beginning to investigate and understand the impacts of heat waves in rural areas. The impacts of extreme heat on rural communities have largely been ignored, said Elizabeth Doran, an environmental engineering professor at the University of Vermont. Doran is leading an ongoing study in Vermont that is revealing that towns as small as 5,000 people can stay hotter at night than surrounding rural areas due to heat radiating off hot pavement. “If we as a society are only focused on large urban centers, we’re missing a huge portion of the population and our strategies are going to be limiting in how effective they can be,” Doran said.

Brock Slabach, with the National Rural Health Association, agrees that rural residents desperately need help adapting to extreme heat. They need support installing air conditioning or getting to air-conditioned places to cool off during the day. Many rural residents have mobility issues or don’t drive much due to age or disability. And because they often have to travel farther to access health care services, extra delays in care during a heat-related emergency could lead to more severe health outcomes. “It’s not unreasonable at all to suggest that people will be harmed from not having access to those kinds of services,” he said.

Helping rural populations adapt will be a challenge. People in rural places need help where they live, inside their homes, said Adriane Beck, director of Missoula County’s Office of Emergency Management. Starting a cooling center in a small community may help people living in town, but it’s unrealistic to expect people to drive an hour or more to cool off. Beck said the Missoula County Disaster and Emergency Services Department plans to use data from the 911 study to better understand why people are calling in the first place.

In the coming years, the department plans to talk directly with people living in rural communities about what they need to adapt to rising temperatures. “It might be as simple as knocking on their door and saying, ‘Would you benefit from an air conditioner? How can we connect you with resources to make that happen?’” Beck said.

But that won’t be possible for every rural household because there simply isn’t enough money at the county and state level to pay for that many air-conditioning units, Missoula County officials said. That’s why the county wants to plan ahead for heat waves and have specific protocols for contacting and assisting vulnerable rural residents.

“Ideally we’d be in a situation where maybe we have community paramedics that can be deployed into those areas when we know that these events are going to happen so they can check on them and avoid that hospital admission,” Beck explained. She added that preventing heat-related hospitalizations among rural residents can ultimately save lives.

This article is from a partnership that includes MTPR, NPR, and KFF Health News.

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Shalina Chatlani, Stateline.org

Mercedes Dodge was raised by first-generation immigrant parents from Peru in a modest home in a rural part of southeastern Texas, where there weren’t many health care providers. Sometimes they had to travel to Houston, over an hour and a half away, to get basic health care.

Partly because of that experience, Dodge became a physician assistant. Since 2008, she has provided psychiatric and primary care services to adults and children, many of whom come from communities like hers.

Dodge, who now lives in Austin, Texas, has built up a loyal base of patients, including many who are part of military families. But when any of them move out of Texas, she has to stop treating them, even via telehealth, unless she gets a license to practice in that state.

“I do my best and collaborate with them, but they already feel alone,” Dodge told Stateline. “I wonder, ‘Why can’t I be the glue? Why can’t I step over state lines and provide the care that they deserve?’”

Physician assistants, commonly known as PAs, are licensed clinicians who have a master’s degree and can practice in a range of specialties. Their three years of training typically includes 3,000 hours of direct patient care, and they are an increasingly critical part of the health care workforce, which in many states isn’t keeping pace with a growing and aging population.

By 2028, the nation as a whole will be short some 100,000 critical health care workers — doctors, nurses and home health aides — according to a new report from Mercer, a management consulting firm.

The looming shortage is one reason why 13 states have joined the PA Licensure Compact, a multistate agreement that allows PAs to practice in any participating state, without having to get an additional license.

Delaware, Utah, and Wisconsin enacted the legislation in 2023.

Colorado, Maine, Minnesota, Nebraska, Oklahoma, Tennessee, Virginia, Washington and West Virginia followed suit this year. Ohio became the latest state to enact it in July.

The PA compact is one of several that have emerged over the past several years, especially since the expansion of telehealth services during the COVID-19 pandemic. There are similar compacts for doctors, nurses, occupational therapists and social workers.

One challenge has been completing the background checks required for providers who want to practice under the compacts. For example, Pennsylvania’s participation in the nursing and medical licensure compacts was delayed as the FBI denied the state access to its fingerprint database. They later reached an agreement on how to move forward.

The PA compact grants a “privilege to practice,” allowing PAs to practice in participating states without getting an additional license. The nursing compact gives nurses a multistate license, while the physician licensure compact just expedites the licensing process.

Some large states, such as California and New York, don’t participate in compacts for doctors, nurses, social workers or PAs. Some state lawmakers in those states say joining interstate compacts would reduce the quality of their states’ health care workforces, because other states require lower standards of education and training.

“We are proud that New York’s high standards have resulted in our state being an international destination in health care,” New York Democratic Assemblymember Deborah Glick wrote in an op-ed last year for the Times Union newspaper in Albany. “While it’s possible that it may make sense at some point for New York to join a licensure compact, we should pause before we allow a quick fix to lower New York’s standards.”

In other states, such as Texas, doctors who have succeeded in limiting the “scope of practice” of Texas PAs oppose the compact because they believe it might allow out-of-state PAs to go beyond those limits for their patients who reside in Texas. The American Medical Association and its state affiliates argue that allowing PAs to provide care traditionally provided by physicians puts patients at risk.

Dr. G. Ray Callas, president of the Texas Medical Association, said he values the role that physician assistants play in the health care system, but that his organization objects to any measure that might “give PAs authority to do more in health care than they are trained to do.”

“TMA is not opposed to appropriate, expedited licensure, but we do oppose these compacts when they expand scope of practice and create a patient safety issue, lowering the standard of care in Texas,” Callas said in a statement.

Supporters of the compact say that fear is unfounded, and that the agreement has no effect on state scope of practice rules. The model legislation for the compact specifies that PAs who treat patients in another state can only do so “under the Remote State’s laws and regulations.”

Last year, the Texas legislature considered legislation to join the PA compact, but it died in the state Senate.

Monica Ward, president of the Texas Academy of Physician Assistants, said her group will keep pushing for the bill.

“In the rural areas of Texas, there is absolutely a need and a shortage of health care providers,” Ward said. “We’re surrounded by multiple states, so it’s nice to be able to reduce those administrative burdens, paperwork and possibly fees for those that are looking to work in Texas.”

It will take 18 to 24 months for the compact to become fully operational and for PAs to apply for the privilege to practice in other areas. The compact commission also needs to create a data system to keep track of licenses.

This model of licensure may not have worked even five years ago, said Tennessee Republican state Rep. Jeremy Faison, who sponsored his state’s compact legislation.

“It would have had major pushback and people would have asked, ‘What are you trying to do? We like to control what we’re doing in our state,’” said Faison. “But because we live in a global society and people move around so much more than ever before, I think the average person has embraced this.”

Faison told Stateline that for states such as Tennessee, which borders eight states, joining the compact makes economic sense because it will encourage people to move to the state.

Financial stability was 32-year-old Aneil Prasad’s motivation for getting a compact nursing license. He moved from New Orleans to Asheville, North Carolina, last year.

“It allows people to seek out better-paying jobs and move themselves ahead, buy houses and have better health and education and all that,” Prasad said. “And then the less competitive places are forced to raise their wages in order to attract people.”

After moving from Louisiana to North Carolina with his multistate license, Prasad said his wage increased from $21 an hour to $36 an hour. He notes that while the multistate license for nurses costs a bit more than a regular license, it would be much more expensive for him to apply for a new license in every state.

Since Texas hasn’t joined the PA compact, Dodge maintains active licenses in her home state as well as Alaska, California, Florida, New Mexico and Washington. She said the process to get them was expensive and time-consuming. Licenses can cost upward of $500 and can take three to nine months to obtain. Dodge said it’s been worth the trouble to help her patients, but she would appreciate an easier pathway.

“I got all these state licenses to follow my patients,” she said. “So when the PA compact license gets enacted in Texas, I hope it’s going to help me continue following my patients and I’ll be the glue that they need.”

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Stateline is part of States Newsroom, a national nonprofit news organization focused on state policy.

©2024 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By Sarah Foster, Bankrate.com

For 13 years, the 3% annual salary boost that Ricardo M. could count on every October felt like a beacon of stability and a nod that his loyalty as a plumbing supply salesman was being rewarded.

But in the aftermath of a post-pandemic inflation surge, those raises have since lost their luster. His grocery bills have doubled. The cost of filling up his Toyota 4Runner has jumped to $70 a week, and he’s had to dip into his savings to avoid taking on credit card debt. All the while, his pay increases have stayed the same.

“Inflation has taken it all,” says Ricardo, a California resident who requested that his last name be abbreviated, so he could speak freely about his employment situation. “I know costs are going up everywhere, and I understand that a business has to make money and stay profitable. But at the same time, don’t forget about the people who are bringing you business. I don’t make enough for the sales that I generate.”

Economists have celebrated inflation’s rapid dissent, and perhaps even more, the relatively little pain it’s caused the U.S. job market. For over a year now, wages have been rising faster than inflation as prices slow and the job market holds up, giving Americans an opportunity to recover the buying power that they lost after ultralow interest rates, supply shortages and a stimulus check-fueled spending boom combined to form the worst inflation crisis in 40 years.

But the race isn’t over yet. The past 16 months of “real” wage growth — as economists have called it — haven’t been enough to offset the 25 months where prices were rising disproportionately faster than Americans’ paychecks, according to a new analysis of Bureau of Labor Statistics data from Bankrate.

Bankrate’s 2024 Wage To Inflation Index

Since the beginning of the post-pandemic inflation surge in Jan. 1, 2021, prices have risen 20.0%, compared with a 17.4% increase in wages over the same period, Bankrate’s second-annual Wage To Inflation Index found.

Inflation feels akin to taking a pay cut, helping explain why Americans have been so downtrodden about the U.S. economy. Despite a half-century low unemployment rate at the time, the majority (59%) of Americans said in a Bankrate poll from December 2023 that they felt like the U.S. economy was in a recession.

Americans could even take these frustrations to the voting booth come November. Most adults (89%) say the economy will be an important factor in determining their vote, with two-thirds (62%) calling it very important, according to Bankrate’s Biden and Americans’ Personal Finances Survey from November 2023.

To be sure, some ground has already been recovered. Thanks to over a year of “real” wage growth, the current gap between wage growth and inflation (2.6 percentage points) marks major improvement from when it was at its widest in the summer of 2022 (3.9 points).

Yet, wages have recently lost some momentum. In Bankrate’s 2023 index, Americans’ paychecks were on track to fully recover from post-pandemic inflation by the fourth quarter of this year. Now, Americans’ paychecks are on pace to bounce back by the end of the second quarter of 2025, updates to Bankrate’s index for 2024 found.

The job market has cooled more than expected this year

Wages are taking longer to recover amid a faster-than-expected cooldown in the job market, which has already stripped workers of some of their bargaining power to ask for higher pay.

Between the second quarter of 2023 and 2024, prices rose 3.194%, nearly matching the 3.187% expected increase from last year’s index. Wages, however, rose 4.03% over the same period, after previously being on pace to grow 4.6%.

The labor market functions much like any other open market, economists say. Wage growth is often a reflection of who has the upper hand: the employer or the employee.

When there are too many job openings and not enough workers, employers compete for talent by lifting pay or offering big bonuses. But too few jobs for the number of people seeking work might make Americans hesitant to leave their current positions, wary about how greener other pastures might actually be in a more competitive job market.

If they’ve been on the hunt for a while, they might be inclined to settle for a job that pays less. And if they’re so inclined to negotiate for higher pay, they might not ask for as much.

“We’re seeing wage growth cool because demand is falling,” says Sam Kuhn, labor economist at Appcast, a recruiting platform. “In 2022, there were serious labor shortages. As that gap has closed, there’s just less incentive to give out higher wages or yearly raises.”

Illustrating the shift, there’s now just one job opening per every unemployed worker, the smallest ratio since April 2018, Bureau of Labor Statistics data shows. Employers have created an average 96,000 jobs in the private sector over the past three months, a massive slowdown from a three-month moving average of 203,000 in March. The hiring rate, meanwhile, has plunged to levels that are even lower than they were before the pandemic. Unemployment is now the highest since before the pandemic.

ADP’s Chief Economist Nela Richardson has watched wage growth for job changers dip from a high of 16.4% in June 2022 to the most recent level of 7.3%, according to data that her firm collects. Americans who’ve stayed at their current positions, meanwhile, saw their pay increase 4.8% for the second month in a row, ADP data also shows. In the leisure and hospitality sector, Richardson says she’s starting to notice that workers are accepting new positions for less pay than they were making previously — echoing trends from before the pandemic and painting a picture of a slowing labor market.

“There’s a lot of reasons workers switch jobs that aren’t tied primarily to compensation,” she adds. “It could be a better shift, a better team, a better location.”

What happens next for the U.S. job market can have grave implications for Americans’ prospects of catching up. In June, economists projected that job growth over the next year would average 115,000 jobs a month, Bankrate’s quarterly Economic Indicator Survey found. That would represent an even sharper slowdown in labor demand, with job growth currently averaging 197,000 over the past 12 months.

A cooling economy means less inflation, but slower wage growth, too, setting Americans back in their game of catch up. Richardson says a valid concern is whether their wages will recover at all.

“Will workers make up the ground lost when real wages weren’t growing with inflation? From what I see in key sectors, the answer is not likely,” Richardson says. “It’s really about can the wage level remain above current inflation, to get a better picture for workers.”

Not all workers have lost ground to inflation

Some workers are even further ahead — or behind — in their race against inflation, depending on the specific industry in which they work.

Bankrate’s analysis found that pay has risen faster than inflation in two industries: leisure and hospitality (23.7%) and accommodation and food services (23.3%), compared with a 20% rise in prices from the start of 2021 to the end of June. Paychecks are furthest behind in education (13.6%), construction (14.1%) and financial activities (14.3%) during that same timeframe.

Meanwhile, after increasing at a faster rate than inflation in Bankrate’s 2023 Wage to Inflation Index, pay in the retail sector (up 19.4% since the beginning of 2021) has since fallen behind.

The industries where wage growth has boomed correspond with where labor demand was the strongest. At one point, a record 11.1% of jobs within the accommodation and food services sector and 10.9% of positions within leisure and hospitality were vacant, the most of any other industry. On the flip side, job opening rates in the industries with the slowest wage growth peaked at much lower levels, with construction at 5.4% and education hitting 4%, according to Bankrate’s analysis.

That’s not to say Americans in inflation-beating industries are feeling particularly better off. The average hourly earnings of workers in the financial activities sector ($45.73), for example, are more than two times as high as those in leisure and hospitality ($22.18).

The more money workers make, the better positioned they are to absorb higher prices in their budgets. Low-income households tend to spend more money on essentials that they can’t cut back on, whereas upper-income Americans have more options to free up cash, such as trimming discretionary spending or their savings contributions.

Workers making less than $50,000 a year (at 43%) were nearly twice as likely as those who earn $100,000 or more a year (24%) to feel that they’re living paycheck to paycheck, according to a Bankrate survey from July.

Americans working jobs in retail, leisure and hospitality and food services were also more likely to have lost their jobs during the pandemic, making it hard to say whether they’re truly better off today, says Elise Gould, senior economist at the independent Economic Policy Institute.

“Even if their wages have risen, it has been very hard for people to make ends meet on the kinds of wages that our labor market has been delivering over the last 50 years,” Gould says. “But the fact that people are struggling doesn’t mean that they didn’t experience real wage growth. Both things can be true.”

‘I don’t know if it’ll get as good as it was’

Robert Santy, a psychotherapist based in Connecticut, has taken on 20 extra clients in the four years since the pandemic. He says the decision was equal parts personal necessity and societal urgency.

For starters, every corner of Santy’s budget has grown more expensive. Car insurance for his family of five is costing him $10,000 a year. His monthly electric bills often range between $600-$800. His cell phone bill jumped by $40 a month, and even his grocery costs can easily reach $1,000 a week. He’s taken on longer hours simply to replace some of his lost income.

“It’s nickel and dime, nickel and dime, and everyone wants a piece of the pie,” he says. “My pie keeps getting smaller and smaller and smaller.”

But whether it’s lingering stress from the pandemic or financial anxieties surrounding inflation and recession fears, Santy says he’s been in no need for clientele over the past four years, either. He often takes calls from patients after hours and goes to his office on weekends to catch up on paperwork. He estimates that he gets about four cold calls a week from new, inquiring clients, whom he has to turn away because he doesn’t have enough room for them in his schedule.

“People are highly stressed, highly anxious, struggling financially. That leads to family squabbles, relationship issues,” he says. “You get the cable company, the electric company, the cell phone company, your mortgage goes up, your taxes go up. Any one thing might be manageable, but when it’s death by a thousand needles, that just wears on people over time.”

Contributing to his rising expenditures, his two youngest children are in college, while his oldest daughter is living at home on an extended job hunt after graduating two years ago. Him and his wife are now earning nearly $300,000 a year as a household, but they feel like they had an easier time getting by when they were in their early 20s, earning just $22,000 a year. Still feeling surprised by bills or unexpected expenses, he’s had to temporarily halt his retirement contributions.

“I’m certainly in better shape financially than I’ve ever been in my life, but I’m not where I thought I was going to be or where I think I should be,” Santy says. “It’ll get better, but I don’t know if it’ll get as good as it was. I realize everything goes up and up and up, but did it have to go up so much so quickly when I didn’t have time to adjust? It felt like it just happened overnight.”

Even if wages recover, inflation may have already damaged the American psyche

Americans look at inflation differently than economists. Analysts track annual rates of change in inflation to determine whether the U.S. economy is overheating, while the typical American consumer focuses on how much the items they see everyday have risen in cost.

Just 6% of the nearly 400 items the Bureau of Labor Statistics tracks are cheaper today than before the pandemic, a Bankrate analysis of inflation data shows. Key essentials that consumers regularly buy — like gasoline, groceries, utilities, rent and more — have risen at a faster rate than overall inflation. Car insurance, meanwhile, is up almost 50% since February 2020.

Inflation can have a profound effect on consumer psychology. Nearly half of adults (47%) say money has a negative impact on their mental health at least occasionally, Bankrate’s Money and Mental Health Survey from May 2024 found. Almost two-thirds of them (65%) cited rising prices as a reason.

“It will require that workers continue to enjoy some restoration of buying power through real wage gains,” Hamrick says, referring to when Americans could start to feel better. “To the extent we see falling prices for goods within a fairly normal, not recessionary, economic environment, that would be helpful.”

Ricardo is already gearing up for his annual review next month. He’s preparing to make a case for why he deserves a bigger raise than usual, citing his sales numbers and translating how it adds to his company’s bottom line. He hopes to use the money to visit his five grandchildren, who live across the country in both Florida and Seattle.

But even if he doesn’t get the money he’s hoping for, he says he’s unlikely to quit. He hopes to retire within the next few years and is afraid of taking a pay cut by starting over somewhere else.

“I’m waiting for them to one day tell me, ‘Don’t worry, we’ll take care of you.’ That’s what you want to hear after 16 years,” he says. “Hopefully, I don’t get disappointed with what I’m going to hear.”

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Visit Bankrate online at bankrate.com.

©2024 Bankrate.com. Distributed by Tribune Content Agency, LLC.

Noah Haggerty | (TNS) Los Angeles Times

LOS ANGELES — A mind-bending hypothesis is gaining traction among scientists: The universe may be teeming with microscopic black holes the size of an atom, but with the mass of a city-sized asteroid.

Created just a split second after the Big Bang, these hypothetical black holes would whip quietly through the solar system roughly once every few years, traveling over a hundred times faster than a bullet.

Some have even argued that an immense explosion that flattened a Siberian forest in 1908 could have been the result of one of these micro black holes impacting Earth.

Now, researchers say they’ve figured out a way to test whether these cosmic bullets truly exist.

In a study published Tuesday in the journal Physical Review D, physicists at MIT say the presence of a tiny black hole speeding through the solar system could be identified by the gentle gravitational nudge it exerted on the Earth and other planets, which would alter their orbital paths by no more than a few feet.

The possibility of proving the existence of micro black holes is generating excitement among some astrophysicists because it could help them to explain a mystery that has taunted them for almost a century: the nature and composition of dark matter.

In the 1930s, astronomers started noticing anomalies in the way galaxies were moving. Lurking in the dark and empty expanse of intergalactic space, something was generating tremendous amounts of gravity to tug on the galaxies — yet it seemingly refused to interact with light or any other force.

Scientists found this mysterious gravitational tugging everywhere. In order to account for it, they hypothesized that it was being caused by invisible mass, or dark matter, that made up roughly 85% of all matter in the universe.

Some physicists have suggested dark matter may be made up of exotic undiscovered particles. Others, such as the MIT researchers, think dark matter probably is just regular matter that is extremely hard to detect. And black holes, the researchers say, are a prime example of the properties of dark matter.

“It’s just fantastic that the most conceptually conservative response is to say, ‘It’s just super tiny black holes that were made a split second after the Big Bang,’” said David Kaiser, a physics professor at MIT and an author on the study.

“It’s not inventing new forms of matter that have not yet been detected. It’s not changing the laws of gravity,” he said.

Still, black holes are not the sole potential culprit and there remains a lot of debate in the field.

Physicists have, in their quest to find dark matter, searched for new exotic particles, as well as regular matter that may have been overlooked — such as black holes of varying sizes. So far, they have come up empty-handed.

Until now, astronomers have been unsure how to search for black holes of a particularly pesky size — those that are too small for their gravity to bend star light.

The MIT researchers determined, through modeling, that these tiny black holes may have formed from pockets of dense matter that collapsed on themselves immediately following the Big Bang.

The researchers simulated what might happen if one of these primordial black holes made a flyby within the orbit of Jupiter. They found that the orbits of Earth, Mars, Venus and Mercury could veer off their original course by up to 3 feet over a decade.

The researchers said they would expect to detect a black hole nudge somewhere between once a year to once every century — depending on the abundance and masses of the black holes.

To put their own minds at ease, the researchers also calculated the likelihood that one of these tiny black holes would strike Earth and found it would only happen roughly once in a billion years.

Even then, the black hole wouldn’t lead to an apocalypse.

Instead, it would pass straight through the Earth, leaving the planet relatively unbothered.

Scientists in the 1970s even showed that a black hole impact would look strikingly similar to an streaking light and explosion over Russia 116 years ago that scientists believe was caused by a small asteroid or comet. (Although, a black hole would also leave an “exit wound.”)

Detecting the existence of mini black holes will require extremely precise measurements of where planets are and models of where they’re supposed to be. Fortunately, scientists have the tools to accomplish this.

NASA’s Jet Propulsion Laboratory in La Cañada Flintridge, for example, has created a detailed model of the solar system that uses Albert Einstein’s general relativity theory of gravity to calculate the expected orbits of the planets and account for hundreds of asteroids in excruciating detail. (They even calculated how the Earth’s ocean tides affect the moon’s orbit.)

NASA scientists also have developed an extremely precise means of determining the distance between the Earth and Mars. By measuring the time it takes radio signals to travel from Earth to spacecraft orbiting Mars, or to rovers on its surface, scientists can calculate the red planet’s distance from Earth within two feet.

“It’s really only a few decades where we’ve had that level of accuracy,” Kaiser said. “From a series of space program missions, we can worry about if Mars is 50 centimeters off from where we expect it to be.”

To convince the skeptics, the scientists also would have to show that the nudge wasn’t caused by a passing asteroid.

The researchers say that the speed of the black holes — which would be traveling more than two times faster than anything else in our solar system — would create an unmistakably unique wobble in the planets’ orbits.

And astronomers are pretty good at spotting objects with a mass similar to that of the hypothetical black holes. In 2017, researchers identified the first object from another star to enter our solar system, which had far less mass than a microscopic black hole would.

Whether or not they detect a passing black hole, the scientists say it will push forward humanity’s understanding of dark matter.

“Of course I’d love to discover dark matter in the solar system,” said Benjamin Lehmann, a postdoctoral student at MIT and an author of the study. However, “if this kind of observation is what helps us to close this window and say dark matter is not in the form of these primordial black holes, that’s really important information.”

By proposing a method for simply testing this possibility, “they’ve done … exactly what we should be doing in dark matter searches,” said Vera Gluscevic, a cosmology professor at USC who was not involved with the study. “We should not leave any stone unturned.”

Although the scientists plan to keep refining planetary motion models and dig through historical observations from the last few decades for signs of the black holes, the main test will be to simply watch and wait.

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©2024 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

Tim Henderson | Stateline.org (TNS)

At 43, Sharon Reese is a housing market refugee — forced to return to her Ohio hometown after 18 years in Las Vegas, despite a successful career training dancers for nightclub acts.

“If you don’t have between $600,000 and $800,000, you’re not buying a house out there,” Reese said. “Las Vegas has a lot of opportunity, and it was affordable in 2006, but it’s become unaffordable. We quit our jobs and moved across the country. We’re hoping this is the right decision for us.”

Reese and her family are unpacking at her parents’ Youngstown home, a temporary stop until she and her husband, who was a casino worker in Las Vegas, can find jobs and a house of their own with their young daughter. Youngstown is one of the last two metro areas in the country where a household with nearly any income should be able to find a single-family home they can afford to buy, according to an analysis of April data by the National Association of Realtors.

Before the pandemic, there were 20 states that were considered affordable as a whole under the group’s definition, including the presidential election swing states of Michigan, Pennsylvania and Wisconsin. As of this year, there is none. Even the states with the closest match between income and home prices — Iowa, West Virginia, Ohio, Indiana and Michigan — didn’t make the cut.

Since the pandemic, two states, Montana and Idaho, have surpassed California as the most unaffordable states for local homebuyers, according to the analysis. Hawaii and Oregon round out the list of the five least affordable states.

The Realtors’ analysis assigns affordability scores to states and large metro areas on a scale of 0 to 2. A score of 0 means that no household can afford any home on the market.

A score of 1 means that homes on the market are affordable to households in proportion to their position on the income ladder — in other words, 100% of families can afford at least some homes on the market. And a score of 2 would mean that all households can afford all homes on the market, but no state or metropolitan area even reached a 1.

The least affordable metro area was Los Angeles, which scored only 0.3, while the metro areas of Youngstown (0.97) and Akron (0.95) in Ohio were rated most affordable.

According to the latest estimates from July by real estate company Redfin, median single-family home sale prices were $175,000 in Youngstown and $239,500 in Akron. That compared with $487,000 in Las Vegas, $490,000 in Boise and $1 million in the Los Angeles area.

The Las Vegas area, where the Reese family had lived for 18 years, had a score of 0.5 on the Realtors’ scale. No state earned an overall score of 1, though Iowa, West Virginia and Ohio came close, at nearly 0.9. The least affordable states, Montana, Idaho, California, Hawaii and Oregon, all had scores around 0.4.

Nationwide, home affordability has evaporated over the past three years as interest rates have gone up, according to a monitoring index maintained by the Federal Reserve Bank of Atlanta. It measures affordability more simply than the Realtors’ analysis, focusing solely on the ability of a homebuyer with the median household income to buy the median-priced house.

By that measure, the national affordability percentage was above 100% between January 2019 and April 2021. But it fell as low as 67% last year and remained below 70% in June, meaning a homebuyer with the median income had only two-thirds of the earnings needed to buy the median-priced house.

Home prices have increased by 47% nationwide just since 2020, according to a June report by the Harvard Joint Center for Housing Studies. A major factor is that there aren’t many homes for sale: Many current homeowners are reluctant to sell because they’re locked into historically low interest rates. Meanwhile, investors have gobbled up single-family starter homes, reducing the supply.

Lawrence Yun, chief economist for the National Association of Realtors, said there are signs of more houses coming up for sale. For example, there was a 20% increase in houses and condos for sale in July compared with July 2023, according to the association.

“We are still short on inventory, but I think the worst is over,” Yun said. “We have seen mortgage rates begin to decline, so it’s less of a big financial penalty to move and give up a low interest rate. And the second factor is just the passage of time — life-changing events always occur, a death, a divorce, a new child or just job relocation, and that means changing residence.”

Along with high prices and interest rates, home buyers are getting slammed by higher property taxes and insurance costs, according to the Harvard Joint Center for Housing Studies.

Home prices in northeast Ohio might be lower because the area has a stable population, curbing competition and bidding wars, said Alison Goebel, executive director of the Greater Ohio Policy Center, a Columbus nonprofit aimed at revitalizing Ohio cities.

“Our population numbers have remained fairly steady in the last several decades, so we don’t have egregious demand and supply issues like you see on the West Coast and other rapidly growing areas,” Goebel said.

Montana and Idaho are the least affordable states: Housing prices are exploding in both, as deep-pocketed newcomers — many of them white-collar employees working in high-wage jobs based out of state — have driven up prices beyond what longtime residents can afford.

The city of Boise scored 0.4 on the Realtors’ affordability scale, on par with the New York City area. Like Montana, Idaho has natural beauty that is attracting people who are cashing out of more expensive areas, said Nicki Hellenkamp, Boise’s director of housing and homelessness policy.

“It’s one of the Zoom boom towns, where it’s beautiful but the wages are low, and the cost of living is low. If you sell your house in Los Angeles and buy two houses here, as my uncle did, then you can have a very different standard of living,” Hellenkamp said.

It’s not just home prices — rents are up 40% in Boise since the pandemic began, she added.

“Obviously wages didn’t go up 40%, so some people have been displaced,” Hellenkamp said.

The city is working on modest proposals to help with down payments and to create more affordable apartments, she said, but building more affordable housing will mean state and federal cooperation to help solve labor shortages and soaring material costs.

“We can’t do this alone as a city. This issue is a big one,” Hellenkamp said.

A state housing task force in Montana made recommendations in June to streamline construction of houses and apartments statewide and create incentives for cities to loosen zoning and allow denser housing.

A member of the task force, Kendall Cotton, said he personally found it impossible to buy a house in Montana, but was happy to recently purchase half a duplex for his growing family.

“We were thrilled to have that as an option, just to get our foot in the door and start on our journey to homeownership,” Cotton said. “Montana is an in-demand place. We’ve been kind of discovered in the last couple of years.”

Republicans and Democrats have come together to support fighting restrictive zoning, said Cotton, director of the Frontier Institute, a nonprofit policy and educational organization.

“We’re a free-market organization that tends to lead from right of center, but when I was at the governor’s press conference to support these issues, I was standing shoulder to shoulder with a Democratic socialist city council member and we were all united on this,” Cotton said.

Shallon Lester, a YouTube influencer who moved from New York to Montana and paid $1 million for a five-bedroom house in Bozeman in 2022, said she likes both the lower cost of living and the lifestyle there. Locals tend to think she’s an outsider “invading” the area, she said, but “people like me take nothing from this economy — we only give. We spend and spend.”

“People who are remote workers are sick of the cost of living in cities,” Lester added. “There’s a mass return to the concept of the simple life.”

Even in the Youngstown metro area, which includes a slice of Pennsylvania, housing can be a challenge for residents with low incomes. A forthcoming regional housing study has found a 4,000-unit shortage for households making less than $25,000 a year; 7,500 people are on a waiting list for subsidized housing. Black and Hispanic residents are more likely to struggle with housing costs, as are older people, young singles and families with young children, according to preliminary conclusions discussed in April.

But for many, Youngstown is a rare island of affordability. Jim Johnston, 40, a digital account executive at media company Nexstar in Youngstown, said many of his high school classmates from the area, who now live in places such as Montana, Illinois and Maryland, envy his decision to stay there and buy a $250,000 house in 2022 when interest rates were lower.

“One of them has a mortgage payment three times mine for the same size house, and a child care bill that’s bigger than my mortgage,” said Johnston. “They could put an extra $50,000 or $60,000 a year in their pockets. Remote work has opened up new possibilities for them, and they’re considering this very seriously.”

Stateline is part of States Newsroom, a national nonprofit news organization focused on state policy.

©2024 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By Los Angeles Times

LOS ANGELES — The 2024 Primetime Emmy Awards arrived on Sunday.

The awards, presented by the Television Academy, honored the best of the 2023-2024 TV season. The 76th edition of the ceremony came just months after the 75th edition, which was held in January after being delayed by the dual Hollywood strikes.

Here are the winners, including several previously announced at the Creative Arts Emmys.

Comedy series

“Abbott Elementary”

“The Bear”

“Curb Your Enthusiasm”

Winner: “Hacks”

“Only Murders in the Building”

“Palm Royale”

“Reservation Dogs”

“What We Do in the Shadows”

Drama series

“The Crown”

“Fallout”

“The Gilded Age”

“The Morning Show”

“Mr. & Mrs. Smith”

Winner: “Shōgun”

“Slow Horses”

“3 Body Problem”

Drama lead actress

Jennifer Aniston, “The Morning Show”

Carrie Coon, “The Gilded Age”

Maya Erskine, “Mr. & Mrs. Smith”

Winner: Anna Sawai, “Shōgun”

Imelda Staunton, “The Crown”

Reese Witherspoon, “The Morning Show”

Drama lead actor

Donald Glover, “Mr. & Mrs. Smith”

Walton Goggins, “Fallout”

Gary Oldman, “Slow Horses”

Winner: Hiroyuki Sanada, “Shōgun”

Dominic West, “The Crown”

Idris Elba, “Hijack”

Limited series

Winner: “Baby Reindeer”

“Fargo”

“Lessons in Chemistry”

“Ripley”

“True Detective: Night Country”

Limited series / TV movie lead actress

Winner: Jodie Foster, “True Detective: Night Country”

Brie Larson, “Lessons in Chemistry”

Juno Temple, “Fargo”

Sofía Vergara, “Griselda”

Naomi Watts, “Feud: Capote vs. the Swans”

Limited series / TV movie lead actor

Matt Bomer, “Fellow Travelers”

Winner: Richard Gadd, “Baby Reindeer”

Jon Hamm, “Fargo”

Tom Hollander,“Feud: Capote vs. the Swans”

Andrew Scott, “Ripley”

Directing for a drama series

Hiro Murai, “First Date,” “Mr. & Mrs. Smith”

Winner: Frederick E.O. Toye, “Crimson Sky,” “Shōgun”

Saul Metzstein, “Strange Games,” “Slow Horses”

Stephen Daldry, “Sleep, Dearie Sleep,” “The Crown”

Mimi Leder, “The Overview Effect,” “The Morning Show”

Directing for a comedy series

Randall Einhorn, “Party,” “Abbott Elementary”

Lucia Aniello, “Bulletproof,” “Hacks”

Winner: Christopher Storer, “Fishes,” “The Bear”

Ramy Youssef, “Honeydew,” “The Bear”

Guy Ritchie, “Refined Aggression,” “The Gentlemen”

Writing for a limited or anthology series or movie

Winner: Richard Gadd, “Baby Reindeer”

Charlie Brooker, “Joan Is Awful,” “Black Mirror”

Noah Hawley, “The Tragedy of the Commons,” “Fargo”

Ron Nyswaner, “You’re Wonderful,” “Fellow Travelers”

Steven Zaillian, “Ripley”

Issa López, “Part 6,” “True Detective: North Country”

Writing for a drama series

Geneva Robertson-Dworet, Graham Wagner; “The End,” “Fallout”

Francesca Sloane, Donald Glover; “First Date,” “Mr. & Mrs. Smith”

Rachel Kondo, Justin Marks; “Anjin,” “Shōgun”

Rachel Kondo, Caillin Puente; “Crimson Sky,” “Shōgun”

Winner: Will Smith, “Negotiating With Tigers,” “Slow Horses”

Peter Morgan, Meriel Sheibani-Clare; “The Ritz,” “The Crown”

Limited series / TV movie supporting actor

Jonathan Bailey, “Fellow Travelers”

Robert Downey Jr., “The Sympathizer”

Tom Goodman-Hill, “Baby Reindeer”

John Hawkes, “True Detective: North Country”

Winner: Lamorne Morris, “Fargo”

Lewis Pullman, “Lessons in Chemistry”

Treat Williams, “Feud: Capote vs. the Swans”

Talk series

Winner: “The Daily Show”

“Jimmy Kimmel Live!”

“Late Night With Seth Meyers”

“The Late Show With Stephen Colbert”

Writing for a comedy series

Quinta Brunson, “Career Day,” “Abbott Elementary”

Meredith Scardino, Sam Means; “Orlando,” “Girls5eva”

Winner: Lucia Aniello, Paul W. Downs, Jen Statsky; “Bulletproof,” “Hacks”

Christopher Storer, Joanna Calo; “Fishes,” “The Bear”

Chris Kelly, Sarah Schneider; “Brooke Hosts a Night of Undeniable Good,” “The Other Two”

Jake Bender, Zach Dunn; “Pride Parade,” “What We Do in the Shadows”

Directing for a limited or anthology series or movie

Weronika Tofilska, “Episode 4,” “Baby Reindeer”

Noah Hawley, “The Tragedy of the Commons,” “Fargo”

Gus Van Sant, “Feud: Capote vs. the Swans”

Millicent Shelton, “Poirot,” “Lessons in Chemistry”

Winner: Steven Zaillian, “Ripley”

Issa López, “True Detective: North Country”

Writing for a variety special

Winner: Alex Edelman, “Alex Edelman: Just For Us”

Jacqueline Novak, “Jacqueline Novak: Get On Your Knees”

John Early, “John Early: Now More Than Ever”

Mike Birbiglia, “Mike Birbiglia: The Old Man and The Pool”

“The Oscars”

Scripted variety series

Winner: “Last Week Tonight With John Oliver”

“Saturday Night Live”

Limited series / TV movie supporting actress

Dakota Fanning, “Ripley”

Lily Gladstone, “Under the Bridge”

Winner: Jessica Gunning, “Baby Reindeer”

Aja Naomi King, “Lessons in Chemistry”

Diane Lane, “Feud: Capote vs. the Swans”

Nava Mau, “Baby Reindeer”

Kali Reis, “True Detective: Night Country”

Reality competition program

“The Amazing Race”

“RuPaul’s Drag Race”

“Top Chef”

Winner: “The Traitors”

“The Voice”

Comedy lead actress

Quinta Brunson, “Abbott Elementary”

Ayo Edebiri, “The Bear”

Selena Gomez, “Only Murders in the Building”

Winner: Jean Smart, “Hacks”

Kristen Wiig, “Palm Royale”

Maya Rudolph, “Loot”

Drama supporting actress

Christine Baranski, “The Gilded Age”

Nicole Beharie, “The Morning Show”

Winner: Elizabeth Debicki, “The Crown”

Greta Lee, “The Morning Show”

Lesley Manville, “The Crown”

Karen Pittman, “The Morning Show”

Holland Taylor, “The Morning Show”

Comedy supporting actress

Carol Burnett, “Palm Royale”

Winner: Liza Colón-Zayas, “The Bear”

Hannah Einbinder, “Hacks”

Janelle James, “Abbott Elementary”

Sheryl Lee Ralph, “Abbott Elementary”

Meryl Streep, “Only Murders in the Building”

Comedy lead actor

Matt Berry, “What We Do in the Shadows,”

Larry David, “Curb Your Enthusiasm”

Steve Martin, “Only Murders in the Building”

Martin Short, “Only Murders in the Building”

Winner: Jeremy Allen White, “The Bear”

D’Pharaoh Woon-A-Tai, “Reservation Dogs”

Drama supporting actor

Tadanobu Asano, “Shōgun”

Winner: Billy Crudup, “The Morning Show”

Mark Duplass, “The Morning Show”

Jon Hamm, “The Morning Show”

Takehiro Hira, “Shōgun”

Jack Lowden, “Slow Horses”

Jonathan Pryce, “The Crown”

Comedy supporting actor

Lionel Boyce, “The Bear”

Paul W. Downs, “Hacks”

Winner: Ebon Moss-Bachrach, “The Bear”

Paul Rudd, “Only Murders in the Building”

Tyler James Williams, “Abbott Elementary”

Bowen Yang, “Saturday Night Live”

Television movie

Winner: “Quiz Lady”

“Mr. Monk’s Last Case: A Monk Movie”

“Red, White & Royal Blue”

“Scoop”

“Unfrosted”

Guest actor in a drama series

Winner: Néstor Carbonell, “Shōgun”

Paul Dano, “Mr. & Mrs. Smith”

Tracy Letts, “Winning Time: The Rise of the Lakers Dynasty”

Jonathan Pryce, “Slow Horses”

John Turturro, “Mr. & Mrs. Smith”

Guest actress in a drama series

Winner: Michaela Coel, “Mr. & Mrs. Smith”

Claire Foy, “The Crown”

Marcia Gay Harden, “The Morning Show”

Sarah Paulson, “Mr. & Mrs. Smith”

Parker Posey, “Mr. & Mrs. Smith”

Guest actor in a comedy series

Winner: Jon Bernthal, “The Bear”

Matthew Broderick, “Only Murders in the Building”

Ryan Gosling, “Saturday Night Live”

Christopher Lloyd, “Hacks”

Bob Odenkirk, “The Bear”

Will Poulter, “The Bear”

Guest actress in a comedy series

Winner: Jamie Lee Curtis, “The Bear”

Olivia Colman, “The Bear”

Kaitlin Olson, “Hacks”

Da’Vine Joy Randolph, “Only Murders in the Building”

Maya Rudolph, “Saturday Night Live”

Kristen Wiig, “Saturday Night Live”

For a complete list of Emmy nominees, go to Emmys.com.

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©2024 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

By Los Angeles Times

LOS ANGELES — The 2024 Primetime Emmy Awards arrived on Sunday.

The awards, presented by the Television Academy, honored the best of the 2023-2024 TV season. The 76th edition of the ceremony came just months after the 75th edition, which was held in January after being delayed by the dual Hollywood strikes.

Here are the winners, including several previously announced at the Creative Arts Emmys.

Comedy series

“Abbott Elementary”

“The Bear”

“Curb Your Enthusiasm”

Winner: “Hacks”

“Only Murders in the Building”

“Palm Royale”

“Reservation Dogs”

“What We Do in the Shadows”

Drama series

“The Crown”

“Fallout”

“The Gilded Age”

“The Morning Show”

“Mr. & Mrs. Smith”

Winner: “Shōgun”

“Slow Horses”

“3 Body Problem”

Drama lead actress

Jennifer Aniston, “The Morning Show”

Carrie Coon, “The Gilded Age”

Maya Erskine, “Mr. & Mrs. Smith”

Winner: Anna Sawai, “Shōgun”

Imelda Staunton, “The Crown”

Reese Witherspoon, “The Morning Show”

Drama lead actor

Donald Glover, “Mr. & Mrs. Smith”

Walton Goggins, “Fallout”

Gary Oldman, “Slow Horses”

Winner: Hiroyuki Sanada, “Shōgun”

Dominic West, “The Crown”

Idris Elba, “Hijack”

Limited series

Winner: “Baby Reindeer”

“Fargo”

“Lessons in Chemistry”

“Ripley”

“True Detective: Night Country”

Limited series / TV movie lead actress

Winner: Jodie Foster, “True Detective: Night Country”

Brie Larson, “Lessons in Chemistry”

Juno Temple, “Fargo”

Sofía Vergara, “Griselda”

Naomi Watts, “Feud: Capote vs. the Swans”

Limited series / TV movie lead actor

Matt Bomer, “Fellow Travelers”

Winner: Richard Gadd, “Baby Reindeer”

Jon Hamm, “Fargo”

Tom Hollander,“Feud: Capote vs. the Swans”

Andrew Scott, “Ripley”

Directing for a drama series

Hiro Murai, “First Date,” “Mr. & Mrs. Smith”

Winner: Frederick E.O. Toye, “Crimson Sky,” “Shōgun”

Saul Metzstein, “Strange Games,” “Slow Horses”

Stephen Daldry, “Sleep, Dearie Sleep,” “The Crown”

Mimi Leder, “The Overview Effect,” “The Morning Show”

Directing for a comedy series

Randall Einhorn, “Party,” “Abbott Elementary”

Lucia Aniello, “Bulletproof,” “Hacks”

Winner: Christopher Storer, “Fishes,” “The Bear”

Ramy Youssef, “Honeydew,” “The Bear”

Guy Ritchie, “Refined Aggression,” “The Gentlemen”

Writing for a limited or anthology series or movie

Winner: Richard Gadd, “Baby Reindeer”

Charlie Brooker, “Joan Is Awful,” “Black Mirror”

Noah Hawley, “The Tragedy of the Commons,” “Fargo”

Ron Nyswaner, “You’re Wonderful,” “Fellow Travelers”

Steven Zaillian, “Ripley”

Issa López, “Part 6,” “True Detective: North Country”

Writing for a drama series

Geneva Robertson-Dworet, Graham Wagner; “The End,” “Fallout”

Francesca Sloane, Donald Glover; “First Date,” “Mr. & Mrs. Smith”

Rachel Kondo, Justin Marks; “Anjin,” “Shōgun”

Rachel Kondo, Caillin Puente; “Crimson Sky,” “Shōgun”

Winner: Will Smith, “Negotiating With Tigers,” “Slow Horses”

Peter Morgan, Meriel Sheibani-Clare; “The Ritz,” “The Crown”

Limited series / TV movie supporting actor

Jonathan Bailey, “Fellow Travelers”

Robert Downey Jr., “The Sympathizer”

Tom Goodman-Hill, “Baby Reindeer”

John Hawkes, “True Detective: North Country”

Winner: Lamorne Morris, “Fargo”

Lewis Pullman, “Lessons in Chemistry”

Treat Williams, “Feud: Capote vs. the Swans”

Talk series

Winner: “The Daily Show”

“Jimmy Kimmel Live!”

“Late Night With Seth Meyers”

“The Late Show With Stephen Colbert”

Writing for a comedy series

Quinta Brunson, “Career Day,” “Abbott Elementary”

Meredith Scardino, Sam Means; “Orlando,” “Girls5eva”

Winner: Lucia Aniello, Paul W. Downs, Jen Statsky; “Bulletproof,” “Hacks”

Christopher Storer, Joanna Calo; “Fishes,” “The Bear”

Chris Kelly, Sarah Schneider; “Brooke Hosts a Night of Undeniable Good,” “The Other Two”

Jake Bender, Zach Dunn; “Pride Parade,” “What We Do in the Shadows”

Directing for a limited or anthology series or movie

Weronika Tofilska, “Episode 4,” “Baby Reindeer”

Noah Hawley, “The Tragedy of the Commons,” “Fargo”

Gus Van Sant, “Feud: Capote vs. the Swans”

Millicent Shelton, “Poirot,” “Lessons in Chemistry”

Winner: Steven Zaillian, “Ripley”

Issa López, “True Detective: North Country”

Writing for a variety special

Winner: Alex Edelman, “Alex Edelman: Just For Us”

Jacqueline Novak, “Jacqueline Novak: Get On Your Knees”

John Early, “John Early: Now More Than Ever”

Mike Birbiglia, “Mike Birbiglia: The Old Man and The Pool”

“The Oscars”

Scripted variety series

Winner: “Last Week Tonight With John Oliver”

“Saturday Night Live”

Limited series / TV movie supporting actress

Dakota Fanning, “Ripley”

Lily Gladstone, “Under the Bridge”

Winner: Jessica Gunning, “Baby Reindeer”

Aja Naomi King, “Lessons in Chemistry”

Diane Lane, “Feud: Capote vs. the Swans”

Nava Mau, “Baby Reindeer”

Kali Reis, “True Detective: Night Country”

Reality competition program

“The Amazing Race”

“RuPaul’s Drag Race”

“Top Chef”

Winner: “The Traitors”

“The Voice”

Comedy lead actress

Quinta Brunson, “Abbott Elementary”

Ayo Edebiri, “The Bear”

Selena Gomez, “Only Murders in the Building”

Winner: Jean Smart, “Hacks”

Kristen Wiig, “Palm Royale”

Maya Rudolph, “Loot”

Drama supporting actress

Christine Baranski, “The Gilded Age”

Nicole Beharie, “The Morning Show”

Winner: Elizabeth Debicki, “The Crown”

Greta Lee, “The Morning Show”

Lesley Manville, “The Crown”

Karen Pittman, “The Morning Show”

Holland Taylor, “The Morning Show”

Comedy supporting actress

Carol Burnett, “Palm Royale”

Winner: Liza Colón-Zayas, “The Bear”

Hannah Einbinder, “Hacks”

Janelle James, “Abbott Elementary”

Sheryl Lee Ralph, “Abbott Elementary”

Meryl Streep, “Only Murders in the Building”

Comedy lead actor

Matt Berry, “What We Do in the Shadows,”

Larry David, “Curb Your Enthusiasm”

Steve Martin, “Only Murders in the Building”

Martin Short, “Only Murders in the Building”

Winner: Jeremy Allen White, “The Bear”

D’Pharaoh Woon-A-Tai, “Reservation Dogs”

Drama supporting actor

Tadanobu Asano, “Shōgun”

Winner: Billy Crudup, “The Morning Show”

Mark Duplass, “The Morning Show”

Jon Hamm, “The Morning Show”

Takehiro Hira, “Shōgun”

Jack Lowden, “Slow Horses”

Jonathan Pryce, “The Crown”

Comedy supporting actor

Lionel Boyce, “The Bear”

Paul W. Downs, “Hacks”

Winner: Ebon Moss-Bachrach, “The Bear”

Paul Rudd, “Only Murders in the Building”

Tyler James Williams, “Abbott Elementary”

Bowen Yang, “Saturday Night Live”

Television movie

Winner: “Quiz Lady”

“Mr. Monk’s Last Case: A Monk Movie”

“Red, White & Royal Blue”

“Scoop”

“Unfrosted”

Guest actor in a drama series

Winner: Néstor Carbonell, “Shōgun”

Paul Dano, “Mr. & Mrs. Smith”

Tracy Letts, “Winning Time: The Rise of the Lakers Dynasty”

Jonathan Pryce, “Slow Horses”

John Turturro, “Mr. & Mrs. Smith”

Guest actress in a drama series

Winner: Michaela Coel, “Mr. & Mrs. Smith”

Claire Foy, “The Crown”

Marcia Gay Harden, “The Morning Show”

Sarah Paulson, “Mr. & Mrs. Smith”

Parker Posey, “Mr. & Mrs. Smith”

Guest actor in a comedy series

Winner: Jon Bernthal, “The Bear”

Matthew Broderick, “Only Murders in the Building”

Ryan Gosling, “Saturday Night Live”

Christopher Lloyd, “Hacks”

Bob Odenkirk, “The Bear”

Will Poulter, “The Bear”

Guest actress in a comedy series

Winner: Jamie Lee Curtis, “The Bear”

Olivia Colman, “The Bear”

Kaitlin Olson, “Hacks”

Da’Vine Joy Randolph, “Only Murders in the Building”

Maya Rudolph, “Saturday Night Live”

Kristen Wiig, “Saturday Night Live”

For a complete list of Emmy nominees, go to Emmys.com.

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©2024 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

Christopher Snowbeck | (TNS) The Minnesota Star Tribune

Bobbie Putman-Bailey knows how to solve problems when it comes to medical bills and health insurance.

In one instance, upon the surprise realization her specialist doctor had gone out of network for her health plan, the 42-year-old Maple Grove, Minnesota, resident convinced the insurer to overturn coverage denials that could have cost her hundreds of dollars. The key, Putman-Bailey said, was to write an appeal that was long on details, while also agreeing to eventually switch to an in-network doctor — just not immediately, since she was beginning a new treatment at the time.

In another case, she wrangled with a specialty pharmacy to prevent billing for a shipment of the wrong medication to her house. It helped, Putman-Bailey said, that she was prompt in calling to report the problem and already had talked with the pharmacy several times about ambiguities with its online ordering system.

For consumers, the first step in all such disputes is to stay on top of billing documents, Putman-Bailey advised, and ask questions as soon as possible. She recognizes, of course, this can be easier said than done.

“It sucks because you are sick, and you’re chronically ill, and there are days when … you don’t have the energy to get up and look at things,” said Putman-Bailey, who has Crohn’s disease. “But if you wait until things show up in your mailbox, it’s almost too late.”

Getting sick in the U.S. health care system can trigger an avalanche of confusing paperwork. Here’s what you need to know about how to read a medical bill — plus those documents proclaiming “This Is Not a Bill” from health insurers — to help prevent the illness from spreading to your bank account.

Bills vs. EOBs

Two types of documents typically arrive in a patient’s mailbox and/or online portal after receiving health care services: One is a medical bill from a doctor’s office or health system, the second is an“explanation of benefits” form from your health insurer.

The insurance document, called an EOB, often arrives first. It reflects the health plan’s evaluation of the service received, including the amount of insurance coverage for the service, according to the Minnesota Council of Health Plans, a trade group for nonprofit health insurers in the state.

EOBs typically list the provider’s charge for a service. They also show the negotiated price the insurance company and provider agreed to consider full payment. And then, the form shows how the negotiated cost will split between the insurer and the patient.

Insurers typically describe this split as “cost-sharing,” which factors in deductibles and co-insurance that are key for patients to understand when shopping for a health plan.

“If there is a remaining bill, the doctor’s office directly sends you a bill for the remaining amount,” said Lucas Nesse, chief executive of the Minnesota Council of Health Plans, via email. “If the amount on the bill you receive from your doctor’s office does not match the amount on your EOB, the first step is to call your clinic to see if they have updated their bill to reflect payment from your insurance.”

Patients often notice on EOBs the contrast between the health care provider’s charge and the negotiated payment rate because the discounts can be very large.

“You can see them allow only 10% of the charge sometimes,” said Bill Foley, an insurance advocate and volunteer leader with Cancer Legal Care, a nonprofit group in Oakdale. “The spread can be tremendous.”

Once the bill comes from the doctor’s office or health system, patients should compare the amount due with the EOB to make sure they agree on the patient’s financial responsibility. When they don’t match, patients should call the health care provider and/or health insurer.

“Typically, your medical bill should not be more than what your explanation of benefits says you owe,” said Julia Dreier, the deputy commissioner of insurance at the Minnesota Department of Commerce.

Starting Oct. 1, a new state law goes into effect that lets patients request a review from their health care provider to check the accuracy of medical codes used in their billing. The law prohibits providers from making further collection efforts during this process, which culminates in a notice sent to patients within 30 days of the review’s completion.

“A medical provider will always … provide notice about whether the coding was accurate,” said Joe Schindler, vice president of finance policy and analytics at the Minnesota Hospital Association.

Comparing EOBs and medical bills can be difficult when health care providers practice “global billing” and roll all charges into one final bill, said Eric Ellsworth, director for health data strategy at Consumers’ Checkbook Health. Schindler of the Hospital Association noted patients can always ask for a more detailed bill from their health care provider.

Denials and codes

Consumer advocates say patients, in many ways, are better off relying on their online portals for billing documents rather than paper statements that arrive in the mail. That’s because a health insurer’s decision on whether to pay or deny a claim can change as more information becomes available.

Foley recommends, in fact, patients compare the bill they receive in the mail to the online version to see if that one is more current.

When there’s a balance due, the key question is: Why?

“Is it because insurance hasn’t adjudicated your claim yet?” Foley asked. “Is it because you have a legitimate out-of-pocket expense? Is it due to a denial?”

There are several types of denials, Ellsworth said. Some services just aren’t a covered benefit, he added, pointing to in-vitro fertilization as an example in a number of health plans. Sometimes there’s a limitation patients might not have appreciated, such as when an insurer will pay for cataract surgery but not some multifocal lenses.

Insurers might deny a claim because the health plan deems the service not medically necessary. Some denials result in financial responsibility for patients, Ellsworth said, while others create a financial risk for the health care provider.

The Minnesota Council of Health Plans said insurers list on the EOB a “reason code” to explain the reason for a claim’s denial. Reasons can vary from services being out of network to the lack of prior authorization from a health plan.

It’s not clear exactly how often denials happen across all types of insurance, but consumer advocates say appeals are few and far between. They worry the process of filing appeals is just too confusing and/or difficult for patients to navigate.

To appeal a denied claim, patients must navigate the language of medical coding, which is how health care providers and health insurers communicate about the services provided. Many medical bills and EOBs don’t actually include these codes, so patients must contact either their provider or health plan to understand. Patients can then use the codes and descriptions to determine whether their insurer processed their claims correctly according to their plan’s benefits.

“If there’s a balance due that you’re questioning, then it’s really important to know those codes,” Foley said. “We’ve set up this system where all of these claims are handled by computers now instead of people. So, the codes are really key. That’s the magic.”

When facing big bills for out-of-network care, patients should explore whether the federal No Surprises Act provides any help. And advocates say rather than trying to navigate all this alone, patients should seek help from a friend, family member or even government agencies.

“If someone’s stuck, I would encourage people to call us,” said Dreier of the Commerce Department.

‘I’m not trying to duck the bill’

The Minnesota Attorney General’s Office has online tips for handling medical bills and pointers for ensuring your portion is accurate. The state Commerce Department has online information about denials and appeals. Ellsworth of Consumers’ Checkbook said people in “self-insured” health plans that large employers typically run — especially those operating in multiple states — can seek help from the Employee Benefit Services Administration (EBSA) at the U.S. Department of Labor.

Some advocates refer to a book called “Never Pay the First Bill” when talking about how consumers should think about questionable medical bills. Patients often want to pay promptly, Foley said, either because they received good care or from fear of being sent to collections and suffering credit score dings.

Those are good instincts, Foley said, yet there are times when he advises consumers to let everything play out a bit before making a payment.

“The key is: Just keep the provider in the loop. Let them know that you are aware that they’ve sent you a balance-due statement but that you’re still working through the details of it,” he said. “Make sure you are staying in contact with your provider and telling them: ‘Hey, I’m not trying to duck the bill.’ That’s really an important thing.”

Putman-Bailey, the patient from Maple Grove, said to be suspicious if any medical paperwork is delayed since that can be a sign of trouble.

The Minnesota Medical Association said providers must submit claims to insurance companies within six months of the date of service, although most are quicker. Insurers generally pay claims within 30 days of receipt, the Medical Association said, and EOBs are available when claims process.

As for phone calls, Putman-Bailey said she’s learned the importance of recording the date of the conversation, the name of the customer service representative and the agent’s phone number, if possible. Another tip: When insurers assert a service is not medically necessary, Putman-Bailey asks to talk with the physician who made that decision.

The process can feel adversarial and is often emotional, Putman-Bailey said, but she always tries to stress how it’s not personal.

“I usually am saying to the person on the phone: ‘This is not about you,’” she said, “‘this is about the system.’”

©2024 The Minnesota Star Tribune. Visit at startribune.com. Distributed by Tribune Content Agency, LLC.

Gretchen McKay | Pittsburgh Post-Gazette (TNS)

Come dinnertime, pasta made with corn, rice, lentils or chickpeas can be a godsend to those with gluten sensitivities. But it also can break their hearts, just a little.

Not only is gluten-free pasta super expensive when compared to “regular” spaghetti, rigatoni and other noodles made with milled durum wheat, but it’s tough to find a gluten-free product that’s not gummy or doesn’t generally taste like mush.

That’s my son Jack’s view, anyway. He’s avoided eating anything with gluten for about a decade due to celiac disease.

As someone who absolutely adores, cooks and eats a lot of pasta, I can’t imagine how hard that must be. So the mom in me is always on the lookout for a tasty alternative he might enjoy.

A great sauce can help disguise the weird (some might say off-putting) textures that are a signature characteristic of gluten-free pasta. But what my kid misses most is wheat-free pasta that not only tastes like the real deal he remembers from childhood, but also boasts the same structural integrity.

This recipe, which couples highly rated Le Veneziane gluten-free potato gnocchi with an easy, cheesy cream sauce kissed with fresh lemon, just might be the answer.

Made with minimal prep in a single skillet, it takes about 15 minutes to pull together and includes one of the healthiest leafy greens, fresh spinach, along with peas, which are loaded with fiber and a great source of inexpensive plant-based protein.

True, the light cream, cheese and butter in the dish add calories and dreaded fat. But so long as you go easy on the serving size and don’t eat the entire pan yourself (Jack, are you listening?), it’s a wonderful occasional comfort food for the gluten-sensitive.

To make it less rich, substitute half-and-half for the cream and add more lemon or chicken broth. It’s best served right from the stove. If you have leftovers, you’ll want to add a little broth when you rewarm it.

You can find Le Veneziane gnocchi on Amazon. Like most gluten-free products, it’s a bit of a splurge, but worth it.

“This is the best thing you’ve ever made me,” raved my kid after I fed him and his wife.

Gnocchi with lemon, peas and spinach

PG tested

• 2 17.5-ounce packages gluten-free gnocchi, fresh or frozen
• 2 tablespoons unsalted butter
• 1 shallot, finely minced
• 4 cloves garlic, finely minced
• 1 1/2 teaspoons corn starch
• 1/2 cup gluten-free vegetable broth
• Zest and juice of 1 lemon
• 1 cup light cream or half-and-half
• Kosher salt and freshly ground black pepper, to taste
• 1/2 cup freshly grated Parmesan cheese, plus more for garnish
• 2 or 3 cups chopped fresh spinach
• 1 cup frozen peas
• Crushed red pepper flakes or chopped chives, for garnish

Bring a large pot of salted water to a boil. Cook gnocchi according to package instructions (about 2 minutes, or until they float to the top).

Drain and set aside. To keep them from sticking together while you make the sauce, drizzle with a little olive oil or add a bit of butter and stir to combine.

To make the sauce, melt butter in large skillet over medium heat. Add shallot and cook for 1 minute. Stir in garlic and cook until fragrant, about 30 seconds. Whisk in flour and slowly pour in the broth. Whisk in lemon zest and lemon juice

Pour in heavy cream and whisk to combine. Season with salt and pepper. Turn the heat to medium low and cook for 2-3 minutes, stirring occasionally, until the sauce thickens a bit.

Stir in Parmesan cheese until melted. Add chopped spinach and frozen peas and cook for 2 minutes or until spinach is wilted. If you want a thicker sauce, you can cook for a few more minutes, stirring to help it thicken up.

Stir in cooked gnocchi and cook for 1 minute or until heated through.

Plate the gnocchi, spooning the sauce and peas over the top. Garnish with crushed red pepper, basil or chives, and extra Parmesan cheese, if desired. Enjoy!

Serves 2-3.

— Gretchen McKay, Post-Gazette

©2024 PG Publishing Co. Visit at post-gazette.com. Distributed by Tribune Content Agency, LLC.

Julie Appleby | (TNS) KFF Health News

Suspicions that U.S. consumers’ personal information could be accessed from India led regulators to abruptly bar two large private sector enrollment websites from accessing the Affordable Care Act marketplace in August.

New details about the suspensions come in legal filings made late Friday stemming from an effort by the two to regain access to the Obamacare marketplace before the upcoming ACA open enrollment period, which starts Nov. 1.

The Centers for Medicare & Medicaid Services wrote in a Sept. 2 letter to the companies that they were suspended after the agency identified “a serious lapse in the security posture” that could have led to marketplace data, including consumers’ personal information, being accessed from overseas.

The letter, included in the court filings, also noted that regulators will audit the two companies because they have “reasonable suspicion” that they are players in a separate problem: signing people up for Obamacare coverage — or changing their policies — without the consumers’ permission.

Whether those legal issues will be resolved before the upcoming enrollment period is an open question. Currently, the concerns raised about the companies remain allegations, with none of the legal challenges or the audit close to a ruling or conclusion.

Still, the larger issue of fraudulent ACA enrollment by rogue insurance agents seeking commissions will continue to pose a headache for regulators, with more than 200,000 complaints filed by consumers in the first six months of 2024. And it has become a political problem for the Biden administration. GOP lawmakers blamed the schemes partly on Biden-backed expanded Obamacare premium subsidies.

President Joe Biden has claimed record-breaking enrollment under the ACA as one of his administration’s major accomplishments, and regulators are looking to thwart deceptive enrollment schemes without slowing legitimate sign-ups. In recent weeks they’ve removed at least 200 agents’ access to the federal ACA marketplace, and in July began requiring, in many circumstances, that brokers participate in three-way calls with their clients and the healthcare.gov help center before changes can be finalized.

The CMS letter now adds another layer. It is the first time this year the agency has called out a company over questionable enrollments, saying it suspects “the Speridian Companies” might have “directed its employees and other agents to change Marketplace enrollees’ coverage and enroll insured and uninsured consumers without the enrollees’ consent.”

California-based Speridian Global Holdings owns the companies in question, which include enrollment platform Benefitalign and TrueCoverage, doing business as the Inshura enrollment site. It has a data center in India.

The now-suspended Benefitalign site handled at least 1.2 million applications for ACA coverage during the last open enrollment period, according to court documents, which would rank it among the largest of the private enrollment sites allowed to integrate with healthcare.gov, the federal marketplace.

Previously, CMS had said publicly only that it suspended the websites for “anomalous activity.”

The suspended companies deny any wrongdoing related to enrollment schemes. Spokesperson Catherine Riedel declined comment beyond their court filings.

In late August they filed a complaint against CMS over the suspensions in U.S. District Court for the District of Columbia, seeking a restraining order. They added to that complaint on Sept. 6, calling CMS’ suspension action “lawless.”

On Aug. 8, CMS suspended the two websites from accessing healthcare.gov information.

It did so, according to the Sept. 2 letter, over concerns that some consumer information “is processed and/or stored” in India, citing “suspicions” that the data is “being accessed from outside of the United States.”

That’s a problem, the letter says, because marketplace data must stay in the U.S. to “eliminate the possibility that foreign powers might obtain access.” Additionally, websites approved by CMS to integrate with the federal marketplace cannot transmit data outside of the U.S. or allow access from outside the country, under the terms of agreements such companies sign to get CMS approval to operate.

CMS did not spell out what consumer information might have been included, but ACA applications can contain information including a person’s name, date of birth, address, and detailed household income information.

Speridian companies were suspended, then reinstated, from the marketplace in prior years over other concerns, including problems with false Social Security Numbers submitted with some TrueCoverage ACA applications in 2018, and for a 2023 effort by Benefitalign to access the federal marketplace’s “software testing environment” from India, according to the CMS letter.

In seeking a restraining order against CMS, the companies argue that the agency’s action to suspend them now is arbitrary and capricious and violates its own regulations as well as the due process clause of the Constitution.

The filing calls the Sept. 2 CMS letter explaining the reasons for the suspensions “a post hoc justification” that includes a litany of “‘concerns,’ suspicions,’ ‘allegations.’” The filing also asserts “these intimations of violations are made without evidence of any actual violation.”

The court documents say the suspensions will prevent the companies from participating in the upcoming open enrollment period, harming them and “the thousands of brokers” and “millions of consumers who count on brokers” using those websites to sign up for ACA coverage.

The suspension remains in place, the CMS letter says, partly because its concerns have not been allayed by information provided by the companies, but also while the audit is conducted.

CMS has “reasonable suspicion, based on credible evidence it has considered,” that the companies were involved in enrolling consumers or changing their coverage without specific permission, the letter stated, noting that such allegations are included in a civil lawsuit filed by private sector lawyers in U.S. District Court for the Southern District of Florida.

The firms have previously said the allegations in the civil lawsuit are without merit.

Brokers who have used the suspended websites in the past have other options to enroll clients, including several other websites currently approved to integrate with the federal Obamacare marketplace. Consumers can also go directly to the federal or state ACA websites and enroll themselves or get assistance from call centers associated with those marketplaces.

___

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Phil Galewitz | (TNS) KFF Health News

The proportion of Americans without health insurance remained stable in 2023, the Census Bureau reported Tuesday, close to the record low the Biden administration achieved in 2022 through expansions of public programs, including the Affordable Care Act.

About 8% of Americans were uninsured, a statistically insignificant increase of just 0.1 percentage point from a year earlier. But because of the Census survey’s methodology, the findings likely don’t capture the experience of tens of millions of Americans purged from Medicaid rolls after pandemic-era protections expired in spring 2023.

Enrollment in Medicaid, the government health program for people with low incomes and disabilities, reached its highest level in April 2023. That was just before what’s called the “unwinding,” the process states have used to disenroll people from the program after the federal government lifted a prohibition on culling enrollment.

It isn’t yet clear what effect the unwinding has had on insurance coverage, but the Census Bureau will release additional data on Thursday from a different survey that may refine the numbers.

“We are likely at a turning point,” said Leighton Ku, director of the Center for Health Policy Research at George Washington University. “We are about to change to a new season where things will be a little worse off from Medicaid unwinding.”

The Medicaid unwinding has been completed in most states, and more than 25 million people have been disenrolled, according to KFF, a health information nonprofit that includes KFF Health News. The Census report, based on surveys conducted early this year, counts people as uninsured only if they lacked insurance for all of 2023. So, for example, a person who was on Medicaid in April 2023 before the unwinding began then lost coverage and never regained it would nonetheless be counted as insured for the entire year.

Many people purged from Medicaid were successfully reenrolled in or obtained other insurance, such as Affordable Care Act marketplace or job-based coverage. Others remained uninsured.

Advocates have feared the unwinding would trigger a rise in the uninsured rate as people struggled to find alternative coverage.

But states, private health insurers, and advocates launched intense efforts to contact enrollees by phone, email, and social media to ensure they did not experience gaps in coverage.

Still, because of the way the Census Bureau reports the uninsured rate, the full impact of the unwinding won’t be known until the 2026 report.

Beyond Medicaid, several other factors boosted the number of Americans with health insurance last year, including a strong economy and near-record-low unemployment. Most Americans obtain insurance through their jobs, according to the Census, meaning that higher employment typically results in broader health coverage.

Another key factor: enhanced federal subsidies that since 2021 helped lower the cost of private coverage through Obamacare. Sign-ups on Affordable Care Act marketplaces hit a record high of 20.8 million in 2024, according to a Treasury report released Tuesday.

But that extra financial assistance is slated to expire at the end of 2025, setting up a flashpoint for whichever party controls power in Washington after the November elections. Democrats want to extend the subsidies introduced during the pandemic, while many Republicans wish to let them end.

Before Congress passed the ACA in 2010, the uninsured rate had been in double digits for decades. The rate fell steadily under President Barack Obama but reversed under President Donald Trump, only to come down again under President Joe Biden.

In addition to expanding subsidies, the Biden administration increased advertising and the number of counselors who help people sign up for plans during the open enrollment season, which Trump greatly curtailed.

Also contributing to the reduction in the number of uninsured Americans are state efforts to expand coverage to mostly low-income residents. North Carolina, for example, expanded Medicaid eligibility in December 2023, resulting in more than 500,000 additional enrollees.

Decades of research shows that expanded health coverage helps people individually and the public overall. Health insurance pays for routine care and can protect people from financial calamity because of severe injuries or illness.

People who are uninsured are more likely to delay or avoid getting health care, which can lead to relatively minor problems becoming more severe and costly to treat. Having more people covered also means more patients can pay their bills, which can improve the financial condition of hospitals and other providers.

The health insurance data released annually by the Census Bureau is considered the most accurate picture of health coverage in the United States. The state-level uninsured data it plans to release Thursday, based on a larger survey, counts people as uninsured if they say they don’t have coverage at the time they’re contacted. Thus, it likely will provide more insight into the effects of the unwinding.

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Andrew Dehan | (TNS) Bankrate.com

The housing market has an affordability problem. During the pandemic, historically low mortgage rates boosted demand, driving home prices to record highs. After decades of underbuilding, construction labor shortages and rising material costs, the supply shortage continues to push homeownership further out of reach. To afford the typical home today, Americans need at least a six-figure salary, according to a Bankrate study.

While the housing market typically isn’t moved by presidential elections, both Vice President Kamala Harris and former President Donald Trump have weighed in with varying proposals. While these would need approval in Congress to move forward, here’s what we know about their plans so far, and what the experts think.

Affordable housing

Vice President Harris has shared plans for 3 million new housing units over the next four years, spurred by a tax break incentivizing home builders to create more starter homes. She has also proposed up to $25,000 in down payment assistance for eligible first-time homebuyers, along with restrictions on how landlords determine rent increases and limits on tax breaks for institutional investors who buy single-family homes.

It’s unclear if such plans would work. The rent cap, for example, could have unintended consequences, says Mark Hamrick, Washington bureau chief and senior economic analyst for Bankrate.

“Price controls including constraints on rent can have the impact of limiting supply which, in turn, can exacerbate the problem,” Hamrick says. “Who wants to build or own if they’re constrained from setting prices?

Meanwhile, former President Trump has suggested opening tracts of federal land for housing development, removing restrictive regulations on homebuilding and addressing supply chain disruptions.

“Almost 25% of the cost of a newly constructed single-family home is embedded in regulations at all three levels of government,” says Jim Tobin, president and CEO of the National Association of Home Builders (NAHB), which lobbies on behalf of pro-business and pro-housing candidates. For a multifamily unit, that share is closer to 43%.

Though Trump hasn’t yet detailed how he’d reduce regulations, his past tenure could hint at what might come. In his first term, he signed into law the Tax Cuts and Jobs Act (TCJA), which included a lower corporate tax rate and a provision creating Opportunity Zones to encourage investment in lower-income areas.

“Changes in tax policy, if significant, could have a variety of impacts on the economy and the housing market, in particular,” Hamrick says. “A lower corporate tax rate could stimulate housing activity, boost investment and potentially lead to increased housing market activity. Among the potential ripple effects could be a rise in construction, more supply and lower home prices.”

On the flip side, a higher corporate tax rate could have the inverse effect, Hamrick says. Home builders could scale back activity or pass the higher costs onto homebuyers.

“Former President Trump said he wants to lower the C corp rate,” says Bill Kilmer, senior vice president of Legislative and Political Affairs at the Mortgage Bankers Association (MBA), which represents the housing finance industry. “I imagine that, like the Biden budget proposal, Vice President Harris would want to raise the corporate rate as a means of revenue to pay for some other priorities.”

Fannie Mae and Freddie Mac

In his first term, Trump zeroed in on Fannie Mae and Freddie Mac, the two government-sponsored enterprises (GSEs) underpinning the U.S. housing finance system. In the wake of the 2008 housing crisis, Fannie and Freddie were placed under government conservatorship to help stabilize the market.

Trump has advocated for taking the GSEs out of conservatorship, which could lead to more competition — in other words, more options — in the mortgage market and minimize taxpayer exposure, Kilmer of the MBA says.

It could also raise mortgage costs, says Chen Zhao, senior manager of Economics at real estate brokerage Redfin.

“When Fannie and Freddie were in trouble, there was this question of, ‘Is there an applied guarantee from the federal government for these mortgage-backed securities (MBS)?’ And the answer turned out to be yes, because the government basically just took them over,” Zhao says. “But once you introduce that question mark about whether or not the MBS are guaranteed, it means that rates have to trade for a little bit higher in order to account for that additional risk.”

For her part, Harris has pointed to a 2015 Moody’s study that found privatizing Fannie and Freddie would add approximately $1,200 a year to the cost of a typical mortgage. ​​

“(Harris) really wants (the GSEs) as permanent, sponsored entities with those professional charters to lean in more to the mission side of their charter and their affordable housing mandate,” Kilmer says. “Not just their goals, but also sort of what they can be doing to increase supply and affordability.”

Immigration

Trump has indicated that, if reelected, he plans to deport millions of undocumented immigrants — a move his campaign has said would help lower housing costs.

Yet, approximately 20% of the construction labor force — residential and otherwise — is immigrant labor, according to Tobin of the NAHB.

“The construction industry has struggled with lack of labor supply for years,” Hamrick says.

“The thing about the recent wave of immigrants is that they don’t demand a lot of housing, actually, because they are either housed in public housing or they’re housing with relatives or friends,” Zhao says. “So, there’s not a lot of net housing demand that’s being added.”

Harris has shifted her stance on immigration — circling back to investing in the southern border wall — but continues to oppose mass deportations. During the Democratic National Convention in August, Democrats touted solutions to expanding legal entry and paths to citizenship.

“We’ve got to find a way to create a visa system for immigrants who want to work in the construction sector, to come into this country under a visa and work in our sector,” Tobin says. “We’re hopeful that the next President of the United States will lead into that and solve that problem.”

Interest rates

Trump has also suggested he would lower interest rates if reelected — but the Federal Reserve, not the president, sets monetary policy, and the Fed operates independently of who sits in the Oval Office.

“History has shown that in countries where politics infects monetary policy, it is less effective,” Hamrick says. “Translated, that means there’s a higher risk of inflation when heads of state or government try to muscle their central banks.”

Harris has said she wouldn’t interfere with the Fed, but rather focus on lowering costs.

To that end, mortgage rates have already started retreating, and forecasters expect them to continue cooling into 2025.

“Rates probably are coming down on their own anyways,” Zhao says.

Tariffs and trade

In his first term, Trump imposed a series of tariffs to restrict foreign trade, particularly with China, including on building materials like steel and aluminum. Many of these tariffs are still in place today.

Harris hasn’t said much on trade to date, but it’s unlikely the U.S. would return to the pre-Trump era of free trade.

If elected to a second term, Trump has said he’d impose further tariffs, including a 10% to 20% tax on all imports, and up to a 60% tax on imports from China. That would add to inflation, according to a recent Goldman Sachs report.

“It is well documented that if you increase tariffs, you basically increase prices. So that has a big inflationary impact,” Zhao says.

While housing costs tend to outpace inflation, higher prices overall make it harder for Americans to afford everyday expenses and set aside savings, such as for a down payment on a home.

“Abnormally high inflation does what inflation tends to do, which is to make prices go higher, robs purchasing power and would ultimately coincide with rising or higher interest rates,” Hamrick says. “Does that sound familiar? It should because that’s what we experienced in recent years. Central banks, like our own Federal Reserve, raise benchmark rates in response to high inflation. That ultimately catches up to mortgage rates and typically slows the broader economy.”

(Visit Bankrate online at bankrate.com.)

©2024 Bankrate.com. Distributed by Tribune Content Agency, LLC.

Brendan Rascius | (TNS) McClatchy Washington Bureau

Former President Donald Trump now leads Vice President Kamala Harris by 3 points among independents, marking a dramatic shift from one month ago, according to new polling.

In the latest NPR/PBS News/Marist poll, 49% of independent respondents said they are supporting or leaning toward Trump, while 46% said the same for Harris. Three percent said they’re backing a third-party candidate, and 2% said they’re undecided.

In an early August poll, Harris held an 11-point lead over Trump with independents — with 48% support versus his 37%.

In that poll, independent presidential candidate Robert F. Kennedy Jr. was backed by 12% of independents and other third party candidates received 2% support.

Kennedy has since suspended his campaign, endorsed Trump and urged his supporters to back him.

Political experts previously told McClatchy News that his endorsement “could potentially boost support for Trump.”

In August, Harris likely also benefited from a honeymoon period with voters, having only been in the presidential race since mid-July, experts previously said.

The latest poll, conducted between Sept. 3 and 5, sampled 1,529 U.S. adults and has a margin of error of 3.2 percentage points, meaning Trump’s lead is within this margin.

Other findings in the poll:

Trump has similarly seen a significant increase in his support among Latino voters since August, erasing Harris’ lead, according to the poll.

In the latest poll, 51% of Latino voters said they support the former president, while 47% said the same for Harris.

In August, Harris held a 15-point edge over Trump with Latino voters.

The latest poll also found there is a large gender gap in the support for the two candidates, with Harris leading among women by 15 points and Trump ahead among men by 12 points.

Trump is also leading with white voters, with 50% versus Harris’ 47%. However, Harris is receiving a larger share of support from this demographic than her Democratic predecessors. Biden garnered 41% support among white voters in 2020, and Hillary Clinton received 37% in 2016.

Among all registered voters, Harris is leading Trump by one point — 49% to his 48% — narrowing the race from August, when the vice president was up 48% to Trump’s 45%.

And among those who said they definitely plan on voting, Harris outpaced Trump by three points, 51% compared with his 48%.

The poll comes just hours before the two candidates are set to take part in their first — and potentially only — televised presidential debate. The debate, hosted by ABC News, will air live at 9 p.m. E.T.

The majority of respondents, 70%, said they plan to watch most or all of the debate, and 30% of registered voters said it will be an important factor in determining how they vote.

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©2024 McClatchy Washington Bureau. Visit at mcclatchydc.com. Distributed by Tribune Content Agency, LLC.

By John T. Bennett, CQ-Roll Call

Vice President Kamala Harris and Donald Trump will be face-to-face for the first time Tuesday night as they debate, aiming to keep the other out of the Oval Office.

Harris closed the polling gap on Trump after her surprise ascension to the Democratic nomination, but she still trails in some polls. She will have a chance to change that when the nominees square off in Philadelphia.

The vice president had narrow leads nationally in a list of polls released in the past few weeks, but her campaign got a surprise Sunday when a New York Times-Siena College survey put Trump up 1 percentage point — suggesting her surge after President Joe Biden dropped out has ended.

But a strong debate performance against the unpredictable, bare-knuckle debater Trump could give her White House bid a boost with less than two months until Election Day. The stakes couldn’t be higher in a race that shows ample signs of a photo finish on Nov. 5.

“If her momentum continues, Harris will probably win. But it may not. If she stumbles in the Sept. 10 debate, the momentum of the race may change,” according to William Galston of the Brookings Institution, a former White House aide under President Bill Clinton. “Trump’s campaign could regain its balance and sharpen its focus. And unforeseen events could shift the dynamic between the candidates.”

Polls suggest voters want to hear from Harris about policy, and prognosticators in Las Vegas say she has a better chance of winning the debate. “Latest odds reveal Harris has an implied probability of 57% of winning the debate, while Trump only holds a 53% chance,” according to Vegas Insider. “Kamala Harris’ past debate performance gives her a 55 percent chance of winning the debate, while Donald Trump has a 45 percent shot.”

Here are three things to watch as Harris and Trump debate.

Donald the distracted?

The nominees have taken different paths to Philadelphia, with Harris debate-prepping in Pittsburgh and Trump saying and posting more outlandish things — even threatening, if elected, to throw his opponents in the slammer.

“Therefore, the 2024 Election, where Votes have just started being cast, will be under the closest professional scrutiny and, WHEN I WIN, those people that CHEATED will be prosecuted to the fullest extent of the Law, which will include long term prison sentences so that this Depravity of Justice does not happen again,” Trump wrote in a post on Sunday. “Those involved in unscrupulous behavior will be sought out, caught, and prosecuted at levels, unfortunately, never seen before in our Country.”

That followed a wild Friday press appearance in New York during which Trump repeatedly insulted several women who have accused him of sexual assault at a time when women voters could decide the election.

The former president’s antics in recent weeks led one Republican pollster to question whether his heart really is in the presidential race.

“I have never seen a candidate more determined to blow an election. Instead of talking about affordability and immigration security (the top public issues), Trump is once again screaming about prosecuting his opponents,” pollster Frank Luntz wrote on X. “Message to Donald: Focus on helping voters, not yourself.”

Abortion access

Harris has been telling supporters at her rallies for more than a month that the election likely will be extremely close and that Democrats have work to do to secure enough votes to put her in the White House.

She and her campaign are banking that access to abortion will help her with women voters, especially college-educated white suburban ones who often vote Republican.

“The impact of abortion on the 2022 midterms, when Democrats did much better than expected, is undeniable. But some evidence suggests that its impact may be more muted in this year’s contest,” Galston noted.

Abortion ranked second, at 15 percent, in the Times-Siena survey when likely voters were asked what issue was most important to them. The economy was first, at 22 percent, and immigration third, at 12 percent.

But, to Galston’s point, abortion ranked eighth when registered voters in seven swing states were asked by polling firm Blueprint about their top issues. Still, more of them said they trusted Harris more on abortion than Trump by an 11-point margin. Notably, among registered independent voters in those battlegrounds, the vice president’s advantage grew to 24 percentage points.

Expect her to try to appeal to more voters in that crucial bloc on Tuesday night.

‘Old guard’

It’s doubtful anyone had this on their election-year bingo card: A Democratic presidential nominee praising Iraq War architect and staunch conservative Dick Cheney. In any other year, that might seem laughable.

After all, Democratic lawmakers and officials spent most of the super-hawkish Cheney’s run as vice president harshly criticizing him over his moves as President George W. Bush’s right-hand man on national security and foreign policy after the Sept. 11, 2001, terrorist attacks.

Yet, in this campaign, which already has been defined by twist and turns, it seems fitting and could add a twist to Tuesday’s debate. Harris on Saturday told reporters she is “proud” to have Cheney’s endorsement. Her campaign also released an ad Monday showing members of Trump’s administration, including former Vice President Mike Pence, saying they would not support him again this year.

It’s an effort to win over Republicans uncomfortable with Trump that Harris began by having GOP speakers at the Democratic convention last month. But bringing up Cheney could give Trump, who has struggled to settle on an anti-Harris message, a much-needed line of attack. In fact, Trump could opt to use the Cheney endorsement to try painting Harris as too much of a wild card on national and global security matters — especially amid worries of a regional Middle East war and the ongoing Russia-Ukraine conflict.

Cheney has long been a proponent of using U.S. military force, even starting preemptive wars. Trump is unabashedly anti-war, often calling them “stupid” and even appearing, at times, to harshly judge those who have made the ultimate sacrifice.

“Well, he’s clearly the old guard, the guard that, you know, the country club Republicans that don’t support Donald Trump,” Corey Lewandowski, a Trump campaign adviser, told Fox News on Sunday.

“And so, look, I don’t really care what Dick Cheney says. We saw what happened to Liz Cheney in her last election,” he added. Cheney’s daughter Liz was ousted from House GOP leadership for questioning Trump’s false claims about election fraud and then lost her reelection bid in the 2022 Wyoming Republican primary by a more than 2-to-1 margin after serving as vice chair of the special committee that investigated the Jan. 6, 2021, Capitol riot. “She was absolutely destroyed. … So they’re bitter and they’re angry and they’re living in the past. It’s time to move forward.”

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©2024 CQ-Roll Call, Inc., All Rights Reserved. Visit cqrollcall.com. Distributed by Tribune Content Agency, LLC.

Miriam Fauzia | The Dallas Morning News (TNS)

A fentanyl vaccine developed by researchers at the University of Houston is expected to head to clinical trials sometime in the middle of next year, with the hope of being a groundbreaking solution to a deadly crisis.

The vaccine, which has shown success in animal studies, is designed to stop the highly addictive opioid from entering the brain and causing an overdose. Biopharmaceutical startup Ovax acquired the license to produce and test the vaccine in November 2023 and raised over $10 million toward that effort by June.

“We’re all incredibly excited,” said Collin Gage, the start-up’s co-founder and chief executive officer. He added that his company is starting at “ground zero,” but he is confident it will one day have a fentanyl vaccine available to the public.

That day may be a long time from now. While public health emergencies, like the COVID-19 pandemic, can accelerate a vaccine’s development, testing a new vaccine can take anywhere from five to 10 years — sometimes longer.

Meanwhile, fentanyl overdose deaths have been on the rise in Texas, from less than 80 in 2014 to nearly 2,300 in 2023, according to the Texas Department of State Health Services. The synthetic opioid — made illegally but also available by prescription — is 50 times stronger than heroin and 100 times stronger than morphine, making it the deadliest drug in the opioid crisis.

For fentanyl vaccines, adjuvants are key

The idea of creating an opioid vaccine has drawn scientific attention since the 1970s. Unlike bacteria or viruses, opioids aren’t recognized by our immune systems as foreign invaders. But the immune system can be trained to make antibodies in response to an opioid like fentanyl through a vaccine that links bits of the drug to noninfectious bits of bacteria and uses substances called adjuvants.

Adjuvants are designed to enhance immune response, and are particularly important in vaccines targeting substance use disorders. Past attempts to make these vaccines have been unsuccessful in part because the adjuvants weren’t effective enough, said Jay Evans, director of the Center for Translational Medicine at the University of Montana. Evans is also the chief scientific and strategy officer of Inimmune, a Montana-based biotech company developing and testing a variety of vaccines including ones targeting fentanyl and heroin addiction.

The adjuvant in the University of Houston’s fentanyl vaccine is an enterotoxin, a chemical produced by the bacteria Escherichia coli and modified to be noninfectious. It was first developed at Tulane University in Louisiana in the early 2000s and has been used in a variety of vaccines, said Colin Haile, a research associate professor of psychology at the University of Houston who led its fentanyl vaccine development. Haile is also an Ovax co-founder and adviser.

“It has been in 15 human clinical trials in combination with other vaccines,” he said, referring to the adjuvant used in his team’s vaccine. “There have been studies in infants where the results have been fantastic, nearly no side effects.”

Other researchers such as David Dowling and Dr. Ofer Levy, both Ovax co-founders, are using adjuvants that haven’t been tested in humans but appear to effectively enhance the immune response to vaccines targeting substance use disorders, at least based on animal studies, Dowling said.

Clinical trials littered with challenges

Phase 1 clinical trials for the University of Houston vaccine are planned to begin in the second quarter of 2025. Ovax is also in licensing negotiations with Boston Children’s Hospital for a fentanyl vaccine developed by Dowling and Levy. If those negotiations are successful, phase 1 clinical trials could begin in early 2026.

These trials will aim to establish the vaccine’s safety level, potential side effects and optimal dosage. Finding people to take part in them will be a challenge, Evans said.

“Compared to a normal infectious disease clinical trial, it will be more difficult. The FDA (Food and Drug Administration) is pretty adamant that you’re not going to test this vaccine in healthy individuals that don’t already have some sort of opioid addiction,” he said. “So we need to target patients in phase 1 who have a history of opioid use disorder, and that’s a harder population to try to recruit. It’s going to take longer; the patient population will have more adverse events because they’re drug users and they will be harder to track.”

Evans added that the stigma around addiction and drug use might make people reluctant to disclose their condition and participate in a clinical trial.

Ovax has yet to decide where it plans to run its phase 1 clinical trials, Gage said, but it has been looking at sites in Australia and the Netherlands.

“We’re also looking in the United States,” he said, “but it’s difficult to find the right patient population.”

Future clinical trials would need to determine the effectiveness of the vaccine, who would benefit the most and how long immunity would last.

Vaccines as part of the solution

Some critics of fentanyl vaccines say they pull resources from existing treatments for opioid addiction such as buprenorphine, methadone and naltrexone. Some have questioned whether people would seek out the vaccine.

“People have to say they want to be injected, and they have to choose to keep coming back for each injection or infusion,” Keith Humphreys, a Stanford University professor of psychiatry and behavioral sciences, told The Washington Post in 2023. “The vaccines do nothing to reduce craving or withdrawal or to motivate anyone to return for more care.”

For Haile, a fentanyl vaccine is not the sole solution but another weapon in the fight against the opioid crisis. He and his colleagues at the University of Houston have conducted animal studies investigating how the vaccine affects treatment with buprenorphine, a medication commonly prescribed to manage withdrawals and drug cravings. The findings have yet to be published but are “quite impressive,” Haile said, noting fentanyl vaccines could improve the effectiveness of existing treatments.

“The most important thing to keep in mind is that we’re moving as fast as we can go. … We need to get something to market as quickly as possible to address this terrible problem,” Haile said. “The ultimate goal is to protect people and save lives.”

©2024 The Dallas Morning News. Visit dallasnews.com. Distributed by Tribune Content Agency, LLC.

Nardine Saad | (TNS) Los Angeles Times

Adele says she’s making good on a promise to take a break from music after she completes her residency in Las Vegas.

The “Hello” and “Rolling in the Deep” singer confirmed during her Saturday show in Germany — her last in a 10-show run abroad — that she plans to “rest” when she wraps her three-year gig in Sin City this November.

“I’m not the most comfortable performer, I know that, but I am very f— good at it. And I have really enjoyed performing for nearly three years now, which is the longest I’ve ever done and probably the longest I will ever do,” the 15-time Grammy Award winner said onstage in Munich, according to fan footage posted on TikTok.

Adele has 10 shows left in her “Weekends With Adele” residency at the Colosseum at Caesars Palace. The shows will span five weekends this fall after she had to postpone them in February due to illness.

“After that, I will not see you for an incredibly long time and I will hold you dear in my heart for that whole length of my break,” she said, adding that she will “fantasize” about her time onstage. “It has been amazing. I just need a rest.”

“I have spent the last seven years building a new life for myself and I want to live it now,” the 36-year-old said through tears. “I want to live my life that I’ve been building and I will miss you terribly.”

On Tuesday, Adele took Instagram to reflect on her “bespoke” gig in Munich, which launched Aug. 2.

“Wow! Wow! Wow! Munich you were incredible! What a phenomenal experience. I am truly touched by the genuine outpouring of love and good will I felt from every single person who came to every single show,” she wrote, captioning a highlight reel from the shows. She also thanked the fans who attended and her team for making it happen.

“There truly is no feeling like standing in front of people you’ve never met, belting out a bunch of songs that changed your life that in ways somehow changed theirs too. It’s truly remarkable and an extraordinary story to be able to tell. I’ve been sobbing watching this beautiful video! Danke Munchen!,” she wrote.

In July, the superstar told German broadcaster ZDF that her “tank is quite empty” and that she doesn’t have plans for new music “at all.”

“I want a big break after all this and I think I want to do other creative things just for a little while,” the hitmaker said. “You know, I don’t even sing at home at all. How strange is that?”

Likewise, before her Las Vegas residency began, the Oscar winning “Skyfall” singer said she planned to take a break from music and perhaps pursue a degree in English literature or an acting career. However, during a January show, she said she might be open to touring again after completing a follow-up to her award-winning 2021 album “30.” But, as she told a fan in the audience, she wasn’t in any rush to do either of those things yet.

Instead of touring to promote “30,” she took up residence at the Colosseum. She was initially set to launch her residency in January 2022, but unexpectedly shut it down a day before it was meant to open. She blamed the COVID-19 pandemic and issues with the supply chain at the time, then explained later that the postponement was because her “artistic needs” were not being met. She said the show had “no soul in it” and that it “lacked intimacy” inside the 4,000-person theater.

The “Easy on Me” singer ultimately launched “Weekends With Adele” in November 2022 and extended the run twice.

Earlier this month, the British balladeer confirmed during another Munich show that she and sports agent Rich Paul were engaged after repeatedly referring to Paul as her fiance — and sometimes her “husband” — for months. (The two went public with their romance in 2021.) The singer, who shares 11-year-old son Angelo with ex-husband Simon Konecki, has also been vocal about wanting to expand their blended family.

©2024 Los Angeles Times. Visit latimes.com. Distributed by Tribune Content Agency, LLC.

Emma Hall | The Sacramento Bee (TNS)

SACRAMENTO, Calif. — Pit River Tribe elder Theodore Martinez knows more of death than anyone should.

“I want to acknowledge some of the people that have been murdered from my tribe,” Martinez said. “These are all my people.”

Martinez’s family, close friends and members of his tribe are among the more than 150 documented cases of Missing and Murdered Indigenous People crisis in California. The state has the fifth most unsolved cases involving Native people in the country, and tribal leaders have urged for the crisis to be declared a state emergency.

Earlier this year as he stood on the west Capitol steps, Martinez, with anguish in his eyes, recalled each person he’s lost in his lifetime.

There was Little George Montgomery, who was like a brother to Martinez. He was killed decades ago, with the tribe finding his body dismembered, Martinez said. All they had left to bury was his skull.

There was his own brother, Victor, who Martinez said was killed in 1992.

There was his cousin who lived on the Fort Bidwell Reservation in Modoc County. Martinez said she was found dead, face down in the water of the tribe’s hot springs.

There was Dewey McGarva. At 36, he went missing for more than a year. When his tribe found him, there wasn’t much left, Martinez said.

And then, there was Milton “Yogi” McGarva, who identified as Two-Spirit, a third gender identity for Indigenous people. McGarva was stabbed and fatally wounded in 2020.

“These are things that have gone on historically, throughout my territory,” Martinez said. “None of these things have been investigated. Nothing has been done.”

As Martinez looked upon a crowd of Native Californians, he knew he wasn’t the only one who had lost relatives.

The deaths and disappearances of his relatives have gone unsolved by law enforcement for decades, Martinez said. It’s a pain many families relate to: the feeling of being let down and left without closure.

“We as Native people, we need to help each other. We need to support this movement,” Martinez said. “Because without that support, it’s not going to go very far.”

After feeling neglected by law enforcement, these families have taken matters into their own hands. They offer monetary rewards for anyone with knowledge of their relatives’ whereabouts, carrying posters with their loved one’s faces and names.

They haven’t given up. They all want justice.

Families of Missing and Murdered Indigenous People seek justice

Toni Espinoza, a member of Wilton Rancheria, is the sister of Angel Baby Espinoza, who died on Nov. 18, 2001. Her family believes she was killed.

Toni Espinoza said her sister died following a hit and run on Norwood Avenue in North Sacramento. Her family believes Angel Baby was pushed in front of the car by an ex-partner.

“We want justice. I want to be able to tell her kids who did this to their mom,” Toni Espinoza said, her voice beginning to break. “We have a right to know, everybody has the right to justice.”

Toni Espinoza said she worked with a police detective and allegedly found an eye witness. But the case was deemed manslaughter after three years and not pursued as a murder investigation.

To this day, her family, including Angel Baby’s own five children,still mourn her death. They are left with no answers.

“This is why we do what we can,” Toni Espinoza said. “To spread the word, to say her name, to do marches and hold protests in front of the Capitol so somebody will care.”

Over in Mendocino County, 81-year-old Ronnie Hostler and his family have been searching for his beloved granddaughter, Khadijah Britton, 23, who has been missing for the past seven years. Britton belongs to the Wailaki Round Valley Indian tribes.

Britton was last seen in Covelo, California, according to the Federal Bureau of Investigations, with an ex-boyfriend forcing her into a car at gunpoint.

While the Mendocino County Sheriff’s Office was involved in the case, Hostler is unsatisfied. He said Britton’s disappearance wasn’t investigated until two weeks after her family reported her missing. Today, Britton has been deemed a cold case.

Britton’s family is still trying to find herbut at this point, they are looking for her body to bury in the family cemetery.

“We want to find her, wherever she may be, and we want to take care of her,” Hostler said. “That’s what we want right now, and we’re not getting it.”

Tribes face issues with law enforcement

The Sacramento Bee has spoken to, or heard from, 46 families, tribal leaders and experts in Indian Country affected by the Missing and Murdered Indigenous People crisis. They identified obstacles preventing cases from getting solved.

Missing and Murdered Indigenous People cases reflect disproportionate rates of violence against Native communities nationwide. Native people are 2.5 times more likely to experience a violent crime, according to the Association on American Indian Affairs.

When cases are reported, there is sometimes no response, little follow through or poor coordination with criminal investigations, said Keely Linton, the operations director for the Strong Hearted Native Women’s Coalition, a nonprofit that supports families with Missing and Murdered Indigenous People cases.

Local law enforcement can be slow to respond to calls of crime and are “less attentive to the interests of tribes,” according to the UCLA American Indian Studies Center. Tribal communities also struggle to trust law enforcement.

Erik Apperson, the former Del Norte County sheriff, saw this dynamic firsthand when working on Yurok and Tolowa Dee-ni’ tribal lands. Now retired, he recalled meeting a shocked and grieving mother whose young son was killed by another boy on tribal lands.

Despite the tragedy of a young boy dying that night, the need to bring an offender to justice did not outweigh the absence of ability and desire to pursue the case, Apperson said.

“I believe in my heart that it was a homicide, even if negligence played a part in it,” he said.

Why do Missing and Murdered Indigenous People cases go cold?

Missing and Murdered Indigenous People crisis cases are seven times less likely to be solved than any other ethnic group statewide, according to Sovereign Bodies Institute. As a result, most cases go cold, said Linton, who is Íipay and Cupeno.

Families will often feel stigmatized by law enforcement and are often faced with skepticism due to racist stereotypes. They feel law enforcement is uncaring or that their loved one’s disappearance is minimized.

Racism against Native people can prevent cases from being pursued or taken seriously, said Linton. Officers are not always understanding or trauma-informed about the tribal communities they serve.

As a result, some harbor stereotypical beliefs and prejudices. It’s an issue Greg O’Rourke, the Yurok tribal police chief, faced when he handled a sexual abuse case with his non-Native partner in the his local sheriff’s department.

“I remember very specifically my partner saying ‘do the people on the reservation have kids just so they can molest them?’” said O’Rourke during a hearing on Public Law 280 in March. “This person was a good man, a good cop. But that was the response. How can you provide accurate and humane services when that is the first thing that comes to mind?”

Barriers are also deeply rooted in California’s colonial origins and laws today.

What is Public Law 280?

Enacted in 1953, Public Law 280 requires tribal law enforcement to share criminal jurisdiction with state police agencies, causing overlap and confusion. It’s a law that impeded on Britton’s case being pursued, Hostler said.

“The piece of colonization is still here, embedded with all these laws, all these laws that have moved forward in the state of California,” said Assemblyman James Ramos, D-San Bernardino. “It’s now, recently, that we’re layering back those laws and trying to insert the California Indian voice into it.”

Because of Public Law 280, tribal law enforcement are unable to prosecute non-Native people on tribal land. Tribal police can only arrest and detain non-Natives for “delivery to state and federal authorities,” according to the Department of Justice.

In regards to Missing and Murdered Indigenous People cases, it’s often non-Native people perpetrating sexual violence against Native women. Between 86% to 96% of abuse against Native women comes from non-Native offenders, who are rarely punished, the Mailman School of Public Health at Columbia University found.

How California legislation could help

Tribal police know their communities best, yet they lack the authority of a state officer to investigate murders, said O’Rourke.

This is where Assembly Bill 2138 could provide a solution. This bill, authored by Ramos, would launch a pilot program to grant state peace officer status to tribal police in selected tribal communities from 2025 until 2028.

If passed, this program would go into effect under the Department of Justice. By no later than 2027, the DOJ would submit a report about case clearance rates, including those for Missing and Murdered Indigenous People cases.

As another way to combat Missing and Murdered Indigenous People cases, California passed the Feather Alert in 2022, an emergency notification system similar to the Amber Alert.

But the alert has run into obstacles.

In December, The Bee found that the California Highway Patrol only sent out one Feather Alert. CHP has a history of not issuing alerts tribes requested, either because it did not meet their criteria or for undisclosed reasons. Since then, about 60% of Feather Alert requests have been rejected, according to the Press Democrat.

New amendments have been implemented for the Feather Alert. Law enforcement agencies are now required to respond to requests within 48 hours. If an alert is denied, law enforcement must provide written notice to a government agency or tribe that explains why.

“We’re starting to address and make the alert system stronger,” said Ramos, who is Cahuilla and Serrano.

Tribal leaders have urged more funding toward investigations. In July, Gov. Gavin Newsom awarded almost $20 million in grants to 18 tribes to fund prevention efforts for Missing and Murdered Indigenous People cases.

Families, meanwhile, called for the convictions of the perpetrators who enact violence against their loved ones. Justice has not been swift for most families, but McGarva’s family did have their call answered. Jarrett Bleu Rucker, the man who killed McGarva, one of Martinez’s relatives, was sentenced to 26 years to life in prison earlier this year.

“The victory and justice for Yogi was not easily won,” said Morning Star Gali, the founder of Indigenous Justice, who assisted McGarva’s family in the criminal justice process. “It was a difficult four years in the making, with his family not knowing when they would be able to breathe a sigh of relief.”

The road to support starts with visibility, priority and mutual respect for California’s first people, Ramos said.

“It’s time that our voices be heard,” Ramos said. “It’s time that our voices and what’s affecting our people doesn’t go in silence.”

The Strong Hearts Native Helpline provides culturally-specific resources for Native Americans experiencing domestic and sexual violence through a helpline 1-844-7NATIVE (762-8483).

©2024 The Sacramento Bee. Visit at sacbee.com. Distributed by Tribune Content Agency, LLC.

By René Bennett, Bankrate.com

Many of us have given in to the temptation to buy something we don’t need.

Maybe you were passively scrolling through your social media feed when a sponsored post came up, showcasing the latest tech gadget with glowing reviews. Unable to resist, you clicked the “buy” button for fear of missing out, only to find the excitement faded not long after, leaving you with regret and a dent in your bank account.

What is impulse buying?

Impulse buying is the act of making unplanned purchases on a whim without considering long-term goals and needs. From flashy tech to trendy fashion items, impulse purchases can quickly drain your bank account and hinder your long-term financial goals.

The temptation is further fueled by social media — 48% of social media users have made an impulse purchase, according to Bankrate’s Social Media Survey. And 68% of those said they regretted an impulse purchase they made on social media.

Coupled with the current high-inflation environment, succumbing to impulse purchases can have even more detrimental effects on our savings than usual. But there are ways you can curb impulsive spending habits and focus on more long-term financial goals.

Strategies to stop impulse buying

1. Reflect before purchasing

Getting into the habit of slowing down and reflecting before making an impulse buy can be a big money-saver.

Some questions you should ask yourself:

• Is this item a want or a need?
• Can I afford it without sacrificing something more important?
• Will this bring long-term value and satisfaction?

2. Stick to a shopping list

Before heading to the store or browsing online, make a shopping list of items that you genuinely need. A shopping list provides a clear plan for your shopping trip, eliminating ambiguity and reducing the chances of being swayed by impulses. It also acts as a reminder of your goals and priorities.

You could try using a shopping list app which can help you organize your shopping lists and even share them with friends or family members to streamline your shopping process.

3. Implement the 24-hour rule

When you come across something you’re tempted to buy immediately, give yourself a cooling-off period of 24 hours. Why? The purpose of the 24-hour rule is to create a space between the initial impulse and the actual purchase — often, the initial excitement and compulsion to buy can fade after that time period. By waiting, you give yourself a chance to reconsider the purchase in a more neutral state of mind.

During those 24 hours, you can take the time to research the item’s features, read reviews, compare prices and consider if it aligns with your needs and budget.

4. Unfollow accounts that fuel your temptation

The constant stream of captivating images, flashy ads and influencers promoting products on social media can make it incredibly tempting to click that “buy now” button without a second thought. With just a swipe or a scroll, we’re exposed to a never-ending array of products and services, each promising to improve our lives in some way. But that promise can be deceiving and succumbing to the temptation can lead to financial stress and instability.

One big step you can take to help resist the siren call of impulse buys is to carefully curate your social media feed to prevent yourself from seeing those items in the first place. Unfollow brands and promoters that consistently tempt you. You might even want to remove certain shopping apps from your phone or set time limits for those that have the strongest pull on you. Even a few changes to your social media feed can reduce the constant exposure to shopping triggers and help you save money.

5. Prioritize clear financial goals for long-term gratification

Envision your ideal financial future, and set clear goals. Instead of simply saying you want to save money, set a specific target, such as saving $5,000 within the next year. Once you’ve established goals, you can fit them into your budget to align your spending with what you want to achieve in the long term.

It’s easy to give in to temporary pleasures when we’re surrounded by lures to buy stuff all the time, but reminding yourself of your financial goals and learning to wait can help you find long-term fulfillment. As you achieve smaller milestones toward your goals, reward yourself (within reason) to maintain a positive mindset and reinforce your commitment to the larger goals.

6. Pay with cash

Take the time to budget exactly how much you can spend on your purchases and withdraw cash to spend on those purchases. By using cash, you avoid overspending and impulse purchases.

If you’re used to paying with a card to rack up credit card points or cashback rewards, you’ll lose out on these benefits when you pay with cash. But once you start to gain more discipline by paying with cash, you might be able to transition back to responsible credit card use.

Be aware of signs of impulsive spending habits

The thrill of impulsive buying might not show up right away, but there are some signs to look out for, including:

• You’re spending beyond your means or more than you intended during your purchase.
• You hide purchases from family members or a partner.
• You’re unable to pay bills or save as much as you’d like because of high spending elsewhere.
• You feel guilty or regretful about spending.

Bottom line

By establishing clear financial goals and prioritizing your long-term needs over short-term impulse purchases, you can regain control of your finances and make decisions that support future aspirations. Keep track of how much you’ve saved from cutting back on impulse buying — those savings can go toward a specific savings fund or be invested in a high-yielding certificate of deposit (CD) to earn money back in the form of interest.

Key takeaways

• Impulse buying means purchasing items you did not plan to buy.
• Impulse buying can result in more spending which can lead to less savings and even an increase in debt.
• There are steps you can take to reduce impulse buying, such as prioritizing financial goals and sticking to a shopping list.

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©2024 Bankrate.com. Distributed by Tribune Content Agency, LLC.