Everett LaBrash is a Children’s Miracle Child.

The son of Alex and Marianne LaBrash of Sterling Heights, he is now a year old who is continuing to reach milestones and exemplifies the healthy outcomes that are made possible through the support of the annual Feldman Automotive Children’s Miracle Celebrity Invitational presented by Corewell Health Foundation of Southeast Michigan and the Mark Wahlberg Youth Foundation.

This year’s golf outing raised $1.5 million.

All of the money garnered through sponsorship support, on site-donations and a live auction, which included an electric guitar signed by Taylor Swift, benefit Children’s Miracle Network programming at Corewell Health Children’s and patients like Everett.

Everett  came early at 24 weeks.

Being a preemie, he faced a plethora of challenges, especially lung development, which required a C-pap at birth, and a ventilator after developing pneumothorax, to regulate his oxygen and help with breathing.

During his stay at Corewell Health Beaumont Troy Hospital a team of health care professionals at Corewell Health Children’s Child Life Services provided Everett and his parents with care and compassion. Panda Warmers, Giraffe Omni Beds, and fold-out furniture for long stays were just some of the benefits that they received with the help of donations made to Corewell Health Children’s through Children’s Miracle Network Hospitals.

“Our team at Troy, honestly, they were life-changing,” Marianne LaBrash said in a video released by the hospital. “They helped us through… so much. I definitely have a couple of lifelong friends with them.”

Alex concurred.

“Everyone’s easy going,” he said. “They’d lend an ear if you needed to vent to them. Thank you doesn’t wrap it up enough.”

The Feldman Automotive Children’s Miracle Celebrity Invitational is the largest celebrity golf event in the Detroit area, where every foursome enjoys an up-close and personal celebrity pairing.

This year’s event featured more than 50 national and local celebrities, including actors Donnie Wahlberg (last year it was Mark Wahlberg), Kevin Chapman, Jamie Denton, Marion “Pooch” Hall, Jamie Hector, and Jesse Spencer. From the world of sports, Kenny Anderson, Joique Bell, Lomas Brown, Johnny Damon, Braylon Edwards, Calvin Johnson, Pepper Johnson, Frank Zombo, and dozens of others took part in the day’s activities. It’s one of those events that everyone looks forward to, players and donors alike.

The morning began with Wahlberg accepting a “putting challenge” from three Corewell Health Children’s “Miracle” children selected to represent the more than 200,000 children treated at Corewell Health Children’s each year.

“We are delighted with the incredible success of this event”, said Lamong Yoder, a registered nurse and president of Corewell Health in Southeast Michigan. “Our gratitude goes out to the many sponsors and celebrities that are the backbone of this one-of-a kind invitational. Funds raised will be used to help the children in our communities when they need it the most.”

After golf, a spirited live auction and course contests raised about $300,000 from bids on items like Taylor’s guitar donated by Bob and Connie Skandalaris, which went for $31,000, a private tour of Rick Hendrick’s Automotive Heritage Museum in Charlotte, North Carolina, hosted and donated by Jay Feldman and Rick Hendrick, a 2025 Formula 1, Monaco package donated by Nino Cutraro; an Italian villa vacation, donated by the Rugiero Family and dinner in the Celani Wine Cellar, donated by Tom and Vicki Celani.

“It was inspiring to see so many people lending their support and contributing to our cause. We are helping so many children and families with the money raised. We are already planning for next year’s event and aiming to raise even more money to continue to provide support for those families in need,” said Jay Feldman, chairman and CEO of the Feldman Automotive Group.

Supporting the fundraising event this year was its title sponsor, the Feldman Automotive Group; lead presenting sponsor Quantum Ventures of Michigan; presenting sponsors Shift Digital and Vesco Oil Corporation; and supporting sponsors including the Celani Family Foundation, CIBC, Corewell Health, The Fourth Tri Sanctuary, Aaron and Carolynn Frankel Family Foundation, Mechanical Services, NativeWahl, and Terra Capital Industries and more than 50 other generous sponsors.

Also praising the generosity shown during the invitational was Ryan Daly, president of the Corewell Health Foundation Southeast Michigan.

“Corewell Health Children’s will receive support to provide life-saving services, vital pediatric equipment, and funds for patient scholarships for families unable to afford needed care,” Daly said, while the Mark Wahlberg Youth Foundation will utilize its funds to improve the quality of life for youth across the country by providing financial resources and community support to youth services.

Organizers of the event included a dedicated committee of community members — Tom Celani, Nino Cutraro, Jay Feldman, Ken Noonan, Bob Skandalaris, and Sam Yamin.

For more information visit corewellhealth.org/childrens  or call 855-480-KIDS (5437). Children’s Miracle Network Hospitals raises funds and awareness for 170 member hospitals that provide 32 million treatments each year to kids across the U.S. and Canada.

All of the donations and money raised is used locally, to help Miracle families in nine counties throughout Southeast Michigan including Macomb, Oakland and Wayne counties.

For more information visit CMNHospitals.org.

For more than a decade, independent pharmacist Jay Patel has built a close and enduring relationship with his customers, who come to him for help in sickness and in health.

But now there are interlopers: Drug middlemen, companies known as pharmacy benefit managers (PBMs) that influence which medicines can be bought, where to buy them and at what cost.

Patel and other independent pharmacists say their businesses are threatened by the growing influence of these companies, tied to huge health care conglomerates. In a system that is opaque and complex, patients are steered to affiliated pharmacies, such as CVS and mail-order pharmacies, they say. Pharmacists face high fees and low reimbursement rates, so are unable to cover their costs.

That could put Patel — and other locally-owned pharmacists — out of business.

“I want to do what matters to the community. But how long can I sustain this?” said Patel, 48, who owns Savco Pharmacy in San Jose’s West San Carlos neighborhood. “We are at their mercy.”

The PBMs respond that critics base their conclusions on incomplete evidence. According to the trade organization Pharmaceutical Care Management Association, they protect consumers from high drug prices by negotiating for discounts, called rebates, from drug companies.

The disappearance of independent pharmacies could limit consumer choice and health care access — especially in low-income or rural communities.

On Oakland’s Telegraph Avenue, Selam Pharmacy owner Michael Gebru called PBMs “a big black box.” He said “They bill me whatever they want, and can reclaim it. That’s pretty scary. It’s a Wild West.”

In the coastal village of Point Reyes Station, tiny West Marin Pharmacy recently lost its contract with PBM company Express Scripts, used by insurer Cigna and others. Now residents covered by Cigna must get their prescriptions by mail or make a 20-mile drive to find another pharmacy.

“If any of us, our children and families are ill, suffering from fevers, vomiting, diarrhea or worse, we may be forced to drive an hour or more to San Rafael, Novato or Petaluma just to get a prescription filled,” worried pharmacy customer Christine Cordaro of Inverness Park.

PBMs were created in the 1960s as a way to process prescription drug claims. They are responsible for paying pharmacies on behalf of insurance companies, employers and the government. The three largest companies are run by CVS Health, Cigna and UnitedHealth Group, which oversee prescriptions for more than 200 million Americans.

In 2012, the year San Jose pharmacist Patel bought his modest shop, PBMs processed fewer than 50% of prescriptions.

A series of mergers in 2018 created the current system, where health care conglomerates are vertically integrated — owning the insurer, the PBM and pharmacy. The giant health insurer Aetna combined with drug retailer CVS. Another large insurer, Cigna, bought Express Scripts. UnitedHealth built its own PBM.  All three companies operate mail-order pharmacies.

“It’s like they’re taking the money from one pocket, and putting it into the other,” said Zsuzsanna Biran, pharmacist owner of West Marin Pharmacy.

Despite consumer opposition, the FTC approved the mergers.  But now there are concerns about PBMs’ economic leverage. The smaller, locally owned pharmacies feel muscled out of the market.

CVS calls the plight of independent pharmacies “overblown.”

“Contrary to much of the independent pharmacy lobby’s rhetoric, there is no crisis facing independent pharmacies,” CVS said in a statement.

“What the independent pharmacy lobby has long coveted is a world without managed pricing or the competitive pressure from PBM negotiations on behalf of payer clients and consumers,” CVS said.

According to Express Scripts, “If we didn’t provide significant value for our thousands of partners, we wouldn’t exist.”

The PBMs work by negotiating rebates on the “sticker price” of medicines. Some of these savings are shared with insurers and employers.  But a slice is kept by the PBMs. This is enormously profitable.

There is evidence of anticompetitive behavior that illegally distorts the market, hurting consumers and threatening the survival of independent pharmacies, according to new reports by the U.S. Federal Trade Commission and a House Committee on Oversight and Accountability investigation.

PBMs steer patients toward pricier drugs, with “formularies” of preferred medicines that discourage use of lower-priced alternatives, according to the reports, released last month. Because these high-priced drugs command a greater rebate, there’s more profit.

They also sometimes restrict patients’ access to mail-order deliveries, which they own. This cuts out the role of the local pharmacy.

Independent pharmacies say they’re saddled with unnecessary extra fees. When he started his business in 2012, Patel paid $15,000 to $20,000 in PBM fees; this year, his fees could surpass $110,000.

High fees and low reimbursement may discourage pharmacists from filling a prescription. If he loses money on a prescription, “I have two options,” said Patel. “Take the loss, or tell the patient that I cannot fill it.”

“With lower prescription reimbursements in one corner and higher back-end fees in the other, many community pharmacists are thinking about throwing in the towel,”  according to the National Community Pharmacists Association, which represents more than 19,400 independent U.S. pharmacies.

Nearly one-third of independent pharmacy owners may close their stores this year, it predicted.

But in Sacramento and other state capitals, lawmakers are taking a tougher look.

State Sen. Scott Wiener has authored legislation, Senate Bill 966, that would impose new rules on PBMs, better regulating the companies. It would require PBMs to be licensed with the California State Board of Pharmacy and to pass down drug rebates to consumers.

Meanwhile, Patel takes joy in things that don’t cost money — recognizing customers’ names and faces, making birthday phone calls and reminding them to be immunized. Once he provided a cane, for free, to a customer with a gimpy leg.

And there are rewards that are priceless, such as the gifts of fruit, chocolate and home-baked cookies from grateful customers.

“He’s the best,” said customer Rob Souza, picking up a prescription for an ailing wife. “He’s like a small-town pharmacist, always working things out.”

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.

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For many women experiencing symptoms caused by uterine fibroids the only option for relief was a hysterectomy and that created its own kind of pain for women still wanting to have children.

Now there’s another way.

Through laparoscopic radiofrequency ablation (Lap-RFA) women have a viable and considerably less invasive option, for the treatment of uterine fibroids should they choose to seek a diagnosis and treatment.

But will they?

Dr. Jay Fisher, a Corewell Health obstetrician-gynecologist pioneering the treatment in Southeast Michigan, also known as the Acessa procedure, said up to 75 million women in the United States may experience symptoms caused by uterine fibroids, but only 1.4 million will seek care for it.

“Most of them just live with it,” Fisher said.

Once a month these women suffer a variety of symptoms such as excessive menstrual bleeding, cramping and anemia and, while a laparoscopic hysterectomy is less invasive, it still requires the surgical removal of the uterus, or womb, from a woman’s body. Plus, a lot of women are unable to take the medication (estrogen) that was typically prescribed afterwards.

Laparoscopic radiofrequency ablation (Lap-RFA) was  first used in the treatment of liver tumors uses radiofrequency energy to treat uterine fibroids.

“It’s really remarkable technology because it’s very precise, delivering (the radiofrequency) directly to the fibroid itself while not damaging any tissue around it.”

Among those who were trying to live with the symptoms caused by uterine fibroids was Balsam Goriel, 47, of Warren.

“Every other month I would be in the emergency room,” said Goriel, whose condition got so bad it required blood transfusions.

“It was exhausting,” she said. “I wouldn’t go anywhere. I barely ate. I was like a car without lights.”

Her doctor tried a procedure that has had some success but it didn’t work for her and it appeared that her only option would be a hysterectomy, which she was not ready to accept.

“I don’t like getting my periods but I think it’s like a detox for a woman,” Goriel said. “It wasn’t about having children.”

It’s then she was told about laparoscopic radiofrequency ablation (Lap-RFA), which at one time was not covered by many health insurance plans. However, in recent years data has shown that it’s not only an effective treatment medically, but also financially more cost effective.

“It’s the best thing I’ve ever done. Dr. Fisher was amazing. He worked hard to identify the right solution for me,” she said.

The renewed energy she experienced after the outpatient procedure enabled her to return to a normal life.

“I have not gone to the ER since,” she said, adding she has not had to call in sick to work as well. She is socializing, happy and robustly practicing the tenets of self-care such as walking and exercise, journaling, prioritizing water intake, a solid sleep routine and a diet rich in fruits and vegetables.

“It’s the best thing I’ve ever done,” said Goriel. “I still get cramps but it’s nothing like it used to be. Now, I just have the same discomfort as everyone else.”

For more information visit beaumont.org/services/doctors.

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Anna Claire Vollers | (TNS) Stateline.org

Helping a pregnant minor travel to get a legal abortion without parental consent is now a crime in at least two Republican-led states, prompting legal action by abortion-rights advocates and copycat legislation from conservative lawmakers in a handful of other states.

Last year, Idaho became the first state to outlaw “abortion trafficking,” which it defined as “recruiting, harboring or transporting” a pregnant minor to get an abortion or abortion medication without parental permission. In May, Tennessee enacted a similar law. And Republican lawmakers in Alabama, Mississippi and Oklahoma introduced abortion trafficking bills during their most recent legislative sessions, although those bills failed to advance before the sessions ended.

Those five states are among the 14 that enacted strict abortion bans following the U.S. Supreme Court’s June 2022 Dobbs decision, which dismantled the federal right to abortion. Now, conservative state lawmakers are pushing additional measures to try to restrict their residents from getting them in states where it remains legal.

“A lot of folks thought Dobbs was the floor and it’s really not,” said Tennessee state Rep. Aftyn Behn, a Nashville Democrat who’s challenging Tennessee’s trafficking law in court. “[Anti-abortion lawmakers] are coming for state travel and the ability to even talk about abortion.”

Abortion-rights advocates have filed lawsuits in Alabama, Idaho and Tennessee, arguing the laws are vague and violate constitutional rights to free speech and travel between states. A federal judge has temporarily blocked Idaho’s law from being enforced while the case is ongoing.

Proponents of the laws argue they’re needed to protect parental rights and to prevent other adults from persuading adolescents to get abortions.

“This is a parental rights piece of legislation,” Idaho Republican state Rep. Barbara Ehardt told Stateline. “We can’t control someone getting an abortion in Oregon. But you cannot take a child to get an abortion without the parent’s knowledge because, at least in the past, we would have called that kidnapping.”

But critics warn that abortion trafficking laws could have grave implications not only for interstate travel, but also for personal speech and communication between friends, or between children and adults they trust.

“If courts go down this road, it could change the scope of the First Amendment,” Mary Ziegler, a legal historian and law professor at the University of California, Davis School of Law, told Stateline. “It could have an effect on what else qualifies as crime-facilitating speech, and that could limit the kinds of things people can say and do online and in other contexts.”

Opponents also question whether states should be permitted to interfere in the business of other states. Criminalizing travel within an abortion-ban state to reach another state for a legal abortion would “allow prosecutors to project power across state lines,” said Ziegler.

“We haven’t seen states try to interfere in what’s happening in other states in quite the same way in a long time,” she said. “That’s why there is legal uncertainty — because we’re not talking about something where we have a lot of legal precedent.”

‘Parental rights’

Tennessee state Rep. Jason Zachary, a Knoxville Republican, defended Tennessee’s legislation as “a parental rights bill” that “reinforces a parent’s right to do what’s best for their child,” in remarks he made to the Tennessee General Assembly before the bill passed. Republican Gov. Bill Lee signed it into law in May.

The following month, Behn joined with Nashville attorney and longtime abortion access activist Rachel Welty to file a lawsuit challenging the new law.

Behn and Welty sued nearly a dozen district attorneys in Tennessee, alleging they ignored Welty’s requests to define what behavior would be deemed illegal under the new law. The Tennessee law says that abortion trafficking occurs when an adult “intentionally recruits, harbors, or transports” a pregnant minor within the state to get an abortion or an abortion-inducing drug without parental consent, “regardless of where the abortion is to be procured.”

A hearing to determine whether the court will grant a temporary injunction blocking the Tennessee law, which is currently in effect, is scheduled for Aug. 30.

After Idaho passed its law in April 2023, two advocacy groups and an attorney who works with sexual assault victims sued the state attorney general. The plaintiffs claim Idaho’s law is vague and violates the First Amendment right to free speech, as well as the right to travel freely between states. The right to interstate travel isn’t spelled out in the U.S. Constitution but it’s implied, legal experts say. The Idaho law directly applies to travel within the state, but it also notes that defendants are not immune from liability if “the abortion provider or the abortion-inducing drug provider is located in another state.”

Megan Kovacs, a board member with the Northwest Abortion Access Fund, which is a plaintiff in the case along with the Indigenous Idaho Alliance, said it is “so clearly unconstitutional to disallow people from accessing health care from within or outside their state.” Kovacs added that her group also wants to protect its volunteers from legal liability.

Neither the Idaho nor the Tennessee law exempts minors who become pregnant after being raped by a parent.

“If that person had to go to a parent who didn’t believe them or wanted to defend that family member who was the abuser, that only impedes healing even more,” said Kovacs, who has spent a decade working with survivors of domestic and sexual violence.

Ehardt, who sponsored the Idaho bill, said any adult who is told by a child about an incident of incest should call authorities rather than helping the minor obtain an abortion without parental consent.

“You have to call the police and they will be the ones to help protect the child’s safety,” she said.

The 9th U.S. Circuit Court of Appeals held a hearing in May in Seattle, and Kovacs said she expects to learn in the next few weeks whether the court will uphold the temporary injunction blocking Idaho’s law while the lawsuit rolls on.

In July 2023, a group of health care providers sued Alabama Republican Attorney General Steve Marshall and district attorneys, asking the court to prevent the state from prosecuting people who help Alabamians travel to get abortion care in states where it’s legal.

The providers filed the lawsuit in response to remarks that Marshall made on a radio show in 2022, when he suggested that some people who aid a pregnant person in planning or traveling to get an abortion in another state could be prosecuted under the state’s criminal conspiracy laws. A judge denied Marshall’s motion to dismiss the lawsuit earlier this year, and the case is ongoing.

A coordinated effort

The Tennessee and Idaho laws mirror language in model legislation that was published in 2022 by the National Right to Life Committee, which bills itself as the nation’s oldest and largest grassroots pro-life organization.

“With this model law, we [are] laying out a roadmap for the right-to-life movement so that, in a post-Roe society, we can protect many mothers and their children from the tragedy of abortion,” said Carol Tobias, president of National Right to Life Committee, in a June 2022 statement introducing the model anti-abortion law.

Anti-abortion-rights organizations, like other interest groups, have long coordinated strategies to promote their preferred legislation to state and federal lawmakers.

The Idaho and Tennessee laws focus specifically on minors, even though they comprise a small fraction of people who get abortions. Those under 19 accounted for 8.1% of abortions, and those under age 15 accounted for just 0.2% of abortions in 2021, the most recent year for which the federal Centers for Disease Control and Prevention has published data.

Kovacs and Ziegler say the bills zero in on minors’ access to abortion because policies that regulate children and teens tend to be more politically acceptable than broader restrictions that affect adults. Such bills also tend to be more likely to survive legal challenges in court.

A chilling effect

Nobody in Tennessee or Idaho has yet been prosecuted under the abortion trafficking laws, but an Idaho woman and her son were charged with kidnapping last fall for allegedly taking the son’s girlfriend, a minor, out of state to get an abortion.

One main goal of a law such as Tennessee’s, Behn believes, is to create a chilling effect so that average people are scared to help anyone who might need an abortion, for fear of breaking the law.

“These bills create an environment of suspicion, fear and misinformation,” said Behn. “But I do think we will see more aggressive district attorneys start to prosecute these cases. [The law] widens the permission structure to start prosecuting people.”

Laws criminalizing abortion travel and imposing other abortion restrictions may be designed to provoke a legal challenge, Ziegler said. With a 6-3 conservative majority, the U.S. Supreme Court might be inclined to support them.

Abortion-rights advocates argue that restrictive abortion laws end up harming even those people who live in states where abortion is still legal.

Oregon, for example, has some of the strongest abortion protection laws in the nation. And yet the strict abortion ban next door in Idaho has made it more difficult for Oregonians to access care, said Kovacs, who lives in Oregon.

Before Idaho’s ban, many people in Eastern Oregon traveled to Idaho for abortion care, she said, because its clinics were closer than Oregon’s clinics, most of which are concentrated on the western side of the state. Last year, in response to increasing abortion restrictions in other states, Oregon passed a sweeping health care omnibus bill that strengthens protections for abortion providers and explicitly allows minors to seek abortions without parental consent. It was signed into law and took effect in January.

Ziegler said it’s not hard to imagine that if abortion trafficking laws are upheld in abortion-ban states, at some point prosecutors in those states could file charges against providers in “safe” states for providing abortion help, such as mailing abortion pills.

“I think it’s not intended to just stop with the people who are in the ban states,” Ziegler said.

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

Sarah Varney, KFF Health News | KFF Health News (TNS)

Ashley and Kyle were newlyweds in early 2022 and thrilled to be expecting their first child. But bleeding had plagued Ashley from the beginning of her pregnancy, and in July, at seven weeks, she began miscarrying.

The couple’s heartbreak came a few weeks after the U.S. Supreme Court overturned the federal right to abortion. In Wisconsin, their home state, an 1849 law had sprung back into effect, halting abortion care except when a pregnant woman faced death.

Insurance coverage for abortion care in the U.S. is a hodgepodge. Patients often don’t know when or if a procedure or abortion pills are covered, and the proliferation of abortion bans has exacerbated the confusion. Ashley said she got caught in that tangle of uncertainties.

Ashley’s life wasn’t in danger during the miscarriage, but the state’s abortion ban meant doctors in Wisconsin could not perform a D&E — dilation and evacuation — even during a miscarriage until the embryo died. She drove back and forth to the hospital, bleeding and taking sick time from work, until doctors could confirm that the pregnancy had ended. Only then did doctors remove the pregnancy tissue.

“The first pregnancy was the first time I had realized that something like that could affect me,” said Ashley, who asked to be identified by her middle name and her husband by his first name only. She works in a government agency alongside conservative co-workers and fears retribution for discussing her abortion care.

A year later, the 1849 abortion ban still in place in Wisconsin, Ashley was pregnant again.

“Everything was perfect. I was starting to feel kicking and movement,” she said. “It was the day I turned 20 weeks, which was a Monday. I went to work, and then I picked Kyle up from work, and I got up off the driver’s seat and there was fluid on the seat.”

The amniotic sac had broken, a condition called previable PPROM. The couple drove straight to the obstetrics triage at UnityPoint Health-Meriter Hospital, billed as the largest birthing hospital in Wisconsin. The fetus was deemed too underdeveloped to survive, and the ruptured membranes posed a serious threat of infection.

Obstetrician-gynecologists from across Wisconsin had decided that “in cases of previable PPROM, every patient should be offered termination of pregnancy due to the significant risk of ascending infection and potential sepsis and death,” said Eliza Bennett, the OB-GYN who treated Ashley.

Ashley needed an abortion to save her life.

The couple called their parents; Ashley’s mom arrived at the hospital to console them. Under the 1849 Wisconsin abortion ban, Bennett, an associate clinical professor at the University of Wisconsin School of Medicine, needed two other physicians to attest that Ashley was facing death.

But even with an arsenal of medical documentation, Ashley’s health insurer, the Federal Employees Health Benefits Program, did not cover the abortion procedure. Months later, Ashley logged in to her medical billing portal and was surprised to see that the insurer had paid for her three-night hospital stay but not the abortion.

“Every time I called insurance about my bill, I was sobbing on the phone because it was so frustrating to have to explain the situation and why I think it should be covered,” she said. “It’s making me feel like it was my fault, and I should be ashamed of it,” Ashley said.

Eventually, Ashley talked to a woman in the hospital billing department who relayed what the insurance company had said.

“She told me,” Ashley said, “quote, ‘FEP Blue does not cover any abortions whatsoever. Period. Doesn’t matter what it is. We don’t cover abortions.’”

University of Wisconsin Health, which administers billing for UnityPoint Health-Meriter hospital, confirmed this exchange.

The Federal Employees Health Benefits Program contracts with FEP Blue, or the BlueCross BlueShield Federal Employee Program, to provide health plans to federal employees. In response to an interview request, FEP Blue emailed a statement saying it “is required to comply with federal legislation which prohibits Federal Employees Health Benefits Plans from covering procedures, services, drugs, and supplies related to abortions except when the life of the mother would be endangered if the fetus were carried to term or when the pregnancy is the result of an act of rape or incest.”

Those restrictions, known as the Hyde Amendment, have been passed each year since 1976 by Congress and prohibit federal funds from covering abortion services.

In Ashley’s case, physicians had said her life was in danger, and her bill should have immediately been paid, said Alina Salganicoff, director of Women’s Health Policy at KFF, a health information nonprofit that includes KFF Health News.

What tripped up Ashley’s bill was the word “abortion” and a billing code that is insurance kryptonite, said Salganicoff.

“Right now, we’re in a situation where there is really heightened sensitivity about what is a life-threatening emergency, and when is it a life-threatening emergency,” Salganicoff said. The same chilling effect that has spooked doctors and hospitals from providing legal abortion care, she said, may also be affecting insurance coverage.

In Wisconsin, Bennett said, lack of coverage for abortion care is widespread.

“Many patients I take care of who have a pregnancy complication or, more commonly, a severe fetal anomaly, they don’t have any coverage,” Bennett said.

Recently, the bill for $1,700 disappeared from Ashley’s online bill portal. The hospital confirmed that eight months later, after multiple appeals, the insurer paid the claim. When contacted again on Aug. 7, FEP Blue responded that it would “not comment on the specifics of the health care received by individual members.”

Ashley said tangling with her insurance company and experiencing the impact of abortion restrictions on her health care, similar to other women around the country, has emboldened her.

“I’m in this now with all these people,” she said. “I feel a lot more connected to them, in a way that I didn’t as much before.”

Ashley is pregnant again, and she and her husband hope that this time their insurance will cover whatever medical care her doctor says she needs.

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

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

Rae Ellen Bichell | (TNS) KFF Health News

GREELEY, Colo. — In early August, farmworkers gathered under a pavilion at a park here for a picnic to celebrate Farmworker Appreciation Day. One sign that this year was different from the others was the menu: Beef fajitas, tortillas, pico de gallo, chips, beans — but no chicken.

Farms in Colorado had culled millions of chickens in recent months to stem the transmission of bird flu. Organizers filled out the spread with hot dogs.

No matter the menu, some dairy workers at the event said they don’t exactly feel appreciated. They said they haven’t received any personal protective equipment beyond gloves to guard against the virus, even as they or colleagues have come down with conjunctivitis and flu-like symptoms that they fear to be bird flu.

“They should give us something more,” one dairy worker from Larimer County said in Spanish. He spoke on the condition of anonymity out of fear he’d lose his job for speaking out. “What if something happens to us? They act as if nothing is wrong.”

Agricultural health and safety experts have been trying to get the word out about how to protect against bird flu, including through bilingual videos on TikTok showing the proper way to gear up with respirators, eye protection, gloves, and coveralls. And Colorado’s health and agriculture departments have offered a free month’s supply of protective equipment to any producer who requests it.

But so far, many farms aren’t taking them up on it: According to numbers provided by the state health department in late August, fewer than 13% of the state’s dairies had requested and received such PPE.

The virus is known to infect mammals — from skunks, bears, and cows to people and house pets. It began showing up in dairy cattle in recent months, and Colorado has been in the thick of it. Ten of the 13 confirmed human cases in the U.S. this year have occurred in Colorado, where it continues to circulate among dairy cows. It isn’t a risk in cooked meat or pasteurized milk but is risky for those who come into contact with infected animals or raw milk.

Weld County, where the farmworker event was held, is one of the nation’s top milk producers, supplying enough milk each month this year to fill about 45 Olympic-size swimming pools, according to U.S. Department of Agriculture data. Neighboring counties are notable producers, too.

Concerns are growing about undiagnosed illness among farmworkers because of a lack of testing and safety precautions. One reason for concern: Bird flu and seasonal flu are capable of gene trading, so if they ended up in the same body at the same time, bird flu might end up with genes that boost its contagiousness. The virus doesn’t appear to be spreading easily between people yet. That could change, and if people aren’t being tested then health officials may be slow to notice.

Strains of seasonal flu already kill some 47,000 people in the U.S. a year. Public health officials fear the havoc a new form of the flu could wreak if it spreads among people.

The Centers for Disease Control and Prevention recommends that dairy workers don a respirator and goggles or a face shield, among other protections, whether they are working with sick animals or not.

A recent study found that not all infected cows show symptoms, so workers could be interacting with contagious animals without realizing it. Even when it is known that animals are infected, farmworkers often still have to get in close contact with them, sometimes under grueling conditions, such as during a recent heat wave when Colorado poultry workers collected hundreds of chickens by hand for culling because of the outbreak. At least six of the workers became infected with bird flu.

One dairy worker in Weld County, who spoke on the condition of anonymity for fear of losing his job, said his employer has not offered any protective equipment beyond gloves, even though he works with sick cows and raw milk.

His bosses asked the workers to separate sick cows from the others after some cows produced less milk, lost weight, and showed signs of weakness, he said. But the employer didn’t say anything about the bird flu, he said, or suggest they take any precautions for their own safety.

He said he bought protective goggles for himself at Walmart when his eyes became itchy and red earlier this summer. He recalled experiencing dizziness, headaches, and low appetite around the same time. But he self-medicated and pushed through, without missing work or going to a doctor.

“We need to protect ourselves because you never know,” he said in Spanish. “I tell my wife and son that the cows are sick, and she tells me to leave, but it will be the same wherever I go.”

He said he’d heard that his employers were unsympathetic when a colleague approached them about feeling ill. He’d even seen someone affiliated with management remove a flyer about how people can protect themselves from the bird flu and throw it in a bin.

The dairy worker in neighboring Larimer County said he, too, has had just gloves as protection, even when he has worked with sick animals — close enough for saliva to wipe off on him. He started working with them when a colleague missed work because of his flu-like symptoms: fever, headache, and red eyes.

“I only wear latex gloves,” he said. “And I see that those who work with the cows that are sick also only wear gloves.”

He said he doesn’t have time to wash his hands at work but puts on hand sanitizer before going home and takes a shower once he arrives. He has not had symptoms of infection.

Such accounts from dairy workers echo those from farmworkers in Texas, as reported by KFF Health News in July.

“Employers who are being proactive and providing PPE seem to be in the minority in most states,” said Bethany Boggess Alcauter with the National Center for Farmworker Health, a not-for-profit organization based in Texas that advocates for improving the health of farmworkers and their families. “Farmworkers are getting very little information.”

But Zach Riley, CEO of the Colorado Livestock Association, said he thinks such scenarios are the exception, not the rule.

“You would be hard-pressed to find a dairy operation that isn’t providing that PPE,” he said. Riley said dairies typically have a stockpile of PPE ready to go for situations like this and that, if they don’t, it’s easily accessed through the state. “All you have to do is ask.”

Producers are highly motivated to keep infections down, he said, because “milk is their life source.” He said he has heard from some producers that “their family members who work on the farm are doing 18-to 20-hour days just to try to stay ahead of it, so that they’re the first line between everything, to protect their employees.”

Colorado’s health department is advertising a hotline that ill dairy workers can call for help getting a flu test and medicine.

Project Protect Food Systems Workers, an organization that emerged early in the covid-19 pandemic to promote farmworker health across Colorado, is distributing PPE it received from the state so promotoras — health workers who are part of the community they serve — can distribute masks and other protections directly to workers if employers aren’t giving them out.

Promotora Tomasa Rodriguez said workers “see it as another virus, another covid, but it is because they don’t have enough information.”

She has been passing out flyers about symptoms and protective measures, but she can’t access many dairies. “And in some instances,” she said, “a lot of these workers don’t know how to read, so the flyers are not reaching them, and then the employers are not doing any kind of talks or trainings.”

The CDC’s Nirav Shah said during an Aug. 13 call with journalists that awareness about bird flu among dairy workers isn’t as high as officials would like it to be, despite months of campaigns on social media and the radio.

“There’s a road ahead of us that we still need to go down to get awareness on par with, say, what it might be in the poultry world,” he said. “We’re using every single messenger that we can.”

____

KFF Health News correspondents Vanessa G. Sánchez and Amy Maxmen contributed to this report.

Healthbeat is a nonprofit newsroom covering public health published by Civic News Company and KFF Health News. Sign up for their newsletters here.

___

(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.

Aneri Pattani and Henry Larweh and Ed Mahon, Spotlight PA | (TNS) KFF Health News

The conversation wasn’t sounding good for Kensington residents on June 20.

The Philadelphia neighborhood is a critical center of the nation’s opioid crisis, and the city had decided to spend $7.5 million in opioid settlement money to improve the quality of life there. But on that day, a Pennsylvania oversight board was about to vote on whether to reject the city’s decision.

It was a thorny issue with major implications — both for Kensington residents and people across the state, as the decision could set a precedent for what kind of spending the board would allow for years to come.

But a lot of people were shut out of the discussion.

Pennsylvania’s board doesn’t allow members of the public to speak at its meetings, a rule that sets it apart from about two dozen similar opioid councils nationwide.

“It’s another moment where folks not connected to this community are making decisions for this community, and I think that’s inappropriate,” said Bill McKinney, a Kensington resident whose nonprofit is involved in some of the city’s settlement-funded initiatives. “Those that are sort of most affected are not at the table.”

It’s one example of how the public, including people who have lost loved ones to the opioid crisis or are dealing with it daily, are routinely shut out of having a meaningful say in how this windfall can be best used to address the damage. They are eager to suggest solutions for dollars that many of them consider blood money. But a first-of-its-kind survey conducted by KFF Health News and Spotlight PA found that, in many places, their voices are systematically dismissed.

In at least 39 states and Washington, D.C., councils consisting of government officials, clinicians, law enforcement officers, and others guide decisions about how to spend settlement dollars. These powerful groups are influencing addiction policy and funding at a time when more than 100,000 Americans are dying of overdoses annually.

At least 14 of these councils — including Pennsylvania’s — routinely block members of the public from speaking at their meetings. Four of those typically conduct their meetings in secret, barring the public from even attending or observing.

The survey also found:

• The majority of councils do not make video recordings of their meetings readily available online for those who cannot attend live. Although some councils said recordings can be accessed through public records requests, at least one — Minnesota’s Opioid Epidemic Response Advisory Council — deletes its recordings after using them to create meeting minutes. (Minnesota law does not require the council to record its open meetings or post recordings online.)
• At least five states have used committees or work groups that meet in private, or have a policy for allowing such private meetings. In Pennsylvania, such work groups have become a point of contention, with victims, advocates, and even one member of the council questioning their legality. (The Pennsylvania Opioid Misuse and Addiction Abatement Trust’s administrative director said the work groups’ meetings are not required to be public. They make recommendations that the full council decides on.)

Practices that close the public out of settlement spending discussions are “unconscionable,” said Stephen Loyd, chair of Tennessee’s Opioid Abatement Council, which regularly allows public attendance and comment at its meetings. “This is the population we’re there to serve. They have to have a voice in this process.”

Different Stances on Public Comment

People directly affected by the issue are a staple of the Tennessee council’s meetings. This year, commenters have included several parents holding photos of their deceased children and choking back tears, and at least one frustrated community member.

At the June meeting in Memphis, Peter Hossler, an associate professor at Rhodes College, said he was “very angry” about how the council’s recent grant awards of $81 million seemed to shortchange the western part of the state.

Loyd called such critique “invaluable,” comparing it to the feedback he received from loved ones during his recovery journey.

“We have to be held accountable,” he told KFF Health News and Spotlight PA. “And then we have to fix it.” Hossler’s comments are changing the council’s conversation about its next round of grants, Loyd added.

Loyd believes people who have been failed by the current system know what needs to be improved “better than anybody.”

“I want to talk to the people who had medication stopped in jail and laid there and withdrew,” he said. “I want to talk to the people who got out of jail with no money, a couple of felonies hanging over their heads, three meetings they had to make that week or they’re going to be in violation of their probation, and they ain’t got a car or driver’s license.”

States cited a variety of reasons for limiting public involvement. In some, state law does not require councils to take public comment at meetings. Several officials said they’ve sought feedback in other ways. An official in New Jersey said its council held public listening sessions, but that its monthly meetings are not public.

Some officials may worry that public comment would add to meetings that already run multiple hours, but several states manage that by limiting each person’s comment to a few minutes.

For communities of color, being shut out of opioid settlement discussions can compound the negative effects not just from today’s overdose crisis but from the earlier crack cocaine epidemic. Many people considered the government’s response at that time to be ineffective and harmful.

If settlement money is used only to “build on what’s already in place, you’ve already failed,” said Philip Rutherford, an expert on substance use disorder at the National Council for Mental Wellbeing.

At a July 2023 meeting of Illinois’ settlement council, Fanya Burford-Berry said the current system doesn’t work for women of color with substance use disorder — they can risk losing custody of their children. Burford-Berry, director of the West Side Heroin/Opioid Task Force in Chicago, hopes comments like hers will prompt the council to support solutions tailored to women of color, including bringing together more organizations that already work in those communities.

“When you allow more people to be involved, and then they have an idea, and they get excited about it, then they get more people involved and the circle of healing can become larger,” she said.

‘A Retraumatizing Moment’

In Pennsylvania, the state’s 13-member opioid settlement board has the power to withhold future funding if it decides local governments spent their money inappropriately. At its June meeting, the board — which includes a state senator representing part of Kensington — voted to disapprove of Philadelphia’s use of$7.5 million for park improvements, home repairs, rent relief, and other initiatives in Kensington. (Philadelphia later appealed the rejection; the issue is pending.)

McKinney, the Kensington resident and executive director of the New Kensington Community Development Corporation, called the board’s decision “a retraumatizing moment” for residents and criticized the way they were silenced.

“I think it’s unfortunate that things were chosen to be done that way,” McKinney said.

Others have also been frustrated by Pennsylvania’s settlement council.

Gail Groves Scott, a public health policy advocate who has a child in sustained recovery from an opioid use disorder, attended a board meeting in person last year. Not allowing the public to comment at meetings, she said, prevents them from offering feedback at critical times, such as when the board is considering county spending plans or contracts for its operations.

“We could be questioning those decisions or adding information they may not be aware of,” Groves Scott said. “It’s disappointing that, despite pushback from multiple people, they have not changed.”

Some advocates say the closed sessions of work groups, which make recommendations about which programs to approve, obscure why the full board takes certain action.

Pennsylvania trust officials have defended their practices.

Briana Anderson, the trust’s administrative director, downplayed the group’s role, saying it does not make specific spending decisions on settlement money but reviews choices made by local governments. State law doesn’t require the trust to offer public comment at its meetings but the public is encouraged to participate at the local level, Anderson added.

Pennsylvania’s practices contrast sharply with the way councils operate in places like Illinois, Kentucky, and Oregon, which routinely allow public comment at both full council and smaller committee meetings. In Kentucky, the open process has allowed members of the public to weigh in on a fierce debate over funding research into ibogaine, a psychedelic drug that has shown potential to treat addiction. At least eight people spoke in favor of the drug at the council’s January meeting.

Back in Tennessee, council chair Loyd said he hopes to increase public participation by creating an advisory panel that consists primarily of people who have personally experienced addiction or their loved ones.

He also encouraged other settlement councils to embrace opportunities to hear from people in their states.

“You’ll make better decisions as a result. I can’t be convinced otherwise,” he said.

____

Methodology

In June and July, reporters from KFF Health News and Spotlight PA surveyed opioid settlement councils in 39 states and Washington, D.C., to assess their general and standard practices for engaging with the public. The team also reviewed council websites, meeting minutes, agendas, and, in some cases, hours of meeting recordings. These councils have various roles, including directly deciding how to spend the money, making recommendations, or providing oversight. Although they go by different names, including advisory councils, boards, committees, and commissions, we refer to them as councils as a broad, encompassing term.

Spotlight PA is an independent, nonpartisan, and nonprofit newsroom producing investigative and public-service journalism that holds power to account and drives positive change in Pennsylvania. Sign up for its free newsletters.

(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.

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Some years ago, a young man with an opioid addiction was well known to staff at the Birmingham Fire Department.

Firefighters revived him after overdoses several times. The last time, they couldn’t save him.

“It really affects all of us,” said Fire Chief Paul Wells. “We want them (overdose victims) to lick that addiction.”

Those kinds of cases are the motivation for a new program by the Birmingham police and fire departments to provide “leave-behind” kits after an overdose incident.

The kits contain two doses of naloxone, a drug that reverses the effects of opioids; instructions on how to use them; and a list of resources that can provide help.

Most importantly, Wells said, the surviving overdose victim is connected with the police department’s co-responder, a staff member with mental health training, who can connect the addict with recovery experts.

“We really don’t have an opioid problem in Birmingham,” Wells said. But in his more than 20 years with the department, he’s seen a few cases per year.

“The kits are on all the trucks,” he said. So far, firefighters have yet to experience an incident where it’s appropriate to leave a kit with a family.

Birmingham’s first responders have teamed up with Oakland Community Health Network and the Alliance of Coalitions for Healthy Communities and Corewell Health, which assembles the kits.

Funding comes from OCHN via a federal grant program for organizations that are addressing what has been called an opioid crisis.

From 1999-2021, nearly 645,000 people died from an overdose involving any opioid, including prescription and illicit drugs, according to the Centers for Disease Control and Prevention.

Of the 107,000 overdose deaths in 2022, 75% involved an opioid, the CDC said.

Opioids are a class of drugs that produce a variety of effects, including pain relief.

Firefighters can offer the kits in situations other than just responding to an overdose. Maybe someone in the household is on powerful pain medication after surgery. Even though there isn’t an addict in the household, the family may have teenagers who have friends who could access the medication, Wells said.

Naloxone is easy to administer, requiring the user to spray it into the nostrils of the affected person, Wells said. Firefighters are even willing to demonstrate how to use it when they leave the kits at a home.

Organizers hope to expand the program into other Oakland County communities.

They’ve already placed dozens of “Save A Life” stations around the county, where people can access free naloxone kits, no questions asked.

The stations are placed in front of police and fire stations, municipal buildings, motels and other locations. For more information, visit https://alliancemi.org/overdose-prevention/save-a-life-stations.

By Fenit Nirappil
The Washington Post

The Food and Drug Administration approved new mRNA coronavirus vaccines Thursday, clearing the way for shots manufactured by Pfizer-BioNTech and Moderna to start hitting pharmacy shelves and doctor’s offices within a week.

Health officials encourage annual vaccination against the coronavirus, similar to yearly flu shots. Everyone 6 months and older should receive a new vaccine, the Centers for Disease Control and Prevention recommends.

The FDA has yet to approve an updated vaccine from Novavax, which uses a more conventional vaccine development method but has faced financial challenges.

Our scientific understanding of coronavirus vaccines has evolved since they debuted in late 2020. Here’s what to know about the new vaccines.

– – –

Why are there new vaccines?

Coronavirus keeps evolving to overcome our immune defenses, and the shield offered by vaccines weakens over time. That’s why federal health officials want people to get an annual updated coronavirus vaccine designed to target the latest variants. They approve them for release in late summer or early fall to coincide with flu shots that Americans are already used to getting.

The underlying vaccine technology and manufacturing process is the same, but components change to account for how the virus morphs. The new vaccines target the KP.2 variant because most recent covid cases are caused by that strain or closely related ones.

Covid is less dangerous overall than it was earlier in the pandemic because our bodies have become used to fighting the virus off and nearly everyone has some degree of immunity from receiving shots or getting sick. A new shot is meant to shore up existing defenses.

“It’s an opportunity to mitigate or to reduce that risk even further rather than just relying on what happened in the past,” said Robert Hopkins Jr., medical director of the National Foundation for Infectious Diseases and a physician in Arkansas.

– – –

Who needs a new coronavirus vaccine?

The United States differs from other countries in recommending an updated coronavirus vaccine for everyone except young infants, rather than just those at heightened risk for severe disease because they are 65 and older and people who are moderately to severely immunocompromised or have serious medical conditions.

Health officials rejected a more targeted recommendation, some contending it’s easier to tell everyone to get vaccinated rather than try to define what makes a person high-risk. Most Americans have a risk factor for severe covid, such as being overweight or having diabetes.

Critics of this approach, including Paul A. Offit, a pediatrician and director of the Vaccine Education Center at Children’s Hospital of Philadelphia, worry that it detracts from the urgency of vaccinating vulnerable people who have a harder time mounting an immune response to coronavirus.

– – –

Do the vaccines prevent infection?

You probably know by now that vaccinated people can still get covid. But the shots do offer some protection against infection, just not the kind of foolproof protection you get from highly effective vaccines for other diseases such as measles.

The 2023-2024 vaccine provided 54 percent increased protection against symptomatic covid infections, according to a CDC study of people who tested for the coronavirus at pharmacies during the first four months after that year’s shot was released.

“People who get vaccinated are much less likely to get infected in the first place,” said David J. Topham, director of the University of Rochester Translational Immunology and Infectious Disease Institute. “We’d love vaccines to be perfect, but Mother Nature is pretty damn smart.”

A nasal vaccine could be more effective at stopping infections outright by increasing immunity where they take hold, and one is being studied in a trial sponsored by the National Institutes of Health.

If you really want to dodge covid, don’t rely on the vaccine alone and take other precautions such as masking or avoiding crowds. But if you want to carry on with life as normal, a new vaccine lowers your risk of getting covid – at least in the short term.

– – –

Do the vaccines help prevent transmission?

You may remember from early coverage of coronavirus vaccines that it was unclear whether shots would prevent transmission. Now, scientists say the answer is yes – even when vaccinated people get sick.

That’s because the vaccine creates antibodies that reduce the amount of virus entering your cells, limiting how much the virus can replicate and make you even sicker. When vaccination prevents symptoms such as coughing and sneezing, people expel fewer respiratory droplets carrying the virus. When it reduces the viral load in an infected person, people become less contagious.

That’s why Peter Hotez, a physician and co-director of the Texas Children’s Hospital Center for Vaccine Development, said he feels more comfortable in crowded medical conferences where attendees are probably up to date on their vaccines than in a crowded airport.

“By having so many vaccinated people, it’s decreasing the number of days you are shedding virus if you get a breakthrough infection, and it decreases the amount of virus you are shedding,” Hotez said.

– – –

How long does vaccine protection last?

CDC data shows the effectiveness of the 2023-2024 vaccine against emergency room visits and hospitalizations declined sharply more than four months after receiving it. But the risk of hospitalization still remains low for most people, which made it harder for the CDC to compare outcomes for people who received an updated shot with those who did not.

The CDC usually recommends a second dose for those at greatest risk, rather than everyone.

Vaccines create antibodies that target the spike protein of a virus that enters a cell, but the spike protein is often evolving to overcome them or avoid detection. Other elements of the immune response, such as killer T cells, are more durable and recognize the additional parts of the virus that are not mutating.

“Once the virus gets in, they can kill off infected cells,” Topham said. “They can slow the infection down. They can prevent it from spreading throughout the body. It shortens your disease.”

– – –

Do vaccines prevent long covid?

While the threat of acute serious respiratory covid disease has faded, the lingering symptoms creating a condition known as long covid remain a concern for people who develop mild cases. The CDC says vaccination is the “best available tool” to reduce the risk of long covid in children and adults. The exact mechanism is unclear, but experts theorize that vaccines help by reducing the severity of illness, which is a major risk factor for long covid.

– – –

When is the best time to get a new coronavirus vaccine?

It depends on your circumstances, including risk factors for severe disease, when you were last infected or vaccinated and plans for the months ahead, and it’s best to talk these issues through with a doctor.

If you are at high risk and have not recently been vaccinated or infected, you may want to get a shot as soon as possible while cases remain high. The summer wave has shown signs of peaking, but cases can still be elevated and take weeks to return to low levels. It’s hard to predict when a winter wave will begin.

If your priority is to avoid getting sick ahead of the holidays or a major event such as an international vacation, you could time your vaccine to receive it a month ahead of the event to increase your protection against infection.

Health officials have yet to advise how long to wait to get a new vaccine if you were infected or received a shot this summer, but usually the guidance is between two and four months.

Manisha Juthani, Connecticut’s public health commissioner, said people who recently had covid could time their next vaccine several weeks before a holiday when they will be exposed to a lot of people, whether that’s Halloween, Thanksgiving or end-of-year celebrations.

– – –

Where do I find vaccines?

Coronavirus vaccines are sold as a commercial product and are no longer purchased and distributed by the federal government free. That means they won’t be as readily accessible as they once were, but they shouldn’t be too hard to find.

While major pharmacy chains should stock coronavirus vaccines, availability at doctor’s offices might take longer. Finding shots for infants and toddlers could be more difficult because many pharmacies do not administer them and not every pediatrician’s office will stock them given low demand and limited storage space.

Updated coronavirus vaccines are supposed to have a longer shelf life this year, which eases the financial pressures of stocking them.

CDC plans to relaunch its vaccine locator when the new vaccines are widely available, and similar services are offered by Moderna and Pfizer.

– – –

Are coronavirus vaccines free?

Most insurance plans are required to cover recommended vaccines under the Affordable Care Act, but some may not cover shots administered by out-of-network providers. Officials say billing code errors and failure to updates systems that led to improper charges last year should mostly be resolved, but if you are still getting charged for vaccines, you or your provider should contact your insurance company or appeal to the agency that regulates your plan.

The federal Bridge Access Program, which provided free coronavirus vaccines to people without health insurance, ends this month. People might be able to find other assistance through federally qualified health centers, local health departments or nonprofits.

– – –

Can you get your covid and flu shot together?

Public health officials encourage receiving covid and flu shots in the same visit as a way to increase vaccination rates and say no serious side effects associated with co-administering the vaccines have been identified.

But if you are someone who will get both vaccines no matter what, it could be beneficial to space them apart. Flu shots are best administered in September or October, so it might make sense to get a flu shot first with a coronavirus vaccination shot later.

Coronavirus vaccine manufacturers are working on combination flu/coronavirus shots to protect against both viruses with a single needle prick. Moderna reported promising results from trials that keep it on track to go to market as early as fall 2025. Pfizer-BioNTech reported mixed results from its trials, a setback.

Drew Hawkins, Gulf States Newsroom | (TNS) KFF Health News

For Roderick Givens, a radiation oncologist, the expansion of Medicaid isn’t just a policy issue. He practices medicine in a rural area in the Mississippi Delta and he sees daily how Medicaid coverage could help his uninsured patients.

“I can’t tell you the number of patients who I see who come in with advanced disease, who have full-time jobs,” Givens said. “They haven’t seen a physician in years. They can’t afford it. They don’t have coverage.”

This spring, the Mississippi Legislature considered but ultimately failed to expand Medicaid, which would have extended coverage to around 200,000 low-income residents. Mississippi is one of 10 states that haven’t expanded Medicaid, the state and federal health insurance program for people with low incomes or disabilities.

Seven of those states are in the South. But as more conservative-leaning states like North Carolina adopt it, the drumbeat of support, as one Southern state lawmaker put it, grows louder.

Advocates for expanding Medicaid say opposition is largely being driven by political polarization, rather than cost concerns.

Givens, who is also chair of the board of trustees for the Mississippi State Medical Association, which supports Medicaid expansion, said the federal government would pay for the vast majority of it and that most Mississippians support it. “Why does that not translate when it comes to policy?” Givens asked. “It’s called the stupidity of politics. Period.”

Givens pointed to Arkansas as a potential model for Mississippi because the state has similar demographics and expansion has been in place there for a decade. “Look at what has worked for them and what needs to be tweaked,” he said. “For me, that’s just common sense.”

In states that have not expanded Medicaid, hundreds of thousands of people fall into the “coverage gap,” meaning they earn too much to qualify for Medicaid but are not eligible for subsidies to help pay for private insurance. Those in the coverage gap also can’t afford premiums and other out-of-pocket expenses on employer-sponsored insurance even if they are eligible.

The coverage gap is not an issue in states that have expanded Medicaid. In those states, a single person making up to 138% of the poverty level, or about $20,000 a year, can get on Medicaid. Someone making more than that can get subsidies for private health insurance.

For the first time in Mississippi, both the state Senate and House of Representatives proposed expanding Medicaid during the legislative session that ended in May. In the end, the efforts fizzled at the last minute.

Had the proposed bills succeeded, some 74,000 Mississippians who are stuck in the coverage gap would have gained access to Medicaid.

The House speaker, Jason White, a Republican who supports expansion, acknowledged the political hurdles. “It’s President Obama’s signature piece of legislation. It’s known as Obamacare,” White said. “So, there are a lot of political dynamics centered around it that probably never allowed it to get off the ground.”

White said this year was different because of increased support from the business community.

“I kidded some of my fellow Republicans. I said, ‘Come for the savings, if you will, and then you can stay for the salvation and the good things that it does to improve people’s lives,’” White said. “If you can’t get there because it’s the right or compassionate thing to do to help these individuals, get there because it makes sense from a business standpoint.”

In neighboring Alabama, politics also thwarted attempts to provide more health care this year. Although the state legislature didn’t vote on any direct expansion bills, there was an attempt to include expansion language in a bill about casino gambling — specifically, a provision to allocate some gambling profits to rural health systems.

Ultimately, the Alabama bill was stripped down, and the funding for rural health was removed.

If Alabama expanded Medicaid, at least 174,000 more people would be covered, according to KFF. But the connection to Obamacare remains a stumbling block in Alabama’s Republican-dominated state legislature.

“Just the partisan nature of this is definitely a problem,” said Regina Wagner, an assistant professor of political science at the University of Alabama. Wagner said that most Alabama voters support expansion and that other states have adopted the programs after mounting public pressure.

“A lot of rural voters are Republicans. And so your own constituents are being hit by this and you’re not addressing it,” she said. “If the pressure gets high enough and sentiment shifts, maybe that’s going to be enough to push them.”

The main disagreement in the Mississippi Legislature revolved around work requirements — recipients would have to show they were working part-time or in school.

White said many of his Republican colleagues view extending health coverage through Medicaid as “some form of welfare, some form of giveaway, some form of expanding government.”

Opponents of Medicaid expansion in Alabama are also concerned about potential impacts on the workforce of what they call free health care.

“If you open up this federal subsidized program for hundreds of thousands of people, then it could actually hurt that labor participation rate, give them another reason not to go to work, to stay at home,” said Justin Bogie, senior director of fiscal policy at the Alabama Policy Institute, a research group that says it is committed to limited government.

The federal Centers for Medicare & Medicaid Services, or CMS, would have to issue a waiver to allow an expansion plan with a work requirement — something the Biden administration hasn’t done for any state.

This spring, Mississippi came close to a compromise bill that included a work requirement, something that needs a CMS waiver. Had the bill passed and CMS denied the waiver, expansion still would not have taken effect, and the state would have had to apply for the waiver from CMS every year, hoping for approval under a future — potentially more conservative — presidential administration.

That’s what happened in Georgia. In 2020, the Trump administration approved a waiver for a work requirement as part of a limited expansion effort. CMS later rescinded the waiver under the Biden administration, leading to a lawsuit. A federal judge ruled in favor of Georgia, reinstating the work requirement provisions.

However, only about 2,300 people are enrolled — which is fewer than half of 1% of the more than 430,000 uninsured Georgia adults who could gain access if Medicaid were fully expanded, according to KFF. The state’s alternative expansion plan has cost taxpayers at least $26 million, according to KFF, with nearly all of it going to administrative and consulting fees, not medical care for low-income residents.

As public support for expansion continues to grow in holdout states, North Carolina, the most recent Southern state to pass Medicaid expansion, may offer a glimpse of the future. Since its adoption last year, more than 600,000 people have become eligible.

“But it still took a long time,” said Robin Rudowitz, a vice president and director of the Program on Medicaid and the Uninsured at KFF, a health information nonprofit that includes KFF Health News. “It took the governor who continually supported expansion, and the legislature finally came to endorse and pass the expansion.”

Rudowitz said the fiscal incentive under the American Rescue Plan Act played a role in moving the needle in North Carolina and could help ignite debate in other holdout states. But ultimately, she said, the reasons the Affordable Care Act was established continue to be the strongest motivators.

“Without expansion, there are more people who are uninsured. Hospitals and other providers are not able to get reimbursement because individuals are uninsured,” Rudowitz said. “Those are the underlying issues that existed pre-ACA and continue to exist, particularly in states that haven’t adopted expansion.”

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This article is from a partnership that includes the Gulf States Newsroom , 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.

Morayo Ogunbayo | (TNS) The Atlanta Journal-Constitution

Worried you might have syphilis but are afraid to go to a clinic? Now you can get tested at home.

The Food and Drug Administration has authorized the first over-the counter antibody test for detecting syphilis in human blood. The move is an effort to stall the recent increase in cases within the United States.

This new test will be available without a prescription and inform the user of their status within 15 minutes, according to the FDA. The test is just an indicator of syphilis antibodies, however. Anyone who tests positive should see their doctor.

Between 2018 and 2022, the Atlanta-based Centers for Disease Control and Prevention reported an 80% increase in syphilis cases within the U.S., moving from 115,000 cases to more than 207,000, a development that had been part of a decades-long trend.

Syphilis, if left untreated, can cause heart damage, brain damage, deafness, blindness and paralysis. If the transmission happens during pregnancy, it can cause a miscarriage, or lifelong or terminal health issues for infants.

“Access to home tests may help increase initial screening for syphilis, including in individuals who may be reluctant to see their health care provider about possible sexually transmitted infection exposure,” Michelle Tarver, M.D., Ph.D., director of the FDA’s Center for Devices and Radiological Health, said in a statement. “This can lead to increased lab testing to confirm diagnosis, which can result in increased treatment and reduction in the spread of infection.”

Today, medical professionals are well-versed in treating syphilis, and typically a penicillin-based treatment is all it takes to recover from this sexually transmitted illness. With increased access to over-the-counter test kits, the hope is fewer Americans will unknowingly spread this disease.

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©2024 The Atlanta Journal-Constitution. Visit at ajc.com. Distributed by Tribune Content Agency, LLC.

By Lauren Sausser, Kaiser Health News

MOUND BAYOU, Miss. — In the center of this historically Black city, once deemed “the jewel of the Delta” by President Theodore Roosevelt, dreams to revitalize an abandoned hospital building have all but dried up.

An art deco sign still marks the main entrance, but the front doors are locked, and the parking lot is empty. These days, a convenience store across North Edwards Avenue is far busier than the old Taborian Hospital, which first shut down more than 40 years ago.

Myrna Smith-Thompson, who serves as executive director of the civic group that owns the property, lives 100 miles away in Memphis, Tennessee, and doesn’t know what’s to become of the deteriorating building.

“I am open to suggestions,” said Smith-Thompson, whose grandfather led a Black fraternal organization now called the Knights and Daughters of Tabor. In 1942, that group established Taborian Hospital, a place staffed by Black doctors and nurses that exclusively admitted Black patients, during a time when Jim Crow laws barred them from accessing the same health care facilities as white patients.

“This is a very painful conversation,” said Smith-Thompson, who was born at Taborian Hospital in 1949. “It’s a part of my being.”

A similar scenario has played out in hundreds of other rural communities across the United States, where hospitals have faced closure over the past 40 years. In that regard, the story of Mound Bayou’s hospital isn’t unique.

But there’s more to this hospital closure than the loss of inpatient beds, historians say. It’s also a tale of how hundreds of Black hospitals across the U.S. fell casualty to social progress.

The Civil Rights Act of 1964 and the enactment of Medicare and Medicaid in 1965 benefited millions of people. The federal campaign to desegregate hospitals, culminating in a 1969 court case out of Charleston, South Carolina, guaranteed Black patients across the South access to the same health care facilities as white patients. No longer were Black doctors and nurses prohibited from training or practicing medicine in white hospitals. But the end of legal racial segregation precipitated the demise of many Black hospitals, which were a major source of employment and a center of pride for Black Americans.

“And not just for physicians,” said Vanessa Northington Gamble, a medical doctor and historian at George Washington University. “They were social institutions, financial institutions, and also medical institutions.”

In Charleston, staff members at a historically Black hospital on Cannon Street started publishing a monthly journal in 1899 called The Hospital Herald, which focused on hospital work and public hygiene, among other topics. When Kansas City, Missouri, opened a hospital for Black patients in 1918, people held a parade. Taborian Hospital in Mound Bayou included two operating rooms and state-of-the-art equipment. It’s also where famed civil rights activist Fannie Lou Hamer died in 1977.

“There were Swedish hospitals. There were Jewish hospitals. There were Catholic hospitals. That’s also part of the story,” said Gamble, author of “Making a Place for Ourselves: The Black Hospital Movement, 1920-1945.”

“But racism in medicine was the main reason why there was an establishment of Black hospitals,” she said.

By the early 1990s, Gamble estimated, there were only eight left.

“It has ripple effects in a way that affect the fabric of the community,” said Bizu Gelaye, an epidemiologist and program director of Harvard University’s Mississippi Delta Partnership in Public Health.

Researchers have largely concluded that hospital desegregation improved the health of Black patients over the long term.

One 2009 study focusing on motor vehicle accidents in Mississippi in the ’60s and ’70s found that Black people were less likely to die after hospital desegregation. They could access hospitals closer to the scene of a crash, reducing the distance they would have otherwise traveled by approximately 50 miles.

An analysis of infant mortality, published in 2006 by economists at the Massachusetts Institute of Technology, found that hospital desegregation in the South substantially helped close the mortality gap between Black and white infants. That’s partly because Black infants suffering from illnesses such as diarrhea and pneumonia got better access to hospitals, the researchers found.

A new analysis, recently accepted for publication in the Review of Economics and Statistics, suggests that racism continued to harm the health of Black patients in the years after hospital integration. White hospitals were compelled to integrate starting in the mid-1960s if they wanted to receive Medicare funding. But they didn’t necessarily provide the same quality of care to Black and white patients, said Mark Anderson, an economics professor at Montana State University and co-author of the paper. His analysis found that hospital desegregation had “little, if any, effect on Black postneonatal mortality” in the South between 1959 and 1973.

Nearly 3,000 babies were born at Taborian Hospital before it closed its doors in 1983. The building remained vacant for decades until 10 years ago, when a $3 million federal grant helped renovate the facility into a short-lived urgent care center. It closed again only one year later amid a legal battle over its ownership, Smith-Thompson said, and has since deteriorated.

“We would need at least millions, probably,” she said, estimating the cost of reopening the building. “Now, we’re back where we were prior to the renovation.”

In 2000, the hospital was listed as one of the most endangered historic places in Mississippi by the Mississippi Heritage Trust. That’s why some people would like to see it reopened in any capacity that ensures its survival as an important historical site.

Hermon Johnson Jr., director of the Mound Bayou Museum, who was born at Taborian Hospital in 1956, suggested the building could be used as a meeting space or museum. “It would be a huge boost to the community,” he said.

Meanwhile, most of the hospital’s former patients have died or left Mound Bayou. The city’s population has dropped by roughly half since 1980, U.S. Census Bureau records show. Bolivar County ranks among the poorest in the nation, and life expectancy is a decade shorter than the national average.

A community health center is still open in Mound Bayou, but the closest hospital is in Cleveland, Mississippi, a 15-minute drive.

Mound Bayou Mayor Leighton Aldridge, also a board member of the Knights and Daughters of Tabor, said he wants Taborian Hospital to remain a health care facility, suggesting it might be considered for a new children’s hospital or a rehabilitation center.

“We need to get something back in there as soon as possible,” he said.

Smith-Thompson agreed and feels the situation is urgent. “The health care services that are available to folks in the Mississippi Delta are deplorable,” she said. “People are really, really sick.”

©2024 Kaiser Health News. Visit khn.org. Distributed by Tribune Content Agency, LLC.

By Nina Heller, CQ-Roll Call

WASHINGTON — Doctors and advocates say efforts to ban gender-affirming care and the often inaccurate language lawmakers use to do it exploits most Americans’ relative unfamiliarity with transgender people to push a political agenda.

As those efforts have grown — nearly exclusively led by Republicans — they have superseded both abortion rights and same-sex marriage as the go-to social issue among conservatives in the lead-up to the November elections.

The attacks have had an impact. Kellan Baker, the executive director of Whitman-Walker Institute, a D.C.-based health clinic specializing in LGBTQ+ health care, said that basing these attacks on falsehoods helps craft the narrative of transgender people as a “boogeyman” in order to scare people.

“There’s less than 1 percent of the U.S. population that is transgender, which means that many people don’t know a transgender person personally, or even if they do, they maybe don’t know that much about what medical care for transgender people looks like,” Baker said.

“And so it’s very easy to project this kind of false image of a boogeyman, to have this kind of nightmare scenario that’s not real.”

Most major medical and mental health associations in the United States, including the American Medical Association, American Academy of Pediatrics and the American Psychiatric Association, say gender-affirming care, which includes a wide range of services including hormone therapy and surgical procedures, is medically necessary.

“This is not just kind of made-up care, or just, we’re kind of freestyling it,” said Terrence Weeden, a staff adolescent physician at Whitman-Walker. “This is supported by multiple organizations, professional organizations, who are providing guidelines.”

In April 2021, the American Medical Association sent a letter to the National Governors Association urging its members to oppose laws that limit choices for health care by families and providers related to gender-affirming care after Arkansas passed a law that would prohibit physicians from providing gender-affirming care for minors.

“We believe it is inappropriate and harmful for any state to legislatively dictate that certain transition-related services are never appropriate and limit the range of options physicians and families may consider when making decisions for pediatric patients,” the letter said.

The bill was vetoed by Arkansas Gov. Asa Hutchinson, a Republican, who called it a “vast government overreach.” The Arkansas State Legislature successfully voted to override his veto. A federal district judge in Arkansas struck down the ban in June 2023 as unconstitutional. It was then appealed to the U.S. Court of Appeals for the 8th Circuit, where judges heard arguments for the case in April. The case is ongoing.

Efforts to ban gender-affirming care in state legislatures have a ripple effect in Congress.

“Mutilating children is bad — that’s generally a good stance to take,” said Rep. Daniel Crenshaw, R-Texas.

Crenshaw, who does not have a background in medicine, said doctors who practice gender-affirming care are performing “pseudoscience” and recommended that doctors should “read a book.”

Gillian Branstetter, a communications strategist for the American Civil Liberties Union’s LGBTQ and HIV project, said lawmakers like Crenshaw base their attacks on a concern for children’s well-being to get support for their views.

“That’s all designed to inflame people’s emotions,” Branstetter said. “Because they know people are generally concerned for children, and they want to use the mantle of protecting children to go after trans kids more broadly.”

The focus on rhetoric like Crenshaw’s is part of an effort to discredit health care that has been established as safe and to manufacture doubt, Branstetter said. Part of that, she said, is to use as many lies as possible to see what sticks with people who may have never met a trans person like Branstetter.

“I don’t think the goal is getting people to believe one lie. It’s throwing out as many lies as possible in order to make people believe in nothing so that when they hear from transgender people ourselves or the parents of transgender youth or medical experts or medical organizations, that they aren’t believed either,” she said.

Medicine misconceptions

Though attacks on gender-affirming care have increased over the past few years, many of the medical procedures under the umbrella of gender-affirming care are not new.

Puberty blockers were first approved by the FDA in 1993. Originally approved to temporarily delay puberty in children who were going through it too early, they block the release of hormones leading to puberty-related changes in the body. Such treatments are also reversible — a child who was taking them would be able to eventually go through puberty if they stopped taking them, Weeden said.

“Essentially, puberty is paused. And basically, that allows that youth or that child to kind of explore their gender, explore if they really want to pursue hormones or not. And so puberty-pausing medications are reversible,” Weeden said.

Weeden said that one misconception people have about gender-affirming care is how long it takes for people to start certain aspects of care, such as puberty blockers or hormone replacement therapy.

Unlike other medications, the process isn’t as simple as getting a prescription after one appointment — people will see multiple providers, including a behavioral health specialist, before they start the medication. The process, Weeden said, can take weeks to months.

“It is a multidisciplinary approach in that you have input from behavioral health specialists and clinicians, psychiatrists, sometimes an endocrinologist . . . A lot of different specialties come together in agreement to support this view in their transition,” he said.

In the case of minors, all aspects of gender-affirming care, from puberty blockers to hormone replacement therapy, are done only with parental consent, Weeden said.

But for Sen. Ted Cruz, R-Texas, the guidance from major medical organizations and from physicians like Weeden is insignificant.

“​​It is never medically necessary to sterilize or castrate a child. And it is only adults in pursuit of a political agenda who do that to little boys and little girls, even though an eight-year-old lacks the emotional maturity to make lifelong decisions and give up the ability to be a mother or father because of peer pressure in the moment,” Cruz said.

“My opposition has been really on the minors side of it,” said Sen. James Lankford, R-Okla.

Many Republicans, like Cruz, often point to surgery for youth as a driving force behind their objections, portraying it as a common procedure for trans youth.

But most transgender youth who receive gender-affirming care do not have surgery as minors. A study published in 2023 in JAMA Network Open tracked more than 48,000 patients who had operations in hospitals and outpatient surgery centers. It found that, of those who had gender-affirming surgery from 2016-20, fewer than 8 percent — 3,678 — were aged 12-18. Surgeries in younger patients were primarily breast and chest procedures, while genital surgical procedures were more common in older patients.

Such procedures for youth are rare, and when they do happen, happen only with the consent of parents and in consultation with multiple other health providers, Weeden said.

“This is an informed-consent process with consent from parents and support from providers and professionals. So we cannot do any of this without the consent from their parents,” Weeden said.

Legislation

Seventy-five anti-trans bills have been introduced during this Congress, including bills that would prohibit trans people from serving in the military and a bill that would make it a felony for doctors to perform gender-affirming care on minors, according to the Trans Legislation Tracker, an independent database tracking bills affecting transgender people across the United States.

At the state level, 638 bills have been introduced across 43 states in 2024, with 45 of them having passed. Of those introduced, 466 failed. The remainder have yet to move.

Although there has yet to be a federal law restricting access to gender-affirming care, 25 states have laws that limit youth access to gender-affirming care, according to KFF, a health care think tank.

Restrictions on gender-affirming care have made their way into a series of must-pass appropriations bills.

They’ve also been attached to must-pass authorizations: An amendment to the fiscal 2025 National Defense Authorization Act that would prohibit TRICARE from covering and the Defense Department from furnishing gender transition surgeries and gender hormone treatments for individuals who identify as transgender. The House adopted the amendment June 13 by a vote of 213-206. The bill ultimately passed the House by a vote of 217-199.

The Senate Armed Services Committee approved its version of the NDAA last month, which also included an amendment to prohibit the Defense Department from providing gender-affirming surgeries to transgender servicemembers or insurance coverage for any gender-affirming medical care for transgender youth whose parents are serving in the military.

The bill would likely not pass the full Senate with such an amendment, let alone get signed into law by President Joe Biden.

But for Branstetter and others, that doesn’t make the existence of these bills any less frightening.

“Part of the effort is again dehumanizing trans people from a kind of person into a toxic influence that can be stamped out,” Branstetter said.

Ariel Cohen contributed to this report.

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