But not all important work is serious.

One former HHS secretary, Kathleen Sebelius, recalled a highlight of her tenure: recording a public service message with “Sesame Street.” “The Elmo commercial was to teach kids how to sneeze,” she said. “We were trying to spread good health habits.”

The script called for Sebelius to ask her co-star to “bend your elbow and sneeze into your arm.”

“Elmo has no elbow,” the beloved red Muppet replied, veering off script. So, Sebelius said, they swapped roles: “Elmo taught me how to sneeze.”

Her story punctuated a rare, intimate conversation Wednesday with three HHS secretaries, past and present 鈥� and across party lines. Secretary Xavier Becerra, the agency’s current leader, joined Sebelius, who worked under then-President Barack Obama from 2009 to 2014, and Alex Azar, who worked under then-President Donald Trump from 2018 to 2021. Their candid discussion took place at Aspen Ideas: Health, part of the Aspen Ideas Festival, about the job each of them held.

The panel discussion, taped in Aspen, Colorado, before a standing room-only crowd, was hosted as a live episode of 蘑菇影院 Health News’ weekly policy news podcast, “What the Health?,” and is now available to stream.

Becerra, Azar, and Sebelius spoke not only about the common bullet point on their resumes, but also about their shared understanding of what it means to lead the agency at a time when health is at the front of American minds 鈥� and in the crosshairs of American politics. Becerra and Azar have led HHS during the covid-19 pandemic, and Sebelius was in charge during the implementation of the Affordable Care Act.

They offered frank and at times strikingly similar perspectives on leading a department with more than 80,000 employees; a budget of more than $1.5 trillion; and an agenda most often set by outside events or their boss at 1600 Pennsylvania Ave.

Azar, who described fielding “two to five” daily phone calls from Trump, which could come at nearly any hour, said he started his days huddling with senior staff “to discuss what could hit us in the face today.”

“The White House is not a patient place,” said Becerra, who described losing 11 twin towers’ worth of Americans to covid-19 every day when he took the reins. “They want answers quickly.”

“It truly is life and death at HHS,” Becerra added. “The gravity, it hits you. And it’s nonstop.”

The panel offered some behind-closed-doors takes on today’s top issues, including the bruising fights over skyrocketing drug prices under Trump and ACA contraceptive coverage under Obama.

Deciding which “hills do you die on” was Azar’s top challenge as HHS secretary, he said. “When do you fight and when do you not fight with, say, the White House?” He pointed to his push to eliminate drugmaker rebates paid to health plans and pharmacy benefit managers, which drugmakers and others have criticized for driving up drug costs.

“I left a lot of blood on the field of battle just to try to outlaw pharmaceutical rebates,” he said.

All three secretaries agreed that one of the least understood but most important aspects of the department’s work happens outside the United States, performing what Sebelius called “soft diplomacy.” While many countries are loath to welcome officials from the State Department or the military, “they welcome health professionals,” she said. “They welcome the opportunity to learn.”

Asked what they felt unprepared for when they got the job, Azar 鈥� who had worked at HHS previously as general counsel then deputy secretary 鈥� replied: “The Trump administration.”

Coming from the administration of former President George W. Bush and later a stint as president of the U.S. division of the drugmaker Eli Lilly, Azar said he was “used to certain processes and ways people interact.” Working in the Trump administration, “it was different.”

The atypical assembly of current and former political appointees also offered a chance for some unusually friendly banter.

Becerra noted that one reason he was familiar with HHS programs was because he had filed numerous lawsuits challenging the agency’s actions when he was attorney general of California.

“Oh, he sued me a lot,” Azar quipped, as the group laughed. “Becerra v. Azar, all over the place.”

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Grassley, in the midst of what may be since becoming a senator in 1980, said he hears a lot about a lack of prenatal care in rural Iowa. He introduced his answer, called the . “This bill will help fill those voids in rural America to make sure that we can deliver health care for high-risk pregnancies,” he said.

Republicans are favored to win the House of Representatives in the midterm elections, and they would need to gain only one seat to take the Senate, too. With polls showing abortion is a motivating issue for many voters, Republicans have , , or just gone quiet on women’s health as Election Day approaches. Some deflect abortion questions by , .

Women were falling of the health care system the Supreme Court in June overturned a constitutional right to abortion. But state responses to that decision further splintered reproductive health care into and , ensuring that access varies widely across state lines. And new government reports paint a troubling picture of maternal health, showing that the covid-19 pandemic contributed to a rise in deaths from pregnancy and childbirth complications 鈥� and that .

Democrats have made defending abortion access a central theme of their campaign to keep control of Congress, hoping to build on the surge of political engagement that followed the court’s decision. But the economy has become voters’ biggest concern.

A few Republicans, like Grassley, are steering preelection conversations to their own proposals. But policy experts and women’s rights advocates say they do not go far enough to change the situation for women.

“To make a dent in the maternal health crisis, we need more than just guidance,” said Allison Orris, a senior fellow at the Center on Budget and Policy Priorities, a progressive think tank.

In September, when Sen. Lindsey Graham (R-S.C.) introduced a bill that would set a federal ban on abortions after 15 weeks, the proposal appeared to divide his party. Most congressional Republicans have advocated for states to make their own decisions about reproductive health, which was what conservatives had argued before the Supreme Court acted. Others wanted to see federal action but said Graham’s proposal did not go far enough. House Republicans who feel that way have introduced their own proposals.

Senate Minority Leader Mitch McConnell has said Graham’s measure would not get enough support to pass.

However, Graham, who is not up for reelection, has proposed a ban several times in the past decade 鈥� and previous versions of the legislation were .

“If we take back the House and the Senate, I can assure you we’ll have a vote on our bill,” .

The rate of maternal death in the U.S. 鈥� which is higher 鈥� increased during the past two years, spurred in large part by covid infections, . Prenatal care is a major factor in preventing maternal and infant mortality, and the report noted the pandemic had made it harder for women to receive care, from the shutdown of public transit and child care facilities to job losses, which .

Access to reproductive care has dwindled in several states, largely because of Republican efforts, such as and other state laws that made it difficult for health centers to stay open. Many of those centers provided reproductive care, including contraceptive counseling. Republicans control the legislature in 30 states, that ban nearly all abortions before the point in pregnancy when a fetus can survive outside the womb.

The Supreme Court decision “has taken away a constitutional right and created chaos for people around the country who are trying to figure out how to manage,” said Vicki Shabo, a senior fellow with the think tank New America.

“They are doing it in the context of a country that does not provide paid leave; 50% of families live in a child care desert; women and children are not even guaranteed health access in all states; and wages are too low and work is not predictable enough to be able to support a family,” she said.

Last year congressional Democrats passed an economic recovery package that included several policies intended to improve household financial security, including a five-year program that gives states the option to extend Medicaid benefits to women for one year after childbirth.

Under the ongoing public health emergency, no one can be disenrolled from Medicaid. Once that expires, women living in the will be eligible for Medicaid during the year after they give birth, when more than half of occur.

Insured women are more likely to receive regular care, including important interventions for those with health conditions that can make pregnancy riskier, like diabetes.

More than two dozen states, including some with the nation’s strictest abortion restrictions, have not accepted the postpartum coverage extension, meaning women will lose pregnancy-related coverage 60 days after giving birth.

If their state has expanded its adult Medicaid programs under the Affordable Care Act, these women could be eligible for full Medicaid. In other states, they could purchase marketplace coverage through the ACA and experience only a short gap in coverage while changing plans. Low-income women would be eligible for subsidies to cover their premiums.

In a few states, many women would lose coverage entirely after that first two months.

Orris said Grassley’s maternal health bill offered “helpful and important steps” 鈥� in particular, mandatory reporting of maternal quality measures, funding for more coordinated prenatal care, and guidance to states about coverage for doulas and community health workers. But the bill, which offers no major policy proposals, likely would not match the advantages offered through the postpartum coverage extension, she cautioned.

“Extending postpartum coverage for one year after birth would help, and I think it is noteworthy that Iowa isn’t among the states that have adopted that option,” Orris said.

On the day the Supreme Court announced its abortion decision, Sen. Marco Rubio (R-Fla.), one of the most endangered Republican incumbents, : a promise of a wide-ranging legislative package to support mothers.

Over the next three months, Rubio introduced three bills: the , which would establish a government website for pregnancy resources that includes information about alternatives to abortion and other information from groups opposed to abortion; the , which would create mom-to-mom mentorship programs; and the , which included an expanded child tax credit and a paid leave program.

Paid family medical leave, available in 11 states and the District of Columbia, allows people to take paid time off from work for disruptive health events, including having a baby, becoming seriously ill, or caring for a sick relative.

Paid leave has many benefits for the health of a new mom and baby, said Shabo, who has advocated before Congress for a federal program. It is correlated with higher rates of breastfeeding, lower rates of postpartum disorders, more well-baby visits, fewer cases of shaken baby syndrome, and better overall maternal health, she said. It’s also associated with higher rates of labor force participation and earnings over time, which increases financial stability.

Proponents of a federal paid family medical leave program notched a bittersweet victory this congressional session: For the first time, the House approved one. But opposition from Republicans and over its cost and concerns from the business community doomed its chances of becoming law.

Rubio’s proposal would allow new parents to borrow from their future Social Security benefits to make up their income while taking leave. But Shabo noted the proposal would disadvantage women and families of color, who are more likely to rely on Social Security in retirement.

“Asking you to sacrifice 鈥榝uture you’ when you know there are needs at all stages of life is not a smart way to make policy,” Shabo said.

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Massive hurricanes, including Katrina and Ida, have raked the area. Relief efforts struggled to meet the devastation caused in 2005 by Hurricane Katrina, which killed more than 1,800 people along the Gulf Coast, swept away coastal land, and caused more than $100 billion in damage. The island’s only road to the mainland is often impassable because of strong winds and rising water. Encroaching water has made growing food difficult.

Now, just a small number of citizens live on Isle de Jean Charles, Dardar said. “We’re losing land here in Louisiana 鈥� used to say a football field every 90 minutes,” said Dardar, a former chief of the United Houma Nation, which has about 17,000 members. “Now it’s quicker than that.”

In 2016, Louisiana’s state government received a federal grant to , among them the Houma. Some people do not want to move. For many others, moving is a hardship.

Displaced by the loss of land, infrastructure, and cultural heritage along Louisiana’s southern coast, members of the United Houma Nation are among those in the region most vulnerable to climate change and its repercussions on health. Health advocates fear the consequences could be worse for Indigenous people, who experience higher rates of diabetes, heart disease, and certain other health problems than white people.

The Houma Nation is not recognized by the federal government as a tribe, but a 2015 change to federal standards could ease barriers to federal status for the tribe, more than 35 years after its initial application.

That recognition would allow the Houma to work directly with the federal government rather than through intermediaries to secure resources, said Lanor Curole, a member of the Houma Nation who oversees its day-to-day operations. Direct communication with federal officials during an emergency can save precious time in delivering critical relief to communities like the Houma, she said.

“Our people are on that front line, but we don’t have a seat at that table,” she said.

In 2010, when the Deepwater Horizon oil spill released at least 4 million barrels of oil into the Gulf of Mexico, the incident wreaked havoc on the Houma people. It polluted the region, destroyed ecosystems, threatened commercial fishing, and exposed people to toxic substances known to cause cancer. But after that environmental disaster, BP, the company using the drilling rig, wasn’t required to pay damages directly to the Houma because the tribe isn’t one of the .

For federal recognition, tribes must prove they meet several criteria, including that their members descend from a historical tribe and that they are a distinct community. Dan Lewerenz, a law professor at the University of North Dakota, said the lack of federal recognition means the government does not see the Houma as a self-governing sovereign entity.

Houma leaders said the community’s status has become a barrier to getting support to tackle climate emergencies. Meanwhile, the Chitimacha, a federally recognized tribe in the region, partnered with the federal government in 2016 to develop an adaptation plan to address climate pressures.

Serious health concerns associated with climate change include water-borne infections like E. coli and diseases transmitted by mosquitoes like dengue and West Nile virus, problems that plague communities inundated with water.

The Houma are not eligible for care through the Indian Health Service, winnowing the already slim options in the region. According to a 2010 community needs assessment conducted by the tribe, of Houma members have cardiovascular disease.

Health researchers and social scientists link the health inequities among Indigenous peoples to intergenerational traumas, with younger generations exhibiting poor health outcomes connected to their ancestors’ experiences. The historical traumas experienced by Native people in the U.S. include genocide and displacement.

In the vulnerable communities along the coast, people often don’t have the extra cash needed to rebuild after a storm, putting them at risk of losing their homes. The cost of repairing infrastructure can be astronomical, forcing some people to move elsewhere and leaving already resource-poor communities further choked off from necessities like schools and doctors.

“There are very few grocery stores on the bayous,” said Shanondora Billiot, who studies the effects of environmental changes on the health of Indigenous people in Louisiana. “Many people have to drive 30 to 45 minutes to get to the closest grocery store with fresh fruit, fresh vegetables because many people can no longer grow those vegetables on their soil.”

Billiot’s research on the Houma Nation found that repeated exposure to environmental disasters has taken a toll on people’s mental health, and she noticed a “sadness” among some members that she compared to symptoms of post-traumatic stress disorder. “Climate change interrupts the expression of culture and the protective factors that culture and identity have on health,” Billiot said.

Jobs are scarce, and the cost of flood insurance 鈥� a requirement in coastal areas 鈥� is so high that some people can no longer afford their homes. Pricey flood insurance premiums helped push Curole from her home in Golden Meadow, Louisiana. “I was going to spend just as much per month in insurance than I was going to spend in a house note,” she said. “And I couldn’t afford that.”

In August 2021, Hurricane Ida, a Category 4 hurricane with 150 mph winds, made landfall just 20 miles south of Golden Meadow. Almost 16 years to the day after Hurricane Katrina, Ida caused tremendous damage, overwhelming preparations and relief efforts.

For coastal residents like the Houma, every year could bring the next big storm, and with the acceleration of climate change, it is increasingly likely that it will. Hurricane season typically peaks in September and October, .

“They roll up their sleeves and build, rebuild, and help their neighbors, and start over essentially,” said Billiot. “And they’re deemed resilient for it. However, citizens have talked about, 鈥業 don’t want to have to be resilient.’”

This article includes reporting from Taylor Cook, Zach Dyer, and Dr. Céline Gounder that first aired in the “Climate Displacement, Cultural Resilience” episode of the “American Diagnosis” podcast.

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Y el entusiasmo es aún mayor entre los demócratas y los que viven en estados donde el aborto está prohibido, según (Kaiser Family Foundation).

El sondeo también mostró que la mayoría de los votantes, ya sean demócratas o republicanos, no cree que el aborto deba prohibirse en casos de violación o incesto, ni apoyan las leyes que establecen condenas para los proveedores de abortos y las mujeres que abortan.

Los resultados, recogidos a finales de septiembre en la encuesta periódica de 蘑菇影院 sobre la opinión pública en materia de atención sanitaria, revelan que incluso la mayoría de los votantes republicanos rechaza prohibir directamente casi todos los abortos, como han hecho estados rojos como Texas, Missouri y Kentucky.

Sin embargo, los estados con estas normas tan estrictas han autorizado hasta ahora los abortos para salvar la vida de la madre.

Dado que los demócratas controlan actualmente la Cámara de Representantes y el Senado por estrechos márgenes y que hay varias elecciones reñidas en curso, el control del Congreso podría depender más que nunca de la participación de los votantes.

Y aunque es menos probable que los votantes elijan a los candidatos en base a un solo tema, un asunto importante puede hacer que se inclinen a salir a votar.

La encuesta de 蘑菇影院 mostró que ninguno de los partidos tiene una notable “ventaja de motivación”, y más de la mitad de los votantes, tanto demócratas como republicanos, declararon sentirse más inclinados a votar en estas elecciones que en las anteriores.

Los votantes que se declararon independientes dijeron estar menos dispuestos a votar que en años anteriores.

La diferencia estuvo en los motivos. De los votantes que dijeron estar más entusiasmados a salir a votar, el tema principal para los demócratas fue el aborto, mientras que para los republicanos fue la economía y la inflación.

Los independientes se dividieron a partes iguales entre el aborto y la economía. Casi siete de cada diez demócratas dijeron que estaban inclinados a votar por la decisión de la Corte Suprema, en comparación con el 49% de los independientes y el 32% de los republicanos.

Entre las mujeres en edad reproductiva, el 44% indicó estar más motivada para votar este año: casi seis de cada 10 atribuyeron sus razones a la decisión de la Corte, y más de cinco de cada 10 a las leyes de aborto en sus estados.

De los votantes que viven en estados con prohibición total del aborto, el 51% dijo que esas leyes los motivaron a votar, lo que sugiere la posibilidad de una mayor participación de los votantes demócratas en varios estados republicanos.

La encuesta mostró que el 76% de todos los votantes animados por la decisión del tribunal de anular el caso Roe vs Wade planean votar por candidatos que apoyen el acceso al aborto.

Los resultados también mostraron un fuerte consenso: más de ocho de cada 10 votantes a nivel nacional se oponen a las leyes que prohíben el aborto en casos de violación o incesto, al igual que más de ocho de cada 10 votantes que viven en los estados con las prohibiciones más estrictas del aborto, así como más de ocho de cada 10 votantes que viven en estados que protegen el procedimiento.

Aunque el 70% de los votantes republicanos aprobó la decisión de la Corte, la mayoría de los republicanos también dijo que se opone a las leyes que prohíben el aborto en todos los casos o que hacen que sea un delito tener o realizar un aborto.

Siete de cada 10 votantes republicanos se oponen a prohibir el aborto en casos de violación o incesto. Alrededor del 64% de los republicanos rechaza las leyes que convierten en delito que las mujeres tengan un aborto, mientras que el 51% rechaza las leyes que convierten en delito que un médico lo realice.

Un tercio de los republicanos rechaza prohibir el aborto una vez que se detecta la actividad cardíaca del feto, normalmente unas seis semanas después del último ciclo menstrual de la mujer, el marcador que se ha convertido en la base de las prohibiciones del aborto de seis semanas en varios estados.

El sondeo de 蘑菇影院 también preguntó a los votantes sobre los cambios en Medicare en virtud de la Ley de Reducción de la Inflación, una legislación histórica aprobada por el Congreso controlado por los demócratas en agosto.

Alrededor de un tercio o menos de los estadounidenses conoce las disposiciones sanitarias de la ley, que incluyen la ampliación de los subsidios financieros para quienes compren un seguro de salud en los mercados establecidos por la Ley de Cuidado de Salud a Bajo Precio (ACA), la limitación de los medicamentos recetados para los beneficiarios de Medicare que tienen que pagar de su propio bolsillo, la limitación de los costos de insulina y el permiso al gobierno federal para negociar el precio de algunos medicamentos recetados para los beneficiarios de Medicare.

La encuesta mostró que los estadounidenses mayores de 65 años, que son los que más provecho sacan como principales beneficiarios de Medicare, son más propensos a votar por los candidatos que apoyan los cambios de la ley para los costes de la atención sanitaria.

La encuesta online y telefónica se realizó del 15 al 26 de septiembre con una muestra de 1,534 adultos. El margen de error de muestreo es de más o menos 3 puntos porcentuales para la muestra completa, aunque entre los subgrupos el error de muestreo puede ser mayor.

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

The that most voters, whether they are Democrats or Republicans, do not think abortion should be prohibited in cases of rape or incest, nor do they support laws that set criminal punishments for abortion providers and women who have abortions.

The findings, collected in late September through 蘑菇影院’s regular survey of public opinion on health care issues, highlight that even the majority of Republican voters oppose some of the laws that have strictly restrained abortion access 鈥� including for those who have been raped 鈥� that are now in effect in Republican-led states such as Texas and Missouri. However, states with such strict standards have so far authorized abortions to save the life of a mother.

With Democrats currently holding control of the House of Representatives and the Senate by narrow margins and several close races underway, control of Congress could hinge on voter turnout. And while voters are less likely to pick candidates based on a single issue, an important issue may make them more likely to vote.

The 蘑菇影院 poll showed neither party holds a notable “motivation advantage,” with more than half of both Democratic and Republican voters reporting they feel more inclined to vote in this election than previous ones. Voters who said they were independents, however, said they were less inclined to vote than in previous elections.

The difference was in their reasons. Of those voters who said they are more motivated, the top issue for Democrats was reproductive rights, while the top issue for Republicans was the economy and inflation. Independents were equally split between abortion and the economy. Almost 7 in 10 Democrats said they were motivated by the court’s decision, compared with 49% of independents and 32% of Republicans.

Among women of reproductive age, 44% said they are more motivated to vote this year, with nearly 6 in 10 attributing their feelings to the court’s decision and more than 5 in 10 pointing to abortion laws in their home state.

Of voters living in states with full abortion bans, 51% said their state’s laws had made them more motivated to vote, suggesting the potential for higher Democratic voter turnout in several Republican states.

The poll showed 76% of all voters motivated by the court’s decision to overturn Roe v. Wade plan to vote for candidates who support abortion access.

The findings also showed striking agreement: More than 8 in 10 voters nationally oppose laws that prohibit abortion in cases of rape or incest 鈥� as do more than 8 in 10 voters living in states with the strictest abortion bans, as well as more than 8 in 10 voters living in states with abortion protections.

While 70% of Republican voters approved of the court’s decision, a majority of Republicans also said they oppose laws that ban abortion in all cases or that make it a crime to have or perform an abortion.

Seven in 10 Republican voters oppose prohibiting abortion in cases of rape or incest. About 64% of Republicans oppose laws that make it a crime for women to obtain an abortion, while 51% oppose laws that make it a crime for a doctor to perform one.

One-third of Republicans oppose prohibiting abortion once fetal cardiac activity is detected, typically about six weeks after a woman’s last menstrual cycle 鈥� the marker that has become the basis for six-week abortion bans in several states.

The 蘑菇影院 poll also asked voters about changes to Medicare under the Inflation Reduction Act, landmark legislation approved by the Democratic-controlled Congress in August. About a third or fewer of Americans are aware of the law’s health provisions, which include extending financial subsidies for those who purchase health insurance on the Affordable Care Act’s marketplaces, limiting out-of-pocket costs for prescription drugs for Medicare beneficiaries, capping their insulin costs, and allowing the federal government to negotiate the price of some prescription drugs for those in Medicare.

The poll showed that Americans 65 and older, who stand to benefit most as Medicare’s primary beneficiaries, are more likely to vote for candidates who support the law’s changes for health care costs.

The online and telephone survey was conducted Sept. 15-26 with a sample of 1,534 adults. The margin of sampling error is plus or minus 3 percentage points for the full sample, although among subgroups the sampling error may be higher.

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

She was a teen mom 鈥� like her mother, her grandmother, and her great-grandmother. Her school did not teach sexual health education, and preventing pregnancy was a foreign concept. Her sons are now teenagers.

“If you don’t know your options, you don’t have any,” said Chester, now a program director for Healthy Futures of Texas, a nonprofit sexual health advocacy and education organization. “Everyone was pregnant. And it just felt like: When it happens, it happens.”

While teen pregnancies have declined in the state and across the country in recent decades, Texas continues to have at 22.4 births per 1,000 girls and women ages 15-19 鈥� the lowest, in Massachusetts, is 6.1. Along with Alabama, Texas has . This fall, school districts across Texas are marking a shift to what educators call an “abstinence-plus” curriculum 鈥� the first time the state has revised its standards for sexual health education in more than 20 years.

Although districts may choose their own curriculum and teach more than the state requires, the state’s minimum health standards now go beyond focusing on abstinence to stop pregnancies and include teaching middle schoolers about contraceptives and about preventing sexually transmitted infections, such as (HPV) that has been linked to several cancers.

Previously, a 2017 report showed 58% of Texas school districts offered “abstinence-only” sexual health education, while only 17% offered curriculums that expanded beyond that. A quarter of schools offered no sex ed.

that sex education programs that teach about contraception are effective at increasing contraceptive use and even delaying sexual activity among young people. Abstinence-focused education programs, on the other hand, have not been shown to be particularly effective at curbing sexual activity among teens.

Whether Texas teens receive any sex ed at all, though, depends on whether their parents sign them up. While parents previously had to “opt out” of sex ed portions of their kids’ health classes, they now have to “opt in” for their children to receive those lessons. That means parents must sign and return a permission slip 鈥� a change some fear could lead to kids missing out not so much due to parental objections but because of lost forms and language barriers.

These changes in sex education come as the state ratchets down abortion access following the Supreme Court decision in June overturning Roe v. Wade, which guaranteed a constitutional right to abortion. Texas has one of the nation’s most restrictive abortion laws. The question of how schools educate young people about their sexual health and development has taken on new urgency now that many state governments have enacted abortion bans.

Health advocates say many women may have no choice but to carry a pregnancy to term and that has created a new class of haves and have-nots: those who have the knowledge, resources, and agency to protect themselves from getting pregnant, and those who do not.

Texas is big and diverse enough to need education policies that can be adapted for remote border towns and sprawling metropolitan areas 鈥� both of which have high rates of unintended teen pregnancy.

In 2019, the Texas Board of Education began rewriting the health education standards that had been in place since the 1990s. It kept in place stating “that there are risks associated with sexual activity and that abstinence from sexual activity is the only 100% effective method to avoid risks.”

, a reproductive health research organization, 39 states, plus the District of Columbia, mandate that sex ed classes provide information about abstinence, with 29 of them requiring that it must be “stressed.” Just 20 states and D.C. require that the classes provide information about contraception.

Under Texas law, sex ed must still present abstinence as “the preferred choice.” When schools teach about condoms and other forms of contraception, they must provide what Texas calls “human use reality rates” 鈥� or, as it is described in medical literature, “typical use” 鈥� that detail the effectiveness of those methods outside laboratory settings.

The changes taking effect this year primarily address if and when a Texas student learns about certain sexual health subjects. Under the state’s previous standards, Texas schools could teach about birth control methods beyond abstinence, but only in high school health classes, which are optional. Now, information about contraceptives, as well as more about STIs, is taught in middle school health classes, which are required.

In May, the Dallas Independent School District, , approved lesson materials to meet the state’s new requirements. But school officials here wanted to do more given the scope of the problem. Advocates say Dallas County has the highest rate of repeat teen pregnancies in the nation.

The district curriculum goes beyond the state minimum and includes gender identity and extra information about contraceptives, as well as a contract with Healthy Futures of Texas to teach an optional after-school program for high school students.

The previous curriculum was “very scientific” and “very dry,” said Dustin Marshall, a member of the school district’s board of trustees, and left out basic information about contraceptives, like how to put on a condom.

“One of the primary ways to reduce teen pregnancy and relieve generational poverty from teen pregnancy is to teach contraception,” he said. “Not to just assume that if you teach abstinence, every kid will obey. That’s a little too head-in-the-sand, from my perspective.”

Some critics say the state’s standards, while an improvement, are inadequate when it comes to consent and LGBTQ+ issues, including gender identity. The state board does require that schools teach about healthy relationships and setting personal boundaries for sexual activity.

Under Texas law, parents have the ultimate say over not only whether their child receives sexual health education, but also what is covered in those lessons.

For nearly 30 years, school districts have been required to create and appoint , tasked with reviewing and recommending health curriculums, including on sexual health. Most members must be parents and not district employees, so the content of sex ed classes can still vary widely by district.

Jen Biundo, senior director of policy and research at Healthy Futures of Texas, described a study she helped conduct asking parents and teenagers who they would prefer to teach teens about sex. While parents and teens ranked them differently, she said their choices were the same: schools, doctors, and parents. Health advocates point out that not all parents can or do educate their children about sex 鈥� and that many teens live in unstable situations like foster care.

Biundo said that when they asked teens where they learn about sex, the top answers were “my friends and the internet.”

Indeed, some parents, especially those who were teen mothers themselves, may not know about birth control or how to access it. “Where are the parents supposed to get the knowledge from?” Chester said. “Because they came through the same school system that didn’t teach sex ed, and all of a sudden they’re supposed to know what to teach their kids.”

“We are trying to end that generational curse of being uneducated,” she said.

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Cases of heat-related illness are rising with average air temperatures, and experts say almost half of those getting sick are children. The reason is twofold: Children’s bodies have more trouble regulating temperature than those of adults, and they rely on adults to help protect them from overheating.

Parents, coaches, and other caretakers, who can experience the same heat very differently than kids do, may struggle to identify a dangerous situation or catch the early symptoms of heat-related illness in children.

“Children are not little adults,” said Dr. , a pediatric hospitalist at Boston Children’s Hospital.鈥�

, a meteorologist in California, recalled being surprised at the effect of heat in a car. It was 86 degrees on a July afternoon more than two decades ago when an infant in San Jose was forgotten in a parked car and died of heatstroke.

Null said a reporter asked him after the death, “How hot could it have gotten in that car?”

Null’s research with two emergency doctors at Stanford University eventually . Within an hour, the temperature in that car could have exceeded 120 degrees Fahrenheit. Their work revealed that a quick errand can be dangerous for a kid left behind in the car 鈥� even for less than 15 minutes, even with the windows cracked, and even on a mild day.

As record heat , posing serious risks even to healthy adults, the number of cases of heat-related illnesses , including among children. Those most at risk are young children in parked vehicles and聽adolescents returning to school and participating in sports during the hottest days of the year.

are treated for heat-related illnesses every year.

Heat-related illnesses occur when exposure to high temperatures and humidity, which can be intensified by physical exertion, overwhelms the body’s ability to cool itself. Cases range from mild, like benign heat rashes in infants, to more serious, when the body’s core temperature increases. That can lead to life-threatening instances of heatstroke, diagnosed once the body temperature rises above 104 degrees, potentially causing organ failure.

Prevention is key. Experts emphasize that drinking plenty of water, avoiding the outdoors during the hot midday and afternoon hours, and taking it slow when adjusting to exercise are the most effective ways to avoid getting sick.

Children’s bodies take longer to increase sweat production and otherwise acclimatize in a warm environment than adults’ do, research shows. Young kids are also more susceptible to dehydration because a larger percentage of their body weight is water.

Infants and younger children also have more trouble regulating their body temperature, in part because they often don’t recognize when they should drink more water or remove clothing to cool down. showed that young children who spent 30 minutes in a 95-degree room saw their core temperatures rise significantly higher and faster than their mothers’ 鈥� even though they sweat more than adults do relative to their size.

Pediatricians to monitor and encourage them to drink before they ask for it. Thirst indicates the body is already dehydrated.

They should also dress kids in light-colored, lightweight clothes; limit outdoor time during the hottest hours; and look for ways to cool down, such as by visiting an air-conditioned place like a library, taking a cool bath, or going for a swim.

To address , the National Athletic Trainers’ Association that high school athletes acclimatize by gradually building their activity over the course of two weeks when returning to their sport for a new season 鈥� including by slowly stepping up the amount of any protective equipment they wear.

“You’re gradually increasing that intensity over a week to two weeks so your body can get used to the heat,” said Kathy Dieringer, president of NATA.

Warning Signs and Solutions

Experts note a flushed face, fatigue, muscle cramps, headache, dizziness, vomiting, and a lot of sweating are among the symptoms of heat exhaustion, which can develop into heatstroke if untreated. Call a doctor if symptoms worsen, such as if the child seems disoriented or cannot drink.

to cool a child experiencing heat exhaustion or heatstroke is critical. The child should be taken to a shaded or cool area; be given cool fluids with salt, like sports drinks; and have any sweaty or heavy garments removed.

For adolescents, being submerged in an ice bath is the most effective way to cool the body, while younger children can be wrapped in cold, wet towels or misted with lukewarm water and placed in front of a fan.

Although children’s deaths in parked cars have been well documented, the tragic incidents continue to occur. According to federal statistics, in 2021. Null, , said 13 children have died so far this year.

Caretakers should never leave children alone in a parked car, Null said. Take steps to prevent young children from entering the car themselves and becoming trapped, including locking the car while it’s parked at home.

More than half of cases of vehicular pediatric heatstroke occur because a caretaker accidentally left a child behind, he said. While in-car technology reminding adults to check their back seats has become more common, only a fraction of vehicles have it, requiring parents to come up with their own methods, like leaving a stuffed animal in the front seat.

The good news, Null said, is that simple behavioral changes can protect kids. “This is preventable in 100% of the cases,” he said.

A Lopsided Risk

People living in low-income areas fare worse when temperatures climb. Access to air conditioning, which includes the ability to afford the electricity bill, is a serious health concern.

released last year showed that low-income neighborhoods and communities of color experience much higher temperatures than those of wealthier, white residents. In more impoverished areas during the summer, temperatures .

The study’s authors said their findings in the United States reflect that “the looms large,” referring to a federal housing policy that refused to insure mortgages in or near predominantly Black neighborhoods.

“These areas have less tree canopy, more streets, and higher building densities, meaning that in addition to their other racist outcomes, redlining policies directly codified into law existing disparity in urban land use and reinforced urban design choices that magnify urban heating into the present,” they concluded.

This month, Bernstein, who leads Harvard’s Center for Climate, Health, and the Global Environment, co-authored a commentary in JAMA arguing that advancing health equity is critical to action on climate change.

The center to help their predominantly low-income patients respond to the health impacts of climate change. Federally backed clinics alone provide care to about 30 million Americans, including many children, he said.

Bernstein also recently led that found that from May through September, days with higher temperatures are associated with more visits to children’s hospital emergency rooms. Many visits were more directly linked to heat, although the study also pointed to how high temperatures can exacerbate existing health conditions like neurological disorders.

“Children are more vulnerable to climate change through how these climate shocks reshape the world in which they grow up,” Bernstein said.

Helping people better understand the health risks of extreme heat and how to protect themselves and their families are among the public health system’s major challenges, experts said.

The National Weather Service’s heat alert system is mainly based on the heat index, a measure of how hot it feels when relative humidity is factored in with air temperature.

But the alerts are not related to effects on health, said , director of the Adrienne Arsht-Rockefeller Foundation Resilience Center. By the time temperatures rise to the level that a weather alert is issued, many vulnerable people 鈥� like children, pregnant women, and the elderly 鈥� may already be experiencing heat exhaustion or heatstroke.

The center developed a new heat alert system, which is being tested in Seville, Spain, historically one of the hottest cities in Europe.

The system marries metrics like air temperature and humidity with public health data to categorize heat waves and, when they are serious enough, give them names 鈥� making it easier for people to understand heat as an environmental threat that requires prevention measures.

The categories are determined through a metric known as excess deaths, which compares how many people died on a day with the forecasted temperature versus an average day. That may help health officials understand how severe a heat wave is expected to be and make informed recommendations to the public based on risk factors like age or medical history.

The health-based alert system would also allow officials to target caretakers of children and seniors through school systems, preschools, and senior centers, Baughman McLeod said.

Giving people better ways to conceptualize heat is critical, she said.

“It’s not dramatic. It doesn’t rip the roof off of your house,” Baughman McLeod said. “It’s silent and invisible.”

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Having just moved back to San Antonio, the 30-something searched for a doctor to manage her Crohn’s disease, an inflammatory bowel condition that is successfully managed with medications and lifelong monitoring 鈥� including regular colonoscopies.

Mariel booked an appointment and learned she would be on the hook for a $1,100 colonoscopy 鈥� about three times what she had paid for the same test in a different state. Almost three-quarters of the bill would be a “facility fee” for the in-office procedure at a colonoscopy clinic. (KHN agreed not to disclose Mariel’s last name because she is concerned speaking out might affect her doctor’s willingness to manage her medical condition.)

Preventive colonoscopies are covered without patient cost sharing under the Affordable Care Act, but colonoscopies for patients with existing conditions, like Mariel, are not. patients with inflammatory bowel diseases, including Crohn’s disease, incur about $23,000 in health care costs a year. Medication treatments alone tens of thousands of dollars annually.

But shopping around proved frustrating. Although San Antonio has plenty of gastroenterology offices, are controlled by the same private equity-backed group.

In 2018, one of the nation’s largest independent gastroenterology practices, Texas Digestive Disease Consultants, with the Chicago-based private equity firm to expand by offering management services to other physicians. At the time, the Dallas-based practice had 110 locations, mostly in Texas 鈥� including San Antonio. Today its management group, , operates in a dozen states with more than 400 locations 鈥� and is .

With market dominance comes the business opportunity to set and maintain high prices. “It’s pretty much the only game in town,” Mariel said.

Private equity, known for making a profit on quick-turnaround investments in struggling businesses across many industries, has taken an increasingly active interest in health care in the past decade. It has invested in gastroenterology practices in recent years to tap into the revenue potential in meeting growing demand.

“We are in the of older rectums,” one investment manager .

Tired of having to manage the increasingly complicated business of running a practice and, often, lured by the sweet deals investors offer, more and more doctors have partnered with or even sold their practices to private equity funds. So investment managers now control the financial decisions for many medical offices caring for patients with digestive ailments. With profit the primary driver, patients may find they pay much more for the same 鈥� or less 鈥� care.

The Centers for Disease Control and Prevention recently at which healthy Americans are urged to begin routine screenings for colon cancer 鈥� ensuring that most will undergo regular colonoscopies beginning at age 45. And the population is aging, meaning more people will be needing the procedure.

For those 65 and older, Medicare picks up the tab. But even when a benign polyp is found during a simple screening, patients sometimes end up with an unexpected bill. And less-than-scrupulous providers often find ways to bill for some services, such as out-of-network anesthesia monitoring.

that private equity investment in health care results in and overall higher costs for patients. Surprise billing is the practice of charging insured patients for out-of-network care unknowingly received, including in emergencies and at otherwise in-network facilities.

Before a federal ban on surprise billing took effect this year, it was common for patients to get slapped with an expensive bill after being treated by an emergency room doctor employed by a private equity-owned staffing service 鈥� a problem that policy experts say was not a glitch but rather a for private equity companies.

Nearly 10% of the nation’s 14,000 gastroenterologists were partners in or employed by a private-equity backed organization as of last fall, according to a report by Physician Growth Partners, which represents independent physician groups in transactions with private equity.

In 2021, the number of private equity acquisitions of gastroenterology practices grew by 28% over the previous year, according to .

Complex government regulations, technological innovations, and insurance industry practices have driven many gastroenterologists to sell shares in their practices, said Praveen Suthrum, who runs a consulting company for physician practices. Many physicians argue reimbursement rates are too low to keep up with complex negotiations with insurers and the other rising costs of operating an independent practice.

Private equity typically purchases a stake in a health care practice, then adjusts its operations to make it more profitable. It may switch to cheaper suppliers, shorten appointment windows, bill aggressively, or lay off staff, to name a few strategies 鈥� the kind of changes that save money at the expense of patient care.

In December, on how one private equity-owned group of dermatology practices overbooked patients, lost test results, and leaned on cheaper labor from physician assistants and nurse practitioners who .

A study out last year from the National Bureau of Economic Research when private equity owned a nursing home, patients were more likely to die in their first months there and much more likely to be prescribed antipsychotic drugs 鈥� which are known to increase mortality among the elderly. Taxpayer spending per procedure or service in a private equity-owned facility goes up about 11%.

Private equity has shown a lot of interest in health care practices that perform high-volume procedures, especially those with growth potential.

“Lots of people are needing injections in the eye for macular edema, and lots of people need colonoscopies, and lots of people need skin biopsies,” said Dr. Jane Zhu, a health services researcher at Oregon Health and Science University in Portland who has studied the role of private equity in health care. “And these are things that will only grow in volume over time as the population ages.”

Zhu said usually the investors start by acquiring a well-performing practice, or group of practices, in one geographic area 鈥� called a “platform practice.”

“It’s well established. It has some brand recognition,” Zhu said. “It has good market reach. There may be multiple sites. It has lots of patients that are already affiliated with that practice, and they buy that up, and there are opportunities for consolidation.”

Mergers create larger groups with more power to negotiate rates with insurance companies and charge what they’d like. The possibility of capitalizing on the good name of a respected practice alone may make it a valuable investment.

Zhu said these medical practices are considered a short- to medium-term investment, with an average period of three to eight years before the investors sell.

Suthrum said private equity firms are good at making their case to doctors, assuring them they’ll let the doctors do the medicine while the businesspeople do the business.

Doctors think, “If I’m going to survive, then I will either have to sell myself to the hospital or, what is the alternative?” Suthrum said in an interview. “The alternative is private equity.”

This article was adapted from a of “,” a podcast about the cost of health care, produced in partnership with KHN.

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

The report on patient access to behavioral health care during the covid-19 crisis also casts doubt on whether insurers are abiding by federal law requiring parity in insurance coverage, which forbids health plans from passing along more of the bill for mental health care to patients than they would for medical or surgical care.

The are “the tip of the iceberg” in how Americans with mental, emotional and substance use disorders are treated differently than those with physical conditions, said JoAnn Volk, a research professor at Georgetown University’s Center on Health Insurance Reforms who studies mental health coverage.

The GAO report, shared before publication exclusively with KHN, paints a picture of an already strained behavioral health system struggling after the pandemic struck to meet the treatment needs of millions of Americans with conditions like alcohol use disorder and post-traumatic stress disorder.

Up to 4 in 10 adults on average reported anxiety or depression symptoms during the pandemic, the report showed, compared with about 1 in 10 adults in early 2019.

During the first seven months of the pandemic, there were 36% more emergency room visits for drug overdoses, and 26% more visits for suicide attempts, compared with the same period in 2019.

As the need grew, already spotty access to treatment dwindled, the GAO found: A survey of members of the National Council for Behavioral Health, an organization that represents treatment providers, showed 27% reported they laid off employees during the pandemic; 35% reduced hours; and 45% said they closed programs.

Worker shortages have long been an obstacle to accessing behavioral health services, which experts attribute in large part to problems with how providers are paid. Last fall the federal government estimated that more than one-third of Americans live in an area without enough providers available.

Provider groups interviewed by GAO investigators acknowledged staff shortages and some delays in getting patients into treatment. They noted that the pandemic forced them to cut outpatient services and limit inpatient options. They also told the researchers that payment issues are a significant problem that predated the pandemic. In particular, the GAO said, most groups cited problems getting reimbursed by Medicaid more often than any other payer.

Sen. Ron Wyden (D-Ore.), who chairs the Senate Finance Committee, requested the report from GAO after hearing complaints that constituents’ insurance claims for behavioral health care were being denied.

In an interview, Wyden said he plans to embark on a “long-running project” as chairman to make care “easier to find, more affordable, with fewer people falling between the cracks.”

Spurred by how the pandemic has intensified the system’s existing problems, Wyden identified four “essential” targets for lawmakers: denied claims and other billing issues; the workforce shortage; racial inequality; and the effectiveness of existing federal law requiring coverage parity.

For Wyden, the issue is personal: The senator’s late brother had schizophrenia. “Part of this is making sure that vulnerable Americans know that somebody is on their side,” he said.

State and federal officials rely heavily on people’s complaints about delayed or denied insurance claims to alert them to potential violations of federal law. The report cited state officials who said they “routinely” uncover violations, yet they lack the data to understand how widespread the problems may be.

Congress passed legislation in December that requires that health plans provide government officials with internal analyses of their coverage for mental and physical health services upon request.

Part of the problem is that people often do not complain when their insurer refuses to pay for treatment, said Volk, who has been working with state officials on the issue. She advised that anyone who is denied a claim for behavioral care should appeal it to their insurer and report it to their state’s insurance or labor department.

Another obstacle: Shame and fear are often associated with being treated for a mental health disorder, as well as a belief among some patients that inequitable treatment is just the way the system works. “Something goes wrong, and they just expect that’s the way it’s supposed to be,” Volk said.

The GAO report noted other ways the pandemic limited access to care, including how public health guidelines encouraging physical distancing had forced some treatment facilities to cut the number of beds available.

On a positive note, the GAO also reported widespread approval for telehealth among stakeholders like state officials, providers and insurers, who told government investigators that the increased payments and use of virtual appointments had made it easier for patients to access care.

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

The $1.9 trillion covid relief package that President Joe Biden signed into law in March includes more money to help Americans pay their health insurance premiums for the next two years. KHN correspondent Emmarie Huetteman explains some of the changes that could help consumers.聽

蘑菇影院 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 蘑菇影院鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).