A Record Number of Californians Are Visiting Emergency Rooms for Dog Bites

Those pandemic puppies are growing up to be a public health concern.

The latest California data shows increased rates of emergency room visits, hospitalizations, and deaths from dog bites, with new records set after covid lockdowns. In 2022, there were 48,596 ER visits for dog bites in California, or 125 visits per 100,000 residents, a 70% increase in the rate of visits from 2005, according to the state Department of Health Care Access and Information.

The rate of hospitalizations roughly doubled from 2006 through 2022. And although deaths from dog bites are extremely rare, the death rate in California rose about 70% during roughly the same period, with 28 deaths in the state from 2018 through 2022. Nationally, dog bites were the underlying cause of 96 deaths in 2022, while the death rate more than doubled from 2005 to 2022, according to data from the U.S. Centers for Disease Control and Prevention.

Even before the pandemic, more Americans were welcoming dogs into their homes. The American Veterinary Medical Association estimates that households nationwide owned about 86 million dogs in 2020, up from about 62 million in 2001. The pandemic accelerated that trend as millions more people adopted puppies to provide companionship during a period of isolation.

But lockdowns kept puppies from being socialized, said Elizabeth Stelow, chief of the Behavior Service at the UC Davis Veterinary Medical Teaching Hospital. For healthy development, she said, puppies need to learn acceptable behavior between their first three weeks and 16 weeks of life.

“You're supposed to socialize that puppy to new kinds of people, new kinds of animals, new kinds of places, new kinds of everything,” Stelow said. “Nobody was able to do that. So we're seeing the effects of that all the time right now.”

As poorly socialized puppies turn into adults, their bites can do more harm. From 2021 to 2022, the number of ER visits in California for dog bites grew 12%, marking the highest yearly total to date. Though a recent study did not show a nationwide increase in the rate of ER visits for dog bites from 2005 through 2018, several national studies did show a rise in the proportion of ER visits due to dog bites during the pandemic.

Another potential explanation is the popularity of breeds some people say are aggressive. Kenneth Phillips, one of the nation’s most prominent lawyers specializing in dog bite litigation, pinned much of the blame on pit bulls, which have become one of the most popular breeds in America. “Every study always comes up with the same conclusions, which is that this is the dog that does the most damage,” he said.

Some studies show pit bull bites are often associated with serious injury, while other studies assert that they are not a disproportionate threat. Stelow said a socialized and trained pit bull is not more dangerous than dogs of other breeds. “Why is the No. 1 dog demographic for dog bites pit bulls? Because they're a huge percentage of the canine population in California,” she said.

Phillips said animal shelters are increasingly under pressure to euthanize fewer dogs, meaning people wind up adopting more aggressive dogs without knowing it. The number of “no-kill” animal shelters has increased sharply in the last several years, according to Best Friends Animal Society. However, even no-kill shelters may euthanize aggressive dogs that cannot safely be adopted. A 2019 California law requires animal shelters and rescue groups to disclose a dog’s bite history to anyone adopting it.

A few years ago, a German shepherd was sitting next to a garage as Sacramento, California, postal worker Jacob Studer approached the driveway to make a delivery. The dog crept toward Studer as its owner called the dog. Studer said the dog attacked when he began to pull up his mail bag.

“The dog jumped up, grabbed my arm, bit my arm, and then pretty much ripped my sleeve up and knocked me to the ground,” he said. “I fell backwards and did almost like a little somersault.”

Studer was not seriously injured and didn’t go to the hospital. However, he said the dog’s owner decided not to keep it.

State figures and a recent study by public health researchers show that, in California, children and young adults are the age groups most likely to make ER visits for dog bites. Nationwide, children under 5 were more than twice as likely to die from dog bites as members of other age groups, according to CDC data from 2018 to 2022.

Randall T. Loder, professor emeritus of orthopedic surgery at Indiana University School of Medicine, said the most serious injuries from dog bites often involve the head and neck, making little children especially vulnerable.

“Younger people, they don't understand the risks of a dog,” said Loder, who authored a recent study of tens of thousands of dog bite injuries. “They're vulnerable.”

His study estimated the annual health care cost of treating dog bites is at least $400 million nationwide. Dog bites can lead to infections or transmit serious diseases like rabies.

In California, serious dog bite injuries are more common in rural areas. The rate of ER encounters for dog bites in 2022 was almost 50% higher in counties with fewer than 200,000 people. Modoc, Inyo, Lake, and Siskiyou counties had the highest rates of ER encounters.

Stelow said dogs in rural areas are often not as socialized as their urban cousins. Rural residents also tend to have more dogs.

Stelow said owners of aggressive dogs should reach out early to a veterinarian, particularly one specializing in animal behavior. She said owners should learn to recognize anxiety in dogs and understand their body language. For instance, dogs that are frightened may attempt to flee, fight, fret and fidget, or freeze.

“For the dogs that are already in that situation where they are biting people,” Stelow said, “they need to come see someone who can work with the emotional damage that's been done and try to correct it.”

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

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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.

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Senate Probes the Cost of Assisted Living and Its Burden on American Families

A U.S. Senate committee on Thursday launched an examination of assisted living, holding its first hearing in two decades on the industry as leaders of both parties expressed concern about the high cost and mixed quality of the long-term care facilities.

The federal government has minimal oversight of assisted living, which is regulated by states, unlike skilled nursing homes. Both the Democratic and Republican leaders of the Senate Special Committee on Aging said their inquiry aimed to detail the financial practices and quality levels in the industry so that consumers would be better able to choose facilities. Lawmakers expressed little appetite for Congress to take a more direct role in regulating the sector, such as by setting federal standards for staffing levels and how workers are trained.

Prompted by a New York Times-KFF Health News series, Sen. Bob Casey, the Pennsylvania Democrat who chairs the panel, put out a call for residents and their families to submit their bills so the panel could assess the industry’s business practices.

“I want to know more about what people are paying for assisted living and to have people tell their stories,” Casey said. “We want to hear from you about the true cost of assisted living and understand whether families have the information — the information that they need — to make this difficult financial and health care decision for a family member and for the family.”

Sen. Mike Braun of Indiana, the ranking Republican on the committee, endorsed the inquiry while cautioning against actions that would lead to new financial burdens on the federal budget. “When you’re promoting transparency, it can bring odd partners together,” Braun said.

More than 800,000 older Americans reside in assisted living facilities, which cater to people who have dementia or trouble walking, eating, or doing other daily activities. Most residents have to pay out-of-pocket because Medicare doesn’t cover long-term care and only a fifth of facilities accept Medicaid, the federal-state insurance for people with low incomes or disabilities. The industry is quite profitable, running median operating margins around 20% and often charging residents with extensive needs $10,000 or more a month. The national median cost of assisted living is $54,000 a year, according to a survey by the insurer Genworth.

The New York Times-KFF Health News series detailed industry’s pursuit of maximum profits by charging residents extra at every opportunity. Facilities have billed residents $50 for each injection, $12 for a single blood pressure check, and $93 a month to order medications from a pharmacy.

The quality problems in assisted living have been widely exposed by national and state news organizations. At the Jan. 25 hearing, Patricia Vessenmeyer, a Virginia woman, described the poor care and overwhelmed workers she observed at a dementia care facility where her late husband, John Whitney, lived.

“I once believe I saved a man’s life,” she said, describing how she helped stop a resident who was beating another resident using the victim’s cane. “It took several minutes before a staff member finally heard me and came to help,” she testified. Vessenmeyer said the facility, which she did not name, charged her husband around $13,000 a month.

Jennifer Craft Morgan, director of the Gerontology Institute at Georgia State University, testified that state governments have inconsistent and nontransparent monitoring and enforcement of quality at facilities. She said fewer than 10 states shared information about these procedures in a manner easily accessible to the public.

She said the crux of the problem is that assisted living “is marketed to those who can afford it with a hospitality mindset. They advertise and compete on the basis of amenities, beautiful campuses, luxury food and furnishings, and concierge service.”

Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit advocacy group, testified there is “an escalating demand for federal involvement,” which he said is justified by the fact that a large amount of federal Medicaid funds are going to facility operators, some of which also get loans from the U.S. Department of Housing and Urban Development.

“While some assisted living can be wonderful places to live and to work, too many take in or retain residents for whom they are unable to provide safe care and dignified living conditions,” Mollot said. “Too many residents and families are at risk for financial exploitation and even fraud.”

Casey and other Democratic senators on Jan. 24, citing the Times-KFF Health News series, sent a letter to the Government Accountability Office requesting it study how much Medicaid and other federal agencies pay for assisted living.

A GAO report in 2018 called for improved federal oversight and found that state Medicaid agencies spent $10 billion to provide care in assisted living for 330,000 people in 2014.

In a news release, the National Center for Assisted Living, an industry trade group, said the overall quality of facilities is strong and best overseen by states. It acknowledged that the U.S.’ method of funding long-term care is “broken” and that assisted living is “out of reach for too many seniors.”

Julie Simpkins, co-president of Gardant Management Solutions, which operates senior living facilities in Illinois, Indiana, Ohio, Maryland, and West Virginia, testified that a national standard for all assisted living facilities would be “both unworkable and irresponsible for resident care,” and that injuries, neglect, and deaths are rare. She called for government and private entities to work to develop more affordable options and address the shortage of caregivers.

“These efforts could make a real difference,” she testified.

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.

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KFF Health News' 'What the Health?': Health Enters the Presidential Race

The Host

Julie Rovner KFF Health News @jrovner Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

Based on the results of the first-in-the-nation primary in New Hampshire, it appears more likely than ever before that the 2024 presidential election will be a rerun of 2020: Joe Biden versus Donald Trump. And health is shaping up to be a key issue.

Trump is vowing — again — to repeal the Affordable Care Act, which is even more popular than it was when Republicans failed to muster the congressional votes to kill it in 2017. Biden is doubling down on support for contraception and abortion rights.

And both are expected to highlight efforts to rein in the cost of prescription drugs.

This week’s panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, Anna Edney of Bloomberg News, and Jessie Hellmann of CQ Roll Call.

Panelists

Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories. Anna Edney Bloomberg @annaedney Read Anna's stories. Jessie Hellmann CQ Roll Call @jessiehellmann Read Jessie's stories.

Among the takeaways from this week’s episode:

• Trump had a strong showing in the New Hampshire GOP primary. But Biden may be gathering momentum himself from an unexpected source: Drug industry lawsuits challenging his administration’s Medicare price negotiation plan could draw attention to Biden’s efforts to combat rising prescription drug prices, a major pocketbook issue for many voters.
• Biden’s drug pricing efforts also include using the government’s so-called march-in rights on pharmaceuticals, which could allow the government to lower prices on certain drugs — it’s unclear which ones. Meanwhile, Sen. Bernie Sanders of Vermont is calling on his committee to subpoena the CEOS of two drugmakers in the latest example of lawmakers summoning Big Pharma executives to the Hill to answer for high prices.
• More than a year after the Supreme Court overturned the constitutional right to an abortion, abortion opponents gathered in Washington, D.C., for the March for Life rally, looking now to continue to advance their priorities under a future conservative presidency.
• One avenue that abortion opponents are eying is the 19th-century Comstock Act, which could not only prohibit the mailing of abortion pills to patients, but also prevent them from being mailed to clinics and medical facilities. Considering the abortion pill is now used in more than half of abortions nationwide, it would amount to a fairly sweeping ban.
• And state legislators continue to push more restrictive abortion laws, targeting care for minors and rape exceptions in particular. The ongoing quest to winnow access to the procedure amid public reservations reflected in polling and ballot initiatives highlights that, for at least some abortion opponents, fetuses are framed as an oppressed minority whose rights should not be subject to a majority vote.

Also this week, Rovner interviews Sarah Somers, legal director of the National Health Law Program, about the potential effects on federal health programs if the Supreme Court overturns a 40-year-old precedent established in the case Chevron USA v. Natural Resources Defense Council.

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

Julie Rovner: Health Affairs’ “‘Housing First’ Increased Psychiatric Care Office Visits and Prescriptions While Reducing Emergency Visits,” by Devlin Hanson and Sarah Gillespie.

Alice Miranda Ollstein: Stat’s “The White House Has a Pharmacy — And It Was a Mess, a New Investigation Found,” by Brittany Trang.

Anna Edney: The New Yorker’s “What Would It Mean for Scientists to Listen to Patients?” by Rachael Bedard.

Jessie Hellmann: North Carolina Health News’ “Congenital Syphilis — An Ancient Scourge — Claimed the Lives of Eight NC Babies Last Year,” by Jennifer Fernandez.

Also mentioned on this week’s podcast:

Stat’s “Pharma’s Attack on Medicare Drug Price Negotiation Might Benefit Biden,” by John Wilkerson.

Credits

Francis Ying Audio producer Emmarie Huetteman Editor

To hear all our podcasts, click here.

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

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.

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New York Joins Local Governments in Erasing Billions in Medical Debt

New York City pledged this week to pay down $2 billion worth of residents’ medical debt. In doing so, it has come around to an innovation, started in the Midwest, that’s ridding millions of Americans of health care debt.

The idea of local government erasing debt emerged a couple of years ago in Cook County, Illinois, home to Chicago. Toni Preckwinkle, president of the county board of commissioners, says two staffers came to her with a bold proposal: The county could spend a portion of its federal pandemic rescue funds to ease a serious burden on its residents.

In 2022, Cook County became the first local government to partner with RIP Medical Debt, a nonprofit group that uses private donor funds to buy up and forgive patient debt.

RIP’s model turns debt collection on its head. Normally, debt collectors buy unpaid bills and then try to collect the money owed. RIP identifies unpaid hospital bills owed by people making up to four times the federal poverty level, then buys that debt on secondary markets or directly from hospitals at a small fraction of the original value. Instead of trying to collect, RIP forgives it — so it simply disappears for the patients.

In the Chicago area, as across the country, medical debt is an ongoing problem, causing mental and financial strain that can follow patients for years. An estimated 100 million people in the U.S. carry some form of health care debt, KFF Health News and NPR reported in 2022.

Preckwinkle said the RIP model dovetailed nicely with Cook County’s health care mission. For nearly two centuries, the county has funded its own hospital and health system, Cook County Health, in part to provide care to all residents, regardless of income.

“We have a legacy commitment to delivering quality health care to people without regard to their ability to pay,” Preckwinkle said.

She said that health care mission eats up nearly half of the county’s $9.3 billion annual budget. It is now in the process of spending $12 million — a tiny portion of its budget — to retire $1 billion worth of hospital bills for residents.

Since Cook County announced its program, seven other local governments have followed suit, including Ohio cities Akron, Cleveland, and Toledo; New Orleans; Wayne County, Michigan; Washington, D.C.; and now New York City, which announced its commitment Jan. 22.

During his announcement, New York Mayor Eric Adams noted that medical debt disproportionately affects Black and Hispanic people, who are more likely to be uninsured or underinsured. For the city’s low-income residents, he said, “taking on medical debt isn’t a choice.”

“Working-class families often have to choose between paying their medical bills or some of the basic essentials that they need to go through life,” he said.

RIP is in talks with 30 other municipalities and states, including Connecticut, New Jersey, and Michigan.

Typically, RIP can retire at least $100 worth of debt for every $1 of government funds, so the local initiatives could end up wiping out several billion dollars in medical debt. The software selects eligible patients who remain anonymous, so it’s hard to know what the impact of eliminating that debt might be across a community, or for the families that benefit.

Allison Sesso, CEO of RIP Medical Debt, acknowledged that debt is one of many factors contributing to unequal access to health care, and as hospital costs continue to rise, new debts are also piling up perhaps faster than her group can retire it. She said RIP hopes to retire $2.5 billion worth of unpaid medical bills through various government initiatives this year, but that’s a drop in the bucket of the $195 billion estimated medical debt held by Americans.

“I’m under no illusions,” Sesso said. “I don’t think what I’m doing is the solution to getting rid of medical debt, writ large.”

An Unusual Move for Local Government

Amber Clapsaddle said having the city of Toledo eliminate a $1,500 medical bill of hers from three years ago has given her hope.

In the past, Clapsaddle said, she looked down on those who didn’t pay their bills. “I was like, ‘I’ll never do that,’ and I judged people really hard,” she said.

Then, several years ago, her entire family of five each got sick one after another, requiring numerous surgeries, ultrasounds, and diagnostic tests. She had insurance, but she and her husband, a warehouse worker, couldn’t meet the $6,000 deductible. Clapsaddle, a social worker, realized why medical debt is such a prevalent problem: “It just takes one bill, one bad insurance plan, just one extra diagnosis to have it all fall apart.”

When Toledo’s program with RIP forgave some of her family’s debt two months ago, she cried with joy and relief. She said that motivated her to negotiate with doctors’ offices and her insurance company to try to prevent herself from getting into debt again. “It’s the spark that lights the fire of getting out of medical debt,” she said.

Debt forgiveness is an unusual solution for local governments. More are taking it on, aided by access to federal pandemic rescue funds through the American Rescue Plan Act of 2021, and RIP Medical Debt offered a quick and easy fix to distribute those funds to those most burdened by medical expenses.

Nationally, medical debt is shown to disproportionately affect people of color and people who earn less. It also contributes to a vicious health cycle, discouraging patients from seeking preventive or follow-up care, leading to worse and more expensive outcomes.

Cook County’s Preckwinkle said the pandemic only deepened racial and income gaps that affect people’s access to health care.

“I always talk about the fact that medical debt is the leading cause of bankruptcy in the United States,” she said.

Getting Down to the Root Causes of Debt

Medical debt is being created at high rates, Sesso said, and stronger policies — such as protecting consumers and strengthening insurance coverage — are needed to stop it at its source.

Often that boils down to high prices charged by hospitals and providers.

As Adams, the New York City mayor, put it: “You know, not only do you hold your breath when you go into a hospital or a doctor’s office and wait for a diagnosis, you continue to hold your breath when you see the bill and what it costs, particularly for low-income New Yorkers.”

The idea of forgiving medical debt has broad political support, said Sesso, perhaps because the issue affects people of all political stripes. A recent RIP survey, she said, showed that “84% of people agreed that it is the responsibility of government to ensure health care is affordable, and that position is held by people on the left and the right.”

The enduring benefit of the recent local government initiatives is that they have helped draw more attention to the problem, raising its profile in useful ways, she said. “I think the issue of medical debt is becoming a priority, local governments are talking about it,” and that is leading to other conversations about what else they can do to get more eligible families insured through Medicaid, or through the Affordable Care Act insurance marketplace, for example.

It is also inspiring programs like one recently adopted by Milwaukee County, in which it’s urging more hospitals and health systems to use credit reports to screen and automatically enroll eligible patients in financial assistance programs. These programs already exist to help reduce medical expenses for patients making up to three times the poverty level, but often patients are unaware or not told to apply for them.

By automating the process, as many as 50% more patients may receive free or reduced-cost care, so they have a better chance of avoiding incurring medical debt in the first place, said Shawn Rolland, a member of Milwaukee County’s board of supervisors.

“Why make it more difficult than necessary to get enrolled?” he said. “Because ultimately this will make it more likely that they’ll come back for preventative care.”

About This Project

“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country. 

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability. 

KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

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.

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Estados utilizan dinero de Medicaid para combatir la violencia con armas de fuego

Cada vez más estados utilizan fondos de Medicaid para abordar el problema de las armas, financiando programas comunitarios que tienen como meta prevenir masacres.

Con estos recursos se están creando más programas de prevención de la violencia, que se han visto abrumados en algunas ciudades por un aumento en la criminalidad violenta desde el inicio de la pandemia de covid-19.

Según defensores, una inyección de financiamiento federal confiable podría permitir que estas organizaciones sin fines de lucro amplíen su alcance para llegar a más residentes con mayor riesgo de ser víctimas de disparos, o de disparar a alguien.

Hasta ahora, California, Colorado, Connecticut, Illinois, Maryland, Nueva York y Oregon han aprobado leyes que permiten el uso de fondos de Medicaid para la prevención de la violencia armada, según Kyle Fischer, director de políticas y defensa de The Health Alliance for Violence Intervention, que ha abogado por cambios en las políticas de Medicaid a nivel federal y estatal que permitan este gasto.

Se espera que más estados sigan este ejemplo.

“Se trata de acciones concretas que podemos tomar y que evitan los debates en torno a la Segunda Enmienda“, dijo Fischer.

Con la legislación de control de armas estancada en el Congreso, la administración Biden ha abierto los fondos federales de Medicaid a la prevención de la violencia con armas de fuego para ayudar a estados y ciudades a combatirla. El presidente Joe Biden anunció este enfoque novedoso en abril de 2021, y ahora el dinero está comenzando a llegar a los estados interesados.

Pero el proceso para desbloquear el financiamiento ha sido largo y no está claro cuánto dinero se gastará finalmente en estos programas. Debido a que Medicaid, que proporciona atención médica a residentes de bajos ingresos y discapacitados, es un programa estatal-federal, los estados también deben aprobar el gasto en prevención de la violencia.

En Illinois, que hace dos años se convirtió en uno de los primeros estados en autorizar fondos de Medicaid para prevenir la violencia, Chicago CRED espera obtener la aprobación para su programa esta primavera. Arne Duncan, ex secretario nacional de Educación de la administración Obama y director ejecutivo de este grupo, dijo que vale la pena esperar por este dinero, y que aspira a que la experiencia de su estado acelere el proceso para otros.

“Estamos tratando de construir una infraestructura de salud pública para combatir la violencia con armas de fuego”, dijo Duncan. “Que Medicaid comience a participar en este espacio y cree esas oportunidades podría ser un cambio esencial”.

En 2020, muchas ciudades se enfrentaron a un aumento en los tiroteos y homicidios después que, en respuesta a la pandemia, se cerraran escuelas, negocios y servicios sociales críticos.

Ese mismo año, la policía asesinó al afroamericano George Floyd en Minneapolis, lo que desencadenó protestas a nivel nacional y llamados a reducir el financiamiento policial. Los estadounidenses, que ya están armados hasta los dientes, reaccionaron comprando más armas.

Si bien ya no hay estado de pandemia, y las tasas de homicidios han disminuido a nivel nacional, en algunas ciudades no han bajado. La cantidad de compras de armas es históricamente alta en Estados Unidos, que se estima tiene más armas que personas.

Programas que funcionaron hace unos años en lugares como Oakland, California, que habían recibido elogios por reducir la violencia armada, no dan abasto. Memphis en noviembre superó su récord de homicidios en un año.

“Tenemos una prevalencia excepcionalmente alta de posesión de armas de fuego en Estados Unidos”, dijo Garen Wintemute, profesor de medicina de emergencia y presidente de prevención de la violencia en la Universidad de California-Davis. “Tenemos más armas en manos civiles que civiles, con alrededor de 400 millones de armas en el país”.

“Las armas son herramientas, y si pones una herramienta en manos de alguien, la van a usar”, agregó.

La violencia con armas de fuego también tiene un costo elevado. Estudios de la Oficina de Responsabilidad del Gobierno y la Facultad de Medicina de Harvard han demostrado que el costo de cuidar a los sobrevivientes de disparos va desde $1,000 millones en tratamientos iniciales hasta $2,500 millones en los 12 meses posteriores.

Y no solo las víctimas necesitan ayuda médica.

“Hay mucho dolor. Padres que pierden a sus hijos, abuelos que pierden a sus nietos. Eso afecta enormemente la salud de las personas”, dijo Noha Aboelata, directora ejecutiva fundadora de Roots Community Health Center, en Oakland. “Vecindarios enteros sufren estrés y trauma continuos”.

A pesar del proceso largo y a menudo burocrático, los dólares de Medicaid son increíblemente atractivos para las organizaciones comunitarias que históricamente han dependido de donaciones filantrópicas y subvenciones, que pueden variar de un año a otro.

“Medicaid es confiable”, dijo Fischer. “Si estás haciendo el trabajo, estás calificado y cuidas a los pacientes, puedes obtener un reembolso por el trabajo que haces”.

Esta historia fue producida por KFF Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

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.

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With Trump Front of Mind, New Hampshire Voters Cite Abortion and Obamacare as Concerns

HANOVER, N.H. — Health care issues are important to Lana Leggett-Kealey, who works as a genetic genealogist. But on Tuesday, as she walked out of her polling place at a local high school and into a frigid New England morning, she said she had something bigger on her mind when she cast her vote.

“I want to make sure we have someone competent in the White House,” she said. She wrote in President Joe Biden’s name on her ballot in New Hampshire’s Democratic primary.

The Affordable Care Act’s future is important to Robert Stanhope, a retired bill collector. He said he also wrote in Biden, whose administration has worked to reduce costs under the ACA.

But that wasn’t his motivation for his early-morning visit to the polls. “I’m here to keep Trump out of office,” Stanhope said.

Elaine Kozma, 73, of New London said health care issues are vitally important to her as a cancer survivor. She said she voted for Republican Nikki Haley, a former U.S. ambassador to the United Nations and South Carolina governor, whom she thinks she can trust more than former President Donald Trump.

Voters casting their first ballots in the 2024 presidential election cycle on Tuesday framed health care as a back-burner issue, capping years of political wrangling over Obamacare and a pandemic that strained the nation’s health system.

In interviews with more than 50 voters this week in New Hampshire — a state where 95% of residents have health insurance, one of the highest rates in the country — most people said their vote was about Trump, like him or hate him. But health care concerns — about costs, access, and, especially among Democrats, abortion — weren’t far from many voters’ minds.

“I have two daughters and five sisters and a mom, so making sure women’s reproductive rights are protected is important to me,” said Rob Houseman, 60, a town official in Hanover. Worried that Republicans will try to “weaponize health care” instead of ensuring access, he said he voted for Biden.

Trump defeated Haley in the state’s GOP primary, according to The Associated Press. Biden, who did not appear on the ballot due to disagreements over the primary schedule, won the Democratic contest owing in part to a vigorous write-in campaign.

Many opposed to Trump cited concerns about his fitness to lead, while most Trump voters who spoke with KFF Health News said they supported him for two main reasons: They hoped he would reduce illegal immigration and lower inflation.

Democratic voters were more likely than Republicans to cite heath care as a key issue in the election.

“Oh my, yes,” said Ben Gilson, 90, a retired orthopedic surgeon. “Health care is my No. 1 issue.”

While he said he has excellent coverage and pays little in out-of-pocket costs, he worries many younger people struggle and wants to make sure Obamacare is retained. One of Trump’s earliest promises during his 2016 campaign was to repeal and replace the ACA — a vow he has recently revived in his latest attempt to win the White House.

In New London, Kate Turcotte, a professor at Colby-Sawyer College, said she voted for Biden to keep Trump out of office — and because she trusts Democrats more to improve health coverage and protect abortion rights.

She said she also worries Trump will try to cut health care for the most vulnerable. “Health care should be a right, not a privilege,” she said.

Trump voters frequently cited immigration as a top concern. Republicans have accused Biden of allowing record numbers of immigrants to cross into the U.S. from Mexico.

In Merrimack, Mary Clancy, 69, said she was satisfied with her Medicare coverage and was voting for Trump mainly to secure the southern border.

Kathy Franqui, 54, of Merrimack, said the border and immigration were her main reasons for voting for Trump. But she also said Trump would reduce health costs.

At a coffee shop in Warner, Susan Hencke, 62, said she pays $1,100 a month for health insurance. But she said health care was not among the factors determining how she would vote.

She said having a president who will protect civil rights matters most to her. She was undecided about whom to support.

Both she and her husband, who declined to give his name, said they were concerned about abortion restrictions Trump may impose.

Sitting outside the coffee shop in the freezing weather was Art Sullivan, 75, of Hooksett, who said immigration was his overriding issue in the election — and why he was voting for Trump.

Asked if he had been personally affected by immigration, he said he was worried his children would have to shoulder the financial burden of people coming into the U.S. without authorization.

“The border is a disgrace,” said Sullivan, who said he’s a registered independent voter and sells swimming pools.

Asked if health care was something he thought about when comparing candidates, he said he had a Medicare Advantage plan that covers his bills and provides access to care.

DJ Annicchiarico, co-owner of United Shoe Repair in downtown Concord, said he is a registered Democrat. But while he prefers Biden on health issues, he is not yet persuaded to vote for him in November.

His main concern is inflation. He said the ACA, which he described as a step in the right direction, had helped lower his insurance premiums but hadn’t controlled health care prices. “Something needs to be done to rein in inflation,” he said.

Annicchiarico said he wants to see health care prices regulated by the federal government and worries Trump would try to repeal the ACA. He noted access is still an issue and said getting a dermatology appointment for his daughter meant waiting eight months.

Aalianna Marietta, 21, a college student, said health care was important to her, particularly abortion rights, so she would be voting for Biden. “I am 100% pro-choice, and I cannot see myself voting for someone who is racist and a misogynist,” she said of Trump.

Deb Shope, 57, out walking her dog in Lebanon, said health care is a top issue for her because she works as a clinical social worker and sees how important good health coverage can be. She said she was voting for Biden because she liked how he has tried to help people get coverage and address their mental health care needs.

Shope said it’s hard to look beyond how Trump acts as a person. Asked if she is worried about him getting reelected, she said people shouldn’t worry about things out of their control.

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.

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Medicare Advantage Is Popular, but Some Beneficiaries Feel Buyer’s Remorse

Medicare Advantage plans are booming — 30.8 million of the 60 million Americans with Medicare are now enrolled in the private plans rather than the traditional government-run program.

But a little-known fact: Once you’re in a Medicare Advantage plan, you may not be able to get out.

Traditional Medicare usually requires beneficiaries to pay 20 percent of their medical bills after their deductibles are met — a potentially ruinous expense that most people cover in part with a private supplemental plan called Medigap. But unless you sign up for Medigap soon after you’re first eligible, insurers can often deny coverage or charge steeper premiums based on preexisting conditions. 

Medicare Advantage can look pretty attractive to new Medicare beneficiaries, especially if they’re healthy. While there are co-payments and deductibles, annual out-of-pocket expenses are capped — unlike in traditional Medicare. Many Advantage plans offer low (or zero) premiums compared with the traditional program, while often including drug coverage and sometimes low-cost vision, hearing and dental benefits.

They are also heavily marketed, contributing to their growth, said Christine Huberty, a lead benefit specialist supervising attorney at the Greater Wisconsin Agency on Aging Resources.

“They’re out there, they’re talked about, and I think there’s a little bit of lack of education too,” she said. “People don’t really know what they’re signing up for or what their options are.”

But when enrollees start to depend on the insurance for “bigger issues,” Huberty said, “that’s when people realize, ‘Oh no, this isn’t going to help me at all.’” By then, it may be too late to sign up for a Medigap plan.

Or as David Lipschutz at the Center for Medicare Advocacy put it: “When it comes to Medicare Advantage plans, some people swear by them and other people swear at them.”

Advantage plans control their costs by limiting their customers’ selection of hospitals and doctors and requiring prior authorization for some care — a process detested by doctors and patients. The Biden administration issued new requirements for prior authorization last week, following complaints from major physician and hospital lobbies.

Medicare Advantage open enrollment is happening now through the end of March. It’s a sort of “buyer’s remorse” window, when anyone who entered 2024 already signed up for an Advantage plan can switch plans or go back to traditional Medicare. 

David Meyers at Brown University School of Public Health said about 15 percent of Advantage customers change enrollment annually. Most switch to another Advantage plan.

After I wrote about this issue recently for KFF Health News, I heard from retired pharmacist Jami Holt. The 66-year-old Virginia resident signed up for Medicare last year and “ended up calling a broker who helped explain it.”

Holt said the decision was scary: “I had to make the right decision at that moment.” She picked traditional Medicare and also signed up for a Medigap policy.

But Holt’s husband is on Medicare Advantage. It “works pretty well” but carries a higher deductible than her Medigap plan. “If you have one hospitalization, you’re going to run the bill,” she said.

Holt said she and her husband would like to move him to traditional Medicare, but he has a chronic condition that would make it “cost-prohibitive.”

The inability of most Advantage enrollees to switch back to traditional Medicare has been a known concern for years in policy circles, said Tricia Neuman, executive director of KFF’s Program on Medicare Policy.

One solution under discussion, she said, is putting a limit on out-of-pocket spending under traditional Medicare. That would increase federal spending on the program and might offset the need to increase Medigap premiums when beneficiaries enroll.

Paul Ginsburg, a professor of the practice of health policy at the University of Southern California, said another possible solution is to allow current beneficiaries to enroll in Medigap during specific enrollment periods each year without facing rejection for preexisting conditions, but to let insurers charge higher premiums — say an extra 20 percent for the first year or two.

That might still be too much of a burden for many Medicare beneficiaries; half had income under $30,000 in 2019.

With so many people enrolled in Advantage plans, “the current effective barrier on moving back to traditional Medicare is really a problem that policymakers should want to address,” Ginsburg said.

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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 at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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