Datos de las sobredosis, obtenidos por colaboración colectiva, resaltan en dónde hace falta la ayuda

El proyecto de la Universidad de Texas, llamado TxCOPE, busca resolver un problema que mantiene en vilo a los funcionarios de todo el país en su esfuerzo por reducir el número récord de muertes por drogas: obtener una imagen clara y precisa de las sobredosis no mortales y mortales.

EL PASO, Texas – Los hombres hacían fila en el exterior de Corner of Hope, un centro de recursos para personas sin hogar, esperando recibir los productos gratuitos que distribuía una furgoneta blanca.

Algunos querían bolsas con artículos de aseo personal o preservativos, pero otros se llevaban kits que los ayudan a consumir drogas de forma segura, o naloxona, un medicamento para revertir una sobredosis de opioides.

Gilbert Shepherd, trabajador social de Punto de Partida, una organización sin fines de lucro que atiende a las personas que hacen uso indebido de las drogas, interroga amablemente a quienes se llevan los kits de seguridad. Un hombre con anteojos de sol y camiseta negra le explicó que, no hace mucho, se tomó una pastilla que compró por $1,50 y perdió el conocimiento durante horas. Otro, con camisa a cuadros y pantalones caqui, contó haber visto a alguien sufrir una sobredosis tras tomar una pastilla azul.

Esas dos sobredosis se añadirán a una nueva base de datos de Texas llamada Texans Connecting Overdose Prevention Efforts, cuyo objetivo es mejorar el seguimiento de las sobredosis de drogas en el segundo estado más grande del país.

El proyecto de la Universidad de Texas (UT), conocido como TxCOPE, busca resolver un problema que mantiene en vilo a los funcionarios de todo el país en su esfuerzo por reducir el número récord de muertes por drogas: obtener una imagen clara y precisa de las sobredosis no mortales y mortales.

Los grupos comunitarios utilizan ahora los paneles de datos y los mapas de calor de TxCOPE para ver dónde aumentan las sobredosis, y dirigir así los esfuerzos de prevención a esos puntos conflictivos, con suministros de naloxona y personal que explique cómo usarla, dijo Christopher Bailey, coordinador de Project Vida, una clínica de El Paso.

Se trata de uno de los pocos proyectos en Estados Unidos que reúne datos de sobredosis recopilados de forma sistemática por grupos de reducción de daños (es decir, obtenidos por crowdsourcing), según Leo Beletsky, experto legal en salud pública de la Northeastern University. Estos proyectos compensan la falta de una imagen precisa de la crisis de sobredosis que dura décadas. “Es un escándalo”, añadió Beletsky.

Más de 107,000 estadounidenses murieron por sobredosis en 2021, según los Centros para el Control y la Prevención de Enfermedades (CDC). Pero no hay un recuento nacional de cuántas personas sobreviven a las sobredosis de drogas. Los CDC ni siquiera tienen un método estándar que los estados puedan utilizar para contar las sobredosis no mortales. Suma los datos de sobredosis de las visitas a las salas de urgencias basándose en los códigos clínicos y de facturación de los estados participantes, pero eso excluye a las personas que no interactúan con el sistema médico, señaló Bradley Stein, director del Rand Opioid Policy Center. Se trata de un “enorme punto ciego”, según Stein.

Además, los datos de sobredosis mortales suelen publicarse semanas o meses después, una vez que el informe oficial del médico forense o los resultados toxicológicos muestran qué sustancias causaron las muertes. “A los opioides los miramos por el retrovisor”, añadió Stein.

Otros proyectos que contabilizan las sobredosis no mortales, como el ODMAP, se basan en los informes de las fuerzas del orden o de los primeros intervinientes. Pero muchos consumidores de drogas no llaman a los servicios de emergencia ni informan de las sobredosis por miedo a ser arrestados, deportados o a otras consecuencias, como la pérdida de sus hijos o de su vivienda debido al consumo de drogas, afirmó Traci Green, profesora y directora de la Opioid Policy Research Collaborative de la Universidad de Brandeis.

“Los actuales sistemas nacionales de datos no han estado a la altura de la magnitud de la epidemia de sobredosis”, escribió el doctor Rahul Gupta, director de la Oficina de Política Nacional de Control de Drogas, en un llamamiento a la acción publicado el 30 de junio en JAMA. Añadió que es esencial crear un mejor sistema de datos y que su organismo se ha reunido con otras agencias federales para mejorar el seguimiento de los datos sobre sobredosis no mortales.

Green calcula que, a nivel nacional, un 50% de las sobredosis no mortales no se notifican, y que el recuento es mayor en los lugares donde la aplicación de la ley es más estricta y en las comunidades de color. La parte que falta en esta historia “es la de la diversidad”, apuntó.

En Texas, hasta el 70% de las sobredosis, en su mayoría no mortales, no se denuncian, estimó Kasey Claborn, investigadora principal del proyecto TxCOPE y profesora de la Facultad de Medicina Dell y de la Facultad de Trabajo Social Steve Hicks de la UT.

Según cifras oficiales, unos 5,000 tejanos murieron de sobredosis en 2021. Claborn cree que es un recuento insuficiente porque el estado tiene oficinas de examinadores médicos en solo  15 de sus 254 condados. La mayoría de los condados tienen jueces de paz que no siempre solicitan las costosas pruebas de toxicología para determinar la causa de la muerte.

El estado registró casi 4,000 llamadas relacionadas con los opioides a la Red de Control de Venenos de Texas el año pasado y casi 8,000 visitas a las salas de emergencia relacionadas con los opioides en 2020. Claborn analiza cómo se comparan los datos que recoge TxCOPE con esas estadísticas oficiales.

Los expertos en drogas han mostrado su frustración porque consideran que Estados Unidos no trata la epidemia de sobredosis con la misma urgencia que covid-19. Las muertes por drogas se dispararon durante la pandemia, ya que el fentanilo ilegal, que es entre 50 y 100 veces más potente que la morfina, inundó el suministro de drogas en las calles del país y la gente se quedó sin apoyo por abuso de sustancias.

Pero mientras las autoridades de salud pública basaban las restricciones de la pandemia en el número de casos locales de covid y en el recuento de muertes, los expertos y los trabajadores sociales carecían de datos en tiempo real que les permitieran reaccionar con intervenciones que pudieran salvar las vidas de los consumidores de drogas.

“¿Cómo ayuda eso en una emergencia de salud pública?”, se preguntó Daniel Sledge, un paramédico que ha puesto a prueba TxCOPE en el condado de Williamson, al norte de Austin.

Esa información podría ayudar a los trabajadores sanitarios a identificar qué zonas deben cubrirse con naloxona o si necesitan educar a la gente sobre drogas mezcladas con fentanilo letal.

TxCOPE, financiado por la subvención estatal contra los opioides y la Administración Federal de Servicios de Salud Mental y Abuso de Sustancias, comenzó en El Paso en junio de 2021 y luego se amplió a Austin, San Antonio y, posteriormente, al condado de Williamson. El lanzamiento oficial está previsto para el 1 de septiembre, con un despliegue al resto del estado en etapas.

Antes de que el grupo se pusiera en marcha, la difusión era más aleatoria. Se trataba de “atrápame como se pueda”, dijo Bailey, del Project Vida. Al igual que muchos grupos de reducción de daños, hacían un seguimiento informal de las sobredosis, que a menudo se producían entre una población itinerante.

Pero no tenían una forma de poner en común esa información con otros grupos de la ciudad ni de generar mapas para impulsar el alcance comunitario. TxCOPE ha ayudado al grupo a encontrar personas en riesgo para poder ofrecerles prevención de sobredosis, apoyo entre pares o derivaciones a tratamientos. Ahora “podemos centrarnos realmente en esas zonas, enfocados como un láser”, apuntó Bailey.

Paulina Hijar, trabajadora social de Punto de Partida, por ejemplo, contó que se encuentra habitualmente con personas que inyectaron a sus amigos con remedios caseros contra sobredosis que son peligrosos e ineficaces —leche o una mezcla de agua y sal— o que consiguieron naloxona y nunca llamaron a las autoridades. Aseguran que gracias a que los trabajadores sociales se han ganado la confianza de sus comunidades, ahora pueden recopilar información sobre las sobredosis, incluyendo cuándo y dónde se produjeron, algo que normalmente se omitiría en las estadísticas oficiales.

La privacidad es una clave del proyecto TxCOPE: las personas necesitan poder compartir información acerca de las sobredosis sin temor a las consecuencias, indicó Claborn. Texas aprobó en 2021 una ley para proteger a las personas que llamen a los servicios de emergencia durante una sobredosis, pero su alcance es muy limitado. Las personas que tienen una condena por delito de drogas, por ejemplo, no califican. Y alguien está protegido de la detención solo una vez. TxCOPE cuenta con un certificado federal de confidencialidad que lo protege de las órdenes judiciales, y Claborn no comparte los datos generales con el Estado.

Claborn quiere utilizar el proyecto, que está siendo renovado este verano antes de su lanzamiento, para traer más dólares federales al estado. “Hemos tenido dificultades para demostrar que existe un problema real en Texas, porque se ha ocultado”, afirmó.

Ha estado trabajando en una función que permitiría a cualquier persona de la comunidad informar de las sobredosis, un esfuerzo para mejorar los recuentos en las partes del estado que no cuentan con grupos de reducción de daños. Con el tiempo, Claborn quiere cotejar los datos obtenidos por el público con los informes toxicológicos.

Por ahora, sin embargo, el proyecto se basa en las pruebas anecdóticas de los consumidores de drogas y otras personas de la comunidad que informan de que han reanimado a alguien con naloxona, o que han visto a alguien perder el conocimiento, o sufrir otros efectos de tomar demasiada droga.

Una tarde reciente, Shepherd e Hijar reconocieron a un hombre en el parque Houston de El Paso. Les habló de una mujer que había muerto sola en su apartamento hacía una semana y media tras tomar una mezcla de drogas. También mencionó a un individuo al que pudo reanimar con naloxona unos dos meses antes. Los detalles fueron mínimos.

Los investigadores y los grupos de reducción de daños dicen que estos datos imprecisos son mejores que los que han tenido en el pasado. Aunque los datos anecdóticos del proyecto no se han comprobado a fondo, se trata de un gran paso hacia adelante, dijo Stein. “No tenemos nada más en este momento”, concluyó.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Crowdsourced Data on Overdoses Pinpoints Where to Help

University of Texas researchers are testing a program that would allow harm reduction groups to crowdsource data on fatal and nonfatal drug overdoses statewide. While the data relies on word of mouth, they say, it is more comprehensive than anything that exists now and can be used immediately to prevent overdoses.

EL PASO, Texas — Men lined up outside the Corner of Hope, a homeless resource center, eyeing free supplies on plastic shelves inside a white van.

Some wanted bags with toiletries or condoms, but others took kits that help them safely use drugs or naloxone, an opioid overdose reversal medicine.

Gilbert Shepherd, an outreach worker for Punto de Partida, a nonprofit that serves people who misuse drugs, gently questioned those who took the drug safety kits. A man wearing sunglasses and a black T-shirt explained that not long ago he took a pill he bought for $1.50 and, within minutes, he passed out for hours. A man in a plaid shirt and khaki pants described seeing someone overdose after taking a blue pill a month before.

Those two overdoses would be added to a new Texas database called Texans Connecting Overdose Prevention Efforts, which aims to improve drug overdose tracking across the nation’s second-largest state.

The University of Texas project, known as TxCOPE, is one attempt to solve a problem exasperating officials nationwide who are trying to lower the record number of drug deaths: getting an instant, accurate picture of both nonfatal and fatal drug overdoses. Community groups are now using TxCOPE’s data dashboards and heat maps to see where overdoses are spiking and then target those hot spots with prevention efforts such as naloxone training and supplies, said Christopher Bailey, project coordinator at Project Vida, a health center in El Paso.

It is one of the few projects in the U.S. pooling crowdsourced overdose data from harm reduction groups in a systematic way, according to Leo Beletsky, a public health law expert at Northeastern University. Such projects compensate for the lack of an accurate picture of the decades-long overdose crisis. “It’s scandalous,” Beletsky said.

More than 107,000 Americans died of drug overdoses in 2021, according to the Centers for Disease Control and Prevention. But there is no national count of how many people survive drug overdoses. The CDC doesn’t even have a standard method that states can use to count nonfatal overdoses. It aggregates overdose data from emergency room visits based on clinical and billing codes from participating states, but that excludes people who don’t interact with the medical system, said Bradley Stein, director of the Rand Opioid Policy Center. It is a “huge blind spot,” Stein said.

Plus, fatal overdose data is often published weeks or months later, once an official medical examiner’s report or toxicology results show what substances caused the deaths. “We’re looking in the rearview mirror with opioids,” Stein said.

Other projects that count nonfatal overdoses, such as ODMAP, rely on reports from law enforcement or first responders. But many drug users won’t call emergency services or report overdoses for fear of arrest, deportation, or other consequences such as the loss of their children or housing due to drug use, said Traci Green, a professor and the director of the Opioid Policy Research Collaborative at Brandeis University.

“Simply put, current national data systems have not kept up with the scale of the overdose epidemic,” wrote Dr. Rahul Gupta, director of the Office of National Drug Control Policy, in a call for action published June 30 in JAMA. He added that building a better data system is essential and that his agency is convening with other federal agencies to improve the tracking of nonfatal overdose data.

Nationally, Green estimated, about 50% of nonfatal overdoses go unreported, with a higher undercount in places with stricter law enforcement and among communities of color. The missing part of the picture “is a very diverse one,” she said.

In Texas, up to 70% of overdoses, mostly nonfatal, go unreported, estimated Kasey Claborn, lead researcher on the TxCOPE project and an assistant professor at UT’s Dell Medical School and Steve Hicks School of Social Work.

Officially, about 5,000 Texans died of a drug overdose in 2021. Claborn believes that is an undercount, too, because the state has medical examiners’ offices in only 15 of its 254 counties. Most counties have justices of the peace who don’t always request pricey toxicology tests to determine the cause of death. The state recorded nearly 4,000 opioid-related calls to the Texas Poison Control Network last year and nearly 8,000 opioid-related emergency room visits in 2020. Claborn is analyzing how the data TxCOPE collects compares with those official statistics.

Drug experts are frustrated the U.S. doesn’t treat the overdose epidemic with the urgency it does for covid-19. Drug deaths surged during the pandemic as illegal fentanyl, which is 50 to 100 times more potent than morphine, flooded the nation’s street drug supply and people were cut off from substance abuse support. But while public health authorities based pandemic restrictions on local covid caseloads and death counts, experts and outreach workers have lacked real-time data that would allow them to react with interventions that could save drug users’ lives.

“How is that helping in a public health emergency?” said Daniel Sledge, a paramedic testing TxCOPE in Williamson County, just north of Austin.

That information could help health workers identify which areas to blanket with naloxone or whether they need to educate people about a batch of drugs laced with lethal fentanyl.

TxCOPE, funded by the state’s opioid grant and the federal Substance Abuse and Mental Health Services Administration, started in El Paso in June 2021 and then expanded to Austin, San Antonio, and later Williamson County. An official launch is planned for Sept. 1, with a rollout to the rest of the state in stages.

Before the group started, outreach was more haphazard. “It was catch as catch can,” said Bailey, with Project Vida. Like many harm reduction groups, they would informally track overdoses, which often occurred among an itinerant population. But they didn’t have a way to pool that information with other city groups or generate maps to drive outreach. TxCOPE has helped the group find pockets of at-risk people so they can provide them with overdose prevention, peer support, or treatment referrals. Now “you are able to really home in on those areas with laserlike focus,” he said.

Punto de Partida outreach worker Paulina Hijar, for example, said she routinely meets people who injected their friends with dangerous and ineffective homemade overdose remedies — either milk or a mixture of water and salt — or got naloxone and never called authorities. Because outreach workers have built trust in their communities, they say, they can gather information about overdoses, including when and where they occurred, that would normally be omitted from official statistics.

Privacy is a key feature of the TxCOPE project — people need to be able to share overdose information without fear of consequences, Claborn said. Texas passed a law in 2021 intended to shield from arrest people who call emergency services during an overdose, but it’s narrowly tailored. People who have a felony drug conviction, for example, don’t qualify. And someone is protected from arrest only once. TxCOPE has a federal certificate of confidentiality that protects it from court orders, and Claborn doesn’t share raw data with the state.

Claborn wants to use the project, which is being revamped this summer before the launch, to bring more federal dollars to the state. “We’ve had difficulty proving there is an actual problem in Texas, because it’s been hidden,” she said.

She has been working on a feature that would allow anyone in the community to report overdoses, an effort to improve counts in parts of the state without harm reduction groups. Eventually, Claborn wants to check the crowdsourced data against toxicology reports.

For now, though, the project relies on anecdotal evidence from drug users and others in the community who report reviving someone with naloxone or seeing someone lose consciousness or suffer other effects of taking too much of a drug.

On a recent afternoon, Shepherd and Hijar recognized a man in El Paso’s Houston Park. He told them about a woman who had died alone in her apartment about a week and a half earlier after taking a mixture of drugs. He also mentioned a guy he was able to revive with naloxone about two months earlier. Details were minimal.

Researchers and harm reduction groups say this nebulous data is better than what they’ve had in the past. Even though the project’s anecdotal data isn’t thoroughly vetted, the step toward timeliness is great, Stein said. “We’ve got nothing else right now,” he said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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DEA El Paso Division warns of overdose cases, drugs mixed with synthetic opioids

by Fallon Fischer | 

The Drug Enforcement Administration El Paso Division said in the past few days, it has learned of several instances of individuals who used illegal drugs and then experienced overdose symptoms.

A total of nine patients were transported to local hospitals exhibiting signs of drug overdose in a period of 36 hours, according to the DEA El Paso Division.

Two overdose deaths occurred on May 23 bringing the total number of recent overdose incidents to 11.

It is suspected that the illegal drugs may be mixed with a synthetic opioid, according to the DEA.

KHN’s ‘What the Health?’: Why Health Care Is So Expensive, Chapter $22K

Congress is making slow progress toward completing its ambitious social spending bill, although its Thanksgiving deadline looks optimistic. Meanwhile, a new survey finds the average cost of an employer-provided family plan has risen to more than $22,000. That’s about the cost of a new Toyota Corolla. Alice Miranda Ollstein of Politico, Anna Edney of Bloomberg News and Rebecca Adams of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Rebecca Love, a nurse academic and entrepreneur, about the impending crisis in nursing.

Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

Congress appears to be making progress on its huge social spending bill, but even if it passes the House as planned the week of Nov. 15, it’s unlikely it can get through the Senate before the Thanksgiving deadline that Democrats set for themselves.

Meanwhile, the cost of employer-provided health insurance continues to rise, even with so many people forgoing care during the pandemic. The annual KFF survey of employers reported that the average cost of a job-based family plan has risen to more than $22,000. To provide what their workers most need, however, this year many employers added additional coverage of mental health care and telehealth.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Anna Edney of Bloomberg News and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s episode:

  • Moderate Democrats who were worried about the price tag of the social spending bill said during negotiations last week that they wanted to see the full analysis of spending and costs from the Congressional Budget Office. But members of the House probably won’t get that score before voting on the bill. CBO instead is releasing its assessments piecemeal as analysts go through specific sections of the huge bill.
  • If the House passes the bill next week, which leadership is pledging, the legislation could still undergo major revisions in the Senate. Some provisions will be subject to the Byrd Rule, which says items in this type of bill must be related to the budget. Republicans are expected to challenge parts of the bill, and the parliamentarian will have to rule on whether their objections are valid.
  • Among the provisions that some moderate Democratic senators might object to are the paid family leave and the mechanism for lowering Medicare drug prices.
  • Congress is looking at a very busy end of the year, which could complicate passage of the social spending bill. Leaders already postponed a bill to raise the debt ceiling and the annual federal spending bills until early December.
  • A federal judge has blocked Texas Republican Gov. Greg Abbott’s order prohibiting mask mandates in schools. But a final resolution is likely some time away as the case is appealed. Disability rights groups, which had sued to stop the governor’s order, argued that the ban was keeping children with health problems who are at high risk from covid from coming to school.
  • Despite opposition from conservative leaders to vaccine mandates, the vast majority of workers have had their shots, either because they wanted them or their employer mandated it. Lawsuits brought against those workplace requirements may not signal a broad opposition among the population.
  • In its survey of employers’ health plans, KFF found that premiums are still increasing faster than wages as health costs continue to rise. Leaders of both political parties say they would like to reduce the cost of care, but no magic pill appears likely. Instead, lawmakers generally are more inclined to have the government pick up a bigger portion of the country’s health care costs when not finding a way to cut that spending.
  • One key challenge in addressing rising health care spending in Congress is the power of the health care industry. With the close political party margins on Capitol Hill, it is fairly easy for the industries to use their contributions to pick off a couple of members and keep major reform from passing.
  • The KFF survey also documented the wide expansion of telehealth coverage during the pandemic. Although employers and the government have been concerned that telehealth adds to spending because it duplicates services or allows doctors to charge for services they once performed over the phone without billing, it will be hard to put this genie back in the bottle. Consumers like the convenience. And some services, such as mental health therapy or medical consultations for rural residents, are much easier.

Also this week, Rovner interviews Rebecca Love, a nurse, academic and entrepreneur who has thought a lot about the future of the nursing profession and where it fits into the U.S. health care system

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

Julie Rovner: Washington Monthly’s “The Doctor Will Not See You Now,” by Merrill Goozner.

Alice Miranda Ollstein: NPR’s “Despite Calls to Improve, Air Travel Is Still a Nightmare for Many With Disabilities,” by Joseph Shapiro and Allison Mollenkamp.

Rebecca Adams: KHN’s “Patients Went Into the Hospital for Care. After Testing Positive There for Covid, Some Never Came Out,” by Christina Jewett.

Anna Edney: Bloomberg News’ “All Those 23andMe Spit Tests Were Part of a Bigger Plan,” by Kristen V Brown.

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And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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KHN’s ‘What the Health?’: The Politics of Vaccine Mandates

Like almost everything else associated with the covid-19 pandemic, partisans are taking sides over whether vaccines should be mandated. Meanwhile, Democrats on Capitol Hill are still struggling to find compromise in their effort to expand health insurance and other social programs. Alice Miranda Ollstein of Politico, Jen Haberkorn of the Los Angeles Times and Mary Ellen McIntire of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews best-selling author Beth Macy about her book “Dopesick,” and the new Hulu miniseries based on it.

Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

Should covid vaccines be mandated? The answer to that question has become predictably partisan, as with almost everything else associated with the pandemic. Even as the federal government prepares to issue rules requiring large employers to ensure their workers are vaccinated, GOP governors are trying to ban such mandates, leaving employers caught in the middle.

Meanwhile, on Capitol Hill, Democrats are still working to reach a consensus on a package of social-spending improvements, the size of which will depend largely on how much they can cut prices for prescription drugs.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Jen Haberkorn of the Los Angeles Times and Mary Ellen McIntire of CQ Roll Call.

Among the takeaways from this week’s episode:

  • Congressional Democrats’ struggle to find a compromise on a $3.5 trillion spending package for health and other social programs looks likely to push them past their self-imposed deadline of the end of October to pass a bill. Leaders are wrestling with what to cut as they meet demands from moderates in the party to bring the spending down.
  • Everything in that package appears vulnerable at this stage in the negotiations. Party leaders are considering a variety of strategies, including throwing out some proposals or setting up the new benefits over a shorter time frame to test whether they work and the public appreciates them.
  • It appears that Democrats’ priorities will include proposals to enhance benefits for children. But the health programs at stake — new benefits for Medicare, providing insurance to low-income residents of states that have not expanded their Medicaid programs, and extending the enhanced premium subsidies for the Affordable Care Act — each have strong constituencies and will be hard for leaders to settle on.
  • The proposal to add billions of dollars to long-term care programs may draw the short straw. However, it does have some strong allies in Congress, including Sens. Ron Wyden (D-Ore.) and Bob Casey (D-Pa.).
  • Democratic leaders hope to fund some of the initiatives in this package by cutting Medicare’s drug spending. A poll by KFF this week showed that is a very popular notion, even among Republicans. But drugmakers are fighting that strategy with major ad campaigns and political donations. They need to pick off only a couple of vulnerable lawmakers to thwart the effort since Democrats have razor-thin majorities in both the House and Senate. House Speaker Nancy Pelosi, however, appears determined to get some sort of provision on drug price negotiations in the bill, even without the full effect of her original plan.
  • The Department of Labor reportedly has sent a proposed rule requiring large employers to have their workforce vaccinated to the Office of Management and Budget for review. That means the rule could be coming soon. But it is bound to run headlong into opposition in conservative states, like Texas, where Republican Gov. Greg Abbott has banned mandates. The issue will likely end up in federal court.
  • The fight over vaccine mandates highlights a divide in the Republican Party between the business-oriented faction that wants to move past the pandemic and the more libertarian wing of the party. Some of the most conservative political leaders lean toward that libertarian wing and see the vaccine mandate as a way to excite the base. The experience of some major companies, however, suggests that businesses and many workers don’t object to mandates. One example is United Airlines, where 99% of workers have been vaccinated.
  • As the federal courts bat the Texas abortion law back and forth, it appears headed for a review by the Supreme Court. Some analysts suggest that the urgency of the issue could push the court to take on the Texas issue before they hear a case in December about a different law seeking to limit abortion in Mississippi. But the Supreme Court generally likes to have cases fully debated in lower courts before coming to the justices, so a decision on the Texas law may have to wait.
  • The issue of abortion is getting a good bit of advertising time in the Virginia gubernatorial race. Democratic candidate Terry McAuliffe is telling voters he will work to keep abortions legal in the state and suggesting his opponent, Glenn Youngkin, will not. It’s a strategy that California Gov. Gavin Newsom used as he successfully fought a recall in an election last month.

Also this week, Rovner interviews Beth Macy, author of the best-selling “Dopesick: Dealers, Doctors and the Drug Company That Addicted America” and an executive producer of a miniseries of the same name now streaming on Hulu.

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

Julie Rovner: KHN’s “6 Months to Live or Die: How Long Should an Alcoholic Liver Disease Patient Wait for a Transplant,” by Aneri Pattani

Jen Haberkorn: The Washington Post’s “Covid and Cancer: A Dangerous Combination, Especially for People of Color,” by Laurie McGinley

Mary Ellen McIntire: NPR’s “Judging ‘Sincerely Held’ Religious Belief Is Tricky for Employers Mandating Vaccines,” by Laurel Wamsley

Alice Miranda Ollstein: The 19th’s “Kansas Has Become a Beacon for Abortion Access. Next Year, That Could Disappear,” by Shefali Luthra

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