Category: Health

Sept. 7, 2022 – Pooja Mehta began having anxiety and hearing voices when she was 15 years old.

“I was fortunate to have incredibly supportive parents who insisted that I get professional help. I was very much against the idea, but I listened to them,” says Mehta, who lives in Washington, DC. She was diagnosed with anxiety disorder with auditory hallucinations.

But her parents had a lot of concern about how her diagnosis would be received by others.

“I grew up in a South Asian community, and my parents made it very clear that information about my mental illness would not be received well in the community and I shouldn’t tell anyone,” she says.

Beyond a few household members and friends, Mehta, who’s now 27, didn’t share her diagnosis.

She understands that her parents’ advice was for her own protection. But, she says, “I internalized it as self-stigmatization and felt that mental illness is something to be ashamed of, which led me to be very disengaged in my care and to try to convince myself that nothing was wrong. If a patient is not engaged with their therapy or health care treatment, it won’t work very well.”

When Mehta started college, she had a panic attack. She told her closest friend in the dorm. The friend told college authorities, who asked Mehta to leave because they saw her as a danger to herself and others.

“The first time I really told my whole story to people other than the intimate few at home was to a bunch of college administrators at a meeting where I was forced to defend my right to stay on campus and complete my education,” she says, describing the meeting as an “incredibly hostile experience.”

She and the administrators reached a “deal,” where she was allowed to remain enrolled academically but not live on campus. She moved back to her family’s home and commuted to classes.

This experience motivated Mehta to begin speaking out about stigma in mental illness and openly telling her story. Today, she has a master’s degree in public health and is completing a congressional fellowship in health policy.

Mehta has shared her story in a new book, You Are Not Alone: The NAMI Guide to Navigating Mental Health – With Advice from Experts and Wisdom from Real Individuals and Families, by Ken Duckworth, MD, chief medical officer of the National Alliance on Mental Illness.

Mehta is one of 130 people who shared first-person accounts of their struggles with mental illness in the book, as a way of challenging the stigma that surrounds the illness and educating the public about what it feels like to have mental health challenges.

Stark Difference

Duckworth says he was inspired to write the book after his own family’s experience with mental illness. His father had bipolar disorder, but there was no “social permission” or permission within the family to talk about his father’s condition, which was shrouded in secrecy and shame, he says.

When Duckworth was in second grade, his father lost his job after a manic episode and his family moved from Philadelphia to Michigan. He remembers the police dragging his father from the house.

“Something that could move an entire family hundreds of miles must be the most powerful force in the world, but no one was willing to talk about it,” he says he thought at the time.

Wanting to understand his father led Duckworth to become a psychiatrist and learn practical tools to help people who have mental illness.

When Duckworth was a resident, he had cancer.

“I was treated like a hero, he says. When I got home, people brought casseroles. But when my dad was admitted to the hospital for mental illness, there was no cheering and no casseroles. It was such a stark difference. Like me, my dad had a life-threatening illness that was not his fault, but society treated us differently. I was motivated to ask, ‘How can we do better?’”

His passion to answer that question ultimately led him to become the chief medical officer of the alliance and start writing the book.

“This is the book my family and I needed,” he says.

COVID-19’s ‘Silver Lining’

According to the National Alliance on Mental Illness, an estimated 52.9 million people – about one-fifth of all U.S. adults – had a mental illness in 2020. Mental illness affected 1 in 6 young people , with 50% of lifetime mental illnesses beginning before age 14.

Since the COVID-19 pandemic, mental health has worsened, both in the U.S. and worldwide, Duckworth says. But a “silver lining” is that the pandemic “changed mental illness from a ‘they’ problem into a ‘we’ problem. So many people have suffered or are suffering from mental illness that discussions about it have become normalized and stigma reduced. People are now interested in this topic as never before.”

For this reason, he says, “this is a book whose time has come.”

The book covers a wide range of topics, including diagnoses, navigating the U.S. health care system, insurance questions, how to best help loved ones with mental illness, practical guidance about dealing with a range of mental health conditions, substance abuse that happens along with mental illness, how to handle the death of a loved one by suicide, how to help family members who don’t believe they need help, how to help kids, the impact of trauma, and how to become an advocate. It includes advice from renowned clinical experts, practitioners, and scientists.

Among the “experts” included in the book are the 130 people with mental illness who shared their stories. Duckworth explains that people who live with mental illness have unique expertise that comes from experiencing it firsthand and differs from the expertise that scientists and health professionals bring to the table.

Telling Their Story

Mehta became involved with National Alliance on Mental Illness shortly after her confrontation with the administrators at the university.

“This event prompted me to start a NAMI chapter at college, and it became one of the biggest student organizations on campus,” she says. Today, Mehta serves on the national organization’s board of directors.

She encourages people with mental illness to tell their story, noting that the alliance and several other organizations can “give space to share in a safe and welcoming environment – not because you feel forced or pressured, but because it’s something you want to do if and when you feel ready.”

Duckworth hopes the book will provide useful information and inspire people with mental illness to realize they’re not alone.

“We want readers to know there is a vast community out there struggling with the same issues and to know there are resources and guidance available,” he says.

When the government made school meals temporarily free to virtually all public school students in 2020, the intent was to buffer children and families from the spike in hunger and economic hardship caused by the pandemic. It also inadvertently turned out to be a pilot project for something anti-hunger groups had been pushing for years: making school food free, permanently, for all public school students, regardless of income.

Once free meals were in place, albeit temporarily, many advocates thought that they would at least remain that way for the rest of the pandemic—if not longer. That didn’t turn out to be the case; this spring, Republicans blocked an extension of the waivers that allowed schools to serve free meals to all, which made the prospect of legislation establishing universal school meals remote.

This fall, schools are once again charging for lunch and breakfast, and people who run school food programs are back to the familiar scramble to get students signed up for free and reduced-price meals — and to the familiar worry that some kids will feel stigmatized for getting free meals, end up in lunch debt or go hungry.

Those arguing for universal free meals say that it would put an end to that stigma and to administrative hurdles that can prevent parents from signing their kids up.

While advocates say Republican opposition to expanding school feeding programs is daunting, they haven’t given up on the idea of making school meals free for all. Instead, they’re trying to keep the momentum going by backing state-level efforts that could eventually lay the groundwork for federal action.

States move to free school meals for all kids

This year, California, Maine, Vermont, Massachusetts and Nevada will offer free meals to all public school students, regardless of their family’s income. Connecticut has also funded free meals for part of this year, and Colorado voters will decide in November whether to make school meals free to all. Universal meals legislation has been introduced in a number of other states, including Minnesota, Wisconsin, New York, Maryland and North Carolina.

A state-by-state approach isn’t ideal, says Clarissa Hayes, deputy director of school and out-of-school time programs at the Food Research & Action Center, but it’s still an important step — one that never would have happened if the pandemic hadn’t hit.

“It really moved the needle,” she says. “We are excited to see what’s happening in the states, and in most cases, it is a bipartisan effort and there are a lot of partners at the table.”

But whether action at the state level will translate into more support for federal universal school meals legislation is unclear, says Katie Wilson, the executive director of the Urban School Food Alliance. “You can roll the dice,” she says.

While state initiatives could help popularize the idea of universal meals, they could also give federal lawmakers cover to argue that the question of whether to make meals universally free is best left to state legislatures, she says. That would sell kids short, Wilson says, noting that children’s access to healthy food should not depend on their zip codes.

No matter how much support universal school meals have at the state level, Republican opposition in Congress is formidable, she says.

“Right now, there is just not the desire to do universal school meals at a national level from one side of the aisle,” she says. “So how do you change that? We don’t know. We’ve been trying for decades.”

Federal lawmakers will likely hear from constituents upset that kids’ access to school meals has been curtailed at a time when so many families continue to struggle with food insecurity, and high food and fuel prices, says Diane Pratt-Heavner, director of media relations at the School Nutrition Association.

But she says that passing universal meals legislation, of the sort that Sen. Bernie Sanders, Rep. Ilhan Omar and other Democrats have introduced in recent years, is going to be “an uphill climb.”

Another workaround to help hungry kids

Pratt-Heavner and other advocates point to an upcoming opportunity to increase kids’ access to free school meals in a less sweeping, but still significant way — the child nutrition reauthorization process. Every five years, Congress is required to reauthorize school feeding programs, and it’s a critical chance to strengthen them, advocates say.

Congress is overdue to reauthorize the program, but there was finally some movement in July when House Committee on Education and Labor Chairman Bobby Scott, a Virginia Democrat, introduced a childhood nutrition reauthorization bill that was praised by anti-hunger advocates.

The bill, if enacted as written, would alter the rules governing the Community Eligibility Provision. In its current form, the provision allows schools where at least 40% of students are “directly certified” — that is, enrolled in federal safety net programs like SNAP or TANF or are in the foster care system — to offer free meals to all students at the school, regardless of need.

In the 2021-22 school year, 33,300 schools serving 16.2 million children used the provision, according to a USDA spokesperson — that’s nearly a third of the nation’s 49.5 million public school students.

But advocates say that the program isn’t reaching as far as it could. That’s because under the current rules, schools that have between 40% and 62.5% of their students directly certified still have to pay for a portion of the meals they serve, which not all schools or districts can afford or want to do. It’s only when 62.5% or more of the student body is directly certified that the federal government pays the entire amount.

The Scott bill would change reimbursement rates so that schools would only have to have 40% directly certified students to be fully reimbursed for all meals served. And it would allow schools or districts in which 25% of students are directly certified to participate in the program if they were willing to cover a portion of the cost.

Pratt-Heavner says the bill’s provisions would help many more schools in high poverty communities offer meals to all students. But she says that it still wouldn’t help the economically-stressed families who live in wealthier communities.

“At the end of the day, these meals are important to all students,” she says. “And that’s why it’s important to just offer meals to all students, without an application, just like we offer them textbooks and bus service.”

This story was produced by Ag Insider, a publication of the Food & Environment Reporting Network . FERN is an independent, nonprofit news organization, where Bridget Huber is a staff writer.

The passage of the Inflation Reduction Act (IRA) on August 12 affects the healthcare of millions of Americans. Provisions will change how certain drug prices get determined, limit out-of-pocket costs for older Americans, and could help ensure continued coverage for Medicaid beneficiaries when the COVID-19 Public Health Emergency ends.

Several provisions of the bill affect Medicare, but beneficiaries who take expensive prescription drugs are likely to feel the biggest impacts. Adults who depend on the American Rescue Plan’s expanded subsidies to afford individual coverage will also experience significant benefits. The bill doesn’t expand eligibility for subsidized individual coverage, so adults who don’t already qualify for reduced-price plans through state or federal marketplaces won’t be affected.

Still, for many Americans, the IRA could meaningfully improve their ability to afford the care they need. “Half of people report difficulty paying for their healthcare or having to make difficult decisions about paying for basic necessities versus prescription drugs or co-payments. That’s where this bill makes some incremental advances that are potentially quite important,” said Dr. Atul Grover, Executive Director of the Research and Action Institute at the Association of American Medical Colleges.

Here’s a breakdown of what the bill does for Medicare beneficiaries, adults who purchase private insurance coverage, and Medicaid enrollees.

For Medicare Beneficiaries

If you have high out-of-pocket prescription drug costs, you could end up paying less out of pocket. The IRA caps out-of-pocket spending on prescription drugs at $2,000 for all Medicare beneficiaries, regardless of income, starting in 2025. This “will probably be one of the more impactful” provisions of the bill, according to Juliette Cubanski, Deputy Director of the Program at Medicare Policy at KFF, a nonpartisan source of health policy analysis. In 2020, 1.4 million Medicare beneficiaries racked up more than $2,000 in out-of-pocket prescription drug spending, according to a KFF report. “Not having an out-of-pocket spending cap potentially exposes people to thousands of dollars in prescription drug costs, especially if they need really high cost medications or have a lot of conditions that require prescription drugs to maintain health,” Cubanski added.

However, with more patients able to afford prescriptions and covering less of the cost, insurers could raise monthly insurance premiums to make up the difference. “Ratcheting that down to a $2,000 maximum provides a lot of help. But it’s going to mean higher premiums for Medicare Part D plans,” said Dr. Alan Sager, a Professor at Boston University School of Public Health’s Department of Health Law, Policy & Management.

If you take prescription drugs covered under Medicare Part D, you could experience savings on prescriptions. Starting in 2026, the federal government will be able to negotiate directly with drugmakers on prices for some prescription drugs covered under Medicare Part D that lack comparable or generic alternatives. The first 10 drugs will be announced in 2023, followed by 15 more drugs in both 2027 and 2028, and 20 more drugs in both 2029 and 2030. Because the drugs haven’t been announced yet, it’s difficult to say “with any level of precision” how many and which categories of patients could benefit from the negotiated prices, according to Cubanski. But negotiated pricing will likely apply to drugs taken by many beneficiaries or that account for significant Medicare spending, such as cancer, rheumatoid arthritis, and diabetes drugs, according to Cubanski.

Starting in 2028, the government will be able to negotiate prices on Part B drugs, which are typically administered by physicians at a doctor’s office or hospital outpatient facility, rather than picked up at a retail pharmacy. Chemotherapy drugs are one example.

If you take any prescription drugs, you could see more stable out-of-pocket prescription drug costs starting in 2024, when a new regulation will interfere with drugmakers’ ability to ramp up prices each year. Under the provision, drugmakers that raise prices faster than inflation will have to pay a rebate to Medicare. Drug price increases do translate into higher out-of-pocket spending for patients, so the rebate is intended to help prevent both of those things from happening. But the bill doesn’t regulate how drug manufacturers set prices for new drugs, which means “manufacturers still have the ability to launch drugs at whatever price they want,” Cubanski said.

If you take insulin, your monthly costs could be capped at $35. Compared to some other countries, patients in the U.S. are “paying 10 or 12 times as much” for insulin, according to Grover. The IRA addresses this with a $35 cap on monthly out-of-pocket insulin costs for all Medicare beneficiaries, starting in 2023. An analysis by KFF found that most Medicare beneficiaries are spending more than $35 on average per prescription.

However, “an important caveat” is that plans won’t be required to cover all insulin products, so some Medicare beneficiaries could end up paying more than $35 per month, according to Cubanski.

If you need vaccinations, your vaccines will be free. Some vaccines, including pneumonia and the flu, are already free under Medicare, but many are not. That will change in 2023, when all vaccinations covered under Medicare Part B will be available at no cost. “This provision will help millions of beneficiaries each year,” Cubanski said. “A lot of these vaccines aren’t super expensive, but when we’re talking about a population that lives on relatively modest income, even a modest out of pocket expense could be burdensome.” The shingles vaccine, for example, is recommended for everyone over age 50, but can cost $50 or more and requires two doses.

If you receive partial financial assistance for Part D coverage, your prescription co-payments will be lower. Currently, low-income Medicare beneficiaries who receive partial financial assistance for Part D coverage typically pay 15 percent coinsurance on prescriptions. But an IRA provision will reduce those copayments to “very modest” flat-dollar copayments of about $1 to $3 for generic drugs and no more than $10 for brand-name drugs, according to Cubanski.

For Adults Who Purchase Individual Coverage Through the Affordable Care Act

If you were eligible for expanded subsidies created by the American Rescue Plan, you could continue to qualify for those subsidies. The American Rescue Plan of March 2021 expanded subsidies created through the Affordable Care Act (ACA) for people who buy health insurance through state and federal marketplaces. The larger subsidies reduced monthly premiums for nearly 90 percent of enrollees, leading to a record 14.5 million people signing up for coverage during the 2022 Open Enrollment Period. With the IRA, those expanded subsidies have been extended for another three years.

According to Sager, the extension will be “vital to prevent returning to the ACA levels of subsidies, which were not big enough to enable many people to afford coverage.” Without the extension, approximately three million people could have lost their ability to afford insurance, and more than 10 million people would have seen their tax credits reduced or lost entirely.

For Medicaid Beneficiaries

You may qualify for a subsidized plan when the Public Health Emergency ends. Under the ongoing COVID-19 Public Health Emergency (in effect since January 31, 2020), states receiving extra Medicaid funding from the federal government are banned from disenrolling people from Medicaid coverage. This strategy has “been effective over the past two years” in keeping people insured, according to Grover. But when the Emergency ends, about 15 million Medicaid enrollees could lose coverage, including two million adults in states that have not expanded Medicaid access to include people in the 100-to-138 percent of poverty range. The IRA’s extension of expanded subsidies for plans available through state and federal marketplaces could help keep them insured through similarly low-cost plans.

The U.S. has reached an important milestone in the pandemic, according to federal health officials.

Going forward, COVID-19 could be treated more like the flu, with one annual shot offering year-long protection against severe illness for most people.

“Barring any new variant curve balls, for a large majority of Americans we are moving to a point where a single, annual COVID shot should provide a high degree of protection against serious illness all year,” said White House COVID response coordinator Ashish Jha at a press briefing Tuesday.

The federal government has started rolling out a new round of boosters for the fall — they are updated versions of the Moderna and Pfizer-BioNTech vaccines targeting both the original coronavirus and the two omicron subvariants that are currently causing most infections.

These vaccines could be tweaked again if new variants become dominant in the future, which is how the flu shot works. Every fall, people get a new flu vaccine designed to protect against whatever strains of the virus are likely to be circulating that season. The hope is the COVID boosters will act the same way.

Jha cautioned that older people and those with health problems that make them more vulnerable to severe disease may need to get boosted more often. But for most people Jha hopes this latest booster will be the last shot they need for at least another year.

Throughout the pandemic, SARS-CoV-2 has been incredibly unpredictable and has been evolving much faster than anyone expected, so officials say they will continue to monitor the virus closely and they are ready to reprogram the vaccines again if necessary.

“You’ve got to put the wild card of a way-out-of-left-field variant coming in,” said White House adviser Dr. Anthony Fauci, at the briefing. If that happens he says the recommendations may change. But, “if we continue to have an evolution sort of drifting along the BA.5 sublineage,” he says the annual shot should be able to cover whatever is out there as the dominant variant.

But there is still a lot of debate about just how much of an upgrade the new boosters will really be. Some infectious disease experts are not convinced the updated vaccines will be a game-changer, because they haven’t been tested enough to see how well they work.

“I think the risk here is that we are putting all our eggs in one basket,” Dr. Celine Gounder, a senior fellow at the Kaiser Family Foundation, told NPR. “We’re only focusing on boosting with vaccines. I think the issue is people are looking for a silver bullet. And boosters are not a silver bullet to COVID.”

Federal officials are concerned that a low number of people will sign up for the new boosters, following a low demand for the initial booster shots. According to the Centers for Disease Control and prevention only 34% of people over 50 have gotten their second booster.

So, as we head into the winter, the administration is urging everyone age 12 and older to get boosted right away to help protect themselves and the more vulnerable people around them. People have to wait at least two months since their last shot and should wait at least three months since their last infection.

But they can sign up to get a COVID booster at the same time as a flu shot.

Because Congress has balked at providing addition funding to fight the pandemic, the new boosters are likely to be the last COVID shots provided for free. People who have insurance will get them covered through their policies. The administration says it’s working to make sure those who are uninsured have access to future COVID-19 vaccinations.

The Federal Trade Commission is investigating Amazon’s $3.9 billion acquisition of primary care provider One Medical.

According to a filing with the Securities and Exchange Commission, One Medical parent 1Life Healthcare and Amazon both received requests from the FTC for more information regarding the deal on Sept. 2. The planned acquisition was first announced in late July.

In the filing, 1Life said both companies plan to “promptly respond to the second request and to continue to work cooperatively with the FTC in its review of the merger.” Amazon declined to comment. 

THE LARGER TREND

This isn’t the company’s only deal potentially being held up by the FTC. The regulator also reportedly began reviewing Amazon’s planned acquisition of robot vacuum maker iRobot late last week. The tech and retail giant last year had unsuccessfully petitioned to remove FTC Chair Lina Khan from antitrust probes into the company, citing her previous criticism of Amazon and other tech firms. 

In late August, Amazon revealed it would shut down its Amazon Care telehealth service geared toward employers. Neil Lindsay, senior vice president of Amazon Health Services, said in an internal memo it wasn’t “a complete enough offering for the large enterprise customers we have been targeting, and wasn’t going to work long-term.”

But Amazon still has a number of initiatives in the healthcare and health tech space. It launched Amazon Pharmacy after it purchased digital pharmacy PillPack several years ago. 

The company has also been utilizing its virtual assistant Alexa for senior care and assistance as part of its Alexa Together subscription service. Alexa is also available for senior living facilities and health systems. 

Amazon is also competing with Apple and Fitbit in the wearables space with its line of Halo fitness tracking devices. 

A study led by researchers from the Nanyang Technological University Singapore has revealed that individuals are more likely to accept preventive health interventions suggested by AI with the involvement of human health experts.

It also found lesser trust in AI-powered preventive care than in interventions led by human experts.

FINDINGS

The study has inquired into users’ perceptions of preventive health interventions, such as health screening and physical activity prompts, proposed by AI as compared to those recommended by humans. It involved about 15,000 participants in South Korea using an undisclosed mobile health application.

The first set of 9,000 participants was grouped into three: one group was given AI-recommended daily steps; another group received steps recommendations from human experts, and a third controlled group received a neutral intervention that mentioned neither AI nor a health expert.

It was found that almost one in five of those who received AI suggestions accepted the intervention while 22% of people in the second group accepted the recommendations from human experts.

Later, another set of participants was recruited with one group receiving an intervention that disclosed the use of AI in tandem with health experts and another group receiving an intervention that explained how AI came up with steps recommendations.

From this cohort, the researchers noted that individuals are more accepting of AI-suggested health interventions that are complemented by human experts than those interventions based on purely AI or humans. There is also a higher rate of trust in transparent AI-generated interventions.

WHY IT MATTERS

The study’s findings, which have been published in the journal Production and Operations Management, indicate that the human element remains important even as the health system moves to further adopt AI for screening, diagnosing, and treating patients.

“Our study shows that the affective human element, which is linked to emotions and attitudes, remains important even as health interventions are increasingly guided by AI, and that such technology works best when complementing humans rather than replacing them,” said Hyeokkoo Eric Kwon, an associate professor from the NTU Nanyang Business School who led the study.

THE LARGER TREND

Given the growing ubiquity of machine learning and AI in healthcare settings, it has become more crucial to design digital technology with the users in mind to ensure these become an integral part of care interventions. 

In a HIMSS forum late last year, Jai Nahar, a pediatric cardiologist at Children’s National Hospital in the US, said that “whenever we’re trying to roll out a productive solution that incorporates AI, [the patients should be involved] right from the designing stage of the product or service”. Clinicians too must also be included in this process, he added.

Meanwhile, another mobile health study in South Korea published earlier this year found that mobile health apps could moderate the effects of social determinants on the health of South Koreans. Based on a survey of over 1,000 participants, it was revealed that frequent use of mobile health technologies could ease the effects of SDOH, such as societal economic inequality, on a person’s capacity for self-health management and on the personal view of their health.