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An Arm and a Leg: Self-Defense 101: Keeping Your Cool While You Fight

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Dan Weissmann
Tue, 30 Jan 2024 10:00:00 +0000

Navigating the U.S. health care system can feel like a “battle royale.” From challenging unfair medical bills to wrestling with insurance companies over pre-authorizations, patients have to be ready to stick up for themselves. 

So, how can you stay cool and confident in these fights? In this rebroadcast of “An Arm and a Leg” from 2020, host Dan Weissmann hits up self-defense coach Lauren Taylor about strategies for standing up for yourself and hears how she applied her approach in her own fight for health care coverage.

Dan Weissmann


@danweissmann

Host and producer of “An Arm and a Leg.” Previously, Dan was a staff reporter for Marketplace and Chicago’s WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.

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Emily Pisacreta
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Adam Raymonda
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Ellen Weiss
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Transcript: Self-Defense 101: Keeping Your Cool While You Fight

Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Dan: Hey there – Before we start, I just want to say THANK YOU for supporting our work here. Thanks to you, we beat all of our goals for the end of 2023. 

That means we collected every dollar of matching funds that were on offer — and because so many folks became donors for the first time, we earned a bonus from the Institute for Nonprofit News. 

So we are starting this year in good shape, which is great, because we’ve got some big projects planned. 

Thank you so much.

Now, in less delightful news, I’m fighting a little bit with my insurance company right now. Or … is it the hospital billing office I’m fighting with? Each one keeps sending me back to the other. It’s … a good time.

There’s a First Aid Kit newsletter in all this, but for now I’m struggling to find the hours for all the phone calls, and to keep my composure. 

On that last note– keeping my composure —  this seems like a good time to bring back what may be the most useful episode we’ve ever done, from late 2020.

You ready? Here we go.

I got a voicemail from a listener named Amanda Jaffe. She’s been listening to our episodes about folks who fight back against insurance companies and outrageous bills. And she says she’s kind of a bulldog herself on this stuff. BUT she says there’s a snag. Maybe you can relate — I definitely can.

Amanda Jaffe: When I call the insurance companies, I start to get angry to a point where maybe it’s unproductive. So I need some guidance on how to remain cool when calling insurance companies. Thanks. I’d really need the help.

Dan: YES. I have been thinking about this for months and months. We’ve been hearing from people who fight and fight, and sometimes win, and a couple of things keep getting clearer:  

ONE: You’re probably gonna spend a LOT of time on the phone, a lot of it on hold, and a lot of it with people who, for one reason or another, are not gonna seem that helpful. 

And TWO, I keep hearing over and over again:  You’ve gotta keep your cool. OK, sure.

But I keep wondering again and again: OK, HOW?

And today, I think I’ve got exactly the person I’ve been looking for.

Lauren Taylor: My name is Lauren Taylor. I run Defend Yourself in Washington, DC, and we teach people skills for stopping harassment, abuse, and assault.

Dan: So for like a YEAR I’ve been describing this show as being focused on self-defense against the cost of health care. And Lauren is an actual self-defense teacher. Has been one for thirty-five years.

And it turns out self-defense — the way Lauren and her colleagues teach it —  is NOT just the hitting and the kicking. It’s defending yourself against all kinds of … encroachment. Street harassment. Creepy co-workers. Just standing up for yourself. You might’ve noticed, Lauren said her group teaches people skills for stopping harassment, abuse, and assault. 

And abuse …  I’m not sure that’s too strong a word for how the health-care industrial complex treats people. 

So, Lauren herself is just wrapping up an EPIC fight with her health insurance.  And she has been using self-defense skills all along the way. I’m not going into all the details. 

Lauren Taylor: There’s been so many things. I honestly can’t remember them all. 

Dan: But we talked through them– because she’s got ’em written down.

Lauren Taylor: This is also a self-defense thing, which is document, right?

Just like you would with a stalker or a workplace harasser or, uh, even uh, An abusive partner, is document everything because, you might need it 

Dan: You teach this in the class.

Lauren Taylor: Oh yeah.

Dan: I walk in, think I’m gonna learn how to need somebody in the nuts. And you’re like, “get a notebook.” I’m like, wow.

Lauren Taylor: People, people do walk in thinking they’re going to learn how to, , knee someone in the groin, and we do teach that. but I can’t tell you how often in evaluations people  tell us that they were completely blown away by all the other stuff that they learn, which is really about empowerment.

Dan: Yes. Yes, please. Let’s have some of that. 

This is An Arm and a Leg — a show about the cost of health care. I’m Dan Weissmann. I’m a reporter, and I like a challenge. So my job here is to take one of the most enraging, terrifying, depressing issues in American life– and YES, there’s a bunch of those, but I’m sticking with this one– and produce a show that’s entertaining, empowering, and useful.

And here we are.    

Here’s Lauren’s deal: It starts the early 1980s, 

Lauren Taylor: I had saved up money and I was gonna take some time and travel by myself. And a friend of mine told me about a self-defense class that she had taken. And I thought, “Oh, that’s a really good idea. I should probably do that if I’m going to travel by myself.”   

Dan: She says it changed her life. Like, as a teenager, she’d dealt with a LOT of street harassment. She figured, man, that’s just how it goes.

Lauren Taylor: And I had always thought that if anybody tried to rape me, there would be nothing I could do because by definition they would be bigger and stronger than me. 

And the real life-changing piece of the self-defense class was realizing that that was wrong. It was realizing that I had power and that I could hurt somebody who was trying to hurt me. 

Dan: How did that feel?   

Lauren Taylor: It’s, it’s totally life changing. I mean, even now,  like, just tell it to you. I still feel like a rush of energy through my body saying it.

Dan: It’s thrilling. It’s like, holy shit! I’m not helpless

Lauren Taylor: Yeah. I can protect myself. Yeah. And I have power and, and . A big piece of it also is I have permission to do this and I deserve to be protected.I deserve to be able to defend myself. 

And all of those are not messages that, you know, most of us get growing up still. And certainly not when I was growing up. So, it’s kind of like, caught the fever and then wanted to spread the gospel of self-defense. 

Dan: So, she’s been teaching self-defense since 1985.

I asked her: So, how did it change your life– beyond the fact that you started teaching it? Like, what did you do differently?

She says for starters, she did take that trip, and there was a night or two that didn’t go according to plan: Her place to crash fell through, she was out late, lost, a little scared. And she took out a pen, so in case she needed to hurt somebody, she’d have a pen to hurt them with. She did NOT have to use it, but having a plan helped her keep cool.

But that wasn’t the big stuff. The big stuff was standing up for herself in other ways. Like when her boss in a full-time volunteer gig started sexually harassing her.  

Lauren Taylor: Whereas before I would have liked, you know, suffered and wrung my hands and journaled about it and called 12 friends and, thought maybe there was something wrong with me  and you know, all of those things I didn’t do, I was just like, Really no, don’t do this.

Dan: And then what happened?

Lauren Taylor: Ge pretty much cut it out. 

Dan: YEAH. And then there was her mom. Who did NOT deal well with Lauren being gay. It was painful. And then there was the final straw:  

Lauren Taylor: We had a large family reunion and She didn’t invite my partner and she invited my siblings partners.

Jesus, ouch. They’d had a lot of conversations. Now Lauren set a hard boundary. She put it in writing to her mom: 

Lauren Taylor: There are some basic things I need from you, or I’m not going to be able to stay in contact with you. Right. So, if there’s a family event, My partner gets invited , that’s self-defense 

Dan: That first self-defense class Lauren took had not covered Dealing With Difficult Family Members, but Lauren says she’d gotten the message:

Lauren Taylor: It was okay. to require certain kinds of respect from people.  it was okay to be who I was, that wasn’t my fault that people treated me as less than all of that kind of stuff.

Dan: And by the way, Lauren says the classes she leads now,  they DO cover all that kind of stuff.

In other words, self-defense covers a LOT of territory. The big idea: If you’re in a tough spot, you want some options. 

Lauren says she gives students a five-part framework– five kinds of options. 

They are:  Run, yell, hit, tell, and go along. 

And they’re not all literal. Like, RUN is …

Lauren Taylor: Leave walk away. Don’t show up for the appointment, break up with the person, anything that makes you not there. 

Dan: And she says by YELL, she means: Use your voice.

Lauren Taylor: Assertiveness or deescalation or negotiation, or, you know, that’s not okay with me or don’t come any closer or, you know, I won’t come to family events if you don’t invite my partner. Right.

Dan: “Yell” covers a lot of territory there.

Lauren Taylor: Everything with your words pretty much. 

Dan: Everything with words you use with the other person. Because there’s also TELL. Which she says mean — also really broadly — get help.

Lauren Taylor: It can be getting help in the moment. uh, this person is bothering me. Can I stand with you? And then there’s, longer-term getting help going to HR, going to a hotline, , talking to a lawyer, 

Dan: Posting to social media.

Lauren Taylor: Posting it. Right. exactly. 

Dan: Hit is — well, it’s actually hitting. They practice that too.

And then there’s the last one: Go along. 

Lauren Taylor: We want people to know that that’s an option, right? We’re not saying. Always resist. We’re saying resistance is successful way more than you’ve been told and way more than you believe. 

But there are times when, going along, is the smartest and safest thing for you to do. And for example, if someone’s trying to take your property, right, if it’s a mugging, And you want to get out of there, unharmed, the smartest and safest thing to do is to give them your property. 

Dan: Yeah. I think you can probably see the broad outlines of how this could apply to wrangling with your insurance company or fighting unfair medical bills. I mean, talk about a mugging.  

It definitely reminds me of something I said when we started this self-defense series:  We’re not gonna win ’em all. We just don’t have to lose them all either. 

So, that’s Lauren’s framework.

Next: Let’s learn some SPECIFIC techniques and how we can start applying them. That’s right after this.

This episode of An Arm and a Leg is produced in partnership with KFF Health News. That’s a non-profit newsroom covering health care in America. Their work is terrific, wins all kinds of awards every year. I am so proud to work with them.

OK. How to actually USE self-defense techniques with medical bills and insurance BS.

We’ll start with an example from Lauren’s epic health-insurance fight this year. We’re not gonna get into the story– it’s too long, too weird, and it’s not even really over. BUT we will zoom in on a moment when Lauren’s on the phone and the other person opens by throwing up a roadblock, saying, YOU probably did something wrong.   

I’m like, Argh, I’m already angry. What do you do now? And Lauren’s like, “I stayed on my agenda.” 

STAYING ON YOUR AGENDA. This is a whole self-defense thing. Lauren walks me through it: 

Lauren Taylor: Here’s the process. Okay. Something’s happening. You know, like somebody is harassing you on the street or whatever …

Dan: Or you’re calling your insurance, and the other person is being REALLY unhelpful.

She says you ask yourself three questions, in this order: First, how am I feeling? It’s probably not pleasant. 

Lauren Taylor: I’m terrified. I’m angry, I’m upset. I want to cry. I feel humiliated. 

Dan: Good times. That’s the first question: How am I feeling?   

Second: What do I need? Which is more big-picture: Need to get a safe distance, need respect.  

Third, what do I WANT? This is more specific– what do you want from the other person:  

Lauren Taylor: I want you to take your hands off me. I want you to take three steps back. I want you to knock before you come in my office. I want you to stop making racist jokes. whatever it is, you turn it into what I want you to sentence, and that is your agenda. What you want to happen is your agenda.

So. Then when they do whatever people who are misusing power do, which is often. Guilt trip you or trying to manipulate you or blame you like, well, why   were you there? Why were you wearing that? Why did you get drunk? Um, it’s just a joke. Um, why wouldn’t have said it, if you hadn’t blah, blah, blah, or why you being such a bitch?

Um, you know, all of those things are to get you into their web of conversation and off of your agenda and you stay on your agenda. So if I say to you,  don’t ask me about my personal life while we’re at work. And you’re like, Oh Lauren, you’re so sensitive. 

Dan: Yeah, I’m changing the subject. Suddenly, we’re not talking about what you want. We’re talking about my perception of you. And you may have a pretty strong impulse to address that– Like, “Oh, geez, am I?” Or, “I AM NOT”  

Lauren Taylor: But instead I’m just going to say again, “Listen, Dan, I asked you. I only want to talk about work at work. And I really don’t like answering personal questions at work. So please stop asking me.” That’s staying on your agenda.

Dan: And so how did that happen in these phone calls?

Lauren Taylor: I just kept saying what I needed or. I would keep saying  so what’s the next step? What can we do from here? 

So for instance, Lauren played out a long, long set of calls with her health insurance company AND the state office that administers the Obamacare exchange in Maryland, where she lives. 

Whenever they hit an impasse, she asked, “What is the next step?” Eventually, the next step was: file an   appeal through the state attorney general’s office. Lauren called, and the first person to pick up the phone did not have a super-encouraging opening line. 

Lauren Taylor: She was like, well, I’m sure you missed a deadline. And, um, instead of saying, I didn’t miss any deadlines because then we’re into her conversation.

I said, so please tell me more about how to appeal. Right? Because  you know, she probably talks to a hundred people a day and, you know, people make all kinds of mistakes and you know, it’s a big headache to her, I’m sure. 

Dan: So Lauren didn’t take the bait. She stayed on her agenda… AND AFTER A WHILE, ONCE THE APPEAL WAS REALLY IN MOTION, Lauren noticed the same woman– who was now calling LAUREN with updates, sometimes more than once a day–  was singing a different tune. Well, definitely some new words.

Lauren Taylor: She was using we language.

Dan: That’s what we like. Yeah, 

Lauren Taylor: right.  So I was like, Oh, this is going very well. she was like, “we just need to figure this thing out and then we’ll let them know.”

“WE” language. 

OK, this is great. 

AND it’s like:  Wait, how do I actually do this?  Like, in the moment?  Like, here’s Amanda’s question again:

Amanda Jaffe:  I start to get angry to a point where maybe it’s unproductive. So I need some guidance how to remain cool when calling insurance companies. 

Dan: YEAH. Me too! Me too. 

And Lauren reframed it. She was like: OK, getting angry, that’s not a problem, not a mistake. It’s a feeling that you’re having. And it’s a really reasonable feeling to have.

And she says Amanda’s nailing it in saying:  those feelings probably aren’t gonna be super-helpful IN this conversation. 

So, you want a strategy. An agenda. A plan. 

Lauren Taylor: If you can ground yourself in the fact that you’re strategy is to remain calm and confident while still being very assertive and persistent.  that is a strategy, it doesn’t mean that you have to feel great about what’s happening. or that you aren’t upset the way that people are treating you.  it just means that as a strategy, you are choosing to use this persona, this common, confident, assertive, persistent persona to try and get what you need.

Dan: So, yeah: You’re gonna be mad. That’s gonna happen. You just don’t wanna act out those feelings in the conversation. So here’s the actual ADVICE part: You take those feelings and… 

Lauren Taylor: Do them somewhere else. You, you know, go for a walk and pound the pavement. You vent to a friend. Um, if you have a car, you roll up the windows and drive on a highway and scream. Um, you find, you know, you find a place that’s probably not alcohol or ice cream too.

Um, To process those feelings because you don’t want them just hanging out in you either. That’s not good for you either. 

Dan: Which is to say: It may be smart to have a plan GOING INTO the conversation about how you’re deal with those feelings afterwards. Maybe even make a plan with somebody else.  You know… 

Lauren Taylor: Call a friend or a family member who’s in your house and say, I’m going to get on the phone with the health insurance company, and we’re going to call you afterwards and vent. Right. And then, you know, I have a place for these feelings. It’s not that I’m squashing

Dan: Right.

Lauren Taylor: There’s a time for that  too. 

Dan: I love that.  But meanwhile, here I am IN the conversation, and things are getting hairy, and I’m HAVING A LOT OF FEELINGS ABOUT IT. 

Not so calm, not so confident, NOT SO CALM. 

Lauren’s like: Right. Got you covered. You want to find a technique that helps you quickly get calm and grounded in the moment. She says paying attention to her breathing is her go-to, but 

Lauren Taylor: My way of doing it may not work for you or her or somebody else. People have to find what works for them to stay calm and grounded. So just a few ideas. It can be, um, breathing. It can be feeling your feet on the floor. Those are my top two, but it also can be, you know, some people saying a quick prayer helps them.

Dan: She’s got more: 

Lauren Taylor: It can be, orienting yourself to the room. Like, what are five things I can see or can I find three blue things? And then what’s one thing I can hear. What’s the one thing I can feel, those orienting things that keep you very much in the present moment and also let you know, like, this may be incredibly upsetting, but right now I’m actually okay. Right now in this moment, I’m actually okay. You know, I’m maybe scared about losing my health insurance. I may be scared about where the money’s going to come from.  But if you can say to yourself, like, Oh right now, I’m sitting in a room in my apartment and, um, you know, My loved ones are around me or my pets are around me, or I have a plan for dinner or I’m going to call a friend right now I’m okay. So there’s lots of ways to get present. and I think that getting present is what can help this woman and everybody else.

Dan: What I hear you talking about … Like when you say: “get into the present,” it’s like, I’m moving my attention. I’m moving my attention from this feeling that I’m having that wants to take up my entire field of attention. And I’m kind of like reminding myself that there are other things to give my attention to. And now that I know that I can give my attention to my strategy

I think one thing that really strikes me about what you’re saying  is … it’s kind of reframing   the question. I start to get angry to a point where maybe it’s unproductive and I think the way that’s framed, is how do I not have the feeling? That’s how I’m reading the questions. The problem is I get angry. And what I’m hearing you say is like, not a problem.

Lauren Taylor: Not a problem

Dan: You’re getting angry.

Lauren Taylor: There are really good reasons to be angry

Dan: YES! For sure. So what you want isn’t to avoid getting angry– it’s just to avoid getting out of control. You probably ARE going to get mad. So you want to plan for it.

And to review, Lauren’s top two tips are:

One: Have a plan for what you’re gonna do with that anger AFTER the call. How are you going to deal with it? 

And two: Have a couple of favorite hacks for quickly re-focusing your attention. To your breath, some other sensation, whatever clicks for you.  

You’re probably gonna want to WRITE down those tricks, practice them, before you get on the phone. 

I really love this. And talking to Lauren, I realized:  Being on the phone with the insurance company– or the medical-billing office or whoever else in the medical-industrial complex you’re talking with– we’ve got advantages we don’t have in some other self-defense situations:  

One: You’re not in the same physical space with that other person. They can’t see you scrunch up your face, or gently rub your heart, or pet the cat, or silently count to ten while they’re talking.  

Which is different from being face-to-face with somebody who could hurt you– physically or emotionally.

And two: You don’t have an ongoing relationship with this particular person. It’s not like telling your mom that you need her to invite your partner to family gatherings. Or telling your colleague to stop making racist jokes. Those are relationships that are going to keep affecting you. And probably keep affecting other relationships. 

Here, you’re like, WHATEVER, anonymous insurance-company person. Which doesn’t mean you can act like a jerk to them– that’s not going to help you. But you do have an escape hatch. If you really can’t take it any more without losing your cool… you can hang up and call back later, when you’re ready, and tell the next person, GEE, I got disconnected before. 

I tell Lauren this, and she’s like

Lauren Taylor: Yeah, I was definitely thinking, you know, you can, if you have, if you’re too filled up with feeling to be doing something that feels useful, you can absolutely say, you know, I can talk about this anymore. I’ll call, call back another time.

Dan: Oh yeah. Right. You don’t have to like fake, dropping the call. You can just say like, wow. I think I need to, I need some time to digest this. , I’d like to call

Lauren Taylor: I’ll call back later.

Dan: YES. I’ll call back later. That’s where we left things with Lauren Taylor in the fall of 2020, and it’s all still super-relevant — as I can attest right now, with my back-and-forth calls to the hospital and the insurance company.

One update: Since we talked, Lauren Taylor has published a book! 

Get Empowered: A Practical Guide to Thrive, Heal, and Embrace Your Confidence in a Sexist World was published in October 2023, and — although the title suggests that the book targets folks with one X chromosome more than I happen to have — I am looking forward to reading it.  

We condensed some of Lauren’s advice into a First Aid Kit newsletter last year — along with related tips from other superstars.  We’ll put a link in the show notes — you should be able to find it wherever you’re listening, and you can sign up for any of our newsletters at arm and a leg show dot com, slash, newsletter.

We will be back in three weeks.  

Till then, take care of yourself.

This episode of An Arm and a Leg was produced by me, Dan Weissmann, edited in 2020 by Marian Wang, and for this re-release by Ellen Weiss. 

Emily Pisacreta is our senior producer. Adam Raymonda is our audio wizard.

Gabrielle Healy is our managing editor for audience — she edits the First Aid Kit newsletter.

Sarah Ballema is our operations manager. Bea Bosco is our consulting director of operations.

An Arm and a Leg is produced in partnership with KFF Health News. 

That’s a national newsroom producing in-depth journalism about health care in America, and a core program at KFF — an independent source of health policy research, polling, and journalism. 

You can learn more about KFF Health News at arm and a leg show dot com, slash KFF. 

Zach Dyer is senior audio producer at KFF Health News. He is editorial liaison to this show. 

Thanks to the INSTITUTE FOR NONPROFIT NEWS for serving as our fiscal sponsor, allowing us to accept tax-exempt donations. You can learn more about INN at I-N-N dot org. 

And thanks to everybody who supports this show financially.  I am about to shout out FIFTY people who donated in the last dozen days of 2023. You ready?

Thanks this time to… [names redacted].

Thank you so much!

“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and X, formerly known as Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

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And subscribe to “An Arm and a Leg” 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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By: Dan Weissmann
Title: An Arm and a Leg: Self-Defense 101: Keeping Your Cool While You Fight
Sourced From: kffhealthnews.org/news/podcast/self-defense-101-keeping-your-cool-while-you-fight/
Published Date: Tue, 30 Jan 2024 10:00:00 +0000

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Kaiser Health News

US Judge Names Receiver To Take Over California Prisons’ Mental Health Program

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kffhealthnews.org – Don Thompson – 2025-03-20 12:46:00

SACRAMENTO, Calif. — A judge has initiated a federal court takeover of California’s troubled prison mental health system by naming the former head of the Federal Bureau of Prisons to serve as receiver, giving her four months to craft a plan to provide adequate care for tens of thousands of prisoners with serious mental illness.

Senior U.S. District Judge Kimberly Mueller issued her order March 19, identifying Colette Peters as the nominated receiver. Peters, who was Oregon’s first female corrections director and known as a reformer, ran the scandal-plagued federal prison system for 30 months until President Donald Trump took office in January. During her tenure, she closed a women’s prison in Dublin, east of Oakland, that had become known as the “rape club.”

Michael Bien, who represents prisoners with mental illness in the long-running prison lawsuit, said Peters is a good choice. Bien said Peters’ time in Oregon and Washington, D.C., showed that she “kind of buys into the fact that there are things we can do better in the American system.”

“We took strong objection to many things that happened under her tenure at the BOP, but I do think that this is a different job and she’s capable of doing it,” said Bien, whose firm also represents women who were housed at the shuttered federal women’s prison.

California corrections officials called Peters “highly qualified” in a statement, while Gov. Gavin Newsom’s office did not immediately comment. Mueller gave the parties until March 28 to show cause why Peters should not be appointed.

Peters is not talking to the media at this time, Bien said. The judge said Peters is to be paid $400,000 a year, prorated for the four-month period.

About 34,000 people incarcerated in California prisons have been diagnosed with serious mental illnesses, representing more than a third of California’s prison population, who face harm because of the state’s noncompliance, Mueller said.

Appointing a receiver is a rare step taken when federal judges feel they have exhausted other options. A receiver took control of Alabama’s correctional system in 1976, and they have otherwise been used to govern prisons and jails only about a dozen times, mostly to combat poor conditions caused by overcrowding. Attorneys representing inmates in Arizona have asked a judge to take over prison health care there.

Mueller’s appointment of a receiver comes nearly 20 years after a different federal judge seized control of California’s prison medical system and installed a receiver, currently J. Clark Kelso, with broad powers to hire, fire, and spend the state’s money.

California officials initially said in August that they would not oppose a receivership for the mental health program provided that the receiver was also Kelso, saying then that federal control “has successfully transformed medical care” in California prisons. But Kelso withdrew from consideration in September, as did two subsequent candidates. Kelso said he could not act “zealously and with fidelity as receiver in both cases.”

Both cases have been running for so long that they are now overseen by a second generation of judges. The original federal judges, in a legal battle that reached the U.S. Supreme Court, more than a decade ago forced California to significantly reduce prison crowding in a bid to improve medical and mental health care for incarcerated people.

State officials in court filings defended their improvements over the decades. Prisoners’ attorneys countered that treatment remains poor, as evidenced in part by the system’s record-high suicide rate, topping 31 suicides per 100,000 prisoners, nearly double that in federal prisons.

“More than a quarter of the 30 class-members who died by suicide in 2023 received inadequate care because of understaffing,” prisoners’ attorneys wrote in January, citing the prison system’s own analysis. One prisoner did not receive mental health appointments for seven months “before he hanged himself with a bedsheet.”

They argued that the November passage of a ballot measure increasing criminal penalties for some drug and theft crimes is likely to increase the prison population and worsen staffing shortages.

California officials argued in January that Mueller isn’t legally justified in appointing a receiver because “progress has been slow at times but it has not stalled.”

Mueller has countered that she had no choice but to appoint an outside professional to run the prisons’ mental health program, given officials’ intransigence even after she held top officials in contempt of court and levied fines topping $110 million in June. Those extreme actions, she said, only triggered more delays.

The 9th U.S. Circuit Court of Appeals on March 19 upheld Mueller’s contempt ruling but said she didn’t sufficiently justify calculating the fines by doubling the state’s monthly salary savings from understaffing prisons. It upheld the fines to the extent that they reflect the state’s actual salary savings but sent the case back to Mueller to justify any higher penalty.

Mueller had been set to begin additional civil contempt proceedings against state officials for their failure to meet two other court requirements: adequately staffing the prison system’s psychiatric inpatient program and improving suicide prevention measures. Those could bring additional fines topping tens of millions of dollars.

But she said her initial contempt order has not had the intended effect of compelling compliance. Mueller wrote as far back as July that additional contempt rulings would also be likely to be ineffective as state officials continued to appeal and seek delays, leading “to even more unending litigation, litigation, litigation.”

She went on to foreshadow her latest order naming a receiver in a preliminary order: “There is one step the court has taken great pains to avoid. But at this point,” Mueller wrote, “the court concludes the only way to achieve full compliance in this action is for the court to appoint its own receiver.”

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

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Amid Plummeting Diversity at Medical Schools, a Warning of DEI Crackdown’s ‘Chilling Effect’

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kffhealthnews.org – Annie Sciacca – 2025-03-20 04:00:00

The Trump administration’s crackdown on DEI programs could exacerbate an unexpectedly steep drop in diversity among medical school students, even in states like California, where public universities have been navigating bans on affirmative action for decades. Education and health experts warn that, ultimately, this could harm patient care.

Since taking office, President Donald Trump has issued a handful of executive orders aimed at terminating all diversity, equity, and inclusion, or DEI, initiatives in federally funded programs. And in his March 4 address to Congress, he described the Supreme Court’s 2023 decision banning the consideration of race in college and university admissions as “brave and very powerful.”

Last month, the Education Department’s Office for Civil Rights — which lost about 50% of its staff in mid-March — directed schools, including postsecondary institutions, to end race-based programs or risk losing federal funding. The “Dear Colleague” letter cited the Supreme Court’s decision.

Paulette Granberry Russell, president and CEO of the National Association of Diversity Officers in Higher Education, said that “every utterance of ‘diversity’ is now being viewed as a violation or considered unlawful or illegal.” Her organization filed a lawsuit challenging Trump’s anti-DEI executive orders.

While California and eight other states — Arizona, Florida, Idaho, Michigan, Nebraska, New Hampshire, Oklahoma, and Washington — had already implemented bans of varying degrees on race-based admissions policies well before the Supreme Court decision, schools bolstered diversity in their ranks with equity initiatives such as targeted scholarships, trainings, and recruitment programs.

But the court’s decision and the subsequent state-level backlash — 29 states have since introduced bills to curb diversity initiatives, according to data published by the Chronicle of Higher Education — have tamped down these efforts and led to the recent declines in diversity numbers, education experts said.

After the Supreme Court’s ruling, the numbers of Black and Hispanic medical school enrollees fell by double-digit percentages in the 2024-25 school year compared with the previous year, according to the Association of American Medical Colleges. Black enrollees declined 11.6%, while the number of new students of Hispanic origin fell 10.8%. The decline in enrollment of American Indian or Alaska Native students was even more dramatic, at 22.1%. New Native Hawaiian or other Pacific Islander enrollment declined 4.3%.

“We knew this would happen,” said Norma Poll-Hunter, AAMC’s senior director of workforce diversity. “But it was double digits — much larger than what we anticipated.”

The fear among educators is the numbers will decline even more under the new administration.

At the end of February, the Education Department launched an online portal encouraging people to “report illegal discriminatory practices at institutions of learning,” stating that students should have “learning free of divisive ideologies and indoctrination.” The agency later issued a “Frequently Asked Questions” document about its new policies, clarifying that it was acceptable to observe events like Black History Month but warning schools that they “must consider whether any school programming discourages members of all races from attending.”

“It definitely has a chilling effect,” Poll-Hunter said. “There is a lot of fear that could cause institutions to limit their efforts.”

Numerous requests for comment from medical schools about the impact of the anti-DEI actions went unreturned. University presidents are staying mum on the issue to protect their institutions, according to reporting from The New York Times.

Utibe Essien, a physician and UCLA assistant professor, said he has heard from some students who fear they won’t be considered for admission under the new policies. Essien, who co-authored a study on the effect of affirmative action bans on medical schools, also said students are worried medical schools will not be as supportive toward students of color as in the past.

“Both of these fears have the risk of limiting the options of schools folks apply to and potentially those who consider medicine as an option at all,” Essien said, adding that the “lawsuits around equity policies and just the climate of anti-diversity have brought institutions to this place where they feel uncomfortable.”

In early February, the Pacific Legal Foundation filed a lawsuit against the University of California-San Francisco’s Benioff Children’s Hospital Oakland over an internship program designed to introduce “underrepresented minority high school students to health professions.”

Attorney Andrew Quinio filed the suit, which argues that its plaintiff, a white teenager, was not accepted to the program after disclosing in an interview that she identified as white.

“From a legal standpoint, the issue that comes about from all this is: How do you choose diversity without running afoul of the Constitution?” Quinio said. “For those who want diversity as a goal, it cannot be a goal that is achieved with discrimination.”

UC Health spokesperson Heather Harper declined to comment on the suit on behalf of the hospital system.

Another lawsuit filed in February accuses the University of California of favoring Black and Latino students over Asian American and white applicants in its undergraduate admissions. Specifically, the complaint states that UC officials pushed campuses to use a “holistic” approach to admissions and “move away from objective criteria towards more subjective assessments of the overall appeal of individual candidates.”

The scrutiny of that approach to admissions could threaten diversity at the UC-Davis School of Medicine, which for years has employed a “race-neutral, holistic admissions model” that reportedly tripled enrollment of Black, Latino, and Native American students.

“How do you define diversity? Does it now include the way we consider how someone’s lived experience may be influenced by how they grew up? The type of school, the income of their family? All of those are diversity,” said Granberry Russell, of the National Association of Diversity Officers in Higher Education. “What might they view as an unlawful proxy for diversity equity and inclusion? That’s what we’re confronted with.”

California Attorney General Rob Bonta, a Democrat, recently joined other state attorneys general to issue guidance urging that schools continue their DEI programs despite the federal messaging, saying that legal precedent allows for the activities. California is also among several states suing the administration over its deep cuts to the Education Department.

If the recent decline in diversity among newly enrolled students holds or gets worse, it could have long-term consequences for patient care, academic experts said, pointing toward the vast racial disparities in health outcomes in the U.S., particularly for Black people.

A higher proportion of Black primary care doctors is associated with longer life expectancy and lower mortality rates among Black people, according to a 2023 study published by the JAMA Network.

Physicians of color are also more likely to build their careers in medically underserved communities, studies have shown, which is increasingly important as the AAMC projects a shortage of up to 40,400 primary care doctors by 2036.

“The physician shortage persists, and it’s dire in rural communities,” Poll-Hunter said. “We know that diversity efforts are really about improving access for everyone. More diversity leads to greater access to care — everyone is benefiting from it.”

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

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Tribal Health Leaders Say Medicaid Cuts Would Decimate Health Programs

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kffhealthnews.org – Jazmin Orozco Rodriguez – 2025-03-19 04:00:00

As Congress mulls potentially massive cuts to federal Medicaid funding, health centers that serve Native American communities, such as the Oneida Community Health Center near Green Bay, Wisconsin, are bracing for catastrophe.

That’s because more than 40% of the about 15,000 patients the center serves are enrolled in Medicaid. Cuts to the program would be detrimental to those patients and the facility, said Debra Danforth, the director of the Oneida Comprehensive Health Division and a citizen of the Oneida Nation.

“It would be a tremendous hit,” she said.

The facility provides a range of services to most of the Oneida Nation’s 17,000 people, including ambulatory care, internal medicine, family practice, and obstetrics. The tribe is one of two in Wisconsin that have an “open-door policy,” Danforth said, which means that the facility is open to members of any federally recognized tribe.

But Danforth and many other tribal health officials say Medicaid cuts would cause service reductions at health facilities that serve Native Americans.

Indian Country has a unique relationship to Medicaid, because the program helps tribes cover chronic funding shortfalls from the Indian Health Service, the federal agency responsible for providing health care to Native Americans.

Medicaid has accounted for about two-thirds of third-party revenue for tribal health providers, creating financial stability and helping facilities pay operational costs. More than a million Native Americans enrolled in Medicaid or the closely related Children’s Health Insurance Program also rely on the insurance to pay for care outside of tribal health facilities without going into significant medical debt. Tribal leaders are calling on Congress to exempt tribes from cuts and are preparing to fight to preserve their access.

“Medicaid is one of the ways in which the federal government meets its trust and treaty obligations to provide health care to us,” said Liz Malerba, director of policy and legislative affairs for the United South and Eastern Tribes Sovereignty Protection Fund, a nonprofit policy advocacy organization for 33 tribes spanning from Texas to Maine. Malerba is a citizen of the Mohegan Tribe.

“So we view any disruption or cut to Medicaid as an abrogation of that responsibility,” she said.

Tribes face an arduous task in providing care to a population that experiences severe health disparities, a high incidence of chronic illness, and, at least in western states, a life expectancy of 64 years — the lowest of any demographic group in the U.S. Yet, in recent years, some tribes have expanded access to care for their communities by adding health services and providers, enabled in part by Medicaid reimbursements.

During the last two fiscal years, five urban Indian organizations in Montana saw funding growth of nearly $3 million, said Lisa James, director of development for the Montana Consortium for Urban Indian Health, during a webinar in February organized by the Georgetown University Center for Children and Families and the National Council of Urban Indian Health.

The increased revenue was “instrumental,” James said, allowing clinics in the state to add services that previously had not been available unless referred out for, including behavioral health services. Clinics were also able to expand operating hours and staffing.

Montana’s five urban Indian clinics, in Missoula, Helena, Butte, Great Falls, and Billings, serve 30,000 people, including some who are not Native American or enrolled in a tribe. The clinics provide a wide range of services, including primary care, dental care, disease prevention, health education, and substance use prevention.

James said Medicaid cuts would require Montana’s urban Indian health organizations to cut services and limit their ability to address health disparities.

American Indian and Alaska Native people under age 65 are more likely to be uninsured than white people under 65, but 30% rely on Medicaid compared with 15% of their white counterparts, according to KFF data for 2017 to 2021. More than 40% of American Indian and Alaska Native children are enrolled in Medicaid or CHIP, which provides health insurance to kids whose families are not eligible for Medicaid. KFF is a health information nonprofit that includes KFF Health News.

A Georgetown Center for Children and Families report from January found the share of residents enrolled in Medicaid was higher in counties with a significant Native American presence. The proportion on Medicaid in small-town or rural counties that are mostly within tribal statistical areas, tribal subdivisions, reservations, and other Native-designated lands was 28.7%, compared with 22.7% in other small-town or rural counties. About 50% of children in those Native areas were enrolled in Medicaid.

The federal government has already exempted tribes from some of Trump’s executive orders. In late February, Department of Health and Human Services acting general counsel Sean Keveney clarified that tribal health programs would not be affected by an executive order that diversity, equity, and inclusion government programs be terminated, but that the Indian Health Service is expected to discontinue diversity and inclusion hiring efforts established under an Obama-era rule.

HHS Secretary Robert F. Kennedy Jr. also rescinded the layoffs of more than 900 IHS employees in February just hours after they’d received termination notices. During Kennedy’s Senate confirmation hearings, he said he would appoint a Native American as an assistant HHS secretary. The National Indian Health Board, a Washington, D.C.-based nonprofit that advocates for tribes, in December endorsed elevating the director of the Indian Health Service to assistant secretary of HHS.

Jessica Schubel, a senior health care official in Joe Biden’s White House, said exemptions won’t be enough.

“Just because Native Americans are exempt doesn’t mean that they won’t feel the impact of cuts that are made throughout the rest of the program,” she said.

State leaders are also calling for federal Medicaid spending to be spared because cuts to the program would shift costs onto their budgets. Without sustained federal funding, which can cover more than 70% of costs, state lawmakers face decisions such as whether to change eligibility requirements to slim Medicaid rolls, which could cause some Native Americans to lose their health coverage.

Tribal leaders noted that state governments do not have the same responsibility to them as the federal government, yet they face large variations in how they interact with Medicaid depending on their state programs.

President Donald Trump has made seemingly conflicting statements about Medicaid cuts, saying in an interview on Fox News in February that Medicaid and Medicare wouldn’t be touched. In a social media post the same week, Trump expressed strong support for a House budget resolution that would likely require Medicaid cuts.

The budget proposal, which the House approved in late February, requires lawmakers to cut spending to offset tax breaks. The House Committee on Energy and Commerce, which oversees spending on Medicaid and Medicare, is instructed to slash $880 billion over the next decade. The possibility of cuts to the program that, together with CHIP, provides insurance to 79 million people has drawn opposition from national and state organizations.

The federal government reimburses IHS and tribal health facilities 100% of billed costs for American Indian and Alaska Native patients, shielding state budgets from the costs.

Because Medicaid is already a stopgap fix for Native American health programs, tribal leaders said it won’t be a matter of replacing the money but operating with less.

“When you’re talking about somewhere between 30% to 60% of a facility’s budget is made up by Medicaid dollars, that’s a very difficult hole to try and backfill,” said Winn Davis, congressional relations director for the National Indian Health Board.

Congress isn’t required to consult tribes during the budget process, Davis added. Only after changes are made by the Centers for Medicare & Medicaid Services and state agencies are tribes able to engage with them on implementation.

The amount the federal government spends funding the Native American health system is a much smaller portion of its budget than Medicaid. The IHS projected billing Medicaid about $1.3 billion this fiscal year, which represents less than half of 1% of overall federal spending on Medicaid.

“We are saving more lives,” Malerba said of the additional services Medicaid covers in tribal health care. “It brings us closer to a level of 21st century care that we should all have access to but don’t always.”

This article was published with the support of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, assisted by grants from The Commonwealth Fund.

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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