Kaiser Health News
US Surgeon General Declares Gun Violence ‘a Public Health Crisis’
Rachana Pradhan and Fred Clasen-Kelly
Tue, 25 Jun 2024 09:00:00 +0000
U.S. Surgeon General Vivek Murthy declared firearm violence a public health crisis, as gun deaths and injuries punctuate daily life in America.
On nearly every day of 2024 so far, a burst of gunfire has hit at least four people somewhere in the country. Some days, communities have endured four or five such shootings.
The nation's top doctor called on policymakers to consider gun safety measures such as bans on assault weapons and high-capacity ammunition magazines and universal background checks for all firearm purchases. His advisory also urges a “significant increase” in funding for research on gun injuries and deaths, as well as greater access to mental health care and trauma-informed resources for people who have experienced firearm violence.
In 2022, more than 48,000 people were killed by guns in the U.S., or about 132 people a day, and suicides accounted for more than half of those deaths, according to data from the Centers for Disease Control and Prevention. An additional 200-plus Americans seek emergency care for firearm injuries each day, according to estimates from Johns Hopkins University research. No federal database records nonfatal gun injuries.
The Office of the Surgeon General does not set or carry out gun policy, but historically its reports and warnings have nudged policymakers and lawmakers to act.
Murthy, a physician, told KFF Health News he hoped to convey the broader toll of gun violence on the nation and the need for an urgent public health response. He cited soaring gun deaths among children and teens and noted that “the mental health toll of firearm violence is far more profound and pervasive than many of us recognize.”
“Every day that passes we lose more kids to gun violence,” Murthy said, “the more children who are witnessing episodes of gun violence, the more children who are shot and survive that are dealing with a lifetime of physical and mental health impacts.”
Firearm-related homicides over the past decade and suicides over the past two decades have driven the sharp rise in gun deaths, the advisory says.
Guns are the leading cause of death for children and teens, with higher death rates among Black and Hispanic youths. Researchers from Boston University found that during the height of the covid pandemic, Black children were 100 times as likely as white children to experience gun injuries. Hispanic and Asian children also saw major increases in firearm assault injuries during that time, that study showed.
Joseph Sakran, executive vice chair of surgery at John Hopkins Hospital in Baltimore and chief medical officer for Brady United Against Gun Violence, said the surgeon general's declaration is a “historic moment that sounds the alarm for all Americans.”
But Sakran added: “It cannot stop here. We have to use this as another step in the right direction. No one wants to see more children gunned down.”
Murthy has long said gun violence should be framed as a health issue. He argued that the approach has been successful in combating significant societal problems, citing tobacco control efforts that took hold following the then-surgeon general's landmark 1964 report concluding that smoking cigarettes causes lung cancer and other diseases.
“We saved so many lives, and that's what we can do here, too,” Murthy said.
Murthy's move is one of several recent Biden administration actions designed to combat gun violence, as most gun-related measures remain political nonstarters in Congress. Federal officials have allowed states to use Medicaid dollars to pay for gun violence prevention, and the White House has called on hospital executives and doctors to gather more data about gunshot injuries and to routinely counsel patients about the safe use of firearms.
While available data points to tragic outcomes across American communities, government officials and public health researchers have long been stymied by sparse federal funding devoted to gun violence research and the scope of its health effects.
“I've been studying gun violence for about 33 years now and there's still some really basic and fundamental questions I can't answer,” said Daniel Webster, a gun violence researcher at Johns Hopkins University.
“To really understand gun violence, you need to do more than just look at publicly available surveillance data,” he said. “You need to actually do in-depth studies involving the populations at highest risk for shooting or being shot.”
A Brady analysis found that of the 15 leading causes of death in the U.S., firearm injuries received the third-lowest amount of federal research funding through the National Institutes of Health for each person who died. The only causes of death that garnered less research funding through NIH were poisonings and falls, according to the analysis.
Sonali Rajan, an adjunct associate professor of epidemiology at Columbia University who researches the effects of gun violence on children, said political leaders and others need to reframe the debate on gun violence from crime to public health.
“We are raising a whole generation of children for whom exposure to gun violence is normal,” Rajan said.
In Michigan, “we had a kid survive the Oxford High School shooting only to go to Michigan State University and see another mass shooting,” she said. “It is unbelievably shameful.”
Serving as President Joe Biden's surgeon general since 2021, Murthy has, at times, caused political controversy with his views on gun violence.
Over a decade ago, former President Barack Obama nominated Murthy to be the nation's top doctor. But Murthy's support for a federal ban on the sale of assault weapons and ammunition and additional restrictions on gun purchases drew the ire of the National Rifle Association, as well as Republicans and some Democrats in Congress. The U.S. Senate narrowly confirmed Murthy to the job in December 2014, more than a year after his nomination.
Murthy has previously issued advisories on social isolation and loneliness, youth mental health, and the well-being of health workers. He said gun violence comes up in many of his conversations with young people about the mental health challenges they're facing.
“Fears around gun violence have really pervaded so much of the psyche of America in ways that are very harmful to our mental health and well-being,” Murthy said.
Many other causes of death are treated differently as to understanding the problems and developing solutions, Webster said. But “that's generally not what we've done with gun violence. We've oversimplified it and overpoliticized it.”
As Sakran put it: “As we look at firearm injuries, there's arguably no public issue that's as urgent.”
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By: Rachana Pradhan and Fred Clasen-Kelly
Title: US Surgeon General Declares Gun Violence ‘a Public Health Crisis'
Sourced From: kffhealthnews.org/news/article/gun-violence-us-surgeon-general-vivek-murthy-public-health-crisis/
Published Date: Tue, 25 Jun 2024 09:00:00 +0000
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Kaiser Health News
KFF Health News’ ‘What the Health?’: SCOTUS Ruling Strips Power From Federal Health Agencies
Fri, 28 Jun 2024 19:00:00 +0000
The Host
Julie Rovner
KFF Health News
Julie Rovner is chief Washington correspondent and host of KFF Health News' weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
In what will certainly be remembered as a landmark decision, the Supreme Court's conservative majority this week overruled a 40-year-old legal precedent that required judges in most cases to yield to the expertise of federal agencies. It is unclear how the elimination of what's known as the “Chevron deference” will affect the day-to-day business of the federal government, but the decision is already sending shockwaves through the policymaking community. Administrative experts say it will dramatically change the way key health agencies, such as the FDA and the Centers for Medicare & Medicaid Services, do business.
The Supreme Court also this week decided not to decide a case out of Idaho that centered on whether a federal health law that requires hospitals to provide emergency care overrides the state's near-total ban on abortion.
This week's panelists are Julie Rovner of KFF Health News, Joanne Kenen of the Johns Hopkins schools of public health and nursing and Politico Magazine, Victoria Knight of Axios, and Alice Miranda Ollstein of Politico.
Panelists
Joanne Kenen
Johns Hopkins University and Politico
Victoria Knight
Axios
Alice Miranda Ollstein
Politico
Among the takeaways from this week's episode:
- In 1984, the Supreme Court ruled broadly that courts should defer to the decision-making of federal agencies when an ambiguous law is challenged. On Friday, the Supreme Court ruled that the courts, not federal agencies, should have the final say. The ruling will make it more difficult to implement federal laws — and draws attention to the fact that Congress, frequently and pointedly, leaves federal agencies much of the job of turning written laws into reality.
- That was hardly the only Supreme Court decision with major health implications this week: On Thursday, the court temporarily restored access to emergency abortions in Idaho. But as with its abortion-pill decision, it ruled on a technicality, with other, similar cases in the wings — like one challenging Texas' abortion ban.
- In separate rulings, the court struck down a major opioid settlement agreement, and it effectively allowed the federal government to petition social media companies to remove falsehoods. Plus, the court agreed to hear a case next term on transgender health care for minors.
- The first general-election debate of the 2024 presidential cycle left abortion activists frustrated with their standard-bearers — on both sides of the aisle. Opponents didn't like that former President Donald Trump doubled down on his stance that abortion should be left to the states. And abortion rights supporters felt President Joe Biden failed to forcefully rebut Trump's outlandish falsehoods about abortion — and also failed to take a strong enough position on abortion rights himself.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: The Washington Post's “Masks Are Going From Mandated to Criminalized in Some States,” by Fenit Nirappil.
Victoria Knight: The New York Times' “The Opaque Industry Secretly Inflating Prices for Prescription Drugs,” by Rebecca Robbins and Reed Abelson.
Joanne Kenen: The Washington Post's “Social Security To Drop Obsolete Jobs Used To Deny Disability Benefits,” by Lisa Rein.
Alice Miranda Ollstein: Politico's “Opioid Deaths Rose 50 Percent During the Pandemic. in These Places, They Fell,” by Ruth Reader.
Also mentioned in this week's podcast:
- Politico's “Inside the $100 Million Plan To Restore Abortion Rights in America,” by Alice Miranda Ollstein.
- JAMA Network Open's “Use of Oral and Emergency Contraceptives After the US Supreme Court's Dobbs Decision,” by Dima M. Qato, Rebecca Myerson, Andrew Shooshtari, et al.
- JAMA Health Forum's “Changes in Permanent Contraception Procedures Among Young Adults Following the Dobbs Decision,” by Jacqueline E. Ellison, Brittany L. Brown-Podgorski, and Jake R. Morgan.
- JAMA Pediatrics' “Infant Deaths After Texas' 2021 Ban on Abortion in Early Pregnancy,” by Alison Gemmill, Claire E. Margerison, Elizabeth A. Stuart, et al.
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Audio producer
Emmarie Huetteman
Editor
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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Title: KFF Health News' ‘What the Health?': SCOTUS Ruling Strips Power From Federal Health Agencies
Sourced From: kffhealthnews.org/news/podcast/what-the-health-353-supreme-court-chevron-federal-health-agencies-june-28-2024/
Published Date: Fri, 28 Jun 2024 19:00:00 +0000
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KFF Health News and PolitiFact staffs
Fri, 28 Jun 2024 15:28:00 +0000
President Joe Biden and former President Donald Trump, the presumptive Democratic and Republican presidential nominees, shared a debate stage June 27 for the first time since 2020, in a confrontation that — because of strict debate rules — managed to avoid the near-constant interruptions that marred their previous encounters.
Biden, who spoke in a raspy voice and often struggled to articulate his arguments, said at one point that his administration “finally beat Medicare.” Trump, meanwhile, repeated numerous falsehoods, including that Democrats want doctors to be able to abort babies after birth.
Trump took credit for the Supreme Court's 2022 decision that upended Roe v. Wade and returned abortion policy to states. “This is what everybody wanted,” he said, adding “it's been a great thing.” Biden's response: “It's been a terrible thing.”
In one notable moment, Trump said he would not repeal FDA approval for medication abortion, used last year in nearly two-thirds of U.S. abortions. Some conservatives have targeted the FDA's more than 20-year-old approval of the drug mifepristone to further restrict access to abortion nationwide.
“The Supreme Court just approved the abortion pill. And I agree with their decision to have done that, and I will not block it,” Trump said. The Supreme Court ruled this month that an alliance of anti-abortion medical groups and doctors lacked standing to challenge the FDA's approval of the drug. The court's ruling, however, did not amount to an approval of the drug.
CNN hosted the debate, which had no audience, at its Atlanta headquarters. CNN anchors Jake Tapper and Dana Bash moderated. The debate format allowed CNN to mute candidates' microphones when it wasn't their turn to speak.
Our PolitiFact partners fact-checked the debate in real time as Biden and Trump clashed on the economy, immigration, and abortion, and revisited discussion of their ages. Biden, 81, has become the oldest sitting U.S. president; if Trump defeats him, he would end his second term at age 82. You can read the full coverage here and excerpts detailing specific health-related claims follow:
Biden: “We brought down the price [of] prescription drug[s], which is a major issue for many people, to $15 for an insulin shot, as opposed to $400.”
Half True. Biden touted his efforts to reduce prescription drug costs by referring to the $35 monthly insulin price cap his administration put in place as part of the 2022 Inflation Reduction Act. But he initially flubbed the number during the debate, saying it was lowered to $15. In his closing statement, Biden corrected the amount to $35.
The price of insulin for Medicare enrollees, starting in 2023, dropped to $35 a month, not $15. Drug pricing experts told PolitiFact when it rated a similar claim that most Medicare enrollees were likely not paying a monthly average of $400 before the changes, although because costs vary depending on coverage phases and dosages, some might have paid that much in a given month.
Trump: “I'm the one that got the insulin down for the seniors.”
Mostly False. When he was president, Trump instituted the Part D Senior Savings Model, a program that capped insulin costs at $35 a month for some older Americans in participating drug plans.
But because it was voluntary, only 38% of all Medicare drug plans, including Medicare Advantage plans, participated in 2022, according to KFF. Trump's plan also covered only one form of each dosage and insulin type.
Biden points to the Inflation Reduction Act's mandatory $35 monthly insulin cap as a major achievement. This cap applies to all Medicare prescription plans and expanded to all covered insulin types and dosages. Although Trump's model was a start, it did not have the sweeping reach that Biden's mandatory cap achieved.
Biden: Trump “wants to get rid of the ACA again.”
Half True. In 2016, Trump campaigned on a promise to repeal and replace the Affordable Care Act, or ACA. In the White House, Trump supported a failed effort to do just that. He repeatedly said he would dismantle the health care law in campaign stops and social media posts throughout 2023. In March, however, Trump walked back this stance, writing on his Truth Social platform that he “isn't running to terminate” the ACA but to make it “better” and “less expensive.” Trump hasn't said how he would do this. He has often promised Obamacare replacement plans without ever producing one.
Trump: “The problem [Democrats] have is they're radical, because they will take the life of a child in the eighth month, the ninth month, and even after birth.”
False. Willfully terminating a newborn's life is infanticide and illegal in every U.S. state.
Most elected Democrats who have spoken publicly about this have said they support abortion under Roe v. Wade's standard, which allowed access up to fetal viability — typically around 24 weeks of pregnancy, when the fetus can survive outside the womb. Many Democrats have also said they support abortions past this point if the treating physician deems it necessary.
Medical experts say situations resulting in fetal death in the third trimester are rare — fewer than 1% of abortions in the U.S. occur after 21 weeks — and typically involve fatal fetal anomalies or life-threatening emergencies affecting the pregnant person. For fetuses with very short life expectancies, doctors may induce labor and offer palliative care. Some families choose this option when facing diagnoses that limit their babies' survival to minutes or days after delivery.
Some Republicans who have made claims similar to Trump's point to Democratic support of the Women's Health Protection Act of 2022, which would have prohibited many state government restrictions on access to abortion, citing the bill's provisions that say providers and patients have the right to perform and receive abortion services without certain limitations or requirements that would impede access. Anti-abortion advocates say the bill, which failed in the Senate by a 49-51 vote, would have created a loophole that eliminated any limits on abortions later in pregnancy.
Alina Salganicoff, director of KFF's Women's Health Policy program, said the legislation would have allowed health providers to perform abortions without obstacles such as waiting periods, medically unnecessary tests and in-person visits, or other restrictions. The bill would have allowed an abortion after viability when, according to the bill, “in the good-faith medical judgment of the treating health care provider, continuation of the pregnancy would pose a risk to the pregnant patient's life or health.”
Trump: “Social Security, he's destroying it, because millions of people are pouring into our country, and they're putting them onto Social Security. They're putting them onto Medicare, Medicaid.”
False. It's wrong to say that immigration will destroy Social Security. Social Security's fiscal challenges stem from a shortage of workers compared with beneficiaries.
Immigration is far from a fiscal fix-all for Social Security's challenges. But having more immigrants in the United States would likely increase the worker-to-beneficiary ratio, potentially for decades, thus extending the program's solvency.
Most immigrants in the U.S. without legal permission are also ineligible for Social Security. However, people who entered the U.S. without authorization and were granted humanitarian parole — temporary permission to stay in the country — for more than one year are eligible for benefits from the program.
Immigrants lacking legal residency in the U.S. are generally ineligible to enroll in federally funded health care coverage such as Medicare and Medicaid. (Some states provide Medicaid coverage under state-funded programs regardless of immigration status. Immigrants are eligible for emergency Medicaid regardless of their legal status.)
——————————By: KFF Health News and PolitiFact staffs
Title: 1st Biden-Trump Debate of 2024: What They Got Wrong, and Right
Sourced From: kffhealthnews.org/news/article/biden-trump-2024-presidential-debate-fact-check/
Published Date: Fri, 28 Jun 2024 15:28:00 +0000
Julie Rovner, KFF Health News
Fri, 28 Jun 2024 09:00:00 +0000
For generations, the GOP campaigned on eliminating the right to an abortion in the United States. Now, torn between a base that wants more restrictions on reproductive health care and a moderate majority that does not, it seems many Republicans would rather take an off-ramp than a victory lap.
And yet, they just can't escape talking about it.
The policy high point for abortion opponents — the Supreme Court's 2022 decision to strike down Roe v. Wade — is proving a low point for public support for their cause. More American adults consider themselves “pro-choice” than at any time in the past 30 years, according to a recent survey from Gallup: 54%, compared with 41% who identify as “pro-life.”
The tide is turning even as some conservatives seek restrictions on birth control and fertility treatments. A new KFF survey of women voters found that Democrats are more likely than Republicans to say that abortion is the most important issue in their vote for president — a reversal from recent elections. One in 5 women under age 30 and 13% of those under age 50 said it is their top concern. Among independents, 81% said they believed abortion should be legal.
Democrats are counting on the issue to help turn out their votes and ensure President Joe Biden's reelection, despite persistent dissatisfaction with his leadership. Abortion could prove particularly disruptive in battleground states expected to have initiatives on the ballot to enshrine access to abortion in state constitutions, including Arizona and Nevada.
Eight in 10 Democratic women in states with possible ballot measures said they were “absolutely certain” they would vote — and also said they were more likely to back Biden compared with Democratic women in other states, KFF found.
So far, abortion rights supporters have prevailed in each of the seven states that have put ballot initiatives before voters — including in states where Republicans control the legislatures, such as Kansas, Ohio, and Kentucky. About two-thirds of women in Arizona told KFF they support the state's proposed Right to Abortion Initiative, including 68% of independents.
On the campaign trail, Republicans are bobbing and weaving to avoid the subject, even when that means distancing themselves from — well, themselves. Former President Donald Trump, who has taken a few different stances since calling himself “pro-choice” in 1999, reportedly urged lawmakers during a recent closed-door visit to the Capitol not to shy away from the issue, but also to support exceptions to bans, including to protect the life of the pregnant person.
In pivotal Arizona, U.S. Senate Republican candidate Kari Lake, who embraced a near-complete abortion ban while running for governor two years ago, recently said “a full ban on abortion is not where the people are.” In Nevada, the GOP Senate nominee, Sam Brown, who as recently as 2022 headed up a branch of a conservative anti-abortion group, has said he will respect his state's permissive abortion law and would not vote for a nationwide ban if elected.
The Supreme Court is keeping the issue on the front burner. In a decision June 27, the court left emergency abortions legal in Idaho, a state with a strict ban, though the issue remains unsettled nationally. Justice Ketanji Brown Jackson, who joined the majority in an unusual ruling that sent the case back to the lower court and declared it had been accepted prematurely, accused her colleagues of dawdling on the issue.
“Pregnant people experiencing emergency medical conditions remain in a precarious position, as their doctors are kept in the dark about what the law requires,” she wrote.
The KFF survey found broad, strong support for preserving access to abortion in cases of pregnancy-related emergencies: 86% of women voters — including 79% of Republican women — support laws protecting access in those circumstances.
In mid-June, the court rejected an effort to overturn the FDA's 24-year-old approval of the abortion pill mifepristone, but only on a technicality. With no actual ruling on the merits of the case, the justices left open the possibility that different plaintiffs could provoke a different outcome. Nevertheless, the push to redefine reproductive health care post-Roe v. Wade continues. The influential evangelical Southern Baptist Convention recently called for significant legislative restrictions on in vitro fertilization, which its members call morally incompatible with the belief that life begins at fertilization.
Abortion opposition groups are pressing Trump not to discard a main plank of the GOP's presidential platform since 1976: a federal abortion ban. Trump has recently said states should make their own decisions about whether to restrict abortion.
Democrats and Democratic-aligned groups are exploiting Republicans' discomfort with the issue. On the day Senate Democrats forced a vote on legislation that would have guaranteed a federal right to contraception, a group called Americans for Contraception floated a giant balloon shaped like an IUD near the Capitol. (Republicans blocked the bill, as expected — and no doubt Democrats will frequently remind voters of that this year.)
A week later, Senate Democrats tried to bring up a bill to guarantee access to IVF, which Republicans also voted down. No giant balloon for that one, though.
Republicans still appear bent on dodging accountability for the unpopularity of their reproductive health positions, if only by highlighting other issues they hope voters care about even more — notably, the economy. But one thing they're unlikely to accomplish is keeping the issue out of the news.
HealthBent, a regular feature of KFF Health News, offers insight into and analysis of policies and politics from KFF Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.
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By: Julie Rovner, KFF Health News
Title: Republicans Are Downplaying Abortion, but It Keeps Coming Up
Sourced From: kffhealthnews.org/news/article/republicans-downplay-abortion-election-issue-voter-opinion/
Published Date: Fri, 28 Jun 2024 09:00:00 +0000
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