CHARLESTON, W.Va. - An early call to sign up under the state's expanded Medicaid program has brought a huge and immediate response, and it is similar to what is being seen in other states.
Jeremiah Samples is the assistant to the cabinet secretary for the West Virginia Department of Health and Human Resources. He said the agency looked in its files to see which clients in other programs might have incomes low enough to now qualify for health care. They sent letters three weeks ago, and in less then a month they have gotten back more than 40,000 requests to enroll - nearly half the total they hope to enroll over the next three years, he said.
"We are pleasantly surprised by the amount we've received," Samples said. "To have already identified and enrolled 45,000 folks, before the process really even begins, we're that much farther ahead of the game."
Several other states are seeing a similarly strong demand.
Dee Mahan, director of Medicaid advocacy for the consumer group Families USA, said states including Illinois and Arkansas have gotten huge responses to outreach efforts similar to West Virginia's. She added that, a few years ago, Oregon was overwhelmed by the demand when it offered to cover the working poor.
"In 2008, Oregon expanded their Medicaid program. They expanded it to low-income adults, and they had 90,000 adults apply for 10,000 slots," Mahan said.
More than half of the states are considering the option offered under the Affordable Care Act to use Medicaid to cover working people too poor to buy insurance. Critics of the law say the government should not be involved. However, Mahan pointed out, there is a clear pattern of pent-up demand in that population, all around the country.
Samples said West Virginia officials still want to hear from the other people who got letters; he said his office will send another copy, if need be. West Virginians can also find out if they're qualified by going on-line, he added.
"The best way to find out if you are, is to go to the federal exchange website or to http://wvinroads.org, or walk into a county office."
Samples stressed that folks here can still sign up. To see if they qualify, they can get in touch with the Department of Health and Human Resources or go to one of the enrollment websites, he said.
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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.
Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.
Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.
"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."
Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.
Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.
"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."
Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.
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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.
Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.
"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained
Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.
Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.
"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.
Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.
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New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.
The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.
"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.
Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.
Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."
"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.
Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.
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