TALLAHASSEE, Fla. – Dos tercios de los estados han ampliado sus programas de Medicaid, pero Florida no es uno de estos. En consecuencia, dice un reporte, los residentes con menores ingresos del estado carecen de seguros de salud, en cantidades mayores que en otros estados. Comenta Anne Swerlick, defensora y analista de políticas, en el Instituto de Políticas de Florida ("Florida Policy Institute"); y Joan Alker, coautora del estudio y directora ejecutiva del Centro de la Universidad Georgetown para los Niños y las Familias ("Georgetown University Center for Children and Families").

La Florida no es uno de los 33 estados que ampliaron su programa "Affordable Care Act" - pero si hubiera sido, más residentes rurales de bajos ingresos tendrían seguro médico. Un reporte reciente de la Universidad Georgetown muestra grandes vacíos de cobertura en estados que no expandieron Medicaid. Anne Swerlick, del Instituto de Políticas de Florida ("Florida Policy Institute"), dice que principalmente los pueblos pequeños están perdiendo en términos de la salud y el progreso económico que el acceso a la atención ha traído a otros estados. En vez de eso, dice Swerlick, Florida está entre un montón de estados con altos índices de adultos de bajos ingresos que no tienen seguro, en las áreas de mayor necesidad.

"En las areas rurales llega hasta el 37 por ciento, contra el 24 en areas urbanas. En algunos condados de Florida, como Columbia y Jackson, las tasas son incluso mas altas, en el rango del 40 o 42 por ciento."

El reporte muestra que la tasa de no asegurados entre los adultos de bajos ingresos ha bajado en la última década en casi todos los estados, pero los descensos más marcados están en pueblos pequeños y áreas rurales, donde los programas de Medicaid fueron ampliados. Luego de dudar un poco, el Gobernador Rick Scott y la Legislatura controlada por los Republicanos rechazaron la expansión por motivos de costos.

La co-autora del estudio, Joan Alker, de la Universidad Georgetown, dice que realmente hay ahorros en las tarifas de mejor cobertura y un sistema más estable de atención a la salud.

"Realmente es un uso mas inteligente de los dolares de los contribuyentes para proveerles la atencion preventiva primaria que viene para empezar al tener seguro medico, para que no se enfermen y terminen en la sala de emergencias."

Swerlick dice que en todo el estado, muchos que andan sin seguro son padres de hijos pequeños.

"Florida tiene una elegibilidad extremadamente restrictiva para que estos padres entren a Medicaid; apenas el 34 por ciento del nivel de pobreza, que se traduce en $7,000 al ano por familia de tres."

Las comunidades no metropolitanas de Florida, con la mayor participación de adultos en 2015 y 2016, fueron los condados de Columbia, Jackson, Putean, Okeechobee y Suwannee.

Florida no esta entre los 33 estados que ampliaron su programa Medicad bajo la Ley de Cuidado Asequible (Affordable Care Act), pero si hubiera sido, mas residentes rurales, mas residentes de bajos ingresos tendrian cobertura de salud. Un reporte de Trimmel Gomes (trim-MELL GOAMZ).

...Republicanos rechazaron la expansion por motivos de costos.

El informe: ccf.georgetown.edu/topic/rural-health/.


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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.

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.