PHOENIX, Ariz. – La pelota está en la cancha de la Legislatura, para secundar la propuesta de la Gobernadora Jan Brewer de ampliar el programa Medicaid de Arizona bajo la Affordable Care Act (Ley de Atención Asequible). Quienes apoyan la expansión están cautelosamente optimistas de que los legisladores estatales respalden la idea.

Len Kirschner fue director del programa Medicaid de Arizona, conocido como Acceso (AHCCCS). Le da crédito a la Gobernadora Brewer por reconocer los beneficios que traerá la expansión de Medicaid.

"Esto nos subirá de ser un lugar 47 o 48 en el porcentaje de población sin asegurar, a estar en la mitad del grupo. Agregaría varios cientos de miles de gente que actualmente no está asegurada... pero que de todos modos enferma, se embaraza o se lastima, a la lista de quienes tienen cobertura."

Con la propuesta de Brewer, los hospitales pagarían $154 millones en "impuesto de cama" durante los tres próximos años, para cubrir la parte del estado en la expansión de Medicaid, generando casi $8 billones en nuevos fondos federales.

Steve Jennings es gestor de la AARP Arizona en la legislatura estatal y Director de Defensoría. Piensa que las perspectivas de que los legisladores aprueben son "bastante buenas," porque no involucra dinero de los fondos estatales.

"Se pueden sumar 300,000 personas, darles cobertura de seguro sin impactar el presupuesto estatal negativamente, así que yo diría que hay buenas posibilidades, pero la gente claro que quiere conocerlo a detalle."

Kirschner dice que ha lleva casi 30 años luchando contra la reticencia de la legislatura a aceptar Medicaid, desde que Arizona fue el último estado de la unión en adoptar el programa Medicaid... aunque le dimos otro nombre.

"La Legislatura no quería llamarle Medicaid, así que sacaron este nombre bastante interesante, el Sistema de Contención de Costos del Cuidado a la Salud de Arizona (Arizona Health Care Cost Containment System). Y mucha gente que votó a favor de la iniciativa en 1981 aún ahora no sabía que tenía Medicaid en el estado."

Kirschner dice que no será pronto ni fácil que los legisladores del estado secunden los planes de la gobernadora sobre la expansión de Medicaid, especialmente a la luz de la decisión de la corte que ordena un mayor gasto para educación.

"Quienes pensaban que esta iba a ser una sesión legislativa corta, creo que ahora empiezan a decir que puede ser larga. Y parte de ella claramente será el presupuesto y los enormes recortes que habrá en educación y en el cuidado a la salud."

Una norma de la corte emitida el martes dice que el estado debe tomar en cuenta la inflación completa en el fondeo a las escuelas.


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Toughing it out during spring allergy season is not in your best interest if you want to avoid asthma later in life.

New Mexico has plenty of grass and weed pollens carried by the wind which contribute to itchy, watery eyes, a stuffy nose and sneezing fits this time of year.

Dr. Osman Dokmeci, associate professor of internal medicine at the University of New Mexico, suggested for those who suffer acutely, seek an allergy test and possibly medication to prevent asthma from taking hold.

"One out of 10 has asthma in America," Dokmeci pointed out. "Having seasonal allergies increases your chance of developing asthma at least fivefold."

He recommended treating allergies early and as aggressively as possible. May is "Asthma Awareness Month," which aims to bring attention to the health issue and highlight improvements in care and quality of life. Nationwide, asthma affects more than 25 million Americans, including 4 million children, and disproportionately affects certain racial and ethnic groups.

Allergies do not "cause" asthma but people who have allergies, or have family members who have allergies, are more likely to get asthma than those who do not. Research shows allergy season is starting earlier and lasting longer. A 2022 study from the University of Michigan found pollen count could increase by 200% by the end of the century due to climate change, which is why Dokmeci stressed it is important not to ignore the problem.

"There's no treatment that actually makes your asthma not happen," Dokmeci explained. "But once you develop asthma, there are good treatment options."

The estimated economic impact of asthma is more than $80 billion per year from direct and indirect costs, such as missed school and workdays.

Recent research shows approximately half of people who die by suicide had contact with a health care professional within the month prior to their death.

However, a recent study shows only 8% of hospitals are currently implementing all four recommended suicide prevention practices: safety planning, warm handoffs to outpatient care, patient follow-up and lethal means counseling.

Melissa Tolstyka, director of Behavioral Health Services for Trinity Health Ann Arbor, said a seamless transition from inpatient to outpatient care is critical. At Ann Arbor, she saw a 46% increase in compliance with comprehensive suicide risk assessments and patients discharged on the suicide care pathway now receive a safety plan, which she sees as progress.

"We continue to see a need for really robust programming," Tolstyka explained. "Not just within the behavioral health world, but in the medical world as well. Our organization really wanted to focus on bringing the behavioral health and the medical services together to enhance our safer suicide care practices for our patients."

The initiative is being piloted across various units at Trinity Hospitals in Ann Arbor and Grand Rapids including the emergency department, psychiatric medical and inpatient nursing units. If you or anyone you know is struggling or in crisis, help is available 24 hours a day, seven days a week, by calling or texting 988, the Suicide and Crisis Lifeline.

Casie Sultana, clinical nurse leader for Trinity Health Grand Rapids, prioritizes patient well-being, emphasizing support and improvement over solely managing risks within the facility.

"We want to be someplace that people feel welcome to come to who are dealing with suicide," Sultana emphasized. "You feel so alone. It's a very lonely journey and we want people to come seek help and feel welcomed when they do that."

Susan Burchardt, clinical services manager at Trinity Grand Rapids, advised other hospitals considering a similar program to learn from organizations already using it.

Support for this reporting was provided by The Pew Charitable Trusts.


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Access to reduced-price medication is a necessity for many rural Missourians with low income.

Rep. Cindy O'Laughlin, R-Shelbina, the Senate Floor Leader, said Big Pharma is trying to confuse legislators with unrelated hot-button topics such as abortion access and illegal immigration in a last-ditch effort to stop the state from joining a program to force drugmakers to sell medicines at a discount.

"Appealing to nuclear topics, which really do not apply in this situation, is a disingenuous way to try to defeat a bill that is actually good for Missouri," O'Laughlin asserted.

O'Laughlin pointed out the program is transparent, and uses the tax money saved to help low-income families deal with chronic conditions such as diabetes.

The drugmakers object to the government forcing them to give significant discounts, arguing hospitals' and for-profit pharmacies' bottom lines, particularly those owned by pharmacy benefits managers, are being exploited. Nationally, 46% of contract pharmacy agreements involve pharmacies linked to the three largest benefits managers.

Rep. Tara Peters, R-Rolla, introduced the 340B contract pharmacy access billand said the lobbying is absurd.

"Federally, 340B program does not allow for abortion drugs," Peters stressed. "Why would any legislation that we're trying to pass in the state allow for that? I mean, the thought of that even being in existence is absolutely ludicrous."

The Missouri Senate passed the bill 27-3 on Monday and it now goes to the House.


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