Missouri is taking a baby step toward meeting the huge demand for home-care services and building a work force industry for the baby boomer generation. Now that voters have approved Proposition B, one of governor-elect Jay Nixon's first tasks will be to appoint the Missouri Quality Homecare Council to oversee the recruitment and training of more home-care attendants.

Currently, 22,000 personal-care aides in Missouri provide a lifeline for people who can't care for themselves. Reinforcements for them are needed as baby boomers retire but the traditional labor pool for caregivers is shrinking, compounding problems for a workforce already beset by low wages and high turnover.

Bob Pund was in a car accident nearly 20 years ago that paralyzed him from the neck down. He says keeping a reliable attendant is nearly impossible, but his life depends on it.

"If someone quits on me, I need someone tonight just to go to bed, so, you know, it's very important to get
someone quick."

Pund says the problem of keeping good in-home care is very real and only going to get worse if the state doesn't oversee the home-care attendants' training and pay.

"We have a lot of problems right now and it's only going to get worse as the baby boomers retire and start
needing services so that they can stay in their own homes."

The Missouri Quality Homecare Council will maintain a list of eligible attendants and recommend to the General Assembly how much attendants should be paid. Under Prop B, home-care workers can also vote to form a union, but they are not allowed to strike. Critics of Prop B said forming this council is too costly for taxpayers.

But Krissi Jimroglou of Missourians For Quality Homecare says by building a strong, happy workforce to keep those on Medicaid in their homes, instead of in nursing homes, will be a huge savings for taxpayers. She says it is a win-win alternative for everyone.

"Home care is the cheaper option for taxpayers, it's the preferred option for consumers, and, frankly, workers get to develop great relationships, often calling these folks their second family."

Jimroglou says it costs the state about $9,000 to cover the annual cost of in-home services for a person on Medicaid, while nursing home care averages about $24,000.

For more information log onto www.moqualityhomecare.org



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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.