INDIANAPOLIS - It turns out it takes only half as much lead ingestion to cause problems for children as previously thought, so more Indiana children could be at risk of lead poisoning and the problems which can ensue.
The CDC recently cut in half the level of lead exposure deemed to be a health risk. In the meantime, Congress allocated only $2 million for lead-poisoning prevention this year, compared to $29 million the year before. That leaves very few staff members to get the word out.
A toxicologist, Dr. Jennifer Lowry, says it also means that it's now up to parents and pediatricians to become more proactive.
"The CDC recommends that lead testing occur at the age of one year and at two years and actually annually up until the age of six years."
Dr. Lowry suggests that doctors go to the CDC website and make themselves aware of the new guidelines. She also recommends that parents talk to their pediatricians about testing. New studies have found attention problems and reduced IQ in kids who are within the new guidelines.
Sources of lead include toys, children's jewelry, paint chips from old houses, and sometimes even the soil around houses. Hoosier parents with concerns about lead can call the Indiana Family Helpline at 1-800-433-0746.
Dr. Lowry says parents need to get rid of old paint chips in houses built before 1978, and she says dusting the floors and toys in such houses is important. She adds that houses with old paint on the outside can make the nearby soil hazardous as play areas or for planting vegetables.
"If there's peeling paint chips out in the soil from the home, it gets into the soil and the lead can get there. Usually, it concentrates around the first feet around the home."
Some soil has also been contaminated from the old leaded gasoline. This can happen in houses near highways or around old factory sites. And doctors in Boston just last month discovered lead poisoning in a child that came from a folk remedy for the eyes. The parents had brought it from Nigeria.
Dr. Lowry says parents can't just call up the health department and ask them to test their soil or their house. The children need to be tested first.
"They cannot come out to the home and assess your home for lead hazards unless there is a child that has an elevated blood-lead level."
The CDC says that all houses built before 1978 probably contain some lead. When the paint deteriorates and gets into the dust it causes problems. It says that more than 20 million houses have elevated levels of lead contamination in house dust.
Lowry says doctors and parents need to be more diligent about testing.
More information is at www.cdc.gov and at tinyurl.com/8ov84mg.
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A recent report examined how some rural Tennessee hospitals have managed to stay afloat despite financial challenges.
The report includes interviews from staff at five different rural hospitals, which range in size from 25 to 125 beds.
Judy Roitman, executive director of the Tennessee Health Care Campaign, said some of the hospitals are drowning in uncompensated care. She explained as part of their research, they did an interview with a CEO from a rural hospital in Kentucky who expressed the importance of Medicaid expansion.
"Kentucky has expanded its Medicaid program and Tennessee has not," Roitman pointed out. "He said that's the key to our stability is actually having the funds coming in to treat these patients. And the CEOs and others in Tennessee hospitals said it would make a huge difference to have that federal funding."
Roitman added the federal government is offering Tennessee a nine-to-one match. If Tennessee were to expand Medicaid, at least 330,000 people would gain access to coverage.
Roitman pointed out the report suggested further steps hospitals could take, including examining how they are reimbursed for services provided. She noted private insurance plans tend to provide the highest reimbursement rates, and said more funding is needed to support TennCare, which does not cover enough of the cost.
"TennCare is all managed by managed-care organizations," Roitman explained. "They negotiate with every hospital about how they're going to reimburse and the big hospitals have some leverage to demand better payment and the smaller hospitals are just, they're just not getting paid."
Roitman added the report credited strong community engagement and effective hospital leadership as key factors in staff retention. Robust management and maintaining an engaged workforce significantly affect a hospital's viability, according to the report.
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Medicare and Medicaid are key sources of health coverage for many Americans and some people qualify for assistance under both programs. With lagging enrollment for the unique plans, outreach efforts are underway.
According to KFF Health News, only about three in 10 people who qualify for Dual-Eligible Special Needs Plans were enrolled in 2021. Experts said the option is designed for people who need additional help because of disabilities, certain health conditions or their age.
Dr. Gina Williams, associate medical director for UnitedHealthcare, said the plans try to take a dynamic approach to serving those eligible.
"Everything from managing your wellness to managing your behavioral health needs and then everyday needs," Williams outlined. "It's kind of a more comprehensive package for people who need a little bit more support."
Everyday needs include meal benefits and bathroom safety devices. The National Council on Aging said D-SNPs aim to provide a more streamlined coordination of care because there is assistance in arranging the services. Wisconsin's enrollment numbers are similar to the national rate, at 28%.
Christine Huberty, lead benefit specialist and northern region supervising attorney for the Greater Wisconsin Agency on Aging Resources, said a tricky component of the plans is navigating provider network restrictions. A rural resident might have to travel farther to see a doctor covered under the plan and she cautioned it warrants careful research when enrolling.
"I would say first and foremost, look at the provider network restrictions," Huberty advised. "Look at what's available in your area."
Meanwhile, Williams noted the push to get more eligible people to sign up coincides with more awareness around preventive care in a post-pandemic world.
"Everybody's kind of going into a phase where they're not only thinking about acute illness, but they're thinking about overall care," Williams observed. "What was the impact of the pandemic from a psychological standpoint? Do you need more support and then you also need more coordination of benefits?"
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In Mississippi and across the country, Community Health Centers are getting a funding increase, thanks to Congress passing a bipartisan spending package.
Community Health Centers in Mississippi serve patients without regard to their insurance status or ability to pay. More than 20 locations in the state provide medical care to more than more than 380,000 people.
Joe Dunn, senior vice president of public policy and advocacy for the National Association of Community Health Centers, said roughly one in 11 Americans gets their care from this type of clinic.
"Community Health Centers are the largest primary care network in the nation, providing care for 31 million Americans," Dunn pointed out. "This network is critically important, because they provide primary care, behavioral health, dental; just an array of services that are so critically needed."
Dunn emphasized more can be done. Research shows more than 100 million Americans need better access to primary care. Community Health Centers in Mississippi also support more than 4,000 jobs and about $678 million dollars in economic activity in the communities where they're located.
Dunn noted the increased funding from Congress will help the clinics provide more comprehensive care and reach more underserved patients, especially in rural communities, which ends up saving the state money.
"By incentivizing people to go get primary care, you alleviate more downstream costs," Dunn emphasized. "There's fewer hospitalizations and complications from chronic conditions, based on preventive screening and care at the outset."
The Congressional Budget Office reports the increase in funding for Community Health Centers just through the end of this year will reduce federal spending on public health insurance programs by more than $700 million.
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