RICHMOND, Va. - As the fight over Medicaid expansion continues, budget numbers from around the nation suggest expansion actually could be financially good for Virginia.

Critics of expanding the program to cover the working poor have argued it's a budget-buster. However, Michael Cassidy, president of The Commonwealth Institute for Fiscal Analysis, said figures from the Congressional Budget Office and from states that have expanded Medicaid programs indicate that's not the case.

Cassidy said Virginia would save $225 million in the next two-year budget cycle.

"A more financially responsible path is for Virginia to go ahead and close the coverage gap," he said, "because there's a lot of stuff we currently pay for through general-fund dollars that would no longer be needed when folks have coverage."

Critics charge that the states that are expanding Medicaid are benefiting from unsustainable federal spending. According to the CBO, however, health-care reform will cut the deficit by $10 billion a year over the next decade.

Dr. Christopher Lillis, a primary-care provider in Fredericksburg and Virginia director of Doctors for America, said he thinks expansion will make a chaotic and inefficient system smarter and more focused on prevention.

"We are already paying for the uninsured through our tax dollars, through higher insurance premiums and higher health-care prices," he said, "but we're doing it in the most inefficient manner."

Lillis gave the example of a woman with breast cancer who ends up with a huge emergency-room bill she can't pay, for lack of an inexpensive screening.

One hospital system in West Virginia reported it is seeing 85 percent fewer uninsured patients this year, largely thanks to Medicaid. Cassidy said Virginia's hospitals would be hurt without expansion.

"Hospitals are really left holding a bag, because they know they have cuts coming down the pike," he said, "and yet Virginia lawmakers refuse to close the coverage gap, leaving 400,000 folks without health care."

Expanding states say they're gaining as much as $10 to $15 in federal funding for every dollar they invest. Cassidy said Virginia could expect a similar return.


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An Indiana licensing board has fined a local physician $3,000 and handed her a letter of reprimand after she went public about a 10-year-old Ohio patient forced to travel across state lines for an abortion.

Indiana Attorney General Todd Rokita brought the case against obstetrician/gynecologist Dr. Caitlin Bernard, for comments she made last July to the Indianapolis Star about a young rape victim who could not legally receive an abortion in Ohio because she was just over six weeks pregnant.

Bernard testified she did not feel she would have ever been brought before the board - where she risked losing her license - if Rokita had not chosen to make the case a political stunt.

"I feel an obligation as a physician to share information that is relevant to public health," said Bernard, "as well as potentially in light of certain legislation, ensuring that it is clear that those are contrary to the best interest of my patients."

The AG's office had argued Bernard made the decision to speak about her patient to the largest newspaper in Indiana, which resulted in national publicity for the case.

Indiana University Health, where Bernard works, issued a statement after the decision maintaining its findings that Bernard did properly follow privacy laws.

After the story broke, Rokita appeared on Fox News to discuss it. Other Republican leaders, including Ohio U.S. Rep. Jim Jordan - R-Urbana - suggested Bernard fabricated the story.

Bernard acknowledged that politics made the case more challenging.

"Certainly, there was a lot of media frenzy," said Bernard. "I was receiving significant harassment, particularly after Fox News picked up on the story and began featuring the story in their news segments. I was quite surprised by all of the attention."

Bernard told the licensing board she was surprised that people think young girls are not, unfortunately, frequently raped and become pregnant.




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As Lyme disease Awareness Month draws to a close, levels of some tick-borne illnesses in Missouri are on the rise.

While Lyme infections in Missouri are not as dramatic as they are in northeastern states, officials said there is still cause for concern. Ticks cause a higher number of human diseases than any other insect in the U.S.

The most common tick related diseases in Missouri are Rocky Mountain spotted fever, ehrlichiosis, tularemia, and Lyme, along with newer viruses such as Heartland and Bourbon. Studies show the frequency of infections are increasing.

Dr. Ram Raghavan, associate professor of veterinary pathobiology at the University of Missouri Veterinary Medical School, said there are several reasons why.

"Some of these suburban areas are built around wooded backyards, and people are interacting with the wild more than they used to be in the past," Raghavan explained. "We are also getting very clever and very accurate in the way we detect diseases, there is increased awareness, not only among practitioners, but also patients."

He pointed out climate change is also making winters warmer and extending tick season. When outdoors experts recommend hikers stay in the center of trails and avoid tall grass and brush. Recommendations also include wearing clothing treated with permethrin or insect repellent containing at least 20% DEET, to check clothing for ticks, showering after being outdoors, then conducting a thorough tick check.

Raghavan noted in addition to the many bacterial pathogens transmitted by ticks, there are also threats from emerging viruses.

"Recently, in the past 10 years or so, a couple of new tick-borne viruses emerged in our area here in the central Midwest," Raghavan outlined. "One of them is called Heartland virus, and another one is Bourbon virus. Heartland and Bourbon viruses can actually kill somebody and there have been a few fatalities that have occurred over the years."

The Missouri Department of Health reports the majority of Heartland virus patients required hospitalization to recover. Bourbon virus is named after Bourbon County, Kansas, where the first U.S. incidence of the disease occurred.

A relatively new condition associated with tick-borne illness is Alpha-Gal Syndrome, when people become allergic to red meat. Raghavan said it is transmitted by the most common tick in the state.

"Meat allergy is a significant problem, and it is transmitted by the tick called the Lone Star tick, which is actually the most abundant tick in our region," Raghavan stressed. "Chances are, if someone is ever going to see a tick on them, it's most likely going to be a Lone Star tick. So we need to be watching out for that."

Ticks cannot fly or jump, nor do they drop from trees. They stay relatively close to the ground where they can access soil moisture which they need to stay alive. After rain, the wet conditions and higher humidity will bring ticks out in greater numbers.


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Extreme heat kills about 700 people in the United States each year, but a new toolkit and weather alerts can protect folks in Texas and beyond.

According to an analysis by Climate Central, the annual number of risky heat days has increased in 232 U.S. locations since 1970.

Saqi Maleque Cho, president of the health and development nonprofit Americares, said the new Heat.gov pilot project will help frontline clinics and the patients they serve better prepare for and respond to climate shocks.

"For example, our hurricane resources remind patients to refill their medications before a major storm," she said. "For diabetic patients who depend on insulin, we remind them to keep icepacks and a cooler in the event of a power outage."

From 1970 to 2022, Reno, Nevada, reported the highest number of what Climate Central called "minimum-mortality temperature" days. However, three Texas cities - Austin, Houston and McAllen - were in the top ten for hottest temps.

The toolkit is available at Americares.org.

Kimberlyn Clarkson, chief advancement officer at Texas' San Jose Clinic, said doctors already are seeing health impacts to patients from high heat, including life-threatening dehydration. Those are often people, she said, who work in the agribusiness industry or construction.

"They don't have the option of not going in when it's a 99-degree day, or not reporting for work if there's some sort of inclement weather," she said. "They need the work. They don't have PTO; if they don't go to work, they don't earn income."

To create the Climate Resilience for Frontline Clinics Toolkit, said Caleb Dresser, a physician and director of Harvard University's climate program, a needs assessment was conducted of 450 physicians and clinicians to learn what would help them better respond to their patients affected by heatwaves, hurricanes, floods or wildfires.

"As we look both short-term, medium-term and long-term at what climate change is," he said, "it means greater exposure to climate-responsive hazards for a whole lot of people, all over the country."


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