PORTLAND, Ore. -- This year marks the 25th anniversary of a unique program that provides in-home care for some of Oregon's most vulnerable residents.

Housecall Providers has expanded to three programs since it began in 1995. At any given time, its primary-care arm serves 1,500 to 1,600 patients. It also has about 120 hospice patients, and provides community-based palliative care for 150 people with serious but non-life-threatening conditions that require wraparound services.

Chief executive Rebecca Ramsay said staff is on call for patients' serious needs.

"If the patient has the flu or is having any kind of exacerbation of their chronic illness, we can make urgent visits as well," she said. "So the difference there is that we're going to the patient on an urgent basis, instead of the patient having to come to an office setting."

In 2017, the nonprofit community-benefits company CareOregon acquired Housecall Providers.

The program's primary-care medical director, Dr. Pamela Miner, said they serve homebound elderly Oregonians, people coping with physical or developmental disabilities, and those with medical or behavioral health challenges. She said the ability to provide house calls allows them to care for so-called "super-utilizers" -- the handful of Medicare beneficiaries that makes up the majority of hospital visits.

"We help prevent expensive trips to the hospital and unnecessary nursing-home stays," she said. "Not only does this set a new standard for the quality of care that patients can expect at home, it improves patient health outcomes, lowers health-care costs and improves the care team's satisfaction as well."

Miner said her team takes COVID-19 precautions on home visits and uses teleconferencing as much as possible.

In 2012, Housecall Providers began participating in the federal Independence at Home demonstration, a Medicare shared-savings model. Still, Ramsay said it's hard to remain financially viable and the program relies on donations. She said home-based service is an option many people want, and it is likely to be in even greater demand as the population ages.

"There's a lot of work to do," she said, "in order to really make sure that the health-care financing system is coming along with us in the recognition of the value of this type of care."

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.