Los centros de salud comunitarios de Colorado, que atienden a todos los pacientes independientemente de su capacidad de pago, llevan ya un mes en su nuevo año fiscal. Pero el Congreso aún no ha aprobado su financiación anual.

Stephanie Einfeld es consejera delegada del Northwest Colorado Health, que atiende a residentes rurales en Craig y Steamboat Springs. Afirma que la alta calidad de la atención médica, conductual, dental y de otro tipo que prestan los centros de salud está en peligro. Necesitan fondos federales para evitar que se reduzcan las horas de funcionamiento y las listas de espera.

"Para continuar haciendo lo que hacemos, necesitamos apoyo federal," asegura Einfeld Y nuestros legisladores necesitan escuchar eso. Necesitan priorizar primero, continuar con nuestra financiación federal y luego aumentarla."

A diferencia de la mayoría de las empresas que se enfrentan a los aumentos de costos laborales y de otro tipo, afirma que los centros de salud públicos no pueden transferir esos gastos a los pacientes. Los centros de salud atienden de forma desproporcionada a pacientes de Medicaid y son especialmente vulnerables al aumento de los costos de atención no compensada tras el fin de la cobertura continua a principios de este año, una medida que dejará sin seguro a 325,000 habitantes de Colorado.

Los centros de salud tienen múltiples fuentes de ingresos, como la facturación a los pacientes y los subsidios.

Pero el Dr. Simon Hambidge, de Denver Health, dice que la financiación federal es importante y que los centros de salud han contado con un fuerte apoyo bipartidista durante más de 60 años. Con frecuencia, los centros de salud son los mayores empleadores de las comunidades a las que atienden, emplean directamente a más de seis mil personas en Colorado y crean un total de más de 11,000 puestos de trabajo indirectos.

"Se calcula que el impacto económico total de las operaciones de los centros de salud en Colorado supera los 1.7 billones," informa Hambidge. "Y los ingresos fiscales que generan los centros de salud en sus comunidades superan los 1.2 billones."

Los centros de salud comunitarios también hacen lo que parece estar fuera del alcance de prácticamente todos los demás aspectos del sistema de atención de salud del país: ahorrar dinero a los contribuyentes. El año pasado, los centros de salud de Colorado ahorraron a los Centros de Servicios de Medicare y Medicaid más de 15 millones de dólares al atender a casi 14 mil pacientes.

"Existe un retorno documentado de la inversión de los centros de salud. Los centros de salud ahorran a Medicaid el 24% de los costos totales por cada paciente de Medicaid que es atendido," concluye Hambidge.



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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.