ANNAPOLIS, Md. -- As the coronavirus outbreak worsens, Maryland has reopened its health insurance exchange to boost coverage and expand treatment for the uninsured. The state joins Washington and Massachusetts in offering a special sign-up period while the pandemic continues.

During this crisis, it's essential that all uninsured people get coverage, according to Stephanie Klapper, deputy director at Maryland Health Care for All. She pointed out that a lot of folks without health insurance end up getting treated in emergency rooms, which could create chaos in the middle of a pandemic.

"It's the most expensive place to get health care," Klapper said. "But also, in a public health crisis like this, the emergency rooms could be overwhelmed by too many people needing health care at the same time."

As of Monday, Maryland announced the number of confirmed cases was up to 37.

Signup for the state's health exchange is available until April 15. For more information, visit MarylandHealthConnection.gov.

Twelve states and the District of Columbia operate their own health insurance plans, which Klapper said gives state lawmakers the authority to reopen enrollment in the face of an emergency such as the coronavirus. She said Maryland is the first state in the nation to also have what's called an Easy Enrollment program, which is linked through state tax forms.

"Already 18,000 Marylanders have checked a box on their state tax return to find out their health insurance options and learn how to take the next steps to enroll in coverage," she said. "That program is also still operational."

Klapper said she hopes the federal government will follow Maryland's lead and establish a special enrollment period for the federal Affordable Care Act. Congress has been urging Health and Human Services to deal with this public health crisis by opening enrollment for the 38 states that rely on the federal exchange, but no action has been taken so far.


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By Skylar Baker-Jordan for The Daily Yonder.
Broadcast version by Chance Dorland for the Tennessee News Service/Public News Service Collaboration

The end of Roe v. Wade - the 1973 Supreme Court ruling that prevents excessive government restriction of abortion services - could create multi-state regions where abortion is illegal, greatly complicating access for rural women who already must travel farther to terminate a pregnancy.

"The effect of this will... fall disproportionately on those who are unable to travel," said Sarah Traxler, M.D., the chief medical officer of Planned Parenthood North Central States, which covers Iowa, Nebraska, Minnesota, North Dakota, and South Dakota.

"It is important to underscore that an abortion ban is not an abortion ban for all people. It is only an abortion ban for those who lack the means to travel to a state where abortion is safe and accessible, and that is one of the true moral outrages of this situation."

A 2017 study from the medical journal the Lancet found that 20% of women must travel more than 43 miles to get access to an abortion. This problem will be exacerbated as states bordering one another enact bans, which could ostensibly create regions where abortion is prohibited. The 50 states will transform into a patchwork quilt of reproductive rights.

Some states, like California and New York, would not be affected as state legislatures and courts have recognized a right to abortion at the state level. The situation elsewhere is much more restrictive. According to the Center for Reproductive Rights, abortion would become illegal in 13 states thanks to so-called "trigger bans" designed to go into effect should they ever become legally permissible. Other states, such as Arizona and Pennsylvania, are expected to try to enact bans should Roe be overturned.

Exacerbating an Existing Problem

Many pro-life activists, however, are quick to caution abortion rights supporters against panicking. While acknowledging that "a post-Roe nation will look different," Patrick T. Brown, a fellow at the Ethics and Public Policy Center - a conservative think tank - said in an interview that "in rural parts of the country and in redder states, it's not going to be a huge paradigm shift..." Those places, he said in an interview, already lack nearby abortion clinics, which means women are already forced to travel to access abortion care.

This pragmatism is shared even by some pro-choice activists. "In seeking abortion care, we already know rural clients are already traveling," said Katie* with the Mountain Access Brigade, an abortion doula collective and abortion fund in East Tennessee, in an interview. "They will continue traveling, their travels will just be further."

Traxler with Planned Parenthood echoed this sentiment in a recording of a video press conference. "There are patients in South Dakota who are already traveling to other places to access abortion," she pointed out. The same is true for other states where legislatures have already burdened abortion providers and restricted access to legal abortions. In that regard, repealing Roe will exacerbate a problem many rural women are already facing.

Abortion providers and reproductive rights activists have been preparing for that eventuality, though. "Our assumption has been that in some way Roe would be decimated and there would be a lack of access to abortion," Traxler said. "So, we've been thinking about our surrounding states and how that might impact patients who live there." To buttress their existing resources and prepare for a surge in interstate patients, Planned Parenthood has "been planning on a regional scale and a national scale about how to navigate places where abortion is accessible."

This is a sentiment shared by Katie with Mountain Access Brigade. "We have been preparing for quite a while," she said. "We are very realistic, down-to-earth people and we kind of had an idea that this was coming." Like Planned Parenthood North Central, the Mountain Access Brigade has been working to strengthen its relationship with providers in nearby states where abortion is likely to remain legal.

Both organizations are also looking at addressing the needs of rural women in a post-Roe world, including logistical challenges women face when seeking abortion. "It's really just going to up the cost," Katie said, listing the cost of travel, lodging, childcare, and lost wages. "That's why abortion funds are so important and so crucial in bridging the gap between clients getting the care that they can't afford. Because the price of an abortion is not going to change, but the price of getting there will."

Conservative Response to Cost of Parenthood?

The cost of parenthood is something that Brown at the Ethics and Public Policy Center has thought about. Though pro-life, Brown supports an economic agenda that he says would empower women and families - including those women who find themselves with an unexpected pregnancy. "I've been encouraging Republicans to be thinking about this and taking it seriously for a while now," he says.

The Republican base has been shifting "more away from the sort of chamber of commerce towards the blue collar or middle-income families," and Brown has been pushing the GOP and pro-life activists to consider how to help women who will no longer have the right to an abortion. Red states such as Tennessee and South Carolina - where he lives - are expanding Medicaid for new mothers, he points out.

This makes him hopeful that conservatives will begin thinking more about how to help expectant mothers. He points to conversations around the child tax credit, which he hopes will help empower women and families and help meet their needs in a post-Roe world. "If you're a mom facing an unplanned pregnancy," he says, "the knowledge that you'll be getting $300 a month after your child is born [is helpful]."

Brown hopes that overturning Roe could serve as a "tipping point towards an economic agenda that's more concerned with strengthening families and supporting parents than lowering tax rates and assuming everything will work out in the end." In an ideal world, he says, this would include expanding access to and options for early-years childcare. "If you have a kid who is under 5 and you want to have a parent stay home, let's make that achievable," he says. "If you're looking for childcare, let's try to make that affordable."

Others on the right have also been considering how to best help women once their constitutional right to abortion has been abolished. "The populist pro-life movement is far more than just making abortion illegal," the blogger Populist Pundit* told me in an email interview. He told me that he and others like him support "enacting an industrial family policy" which would mix "pro-family economics" such as marriage and child subsidies with "industrial policy" around things like trade and antitrust legislation.

"We need to focus on ensuring there are good men and a good economy ready to support our mothers," Populist Pundit says. This includes enacting universal healthcare and childcare in the long term while increasing the Children's Health Insurance Program (CHIP) and Medicaid access in the short-term, as well as "requiring prenatal child support from deadbeat dads."

Traxler cautioned that if Roe is overturned, agencies in states where abortion would still be legal may have trouble meeting demand, - a problem compounded by the overall healthcare worker shortage. "In the short term, as states see a surge, we may actually be at a point where we are not able to meet all the demand in the short term," she said. "But that will eventually work itself out as everything sort of falls into places and we figure out where people will be traveling to."

For his part, Brown hopes that Republicans will pivot away from cultural battles and onto the hard economics of family and childrearing. Pointing to "culture war fights down in Florida and in other places," he hopes that conservatives will adopt an economic platform that helps mothers, families, and the working- and middle-classes. "Actually being for parents involves not just taking their cultural interests seriously," he says, "but also their material interests as well."

As for Katie and the Mountain Access Brigade, they remain ready to help any women they can. "We do this work to meet people's needs, and as those needs change, the work changes," she says. "We've been working really hard to get ready for this, and we do have people's backs - especially here in rural Appalachia."

*Names have been changed or omitted at the interviewees' requests because of fear of reprisals.

Skylar Baker-Jordan wrote this article for The Daily Yonder.


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May is stroke awareness month. People need to act quickly to avoid lasting damage when they happen - and remember the acronym "BE FAST."

'B' stands for balance and watch if someone is losing it. 'E' stands for eyes and changes to vision.

'F' is for face and signs of it drooping. 'A' is for arms and looking for signs that one arm is dropping when raised.

'S' is for speech, listening to hear if it's slurred. And 'T' stands for time to call 911 if any of these signs are present.

Dr. Jennifer Pary is a stroke neurologist at Kaiser Permanente in Spokane. She said in a stroke, time equals brain.

"If you have signs and symptoms of stroke, there's something that can be done about it. And there's new treatments all the time," said Pary. "But time is brain and the longer you wait to go in, the more damage that can be done to the brain that is irreversible."

Pary said strokes are the number four cause of death in the United States and the leading cause of disability. An average of 800,000 Americans experience strokes each year.

Pary said there are factors that increase the risk of stroke, including diabetes and high cholesterol. But she said the main factor people should keep in mind is blood pressure.

"That is the number one treatable risk factor for stroke," said Pary. "And in fact if everyone's blood pressure were under control in this country I probably wouldn't have a job."

Pary also warned about mini-strokes, or transient ischemic attacks, which are strokes that only last for a few minutes. She said this often is a warning sign that a bigger stroke is around the corner.

"I always encourage those patients to go in and get checked out right away as well," said Pary, "because we can find certain things that might put them at high risk that could be handled right away and get them on the right medications to prevent a big stroke from happening."

Today is National Bike to Work Day, and while it may sound "easier said than done," it may not be as daunting as you think.

Enthusiasts said the benefits of commuting by bicycle outweigh the drawbacks. Besides saving money on gasoline and vehicle expenses, research suggests it can increase productivity on the job by improving cognitive performance and lowering stress.

Chuck Smith, chair of the Ohio Bicycle Federation who lives in Vandalia, logged more than 50,000 miles in 22 years on his bike commuting to his job at Wright-Patterson Air Force Base. He explained there are more than 300 miles of connected paths in the region, which makes cycling a practical way to get around.

"Got out early in the morning and I had a good hill to go down," Smith recounted. "On a chilly morning, if that didn't wake me up, nothing would. And then the Great Miami Trail I took on the way home from work. It improved my outlook. Just a wonderful thing."

For especially long commutes, advocates suggest mixing biking with public transit. Nationally about 0.5% of workers ride a bike to work, and 20% of all bicycling trips are to "earn a living."

Lack of sidewalks and paths, traffic volume and speed and unsafe motorist are the top barriers to biking for most Ohioans.

Smith explained his group advocates for policies to improve safety for cyclists and communities.

"Things like bicycle parking; very important that businesses have those," Smith asserted. "We're really concerned about pushing to make the penalties higher for distracted driving and to make it a primary offense, so a distracted driver could be pulled off the road just for doing that."

Ohio has more than 3,000 miles of bike routes, but there are gaps in state, regional and local networks. The Walk.Bike.Ohio plan was launched in 2021 to improve connectivity and safety.

Smith encouraged Ohioans to consider cycling for both transportation and recreation.

"A bike is definitely the best way to tour," Smith contended. "You can see things much better from a bike, a full 360-degree view of things versus a car where you're really limited. Really, cycling is the best way to do so many things."

At the federal level, there are efforts to reinstate a bicycle commuter tax benefit of up to $20 a month, which was eliminated in 2018.

Reporting by Ohio News Connection in association with Media in the Public Interest and funded in part by the George Gund Foundation.