Former President Donald Trump on Tuesday was asked if he supports “any restrictions on a person’s right to contraception.” (Photo of a package of birth control pills by Getty Images)

Policy, politics and progressive commentary

WASHINGTON — Donald Trump, the Republican Party’s presumptive nominee for president, suggested during a taped interview with a Pittsburgh TV news station Tuesday that he might be open to states restricting access to contraceptives, though he later appeared to backtrack.

“We’re looking at that and I’m going to have a policy on that very shortly and I think it’s something that you’ll find interesting,” Trump said on KDKA. “It’s another issue that’s very interesting. But you will find it very smart. I think it’s a smart decision, but we’ll be releasing it very soon.”

Trump had been asked if he supports “any restrictions on a person’s right to contraception.”

Trump later added that “things really do have a lot to do with the states. And some states are going to have different policies than others.” That comment came just after being asked if he “may want to support some restrictions, like the morning-after pill or something?”

The former president, who is currently on trial for allegedly facilitating hush money payments to an adult film actress during his 2016 campaign to cover up a prior affair, later posted on his social media platform that he wasn’t advocating for birth control restrictions.

“​​I HAVE NEVER, AND WILL NEVER ADVOCATE IMPOSING RESTRICTIONS ON BIRTH CONTROL, or other contraceptives,” Trump wrote. “This is a Democrat fabricated lie MISINFORMATION/DISINFORMATION, because they have nothing else to run on except FAILURE, POVERTY, AND DEATH. I DO NOT SUPPORT A BAN ON BIRTH CONTROL, AND NEITHER WILL THE REPUBLICAN PARTY!”

Supreme Court rulings

The U.S. Supreme Court has twice ruled in favor of privacy rights for decisions about contraceptives, meaning that any state looking to restrict or ban access to birth control would quickly see that law challenged in federal court.

In the1965 Griswold v. Connecticut case, the justices struck down a Connecticut law that prevented married couples from using birth control, writing that the “right to privacy can be inferred from several amendments in the Bill of Rights, and this right prevents states from making the use of contraception by married couples illegal.”

The Supreme Court later ruled in the 1972 Eisenstadt v. Baird case that the same privacy rights that protected married couples’ decision-making about contraceptives also protected unmarried people.

In that case, the justices held that “unmarried couples have the right to use contraception, based on the Equal Protection Clause of the Fourteenth Amendment and the more nebulous constitutional right to privacy.”

Biden-Harris spokesperson Sarafina Chitika released a written statement Tuesday that Trump’s comments show he “wants to rip away our freedom to access birth control.”

“Women across the country are already suffering from Donald Trump’s post-Roe nightmare, and if he wins a second term, it’s clear he wants to go even further by restricting access to birth control and emergency contraceptives,” Chitika wrote. “It’s not enough for Trump that women’s lives are being put at risk, doctors are being threatened with jail time, and extreme bans are being enacted with no exceptions for rape or incest.”

KDKA-TV Money & Politics Editor Jon Delano posted on social media that viewers interested in the Trump interview could tune in at “4, 5, and 6 to hear comments on the trial, abortion, contraceptives, the economy, energy, trade, and the fairness of PA’s election.”

The Biden campaign posted clips of the interview on their social media account, but it didn’t appear available anywhere else prior to KDKA’s airing.

Other policy hints from Trump

Trump has teased out providing clear policy plans before, telling Time magazine in an April interview that his campaign would put out details in the weeks ahead about his “strong views” on access to mifepristone. The campaign had not done so as of Tuesday afternoon.

The pharmaceutical is one of two drugs used in medication abortions and is currently in front of the U.S. Supreme Court.

The justices heard oral arguments in the case in March and are expected to decide this summer whether to leave the U.S. Food and Drug Administration’s prescribing guidelines in place or revert to what was used before changes began taking effect in 2016.

Trump said during the Time magazine interview that he wasn’t going to explain his beliefs about access to mifepristone just then.

“Well, I have an opinion on that, but I’m not going to explain,” Trump said, according to the transcript of the interview. “I’m not gonna say it yet. But I have pretty strong views on that. And I’ll be releasing it probably over the next week.”

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A volunteer packs food at Three Square Senior Hunger Campus. (Photo courtesy Three Square of Southern Nevada)

Policy, politics and progressive commentary

Food insecurity climbed across Southern Nevada last year with an estimated one in five children uncertain where their next meal is coming from, according to the latest findings from Three Square Food Bank.

Data released Thursday as part of the Feeding America’s 2024 Map the Meal Gap Study comes after food pantries and services providers warned in 2023 that end of pandemic era benefits on top of rising costs could increase the number of people relying on food assistance programs.

“The surge in food insecurity underscores pressing challenges Southern Nevadans face,” Beth Martino, the president and CEO of Three Square Food Bank, said in a statement. “Inflation and rising living expenses, especially grocery prices and rent, are causing financial strain for too many of our neighbors.”

The report, which includes data from Clark, Nye, Esmerelda and Lincoln counties, all within Three Squares service areas, found 341,480 people, or one in seven, were deemed food insecure.

Combined food insecurity rates for all four counties increased from 12% in 2022 to 14.7% in 2023. An estimated 14.6% of Clark County residents were food insecure, up from 12% the previous year.  

The highest rates are among Esmeralda and Nye counties, at 18.4% and 17.3% respectively. Both counties had a 13.9% rate the previous year.  

The report also found that rates among children spiked from 17.8% in 2023 to 22%. Roughly one in five children, about 115,000 children, live in food-insecure households.

The fear that more people might need to rely on food banks began last year after the supplemental allotment for Supplemental Nutrition Assistance Program, or SNAP, ended. The additional monthly payment began during the pandemic. 

Martino spoke to state lawmakers at the interim joint Committee for Health and Human Services April 8 about the rise in demand the nonprofit has seen.

“Most recently from September through the end of February we saw a 23% increase,” she said. “What’s unique about what we see now in the data is not as many new people are coming into food pantries but people who were food insecure in the past are becoming repeat customers.”

Three Square, which provides food with the assistance of 150 community service providers, distributed more than 43 million pounds of food last year throughout Southern Nevada and anticipates the amount to grow this year.

Martino cited a report earlier this year that found “Nevada has the second highest grocery prices in the country,” and said that coupled with skyrocketing rent prices has added to the strain.

“Those earning minimum wage in Nevada at $11.25 an hour, potentially without health insurance, need to work 82 hours a week in order to afford a one-bedroom apartment,” she noted. 

Martino encouraged lawmakers to revisit universal free school lunches in the next legislative session as a way to keep “children well fed and nourished so they can learn and ultimately live their best lives.”

Republican Gov. Joe Lombardo vetoed a bill carried by Democrats in 2023 that would have provided universal free lunch for K-12 students. 

“Having universal access to free school breakfast and lunches is something that can make a meaningful difference in the life of the child, but also to a family as a whole who may be struggling to put food on the table,” she said. 

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(Getty Images)

Policy, politics and progressive commentary

As local governments in Nevada have used one-shot federal recovery relief dollars toward mental and behavioral health services, city and county officials stressed the importance for state lawmakers to figure out a sustainable funding source.

During Monday’s Interim Committee of Health and Human Service, officials from Clark County, Washoe County, the City of Las Vegas and rural Nevada updated lawmakers on successes and failures of efforts to connect people experiencing mental health crises to behavioral health services. 

The options for people needing emergency mental health services largely have been for them to go to the emergency room or be arrested and jailed. 

Jurisdictions have been able to use dollars provided by the American Rescue Plan Act, a relief package signed into law by President Joe Biden in 2021, to begin setting up regional crisis stabilization centers, operating mental health courts and expanding mobile outreach programs as an alternative. 

Those funding operating many of those programs is finite. 

Clark County Commissioner Justin Jones noted the county was able to use ARPA dollars to purchase a psychiatric hospital to turn into a crisis stabilization center. 

“The state has provided fantastic funds for many programs such as the funding for a crisis stabilization center,” Jones said. “In order to make that facility or any facility viable, there has to be a dedicated funding stream for years to come.” 

Many jurisdictions across the country that are able to offer more robust mental health services have access to stable and consistent funding sources that Nevada does not, Jones added.

“In San Diego County, they benefit from a millionaire tax,” he said. “In Miami-Dade County, they collect a 1% sales tax on food and beverage for homeless programs that support mental health services.” 

Local governments during Monday’s hearing highlighted various efforts in recent years to fund a 988 crisis line and expand mobile crisis teams that come to meet people in help

UMC, which Clark County is working with for its crisis stabilization center, is in the process of contracting a mental health provider to administer and staff it. 

The center is expected to start taking patients starting late December. 

“We don’t think one crisis stabilization center is going to meet the entire needs of Clark County,” said Abigail Frierson, the deputy county manager with Clark County. “We believe we need three or four.”

Officials said additional types of care are needed when people leave the crisis stabilization center. 

“Where do people who are unhoused go to continue their care once they’ve been stabilized?” Frierson asked. 

The City of Las Vegas is looking to expand its Recuperative Care Center, which  offers medical services for the unhoused population, to also offer mental and behavioral health.

Sabra Newby, the deputy city manager with the city of Las Vegas, said the city contracts with the federally qualified health center, Hope Christian Health Center, to operate the facility within the Corridor of Hope, the area downtown where homeless services are located. 

The center currently has 40 beds. The expansion would increase the number of beds to 76. 

“That would add the crisis stabilization unit to the facility and let us service the type of patient that we currently can’t serve that may be both recovering from sort of injury or illness or surgery but may have a higher level of mental health need,” Newby said. 

Newby said the city was awarded a $10 million grant from the state, which came from the ARPA dollars, for the expansion. It is taking an additional $7 million from the city’s share of ARPA funding.

While the city is still determining the exact costs of the project, Newby said early estimates indicate the city will be short about $5 million. 

Similar to efforts in Southern Nevada, a crisis stabilization is in the process of opening in Washoe County later this year, in partnership with Renown Regional Medical Center. 

Steve Shell with Renown said ARPA dollars are being used to renovate the space and cover operating expenses in the first year.

“I want to stress we really have to think beyond the first year at sustainability,” he said. “It’s great to stand up centers like this but we are going to really need to make sure they can sustain for the long haul. I don’t think anyone wants to stand up a new model that can’t continue beyond a certain time.”

Aside from a sustainable funding source to operate facilities, health officials also named other issues hindering access to behavioral health services, including low Medicaid reimbursement rates for providers and the lack of mental and behavioral health providers within the state. 

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“Across and within most states, white people overall receive better quality of care than Black, Hispanic, AIAN, and, often, AANHPI people,” the report says. (Sean Gallup/Getty Images)

Policy, politics and progressive commentary

Nevada’s health care system ranks 41st overall of the 50 states and District of Columbia, according to a report detailing disparities in health care and wellness across racial and ethnic groups.

The care afforded to white residents ranks at 39th in the nation, says the report from the Commonwealth Fund, an independent, non-partisan organization dedicated to improving health care. Nevada ranks 35th for health services available to Black residents, and 36th for services available to Hispanics. 

The care provided to Asian American and Native Hawaiians or Pacific Islander (AANHPI) residents of Nevada ranked 25th in the nation – the state’s highest ranking in the study. 

Premature death from avoidable causes

The report notes that health outcomes, measured by death rates and the presence of health problems, also vary by race and ethnicity.

“Deep-seated racial and ethnic health disparities persist across the United States, even in states with otherwise high-performing health systems,” says the report.

Black Americans, American Indians and Alaskans have lower life expectancies than others, and experienced more COVID-related deaths, the report says.  

In Nevada, Blacks had the highest rate of premature deaths (age 75 and under) from avoidable causes with 553 per 100,000 residents, according to the Centers for Disease Control National Vital Statistics System for 2020 and 2021, followed by AIAN at 549 per 100,000. AANHPI residents in Nevada had the lowest death rate at 237 per 100,000, followed by Hispanics at 286, and white Nevadans at 374 per 100,000.  

Health Care Access

Racial and ethnic disparities in health care are perpetuated by less insurance coverage and unequal access to high-quality care, the report says.

“Large disparities in health care access between white people and members of most other racial and ethnic groups are apparent across states,” the report says. “Hispanic people have the highest uninsured rates and cost-related problems in getting care.”

While more Americans have become insured since the Affordable Care Act became law, some 25 million people remain uninsured. 

“In nearly all states, uninsured rates continue to be higher for Black, Hispanic, and AIAN residents than they are for white and AANHPI residents,” the report says. 

In Nevada, Hispanics have the highest percentage of uninsured adults at 26,4%, followed by Blacks at 16.2%, AANPHI at 11.2%, and whites at 9%.  

“Some Hispanic and AANHPI populations continue to face immigration-related barriers to getting subsidized coverage through Medicaid or the ACA marketplaces,” the report says. 

Americans who don’t have insurance or have plans that lack comprehensive coverage are “unable to get care when they need it or have to pay high out-of-pocket costs for their care,” the report says. “With comparatively lower incomes and fewer savings, Black, Hispanic, and AIAN people are more likely to report experiencing delays in their care or financial distress.”

Access and use of primary care

“Across and within most states, white people overall receive better quality of care than Black, Hispanic, AIAN, and, often, AANHPI people,” the report says, noting primary care clinicians play a critical role in ensuring quality services. 

Patients tend to have better outcomes when they receive care from providers of the same racial background, the report says.

“When there are barriers to obtaining primary care, such as costs or a lack of providers, people are more likely to get care in more intense and costly care settings, particularly an emergency department,” the report says, noting Black patients covered by Medicare are more likely than white patients to be hospitalized for “acute exacerbations of chronic conditions” that could be treated and managed by primary care providers. “For all Medicare beneficiaries, greater use of primary care services is associated with less use of Emergency Departments for treatable conditions and fewer hospital admissions.”

In Nevada, Black residents have 31.9 admissions per 1,000 Medicare patients to hospitals for conditions that could be treated outside a healthcare facility, compared with white residents who are hospitalized for such conditions at a rate of 23.5 per 1,000 Medicare patients. 

Black patients are admitted to emergency departments for avoidable conditions in Nevada at a rate of 181 per 1,000 Medicare patients, compared with 132 for white patients.

The report asserts that equity in health care should be a top priority for policymakers, and urges leaders to evaluate existing policies that thwart the effort.  

Among the report’s suggestions: 

• Congress could extend the insurance premium subsidies set to expire in 2025
• States that have not expanded Medicaid could do so 
• Congress could reduce deductibles and out-of-pocket costs for marketplace plans. 
• Congress could reduce immigration-related barriers to insurance coverage
• Lawmakers could allow undocumented, low-income immigrants to enroll in Medicaid, as several states have already done 
• Policymakers could strengthen primary care by reimbursing providers based on the value of care they deliver

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UnitedHealth CEO Andrew Witty testified before the U.S. Senate Finance Committee on Wednesday, May 1, 2024, about a cyberattack on Change Healthcare, a subsidiary. (Screenshot from committee webcast)

Policy, politics and progressive commentary

WASHINGTON — Capitol Hill lawmakers from both parties on Wednesday grilled UnitedHealth Group’s CEO over the largest-ever cyberattack on the U.S. health care industry, which has crippled payments to providers and pharmacies and left millions of patients clueless about whether their information is now on the dark web.

A Russia-linked cybercrime organization dubbed “BlackCat” infiltrated a vulnerable server in February belonging to Change Healthcare, a subsidiary of the massive Minnesota-based UnitedHealth. The hackers demanded ransom for stolen data.

UnitedHealth’s CEO Andrew Witty told the Senate Committee on Finance the decision to pay the $22 million ransom in Bitcoin “was mine (and) was one of the hardest decisions I’ve ever had to make.”

“To all those impacted, let me be very clear: I am deeply sorry,” Witty said in his opening testimony.

The company warned in its latest update in late April that a preliminary ongoing investigation revealed compromised personal health and identifiable information that “could cover a substantial proportion of people in America.”

‘Mr. Witty owes Americans an explanation’

Witty’s apology did little to stop lawmakers from demanding that he answer for basic cybersecurity missteps, significant revenue losses and delays in notifying patients whether their personal information was among data stolen by the cyber criminals.

Sen. Ron Wyden, the committee’s chair, said “failure starts at the top.”

“Mr. Witty owes Americans an explanation for how a company of UHG’s size and importance failed to have multi-factor authentication on a server providing open door access to protected health information, why its recovery plans were so woefully inadequate and how long it will take to finally secure all of its systems,” the Oregon Democrat said.

UnitedHealth Group, which ranks among the nation’s largest companies, acquired Change Healthcare in a controversial 2022 deal that added to its behemoth footprint in the American health care industry.

Change Healthcare is an information superhighway for payments, requests for insurers to authorize care and roughly a third of Americans’ medical records. It processes 14 billion “clinical, financial and operational transactions annually,” according to the company.

Witty told lawmakers that with the Change purchase came the company’s “legacy technology” that UnitedHealth has been in the process of upgrading.

Both Wyden and the committee’s ranking member, Mike Crapo of Idaho, criticized the U.S. Department of Health and Human Services for not playing a larger role after the attack.

Wyden panned the agency for not conducting “a proactive cybersecurity audit in seven years.”

HHS, which has published recommended cybersecurity standards for the health care industry, did not respond to a request for comment. It released a statement and guidance about the cyberattack on March 5.

That wasn’t soon enough, Crapo said, and “the administration’s delay exacerbated an already uncertain landscape, leaving providers and patients with reasonable concerns about access to essential medical services and life-saving drugs.”

Not a ‘rosy’ picture

The cybercriminals that attacked Change Healthcare allegedly accessed a server using stolen credentials.

The server did not have multi-factor authentication — a widely used two-step log-in process — and hackers were in the system for nine days before being detected, Witty confirmed for the committee.

Wyden said the attack could have been stopped by using “cybersecurity 101.”

“I don’t believe there are any excuses for that,” Wyden said.

The company immediately contacted the Federal Bureau of Investigation and disconnected Change from the rest of its network after discovering the breach, Witty said.

Cutting off the system halted billing, insurance authorizations and other activities for weeks, costing providers more than $100 million a day, according to the American Medical Association.

UnitedHealth maintains medical claims are flowing again at “near normal” levels, and payment processing has reached 86% of pre-incident levels “and is increasing as additional functionality is restored,” according to Witty’s submitted written testimony.

Witty told lawmakers that as of Friday the company had issued $6.5 billion in payments and no-interest loans to medical providers.

Sen. Marsha Blackburn said her office has been inundated with calls about the Change attack. The reality patients and providers are describing “is wildly different from the rosy picture that you have painted,” she said.

The Tennessee Republican said she’s hearing from hospitals and doctors who are facing weeks of backlogged claims and payments.

“Here’s a good ‘for instance’ for you: a small, independent, private hospital in West Tennessee. They have diligently submitted all of their claims, and they are burdened with a backlog of Medicare claims that is equivalent to 30 days revenue, and they’re waiting for these things to be transmitted to Medicare,” Blackburn said.

“This is all because of the missteps you all have had.”

Sen. James Lankford, an Oklahoma Republican, asked Witty for a “target time when everyone will be made completely whole.”

“I would hope that that’s in the next month or six weeks,” Witty said.

Patient data 

Sen. Thom Tillis of North Carolina held up the book “Hacking for Dummies,” which he said he’s used as a resource on various Senate committees, and told Witty “this is basic stuff.”

“Your entire enterprise is based on the movement and exchange of data,” Tillis, a Republican, said during his questioning. “That’s how you create value. … When you have a breach, it’s gotta be your problem, not my problem. So everything that you do to keep those folks whole for any damage in the brief is just a function of doing business. Do you agree with that?”

“I do sir,” Witty responded. “And we’ve (leaned) in to take full responsibility on notification, and we are waiting for that notification. We’ve already stood up credit protection, identity theft protection, and they can reach us through a 1-800 number and through our cyber support.”

The company has provided a call center at 1-866-262-5342 and a website changecybersupport.com.

Witty told Nevada Democratic Sen. Catherine Cortez Masto that the timeline for notifying providers and patients whether their data has been breached — as required by federal and state law — will take “several weeks.”

“You’ve been saying several more weeks since what, this attack was how long ago, 69 days ago?” asked Cortez-Masto.

“Yes, and thank you for the question. We only were able to start this process about a month after the attack when we got the dataset back and were able to start to interrogate it, a very complex process,” Witty replied.

Protesters briefly stood after the hearing adjourned and chanted “Andrew Witty, you can’t hide. We can see your greedy side.”

Witty also testified before the U.S. House Committee on Energy and Commerce Wednesday.

The Department of Justice did not respond to a request for comment on the investigation into the attack.

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(Getty Images)

Policy, politics and progressive commentary

Gov. Joe Lombardo wants the state’s Patient Protection Commission to help find a cure for the state’s shortage of healthcare professionals. 

In an executive order issued Friday, Lombardo notes the PPC was created to review the health care needs of Nevadans. “In order to achieve its objective, the PPC must now work to address current challenges with building an adequate health-care workforce to care for residents.” 

Nevada ranked 45th in the nation for the ratio of active physicians to the population in 2021, with 218 per 100,000 residents, compared with the national average of 272, according to the American Association of Medical Colleges. About 70% of the state’s population live in areas with a shortage of primary care providers, according to data from the state. 

Lombardo wants the PPC to evaluate data and best practices related to:  

• Attracting and retaining health care workers 
• Improving access to primary care and public health services
• Removing obstacles to recruiting and retaining workers
• Identifying funding options for strengthening the healthcare workforce, including supporting competitive Medicaid reimbursements
• Ensuring strategies for increasing reimbursement incentivize and reward better quality and value for taxpayers 
• Identifying strategies for evaluating state investments to improve the capacity of the state’s healthcare workforce.

Last month, the Current reported that licensing requirements and the state’s lack of a reciprocity agreement with other states is preventing some providers from working in Nevada. 

The outlook for Nevada’s physician shortage is made dimmer by the state’s aging population of patients, as well as doctors. About a third of Nevada physicians are 60 years of age or older, according to state data. 

This month, the American Dental Association and the National Center for Interstate Compacts presented to state lawmakers on the Interim Committee on Commerce and Labor a reciprocity compact for dentists and dental hygienists.

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"The private equity business model is built on pooling money from big investors like public pensions to take over companies and quickly restructure them, often in ways that are harmful to workers, patients, customers, residents, and ultimately state and local economies,” according to the report. (Getty Images)

Policy, politics and progressive commentary

Nevada is one of the states most vulnerable to the profit-hungry influence of private equity firms, according to a new analysis by a national watchdog group.

Nevada ranked 5th overall in the Private Equity Stakeholders Project’s Private Equity Risk Index, which the group launched this week. Only New Mexico, North Carolina, Arizona and Florida are considered more at risk.

The housing industry in Nevada is particularly at risk, earning a “very high risk” score of 94 out of 100. Only Georgia and Arizona fared worse. Private equity investment often leads to increased rental costs, housing market disruption and unsafe living conditions, according to PESP.

Nevada has one of the highest shares of single-family homes purchased by corporate investors over a five-year period, according to PESP.

PESP recommends states combat the influence of private equity by passing legislation to prohibit evictions of tenants except for specific reasons (such as non-payment of rent), cap annual rent increases statewide or allow local jurisdictions to cap them, and create a mandatory landlord registry to identify corporations with multiple holdings.

Bills for all three recommendations have been introduced in recent sessions but either died in the Nevada State Legislature or were vetoed by the governor.

Private equity’s hold is growing across myriad industries.

“The private equity business model is built on pooling money from big investors like public pensions to take over companies and quickly restructure them, often in ways that are harmful to workers, patients, customers, residents, and ultimately state and local economies,” states PESP. “The focus is on turning a quick profit for investors regardless of the risks and consequences for communities across the country.

The watchdog group ranked Nevada at “high risk” of private equity influence on public pensions and health care and “medium risk” of private equity influence on workers and jobs.

University Medical Center and Culinary Health Fund leaders last month told a committee of state lawmakers they are already feeling the effects of corporate consolidation and private equity investment.

“I was looked in the eye by this company and told our 10% profit margins are not enough; we had to be at 20%,” said UMC CEO Mason Van Houweling.

PESP estimates that companies controlled by private equity firms employ more than 11 million workers nationwide, own millions of homes, and are increasingly moving into critical industries like health care.

“Let’s call out private equity’s abuse for what it is: legal looting,” said U.S. Sen. Elizabeth Warren (D-Mass.) in a statement praising the risk index. “Together, we’re taking on this trillion-dollar, behemoth industry that’s hurting working people and sucking money out of the rest of the economy.”

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Nevada vaccination rates for adults are less than half the national average. (Photo by Emily Elconin/Getty Images)

Policy, politics and progressive commentary

A decline in “vaccine confidence” has contributed to a decrease in child immunization rates, Nevada health officials warned state lawmakers on Monday.

Vaccine rates among adults, which includes Covid and flu shots for the current season, are also only a fraction of the national average, health officials said at the Interim Committee on Health and Human Services. 

“Vaccine confidence took a major hit through the pandemic,”  Kristy Zigenis, the immunization program manager for the Nevada Department of Health and Human Services. “It’s going to take a lot to get us back on the right track.”

Medical providers recommend infants get a 7-vaccine series, which includes the Measles, mumps, rubella (MMR) shot and the vaccine for Diphtheria-Tetanus-Pertussis (DTaP), before 24 months.

But the number of children getting recommended vaccines in Nevada has decreased 3.3% since 2019, Zigenis said. 

Officials were unable to compare state data to national trends since country-wide data is only available through 2020.

The decrease in immunization comes as the U.S. has seen an uptick in diseases like the measles despite the availability of vaccines. National health experts attribute the decline to misinformation. 

As the number of children getting immunized has gone down in the state, Zigenis said there has been an increase in religious exemptions for school attendance. Medical exemptions have stayed about the same. 

Public and charter schools saw 3.5% exemption rates in the 2021 to 2022 school year and private schools had 5.4% rate the same year, she said. . 

That grew to 4.9% in public schools and 8.2% in private schools in the 2022 to 2023 school year. 

According to the Centers of Disease Control and Prevention, “any exemption rate nationally is about 3%,” Zigenis said. The national rate is not a precise comparison because it doesn’t include more recent years. 

Health officials didn’t offer any explanation why Nevada exemption rates are higher than the nation’s. Lawmakers didn’t ask. 

Non-medical exemptions

During public comment, Leann McAllister, the executive director for the Nevada chapter of the American Academy of Pediatrics, encouraged lawmakers to consider eliminating religious exemptions. 

“Immunization requirements for child care and school attendance are an effective means of protecting people from vaccine-preventable diseases both by direct protection from the vaccine and indirect protection from communal immunity,” she said. 

She added that while “legitimately medical exemptions to immunization requirements are important, non-medical exemptions to immunization requirements are problematic.” 

Republican state Sen. Robin Titus, who is a physician, said eliminating religious exemption would send the public the wrong message. Instead, she said it’s up to health care providers to educate the public to regain trust. 

“When the government comes in and says ‘the heck with that we’re just going to pass a law and make you do it’ it’s giving the wrong message,” she said. 

Officials from the Department of Health and Human Services outlined policy proposals implemented in other states to expand access to vaccines and education efforts for those who seek exemptions for students. 

Vermont, Oregon and Utah require parents to go through an extended process when seeking a religious exemption, Zigenis said. 

She added that includes completing an online educational course before the exemption is implemented.  

“We aren’t making a policy recommendation, just providing an overview of what other states do,” said Jullia Peek, the deputy administrator for the Division of Public and Behavioral Health within the department. 

Peek agreed with Titus that there should be additional efforts to regain trust, and training on how health providers talk with vaccine-hesitant patients.

‘Lots of room to grow’

Lawmakers in 2023 passed Assembly Bill 147, which allows dentists, dental hygienists and other previously unauthorized health care providers to administer vaccines. 

Democratic state Sen. Fabian Doñate, who chairs the Interim Health and Human Services Committee, questioned whether lawmakers should expand the scope of the policy to also allow school nurses to give vaccines. 

It’s not just children lagging in vaccine rates. 

Zigenis said only 10.4% of Nevadans over 18 who are eligible for the most recent Covid-19 vaccine or booster have received one.

“The national comparison is at 22.6% so lots of room to grow,” she said.

Zigenis noted when Covid-19 went “to the commercial market there were some hiccups with the rollout and supply constraints.” 

During the initial roll out of the vaccination, costs were paid for by the federal government rather than through a person’s insurance. When that changed in 2023, some people showed up to appointments and were told they would have to pay out of pocket.

The rate of Nevada adults getting vaccinated for the flu is also less than half the national average.

 “We are coming to the tail end of the flu season” and 21.6% of those aged 18 and over have received a dose of the 2023-2024 flu vaccine, Zigenis told the committee, noting the national average is nearly 43%. 

The new RSV vaccine, which is recommended for adults over 60 years old, has also seen low rates in Nevada. The state rate is 12.5% while the national rate is 23.6%.

With data showing pharmacies in the state are the “key source for adult vaccinations,” Zigenis said officials are working with pharmacists to ensure they encourage more vaccinations. 

“If someone comes in for a flu vaccine but they can get an RSV vaccine we want to make sure it’s being offered,” she said.

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Policy, politics and progressive commentary

Nevada lawmakers last year passed legislation making it easier for teachers and emergency medical services personnel licensed in other states to practice in the Silver State. Now, they are already eyeing another industry for occupational reciprocity: dentistry.

The American Dental Association and the National Center for Interstate Compacts on Thursday presented to state lawmakers on the Interim Committee on Commerce and Labor a new compact for dentists and dental hygienists.

Proponents say occupational license compacts allow for increased mobility across states, which makes it easier for people to begin working in their field after relocating. Approximately 15% of recent dental school graduates relocate within the first five years of entering the profession, according to the American Dental Association.

Interstate compacts also make things simpler for licensees who want to practice in more than one state — maybe because they can work remotely, or because they live near a state border.

NCIC, part of the Council of State Governments, early last year finalized model legislation establishing the Dentist and Dental Hygienist Compact. The compact will begin only after seven states have agreed to enter it. So far, only five states have, but nearly a dozen others have legislation pending.

Nevada’s first chance to formally consider joining the compact will be next year during the 2025 Legislative Session.

NCIC representatives cautioned against seeing any occupational compact as a silver bullet that will fix labor shortages, but proponents say they could offer some relief.

Once seven states enter the dental compact, a commission composed of representatives for those states will be formed to oversee the formation of rules and the application process.

The Nevada Dental Association and the Nevada Dental Hygienists Association support the compact.

Occupational license compacts can be especially beneficial to military spouses, said Kelli May Douglas, the Pacific Southwest liaison for the U.S. Department of Defense, who gave a separate presentation to lawmakers.

Douglas noted that President Joe Biden last year signed, as part of a larger veterans bill, the Military Spouse Licensing Relief Act that is meant to reduce the red tape military spouses encounter when relocating due to military orders, but to what extent states and their licensing boards are implementing the spirit of the act varies wildly.

A recent survey conducted by the DOD of military spouses found that roughly 40% have occupational licenses, said Douglas. Many report experiencing issues transferring their licenses.

Common occupational licenses include cosmetology, massage therapy, nursing, paramedic, pharmacy, real estate agent, and social worker.

Nevada had 5,341 active-duty military spouses in 2022, according to the DOD, as well as 4,356 National Guard and reserve spouses.

In 2023, legislation to have Nevada join the Nurse Licensure Compact faced strong opposition from labor unions like SEIU 1107 and failed to advance out of an Assembly committee. Earlier attempts to join that compact, which has been around for more than two decades, also fell short.

A separate proposal to join the Physical Therapy Licensure Compact died in the same Assembly committee, though it passed the full Senate unanimously.

But the Legislature did join Emergency Medical Services Personnel Licensure Interstate Compact and Interstate Teacher Mobility Compact.

SEIU and other labor organizers at the time argued that joining the nursing compact would exacerbate working conditions for employees and weaken collective bargaining power by allowing employers to break strikes.

An NCIC representative told lawmakers Thursday they’ve seen no evidence of such claims being true.

All 50 states (as well as Washington DC, Guam and the U.S. Virgin Islands) have adopted at least one occupational licensing interstate compact, according to NCIC, and 41 have at least three. Midwestern and Southern states have adopted more of them than the coastal states.

Compacts covering nursing, medical and psychology licenses are the most widely adopted, each with 41 states signed.

Nevada has joined five occupational license compacts: emergency medical services (EMS), massage, medicine, psychology, and teaching.

Nevada is also one of 20 states that has some form of universal license recognition. Established in 2017, according to the Institute for Justice, Nevada’s version allows a person licensed by another state to be granted a license only if the home state’s requirements are “substantially equivalent” to Nevada’s.

The post Dentists, hygienists among latest professions considered for interstate license reciprocity appeared first on Nevada Current.

According to March of Dimes, nearly 7 million people of reproductive age live in a county that is considered a maternity care desert as of 2022. About 2.2 million of those people live in an area with no hospital providing obstetric care, no birth center and no obstetrics providers. (Getty Images)

Policy, politics and progressive commentary

The U.S. Department of Health and Human Services announced Thursday a $25,000 increase in loan forgiveness available to primary care providers in designated underserved areas. That means qualifying individuals are eligible for up to $75,000 in forgiveness if they commit to two full-time years of service.

The amount is available to medical and osteopathic doctors, including OB-GYNs, pediatricians, nurse practitioners and midwives, and physician assistants who practice in areas with shortages of primary care providers. The move is meant to help rural and historically underserved communities provide primary care services. It could also help areas that have been deemed “maternal care deserts” after clinics closed because adequate staffing levels could not be maintained, leaving care limited or completely absent and forcing people to travel long distances for standard appointments. This has especially been a problem in states with abortion bans since 2022, including Idaho, Mississippi and South Dakota. Idaho has lost 22% of its practicing OB-GYNs since a near-total abortion ban went into effect in late 2022, along with half of the state’s maternal-fetal medicine specialists, and three clinics across the state closed their labor and delivery units in the same time frame. Doctors have said it has been difficult to recruit new physicians to fill those positions — one doctor said Wednesday that out-of-state applications for openings have dropped significantly.

According to March of Dimes, nearly 7 million people of reproductive age live in a county that is considered a maternity care desert as of 2022, or about 35%. That number has reportedly grown in the past two years. About 2.2 million of those people live in an area with no hospital providing obstetric care, no birth center and no obstetrics providers. The 2022 report showed more than 97,000 Ohioans were affected by reductions in access to maternity care, the highest of any state.

Another 11.4%, according to the report, live in an area considered to have low access to maternity care, meaning fewer than two hospitals or birth centers providing maternity services and fewer than 60 OB-GYN providers. Research also notes challenges finding care in rural and medically underserved communities disproportionately affect people of color, particularly Black patients.

Medical school costs have grown, and associated debt has increased four-fold over the past 30 years, according to HHS, but the maximum loan forgiveness had remained at $50,000 until now. The Health Resources and Services Administration division of HHS is responsible for the program.

An additional maximum of $5,000 in loan repayment will be available for those who pass an oral exam showing they are fluent in Spanish and practice in high need areas with patients who have limited proficiency in English. Research from the American Medical Association has shown those patients have worse health outcomes and provider experiences.

HHS is also working to create new primary care residency programs in rural communities, which would provide 540 openings for physicians in specialty care, once operational, according to the release. It is also conducting more than 25,000 training sessions for practicing primary care providers, including OB-GYNs, nurse midwives and other maternal care providers to diagnose and treat mental health conditions among pregnant patients, new moms, children and adolescents.

The National Health Service Corps Loan Repayment Program is accepting applications until May 9.

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