Distributing the opioid reversal medication is essential to the center’s work to reduce fatal overdoses in the community. But how long the group can continue doing so is in question. The center depends on Colorado’s Opioid Antagonist Bulk Purchase Fund, also known as the Naloxone Bulk Purchase Fund, which now lacks a recurring source of money — despite hundreds of millions of dollars in national opioid lawsuit settlement cash flowing into the state.

“Our concern is that we won’t have access to naloxone, and that means that more people will die of a very preventable overdose,” said Lisa Raville, executive director of the center.

The bulk fund was created in 2019 to provide free naloxone to organizations like the Harm Reduction Action Center. The fund’s annual budget grew from just over $300,000 in fiscal year 2019 to more than $8.5 million in fiscal 2022, according to legislative reports by the state’s Overdose Prevention Unit.

The fund has boosted the availability of the medication throughout Colorado, which passed a law in 2013 that gives legal immunity to medical providers who prescribe the drug and to any person who administers it to someone suffering an overdose. The fund currently provides more than $550,000 worth of naloxone kits to various entities each month.

Despite the increased availability of naloxone, fatal opioid overdoses continued to rise. In 2023, 1,292 people in Colorado died of an opioid overdose, according to data from the Colorado Department of Public Health and Environment. That was 132 more people than the year before.

And now, one of the fund’s major money sources, the American Rescue Plan passed by Congress in response to the covid-19 pandemic, is set to expire next year. As of September, the Colorado fund had $8.6 million left, according to Vanessa Bernal, a spokesperson for the state health department.

The fund got a boost in September when the state’s Behavioral Health Administration provided it with $3 million from a one-time Substance Use Prevention, Treatment, and Recovery Services Block Grant and nearly $850,000 through a State Opioid Response Grant. Colorado Attorney General Phil Weiser said his office will “ensure that the necessary budget remains in place for the next year.”

The amount of that funding and where it will come from has yet to be determined, and long-term solutions are still being weighed, as well. One option to shore up the fund beyond the next year is to use Colorado’s share of settlement funds from the national opioid lawsuits, said Mary Sylla, former director of overdose prevention policy and strategy at the National Harm Reduction Coalition.

“It’s just completely ironic that something that addresses the opioid overdose crisis is underfunded at the very same time that these settlement funds are flowing,” Sylla said. “There couldn’t be a better use for them.”

As of July, Colorado had received and distributed more than $110 million in opioid settlement money to regions, local governments, state entities, and infrastructure projects, according to the Colorado attorney general’s office, and the total is expected to reach more than $750 million by 2038.

However, more than half of the settlement money Colorado has received thus far has already been disbursed to its 19 Regional Opioid Abatement Councils, which have created their own plans to distribute money to programs such as substance abuse treatment centers, public education campaigns, and training for emergency providers.

For example, Denver’s council, which has received more than $18 million since 2022, has disbursed money to organizations in two- and three-year contracts, the majority not including the purchase of naloxone.

“We thought we could all continue to get [naloxone] from the state health department and the Naloxone Bulk Purchase Fund,” Raville said.

The Denver council is working on a plan for the coming years, expected to come out in mid-2025, and is considering the bulk fund’s dwindling money, said Marie Curran, program coordinator for Denver’s opioid abatement funds.

Lawrence Pacheco, a spokesperson for the attorney general’s office, which manages 10% of the state’s opioid settlement dollars, said the office “is working on options to ensure that this lifesaving medication can continue to be part of the state’s effort to abate the opioid crisis.” Those options have not yet been made public.

California, where Sylla works, has used settlement money for a distribution program that’s similar to Colorado’s. In Washington and Kentucky, as part of the states’ settlements with Teva Pharmaceuticals, tens of thousands of free naloxone kits will be available to residents. Each state uses its opioid settlement funds differently, and while many provide naloxone to residents in some manner, including via vending machines, there is no central tracking of naloxone distribution programs.

Over the past five years, Colorado’s fund has distributed more than half a million doses of the opioid reversal drug to hundreds of organizations and schools across the state. Last year, the Harm Reduction Action Center received 7,284 doses from the fund, which Raville estimates helped save more than 4,500 lives.

Unless additional money is found, the bulk fund runs the risk of having to further limit distribution, leaving the hundreds of organizations that rely on it with little or no access to free naloxone. While the medication became available over the counter nationally last fall, the $45 price tag per two-dose package means it can remain out of reach for some who need it most.

In May, the state announced a plan for prioritizing which groups get the medication from the bulk fund, with four categories, from “essential” to “low need,” based on how frequently an entity directly encounters people who are most at risk of experiencing or witnessing an overdose. The Harm Reduction Action Center has been classified in the “essential” category. School districts, as well as colleges and universities, are in the next-highest category.

Another organization, The Naloxone Project, said it was misclassified by not being put at the highest priority level. As a result, it said, it received just 1,200 naloxone doses from the fund this year, instead of the 6,000 it requested.

“We would argue that we would fall under ‘essential’ because many of our programs are public-facing and consistently provide naloxone for people who use drugs and who are at the highest risk of experiencing overdose,” said Rachael Duncan, associate director of The Naloxone Project.

The group, which has chapters in 12 states, provides nasal and injectable forms of naloxone to more than 90% of Colorado’s hospitals, to give to patients before they are discharged from the emergency department or from labor and delivery units. More than half of the 12,000 naloxone kits the project has distributed to Colorado medical entities have come from the bulk fund.

Another organization, UCHealth’s Center for Dependency, Addiction and Rehabilitation, known as CeDAR, which offers residential, outpatient, and telehealth treatment, is no longer eligible to receive free naloxone, because its patients typically are insured or can pay out-of-pocket.

Karli Yarnell, a CeDAR physician assistant, said that even when someone can pay for it, that doesn’t mean they can get to a pharmacy to pick up the medicine.

And Duncan is concerned about what the loss of doses will mean for organizations like The Naloxone Project and CeDAR.

“What I fear will happen is a scarcity mindset of organizations competing for funding,” Duncan said. “But I also worry about places that are used to getting it so reliably running out.”

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“I didn’t know what I was going to do, where I was going to go,” he told me, describing a period of crisis that began in 2017.

Seeking a change of venue, Rousseau moved to the mountains of North Carolina, the start of an extended period of wandering. Soon, a sense of emptiness enveloped him. He had no friends or hobbies — his work as a doctor had been all-consuming. Former colleagues didn’t get in touch, nor did he reach out.

His wife had passed away after a painful illness a decade earlier. Rousseau was estranged from one adult daughter and in only occasional contact with another. His isolation mounted as his three dogs, his most reliable companions, died.

Rousseau was completely alone — without friends, family, or a professional identity — and overcome by a sense of loss.

“I was a somewhat distinguished physician with a 60-page resume,” Rousseau, now 73, wrote in the Journal of the American Geriatrics Society in May. “Now, I’m ‘no one,’ a retired, forgotten old man who dithers away the days.”

In some ways, older men living alone are disadvantaged compared with older women in similar circumstances. Research shows that men tend to have fewer friends than women and be less inclined to make new friends. Often, they’re reluctant to ask for help.

“Men have a harder time being connected and reaching out,” said Robert Waldinger, a psychiatrist who directs the Harvard Study of Adult Development, which has traced the arc of hundreds of men’s lives over a span of more than eight decades. The men in the study who fared the worst, Waldinger said, “didn’t have friendships and things they were interested in — and couldn’t find them.” He recommends that men invest in their “social fitness” in addition to their physical fitness to ensure they have satisfying social interactions.

Slightly more than 1 in every 5 men ages 65 to 74 live alone, according to 2022 Census Bureau data. That rises to nearly 1 in 4 for those 75 or older. Nearly 40% of these men are divorced, 31% are widowed, and 21% never married.

That’s a significant change from 2000, when only 1 in 6 older men lived by themselves. Longer life spans for men and rising divorce rates are contributing to the trend. It’s difficult to find information about this group — which is dwarfed by the number of women who live alone — because it hasn’t been studied in depth. But psychologists and psychiatrists say these older men can be quite vulnerable.

When men are widowed, their health and well-being tend to decline more than women’s.

“Older men have a tendency to ruminate, to get into our heads with worries and fears and to feel more lonely and isolated,” said Jed Diamond, 80, a therapist and the author of “Surviving Male Menopause” and “The Irritable Male Syndrome.”

Add in the decline of civic institutions where men used to congregate — think of the Elks or the Shriners — and older men’s reduced ability to participate in athletic activities, and the result is a lack of stimulation and the loss of a sense of belonging.

Depression can ensue, fueling excessive alcohol use, accidents, or, in the most extreme cases, suicide. Of all age groups in the United States, men over age 75 have the highest suicide rate, by far.

For this column, I spoke at length to several older men who live alone. All but two (who’d been divorced) were widowed. Their experiences don’t represent all men who live alone. But still, they’re revealing.

The first person I called was Art Koff, 88, of Chicago, a longtime marketing executive I’d known for several years. When I reached out in January, I learned that Koff’s wife, Norma, had died the year before, leaving him hobbled by grief. Uninterested in eating and beset by unremitting loneliness, Koff lost 45 pounds.

“I’ve had a long and wonderful life, and I have lots of family and lots of friends who are terrific,” Koff told me. But now, he said, “nothing is of interest to me any longer.”

“I’m not happy living this life,” he said.

Nine days later, I learned that Koff had died. His nephew, Alexander Koff, said he had passed out and was gone within a day. The death certificate cited “end stage protein calorie malnutrition” as the cause.

The transition from being coupled to being single can be profoundly disorienting for older men. Lodovico Balducci, 80, was married to his wife, Claudia, for 52 years before she died in October 2023. Balducci, a renowned physician known as the “patriarch of geriatric oncology,” wrote about his emotional reaction in the Journal of the American Geriatrics Society, likening Claudia’s death to an “amputation.”

“I find myself talking to her all the time, most of the time in my head,” Balducci told me in a phone conversation. When I asked him whom he confides in, he admitted, “Maybe I don’t have any close friends.”

Disoriented and disorganized since Claudia died, he said his “anxiety has exploded.”

We spoke in late February. Two weeks later, Balducci moved from Tampa to New Orleans, to be near his son and daughter-in-law and their two teenagers.

“I am planning to help as much as possible with my grandchildren,” he said. “Life has to go on.”

Verne Ostrander, a carpenter in the small town of Willits, California, about 140 miles north of San Francisco, was reflective when I spoke with him, also in late February. His second wife, Cindy Morninglight, died four years ago after a long battle with cancer.

“Here I am, almost 80 years old — alone,” Ostrander said. “Who would have guessed?”

When Ostrander isn’t painting watercolors, composing music, or playing guitar, “I fall into this lonely state, and I cry quite a bit,” he told me. “I don’t ignore those feelings. I let myself feel them. It’s like therapy.”

Ostrander has lived in Willits for nearly 50 years and belongs to a men’s group and a couples’ group that’s been meeting for 20 years. He’s in remarkably good health and in close touch with his three adult children, who live within easy driving distance.

“The hard part of living alone is missing Cindy,” he told me. “The good part is the freedom to do whatever I want. My goal is to live another 20 to 30 years and become a better artist and get to know my kids when they get older.”

The Rev. Johnny Walker, 76, lives in a low-income apartment building in a financially challenged neighborhood on Chicago’s West Side. Twice divorced, he’s been on his own for five years. He, too, has close family connections. At least one of his several children and grandchildren checks in on him every day.

Walker says he had a life-changing religious conversion in 1993. Since then, he has depended on his faith and his church for a sense of meaning and community.

“It’s not hard being alone,” Walker said when I asked whether he was lonely. “I accept Christ in my life, and he said that he would never leave us or forsake us. When I wake up in the morning, that’s a new blessing. I just thank God that he has brought me this far.”

Waldinger recommended that men “make an effort every day to be in touch with people. Find what you love — golf, gardening, birdwatching, pickleball, working on a political campaign — and pursue it,” he said. “Put yourself in a situation where you’re going to see the same people over and over again. Because that’s the most natural way conversations get struck up and friendships start to develop.”

Rousseau, the retired South Carolina doctor, said he doesn’t think about the future much. After feeling lost for several years, he moved across the country to Jackson, Wyoming, in the summer of 2023. He embraced solitude, choosing a remarkably isolated spot to live — a 150-square-foot cabin with no running water and no bathroom, surrounded by 25,000 undeveloped acres of public and privately owned land.

“Yes, I’m still lonely, but the nature and the beauty here totally changed me and focused me on what’s really important,” he told me, describing a feeling of redemption in his solitude.

Rousseau realizes that the death of his parents and a very close friend in his childhood left him with a sense of loss that he kept at bay for most of his life. Now, he said, rather than denying his vulnerability, he’s trying to live with it. “There’s only so long you can put off dealing with all the things you’re trying to escape from.”

It’s not the life he envisioned, but it’s one that fits him, Rousseau said. He stays busy with volunteer activities — cleaning tanks and running tours at Jackson’s fish hatchery, serving as a part-time park ranger, and maintaining trails in nearby national forests. Those activities put him in touch with other people, mostly strangers, only intermittently.

What will happen to him when this way of living is no longer possible?

“I wish I had an answer, but I don’t,” Rousseau said. “I don’t see my daughters taking care of me. As far as someone else, I don’t think there’s anyone else who’s going to help me.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit kffhealthnews.org/columnists to submit your requests or tips.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Montana is looking to fast-track Medicaid access for older adults who need help to stay in their homes or towns.

Medicaid, the joint federal-state health care program for low-income Americans, opens the door to services such as paying for help to prepare meals or shower safely. But applying for and obtaining that coverage can take weeks or months, leaving aging people in a dangerous limbo: too vulnerable to live at home without assistance, but too healthy to merit a hospital or nursing home bed.

Montana lawmakers drafted a bill for the legislative session that begins in January that would create a shortcut to that care. The Children, Families, Health, and Human Services Interim Committee’s proposal would allow older people and those with a physical disability who are likely eligible for Medicaid to start receiving in-home and community-based care while awaiting final approval.

The goal of presumptive eligibility is to avoid delays in providing stabilizing care outside of medical facilities. Supporters of the plan say local care is also a lot less expensive than hospital or nursing home care.

Montana would join at least 11 states that have presumptive eligibility for seniors and people with disabilities to access in-home care, according to AARP. Washington state began expediting Medicaid coverage in 2023 for people recently discharged from a hospital and plans to expand coverage further. Rhode Island authorizes such benefits to new long-term care applicants. And a law signed last winter in New Jersey means seniors there will have similar access.

People who are hospitalized or checked into a nursing home can struggle to find the middle-ground option for care they need.

Katy Mack, a spokesperson for the Montana Hospital Association, said bottlenecks in the process are difficult for patients, long-term care providers, and hospitals.

“Many elderly patients do ‘get stuck’ in hospitals waiting for transfer to a more appropriate level of care,” Mack said in an email. “This is due to a variety of issues, including staffing, bed availability, and appropriate payments from the patient’s source of health coverage.”

Tyler Amundson, executive director of Big Sky Senior Services, a nonprofit that helps seniors stay in their home, said in one case, a couple without the support they needed ended up in the hospital dozens of times over two months.

“There are a lot of seniors in our community struggling,” Amundson said. “They’ll go home from a hospital with just enough care to get by for a little while.”

The nation’s pool of older Americans is getting bigger. With age comes more medical complications. People 65 or older have the highest rate of preventable hospitalizations, and medical emergencies risk worse health outcomes.

Rising health care costs are fueling anxiety among tens of millions of seniors, with 1 in 10 living below the federal poverty level. Older adults are struggling to pay the combined cost of housing and medical care, and some become homeless.

For years, states have had the option through the Affordable Care Act to allow qualified hospitals to extend presumptive eligibility to some adults based on their income, on top of the opportunity that most states give pregnant women and children. But in states such as Montana, people 65 and older haven’t been included. States need a federal waiver to expand who qualifies for that early access.

Alice Burns, who researches Medicaid issues at KFF, a health information nonprofit that includes KFF Health News, said widening presumptive eligibility for in-home and community-based care gained momentum during the covid-19 pandemic.

“It’s easy to understand why,” Burns said. “When we had the fatality rates in nursing facilities that we did, it was like, OK, we cannot send these people to the nursing facilities unnecessarily.”

The Montana proposal would, after state training, allow tribal entities, area agencies on aging, and hospitals, among others, to screen patients for presumptive eligibility. Approved patients would begin receiving services while state health officials review their applications.

The draft bill spells out some covered services, such as meal delivery and in-home medical equipment. Lawmakers noted it’s not clear if the proposal would help people move into long-term care, such as assisted living facilities, which offer daily support rather than medical treatment.

Montana officials don’t have an estimate for how much the temporary coverage would cost. Jon Ebelt, a spokesperson for the Montana Department of Public Health and Human Services, declined to comment on the proposal.

Mike White is a co-owner of Caslen Living Centers, which has six small assisted living facilities across central and southwestern Montana. His company no longer accepts Medicaid applicants until their coverage is final, and White said it’s not alone. He said that process can take anywhere from three to six months due to cumbersome paperwork, which he said is too long for small businesses to go without pay.

State officials have said delays in Medicaid approval often stem from ongoing communication with applicants.

The state’s Medicaid program has gone through major upheaval in the past year as states nationwide reviewed eligibility for everyone on the program. Montana officials dropped more than 115,300 people from coverage in that process, according to the state’s final report. Those disenrollments continued as nonprofits and patients alike cited problems in the state’s process, including delays in application processing and access to help for other safety net services.

Now, state lawmakers predict a major political fight during the legislative session over whether to continue to allow expanded Medicaid access to people who earn up to 138% of the federal poverty level, or about $43,000 a year for a family of four.

State Rep. Mike Yakawich, the Billings Republican behind the presumptive eligibility proposal, said he wants to keep some of its language vague. He’s leaving room for negotiations and potential amendments during the legislative session and beyond.

“The focus is to keep people at home, and it’s still going to be a hard lift to get it past the session,” Yakawich said. “We can add more to it two years from now.”

Not everyone on the interim committee was on board.

Sen. Daniel Emrich, a Republican from Great Falls, voted against the policy, saying it sounded too much like a gamble for families.

“We run the risk of taking and providing a service that’s then going to be pulled out from under them,” Emrich said.

The counterargument is that such cases would be rare. Burns, with KFF, said there is no reliable data nationally to show how often people are denied Medicaid after being presumed eligible. Presumptive access to Medicaid in-home programs is relatively new. And, from hospital data for other patients, it’s difficult to know whether a person was denied Medicaid because they didn’t qualify or because they didn’t complete the paperwork after leaving the hospital.

“There’s all these places where the ball could get dropped,” Burns said.

She said the difference with measures like Montana’s is that support services follow patients in their daily life, making it less likely patients would fall off the radar.

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Current enrollees who do not update their information or select an alternative will be automatically reenrolled in their current plan or, if that plan is no longer available, into a plan with similar coverage.

Last year marked a record enrollment of about 21 million people. This time around, consumers will find a few things have changed.

Don’t Fall for Advertising Scams

While some health plans offer small-dollar gift cards or other incentives to encourage participation in wellness efforts, they would not offer cash cards worth thousands of dollars a month to help with groceries, gas, or rent. Even so, social media and online sites are rife with such promises.

Such ads are among the avenues allegedly used by unscrupulous brokers who enroll or switch plans without the express permission of consumers, according to a lawsuit filed in Florida.

Also, be cautious about the websites you use to search for coverage.

Type “Obamacare” or “cheap health insurance” into a search engine and often what pops up first are sponsored private sector websites unaffiliated with the official state or federal government marketplaces for ACA coverage.

While they may try to look official, they are not. Many such sites offer various options, including non-ACA coverage with limited benefits, a “secret shopper” study found in 2023. Such non-ACA coverage would not qualify for federal subsidies to help consumers pay premiums.

The fine print on some websites says that consumers who provide personal information automatically consent to be contacted by sales agents via phone calls, emails, text messages, or automated systems with prerecorded messages.

When exploring plans, always start with the official federal marketplace’s website, healthcare.gov.

Even if you don’t live in one of the 29 states served by the federal marketplace, its website provides the link to your official enrollment site when you select your state, or the District of Columbia, from a drop-down list. The federal and state marketplaces also have call centers and other ways to get enrollment assistance. The “find local help” link on healthcare.gov, for example, gives consumers a choice of finding assisters or sales agents near them.

Is It Real Insurance?

Another concern: Regulators are seeing an increase in complaints from consumers about offers of health coverage requiring consumers to join a limited liability corporation, or otherwise attest they are working for a specific company. Indeed, at least two states — Maryland and Maine — have issued warnings, saying that instead of comprehensive ACA coverage, these are often non-ACA products, amounting to a hodgepodge of discount cards, for example, or limited-indemnity plans. This type of plan pays a flat-dollar amount — say, $50 for a doctor visit or $1,000 for a hospital stay — and is meant to buttress more comprehensive coverage, not replace it.

“Unlike major medical plans, some of these self-funded plans only cover preventive services such as a yearly check-up or annual health screening,” the warning from the Maine Bureau of Insurance says.

Premiums Might Be Higher … and Other New Things

Some insurers will lower premium rates for 2025, but many others are increasing them.

Although final numbers are still being crunched, experts estimate a median increase of 7% for premiums, according to an analysis by KFF, a health information nonprofit that includes KFF Health News. Most people who buy ACA coverage are eligible for a subsidy to help with the premiums, which is likely to offset much of the increase, although the higher cost means the government will be paying out more for those subsidies.

Rising health costs — including for hospital care and the new class of weight loss drugs — are contributing to the increase.

Some other changes this open season:

• People often referred to as “Dreamers” because they qualified for the Deferred Action for Childhood Arrivals — a federal program offering some protection to those brought to the country as children without proper immigration documentation — can now enroll in ACA coverage and are eligible for subsidies.
• Short-term plans, which are technically not ACA coverage and not subject to its benefit rules and preexisting benefit protections, can be issued for, at most, only four months of coverage, based on a Biden administration action that took effect with plans starting Sept. 1. It walks back a Trump administration rule that loosened requirements to allow insurers to offer coverage that ranged up to 364 days, and allowed insurers the option of renewing the policies for up to two additional years. Existing plans and those issued before Sept. 1 don’t fall under the new rules. But consumers who relied on the longer periods need to check their plans’ details and consider enrolling in an ACA plan instead to avoid a situation in which their short-term plan expires early or midyear, potentially leaving them unable to get coverage elsewhere for the remainder of the year.

The Sign-Up Process Might Take Longer, Too

Federal regulators this year wrestled with a growing number of complaints — 200,000 in the first six months alone — from consumers who were being enrolled into or switched from ACA plans without their express permission by agents seeking to gain commissions.

To thwart such efforts, they put new rules in place.

What does that mean for most consumers? If you are working with a new agent — one who wasn’t already listed on your ACA plan — you will likely need to get on a three-way call with the federal marketplace to confirm that you are, indeed, authorizing that agent to make changes to your policy for the coming year. Plan on this taking additional time. No one knows how busy the call lines will get during open enrollment.

You don’t need to use a broker to enroll. But sorting through the dozens of options on the marketplace is challenging, so most people do seek assistance. Consumers need to weigh not only the monthly premium cost, but also variations in deductibles and copayments for such things as doctor visits, hospitalization, and drugs.

Shop Around

Experts say another consideration when choosing a plan is to check whether its network includes the doctors and hospitals you typically see, as well as whether its formulary covers your prescription medications, and how much it charges for them.

To help with making comparisons, rules kicked in two years ago requiring insurers to include some “standardized plans” as options, which must all have the same deductibles, and costs for such things as doctor visits, emergency room care, and other consumer cost sharing.

Even so, many people have dozens of options available, which can be daunting.

But one piece of advice remains constant: Whether you are enrolling for the first time or have an existing plan, it’s always worth it to shop around. Even if you don’t change plans, you can make sure the one you have is still your best option.

In most states, consumers must enroll by Dec. 15 to get coverage that begins Jan. 1. Heads up in Idaho, where open enrollment starts earlier — Oct. 15 — but also ends sooner, closing on Dec. 15. In California, New Jersey, New York, Rhode Island, and the District of Columbia, residents can enroll through Jan. 31.

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New laws to curb aggressive hospital billing, to expand charity care for lower-income patients, and to rein in debt collectors have been enacted in more than 20 states since 2021.

Democrats championed most measures. But the legislative efforts often passed with Republican support. In a few states, GOP lawmakers led the push to expand patient protections.

“Regardless of their party, regardless of their background … any significant medical procedure can place people into bankruptcy,” Florida House Speaker Paul Renner, a conservative Republican, said in an interview. “This is a real issue.”

Renner, who has shepherded controversial measures to curb abortion rights and expand the death penalty in Florida, this year also led an effort to limit when hospitals could send patients to collections. It garnered unanimous support in the Florida Legislature.

Bipartisan measures in other states have gone further, barring unpaid medical bills from consumer credit reports and restricting medical providers from placing liens on patients’ homes.

About 100 million people in the U.S. are burdened by some form of health care debt, forcing millions to drain savings, take out second mortgages, or cut back on food and other essentials, KFF Health News has found. A quarter of those with debt owed more than $5,000 in 2022.

“Republicans in the legislature seem more open to protecting people from medical debt than from other kinds of debt,” said Marceline White, executive director of Economic Action Maryland, which helped lead efforts in that state to stop medical providers from garnishing the wages of low-income patients. That bill drew unanimous support from Democrats and Republicans

“There seems to be broad agreement that you shouldn’t lose your home or your life savings because you got ill,” White said. “That’s just a basic level of fairness.”

Medical debt remains a more polarizing issue in Washington, where the Biden administration has pushed several efforts to tackle the issue, including a proposed rule by the Consumer Financial Protection Bureau, or CFPB, to bar all medical debt from consumer credit reports.

Vice President Kamala Harris, who is spearheading the administration’s medical debt campaign, has touted the work on the presidential campaign trail while calling for new efforts to retire health care debt for millions of Americans.

Former President Donald Trump doesn’t typically talk about medical debt while stumping. But congressional Republicans have blasted the CFPB proposal, which House Financial Services Committee Chairman Patrick McHenry (R-N.C.) called “regulatory overreach.”

Nevertheless, pollster Michael Perry, who has surveyed Americans extensively about health care, said that conservative voters typically wary of government seem to view medical debt through another lens. “I think they feel it’s so stacked against them that they, as patients, don’t really have a voice,” he said. “The partisan divides we normally see just aren’t there.”

When Arizona consumer advocates put a measure on the ballot in 2022 to cap interest rates on medical debt, 72% of voters backed the initiative.

Similarly, nationwide polls have found more than 80% of Republicans and Democrats back limits on medical debt collections and stronger requirements that hospitals provide financial aid to patients.

Perry surfaced something else that may be driving bipartisan interest in medical debt: growing mistrust as health systems get bigger and act more like major corporations. “Hospitals aren’t what they used to be,” he said. “That is making it clear that profit and greed are driving lots of the decision-making.”

Not every state effort to address medical debt has garnered broad bipartisan support.

When Colorado last year became the first state to bar medical debt from residents’ credit reports, just one Republican lawmaker backed the measure. A Minnesota bill that did the same thing this year passed without a single GOP vote.

But elsewhere, similarly tough measures have sailed through.

A 2024 Illinois bill to bar credit reporting for medical debt passed unanimously in the state Senate and cleared the House of Representatives 109-2. In Rhode Island, not a single GOP lawmaker opposed a credit reporting ban.

And when the California Legislature took up a 2021 bill to require hospitals in the state to provide more financial assistance to patients, it passed 72-0 in the state Assembly and 39-0 in the Senate.

Even some conservative states, such as Oklahoma, have taken steps, albeit more modest. A new law there bars medical providers from pursuing patients for debts if the provider has not publicly posted its prices. The measure, signed by the state’s Republican governor, passed unanimously.

New Mexico state Sen. Steve Neville, a Republican who backed legislation to restrict aggressive collections against low-income patients in that state, said he was simply being pragmatic.

“There was not much advantage to spending a lot of time trying to do collections on indigent patients,” Neville said. “If they don’t have the money, they don’t have the money.” Three of 12 GOP senators supported the measure.

North Carolina state Treasurer Dale Folwell, a Republican who as a state legislator spearheaded a 2012 effort to ban same-sex marriage, said all elected officials, no matter their party, should care about what medical debt is doing to patients.

“It doesn’t matter if, as a conservative, I’m saying these things, or if Bernie Sanders is saying these things,” Folwell said, referencing Vermont’s liberal U.S. senator. “At the end of the day, it should be all our jobs to advocate for the invisible.”

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Desde 2021, en más de 20 estados se han promulgado nuevas leyes para frenar la facturación abusiva de los hospitales, ampliar la atención caritativa a los pacientes con ingresos más bajos y frenar a los recaudadores de deudas.

Los demócratas impulsaron la mayoría de las medidas. Pero estas iniciativas legislativas a menudo fueron aprobadas también con el apoyo de los republicanos. Incluso, en algunos estados, los legisladores republicanos lideraron los proyectos para ampliar la protección a los pacientes.

“Independientemente de cuál sea su partido político, independientemente de su origen… cualquier procedimiento médico importante puede llevar a las personas a la bancarrota”, dijo en una entrevista el presidente de la Cámara de Representantes de Florida, Paul Renner, un republicano conservador. “Este es un problema real”.

Renner, que ha liderado controversiales medidas para frenar el derecho al aborto y ampliar la pena de muerte en Florida, también encabezó este año un proyecto para limitar los casos en los que los hospitales podían enviar las cuentas impagas de los pacientes a agencias de cobros. Obtuvo el apoyo unánime de la Legislatura de Florida.

Las medidas bipartidistas adoptadas en otros estados han ido más lejos, prohibiendo que estas facturas médicas figuren en los informes crediticios de los consumidores y restringiendo la posibilidad de que los proveedores médicos embarguen las viviendas de los pacientes.

Según KFF Health News, unas 100 millones de personas en el país están agobiadas por algún tipo de deuda relacionada con la atención médica, lo que obliga a millones a utilizar sus ahorros, pedir segundas hipotecas o recortar los gastos en alimentos y otros artículos de primera necesidad. Una cuarta parte de quienes tienen deudas debían más de $5.000 en 2022.

“En la Legislatura, los republicanos parecen más abiertos a proteger a la gente de la deuda médica que de cualquier otro tipo de deuda”, opinó Marceline White, directora ejecutiva de Economic Action Maryland, una organización sin fines de lucro que ayudó a liderar los esfuerzos en ese estado para detener a los proveedores médicos que pretendían embargar los salarios de los pacientes de bajos ingresos. El proyecto de ley recibió el apoyo unánime de demócratas y republicanos.

“Parece existir un amplio consenso en que no se debe perder la casa o los ahorros de toda la vida por haberse enfermado”, dijo White. “Es un nivel básico de justicia”.

La deuda médica sigue siendo un tema controversial en Washington, donde la administración Biden ha impulsado varias iniciativas para abordar el problema, incluida una propuesta de reglamentación por parte de la Oficina de Protección Financiera del Consumidor (CFPB), que prohibiría que cualquier deuda médica aparezca en los informes de crédito de los consumidores.

La vicepresidenta Kamala Harris, que encabeza la iniciativa del gobierno contra la deuda médica, se ha referido a estas iniciativas en la campaña presidencial. Harris también ha pedido que se refuercen las medidas para ayudar a millones de estadounidenses a pagar su deuda médica.

El ex presidente Donald Trump no suele hablar de la deuda médica cuando hace campaña. Pero los congresistas republicanos han criticado la propuesta de la CFPB, que el presidente del Comité de Servicios Financieros de la Cámara, Patrick McHenry (del Comité Nacional Republicano), calificó de “extralimitación regulatoria”.

Sin embargo, el encuestador Michael Perry, que ha investigado ampliamente lo que opinan los estadounidenses sobre la atención médica, comentó que los votantes conservadores, que suelen desconfiar del gobierno, parecen ver la deuda médica de otra manera. “Creo que sienten que está todo tan en su contra que ellos, como pacientes, realmente no tienen voz”, explicó. “Las divisiones políticas que normalmente vemos, en esta cuestión simplemente no están presentes”.

Cuando los defensores de los consumidores de Arizona propusieron en las boletas electorales de 2022 una medida para limitar los tipos de interés de las deudas médicas, el 72% de los votantes se pronunció a favor de la iniciativa.

Del mismo modo, encuestas a nivel nacional han revelado que más del 80% de los republicanos y demócratas respaldan la implementación de límites en los cobros de deudas médicas y que se fijen requisitos más estrictos para que los hospitales ofrezcan ayuda financiera a los pacientes.

Perry sacó a relucir otro factor que puede estar impulsando el interés de ambos partidos por la deuda médica: la creciente desconfianza de los ciudadanos a medida que los sistemas de salud se hacen más grandes y actúan como grandes corporaciones. “Los hospitales ya no son lo que eran”, dijo. “Eso está dejando claro que el lucro y la codicia son los que están dirigiendo gran parte de la toma de decisiones”.

No obstante, no todos los esfuerzos estatales para hacer frente a la deuda médica han obtenido un amplio apoyo tanto de demócratas como de republicanos.

El año pasado, cuando Colorado se convirtió en el primer estado que prohibió la inclusión de las deudas médicas en los informes de crédito de los residentes, sólo un legislador republicano respaldó la medida.

Y en Minnesota un proyecto de ley similar se aprobó este año sin un solo voto del Partido Republicano.

En otros lugares, medidas igual de estrictas se han aprobado sin inconvenientes.

Por ejemplo en Illinois, este año, se votó por unanimidad en el senado estatal, y se aprobó por 109 votos a favor y dos en contra en la Cámara de Representantes, un proyecto de ley que prohíbe el reporte de deuda médica en los informes de crédito.

En Rhode Island ningún legislador del Partido Republicano se opuso a la prohibición del reporte de crédito.

Finalmente, cuando la Legislatura de California examinó un proyecto de ley de 2021  para exigir a los hospitales del estado que proporcionen más asistencia financiera a los pacientes, la propuesta fue aprobada por 72 votos a favor y ninguno en contra en la Asamblea estatal y por 39 a 0 en el Senado.

Incluso algunos estados conservadores, como Oklahoma, han tomado medidas, aunque más modestas. Una nueva ley prohíbe a los proveedores médicos reclamar deudas a los pacientes si no han hecho públicas sus tarifas. La resolución, firmada por el gobernador republicano del estado, fue apoyada por unanimidad.

Steve Neville, senador republicano por Nuevo México, que respaldó una ley para restringir los cobros abusivos a pacientes de bajos ingresos en ese estado, dijo que simplemente estaba siendo pragmático.

“No era muy beneficioso dedicar mucho tiempo a intentar cobrar a pacientes indigentes”, dijo Neville. “Si no tienen dinero, no tienen dinero”. Tres de los 12 senadores republicanos apoyaron la medida.

El tesorero estatal de Carolina del Norte, Dale Folwell, republicano que como legislador estatal encabezó en 2012 un intento para prohibir el matrimonio entre personas del mismo sexo, dijo que todos los funcionarios electos, sin que importe su partido, deberían preocuparse por el modo en que las deudas médicas están afectando a los pacientes.

“No importa si, como conservador, estoy diciendo estas cosas, o si Bernie Sanders está diciendo estas mismas cosas”, dijo Folwell, en referencia al senador liberal de Vermont. “Al fin y al cabo, todos deberíamos asumir la responsabilidad de defender a aquellos que permanecen invisibles ante la sociedad”.

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“The Republicans don’t want to claim it,” Trump told an interviewer in late September.

Instead, on at least 17 occasions this year, Trump has promised to cut funding to schools that mandate vaccines. Campaign spokespeople have previously said that pledge would apply only to schools with covid mandates. But speeches reviewed by KFF Health News included no such distinction — raising the possibility Trump would also target vaccination rules for common, potentially lethal childhood diseases like polio and measles.

The Trump campaign did not respond to requests for comment on this article.

Trump has presided over a landslide shift in his party’s views on vaccines, reflected this campaign season in false claims by Republican candidates during the primaries and puzzling conspiracies from prominent conservative voices. Republicans increasingly express worry about the risks of vaccines. A September 2023 poll from Politico and Morning Consult showed a narrow majority of those voters cared more about the risks than the benefits of getting inoculated.

A surge in anti-vaccine policy in statehouses has followed the rhetoric. Boston University political scientist Matt Motta, who tracks public health policy, said preliminary data shows that states enacted at least 42 anti-vaccine bills in 2023 — nearly a ninefold surge since 2019.

In some states, it has the look of a crusade: The 2024 Texas GOP platform, for example, proposes a ban on mRNA technology, the innovation behind some covid-19 vaccines that scientists believe could have significant applications for cancer care.

Last month, Trump made an appeal to anti-vaccine voters by landing the endorsement of Robert F. Kennedy Jr., one of the nation’s most prominent vaccine skeptics — and appointing him to his transition team. In a recent tour with former Fox News broadcaster Tucker Carlson, Kennedy said he was “going to be deeply involved in helping to choose the people who run FDA, NIH, and CDC.”

Trump’s outreach can be more discreet: He recently met with a delegation of vaccine-skeptical activists — including one group pushing an end to mandates and certain types of vaccines — at his New Jersey golf club; the discussion was publicized by the conservative blog “Gateway Pundit.”

Trump has options in advancing anti-vaccine goals as president, such as by sowing further doubt and undermining the federal government’s ability to make vaccine recommendations. He has promised to appoint Kennedy, along with “top experts,” to a panel exploring chronic diseases, some of which Kennedy’s nonprofit has linked to inoculations. “Nobody’s done more” to advocate for “the health of our families and our children,” Trump declared at a rally accepting Kennedy’s endorsement.

Still, it’s hard to tell how Trump’s most frequently made proposal — defunding schools that mandate vaccinations — would translate into action, said Judith Winston, former general counsel of the Department of Education during the Obama administration.

Currently, the Department of Education lacks the power to turn off public school funding all at once, she said — meaning a second Trump administration would have to take away money program by program.

And the legal basis for such a move isn’t clear. “I am unaware of any federal law that mandates school districts either provide or not provide a vaccine,” Winston said, adding it would probably require congressional action.

All 50 states have a vaccine requirement tied to school attendance.

Trump’s outreach to anti-vaccine constituencies comes as vaccine hesitancy increases and preventable disease surges. This summer, Oregon experienced its worst outbreak of measles since 1991.

The situation could get worse, said Tom Frieden, a former director of the Centers for Disease Control and Prevention: In the Nineties, during a time when vaccine skepticism also proliferated, the U.S. saw thousands of measles cases. According to the CDC, we haven’t yet returned to those bad old days — but the number of measles cases recorded this year is already quadruple that of last year.

“It was highly disruptive,” he said. “Many children who had measles ended up with hearing problems or cognitive problems that were lifelong. A small number died in this country.”

Worldwide, the disease killed over 100,000 in 2022, mostly among children under age 5, according to the World Health Organization.

Polling shows a substantial minority of Americans, concentrated in the Republican Party, hold vaccine-skeptical positions, said Harvard professor and health politics expert Robert Blendon. And skepticism about covid vaccines is blossoming into suspicion of vaccines generally among that group, he said. “It follows from this rebellion against the covid vaccine mandates.”

Vaccine opposition has divided the GOP. Florida Gov. Ron DeSantis made opposition to vaccines a core part of his ill-fated campaign for the GOP presidential nomination. In states such as Wyoming and Missouri, pitched primary campaigns centered on anti-vaccine themes this year.

Bob Onder, a physician and Republican candidate for Congress in Missouri, was accused in Facebook ads placed by his top opponent of taking millions from pharmaceutical companies to test vaccines. “He profited from our pain,” one ad said. “You suffered the consequences.”

Onder “has never done covid vaccine research” and opposes covid vaccine mandates, his campaign manager, Charley Lovett, told KFF Health News. (Lovett said Onder “conducted” one study sponsored by AstraZeneca on preventing covid in high-risk patients using monoclonal antibodies, not vaccines.)

Onder won the Republican primary, but his vaccine-disparaging opponent still scored just over 37% of the vote.

Anti-vaccine candidates typically become anti-vaccine policymakers. The impact can be seen in Texas, where vaccine politics were once a bipartisan matter. According to researchers, from 2009 to 2019, legislators there passed 19 pro-vaccine bills, such as a measure allowing pharmacists to administer immunizations.

But that consensus began to shift toward the end of the decade. Small groups, often nurtured on Facebook, made their influence felt. One such group, Texans for Vaccine Choice, spurred testimony before the state legislature in 2021 and targeted pro-immunization legislators, some of whom fell in their GOP primaries.

Misinformation has fueled the anti-vaccine turn in Texas, alongside traditional conservative attitudes about individual autonomy, said Summer Wise, a former executive committee member of the state’s Republican Party — particularly misconceptions about the use of fetal cells in vaccine development; falsified research about a link between vaccines and autism; and conspiracy theories about Bill Gates, the billionaire philanthropist who has championed vaccination.

“Politicians see vaccines as an easy foil to propagate fear among the electorate, which can then be leveraged and directed to control a voting bloc,” Wise said.

In addition to calling for a ban on mRNA technology, the Texas GOP’s 2024 platform features a laundry list of policies that could undermine vaccination, including allowing medical residents and physicians the ability to opt out of administering shots for religious reasons. It also calls for enshrining a patient’s ability to opt out of vaccine mandates in the state’s Bill of Rights.

Nationally, anti-immunization policies could take an aggressive turn under a second Trump administration.

Roger Severino, formerly head of the Department of Health and Human Services’ Office of Civil Rights and now with the Heritage Foundation, penned the health agency section of Project 2025, the Heritage Foundation-led initiative to plan for a Republican administration.

Among other ideas, the document proposes clipping CDC authority to issue vaccine or quarantine guidance of a “prescriptive” nature, targeted at schools or elsewhere.

A spokesperson for the Heritage Foundation noted Severino has said the agency’s credibility has been hurt, and it has a burden to explain “all the vaccines on the schedule being taken in combination.”

The proposal misunderstands CDC’s history and powers, said Lawrence Gostin, a public health law professor at Georgetown University. The agency “rarely if ever” makes binding recommendations, he said.

“When the next pandemic hits, we will look to CDC to offer guidance based on the best-known evidence,” he said. “We don’t want a disempowered agency in a public health emergency.”

Some Republican intellectuals have spun dystopian visions surrounding vaccines. Take “Dawn’s Early Light,” a yet-to-be-published book by Heritage president Kevin Roberts. The tome — which earned a glowing foreword by Republican vice presidential nominee JD Vance — reserves especially sharp words for vaccines.

In one section of the book, Roberts imagines that the federal government would somehow use alleged new capabilities to “deplatform drivers” of cars for “failing to follow the latest vaccine mandate.”

“Yet another powerful tool of social control falls into place,” he wrote.

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“Los republicanos no quieren reivindicarlo”, dijo Trump en una entrevista a finales de septiembre.

En cambio, al menos en 17 ocasiones este año, Trump ha prometido cortar los fondos a las escuelas que exigen vacunas.

Los voceros de la campaña han dicho previamente que esta promesa solo se aplicaría a las escuelas con mandatos relacionados con covid. Pero los discursos revisados por KFF Health News no incluían tal distinción, lo que genera la posibilidad de que Trump también apunte a las normas de vacunación para enfermedades infantiles comunes, y potencialmente letales, como la polio y el sarampión.

La campaña de Trump no respondió a las solicitudes de comentarios para este artículo.

Trump ha liderado un cambio radical en la visión de su partido sobre las vacunas, reflejado esta temporada de campaña en afirmaciones falsas de candidatos republicanos durante las primarias y en teorías conspirativas desconcertantes de voces conservadoras prominentes.

Cada vez más, los republicanos expresan preocupación por los riesgos de las vacunas. Una encuesta de septiembre de 2023 de Politico y Morning Consult mostró que una pequeña mayoría de esos votantes se preocupaba más por los riesgos que por los beneficios de vacunarse.

Un aumento en las políticas antivacunas en las legislaturas estatales ha seguido la retórica. Matt Motta, politólogo de la Universidad de Boston que rastrea la política de salud pública, dijo que los datos preliminares muestran que los estados promulgaron al menos 42 proyectos de ley antivacunas en 2023, un incremento casi nueve veces mayor desde 2019.

En algunos estados, parece una cruzada: la plataforma del Partido Republicano de Texas para 2024, por ejemplo, propone una prohibición de la tecnología de ARNm, la innovación detrás de algunas vacunas contra covid-19 que los científicos creen podría tener aplicaciones significativas en el tratamiento del cáncer.

En septiembre, Trump apeló a los votantes antivacunas al obtener el respaldo de Robert F. Kennedy Jr., uno de los personajes públicos anti vacunas más prominentes del país, y nombrarlo en su equipo de transición. En una gira reciente con el ex locutor de Fox News Tucker Carlson, Kennedy dijo que estaría “profundamente involucrado en ayudar a elegir a las personas que dirigen la FDA, los NIH y los CDC”.

El alcance de Trump puede ser más discreto: recientemente se reunió con una delegación de activistas escépticos de las vacunas, incluido un grupo que aboga por el fin de los mandatos y ciertos tipos de vacunas, en su club de golf en Nueva Jersey; la reunión fue publicitada por el blog conservador “Gateway Pundit”.

Trump tiene opciones para avanzar en los objetivos antivacunas como presidente, como sembrar más dudas y socavar la capacidad del gobierno federal para hacer recomendaciones sobre vacunas. Ha prometido nombrar a Kennedy, junto con “los mejores expertos”, para un panel que explore enfermedades crónicas, algunas de las cuales la organización sin fines de lucro de Kennedy ha vinculado con las vacunas.

“Nadie ha hecho más” para abogar por “la salud de nuestras familias y nuestros hijos”, declaró Trump en un mitín aceptando el respaldo de Kennedy.

Aun así, es difícil saber cómo se traduciría en la práctica la propuesta más frecuente de Trump: quitar fondos a las escuelas que exigen vacunas, dijo Judith Winston, ex consejera general del Departamento de Educación durante la administración de Obama.

Actualmente, el Departamento de Educación no tiene la facultad de cortar la financiación de las escuelas públicas de una vez, dijo, lo que significa que una segunda administración de Trump tendría que retirar el dinero programa por programa.

Y la base legal para tal medida no está clara. “No tengo conocimiento de ninguna ley federal que exija a los distritos escolares proporcionar o no proporcionar una vacuna”, dijo Winston, y agregó que probablemente requeriría la acción del Congreso.

Los 50 estados tienen un requisito de vacunación vinculado a la asistencia escolar.

El acercamiento de Trump a los sectores antivacunas ocurre en un momento de aumento de la vacilación hacia las vacunas y un resurgimiento de enfermedades prevenibles. Este verano, Oregon experimentó su peor brote de sarampión desde 1991.

La situación podría empeorar, dijo Tom Frieden, ex director de los Centros para el Control y Prevención de Enfermedades (CDC): en los 90, cuando también proliferó el escepticismo hacia las vacunas, Estados Unidos vio miles de casos de sarampión. Según los CDC, aún no se ha vuelto a esos malos tiempos, pero el número de casos de sarampión registrados este año ya es cuatro veces mayor que el del año pasado.

“Fue muy perturbador”, dijo. “Muchos niños que tuvieron sarampión terminaron con problemas de audición o problemas cognitivos de por vida. Un pequeño número murió en este país”. A nivel mundial, la enfermedad mató a más de 100,000 personas en 2022, en su mayoría niños menores de 5 años, según la Organización Mundial de la Salud.

Las encuestas muestran que una minoría sustancial de estadounidenses, concentrada en el Partido Republicano, sostiene posiciones escépticas respecto a las vacunas, dijo Robert Blendon, profesor de Harvard y experto en política sanitaria. “Es una continuación de esta rebelión contra los mandatos de vacunación contra el covid”.

La oposición a las vacunas ha dividido al Partido Republicano. El gobernador de Florida, Ron DeSantis, hizo de la oposición a las vacunas una parte central de su fallida campaña para la nominación presidencial republicana. En estados como Wyoming y Missouri, este año se libraron intensas campañas primarias centradas en temas antivacunas.

Bob Onder, médico y candidato republicano al Congreso en Missouri, fue acusado en anuncios de Facebook colocados por su principal oponente de recibir millones de las compañías farmacéuticas para probar vacunas. “Él se benefició de nuestro dolor”, decía uno de los anuncios. “Tú sufriste las consecuencias”.

Onder “nunca ha realizado investigaciones sobre la vacuna contra covid” y se opone a los mandatos de vacunas, dijo su gerente de campaña, Charley Lovett, a KFF Health News. (Lovett dijo que Onder “realizó” un estudio patrocinado por AstraZeneca sobre la prevención del covid en pacientes de alto riesgo mediante el uso de anticuerpos monoclonales, no vacunas).

Onder ganó la primaria republicana, pero su oponente antivacunas aún obtuvo poco más del 37% de los votos.

Los candidatos antivacunas suelen convertirse en legisladores antivacunas. El impacto se puede ver en Texas, donde la política de vacunas solía ser un tema bipartidista. Según los investigadores, de 2009 a 2019, los legisladores aprobaron 19 proyectos de ley a favor de las vacunas, como una medida que permitía a los farmacéuticos administrar inmunizaciones.

Pero ese consenso comenzó a cambiar hacia el final de la década. Pequeños grupos, a menudo surgidos en Facebook, hicieron sentir su influencia. Uno de esos grupos, Texans for Vaccine Choice, impulsó testimonios ante la Legislatura estatal en 2021 y atacó a los legisladores pro inmunización, algunos de los cuales cayeron en sus primarias republicanas.

La desinformación ha alimentado el giro anti vacunas en Texas, junto con las actitudes conservadoras tradicionales sobre la autonomía individual, dijo Summer Wise, ex miembro del comité ejecutivo del Partido Republicano del estado, particularmente ideas erróneas sobre el uso de células fetales en el desarrollo de vacunas; investigaciones falsificadas sobre un vínculo entre las vacunas y el autismo; y teorías conspirativas sobre Bill Gates, el filántropo multimillonario que ha defendido la vacunación.

“Los políticos ven las vacunas como un objetivo fácil para propagar el miedo entre el electorado, que luego puede ser aprovechado y dirigido para controlar un bloque de votantes”, dijo Wise.

Además de pedir una prohibición de la tecnología de ARNm, la plataforma del Partido Republicano de Texas para 2024 incluye una lista de políticas que podrían socavar la vacunación, como permitir que los residentes médicos y los médicos opten por no administrar vacunas por motivos religiosos. También pide consagrar la capacidad de un paciente para optar por no vacunarse en la Declaración de Derechos del estado.

A nivel nacional, las políticas anti inmunización podrían tomar un giro agresivo bajo una segunda administración de Trump.

Roger Severino, ex jefe de la Oficina de Derechos Civiles del Departamento de Salud y Servicios Humanos y ahora con la Fundación Heritage, redactó la sección de la agencia de salud del Proyecto 2025, la iniciativa liderada por Heritage Foundation para planificar una administración republicana.

Entre otras ideas, el documento propone recortar la autoridad de los CDC para emitir orientación sobre vacunas o cuarentenas de naturaleza “prescriptiva”, dirigida a las escuelas o en otros lugares.

Un vocero de la Heritage Foundation señaló que Severino dijo que la credibilidad de la agencia se ha visto afectada y que tiene la carga de explicar que “todas las vacunas del calendario se toman en combinación”.

La propuesta malinterpreta la historia y los poderes de los CDC, dijo Lawrence Gostin, profesor de derecho de salud pública en la Universidad de Georgetown. La agencia “rara vez” hace recomendaciones vinculantes, dijo.

“Cuando llegue la próxima pandemia, recurriremos a los CDC para que nos ofrezcan orientación basada en la evidencia más conocida”, dijo. “No queremos una agencia sin poderes en una emergencia de salud pública”.

Algunos intelectuales republicanos han elaborado visiones distópicas en torno a las vacunas. Como ejemplo, “Dawn’s Early Light”, un libro aún no publicado del presidente de Heritage, Kevin Roberts. El texto, que recibió un prólogo entusiasta del candidato republicano a la vicepresidencia, JD Vance, reserva palabras especialmente duras para las vacunas.

En una sección del libro, Roberts imagina que el gobierno federal usaría de alguna manera supuestas nuevas capacidades para “desplazar a los conductores” de automóviles por “no seguir el último mandato de vacunación”.

“Otra poderosa herramienta de control social entra en juego”, escribió.

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Friends and neighbors in the oil- and gas-rich community “take their morning coffee and pull up” to watch workers building the county’s first hospital, said Kari DeWitt, the project’s public relations director.

“I think it’s just gratitude,” DeWitt said.

Sublette County is the only one in Wyoming — where counties span thousands of square miles — without a hospital. The 10-bed, 40,000-square-foot hospital, with a similarly sized attached long-term care facility, is slated to open by the summer of 2025.

DeWitt, who also is executive director of the Sublette County Health Foundation, has an office at the town’s health clinic with a window view of the construction.

Pinedale’s residents have good reason to be excited. New full-service hospitals with inpatient beds are rare in rural America, where declining population has spurred decades of downsizing and closures. Yet, a few communities in Wyoming and others in Kansas and Georgia are defying the trend.

“To be honest with you, it even seems strange to me,” said Wyoming Hospital Association President Eric Boley. Small rural “hospitals are really struggling all across the country,” he said.

There is no official tally of new hospitals being built in rural America, but industry experts such as Boley said they’re rare. Typically, health-related construction projects in rural areas are for smaller urgent care centers or stand-alone emergency facilities or are replacements for old hospitals.

About half of rural hospitals lost money in the prior year, according to Chartis, a health analytics and consulting firm. And nearly 150 rural hospitals have closed or converted to smaller operations since 2010, according to data collected by the University of North Carolina’s Cecil G. Sheps Center for Health Services Research.

To stem the tide of closures, Congress created a new rural emergency hospital designation that allowed struggling hospitals to close their inpatient units and provide only outpatient and emergency services. Since January 2023, when the program took effect, 32 of the more than 1,700 eligible rural hospitals — from Georgia to New Mexico — have joined the program, according to data from the Centers for Medicare & Medicaid Services.

Tony Breitlow is health care studio director for EUA, which has extensive experience working for rural health care systems. Breitlow said his national architecture and engineering firm’s work expands, replaces, or revamps older buildings, many of which were constructed during the middle of the last century.

The work, Breitlow said, is part of health care “systems figuring out how to remain robust and viable.”

Freeman Health System, based in Joplin, Missouri, announced plans last year to build a new 50-bed hospital across the state line in Kansas. Paula Baker, Freeman’s president and chief executive, said the system is building for patients in the southeastern corner of the state who travel 45 minutes or more to its bigger Joplin facilities for care.

Freeman’s new hospital, with construction on the building expected to begin in the spring, will be less than 10 miles away from an older, 64-bed hospital that has existed for decades. Kansas is one of more than a dozen states with no “certificate of need” law that would require health providers to obtain approval from the state before offering new services or building or expanding facilities.

Baker also said Freeman plans to operate emergency services and a small 10-bed outpost in Fort Scott, Kansas, opening early next year in a corner of a hospital that closed in late 2018. Residents there “cried, they cheered, they hugged me,” Baker said, adding that the “level of appreciation and gratitude that they felt and they displayed was overwhelming to me.”

Michael Topchik, executive director of the Chartis Center for Rural Health, said regional health care systems in the Upper Midwest have been particularly active in competing for patients by, among other things, building new hospitals.

And while private corporate money can drive construction, many rural hospital projects tap government programs, especially those supported by the U.S. Department of Agriculture, Topchik said. That, he said, “surprises a lot of people.”

Since 2021, the USDA’s rural Community Facilities Programs have awarded $2.24 billion in loans and grants to 68 rural hospitals for work that was not related to an emergency or disaster, according to data analyzed by KFF Health News and confirmed by the agency. The federal program is funded through what is often known as the farm bill, which faces a September congressional renewal deadline.

Nearly all the projects are replacements or expansions and updates of older facilities.

The USDA confirmed that three new or planned Wyoming hospitals received federal funding. Hospital projects in Riverton and Saratoga received loans of $37.2 million and $18.3 million, respectively. Pinedale’s hospital received a $29.2 million loan from the agency.

Wyoming’s new construction is rare in a state where more than 80% of rural hospitals reported losses in the third quarter of 2023, according to Chartis. The state association’s Boley said he worries about several hospitals that have less than 10 days’ cash on hand “day and night.”

Pinedale’s project loan was approved after the community submitted a feasibility study to the USDA that included local clinics and a long-term care facility. “It’s pretty remote and right up in the mountains,” Boley said.

Pinedale’s DeWitt said the community was missing key services, such as blood transfusions, which are often necessary when there is a trauma like a car crash or if a pregnant woman faces severe complications. Local ambulances drove 94,000 miles last year, she said.

DeWitt began working to raise support for the new hospital after her own pregnancy-related trauma in 2014. She was bleeding heavily and arrived at the local health clinic believing it operated like a hospital.

“It was shocking to hear, ‘No, we’re not a hospital. We can’t do blood transfusions. We’re just going to have to pray you live for the next 45 minutes,’” DeWitt said.

DeWitt had to be airlifted to Idaho, where she delivered a few minutes after landing. When the hospital financing went on the ballot in 2020, DeWitt — fully recovered, with healthy grade-schoolers at home — began making five calls a night to rally support for a county tax increase to help fund the hospital.

“By improving health care, I think we improve everybody’s chances of survival. You know, it’s pretty basic,” DeWitt said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Democratic challenger Will Rollins also called out his rival, Rep. Ken Calvert, and “MAGA extremists” in an ad last week for their backing of a bill that could criminalize medical practitioners who provide abortions.

A few blocks from state Route 14 in Lancaster, about 70 miles north of downtown Los Angeles, Rep. Mike Garcia’s Democratic opponent, George Whitesides, planted two billboards promising to protect reproductive health care, a jab at the Republican congressman, who has voted to cut taxpayer funding of abortions for service members and other Americans.

As Election Day approaches, Democratic hopefuls are doing all they can to tie Republican opponents in contested congressional districts to their anti-abortion records. Aggressive ads are going up in California, Arizona, Nebraska, New Jersey, New York, and Oregon, as Democrats see an opportunity to take control of the House by engaging voters who might not vote straight-ticket — or at all. Republicans currently control the House by a slim margin.

“What we all need to do is to make sure we look at her record, and that record is contrary to what she’s putting out there in her ads,” Tran said in an interview about Steel. “We’re making sure that we educate and remind the voters of who she really is.”

Democrats are also linking Republican incumbents to former President Donald Trump, who has taken credit for the 2022 Supreme Court decision overturning Roe v. Wade. Democrats are warning voters that more restrictions could come. During the Sept. 10 presidential debate, Trump dodged a question about whether he would veto a national abortion ban if elected.

A majority of voters support restoring a federal right to abortion, according to a recent KFF poll. And 1 in 14 voters say abortion is the most important issue in determining their choice. Those voters have the potential to make a difference in the close races, said David McCuan, a political science professor at Sonoma State University.

“The politics of abortion and reproductive health can get voters to participate at higher rates,” McCuan said. “It’s going to be a defining issue.”

Democrats are hoping the issue plays to their favor in California. Voters two years ago codified abortion rights into state law. In May, Planned Parenthood Affiliates of California launched a seven-figure campaign targeting seven Republican seats and Democrat Katie Porter’s open seat.

As a result, political analysts say, Republicans have shied away from their votes on abortion and some incumbents — such as Steel, Garcia, and Central Valley U.S. Rep. David Valadao — have moderated their stances to appeal to voters.

Steel, like Garcia and Valadao, has said she supports exceptions to abortion bans in cases of rape, incest, or threats to the life of the mother. All three co-sponsored a bill amounting to a blanket abortion ban in the previous Congress. Garcia and Valadao left their names off the bill last year, but Steel signed on again as a co-sponsor — briefly.

She withdrew her support after she won her March primary, explaining that it could create confusion because the three-page bill could threaten in vitro fertilization. In a September campaign ad, Steel shared that she had used IVF to have children and reiterated her support for the procedure. Steel spokesperson Lance Trover said she opposes a national abortion ban.

None of the Republican incumbents who represent a California “toss-up” district, as determined by the nonpartisan Cook Political Report, granted KFF Health News an interview. Those who did respond said they do not support a national abortion ban.

Rep. John Duarte added that he opposes a ban because he’s “pro-choice,” and Calvert said “the issue is best decided with the states and their voters directly.” Both voted for a bill to limit medication abortion and supported a measure that would have authorized prison time for medical providers who don’t resuscitate babies born after an attempted abortion.

Tim Rosales, a political strategist who has represented Republican candidates, said these incumbents shouldn’t get heat for changing their minds over time, noting that Democratic former Presidents Bill Clinton and Barack Obama reversed their positions on same-sex marriage.

“There has to be some allowance for evolution on a variety of issues,” Rosales said.

Ben Petersen, a spokesperson for the National Republican Congressional Committee, said Democrats who have called out Republicans for inconsistencies want to move the conversation away from other topics, such as the “disastrous cost of living crisis hurting women and families caused by their one-party control of Sacramento.”

This political dance is playing out on the national stage, especially in battleground races where Republicans find themselves on defense in states where abortion is on the ballot. Roughly two dozen races are considered toss-ups.

In a March post on the social platform X, Republican Nebraska Rep. Don Bacon wrote, “I’ve always defended the life of the mother,” after his Democratic rival, Tony Vargas, called him out for supporting a national abortion ban, which makes no exceptions for cases in which the mother’s life is at risk. That same month, Rolling Stone reported that the Omaha-area congressman had deleted some anti-abortion endorsements from his website. Nebraskans will vote this November on competing abortion ballot measures.

In Arizona, where voters will also be asked whether to enshrine abortion rights into the state constitution, Republican incumbent David Schweikert this year did not support a national abortion ban, which he had co-sponsored at least six times from 2012 to 2021. In April, he wrote on X that he opposed an abortion ban in Arizona, calling on the state legislature to “address this issue immediately.”

On the airwaves, on their websites, and on the campaign trail, Republican candidates are pivoting to convince voters that they have voted to protect women. For example, Steel this month released an ad titled “Champion,” in which the Orange County sheriff says Steel has “worked tirelessly to protect victims of domestic violence and sexual abuse.”

Trover, the Steel spokesperson, said she voted two years ago to reauthorize the Violence Against Women Act. That vote was on a larger $1.5 trillion government spending bill, which included the measure.

The year before, Steel voted against reauthorizing the act.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).