Republicans in Congress are “trying to wipe out federal funding to end the HIV epidemic.”

President Joe Biden on Oct. 14, 2023, in remarks at the 2023 Human Rights Campaign National Dinner.

____

Are Republicans threatening to stop spending federal money to end one of the world’s most pressing public health epidemics? That’s what President Joe Biden said during a dinner hosted by an LGBTQ+ advocacy group.

“In the United States Congress, extreme MAGA Republicans are trying to undo virtually every bit of progress we’ve made,” Biden said Oct. 14 at the Human Rights Campaign event. “They’re trying to wipe out federal funding to end the HIV epidemic.”

Programs to treat HIV and fight its spread have enjoyed bipartisan funding support in recent years, experts said, so Biden’s portrayal signals a significant departure.

When we asked the White House what Biden was referring to, it pointed us to reports of budget recommendations from House Republicans that call for large cuts to the Ending the HIV Epidemic initiative, a Trump administration-era program designed to reduce new HIV infections in the U.S., as well as other programs.

The Senate Appropriations Committee passed a separate spending plan. The recommendations will be subject to negotiation as the House and Senate face a Nov. 17 deadline to pass another spending bill.

We found that although Republicans are recommending significant cuts to HIV prevention efforts across a number of public health agencies, the proposal keeps core funding intact. Meanwhile, political differences are eroding bipartisan support for global HIV-prevention funding.

Despite great strides in prevention and treatment since HIV was first reported in the U.S. in the 1980s, HIV remains at epidemic levels in the U.S. today, with approximately 1.2 million people living with HIV and around 30,000 to 35,000 new infections each year. Experts said cases are rising in the South and in rural areas, and new infection statistics show it is disproportionately affecting Black and Hispanic populations.

What Are the Proposed Cuts?

The AIDS Budget and Appropriations Coalition, a group of more than 100 public health advocacy organizations that track changes in HIV-related federal spending, said a majority of the proposed cuts to domestic HIV funding stem from House Republicans’ effort to eliminate the Ending the HIV Epidemic initiative.

The program started in 2019 with the goal of reducing new HIV infections in the U.S. by 75% by 2025 and 90% by 2030. The program so far worked regionally, targeting areas that have the highest rates of HIV cases for funding.

In 2023, about $573 million was allocated for the program across various agencies, according to KFF’s funding tracker.

• $220 million to the Centers for Disease Control and Prevention.
• $165 million to the Ryan White HIV/AIDS program. (It was named for a 13-year-old diagnosed with HIV in 1984 and is overseen by the Health Resources and Services Administration.)
• $5 million to the Indian Health Service.
• $26 million to the National Institutes of Health for research.
• $157.3 million to community health centers, which have treated around 200,000 HIV patients annually.

The program lags its goals as it approaches the 2025 benchmark. “It’s well designed, well planned, it has targets that makes sense,” said Jeffrey Sturchio, a lead researcher on a Center for Strategic and International Studies report.

Sturchio said the problem is not a fault of design, but funding, adding, “Congress has never fully funded the initiative.”

Sturchio pointed to a range of local and state “bureaucratic hurdles.” Jurisdictions that have pulled together sufficient resources have seen “tremendous progress,” he said, and overall indicators seem to be moving in the right direction.

But COVID-19 reduced HIV testing and may have diverted public health efforts, CDC administrators said. KFF Health News reported in April that stakeholders saw progress but worried that it won’t be enough to make the 2030 deadline.

Democrats appear to share this concern. The spending bill proposed by the Democratic-controlled Senate Appropriations Committee maintained or slightly increased funding levels to all HIV-related programs. The committee requested more data about the program, describing its “lack of quantifiable data showing outcomes.”

The House has not yet passed the bill out of committee. We know of some proposed cuts from the bill, which the Republican-led House Appropriations Subcommittee released in July.

It outlines a $1.6 billion cut to the CDC, including a $220 million reduction in “HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention” and a $238.5 million cut from the Ryan White HIV/AIDS program. The Ryan White program provides medical care and support services to low-income HIV patients and serves more than half of those diagnosed in the U.S.

The bill also proposes cutting funding to the Minority HIV/AIDS fund by more than half — from $60 million to $28 million. According to HIV.gov, the fund supports prevention and care projects targeting disparities that affect communities of color.

Additional details about how these cuts could affect programs are detailed in a committee report that has not been made public. PolitiFact and some advocacy organizations obtained copies of the report, but the House Appropriations Committee did not respond to questions about it. The report we saw recommended cutting all funding for the Ending the HIV Epidemic initiative.

And House Democrats, advocacy organizations, and KFF Health News have each reported that the Ryan White program and CDC cuts result from a plan to eliminate the Ending the HIV Epidemic initiative.

“If they cut funding, it’s going to have a dramatic and draconian impact on the ability of all of the people who are working in these jurisdictions to improve public health,” said Sturchio, the researcher.

Although the cuts would be dramatic, experts said, they would not eliminate all domestic HIV funding.

“There is certainly a demonstration and a commitment to some of the core HIV programs, but there are millions of dollars of proposed cuts in other areas,” said Lindsey Dawson, associate director for HIV policy at KFF. “These cuts would have a meaningful impact on the ability of programs to provide lifesaving interventions for both HIV care and treatment, as well as prevention.”

The cuts would mean a 16% cut to the CDC’s division of STD prevention, a 9% cut to the Ryan White HIV/AIDS program, and a 53% cut to the Minority HIV/AIDS Fund from fiscal year 2023 to 2024.

These funding cuts are only proposals. They require a vote from the full appropriations committee and would have to pass the House and be negotiated with a Democratic-controlled Senate.

“We’ve heard for a long time that HIV is a bipartisan issue. But what some people forget, is that that bipartisanship was hard fought for over the first decade of the HIV epidemic,” said Dawson.

Other Challenges to HIV/AIDS Spending

The U.S. commitment to global HIV prevention, meanwhile, is also under scrutiny. Rep. Chris Smith, R-N.J., challenged reauthorizing the President’s Emergency Plan for AIDS Relief, also known as PEPFAR, without first making some changes. Started in 2003 by President George W. Bush, the program distributes funds in more than 50 countries for HIV testing, prevention, treatment, and medications. It also strengthens health care systems to fight AIDS.

Funding for the program has grown over the past 20 years, totaling more than $110 billion. The program reported 25 million lives saved by medical intervention.

Smith, who chairs the House Foreign Affairs subcommittee on Global Health, has expressed concerns that money is being given to nongovernmental organizations that support abortion rights and access.

U.S. law prohibits the direct use of overseas funding to provide abortions or to lobby for access to abortions. This has been the case since 1973. However, organizations that receive U.S. funding can do so with their own non-U.S. funding.

An official from the State Department, which runs the program, confirmed to PolitiFact that PEPFAR is legally restricted from funding abortion or lobbying for abortion access; the official cited the training of staff and partners and the monitoring of procedures to ensure compliance.

Other anti-abortion groups have favored a“Mexico City Policy,’‘ which has required foreign nongovernmental organizations to certify that they would not perform or promote abortion with funds from any source to be eligible for U.S. government funding. Trump applied the policy to PEPFAR, but Biden rescinded it.

The failure to reauthorize PEPFAR would not eliminate the program, and Congress can continue to fund the program without reauthorization, but it could cause some provisions to lapse over the next few years.

The lack of a reauthorization would have significant symbolic impact, said Kellie Moss, KFF’s associate director of global health and HIV policy. “It could make the program more vulnerable during funding discussions without a clear signal of bipartisan support.”

Although reauthorization is being held up, funding has progressed. On Sept. 28, the House passed a State Department and Foreign Operations Appropriations bill, which would fund PEPFAR for another year but implement a Mexico City-like policy provision on all global health funding. This bill would also extend the lapsing provisions for another year.

Our Ruling

Biden said that Republicans in Congress are “trying to wipe out federal funding to end the HIV epidemic.”

A subcommittee of House Republicans has proposed cutting some HIV prevention programs anywhere from 53% to 9% in fiscal 2024, depending on the program.

A committee’s draft report cited by advocacy and policy groups shows these cuts stem from the elimination of the Trump-era Ending the HIV Epidemic initiative, although the committee did not respond to questions about that.

Taken together, these cuts would not eliminate — or “wipe out” — all federal domestic HIV spending, but they do represent a significant cut.

Meanwhile, the House has not moved ahead to reauthorize PEPFAR, which supplies U.S. dollars for global HIV prevention, over Republican concerns about where organizations that receive the money stand on abortion access. But the House has passed one year of PEPFAR funding with some conditions about how it is distributed, which it can do without reauthorizing the program.

Biden’s statement is partially accurate in that significant funding cuts have been proposed by House Republicans, but he exaggerates by saying these efforts would “wipe out” federal funding.

We rate this claim Half True.

____

(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

A proposed federal policy aims to protect older Americans from contracting HIV by offering free preventive medication, the latest effort to catch up to much of Europe and Africa in stemming the spread of the virus.

Under the plan from the Biden administration, Medicare would cover patients’ full cost of preexposure prophylaxis drugs, which prevent HIV transmission. The drugs, known by the shorthand “PrEP,” would be free in pill form and — for the first time — as long-acting injectables through the government insurance program designed for those 65 and older. Those 50 and over make up half of all people in the U.S. already living with HIV.

The proposed policy change represents a big shift because it means that even new long-acting injectable versions of PrEP drugs, which can cost more than $20,000 a year in the U.S., would be covered fully, without requiring patients to kick in copayments. It is not yet clear what the plan would mean for taxpayers, though, either in paying for the medications or in offsetting the costs of caring for fewer Medicare patients with HIV in the future.

The final green light for the plan was expected Oct. 10, but the Centers for Medicare & Medicaid Services announced it is still working out details of how to transition coverage for patients already taking the drugs.

The U.S. is decades behind nations in Europe and Africa that are on track to end new HIV infections by 2030. But while the proposal should bring down infections in older Americans, it highlights remaining inequities: Many people under age 65 will still struggle to pay for PrEP. And, at the same time, Republican congressional leaders have threatened to cut funding for a federal HIV prevention effort championed by the Trump administration that is intended to help all at risk.

“We’ve done a very poor job in the U.S. of assuring that people who could most benefit from PrEP have access to it,” said Justin Smith, who directs the Campaign to End AIDS at Positive Impact Health Centers in the Atlanta area.

Though PrEP has been embraced by gay and trans Americans, it is prescribed less often to heterosexuals over 50 or women of any age. In the first three months of this year, just 8% of the more than 300,000 people receiving PrEP in the U.S. were women, according to the Centers for Disease Control and Prevention. The racial gap is large, too: While 66% of white people eligible for PrEP got prescriptions for it in that period, only 8% of eligible Black people and 17% of eligible Hispanic people did.

Broadening access for gay and bisexual men of color, as well as straight and cisgender women of color — particularly Black women, who represent the majority of women with HIV in the U.S. as well as the majority of new infections among women — is critical for the nation to catch up to the rest of the world, Smith said.

PrEP, a Key HIV Prevention Tool, Isn’t Reaching Black WomenNew HIV infections occur disproportionately among Black women, but exclusionary marketing, fewer treatment options, and provider wariness have limited uptake of preexposure prophylaxis, or PrEP, drugs, which reduce the risk of contracting the virus.

Leisha McKinley-Beach, a national HIV consultant and CEO of the Black Public Health Academy, which prepares Black health department employees for leadership positions, noted that the Medicare proposal to cover the cost of injectable PrEP could help many women because a shot given every two months can be easier to manage than a daily pill.

But it’s just a start. She and others are lobbying for a national PrEP plan that would build on momentum from the recent Medicare proposal to expand free access to other age groups, much as with covid-19 vaccinations. McKinley-Beach also wants the U.S. government to expand the message that anyone can get HIV, encourage drug companies to advertise more on TV to women of color, and fund outreach to dispel medical mistrust in communities of color.

“Gay white men have had a narrative of dignity and respect with regards to HIV treatment, and I would never want to change that narrative,” she said. “But the message needs to be broadened. Forty-two years into the HIV epidemic, the current HIV prevention model is detrimental to Black women who could benefit from PrEP.”

Though the U.S. was the first nation to approve PrEP, in 2012, it now trails the rest of the world in equitable access. That’s mostly due to the cost of laboratory tests and medical visits. While the cost of the generic form of Truvada, an oral form of PrEP, can be as low as about $30 a month in the U.S., a study by University of Virginia researchers reported the cost of starting PrEP is typically about $2,670 for uninsured patients, including about $1,000 for lab tests and medical visits. The new Medicare proposal would cover up to seven counseling visits every 12 months for HIV risk assessment and reduction.

Meanwhile, PrEP pills are free for people in the United Kingdom and European Union nations including France, Germany, Sweden, and Denmark. Those nations don’t yet cover the more expensive shots, although the U.K. is leading a small test on injectable PrEP in people who cannot take it in tablet form.

The U.S. also lags Western Europe and some nations in Africa in overall HIV treatment and prevention. For example, just 57% of HIV-positive Americans have attained viral suppression, according to the U.S. government website HIV.gov, meaning they regularly take medications to make them unable to transmit the virus. That makes PrEP, which is for people who don’t have the virus, all the more important for Americans to stay negative, according to HIV experts.

In Africa, by contrast, Botswana, Eswatini (formerly Swaziland), Rwanda, Tanzania, and Zimbabwe have already achieved the United Nations’ “95-95-95” targets set for 2025 — 95% of people with HIV know their HIV status, 95% of people with diagnosed HIV infection receive sustained antiretroviral therapy, and 95% of people receiving antiretroviral therapy have achieved viral suppression, or the virus is undetectable in their blood — according to the U.N.

In the U.K., 98% of HIV-positive people have achieved “undetectable” status via free antiretroviral medicines and treatment available through the country’s universal health care program, the National Health Service. Moreover, nearly anyone in the U.K. who is HIV-negative and wants to take PrEP can get it at no charge. The U.K. says it is now on a path to reduce new HIV infections by 80% by 2025.

The U.K. changed its PrEP approach after 2015, when Greg Owen founded “iwantprepnow.co.uk,” a website that ignited a PrEP movement by helping people in the U.K. and Europe self-source low-priced generic forms of Truvada, the first drug approved as PrEP, from pharmacies in Hong Kong and India.

“It became more affordable,” said Owen, now PrEP lead at one of the U.K.’s top HIV and sexual health charities, Terrence Higgins Trust. “Soon people demanded it for free on the NHS.”

In the U.S., Smith said, the lack of a national PrEP program that would make the drugs and associated bloodwork free and a heated political climate around health care have hindered HIV outreach.

“In rural areas of the South, especially in places like Georgia or Tennessee, there has been outright hostility toward accepting money from the CDC and expanding Medicaid to treat and prevent HIV,” Smith said. “People think it’s just politics, but this is having an impact on public health, on people’s lives.”

Anti-queer sentiment in many quarters also creates an environment of hostility around overall sexual health, said Richard Elion, director of clinical research at Washington Health Institute and a professor at George Washington University School of Medicine and Health Sciences. “There’s a chilling effect for everyone, not just queer Americans,” he said.

Elion said shame surrounding sex and the feeling of vulnerability that some people get from taking any medicine may also reduce PrEP uptake among older Americans. “Taking PrEP is actually very empowering, and that needs to be the message,” he said.

___

(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

A long time ago — relatively, in this short-attention-span age — and at multiplexes not so far away, the simultaneous theatrical release of “Barbie “ and “Oppenheimer” was pretty much all anyone could talk about. Admittedly, this was before Travis Kelce crafted a friendship bracelet for a certain someone, before we were well-versed on SAG-AFTRA interim agreements, before we were rewatching “Friends” through our tears.

And now, nearly half a year and three bags of bite-size Halloween candy later, we’re starting to talk about “Barbenheimer” again. This time, the focus isn’t on the propriety of quoting the Bhagavad Gita during sex or how “Barbie” director Greta Gerwig worked in references to “The Umbrellas of Cherbourg” and “The Red Shoes” into what, on paper, could have been an extended toy commercial. The conversation has turned to the Oscars, a ceremony that’s shaping up as a sequel to that magical opening weekend.

How big a sequel? Let’s just say bigger than “Indiana Jones and the Dial of Destiny” and go from there. Or simply note that the producers of the upcoming 96th Academy Awards are probably already working the phones to incorporate some celebrity Ken cameos into a “Barbie” dance number. (Judging from “Maestro,” Bradley Cooper should be game.)

Or we could just put on our thinking caps (fedoras, of course) and comb through the awards categories to chart what’s going to be an (equally?) incredible Oscars for both films.

PICTURE

“Barbie” sold more than $1.4 billion in tickets while winning over most critics, triggering fragile men and launching a thousand think pieces that sifted through the subversive ways Gerwig celebrated and critiqued its namesake toy. That’s enough to cement a nomination. But the “Barbie” team isn’t resting on its laurels, enlisting the likes of filmmakers Todd Field and Judd Apatow and playwright and screenwriter Tony Kushner to lead Q&As at recent events. “I think it’s a masterpiece,” Kushner said.

“Oppenheimer,” meanwhile, grossed nearly a billion dollars, remarkable for a three-hour, R-rated drama about the “father of the atomic bomb.” Between the box office, the reviews and its ambitious examination of our history that isn’t as distant as we’d like to think, “Oppenheimer” possesses the pedigree of a best picture winner. It will be difficult to beat.

Nominations: “Barbie,” “Oppenheimer”

DIRECTOR

Christopher Nolan has one nomination as a director (“Dunkirk”), two as a writer (“Memento” and “Inception”) and two as a producer (“Inception” and “Dunkirk”). He has never won an Oscar. That will likely change soon, as voters will have three different categories — director, writer, producer — this year to finally honor him.

Gerwig has never won an Oscar either, earning nominations for writing and directing “Lady Bird” and writing “Little Women.” She’ll probably be nominated again as both a writer and director with original screenplay (see below) offering her the best chance to prevail.

Nominations: Gerwig, Nolan

ACTRESS

The only thing that could prevent Margot Robbie from being nominated would be voters failing to appreciate the degree of difficulty in what she pulls off in the film — the comic timing, the emotional depth she brings to the character, the precise body control required to play a plastic doll. It’s a star turn and absolute exquisite acting. It would be a crime if she’s overlooked.

Nominations: Robbie

ACTOR

Just as “Barbie” wouldn’t have succeeded as spectacularly without Robbie, “Oppenheimer” owes much of its power to Cillian Murphy’s terrific turn as the tortured title character. Murphy worked with Nolan on the “Dark Knight” trilogy, “Inception” and “Dunkirk,” a fruitful partnership that will now net the actor his first nomination — and, possibly, the Oscar itself.

Nominations: Murphy

SUPPORTING ACTRESS

Both films have women delivering a great speech — Emily Blunt, playing Oppenheimer’s wife, Kitty, laying into the men investigating her husband and America Ferrera’s powerful monologue in “Barbie” in which she laments, “I’m just so tired of watching myself, and every single other woman, tie herself into knots so that people will like us.” Gerwig gives Ferrera a meatier role, whereas Blunt elevates the “long-suffering wife” into something memorable. Blunt’s lengthier film résumé gives her an edge.

Nominations: Blunt

SUPPORTING ACTOR

Robert Downey Jr.’s wily, ranging turn as Adm. Lewis Strauss, Oppenheimer’s antagonist, is essentially a second lead in the movie. You could also make a case for several of the film’s rad scientists (Benny Safdie is brilliant playing Hungarian-born physicist Edward Teller), but Downey’s presence casts a long shadow.

While I wouldn’t go so far to say that Ryan Gosling stole “Barbie,” his playful, perfect turn as Ken questioning the meaning of his existence was an absolute delight. Mark Ruffalo (“Poor Things”) and Robert De Niro (“Killers of the Flower Moon”) will offer Gosling and Downey strong competition, but the Oscar should go to one of these two.

Nominations: Downey, Gosling

SCREENPLAY (ORIGINAL/ADAPTED)

Gerwig and partner Noah Baumbach’s joyous, inspired take on “Barbie” lands in original; Nolan’s painstaking reworking of “American Prometheus: The Triumph and Tragedy of J. Robert Oppenheimer” will compete in adapted. Both will be among the favorites to win.

Nominations: “Barbie,” “Oppenheimer”

CINEMATOGRAPHY

Hoyte van Hoytema has one measly Oscar nomination to show for 15 years of indelible images. His spectacular, immersive work “Oppenheimer,” what he calls a “three-hour-long movie about faces,” will earn him another and quite possibly the trophy. “Barbie” cinematographer Rodrigo Prieto also shot Martin Scorsese’s “Killers of the Flower Moon.” Voters could (and should) opt for both the beautifully backlit world of Barbieland and the brooding, burnished textures of “Killers of the Flower Moon.” But that might be a reach.

Nominations: “Oppenheimer”

PRODUCTION DESIGN

“Oppenheimer” built Los Alamos; “Barbie” created a Dreamhouse.

Nominations: “Barbie,” “Oppenheimer”

COSTUME DESIGN

Jacqueline Durran won an Oscar for her last collaboration with Gerwig, “Little Women.” She’s the favorite again for all those fashion packs and accessories she created for “Barbie.” Ellen Mirojnick has a shot for “Oppenheimer” (Those hats! Those power suits!) — but she’s going to have to compete with the headwear in “Wonka,” “Killers of the Flower Moon” and the bicorn that Napoleon dude dons.

Nominations: “Barbie”

ORIGINAL SCORE

Mark Ronson and Andrew Wyatt had never scored a movie before “Barbie,” but you’d never know that from the way their music supports the emotional undertow of the film. Composer Ludwig Göransson, by contrast, already has an Oscar for “Black Panther” and could well win another for the beautiful melodies and disturbing energy he brought to his “Oppenheimer” score.

Nominations: “Barbie,” “Oppenheimer”

ORIGINAL SONG

“Barbie” is submitting three songs, the maximum allowed — Dua Lipa’s “Dance the Night,” Billie Eilish’s “What Was I Made For” and the Ryan Gosling-sung power ballad “I’m Just Ken” — and, per academy rules, at best, two can be nominated.

Nominations: “Barbie,” two (prayers for “I’m Just Ken”)

FILM EDITING

If, as Van Hoytema says, “Oppenheimer” is a three-hour movie about faces, it’s also a three-hour movie mostly of people talking in rooms. But it goes by quickly! (Your mileage may vary.) That’s superb editing. “Barbie” has its share of transitions — through worlds, tones, textures. It should be nominated, but so should have Nick Houy’s marvelous work on “Lady Bird,” and the academy ignored it.

Nominations: “Oppenheimer”

MAKEUP AND HAIRSTYLING

Between Barbie’s wigs, Ken’s spray tan and Weird Barbie’s Sharpie-fied makeup, “Barbie” should make the cut. And if “Oppenheimer” scores enough points for making Downey almost unrecognizable, it could too.

Nominations: “Barbie”

VISUAL EFFECTS

“Oppenheimer” boasts a small number of visual effects shots, all shot in camera. “Barbie” employed around 1,300 VFX shots, including, of course, that opening “2001: A Space Odyssey” hommage.

Nominations: “Oppenheimer”

SOUND

“Barbie” has a song in its heart (musicals always do well here), whereas “Oppenheimer” lowers the boom.

Nominations: “Barbie,” “Oppenheimer”

©2023 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

Thanksgiving entertainment tends to be dominated by football and parades. Compared to Christmas, there are relatively few specials and movies dedicated to the holiday.

But among the more limited options are some real icons you won’t want to miss. Here are seven of our favorites:

A Charlie Brown Thanksgiving

“A Charlie Brown Thanksgiving” was created after the success of Peanuts’ beloved Christmas special. And while ABC owns the rights to the popular program, it won’t actually be airing on television this year. Instead, head over to AppleTV+ where you can stream it anytime.

Planes, Trains and Automobiles

Traveling during the holidays can be stressful, as Steve Martin learns in this 80s favorite. Desperate to make it home to his wife for Thanksgiving, Martin’s character teams up with an unlikely travel companion. This hilarious film is available on Paramount+ and Pluto TV.

Soul Food

What’s a holiday without a little family drama? This 1997 classic starring Vanessa Williams, Vivica A. Fox and Nia Long tells the story of a family coming together after Big Mama falls into a coma. See if they can make it through a family dinner — while dealing with their issues — on HBO Max.

Instant Family

Inspired by a true story, a couple is ready to start a family and looks into adopting. They fall in love with a little boy only to learn he has two other siblings including a rebellious 15-year-old girl.

Free Birds

This animated flick follows two turkeys as they find a time machine. With their new found device, the two go back in time to try to get turkey off the menu. With voice performances by Owen Wilson, Woody Harrelson and Amy Poehler, this animated movie is fun for adults and kids. It’s available on Netflix.

Lez Bomb

A family event turns chaotic when a closeted woman brings her girlfriend home for Thanksgiving, only to have her coming-out efforts thwarted by the unexpected arrival of her male roommate. Available on Peacock.

Mistress America

A college freshman finds herself alone on Thanksgiving when she cures her disappointment and loneliness by allowing herself to be pulled into the wacky schemes of her future stepsister. Available on Max and Hulu.

©2023 The Atlanta Journal-Constitution. Visit at ajc.com. Distributed by Tribune Content Agency, LLC.

Emily Bendt was in her third trimester of pregnancy when she first heard the Centers for Disease Control and Prevention had approved a new shot for infants to protect them from the respiratory syncytial virus, or RSV.

By Oct. 5, Bendt was cuddling with her new baby, Willow, on the couch at home in Vancouver, Washington. She was excited to get Willow the new therapy for infants, called nirsevimab, which had started shipping in September — but Bendt, a pediatric home health nurse, couldn’t find it anywhere.

That very morning, at Willow’s two-week checkup, Bendt had asked the pediatrician when Willow could get it. “She literally just shrugged and was like, ‘Well, it’s coming, but we don’t know when,’” Bendt said. “I don’t know why I feel like I’m having to chase people down and still not get answers.”

Bendt searched online, too, for clinics or pharmacies or government websites offering nirsevimab — and found nothing.

By mid-October, demand for nirsevimab, sold under the brand name Beyfortus, had already outstripped supply, according to the pharmaceutical company Sanofi, which developed the drug with AstraZeneca.

In response, the CDC issued interim guidance Oct. 23 to help pediatricians allocate the limited supply of doses, advising them to focus on the infants at highest risk of RSV complications: those under 6 months old, and those with underlying medical conditions.

RSV is the leading reason babies under 12 months old end up in the hospital, and an estimated 100-300 kids under age 5 die from it in the U.S. every year.

Nirsevimab, a monoclonal antibody, is one of two new therapies available this fall that could dramatically reduce the risk of lung infections in infants.

The other option is an RSV vaccine from Pfizer called Abrysvo. It was first recommended for adults 60 and older, and then Sept. 22 the CDC approved its use in pregnant people, too, to confer some immunity on their infants.

But this adult vaccine is recommended only within a relatively short window in pregnancy, weeks 32 through 36, because of a potential but unproven concern it may increase preterm births. That might limit uptake during pregnancy.

By the time the vaccine was approved for pregnant people Sept. 22, Emily Bendt had given birth. So for Willow and other babies like her, nirsevimab will be the only option for protection from RSV this respiratory virus season.

Nirsevimab is approved for all infants up to 8 months old, and for some older babies and toddlers considered at higher risk of severe illness from RSV. The American Academy of Pediatrics recommends that every baby whose mother did not get the RSV vaccine while pregnant receive nirsevimab in the first week of life.

The CDC is now asking prenatal care providers to warn their patients about potential nirsevimab supply shortages, with the hope that driving up the maternal vaccination rate could help ease the demand for nirsevimab.

Nirsevimab’s powerful but pricey potential

Pediatricians say the high cost of nirsevimab and bureaucratic obstacles in Medicaid’s vaccine allocation system for children are slowing down nirsevimab’s distribution. They fear these problems leave infants at risk — unnecessarily — of hospitalization this winter.

In clinical trials, nirsevimab reduced RSV hospitalizations and health care visits in infants by almost 80%.

“This is groundbreaking, honestly,” said Katie Sharff, chief of infectious disease for Kaiser Permanente Northwest.

Nirsevimab is a monoclonal antibody treatment, not a traditional vaccine. The passive immunity it confers lasts about five months. That’s long enough to get babies through their first RSV season, when they’re at highest risk for complications.

After an infant’s first winter, “their airways develop and their lungs develop,” Sharff said. “So getting RSV later, as a child instead of as an infant, [means the child is] probably less likely to have severe complications of difficulty breathing, needing to be on a ventilator.”

Sharff’s own daughter had an RSV infection as an infant, needed care in the emergency department, and went on to develop asthma, a condition more common in children who had severe RSV infections.

For health systems worn down by the “tripledemic” of respiratory viruses — covid-19, flu, and RSV — keeping infants out of the hospital this winter could be a game-changer.

Last year was a historically bad season for RSV. Earlier in the pandemic, measures that states took to slow the spread of covid, such as masking, depressed RSV infections for a while, too. But as infection-control measures were rolled back, more babies and toddlers were exposed to RSV for the first time, at the same time.

In Oregon, the surge prompted then-Gov. Kate Brown, a Democrat, to declare a public health emergency and forced hospitals to add capacity to their pediatric intensive care units. Some hospitals even sent patients out of state.

“The promise of nirsevimab is that should never, never happen again,” said Ben Hoffman, a professor of pediatrics at Oregon Health & Science University’s Doernbecher Children’s Hospital in Portland and the president-elect of the American Academy of Pediatrics.

But that depends on the therapy’s availability, and whether providers can get it to newborns efficiently.

The most expensive childhood vaccine

For babies born without the protection of the maternal RSV vaccine, the American Academy of Pediatrics says the best time to get nirsevimab is at birth, before an infant is exposed to RSV at all.

But babies like Willow who were born before nirsevimab became available will need to get it from an outpatient clinic.

Except for the first dose of the hepatitis B vaccine, administration of childhood vaccines start one month after birth, in a pediatrician’s office, but the cost of nirsevimab might make that hard.

At $495 per dose, it’s the most expensive standard childhood shot, and insurers may not reimburse providers for it this year. That’s a particular problem for small pediatric practices, which can’t afford to lose that much money on a standard childhood vaccine.

“When all of a sudden you have a new product that you’re supposed to give to your entire birth cohort, and you’ve got to pay $500 that may or may not get paid back, that’s just not financially viable,” said Sean O’Leary, a pediatric infectious-disease specialist at the University of Colorado School of Medicine.

Some insurers, but not all, have announced they will cover nirsevimab right away. Because of a quirk in the Affordable Care Act, commercial insurance plans can wait up to a year after a new therapy is approved before they are required to cover it.

Sanofi has announced an “order now, pay later” option for doctors, which would give them more time to work out reimbursement deals.

Could hospitals help?

A government program that supplies free shots to about half the children in the United States is structured in a way that makes it hard to get nirsevimab to babies right after birth.

Vaccines for Children is a safety-net program that provides vaccines to kids on Medicaid, uninsured children, and Alaska Native and American Indian children.

Health care providers can’t bill Medicaid for shots like nirsevimab. Instead, they must register and enroll in the VFC program. Through it, the federal government purchases shots from companies like Sanofi at a discount, and then arranges for them to be shipped free to VFC-enrolled providers, which tend to be pediatric practices or safety-net clinics.

But most hospitals aren’t part of VFC, which presents a problem.

“Many of our newborns go home to caring, affectionate, loving siblings who are actively dripping snot at the time that the child is born,” said Eddie Frothingham, a pediatrician with Mid-Valley Children’s Clinic in Albany, Oregon. “The sooner we can protect them, the better.”

Right now, only about 10% of birthing hospitals nationwide are enrolled in VFC and can get nirsevimab free.

Until nirsevimab’s debut a few months ago, most hospitals didn’t have a strong incentive to participate in Vaccines for Children because childhood vaccines outside of hepatitis B are typically given to kids by pediatricians, in outpatient clinics.

VFC can be burdensome and bureaucratic, according to interviews with several Oregon hospitals and immunization experts. The program’s stringent anti-fraud measures discourage health care providers from enrolling, they say.

Once enrolled, providers must track and store VFC-provided vaccines separately, apart from other vaccine supplies. The person giving a pediatric shot has to know what insurance the child has, and account for each dose in a state-run electronic record system.

Mimi Luther, immunization program manager for Oregon, said the rules are nearly impossible for most hospitals to follow.

“I look forward to the day when the feds have the opportunity to modernize that system to make it easier for providers to enroll and stay enrolled,” she said.

The CDC has relaxed some program rules in light of the shortage of nirsevimab, allowing providers to “borrow” up to five VFC doses for infants covered by private insurance — as long as those doses are paid back within a month.

This has forced some health systems to make difficult choices. Many are allowing infants to leave the hospital without the shot, assuming they will get it at the first pediatric outpatient visit.

Frothingham said that also creates an equity problem. Newborns whose parents don’t have transportation, or financial resources, are more likely to miss those first pediatric appointments after birth.

Samaritan Health Services, the health system Frothingham works for, has decided to privately purchase a small number of doses to offer in its hospitals, for newborns whom doctors flag as high risk because of breathing problems or family poverty.

“It’s important to us that infants be able to access this regardless of their financial or social circumstances,” Frothingham said.

Nationwide, many birthing hospitals are trying to enroll in the VFC program for next year. But this fall, most won’t have free nirsevimab on hand.

Most babies who get RSV ultimately recover, including those who require hospitalization to help with their breathing. But it’s challenging to treat, and each year some babies die.

In his decades in medicine, OHSU’s Hoffman has lost infant patients to RSV.

“Knowing that some kids may potentially suffer because of delayed access or absence of access to a product that could potentially save their lives is awful,” Hoffman said. “No pediatrician in the country is happy right now.”

This article is from a partnership that includes OPB, NPR , and KFF Health News.

___

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

The loss of taste and smell — hallmarks of a coronavirus infection early in the pandemic — became a stubborn blight for many long COVID-19 sufferers, but new research shows that the sensory problems gradually abate.

Smell and taste disturbances were reported in almost two-thirds of the 100 people who had caught a mild case of COVID-19 in the fall of 2020 in Trieste, Italy, and were randomly selected for studying alongside 100 uninfected people for comparison. Both groups were followed for three years.

About a quarter of the COVID-19 cases couldn’t taste properly a year after the acute illness but, after two years, there was little difference between them and controls. The research, published Thursday in a letter to the journal JAMA Otolaryngology, suggests that so-called gustatory dysfunction, linked to the taste bud-damaging immune response to lingering vestiges of SARS-CoV-2 in the tongue, resolves faster than problems with smell.

More than a quarter of the COVID-19 group still experienced olfactory dysfunction two years after infection, but after three years, the condition wasn’t significantly more common than in controls, the researchers found.

That’s reassuring for the 28 million Americans estimated to have endured a worse sense of smell after COVID-19. Far from a benign inconvenience, a coronavirus-induced sensory upheaval can make people not want to eat, leading to depression and weight loss, and prevent the detection of harmful gas and smoke.

“A recovery of olfaction appears to continue over three years,” Paolo Boscolo-Rizzo, a researcher at the University of Trieste, and colleagues wrote. “These results can be generalized to individuals of white race who experienced mild symptoms during the early waves of the COVID-19 pandemic.”

The complication has become less common since the omicron variant became the predominant cause of COVID-19 at the end of 2021. Scientists have long sought to understand the cause of the impairment, which has been linked to certain genetic variations, and neurological manifestations and damage to olfactory support cells.

©2023 Bloomberg L.P. Visit bloomberg.com. Distributed by Tribune Content Agency, LLC.

Holly Smith Mount wanted to be first.

Smith Mount, chair of the city council in Huntington, West Virginia, was determined to see her community launch the state’s initial outdoor drinking zone — an idea made possible only after the legislature changed the state’s alcohol law earlier this year.

“I will fully admit I’m very competitive,” she told Stateline. “And I told the mayor, ‘I want to be first on this one.’”

So, when Huntington’s downtown drinking district launched this fall, Smith Mount aimed to be at the front of the line to grab a beer from a local taphouse. The new program sanctions open containers of alcohol within designated boundaries officially known as a Private Outdoor Designated Area, or PODA.

“I walked down the street and I felt so naughty,” she said. “I went into one of my favorite shops and I was like, ‘Look, I’ve got a beer!’”

Huntington leaders saw the district as a way to encourage economic growth by drawing more people to the heart of the city: The hope is that by allowing people to grab a drink and linger, they’ll spend more time and money downtown. Steps away from the banks of the Ohio River, the zone’s few square blocks include local restaurants, bars and shops.

“To me this was just a cherry on top of our already thriving downtown,” Smith Mount said. “It’s a way to kind of get people outside, get people socializing, and ramp up the economy even more.”

In recent years, several states have relaxed alcohol consumption laws to allow communities to create their own limited drinking zones. They aim to revitalize downtown cores hollowed out by the changing nature of retail and the post-pandemic loss of office workers.

North Carolina cities have been creating outdoor “social zones” since Democratic Gov. Roy Cooper signed a new law in 2021. Dozens of Ohio communities big and small have created Designated Outdoor Refreshment Areas, which the legislature sanctioned in 2015 to allow people to walk around freely with a beer, wine or cocktail. Communities in Kansas and Indiana are exploring or creating new areas after legislatures in both states changed their laws earlier this year.

Indiana’s new outdoor refreshment areas largely mirror those in neighboring Ohio. Republican state Sen. Liz Brown sponsored legislation over the past three years after a constituent enjoyed one of the districts in Ohio and asked her why the Hoosier State didn’t have something similar.

“I don’t usually like to give other states credit, but I do have to give Ohio credit,” she said. “ … We copycatted them.”

Aside from bringing foot traffic to shops and restaurants, officials say the success of the new districts reveals the need to update antiquated liquor laws that long banned public consumption in most places to try to reduce public intoxication and drunken driving. While some critics have raised concerns about the new districts’ potential to promote drinking, crime or littering, organizers across the country say they have largely been adopted without incident.

In West Virginia’s second-largest city, officials said the drinking district faced little public opposition.

Huntington, a city of about 47,000, is home to Marshall University. On football game days, the area around campus is already “basically open container,” Smith Mount said.

The district is open on Thursdays, Fridays and Saturdays from April to October. But Smith Mount said the effort was already so successful that city leaders are looking at expanding the season. In the future, she envisions holiday shoppers clutching mulled cider while browsing in downtown shops.

The Private Outdoor Designated Area isn’t a free-for-all. Only licensed bars and restaurants can sell drinks, which must be served in clearly marked cups — no red Solo cups allowed. Drinks must be consumed within the district’s boundaries. And store owners can choose to opt in or out.

So far, the city hasn’t heard of any problems with the program, officials said.

“In the years past, you had to go to places like New Orleans or Key West to walk down the street just having a cold beverage,” Smith Mount said. “And those days are kind of past us.”

‘This is just the start’

In the northern stretches of Topeka, Kansas, Redbud Park is home to sculpture gardens and bright murals. Once a month, the park turns into a concert venue for the area’s First Friday art walks.

But those performances so far have been alcohol-free, said Thomas Underwood, executive director of the NOTO Arts & Entertainment District.

“At this point you can’t buy a beer from the place across the street and come over and listen to the band, because you can’t cross the street with a beer,” he said. “That just seems stupid.”

Until this year, Kansas law only allowed public consumption areas if streets were blocked off to traffic. Underwood’s nonprofit was among the groups that lobbied legislators earlier this year to make a change.

The First Friday events bring valuable foot traffic to the state capital’s arts district. But Underwood said businesses don’t want to see streets closed off — which could dissuade customers from attending, not to mention the complications of renting barricades and acquiring city permits.

This year, the legislature allowed communities to apply for Common Consumption Area permits that don’t require street closures. The Kansas Department of Revenue reports the state has licensed 32 common consumption areas, in a mix of tiny towns, larger cities and booming suburbs.

With little opposition, Underwood expects Topeka to approve a common consumption area soon. In late October, a Topeka City Council committee discussed creating consumption areas in downtown and in the arts district. The city will hold a series of listening sessions before voting on the matter, said city spokesperson Gretchen Spiker.

If approved, Underwood said, the common consumption area will bring more visitors to concerts, galleries and shops in the arts district — and hopefully boost sales for bars and restaurants.

“Nobody down here thinks it should be a seven-day-a-week-type thing,” he said. “We think it should be somewhat limited. We know there’s going to be some enforcement and management issues with this.”

Kansas Republican state Rep. Tory Blew was among those who supported the change in state law. She sits on the board of Great Bend Alive, a nonprofit that hosts a monthly Friday evening event in downtown Great Bend, a city of about 15,000 in the middle of the state.

Called Fridays on Forest, the event has been held on a side street as Great Bend’s Main Street happens to be a state highway — making street closures there prohibitively difficult. So, organizers have closed down Forest Street to bring in food trucks, games and alcohol. As many as 600 people will attend any given Friday, Blew said.

“People look forward to it,” she said. “It’s just everybody coming together. … I think it’s just a sense of something to do in town.”

She knew Great Bend wanted to expand its Friday events without closing down Main Street, but was surprised to learn how many Kansas communities were also planning big events and celebrations with common consumption areas.

“They all have a totally different vision,” she said.

Great Bend is currently exploring ways to expand the seasonal event now that the state law has changed. In her community, the consumption area is part of a wider effort to rejuvenate downtown: Younger people are moving back or into town, bringing new coffee shops and a brewery.

She said the alcohol district isn’t a panacea but has greatly helped improve downtown’s trajectory.

“We’ve got a great start with what we’ve done so far with the common consumption district,” Blew said. “I think this is just the start of the momentum.”

Recovering from the pandemic

Robin Davis had been worried about opposition in Norwood, North Carolina, a town of about 2,600 people about 50 miles east of Charlotte.

One of the community’s main churches sits just steps away from the small downtown where she aimed to create a social district that would allow alcohol following a new law in 2021.

“Luckily, it was a Methodist church,” she said. “We went straight to them and said, ‘Look, this is our vision. We’re not looking to have an outdoor community where people are stumbling around drinking.’”

The church and the town embraced the idea, she said.

Davis owns 110 Main Mercantile, which houses a boutique, co-working space and coffee shop, and runs a nonprofit supporting the downtown businesses. She said the new social district complements other investments in rebuilding the downtown.

“There was really nothing going on downtown,” she said. “You know, there wasn’t a community down there for hanging out and socializing. We actually have built that community.”

Nestled just a few miles from Lake Tillery, Norwood was discovered during the pandemic by dwellers of North Carolina’s bigger cities, Davis said. The social district has helped downtown businesses, but it’s also elevated events such as the town’s annual Arbor Day celebration, which is now able to bring in wineries and breweries in addition to live music and other events.

In fact, some members of the town council questioned why Norwood’s recent fall festival didn’t have any alcohol vendors on hand, Davis said.

“So, it was kind of neat that they were asking for it and a bit disappointed,” she said.

More than 100 miles away, officials in Raleigh purposely created their social district in the parts of downtown most affected by the loss of office workers during and after the pandemic.

“We were avoiding our nightlife area because they didn’t have as many challenges,” said Rachel Bain, the city’s hospitality and nightlife planner.

Raleigh launched its Sip n’ Stroll Downtown in August 2022 centered around Fayetteville Street and the Warehouse District. The district allows patrons to carry around specially marked cups from 10 a.m. to 10 p.m. each day.

That’s helped boost sales at places like Crank Arm Brewing Company, where business remains uneven more than three years after the pandemic.

“2020 was really, really rough, as was the early part of 2021,” said co-owner Adam Eckhardt. “So we are definitely looking for a way to recoup massive and catastrophic losses.”

More people are living in downtown Raleigh, he said, but the after-work crowd has not rebounded, as many employers remain on hybrid schedules or have closed their downtown offices altogether.

Eckhardt said some residents were worried that the social district would cause a rise in public drunkenness or other crimes. But he said that simply hasn’t happened, because all the same laws forbidding drunken driving and disorderly conduct are still enforced.

“Those laws aren’t being done away with. All that’s being done away with is essentially the retail open container law,” he said.

Stateline is part of States Newsroom, a national nonprofit news organization focused on state policy.

©2023 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

More than half the children who attend Munchkin Land Daycare near Billings, Montana, have special needs or compromised immune systems. The kids, who range in age from 4 months to 9 years, have conditions that include fetal alcohol syndrome, cystic fibrosis, and Down syndrome, according to owner Sheryl Hutzenbiler.

“These families came to me knowing we could offer them a safe and healthy environment,” Hutzenbiler said. Part of ensuring that healthy environment is having a strong vaccination policy, she said, especially for those who are immunocompromised or too young to receive the full slate of childhood vaccines.

So, when officials at Montana’s health department revived a proposal that would allow people to claim religious exemptions from immunization requirements at child care facilities, Hutzenbiler was both dismayed and relieved. Dismayed, because allowing more children to claim exemptions could compromise the community immunity levels necessary to defend against highly infectious diseases like measles and pertussis. Relieved, because as she scoured the proposed regulations, she found that her facility, which is licensed to care for up to 15 children, would be in a category of smaller providers that could choose whether to enroll unvaccinated kids.

“If it came down to where I had to, I had no choice, I would stop enrolling children today,” Hutzenbiler said. “In five years, I would be closed.”

Montana, like 44 other states, allows religious exemptions from immunization requirements for school-age children. If the state is successful in expanding its policy to child care facilities, it would become the second this year to add a religious exemption to its immunization requirements for younger kids. Mississippi began allowing such exemptions for schools and child care centers in July following a court ruling that the state’s lack of a religious exemption violated the U.S. Constitution’s free exercise clause.

Until recently, the trend had been going the other way, with four states — California, New York, Connecticut, and Maine — removing religious exemption policies over the past decade. West Virginia has never had a religious exemption.

But religious exemptions, fueled by conservative backlash to covid-19 vaccinations, have become caught up in partisan politics, said Mary Ziegler, a University of California-Davis law professor who specializes in the law, history, and politics of reproduction, health care, and conservatism.

“It tends to be breaking down much more along red state-blue state lines, where progressive states are moving in the direction of mandating vaccines in more situations and conservative states are moving more in the direction of broadening exemptions,” Ziegler said. “So, as much as religious exemptions for vaccines are not a new issue, they’ve become polarized in a new way.”

The proposal in Montana is similar to one the state Department of Public Health and Human Services floated last year, which a legislative committee temporarily blocked after public health advocates and child care providers objected. Afterward, in October 2022, health department officials said they would not enforce a religious exemption ban in child care centers.

“We are committed to ensuring that these families have viable child care options in accordance with state and federal law,” department spokesperson Jon Ebelt told the Montana Free Press at the time.

However, in the state’s latest proposal, 45 pages into a 97-page draft rewrite of child care licensure rules, the health department seeks to extend that exemption to child care facilities, where a family now can claim a vaccine exemption only for medical reasons. (There is an existing religious exemption for the vaccine against Haemophilus influenzae Type B.)

KFF Health News sent the health department a list of questions about its decision to include a religious exemption in the rules proposal. Ebelt emailed a statement that did not address the exemption at all.

“The rules package cuts red tape to increase access to child care for hardworking Montana families, and ensures that related regulations align with statutory changes directed by the Legislature in 2021 and 2023,” his statement said.

The Montana Religious Freedom Restoration Act prohibits the state from infringing on a person’s right to the exercise of religion. Another act bans discrimination based on vaccination status.

A religious exemption under Montana’s proposed rules would require a child’s parent or guardian to submit a form attesting that vaccination is contrary to their religious belief, observance, or practice. With no mechanism to check the validity of such claims, health professionals worry exemptions would spike, reducing community immunity levels.

“Exemptions lead to less people being vaccinated, which can lead to more outbreaks and more sick kids,” said Marian Kummer, a retired pediatrician who practiced in Billings for 36 years.

The risk of disease outbreaks would increase not only in those child care centers but in communities as well, said Sophia Newcomer, an associate professor at the University of Montana School of Public and Community Health Sciences.

A community is protected by herd immunity from measles, for example, if 95% of the population is vaccinated against it, according to the World Health Organization. Montana’s vaccine exemption rate among kindergartners was 3.5% in the 2020-21 school year, according to the most recent data available, putting it within that range of protection.

The health department’s proposed changes also would eliminate a requirement that child care facilities keep out infected and unvaccinated children and staffers when someone becomes sick with a vaccine-preventable disease, said Kiely Lammers, director of the nonprofit advocacy group Montana Families for Vaccines.

Some have questioned the legitimacy of religious exemptions. Most religions, including a majority of Christian denominations, have no theological objection to vaccination, according to a scientific review published in 2013 in the journal Vaccine. And the U.S. Supreme Court has ruled limits do exist on religious and parental rights: “The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death,” says the 1944 ruling in Prince v. Massachusetts.

The American Academy of Pediatrics has called for the elimination of all nonmedical exemptions, including both religious exemptions and personal-belief exemptions, “as inappropriate for individual, public health, and ethical reasons,” according to a 2016 policy statement.

In Connecticut, plaintiffs who challenged the state’s decision to remove religious exemptions said they objected to the use of fetal or animal cell lines in the research and development of vaccines. But a three-judge panel for the 2nd U.S. Circuit Court of Appeals wrote in August that religious exemptions do not serve “to protect the health and safety of Connecticut students and the broader public” when it upheld Connecticut’s decision.

Yet even in California, which eliminated nonmedical exemptions in 2016, efforts are underway to overturn the law. In a lawsuit filed Oct. 31, several parents backed by a conservative law firm are challenging the law’s constitutionality. One plaintiff, Sarah Clark, said she believes vaccines run counter to her interpretation of the Bible “because they are a foreign substance and are harmful to the body.” Attorney General Rob Bonta’s office said Nov. 1 it hadn’t been served with the case yet but will review the complaint and respond as appropriate.

Montana’s proposed rule is scheduled for a public hearing Nov. 13. Some child care providers, like Hutzenbiler, expect it ultimately to take effect. She said she is already drafting language to submit to the state as required under the proposed rules, saying Munchkin Land Daycare will not accept unvaccinated children.

Lammers said state officials should be open to changes and give child care centers with 16 or more kids the same choice as smaller facilities not to enroll unvaccinated children.

“I’m hoping at the very least we can make it equal in all settings,” she said of the rule proposal.

Kummer, the retired pediatrician, said she hopes the proposal prompts enough opposition that the state removes the plans for the religious exemption. But she doubts that will happen, given the anti-vaccination sentiment of Montana policymakers.

“It’s going to take a tragedy in our state or somewhere else where people wake up to the fact that we need vaccinations,” Kummer said.

____

California news editor Judy Lin contributed to this report.

(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

Consumers and investors were spared from a 12th rate hike when Federal Reserve officials voted in November to keep their benchmark borrowing rate steady.

Don’t take the pause as an indication that officials are ready to sound the all-clear on their firefight against inflation.

Fed Chair Jerome Powell’s main message after the Federal Open Market Committee’s (FOMC) November rate decision was that officials are not yet sure they’ve raised interest rates enough to quell inflation. That’s even as the Fed’s key borrowing benchmark sits at a 22-year high of 5.25%-5.5%.

In economic projections last updated in September, officials indicated to Fed watchers that one more increase is on the table for this year. If approved, the move would bring the Fed’s key benchmark interest rate to a new 22-year high of 5.5%-5.75%. It could also possibly be the last rate hike. Just one official sees rates rising higher than that next year, those projections show.

Those projections, however, can prove to be fleeting in an uncertain economic environment. Officials are slated to refresh those estimates at their last meeting of the year in December.

Higher rates mean more expensive borrowing costs. Following the Fed’s moves in lockstep are the prices consumers pay to borrow money, whether it’s the price of financing a purchase on a credit card or the cost of taking out an auto loan.

But that uncertainty is two-sided. Just as officials aren’t confident that interest rates are high enough, they also aren’t convinced that they need to raise interest rates again at all.

“We haven’t made any decisions about future meetings,” Powell repeated at the Fed’s post-meeting press conference. “It’s fair to say that the question we’re asking is: Should we hike more?”

The Fed has been lifting borrowing costs with a purpose: Officials are trying to cool down an overheated post-pandemic economy that contributed to the hottest inflation in generations.

Fed officials are seeing some progress in stabilizing prices, but the job isn’t over yet. Hotter gas prices contributed to a pick up in inflation for two straight months this summer, with prices now stuck at a 3.7% annual growth rate since August, according to the Bureau of Labor Statistics’s latest reading.

Overall inflation can be more volatile because of fluctuating food and energy prices. Yet, if those prices rise for long enough, they could add to the Fed’s headaches. Fed Chair Jerome Powell has said households experience food and energy inflation most, making it an important driver of their expectations for where prices end up in the future.

Powell has also reiterated that how fast prices excluding food and energy — so-called “core” inflation — rise is the better indicator of underlying inflation. That gauge has fallen more than 2 percentage points from its peak but is still about two times higher than the Fed’s target, giving Fed officials another reason to remain on guard.

After the Fed decides whether it’s raised interest rates high enough, next comes the task of determining how long to keep interest rates at that historically high level — a debate that policymakers may be hesitant to let markets in on, out of fear that it could prematurely loosen financial conditions.

Should the Fed raise rates again? Past experience is igniting the U.S. central bank’s hawkishness

Experts say the risks of pulling back too soon and kickstarting another vicious inflation spiral remain higher than the risks of doing too much. The Fed’s failure to slow the economy enough and stomp out inflation in the 1970s led to a painful recession in the 1980s.

“The worst thing we can do is to fail to restore price stability because the record is clear on that,” Powell said in September. “It can be a miserable period to have inflation constantly coming back and the Fed coming in and having to tighten again and again.”

The U.S. economy is showing clear signs of slowing. Job growth last month rose by the slowest pace since June, with employers adding 150,000 jobs in the month. But that slowdown isn’t looking worrisome yet. Even with the Fed raising interest rates a whopping 525 basis points since March 2022, unemployment is still at historic lows below 4%.

The job market’s strength is giving workers time to make up some of the ground that they lost to inflation, though their paychecks haven’t fully recovered yet.

Fed officials hope it suggests they can gradually cool prices without hurting the job market. But the ultimate fear is it could contribute to more inflation.

On the back of the still-strong job market, consumer spending is helping drive the economy. Consumption in September rose 0.7% from the previous month, the fastest pace in six months, according to data from the Department of Commerce. A red-hot summer of spending helped the financial system grow by the fastest rate — 4.9% in the third quarter of 2023 — since 2021, gross domestic product (GDP) figures show.

Economists say signaling another rate hike is more about giving the Fed options.

“It’s important for the Fed at the moment to have all the options on the table,” says Tuan Nguyen, an economist at RSM. “All of those meetings will be live, meaning the Fed will have the options of whether to pause or hike.”

Investors aren’t convinced the Fed will raise rates again — and some economists agree

Investors aren’t convinced the Fed will be able to follow through. Even as the Fed signaled it hasn’t made its mind up yet, most market participants still predominantly assume the Fed is done, according to data from CME Group’s FedWatch tool.

So do some prominent Wall Street firms and their economists, from Morgan Stanley to Moody’s Analytics.

One reason why the Fed might end up going on a prolonged pause is simply because the U.S. economy hasn’t caught up to higher rates just yet. Experts say it may take a year for the full effect of a rate hike to hit the job market. Hiring is often the last shoe to drop. A year ago, rates had just been pushed past the so-called “neutral” rate of interest, or the point where borrowing costs are no longer stimulating economic growth.

Some economists say raising rates is akin to driving a car down the road while looking out of the rearview mirror. Data is backward-looking, and the Fed may find it’s done too much to slow the economy when it’s too late. While the economy had a blockbuster third quarter, it could also be the last hurrah before higher rates come to crash the party. Historically, the Fed hasn’t been able to raise rates without triggering a recession very often.

“Not only is it a concern, but the odds favor it,” McBride says, referring to a recession. “Look at the last three [tightening] cycles: Two of them ended in recessions, and the one that didn’t was an economic slowdown, where they had to reverse course and start cutting rates. History is not on their side.”

Another reason to be cautious, the Fed can keep squeezing the economy without raising rates. What often does the trick is if the “real” cost of money — meaning the difference between interest rates and overall inflation — is on the rise. The Fed’s key benchmark rate has been higher than inflation since May.

“If the Fed continues to raise rates in an environment in which inflation is coming down, that creates more pain for aggregate demand and more pain for the economy,” says Jordan Jackson, global market strategist at J.P. Morgan Asset Management. “Then, you run the risk of further exacerbating a downward movement in inflation. … You’re in a situation where you could be looking at outright deflation.”

Fed officials are also mindful of bank failures from last March, which demonstrate that risks can pop up out of nowhere and without much notice. A massive surge in long-term interest rates — with the 10-year Treasury yield crushing new 16-year highs in October — could also do some of the Fed’s work for it.

To top the balance of risks off, the threat of a possible government shutdown could make it harder for the Fed to track just how much these varying forces are impacting inflation. The government agencies that produce the consumer price index (CPI), personal consumption expenditures (PCE) index and employment situation reports would be on furlough until the gridlock is resolved.

How the Fed navigates the pros and cons of future rate moves depends primarily on the FOMC’s point of view — and how they decide to weigh the conflicting backdrop.

“If you’re balancing risks and you get less worried about the economy slowing and more worried about inflation just staying high and getting built into the price and wage-setting process, then you might conclude you need to move faster,” says Bill English, a finance professor at the Yale School of Management, who spent 20 years at the Fed. “Lags just make the problem harder because you have to be forward-looking and judge where the economy is going to be.”

5 steps to take with your money when rates and recession risks are high

Another increase means higher borrowing costs for consumers, including on credit cards, personal loans, auto loans and more. And even if central bankers are done raising rates, those interest rates are unlikely to fall until the Fed cuts its borrowing benchmark — a move that U.S. central bankers think still remains off in the distance.

The highest rates in more than two decades mean that money is no longer cheap. In this new era of monetary policy, these are the important moves you should be making with more money.

1. Keep a long-term mindset

Differing expectations about what the Fed could do with rates in the months ahead could lead to more market volatility. Plunging stocks mean pain for investors, and the possibility of a recession or even higher Fed interest rates could worsen the volatility. But don’t succumb to market volatility and change your approach. Remember, a diversified portfolio and a long-term mindset protect you through the most brutal times in the stock market.

2. Pay down debt

Consumers with fixed-rate debt, commonly on loans such as mortgages, won’t feel any impact when the Fed raises rates. But Americans are more fragile if they have a variable-rate loan, especially if it’s debt on a high-interest credit card. The average credit card rate is hovering at the highest levels ever recorded, thanks to the Fed’s recent inflation fight, according to Bankrate data.

Consider consolidating that debt with a balance-transfer card to help you make a bigger dent in your principal balance, with some cards offering borrowers 0% introductory annual percentage rates (APRs) for up to 21 months. However, the time to take advantage may be now. Consumers may find it tougher to get approved for one of these offers — or issuers may get rid of them altogether — if the economy ever takes a turn for the worse.

Homeowners with an adjustable-rate mortgage or a home equity line of credit (HELOC) might want to consider refinancing into a fixed-rate loan. “You don’t want to be a sitting duck for higher interest rates on your credit card or home equity line of credit,” McBride says. Home equity lines of credit have also historically been a cheaper way to borrow money, but that’s now looking like a relic of a low-rate era with HELOC rates now pushing 9%.

3. Boost your emergency savings

With the economic outlook uncertain, now’s an important time to take a careful look at your finances and find ways to boost your emergency fund if you don’t already have the recommended six to nine months’ worth of expenses stashed away. But the silver-lining to rising rates: Savers can find the best yields in over a decade that can even help them grow their purchasing power, with many yields at online banks now beating inflation.

4. Find the best place for your cash

Savers can earn even more money on their cash by switching to a high-yield savings account. Many accounts on the market are offering consumers who bank with them yields near 5%. If you put an initial $10,000 deposit into an account with a 5% annual percentage yield (APY), you’d earn $500 in interest, compared with just $60 on the average savings yield of 0.60%.

Consumers who already have an emergency fund may even want to start thinking about locking in those elevated yields for the longer haul by opening a 2-year or 5-year certificate of deposit. Savings account yields are variable, and banks often don’t wait for the Fed to cut rates before lowering their own yields.

5. Think about recession-proofing your finances

Given that plenty of risks lie ahead for the Fed, always be on the lookout for ways that you can recession-proof your finances. Along with building up your emergency fund, experts say it comes down to living within your means, staying connected with your network, identifying your risk tolerance and staying focused on the long haul if you’re an investor.

“To relieve individuals, households and businesses of historically high inflation, the Fed has been prepared to accept the risk of a recession if it achieves the mandate of stable prices,” says Mark Hamrick, Bankrate senior economic analyst. “Choosing from the least of two evils, it isn’t dissimilar from when firefighters trade some damage from water for fire damage.”

(Visit Bankrate online at bankrate.com.)

©2023 Bankrate.com. Distributed by Tribune Content Agency, LLC.

UNIVERSITY CITY, Mo. — As activists parse the results of Tuesday’s vote to protect abortion rights in Ohio, Jamie Corley is already well on her way to putting a similar measure in front of Missouri voters next year.

Corley, a former Republican congressional staffer, filed not one, but six potential ballot measures in August to roll back her state’s near-total ban on abortion, triggered by the U.S. Supreme Court’s June 2022 decision to end federal protections for terminating pregnancies.

“I can’t emphasize enough how dangerous it is to be pregnant in Missouri right now,” Corley said at a restaurant near her home in this St. Louis suburb. “There is a real urgency to pass something to change the abortion law.”

Missouri is one of at least 11 states considering abortion-related ballot measures for next year, part of the wave of such actions since the Supreme Court’s decision on Dobbs v. Jackson Women’s Health Organization. And while November 2024 is still a year away, the groundwork for those campaigns has been in motion for months, sometimes years.

In Iowa, for example, efforts to pass a state constitutional amendment declaring no right to abortion began in 2021, although the legislature has yet to finish the process. In Colorado, competing initiatives — one to enshrine abortion protections and one to ban abortion — could potentially appear on the same ballot if supporters of both manage to garner enough signatures. And in Missouri, potential ballot measures to increase access to abortion have been bogged down in litigation for months, delaying the collection of signatures and highlighting internecine conflicts on both sides of the issue.

“In a way, I think this is what the Supreme Court wanted,” said John Matsusaka, executive director of the Initiative and Referendum Institute at the University of Southern California. “They said, ‘The people ought to figure this out.’”

The push for sending the contentious issue to voters comes on the heels of last year’s string of ballot measure wins for abortion rights in six states: California, Kansas, Kentucky, Michigan, Montana, and Vermont. And on Tuesday, Ohio voters broadly passed a measure to establish a state constitutional right to abortion.

Citizen-initiated ballot measures in the 26 states that allow them are often prompted by legislatures that stray far from public opinion, Matsusaka said. Fourteen states have banned abortion since the Dobbs decision, despite polling suggesting those bans are unpopular. Two-thirds of adults expressed concern in a May KFF poll, for example, that such bans could make it difficult for doctors to safely treat patients.

But in states where abortion is legal, a push is coming from the other direction.

“Colorado was actually the first state, or one of the first states, to provide abortion on demand,” said Faye Barnhart, one of the anti-abortion activists who filed petitions to restrict abortions there. “We were pioneers in doing the wrong thing, and so we’re hopeful that we’ll be pioneers in turning that around to do the right thing.”

A similar effort in Iowa, meanwhile, is up in the air. The legislature in 2021 approved a proposed amendment declaring the Iowa Constitution does not protect abortion rights. But the measure needs to pass the Republican-controlled legislature again to get on the ballot. Lawmakers declined to take up the matter during this year’s legislative session but could do so in 2024. A poll published by the Des Moines Register in March found that 61% of Iowans think abortion should be legal in all or most cases.

If Missouri’s abortion ban is indeed rolled back next year, it would mark the fourth time since 2018 that the state’s voters rebuked their Republican leaders, who have controlled the governorship and both legislative chambers since 2017. Recent initiative petitions have succeeded in raising the minimum wage, legalizing marijuana, and expanding Medicaid, the public insurance program for people with low incomes and disabilities.

The success of those campaigns doesn’t mean the petition process is easy, said Daniel Smith, a political science professor at the University of Florida who specializes in ballot initiatives. Collecting signatures is costly and often requires contracting with what he called the “initiative industrial complex.”

An analysis by Ballotpedia found that the cost per required signature collected for initiative campaigns in 2023 averaged $9.38. At that rate, it would cost more than $1.6 million to get an initiative on the ballot in Missouri — where around 172,000 signatures are needed. And that’s before adding in the cost of running campaigns to persuade voters to choose a side.

In the two months leading up to November’s vote in Ohio, the campaign to protect abortion rights raised about $29 million, and the opposing campaign raised nearly $10 million, according to The Associated Press. Much of the funding came from out-of-state groups, such as the progressive Sixteen Thirty Fund in Washington, D.C., and an Ohio organization associated with the national anti-abortion group Susan B. Anthony Pro-Life America.

And more money will pour into the next efforts: Last month, Illinois Gov. J.B. Pritzker, a billionaire Democrat whose family owns the Hyatt hotel chain, launched the Think Big America organization to help fund abortion-rights ballot measures across the country.

Still, the cost of launching a ballot campaign is a daunting obstacle, said Emily Wales, president and CEO of Planned Parenthood Great Plains, which has clinics in Missouri, Kansas, Oklahoma, and Arkansas. During last year’s vote in Kansas, for example, the competing campaigns raised over $11.2 million combined. That may be a factor in the absence of a ballot measure in Oklahoma despite momentum for one last year.

“It’s not just: Can you pull together a coalition, educate voters, and get them out? But: Can you also raise enough to combat what has been years of misinformation, miseducation, and really shaming and stigmatizing information about abortion?” Wales said.

Polling in Missouri indicates voters statewide, including many Republicans, might back abortion rights in certain circumstances.

That’s what led Corley to file her petitions in August despite a political action committee called Missourians for Constitutional Freedom having already filed 11 proposals to roll back the state’s abortion ban. Corley said her proposals are narrower to attract support from sympathetic Republicans like herself. They provide exemptions for rape, incest, fetal abnormalities, and the health of the mother. Three would prevent restrictions on abortions for the first 12 weeks of pregnancy.

The proposals from Missourians for Constitutional Freedom would allow abortion later in pregnancy. Some versions allow regulations on abortions only after 24 weeks, while others specify after “fetal viability” or don’t give any time frame.

One group withholding support from any effort so far is Planned Parenthood of the St. Louis Region and Southwest Missouri, the state’s other main Planned Parenthood affiliate and the final clinic to provide abortion services before Missouri’s ban.

“My concern is that we would potentially rebuild the same system that failed so many people,” said Colleen McNicholas, its chief medical officer for reproductive health services.

Missouri lawmakers long sought ways to limit abortion even while it was protected by the Supreme Court’s Roe v. Wade decision, including enacting a 72-hour waiting period in 2014. The number of recorded abortions in the state dropped from 5,772 in 2011 to 150 in 2021, the last full year before the current ban.

“We know what it’s like to live in a post-Roe reality, and we knew that reality well before the Dobbs decision,” said McNicholas.

Still, Corley said her group is ready to push ahead with at least one measure.

“People are looking for something like what we’re putting forward, which is something in the middle that provides protections against criminal prosecution,” Corley said. “I also don’t think people understand how much worse it can get in Missouri.”

____

Rural editor and correspondent Tony Leys in Des Moines, Iowa, contributed to this report.

___

(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.