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A local attempt to set heat safety standards for outdoor workers

November 6, 2023
Reporter, Morning Rounds Writer
Good morning. Some of us might be breaking out the SAD lamps and the blankets, but let's not forget the very real dangers that extreme heat poses to people whose jobs keep them outside.

climate change

Outdoor workers have no protections against the heat. That might change in Miami-DadeAP626604814262

Gerry Broome/AP

Remember the heat alerts that came almost daily from the National Weather Service between May and September? Now that we've all turned the clocks back and some of us are bundling up in cooler temperatures, we might forget how vulnerable outdoor workers are to extreme heat. There are no federal heat safety standards, from OSHA or other agencies, so bit by bit local governments are stepping in, with varying degrees of success.

Take Miami-Dade County. Its commissioners will vote tomorrow on proposed protections for workers that go beyond occasional rest breaks to also require acclimatization (gradual exposure to heat), first aid and emergency procedures, and 10-minute water and rest breaks in the shade every two hours. While "better than nothing," Juley Fulcher of Public Citizen told STAT's Isabella Cueto, if adopted, the rules would be part of a patchwork solution that will face legal challenges. Read more.


hospitals

A push for more price transparency from hospitals and more oversight of Medicare Advantage plans

STAT's Bob Herman brings us two updates on efforts to shine a light on hospital prices and Medicare Advantage plans: 

  • The federal government is moving forward with proposals that will force hospitals to be more transparent with Medicare about the prices they charge health insurers and patients. Federal law has required hospitals to post their prices since 2021, but compliance has been dismal. Although somewhat better after government fines went up, hospital pricing information is still tough to find and confusing to interpret. More here.
  • Meanwhile, House Democrats are telling the Biden administration that Medicare Advantage plans need better oversight, citing recent STAT investigations that found insurance companies use artificial intelligence and algorithmic software to deny care even when people still need it. STAT previously reported that Medicare Advantage insurers are using proprietary algorithms and AI to initiate payment denials, but that technology does not fully account for someone's particular care needs. More here.

insurance

Millions of Americans have lost Medicaid coverage

children-account-for-roughly-four-in-ten-39-of-medicaid-disenrollments-in-the-20-states-reporting-age-breakouts-as-of-november-1-2023

More states continue to unwind their Medicaid programs after the federal requirement for continuous courage expired with the Covid-119 public health emergency in April. Disenrollments have now climbed above 10 million people, the latest KFF tracker tells us. That means as of Nov. 1, Medicaid enrollment was confirmed for just over 18 million people. Of all the people who lost coverage, 71% did so for one of two procedural reasons: their eligibility wasn't automatically renewed by the state or they didn't complete the necessary forms for Medicaid renewal. 

Through this redetermination process, an estimated 4 in 10 children have lost coverage. Pushed by the Biden administration, about a dozen states slowed down their redeterminations of who was eligible for coverage. About half a million children were were added back. STAT's Annalisa Merelli has more.



closer look

Opinion: Harm reduction is at risk of becoming a fad

GettyImages-1249168087-1Brendan Smialowski/AFP via Getty Images 

We need harm reduction, Alexandra Plante of the National Council for Mental Wellbeing asserts in a STAT First Opinion. But we can't let it fall victim to rising oversimplified popularity that doesn't account for the complexities of substance use disorder. To understand her point, she cites some history. A century ago, there were "alcohol asylums" in the U.S. that overstated impressive recovery rates, breeding skepticism about addiction treatment. She connects this hype to current policies criminalizing substance use.

Today, we might applaud overdose prevention centers that immediately intervene in crisis situations, but these standalone remedies remain neither a cure nor treatment for substance use disorder. "The problem with fads, however, is that they are short-lived, and the widespread support is fleeting," she writes. "The substance use challenges we face are anything but fleeting and require sustainable, long-term investments in harm reduction, treatment, and recovery support services in tandem." Read more.


health inequity

At any PSA level, Black men more likely to have prostate cancer

Here's a glaring disparity: Black men in the U.S. are 80% more likely to develop prostate cancer and 220% more likely to die from it than white men. That would argue for earlier screening with the prostate‐specific antigen test known as PSA, but people worry about the risk of over-diagnosis. Now a study of more than 280,000 men who received care from the VA health system has found that at any PSA level — early or late — Black men are more likely to have prostate cancer than white men. 

The Black veterans were 50% more likely than white veterans to be diagnosed with prostate cancer after a first biopsy. And before biopsy, Black veterans with a PSA of 4.0 ng/mL had an equivalent risk of prostate cancer as white veterans with a PSA of 13.4 ng/mL. The difference was even larger for younger Black men. "Our findings may indicate a need for PSA biopsy thresholds to be informed by a better understanding of patient risk factors," the authors write. 


children

When guns kill kids, intimate partner violence frequently plays a role 

Half of homicides in children from 2003 through 2020 were caused by guns. Of that number, 12% were connected to intimate partner violence, a new analysis in Pediatrics says today. By far, most of the kids under 18 who died were, to use the researchers' term, "corollary victims" of violence occurring around them, but 14% of these deaths were perpetrated by a teen's current or former dating partner.   

These deaths were typically precipitated by conflict or crises, and two-thirds of them happened at the same time as the perpetrator's suicide. In more than half of these child deaths, an adult also died; 94% of those who died were their mothers, often after a relationship had just ended. "These findings show the safety of the mother is closely linked to that of her children, underscoring the importance of taking the needs of both adult victims and their children into consideration when assessing risk," the authors write.


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What we're reading

  • The retired pilot went to the hospital. Then his life went into a tailspin, Washington Post

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    The rise and fall of Dr. Roxy, The Cut
  • Brazil once pioneered generic drugs, and then came a patent war, Bloomberg

  • Biden pick to lead Social Security pledges action on 'heartbreaking' clawbacks, KFF Health News
  • As billions roll in to fight the US opioid epidemic, one county shows how recovery can work, Associated Press
  • Health plan formularies lowered barriers to fair access to some drugs, analysis finds, STAT


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