closer look
With therapists in short supply, some in the field are looking to lay counselors
Sandy Huffaker for STAT
The U.S. has a mental health care crisis, made worse by the pandemic widening the gap between the number of people who need care and the pool of therapists who can help them. There's a growing movement to expand the ranks of counselors by enlisting people who are trained, but not credentialed with advanced degrees or state therapist licenses, to provide some forms of help.
One proponent of this solution is Gaurav Mishra, chief behavioral health officer at San Ysidro Health, whose San Diego health centers were overwhelmed by the needs of 3,500 unaccompanied minors from Mexico and Central America. Training community health workers to lead group sessions for them worked, so he tried that for other patients, too. Many never need to see a therapist, he said. "The people who do need that higher level of specialty care can get in quicker." Read more from STAT contributor Grace Rubenstein.
vaccines
Substituting homeopathic pellets for childhood immunizations draws fine in New York State
We have seen some strange stories in the world of vaccines, especially since Covid arrived, but this one predates the pandemic. The New York State Health Department said yesterday it fined Nassau County midwife Jeannette Breen $300,000 for creating false immunization records for about 1,500 school-aged children, mostly from Long Island. Those children can't return to school until they get up to date on all their missing vaccinations, from measles-mumps-rubella to chicken pox to polio.
Here's how it started: Just after the state ended non-medical exemptions for school immunizations, Breen gave the children "Real Immunity Homeoprophylaxis Program," a series of oral homeopathic pellets marketed as an alternative to vaccination but not authorized by the FDA, the CDC, or the state health department. "Misrepresenting or falsifying vaccine records puts lives in jeopardy and undermines the system that exists to protect public health," State Health Commissioner James McDonald said in a statement about the settlement, which Breen signed.
insurance
Medicaid is the most common insurance for ER visits
When the Affordable Care Act was passed in 2010, hopes were high that improving access to health care, including regular primary care, would cut down on emergency department visits and hospital admissions. The percentage of people lacking health insurance definitely did go down from late 2013 through 2020, but the picture is less clear on whether expanded Obamacare coverage reduced ER visits. ("The relationship between health insurance and emergency care isn't straightforward," this NEJM piece says.)
While not weighing in on that question, today's report from the CDC's National Center for Health Statistics charts trends in insurance status for people under 65. Those without insurance fell from 25% in 2010 to 11% in 2021. Since 2014, Medicaid has been the top form of insurance, increasing by 22% after the program was expanded in 2014. The charts below offer a glimpse into the differences in the insurance status of Black, white, and Hispanic people:
National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 2010–2021
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