Last fall, before being named the senior U.S. health official, Robert F. Kennedy Jr. said the Trump administration would liberate Americans from the FDA’s “aggressive suppression” of vitamins, dietary supplements, and other substances — ending the federal agency’s “war on public health,” as he put it.

In fact, the FDA can’t even require that supplements be effective before they are sold. When Congress, at the agency’s urging, last considered legislation to require makers of vitamins, herbal remedies, and other pills and potions to show proof of their safety and worth before marketing the products, it got more negative mail, phone calls, and telegrams than at any time since the Vietnam War, by some accounts. The backlash resulted in a 1994 law that enabled the dietary supplement industry to put its products on the market without testing and to tout unproven benefits, as long as the touting doesn’t include claims to treat or cure a disease. Annual industry revenues have grown from $4 billion to $70 billion since.

With Kennedy now in the driver’s seat, the industry will likely expect more: It aims to make bolder health claims for its products and even get the government, private insurers, and flexible spending accounts to pay for supplements, essentially putting them on an equal footing with FDA-approved pharmaceuticals.

On Feb. 13, the day Kennedy was sworn in as secretary of Health and Human Services, President Donald Trump issued a “Make America Healthy Again” agenda targeting alleged corruption in health regulatory agencies and instructing them to “ensure the availability of expanded treatment options and the flexibility for health insurance coverage to provide benefits that support beneficial lifestyle changes and disease prevention.”

Kennedy has said exercise, dietary supplements, and nutrition, rather than pharmaceutical products, are key to good health. Supplement makers want consumers to be able to use programs like health savings accounts, Medicare, and even benefits from the Supplemental Nutrition Assistance Program, or SNAP, to pay for such items as vitamins, fish oil, protein powders, and probiotics.

“Essentially they’re seeking a government subsidy,” said Pieter Cohen, a Harvard University physician who studies supplements.

As the Senate Finance Committee questioned Kennedy during his Jan. 29 confirmation hearing, supporters in the Alliance for Natural Health lunched on quinoa salad in the U.S. Capitol Visitor Center and crowed that the moment had finally arrived for their health freedom movement, which has combined libertarian capitalism and mistrust of the medical establishment to champion unregulated compounds since the 19th century.

“The greatest opportunity of our lifetimes is before us,” said Jonathan Emord, the group’s general counsel, who has brought many successful lawsuits against the FDA’s restrictions on unproven health claims. “RFK has dedicated his whole life to opposing the undue influence” of the pharmaceutical industry and “assuring that our interests triumph,” Emord said.

In speeches and in a pamphlet called “The MAHA Mandate,” Emord and alliance founder Robert Verkerk said Kennedy would free companies to make greater claims for their products’ alleged benefits. Emord said his group was preparing to sue the FDA to prevent it from restricting non-pharmaceutical production of substances like biopeptides — complex molecules related to drugs like Ozempic.

HHS spokesperson Andrew Nixon did not respond to a request for comment on the agency’s plans vis-à-vis dietary supplements.

While the basic law governing the FDA establishes that a substance alleged to have treatment or curative effects is by definition a “drug,” and therefore comes under the agency’s requirements for high standards of scientific evidence, the new administration could reallocate money away from enforcement, said Mitch Zeller, former head of the FDA’s Center for Tobacco Products.

As a Senate aide early in his career, Zeller investigated a tainted L-tryptophan supplement that killed at least 30 people and sickened thousands in the U.S. in 1989. The scandal led the FDA to seek heavier regulation of supplements, but a powerful backlash resulted in the relatively weak supplements law of 1994.

Even that law’s enforcement could be undercut with a stroke of the pen that would keep FDA inspectors out of the field, Zeller said.

Sweeping changes couldn’t come too soon for Nathan Jones, founder and CEO of Xlear, a company that makes products containing xylitol, an artificial sweetener. The Federal Trade Commission sued Xlear in 2021 for making what it called false claims that its nasal spray could prevent and treat covid.

Jones points to a handful of studies evaluating whether xylitol prevents cavities and infections, saying the FDA would require overly expensive studies to get xylitol approved as a drug. Meanwhile, he said, dentists have been bought out by “Big Toothpaste.”

One can hardly find any products “without fluoride for oral health,” he said. “Crest and Colgate don’t want it to happen,” he said.

Kennedy’s desire to rid water supplies of fluoride because of its alleged impact on children’s IQ is welcome news, he said, and not only because it could highlight the value of his products. Jones stresses, as do many health freedom advocates, that clean air and water and unadulterated food do more to prevent and cure disease than vaccines and drugs. For example, he and other advocates claim, wrongly, that the United States eliminated the crippling disease polio through better sanitation, not vaccination.

The Alliance for Natural Health hopes that in lieu of strict FDA standards, Kennedy will enable companies to make expanded marketing claims based on evidence from non-FDA sources, Verkerk said, such as the National Institutes of Health’s nutritional information site, which describes the pros and cons of different supplements.

Kennedy has also called for relaxing the strictures on psychedelic drugs, which interest some veterans as potential remedies for such conditions as post-traumatic stress disorder. VETS, a San Diego-based organization, has paid for 1,000 veterans to get treatment with the powerful hallucinogen ibogaine at clinics in Mexico and other countries, said the group’s co-founder Amber Capone.

She got involved after her husband, a retired Navy SEAL, pulled out of a suicidal spiral after spending a week at an ibogaine clinic near Tijuana, Mexico, in 2017. She wants NIH, the Defense Department, and the Department of Veterans Affairs to fund research on the illegal substance — which can cause cardiac complications and is listed as a Schedule I drug, on par with heroin and LSD — so it can be made legally available when appropriate.

Coincidentally, the push for less onerous standards on supplements and psychedelics would come while Kennedy is demanding “gold-standard science” to review preservatives and other food additives that he has said could play a role in the country’s high rate of chronic diseases.

“Put aside the fact that there’s precious little evidence to support” that idea, said Stuart Pape, a former FDA food center attorney. “There’s been no indication they want the same rigor for supplements and nutraceuticals.”

Although most of these products don’t have major safety concerns, “we have no idea which products work, so in the best case people are throwing away a ton of money,” Zeller said. “The worst-case scenario is they are relying on unproven products to treat underlying conditions, and time is going by when they could have been using more effective FDA-authorized products for diseases.”

Supplement makers aren’t entirely unified. Groups such as the Consumer Healthcare Products Association and the Council for Responsible Nutrition have advocated for the FDA to crack down on products that are unsafe or falsely represented. The Alliance for Natural Health and the Natural Products Association, meanwhile, largely want the government to get out of the way.

“The time has come to embrace a radical shift — from reactive disease management to proactive health cultivation, from top-down public health diktats to personalized, individual-centric care,” Emord and Verkerk state in their “MAHA Mandate.”

The post With RFK Jr. in Charge, Supplement Makers See Chance To Cash In appeared first on Medika Life.

Erica Hayes, 40, has not felt healthy since November 2020 when she first fell ill with covid.

Hayes is too sick to work, so she has spent much of the last four years sitting on her beige couch, often curled up under an electric blanket.

“My blood flow now sucks, so my hands and my feet are freezing. Even if I’m sweating, my toes are cold,” said Hayes, who lives in Western Pennsylvania. She misses feeling well enough to play with her 9-year-old son or attend her 17-year-old son’s baseball games.

Along with claiming the lives of 1.2 million Americans, the covid-19 pandemic has been described as a mass disabling event. Hayes is one of millions of Americans who suffer from long covid. Depending on the patient, the condition can rob someone of energy, scramble the autonomic nervous system, or fog their memory, among many other symptoms.

In addition to the brain fog and chronic fatigue, Hayes’ constellation of symptoms includes frequent hives and migraines. Also, her tongue is constantly swollen and dry.

“I’ve had multiple doctors look at it and tell me they don’t know what’s going on,” Hayes said about her tongue. 

Estimates of prevalence range considerably, depending on how researchers define long covid in a given study, but the Centers for Disease Control and Prevention puts it at 17 million adults.

Despite long covid’s vast reach, the federal government’s investment in researching the disease — to the tune of $1.15 billion as of December — has so far failed to bring any new treatments to market. 

This disappoints and angers the patient community, who say the National Institutes of Health should focus on ways to stop their suffering instead of simply trying to understand why they’re suffering.

“It’s unconscionable that more than four years since this began, we still don’t have one FDA-approved drug,” said Meighan Stone, executive director of the Long COVID Campaign, a patient-led advocacy organization. Stone was among several people with long covid who spoke at a workshop hosted by the NIH in September where patients, clinicians, and researchers discussed their priorities and frustrations around the agency’s approach to long-covid research.

Some doctors and researchers are also critical of the agency’s research initiative, called RECOVER, or Researching COVID to Enhance Recovery. Without clinical trials, physicians specializing in treating long covid must rely on hunches to guide their clinical decisions, said Ziyad Al-Aly, chief of research and development with the VA St Louis Healthcare System.

“What [RECOVER] lacks, really, is clarity of vision and clarity of purpose,” said Al-Aly, saying he agrees that the NIH has had enough time and money to produce more meaningful progress.

Now the NIH is starting to determine how to allocate an additional $662 million of funding for long-covid research, $300 million of which is earmarked for clinical trials. These funds will be allocated over the next four years.

At the end of October, RECOVER issued a request for clinical trial ideas that look at potential therapies, including medications, saying its goal is “to work rapidly, collaboratively, and transparently to advance treatments for Long COVID.”

This turn suggests the NIH has begun to respond to patients. This has stirred cautious optimism among those who say that the agency’s approach to long covid has lacked urgency in the search for effective treatments.

Stone calls this $300 million a down payment. She warns it’s going to take a lot more money to help people like Hayes regain some degree of health.

“There really is a burden to make up this lost time now,” Stone said.

The NIH told KFF Health News and NPR via email that it recognizes the urgency in finding treatments. But to do that, there needs to be an understanding of the biological mechanisms that are making people sick, which is difficult to do with post-infectious conditions.

That’s why it has funded research into how long covid affects lung function, or trying to understand why only some people are afflicted with the condition.

Good Science Takes Time

In December 2020, Congress appropriated $1.15 billion for the NIH to launch RECOVER, raising hopes in the long-covid patient community.

Then-NIH Director Francis Collins explained that RECOVER’s goal was to better understand long covid as a disease and that clinical trials of potential treatments would come later.

According to RECOVER’s website, it has funded eight clinical trials to test the safety and effectiveness of an experimental treatment or intervention. Just one of those trials has published results.

On the other hand, RECOVER has supported more than 200 observational studies, such as research on how long covid affects pulmonary function and on which symptoms are most common. And the initiative has funded more than 40 pathobiology studies, which focus on the basic cellular and molecular mechanisms of long covid.

RECOVER’s website says this research has led to crucial insights on the risk factors for developing long covid and on understanding how the disease interacts with preexisting conditions.

It notes that observational studies are important in helping scientists to design and launch evidence-based clinical trials.

Good science takes time, said Leora Horwitz, the co-principal investigator for the RECOVER-Adult Observational Cohort at New York University. And long covid is an “exceedingly complicated” illness that appears to affect nearly every organ system, she said. 

This makes it more difficult to study than many other diseases. Because long covid harms the body in so many ways, with widely variable symptoms, it’s harder to identify precise targets for treatment.

“I also will remind you that we’re only three, four years into this pandemic for most people,” Horwitz said. “We’ve been spending much more money than this, yearly, for 30, 40 years on other conditions.”

NYU received nearly $470 million of RECOVER funds in 2021, which the institution is using to spearhead the collection of data and biospecimens from up to 40,000 patients. Horwitz said nearly 30,000 are enrolled so far.

This vast repository, Horwitz said, supports ongoing observational research, allowing scientists to understand what is happening biologically to people who don’t recover after an initial infection — and that will help determine which clinical trials for treatments are worth undertaking.

“Simply trying treatments because they are available without any evidence about whether or why they may be effective reduces the likelihood of successful trials and may put patients at risk of harm,” she said.

Delayed Hopes or Incremental Progress?

The NIH told KFF Health News and NPR that patients and caregivers have been central to RECOVER from the beginning, “playing critical roles in designing studies and clinical trials, responding to surveys, serving on governance and publication groups, and guiding the initiative.”

But the consensus from patient advocacy groups is that RECOVER should have done more to prioritize clinical trials from the outset. Patients also say RECOVER leadership ignored their priorities and experiences when determining which studies to fund.

RECOVER has scored some gains, said JD Davids, co-director of Long COVID Justice. This includes findings on differences in long covid between adults and kids.

But Davids said the NIH shouldn’t have named the initiative “RECOVER,” since it wasn’t designed as a streamlined effort to develop treatments.

“The name’s a little cruel and misleading,” he said.

RECOVER’s initial allocation of $1.15 billion probably wasn’t enough to develop a new medication to treat long covid, said Ezekiel J. Emanuel, co-director of the University of Pennsylvania’s Healthcare Transformation Institute.

But, he said,  the results of preliminary clinical trials could have spurred pharmaceutical companies to fund more studies on drug development and test how existing drugs influence a patient’s immune response.

Emanuel is one of the authors of a March 2022 covid roadmap report. He notes that RECOVER’s lack of focus on new treatments was a problem. “Only 15% of the budget is for clinical studies. That is a failure in itself — a failure of having the right priorities,” he told KFF Health News and NPR via email.

And though the NYU biobank has been impactful, Emanuel said there needs to be more focus on how existing drugs influence immune response.

He said some clinical trials that RECOVER has funded are “ridiculous,” because they’ve focused on symptom amelioration, for example to study the benefits of over-the-counter medication to improve sleep. Other studies looked at non-pharmacological interventions, such as exercise and “brain training” to help with cognitive fog.

People with long covid say this type of clinical research contributes to what many describe as the “gaslighting” they experience from doctors, who sometimes blame a patient’s symptoms on anxiety or depression, rather than acknowledging long covid as a real illness with a physiological basis.

“I’m just disgusted,” said long-covid patient Hayes. “You wouldn’t tell somebody with diabetes to breathe through it.”

Chimére L. Sweeney, director and founder of the Black Long Covid Experience, said she’s even taken breaks from seeking treatment after getting fed up with being told that her symptoms were due to her diet or mental health.

“You’re at the whim of somebody who may not even understand the spectrum of long covid,” Sweeney said.

Insurance Battles Over Experimental Treatments

Since there are still no long-covid treatments approved by the Food and Drug Administration, anything a physician prescribes is classified as either experimental — for unproven treatments — or an off-label use of a drug approved for other conditions. This means patients can struggle to get insurance to cover prescriptions.

Michael Brode, medical director for UT Health Austin’s Post-COVID-19 Program — said he writes many appeal letters. And some people pay for their own treatment.

For example, intravenous immunoglobulin therapy, low-dose naltrexone, and hyperbaric oxygen therapy are all promising treatments, he said.

For hyperbaric oxygen, two small, randomized controlled studies show improvements for the chronic fatigue and brain fog that often plague long-covid patients. The theory is that higher oxygen concentration and increased air pressure can help heal tissues that were damaged during a covid infection.

However, the out-of-pocket cost for a series of sessions in a hyperbaric chamber can run as much as $8,000, Brode said.

“Am I going to look a patient in the eye and say, ‘You need to spend that money for an unproven treatment’?” he said. “I don’t want to hype up a treatment that is still experimental. But I also don’t want to hide it.”

There’s a host of pharmaceuticals that have promising off-label uses for long covid, said microbiologist Amy Proal, president and chief scientific officer at the Massachusetts-based PolyBio Research Foundation. For instance, she’s collaborating on a clinical study that repurposes two HIV drugs to treat long covid.

Proal said research on treatments can move forward based on what’s already understood about the disease. For instance, she said that scientists have evidence — partly due to RECOVER research — that some patients continue to harbor small amounts of viral material after a covid infection. She has not received RECOVER funds but is researching antivirals.

But to vet a range of possible treatments for the millions suffering now — and to develop new drugs specifically targeting long covid — clinical trials are needed. And that requires money.

Hayes said she would definitely volunteer for an experimental drug trial. For now, though, “in order to not be absolutely miserable,” she said she focuses on what she can do, like having dinner with her family.

At the same time, Hayes doesn’t want to spend the rest of her life on a beige couch. 

RECOVER’s deadline to submit research proposals for potential long-covid treatments is Feb. 1.

The post Long-Covid Patients Are Frustrated That Federal Research Hasn’t Found New Treatments appeared first on Medika Life.

I have no idea what the outcome of this very close election will be. I do, however, have a fix on several of the ways health care played a role in the election and in campaign strategy. It won’t change much by election day.

With no big health reform debate to command the attention of the nation and no big health proposal from either candidate, this is not a “health care election,” except, of course, for the impact abortion will have on voting and turnout, whatever the outcome on November 5.

But health care has played a role in the campaign and the election in the following significant ways.

First and foremost, voter concerns about their medical bills are an integral part of their worries about the economy and their costs, mixed in with general inflation and other pocketbook issues such as food, gas prices, and the rent or the mortgage. Most national polls continue to miss this, treating health care as a separate issue. When you treat health care as a stand-alone issue, it ranks as a fairly low priority. However, out-of-pocket health care costs and worries about unexpected medical bills are a big part of the public’s economic worries. Exit polls have made the same mistake. Determining the role health plays on voters’ decisions requires an extra question, which takes time that short polls often do not have. The question that needs to be asked is a variation on this follow-up: “You said the economy was your number one concern. What about the economy most worries you?” The question can be open ended, or respondents can be given a list to choose from. There are arguments for either approach.

The advantage Vice President Harris and the Democrats have on health has also had an impact on former President Trump and his campaign strategy. He has generally backed off plans to repeal the Affordable Care Act (ACA), saying various things, including recently that he has “concepts of a plan,” but mostly protesting that he now wants to “make the ACA better” with no specifics. He’s also pledged that he will not cut Medicare (no such pledge on Medicaid). And he backtracked on his earlier, more bullish positions on drug costs, going silent on his plan to tie drug costs in the U.S. to what other countries pay, apparently wanting to stay away from even popular health proposals. Overall, he has ceded health care to Harris, likely wary that she will get traction with criticisms that he would take health coverage away from millions and weaken protections for pre-existing conditions.

Harris has taken the opposite approach on the issue that Trump has about an equivalent advantage on—immigration—by taking the offensive to try to close the gap. And she has tried to do the same on the economy with some success, according to several recent polls. (Of course, positions taken in campaigns do not necessarily presage positions a candidate will take if elected.)

The sweeping proposals made by several conservative think tanks to fundamentally change Medicare, Medicaid, and the ACA have been swept under the rug by the Trump campaign, even as Democrats have had some success making Project 2025 a symbol of right-wing extremism. That doesn’t mean the candidate and his administration will not embrace some elements of these plans if elected or appoint some of their architects to high positions. It is, however, a notable element of the campaign, and an acknowledgment that these ideas are a target for Democrats and that Trump and his campaign know that many of them would be controversial and unpopular.

Senator JD Vance’s brief and somewhat vague foray into segmenting healthy and sick people into separate risk pools as an alternative to ACA protections for people with pre-existing conditions was treated by Trump almost the same way he treated the think tank plans: he ignored it. It was as if health had become radioactive for Trump, who campaigned on other issues, including immigration, which he saw as more favorable to him.

Health might have been more of an important issue in the campaign if differences between the candidates and the parties on converting Medicare to a voucher-like, premium support plan, or Medicaid to a block grant to the states, were clarified for voters by the candidates themselves, the debate moderators, or the media generally. Debate moderators focused more on the ACA, likely because of the drama associated with Trump’s earlier attempts to repeal it. Had Trump been forced to choose between embracing or rejecting either of these big and controversial policy proposals, it would have elevated health in the campaign and might have been a flashpoint.

The Democratic left’s concern that Trump might be elected has led them to hold fire on pushing for the more expansive health reform proposals they favor, instead supporting President Biden’s more moderate, incremental policies, and subsequently, the proposals made by Vice President Harris. Should Harris prevail, expect the left to feel less constrained and to hear again about Medicare for All, the public option, Medicare Buy-In, and other policies favored by the left. Passage of legislation on these ideas, or others, is an entirely different matter, especially if Congress is divided.

Harris’s new proposal to add a home care benefit to Medicare may find favor with some elderly and near elderly voters, especially senior women or their family members. That’s one thing to watch as the voters go to the polls. The idea should be popular unless voters come to doubt that Harris can deliver. So far Harris has proposed popular benefits such as extending the $2,000 cap on out-of-pocket drug costs and the $35 monthly cap on Insulin to the private sector, and she has endorsed continuing the enhanced ACA subsidies. She has avoided proposals that would inflame the powerful health care industry, such as extending drug price negotiation to employer coverage.

These are some of the ways in which health care and health care costs have played a role in the presidential campaign. It’s certainly true that health care has not been decisive in this election, but it has played a role, and always will.

View all of Drew’s Beyond the Data Columns

The post The Role Health PLAYED in the Election appeared first on Medika Life.

Usually I worry about amplifying misinformation by calling attention to it. But when it comes to misinformation about immigrants—and most recently Haitian immigrants in Springfield, Ohio—it can’t be elevated much more than it already has been by the Republican candidates for Vice President and President and subsequent media coverage of their remarks. As if acknowledging the role politicians can play magnifying misinformation, vice presidential candidate JD Vance told CNN: “I have to create stories so the media pays attention.” In this case, sharing a few facts won’t elevate the misinformation further and might help dispel myths.

Black immigrants make up only 8% of all adult immigrants. Nearly half (47%) of Black immigrants—or about 4% of immigrants overall—are from the Caribbean, while about four in 10 (43%) are from sub-Saharan Africa. Most Black immigrants are U.S. citizens (68%), while one in five (21%) has a valid visa or green card. Just about one in 10 (8%) are likely undocumented. There are about 700,000 Haitian immigrants in the U.S. and by the way, around 100,000 of them work in the health care sector.

Overwhelmingly, as with all waves of immigrants before them, Black immigrants come to the United States to improve their lives (87%) and their children’s life chances (80%). To accomplish that, most are working (76%). In the case of Haiti, of course, some are fleeing chaos and political instability and have been granted Temporary Protected Status.

They face all the challenges immigrants have always faced in the U.S. Half of Black immigrants (56%) say they face discrimination or unfair treatment at work, but Black immigrants can experience the double trouble of racism and anti-immigrant sentiment.

Politicians have long appealed to Americans who feel alienated or left behind and can be made to feel threatened by newcomers. In what social scientists call “limited empirical validation,” one anecdote or two can be used to validate a stereotype even if it is an outlier. We see that most sharply in the claim, based on a few incidents, that immigrants are widely committing murder.

As a KFF Health Misinformation Tracking Poll released today shows, the strategy is particularly effective with the Republican base. Republicans are much more likely than Democrats and substantially more likely than Independents to believe that immigrants are causing violent crime in the U.S. or that they are taking away jobs.

Most adults (80%) have heard the claim that immigrants cause violence. It’s the ultimate example of amplification of misinformation by political figures based on the intentional use of anecdotes. And it creates a dilemma for news coverage of this and similar examples of misinformation perpetrated by political figures: whether to cover it because it’s news and fact check it in the process, knowing that spreads it much further, including causing further rounds of social media attention; or ignore it knowing that then it will remain mostly in the echo chamber where it began.

There’s likely no choice when presidential candidates spread false information but to cover it and correct the lies in the process, but there are choices to be made about how it’s done. Giving free media to misinformation by broadcasting endless clips of candidates repeating falsehoods and misinformation may do more harm than good, even if they are followed by fact checking. Just ask the Haitians in Springfield, Ohio how they feel about it.

The post Springfield, Ohio: How Candidates Amplify Misinformation appeared first on Medika Life.

Health misinformation is everywhere, now fueled by AI. But much of the public isn’t fully buying it. And like voting, there is a big group in the middle that is up for grabs.

Most Americans say they have heard various examples of health misinformation—about Covid vaccines, or reproductive health, or gun violence—but a much smaller share say they actually believe it.

Consider two examples:

• 65% of the public have heard false claims that Covid vaccines have caused thousands of deaths, but 10% believe this is definitely true.
• 49% have heard false claims that most gun homicides are gang related but just 9% say this is definitely true.

Most people are in a muddled middle, unsure whether these kinds of claims are true or not.
The believers tend to be less educated, rural, and Republican.

Misinformation is like American politics: There is a large group of “swing voters,” who at least in principle can be reached with reliable information. They say they trust doctors, local news and national news the most. They don’t trust social media much as a source of information but at the same time, many of them do say they regularly turn to social media for news.

Yes, but: Confusion can also lead to inaction. When people are unsure what is true, they may not take actions that health professionals would like them to take, such as getting the latest Covid booster. And misinformation is tricky terrain far more challenging than fact checking: One group’s outright falsehood can be another group’s strongly held belief even if they saw it on some fringe social media platform and it’s totally misguided. The misinformation case is always strongest when it’s built around claims that are clearly false.

At KFF, we’re looking at these issues and developing a new program area on Health Misinformation and Trust, which we’ll launch next year. It will be our fifth program area along with Policy Analysis, Polling and Survey Research, Social Impact Media, and KFF Health News, and the first program that we’ve added in over a decade. We plan to document what health misinformation is out there and where it is coming from in as close to real time as possible; publish regular updates to a new tracking poll to determine how misinformation is affecting the public, and especially vulnerable groups, in order to help those working to counter misinformation better target their efforts; and, investigate who is behind misinformation and why through a new investigative desk at our news service, among many other activities. We hope to work with partners.

One idea that jumps out to me from our pilot survey is pretty obvious: As is often the case, it’s one of those program ideas that is easier to conceptualize than execute. Our survey (and others) shows clearly that doctors and local TV news are among the most trusted sources of health information. So, it might make sense to mobilize local TV stations to feature their own local doctors trained in health misinformation to appear regularly, providing the facts on key health issues and countering mis and disinformation. We know that local audiences love health information almost as much as the weather. At scale, it would constitute a national network of locally based trusted messengers providing a counterweight to health misinformation.

The post Countering Health Misinformation, by the Numbers Via KFF appeared first on Medika Life.

Amid rising inflation, annual family premiums for employer-sponsored health insurance climbed 7% on average this year to reach $23,968, a sharp departure from virtually no growth in premiums last year, the 2023 benchmark KFF Employer Health Benefits Survey finds.

On average, workers this year contribute $6,575 annually toward the cost of family premium, up nearly $500 from 2022, with employers paying the rest. Future increases may be on the horizon, as nearly a quarter (23%) of employers say they will increase workers’ contributions in the next two years.

Workers at firms with fewer than 200 workers on average contribute nearly $2,500 more toward family premiums than those at larger firms ($8,334 vs. $5,889). In fact, a quarter of covered workers at small firms pay at least $12,000 annually in premiums for family coverage.

This year’s 7% increase in average premiums is similar to the year-over-year rise in workers’ wages (5.2%) and inflation (5.8%). Over the past five years, premiums rose 22%, in line with wages (27%) and inflation (21%).

Among workers who face an annual deductible for single coverage, the average this year stands at $1,735, similar to last year. The average deductible amount has increased 10% over the last five years and 53% over the last ten years.  Workers at small firms (under 200 workers) on average face much larger deductibles than workers at larger firms ($2,434 vs. $1,478).

The modest rise in deductibles may reflect employers’ perceptions about the burden of cost-sharing on workers.  More than half (58%) of employers say that their workers have at least a moderate level of concern about the affordability of their plan’s cost-sharing requirements.  

“Rising employer health care premiums have resumed their nasty ways, a reminder that while the nation has made great progress expanding coverage, people continue to struggle with medical bills, and overall the nation has no strategy on health costs,” KFF President and CEO Drew Altman said.

Almost 153 million Americans rely on employer-sponsored coverage, and the 25th annual survey of more than 2,100 small and large employers provides a detailed picture of the trends affecting it. In addition to the full report and summary of findings released today, the journal Health Affairs is publishing an article with select findings online. The article will also appear in its November issue.

Some Large Firms Do Not Cover Legal Abortions; Others Do But with Restrictions

In the wake of the Supreme Court’s June 2022 decision that ended the federal constitutional right to abortion, states have adopted a range of new laws to prohibit or severely restrict access to abortion, creating challenges for large employers with workers in multiple states.

Among all large firms (with at least 200 workers), one in ten (10%) say that their largest plan does not cover legal abortions under any circumstances. An additional 18% say they only cover legal abortions under limited circumstances, such as in cases involving rape, incest, or health or life endangerment.

In contrast, nearly a third (32%) of large firms say they cover legal abortions in most or all circumstances. Another four in ten (40%) say they were unsure of their plan’s abortion coverage, potentially because their policies were in flux or they were unaware of the details.

With abortion banned or severely limited in some states, 7% of large employers say that they provide, or plan to provide, financial assistance for travel expenses for enrollees who have to go out of state to obtain a legal abortion. Very large employers (with at least 5,000 workers) are most likely to provide, or plan to provide, such travel reimbursements (19%).

Concerns Persist About Adequacy of Mental Health and Substance Use Networks

Among large employers (with at least 200 workers) that offer health benefits to at least some workers, the vast majority (88%) say their plan has enough primary care doctors to provide timely access for enrollees. Substantially fewer say the same about their mental health (59%) and substance use condition (58%) networks.

Nearly one in five (18%) of large offering firms say that they took steps in the past year to increase the number of mental health providers in their largest plan’s network. This includes 44% of the largest employers (with at least 5,000 workers).

On the other hand, one in five (21%) of large offering employers say their plan has limits on the number of covered mental health services, potentially restricting access for enrollees with long-term needs.

“For several years now, the survey has shown that many large employers do not believe that their networks have enough mental health providers to provide timely access to care. In 2023, many large employers, including nearly half of the largest employers, say that they are taking steps to better meet enrollees’ needs,” said Gary Claxton, a KFF senior vice president and director of the Health Care Marketplace Project, the lead author of the study and also of the Health Affairs article.

Other findings include: 

• Offer rate. Nearly all employers with at least 200 workers offer health benefits to at least some workers, though smaller firms are increasingly less likely to offer health benefits as they get smaller. For example, 83% of firms with 10 to 199 employees offer health benefits to at least some of their workers, while just 42% of firms with three to nine workers do so.
• Dental, vision and long-term care insurance. Among firms offering health benefits, most also offer separate dental coverage (91%) – double the share that did so in 2010 (46%). Most also offer vision (82%) insurance, also up sharply since 2010 (17%). Fewer offer long-term care insurance (26%).
• Coverage for gender-affirming surgery. Among employers with at least 200 workers, 23% cover gender-affirming survey in their largest health plan. More than a third (37%) say they do not cover such surgeries, while a large share (40%) are not sure about such coverage. Among the largest firms (at least 5,000 workers), nearly two thirds (62%) cover gender-affirming surgery, many of which expanded the benefit in the past two years.
• Centers of Excellence. About one in five (19%) offering employers with at least 200 workers say their plan includes a “center of excellence” program for specific services, either limiting enrollees to a narrower group or providers or offering lower cost-sharing for doing so. Among these firms, 22% have introduced a new center of excellence program within the last two years. Among firms with a center of excellence program, 45% had a program for joint replacement, 42% for back or spine surgery, 31% for bariatric surgery, 30% for mental health, and 28% for substance use disorders.

Methodology

KFF conducted the annual employer survey between January and July of 2023. It included 2,133 randomly selected, non-federal public and private firms with three or more employees that responded to the full survey. An additional 2,759 firms responded to a single question about offering coverage. For more information on the survey methodology, see the Survey Design and Methods Section.

ABOUT KFF:

KFF is the independent source for health policy research, polling and news.

ABOUT HEALTH AFFAIRS:

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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The new survey is one component of a new KFF program area aimed at identifying and monitoring health misinformation and trust in the United States, placing particular emphasis on communities that are most adversely affected by misinformation, such as people of color, immigrants and rural communities.  Alongside today’s survey findings, KFF will soon release companion survey reports highlighting the extent of health misinformation among Black and Hispanic adults, as well as rural residents. KFF will also soon release a regular “Health Misinformation Monitor,” which will document emerging health misinformation, identify its primary sources, and examine the role that social media and news outlets play in its spread. Sign up for alerts from KFF on this topic. KFF Health News is also expanding its reporting on this topic in conjunction with the new program.    “While many Americans struggle to separate health information fact from fiction, our survey shows that credible sources of information, and messengers, represent an opportunity to break through and help increase trust,” said Irving Washington, senior fellow for misinformation and trust at KFF. “We’ll continue to focus on this opportunity and what type of efforts can make a difference.” The misinformation examined in the survey includes:  Vaccines A third (34%) of adults say the false claim that COVID-19 vaccines have caused thousands of sudden deaths in otherwise healthy people is definitely (10%) or probably (23%) true. Black adults are more likely to believe this false statement than White adults, while Republicans and independents are more likely than Democrats to do so. People with college degrees are less likely than those with a high-school education or less to say this is true. Reproductive health About a third of adults say the false claim that using birth control such as the pill or an IUD makes it harder for most women to get pregnant once they stop using them is “definitely” (5%) or “probably” true (29%). Adults under the age of 65, Republicans, independents, and Black and Hispanic adults are more likely to say this claim is true than their counterparts. Gun violence. When asked about the inaccurate statement that people who have firearms at home are less likely to be killed with a gun, about four in ten (42%) say it is “definitely” (13%) or “probably” (29%) true. Gun owners are more likely than non-gun owners to say that this false claim is definitely or probably true (55% vs. 37%). The survey also reveals how varied people’s beliefs and perceptions are about what constitutes misinformation. For example, when asked to describe specific misinformation related to COVID-19 that they’ve heard, people volunteered statements that were in direct contradiction with one another, including about the safety and effectiveness of COVID-19 vaccines and of wearing masks to prevent the virus’ spread. Who People Trust for Health Information The survey also gauges people’s trust in various sources of health information: Doctors. Not surprisingly, people overwhelmingly say that they trust their own doctor’s recommendations – with 93% saying they trust their doctors at least a fair amount. Federal agencies. About two thirds of the public say they have at least a fair amount of trust in the Centers for Disease Control (67%) and the Food and Drug Administration (65%) to make the right recommendations when it comes to health issues. Democrats are more likely than either independents or Republicans to trust the two federal agencies. About half of Republicans say they trust both the CDC (49%) and FDA (54%). Traditional news sources. The largest shares of the public say they would have at least a little trust in health information reported by their local TV news stations (80%), national network news (72%), and their local newspaper (72%). CNN is the most trusted cable news network (58%), with smaller shares trusting MSNBC (52%), Fox News (49%), Newsmax (25%) or One American News Network (22%). Fewer than three in ten adults say they have “a lot” of trust in health information from any of these media sources. Social media sources. About a quarter (24%) of adults say that they use social media at least weekly to find health information or advice, including larger shares of Hispanic and Black adults, and people in low-income households. Of eight specific social media sources, half (52%) would trust information about health issues they saw on YouTube at least a little. Fewer say they would trust health information if they saw it on Facebook (40%), Twitter (29%), Instagram (27%), and other platforms. Fewer than one in ten say they have a lot of trust in health information from any of these social media sources. The survey report examines the sources to which people go to get their news and their susceptibility to misinformation. Less than half (45%) of adults say they have heard one of the five false COVID-19 and vaccine claims and believe it is definitely or probably true. That share rises to 76% of regular Newsmax viewers, and 67% of regular OANN viewers, and 61% of regular Fox News viewers. Similarly, 54% of those who use social media for health information and advice at least weekly say they have heard at least one of the false COVID-19 and vaccine claims and think it is definitely or probably true, compared to 40% of those who don’t use social media for health advice. Designed and analyzed by public opinion researchers at KFF, the KFF Health Misinformation Tracking Poll Pilot was conducted May 23-June 12, 2023, online and by telephone among a representative sample of 2,007 U.S. adults. Interviews were conducted in English and in Spanish. The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on subgroups, the margin of sampling error may be higher. Support for this work was provided by the Robert Wood Johnson Foundation (RWJF). The views expressed do not necessarily reflect the views of RWJF. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities. Read the Survey

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Such problems vary across types of insurance but include such things as denied claims for care they thought was covered, difficulty finding an in-network doctor or other provider, and delays and denials of care that involved an insurer’s prior authorization. 

At least half within each of four major types of health coverage – employer, Medicaid, the Affordable Care Act’s marketplace, and Medicare – say they had a problem using their coverage in the past year. 

Such problems are more common among people with greater health care needs. For example:

• Two-thirds (67%) of consumers who rate their own health as “fair” or “poor” encountered a problem in the past year.
• About three-quarters (74%) of those who received mental health treatment in the past year reported a problem.
• More than three-quarters (78%) of those who received a lot of health care (more than 10 provider visits in the past year) reported a problem.

“The survey shows that the sheer complexity of insurance is as big a problem as affordability, particularly for those with the greatest needs,” KFF President and CEO Drew Altman said. “People report an obstacle course of claims denials, limited in-network providers, and a labyrinth of red tape, with many saying it prevented them from getting needed care.”

Today’s report captures key results from the nationally representative survey of 3,605 people with health coverage through an employer, Medicare, Medicaid or the Affordable Care Act’s marketplaces. Future reports will delve more deeply into the experiences of people with those types of coverage, as well as people with specific chronic conditions and needs across types of insurance.

The frequency that people encounter specific insurance problems varies by type of coverage. For example, people with employer and marketplace coverage report denied claims more often than people with Medicare or Medicaid, and people with Medicaid and marketplace coverage more often report problems finding in-network providers.

Insurance problems can contribute to unexpected costs, with more than a quarter (28%) of those who reported problems saying they had to pay more for their care as a result. This includes about a third of those with marketplace or employer coverage who reported problems in the past year.

Among those who reported recent insurance problems, half say they were able to resolve the issue to their satisfaction, while nearly as many say either that the issue had been resolved in a way they didn’t like (28%) or that it remained unresolved (19%). Most insured adults (60%) do not know they have appeal rights by law, and three quarters (76%) do not know what government agency to call for help dealing with their insurance.

Consumers’ insurance problems can affect their ability to get timely, needed care. Among those with recent problems, about one in six say that they were not able to get recommended care (17%), they faced a significant delay in receiving such care (17%), or their health declined (15%) as a direct result.

About half (51%) of insured adults report some difficulty understanding at least one aspect of their health insurance, such as what their insurance will cover (36%), what they will owe out-of-pocket for care (30%), or what their explanation of benefits statement means (30%). About a quarter say that they find it difficult to understand terms such as “deductible” or “copay” (25%) and to figure out which doctors, hospitals and other providers are in network (23%).

People with Mental Health Challenges Have More Problems

The report also probes the challenges facing insured people who rate their mental health as fair or poor, regardless of whether they sought or obtained mental health treatment. This includes about one in five of all people with insurance, and one in three of those with Medicaid coverage.

Substantial shares of enrollees in this group rate the availability (45%) and quality (37%) of mental health therapists and providers covered by their insurance as “fair” or “poor.” 

Among those who say their own mental health is fair or poor, 43% say that there was a time in the past year when they did not get needed mental health care. Among young adults under age 30 who describe their mental health as fair or poor, more than half (55%) say they did not get needed mental health care in the past year.

People cite various reasons for not getting needed mental health care, but insurance was a factor for many.  Among all insured adults who didn’t get needed mental health care, more than four in 10 (44%) say they couldn’t afford the cost, and more than a third say it was because their insurance wouldn’t cover it. 

• One in six (16%) of all insured people say they have had problems paying or an inability to pay for medical bills in the past year, including similar shares of those with marketplace (19%), employer (17%), and Medicaid (16%) coverage, as well as 12 percent of people with Medicare.
• Premiums also can be an issue for consumers, particularly for those with employer and marketplace plans.  About half of those with marketplace or employer coverage give their insurance plan low marks for the amount that they pay in premiums and the amount they pay out-of-pocket to see a doctor. Far fewer of those with Medicare or Medicaid rate those aspects of their coverage negatively.
• In spite of the problems people report using their insurance, a large majority (81%) give “excellent” or “good” ratings when asked to rate their insurance overall. 
• Large majorities of consumers with insurance say they would support requirements on insurers that could make it easier to avoid or resolve insurance problems. These include requirements to maintain accurate and up-to-date information about who is in their network (91%) and to provide simpler, easier-to read statements explaining coverage decisions and how to appeal if you disagree (94%), all of which have been enacted by Congress though not all have been implemented.   

Designed and analyzed by public opinion researchers at KFF, the KFF Survey of Consumers Experiences with Health Insurance was conducted February 21-March 14, 2023, online and by telephone among a representative sample of 3,605 adults in the U.S. with health insurance coverage, including 978 adults with employer-sponsored insurance, 815 adults with Medicaid coverage, 885 adults with Medicare, and 880 adults with marketplace insurance. Interviews were conducted in English and in Spanish. The margin of sampling error is plus or minus 2 percentage points for the full sample. For results based on subgroups, the margin of sampling error may be higher. 

The post KFF Survey Shows Complexity, Red Tape, Denials, Confusion Rivals Affordability as a Problem for Insured Consumers, With Some Saying It Caused Them to Go Without or Delay Care appeared first on Medika Life.

COLUMBIA FALLS, Mont. — On a recent rainy afternoon in this small town just outside Glacier National Park, Lisa Beaty and Kim Hilton were preparing to sell most of their belongings before moving out of their three-bedroom, two-bathroom rental home.

Hilton, who was recovering from a broken leg, watched from his recliner as friends and family sorted through old hunting gear, jewelry, furniture, and clothes. “The only thing that’s not for sale is the house — everything else has to go,” Hilton, 68, said as he checked his blood sugar.

Hilton has Type 2 diabetes, heart disease, and other health issues that have left him disabled and unable to work for years. For income, he relies on federal disability benefits. Because of a shoulder injury and fibromyalgia, 64-year-old Beaty — Hilton’s partner of seven years — does, too. Combined, their income is roughly $1,500 a month.

That’s no longer enough, though. Investors bought their house this year and raised the rent from $1,000, including utilities, to $1,800, plus the cost of utilities.

“They’re not evicting me — on a fixed income, I can’t do it,” Beaty said as she sorted through her belongings.

They have nowhere else to go. And they were not just losing their home: The stress of the ordeal caused them to end their relationship. Beaty planned to move into her daughter’s one-bedroom apartment.

Despite his poor health and still relying on leg braces to prevent another broken leg, Hilton, who is on Medicare, planned to live out of his truck while he waited for a spot to open up at one of the few assisted living facilities in Flathead County, which is mostly rural. The wait could last days, or months.

Beaty and Hilton are part of a recent surge of homelessness among people older than 60. The housing affordability crisis, driven in part by the covid-19 pandemic, and high inflation are chipping away at their fixed incomes. Although data is limited, advocates for seniors and people who are homeless say greater numbers of adults are showing up at shelters across the country.

The problem is particularly acute in Montana, where the snow has started to fly as the long Rocky Mountain winter sets in.

Rents in Montana have skyrocketed since the pandemic started. Since 2019, Lewis and Clark County, for example, has seen rental costs jump 37%, one of the largest spikes in the U.S., according to data from the research firm CoStar Group published by The Washington Post. Nationally, rents rose 11% on average in 2021.

The fast-paced growth in Montana and elsewhere in the Mountain West has been driven in part by an influx of highly paid remote workers, drawn to wide-open spaces and abundant recreation opportunities in communities that were plagued by housing shortages even before the pandemic. Kalispell, the largest city in Flathead County, is the fastest-growing city among those in the U.S. with fewer than 50,000 people, according to Census Bureau data.

Inflation and rising rents are leaving many older Americans on the brink of ruin. The poverty rate for people 65 and older rose from 8.9% in 2020 to 10.3% in 2021, according to Ramsey Alwin, president and CEO of the National Council on Aging.

Alwin said people who rely on traditional retirement income, such as Social Security, are having trouble affording the basic necessities. “You’ll find that individuals are often coming up short by about $1,000 a month in order to meet their true needs,” she said.

As a result, many older people must make hard choices about whether to pay for daily needs such as food and medication or rent. Others simply can’t stretch their money and must leave their homes. An upcoming 8.7% cost-of-living increase in Social Security benefits will help offset the effects of inflation, which was 8.2% for the 12 months that ended in September. But Alwin said that won’t be enough to stem the tide of seniors who are losing housing because of rising rental prices.

Montana is home to one of the oldest populations in the country. According to a recent survey of older adults in the state, about 44% struggled with housing during the previous year, and only 10% considered housing affordable.

Emergency homeless shelters in Montana, and across the country, are reporting that more seniors have been showing up at their doors over the past year, many of whom could no longer make rent or couldn’t find a new place to live after their homes were sold out from under them, said Steve Berg, vice president for programs and policy at the National Alliance to End Homelessness.

Berg said it’s impossible to say how many seniors are winding up homeless for the first time because national homeless counts don’t break down the number of people 25 and older into smaller age groups and other data isn’t granular enough to differentiate people losing housing for the first time from older people who are chronically homeless.

Community organizers working directly with homeless people have a deep understanding of how the trend is playing out in their areas.

At the Poverello Center in Missoula, Montana, people in their 60s have become the second-largest age group served by the shelter, said Programs Director Lisa Sirois. She said that she has seen people in their 80s and 90s with no place to go and that the shelter has had to turn away some of them because it wasn’t designed for their needs.

People in wheelchairs have difficulty navigating the narrow hallways, she said, and the shelter’s elevator often breaks down, forcing people to use the stairs to access its dorms. The dorms are lined with bunk beds, which also present challenges.

“Any senior clients or folks with disabilities usually can’t do a top bunk,” Sirois said.

Brian Guyer, housing department director for the Human Resource Development Council Bozeman, said that when his shelter can’t serve a senior, it also must ask the person to leave. A memory that still haunts him, he said, is of an older man who froze to death three days after being denied a spot in the Bozeman shelter because he was incontinent and had mobility problems. “He actually was found outside of a Lowe’s store here in Bozeman,” Guyer said.

And with the older homeless population growing, his staff, already overworked and underpaid, cannot take care of them all, he said.

To prevent the worst outcomes, state and national groups are proposing a slew of changes.

The Montana Coalition to Solve Homelessness, a new organization that plans to lobby on behalf of shelter providers during the legislative session that starts in January, wants the state to modify its Medicaid program to make shelters eligible for funding. They would use the money to provide Medicaid services that could assist seniors living in a shelter or pay for case management services to help seniors navigate benefit programs that offer food assistance and subsidized housing or find assisted living and nursing home facilities.

But the number of available spots in those facilities is shrinking. Nationally, nursing home closures have displaced thousands of residents. In Montana, eight nursing homes either have closed this year or are slated to close by the end of December, according to Montana health officials. Rose Hughes, executive director of the Montana Health Care Association, said other facilities are having difficulty keeping their doors open because Medicaid reimbursement rates are often lower than their operating costs.

Other advocacy organizations want to focus on economic stabilization initiatives that would help older people stay in their homes. One idea is to change how Social Security payments are calculated by pegging them to the Elder Index, an online calculator that estimates living expenses by location. But that would require congressional approval.

“Your current housing is your best chance for keeping housing for this population,” said Mark Hinderlie, CEO of Hearth, which focuses on homelessness among seniors nationally.

Then there is increasing the housing supply, which most people agree is a long-term solution. In Montana, Republican Gov. Greg Gianforte is proposing policies that would create incentives to encourage the building of more market-rate apartments. But critics say developers are unlikely to create enough subsidized housing on their own.

For Hilton, any sort of open housing unit can’t come soon enough. As he leaned against his truck in the driveway of his now former home, he hugged Beaty as she sobbed into his shoulder before they parted ways.

He drove away in search of a place to camp out, waiting for a call from a local assisted living facility with an opening. He hoped that call would come before winter temperatures settled in.

This story is printed with permission from Kaiser Health News and in a partnership that includes Montana Public Radio, NPR, and KHN.

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As the federal government prepares to launch the national three-digit number “988” for the mental health crisis hotline next month, a new KFF analysis shows that suicide death rates increased by 12 percent in the decade from 2010 to 2020 — with death rates rising fastest among people of color, younger individuals, and people who live in rural areas.

The number of suicide deaths peaked at 48,344 in 2018 and then decreased slightly in 2019 and 2020, although some research suggests that some suicides may be misclassified as drug overdose deaths. Between 2019 and 2020, drug overdose deaths increased by 31 percent.

Suicide deaths by firearms accounted for more than half of the 45,979 suicides in 2020, the most complete data available, according to the analysis. Looked at another way, suicide deaths accounted for more than half (54%) of all deaths involving a firearm in 2020.

Among people of color, the highest increase in suicide death rates was among Black people (43% increase), followed by American Indian or Alaska Natives (41%), and Hispanic people (27%). As of 2020, American Indian and Alaska Native people had the highest suicide death rate, at 23.9 per 100,000 people – substantially higher than the rate for White people (16.8 per 100,000 people). Suicide death rates for Black, Hispanic, and Asian and Pacific Islander people were all less than half the rate for White people.

Suicide death rates also increased significantly in rural areas, rising 23 percent over the decade — possibly due to acute shortages of mental health workers in these areas. Among adolescents age 12 to 17 the suicide death rate increased 62 percent, and among young adults ages 18 to 23 the increase was 33 percent.

Suicide death rates varied substantially by state in 2020, ranging from 5.5 per 100,000 population in Washington, D.C. to a high of 30.5 per 100,000 people in Wyoming.

Against that backdrop of need, the federally mandated crisis number “988” will be available to all landline and cell phone users beginning July 16. Callers who are suicidal or experiencing a mental health crisis will be routed to the National Suicide Prevention Lifeline and connected to a crisis counselor.

For the full analysis, as well as other KFF data and analyses related to mental health, visit kff.org.

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