Sacramento, CA — Naloxone hydrochloride or another Food and Drug Administration-approved opioid-reversal medication must be included in all workplace first aid kits in California no later than Dec. 1, 2028.

Workers involved in marine cargo handling are exposed to many hazards throughout the course of standard operations, according to OSHA. To protect these workers, the agency suggests proper adherence to first aid procedures.

According to the Centers for Disease Control and Prevention, 1 out of 10 people will experience a seizure in their lifetime.

“When most people think of a seizure, they think of a generalized tonic-clonic seizure, also called a grand mal seizure,” the Centers for Disease Control and Prevention says. “In this type of seizure, the person may cry out, fall, shake or jerk, and become unaware of what’s going on around them.”

Get a complete overview of OSHA’s first aid regulations and what they mean for your business in this helpful white paper from J. J. Keller.

Get a complete overview of OSHA’s first aid regulations and what they mean for your business in this helpful white paper from J. J. Keller.

In Episode 31, the S+H editorial team dives into the September issue’s feature story on setting up a volunteer first aid response team in your workplace, and discusses the ins and outs of worker engagement and buy-in with Shawn Galloway, CEO of ProAct Safety.

In Episode 48, the S+H team examines the February issue’s CEO’s Who “Get It” feature and some of OSHA’s most unique cases. Also, National Safety Council colleague Maria Cordova joins the podcast to discuss the benefits of first aid at work in the “Five Questions With …” segment.

Amputations are serious and potentially life-threatening injuries. These injuries are widespread.

The Due North HTA-Heel Traction Aid is quick and easy to put on and offers injury protection to drivers, delivery personnel or anyone operating machinery when use of a conventional, full-coverage traction aid may interfere with driving capabilities.

Washington — OSHA will soon be able to issue certifications in support of T and U nonimmigrant status visas, a move the agency contends will aid in some workplace safety investigations.

Thinking about creating an in-house first aid response team? Here are five tips for getting started.

Download this guide to learn everything you need to know about the different types of ice cleats and traction aids.

Edmonton, Alberta — A recent study of workers’ compensation claims filed by workers in long-term care facilities shows that the majority involved care aides and musculoskeletal injuries.

What are some best practices for managing first aid supplies and equipment in the workplace?

Whether you are an industrial worker or someone who needs extra stability in winter conditions, All Purpose Traction Aids will provide you with the confidence you need when working in icy and snowy conditions.

Diamond Grips from ICEtrekkers provide aggressive traction for all winter walking conditions.

London — A new guide from the Society of Occupational Medicine addresses the health of “at work driving populations” and reducing road traffic incidents.

TRACTION UP is a revolutionary topical coating application that increases slip resistance on most hard, smooth floor surfaces when wet.

The ability to lose weight and keep it off is the central focus of a health and wellness-focused collaborative study led by researchers from the University of Colorado Anschutz Medical Campus with support from DuPont Nutrition & Health.

AIDP, Inc. announced that it has acquired the core technology and related intellectual property of Olygose SAS (France). This includes the transfer of patents, manufacturing technology, trademarks, but also pre-clinical and clinical studies, regulatory certificates, and other intellectual know-how.

The two new and naturally flavored options for their fitness enthusiasts are Blue Raspberry and Juicy Apple.

AIDP, Inc. is pleased to announce the clinical study publication “A Magtein®, Magnesium L-Threonate, Based Formula Improves Brain Cognitive Functions in Healthy Chinese Adults”, in Nutrients on Dec. 8, 2022.

AIDP, Inc. announces a new clinical study published in Cureus Journal for Mangifera indica extract under the brand name Stadice® from Zeus Hygia, Life Sciences, Telangana, India. 

AIDP, Inc. said that BeautyOLIGO®, from Neo Cremar Co Ltd. (Seoul, Republic of Korea), was granted a Natural Health Product Number by Health Canada. Natural health products cannot be sold in Canada unless they have undergone an exacting review by Health Canada and are then approved and licensed with a Natural Product Number (NPN).

AIDP, Inc. is pleased to announce an exclusive North American distribution agreement with American River Nutrition (Hadley, MA) for GG-Gold® and DuoQuinol®.

The Sun-Maid Board of Imagination embarked on a top-secret mission to create a new product to captivate taste buds and spark imaginations. These young innovators considered everything from color and texture to taste, using their knowledge of flavor profiles to choose their favorite combination.

Loftus, who joined Sun-Maid as president and COO in December 2022, has been recognized for his strong industry experience and ability to align partners around common objectives. As CEO, he will continue to focus on executing the company’s strategic initiatives and driving efficiencies for growth.

A collaboration among several dairy families and nutritionists in California's Central Valley led to the construction of a milk processing facility that exceeds expectations.

Versatrim employees, including CEO Keith Medick and founder Thilo Hessler, delivered three truckloads of essential supplies to Western North Carolina communities affected by Hurricane Helene. 

Designed for large-scale projects, Laid Back offers seamless, efficient glue-down installation and is available in Cali's most popular light and natural colors. 

Children's Geographies; 06/01/2022
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The post States’ Share of Medicaid Costs Remains Low but Is Set to Increase was curated by information for practice.

Many middle-income families are frustrated by the cost of higher education, feeling they earn too much for financial aid, but not enough to pay for it themselves.

This is a test of American resolve, a test of whether we will keep our commitments to our NATO allies and to our allies in Ukraine, Israel and Taiwan or whether we will shrink back into the neo-isolationism that was a catalyst for world war a century ago.

The West has been cutting its funding for Ukraine. Next year loans remain doubtful. European heavyweights have announced a reduction in funding for Ukraine. France, which promised 3 billion euros in aid to Ukraine this year, has cut it by 1 billion, or by one-third. This is due to budget problems — budget deficit for 2024 may amount to about six percent of France's GDP, which is unacceptable according to EU rules. French Defense Minister Sebastien Lecornu clarified in an interview with Politico that he did not plan to request additional funds for Kyiv from parliament until the end of this year.

Continued. Read Part I of the article here. Alexey Golubovich, Yukos's former director for strategic planning and corporate finance was one of the main witnesses in the case against Yukos. How can one determine the basis of his testimony? Was it a wish to help the Russian justice system or the subtle game of a "double agent"? In order to understand this, one may need to recall a few facts from his business biography. In the first part of our investigation, we talked about Alexey Golubovich's business projects and lawsuits in 2010–2022, in which one could see both the shadows of his former Yukos colleagues (for example, Mikhail Khodorkovsky, Yuri Beilin) ​and the non-systemic opposition.

[Politics] :
National security adviser Shin Won-sik said South Korea is no longer the sole beneficiary of the South Korea-U.S. alliance, pledging to defend the country’s core interests as a partner state that contributes to regional and global security and prosperity. In a keynote speech at the 2024 Global Dialogue ...

[more...]

Highly accurate protein structure prediction can generate accurate models of protein and protein–protein complexes in X-ray crystallography. However, the question of how to make more effective use of predicted models for completing structure analysis, and which strategies should be employed for the more challenging cases such as multi-helical structures, multimeric structures and extremely large structures, both in the model preparation and in the completion steps, remains open for discussion. In this paper, a new strategy is proposed based on the framework of direct methods and dual-space iteration, which can greatly simplify the pre-processing steps of predicted models both in normal and in challenging cases. Following this strategy, full-length models or the conservative structural domains could be used directly as the starting model, and the phase error and the model bias between the starting model and the real structure would be modified in the direct-methods-based dual-space iteration. Many challenging cases (from CASP14) have been tested for the general applicability of this constructive strategy, and almost complete models have been generated with reasonable statistics. The hybrid strategy therefore provides a meaningful scheme for X-ray structure determination using a predicted model as the starting point.

Ultra-intense, ultra-fast X-ray free-electron lasers (XFELs) enable the imaging of single protein molecules under ambient temperature and pressure. A crucial aspect of structure reconstruction involves determining the relative orientations of each diffraction pattern and recovering the missing phase information. In this paper, we introduce a predicted model-aided algorithm for orientation determination and phase retrieval, which has been tested on various simulated datasets and has shown significant improvements in the success rate, accuracy and efficiency of XFEL data reconstruction.

Ultrafast, high-intensity X-ray free-electron lasers can perform diffraction imaging of single protein molecules. Various algorithms have been developed to determine the orientation of each single-particle diffraction pattern and reconstruct the 3D diffraction intensity. Most of these algorithms rely on the premise that all diffraction patterns originate from identical protein molecules. However, in actual experiments, diffraction patterns from multiple different molecules may be collected simultaneously. Here, we propose a predicted model-aided one-step classification–multireconstruction algorithm that can handle mixed diffraction patterns from various molecules. The algorithm uses predicted structures of different protein molecules as templates to classify diffraction patterns based on correlation coefficients and determines orientations using a correlation maximization method. Tests on simulated data demonstrated high accuracy and efficiency in classification and reconstruction.

Macromolecular crystallography contributes significantly to understanding diseases and, more importantly, how to treat them by providing atomic resolution 3D structures of proteins. This is achieved by collecting X-ray diffraction images of protein crystals from important biological pathways. Spotfinders are used to detect the presence of crystals with usable data, and the spots from such crystals are the primary data used to solve the relevant structures. Having fast and accurate spot finding is essential, but recent advances in synchrotron beamlines used to generate X-ray diffraction images have brought us to the limits of what the best existing spotfinders can do. This bottleneck must be removed so spotfinder software can keep pace with the X-ray beamline hardware improvements and be able to see the weak or diffuse spots required to solve the most challenging problems encountered when working with diffraction images. In this paper, we first present Bragg Spot Detection (BSD), a large benchmark Bragg spot image dataset that contains 304 images with more than 66 000 spots. We then discuss the open source extensible U-Net-based spotfinder Bragg Spot Finder (BSF), with image pre-processing, a U-Net segmentation backbone, and post-processing that includes artifact removal and watershed segmentation. Finally, we perform experiments on the BSD benchmark and obtain results that are (in terms of accuracy) comparable to or better than those obtained with two popular spotfinder software packages (Dozor and DIALS), demonstrating that this is an appropriate framework to support future extensions and improvements.

Full Text:

The molecular mechanism used by many bacteria to kill neighboring cells has redundancy built into its genetic makeup, which could allow for the mechanism to be expressed in different environments, say researchers at Penn State and the University of Wisconsin-Madison. Their new study provides insights into the molecular mechanisms of competition among bacteria. "Many organisms, including humans, acquire bacteria from their environment," said Tim Miyashiro, a biochemist and molecular biologist at Penn State and the leader of the research team. "These bacteria can contribute to functions within the host organism, like how our gut bacteria help us digest food. We're interested in the interactions among bacteria cells, and between bacteria and their hosts, to better understand these mutually beneficial symbiotic relationships." Cells of the bioluminescent bacteria Vibrio fisheri take up residence in the light organ of newly hatched bobtail squid. At night, the bacteria produce a blue glow that researchers believe obscures a squid's silhouette and helps protect it from predators. The light organ has pockets, or crypts, in the squid's skin that provide nutrients and a safe environment for the bacteria. "When the squid hatches, it doesn't yet have any bacteria in its light organ," said Miyashiro. "But bacteria in the environment quickly colonize the squid's light organ." Some of these different bacteria strains can coexist, but others can't. "Microbial symbioses are essentially universal in animals, and are crucial to the health and development of both partners," says Irwin Forseth, a program director in the National Science Foundation's Division of Integrative Organismal Systems, which funded the research. "The results from this study highlight the role small genetic changes can play in microbe interactions. Increased understanding will allow us to better predict organisms' performance in changing environments."

Image credit: Andrew Cecere

The pandemic has taken a massive toll on people's mental health. But a new report by the U.S. Centers for Disease Control and Prevention confirms what many of us are seeing and feeling in our own lives: The impact has been particularly devastating for parents and unpaid caregivers of adults.

Two-thirds of survey respondents who identified as unpaid caregivers said they experienced mental health challenges during the pandemic, such as symptoms of anxiety or depression, or suicidal thoughts.

Only one-third of people with no caregiving responsibilities reported the same symptoms.

Of the more than 10,000 survey respondents, more than 40% identified as being unpaid caregivers.

"What is striking here is just how widespread unpaid caregiving responsibilities are in the population and how much of a burden and a toll these responsibilities" are having, says Shantha Rajaratnam, a co-author of the study and a psychologist at the Turner Institute of Brain and Mental Health at Monash University in Australia.

The study also found that people who care for both children under 18 and adults — many of them part of the sandwich generation — are faring the worst, with 85% of this group experiencing adverse mental health symptoms.

"It's an extremely important study," says psychologist Dolores Gallagher-Thompson, professor emeritus at Stanford University who has researched family caregivers and their challenges.

The study is the first to document the problems caregivers have experienced during COVID-19, she notes, and underscores "the importance of paying attention to caregiver issues, caregiver mental health" and the need for education and resources to better support them.

The contrast between caregivers and others is stark

The study, part of ongoing research by The COVID-19 Outbreak Public Evaluation (COPE) Initiative, is based on surveys conducted in December 2020 and February-March 2021.

More than half of those who identified as caregivers said they had experienced symptoms of anxiety or depression, or of disorders like PTSD related to the stress and trauma of COVID-19.

A significant number of caregivers said they had contemplated suicide. Nearly 40% reported having passive suicidal thoughts, meaning "wishing that they had gone to bed and didn't wake up," says study co-author Mark Czeisler, a graduate student at Monash University and a research trainee at Brigham and Women's Hospital in Boston.

And more than 30% had seriously considered taking their own life — about five times the number of noncaregivers, the study found.

Across the board, mental health impacts have been more severe for people who care for both children and adults. Half of this group said it had seriously considered suicide in the past month.

The pandemic worsened the challenges caregivers face

Even before the pandemic, being an unpaid caregiver was stressful and associated with a higher risk of mental health issues, says Gallagher-Thompson. The COVID-19 pandemic has made things even harder.

For instance, the pandemic has taken away many formal and informal sources of support for caregivers.

That was the case for Dr. Nicole Christian-Brathwaite. She's a Boston-based child psychiatrist and lives with her husband, her mother, her husband's father and two sons, who are 4 and 6.

Before the pandemic, her father-in-law, who has dementia, went to a day program for seniors with cognitive decline. Her mother, a survivor of breast and lung cancers, went to physical therapy twice a week, doctor appointments and met with friends.

When the pandemic hit, they lost those services and social support — at the same time Christian-Brathwaite and her husband began working from home while taking care of their sons and parents.

Life at home became much more complicated. Her sons developed behavioral problems with the transitions and stresses of the pandemic. Her mother struggled with chronic pain, and was hospitalized during the pandemic. And there were days when her father-in-law was confused, disoriented or aggressive.

"Many days I was walking around on edge waiting for something to happen because our entire setup was so very fragile and vulnerable," says Christian-Brathwaite. "It's been exhausting."

And her mental health has suffered. "I certainly was dealing with insomnia," she says. "I was short tempered. I was more irritable. I didn't have the same tolerance for things."

More support needed to help caregivers cope

The new study highlights the extent to which unpaid caregivers have struggled during the pandemic, says Gallagher-Thompson.

"There are some serious issues here that shouldn't be ignored," she says.

And yet caregivers are often ignored by the health system, which is set up to focus only on patients.

"Family members are rarely asked, 'How does this affect you? What is difficult? How can we help you? How can we support you in being able to carry out your role, your tasks, your responsibilities?'" Gallagher-Thompson says.

As the new study shows, support can make a big difference — respondents who could rely on others for help with caregiving had a lower incidence of mental health symptoms.

So it's important to educate and support caregivers. For example, physicians can start by screening their patients' caregivers for mental health symptoms and provide more resources to those who need it, says Gallagher-Thompson.

Christian-Brathwaite hopes the new study will help physicians recognize that family caregivers are just as important to consider while treating patients.

"We really need to take a step back and look at the village that's around them because our patients can't be successful without having the support from family," she says.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services, leads some of the Biden administration's efforts to expand Medicaid access.; Credit: Caroline Brehman/CQ-Roll Call, Inc via Getty Imag

The Biden administration is quietly engineering a series of expansions to Medicaid that may bolster protections for millions of low-income Americans and bring more people into the program.

Biden's efforts — which have been largely overshadowed by other economic and health initiatives — represent an abrupt reversal of the Trump administration's moves to scale back the safety-net program.

The changes could further boost Medicaid enrollment — which the pandemic has already pushed to a record 80.5 million. Some of the expansion is funded by the COVID-19 relief bill that passed in March, including coverage for new mothers.

Others who could also gain coverage under Biden are inmates and undocumented immigrants. At the same time, the administration is opening the door to new Medicaid-funded services such as food and housing that the government insurance plan hasn't traditionally offered.

"There is a paradigm change underway," said Jennifer Langer Jacobs, Medicaid director in New Jersey, one of a growing number of states trying to expand home-based Medicaid services to keep enrollees out of nursing homes and other institutions.

"We've had discussions at the federal level in the last 90 days that are completely different from where we've ever been before," Langer Jacobs said.

Taken together, the Medicaid moves represent some of the most substantive shifts in federal health policy undertaken by the new administration.

"They are taking very bold action," said Rutgers University political scientist Frank Thompson, an expert on Medicaid history, noting in particular the administration's swift reversal of Trump policies. "There really isn't a precedent."

The Biden administration seems unlikely to achieve what remains the holy grail for Medicaid advocates: getting 12 holdout states, including Texas and Florida, to expand Medicaid coverage to low-income working-age adults through the Affordable Care Act.

And while some of the recent expansions – including for new mothers -- were funded by close to $20 billion in new Medicaid funding in the COVID relief bill Biden signed in March, much of that new money will stop in a few years unless Congress appropriates additional money.

The White House strategy has risks. Medicaid, which swelled after enactment of the 2010 health law, has expanded further during the economic downturn caused by the pandemic, pushing enrollment to a record 80.5 million, including those served by the related Children's Health Insurance Program. That's up from 70 million before the COVID crisis began.

The programs now cost taxpayers more than $600 billion a year. And although the federal government will cover most of the cost of the Biden-backed expansions, surging Medicaid spending is a growing burden on state budgets.

The costs of expansion are a frequent target of conservative critics, including Trump officials like Seema Verma, the former administrator of the Centers for Medicare & Medicaid Services, who frequently argued for enrollment restrictions and derided Medicaid as low-quality coverage.

But even less partisan experts warn that Medicaid, which was created to provide medical care to low-income Americans, can't make up for all the inadequacies in government housing, food and education programs.

"Focusing on the social drivers of health ... is critically important in improving the health and well-being of Medicaid beneficiaries. But that doesn't mean that Medicaid can or should be responsible for paying for all of those services," said Matt Salo, head of the National Association of Medicaid Directors, noting that the program's financing "is simply not capable of sustaining those investments."

Restoring federal support

However, after four years of Trump administration efforts to scale back coverage, Biden and his appointees appear intent on not only restoring federal support for Medicaid, but also boosting the program's reach.

"I think what we learned during the repeal-and-replace debate is just how much people in this country care about the Medicaid program and how it's a lifeline to millions," Biden's new Medicare and Medicaid administrator, Chiquita Brooks-LaSure, told KHN, calling the program a "backbone to our country."

The Biden administration has already withdrawn permission the Trump administration had granted Arkansas and New Hampshire to place work requirements on some Medicaid enrollees.

In April, Biden blocked a multibillion-dollar Trump administration initiative to prop up Texas hospitals that care for uninsured patients, a policy that many critics said effectively discouraged Texas from expanding Medicaid coverage through the Affordable Care Act, often called Obamacare. Texas has the highest uninsured rate in the nation.

The moves have drawn criticism from Republicans, some of whom accuse the new administration of trampling states' rights to run their Medicaid programs as they choose.

"Biden is reasserting a larger federal role and not deferring to states," said Josh Archambault, a senior fellow at the conservative Foundation for Government Accountability.

But Biden's early initiatives have been widely hailed by patient advocates, public health experts and state officials in many blue states.

"It's a breath of fresh air," said Kim Bimestefer, head of Colorado's Department of Health Care Policy and Financing.

Chuck Ingoglia, head of the National Council for Mental Wellbeing, said: "To be in an environment where people are talking about expanding health care access has made an enormous difference."

Mounting evidence shows that expanded Medicaid coverage improves enrollees' health, as surveys and mortality data in recent years have identified greater health improvements in states that expanded Medicaid through the 2010 health law versus states that did not.

Broadening eligibility

In addition to removing Medicaid restrictions imposed by Trump administration officials, the Biden administration has backed a series of expansions to broaden eligibility and add services enrollees can receive.

Biden supported a provision in the COVID relief bill that gives states the option to extend Medicaid to new mothers for up to a year after they give birth. Many experts say such coverage could help reduce the U.S. maternal mortality rate, which is far higher than rates in other wealthy nations.

Several states, including Illinois and New Jersey, had sought permission from the Trump administration for such expanded coverage, but their requests languished.

The COVID relief bill — which passed without Republican support — also provides additional Medicaid money to states to set up mobile crisis services for people facing mental health or substance use emergencies, further broadening Medicaid's reach.

And states will get billions more to expand so-called home and community-based services such as help with cooking, bathing and other basic activities that can prevent Medicaid enrollees from having to be admitted to expensive nursing homes or other institutions.

Perhaps the most far-reaching Medicaid expansions being considered by the Biden administration would push the government health plan into covering services not traditionally considered health care, such as housing.

This reflects an emerging consensus among health policy experts that investments in some non-medical services can ultimately save Medicaid money by keeping patients out of the hospital.

In recent years, Medicaid officials in red and blue states — including Arizona, California, Illinois, Maryland and Washington — have begun exploring ways to provide rental assistance to select Medicaid enrollees to prevent medical complications linked to homelessness.

The Trump administration took steps to support similar efforts, clearing Medicare Advantage health plans to offer some enrollees non-medical benefits such as food, housing aid and assistance with utilities.

But state officials across the country said the new administration has signaled more support for both expanding current home-based services and adding new ones.

That has made a big difference, said Kate McEvoy, who directs Connecticut's Medicaid program. "There was a lot of discussion in the Trump administration," she said, "but not the capital to do it."

Other states are looking to the new administration to back efforts to expand Medicaid to inmates with mental health conditions and drug addiction so they can connect more easily to treatment once released.

Kentucky health secretary Eric Friedlander said he is hopeful federal officials will sign off on his state's initiative.

Still other states, such as California, say they are getting a more receptive audience in Washington for proposals to expand coverage to immigrants who are in the country without authorization, a step public health experts say can help improve community health and slow the spread of communicable diseases.

"Covering all Californians is critical to our mission," said Jacey Cooper, director of California's Medicaid program, known as Medi-Cal. "We really feel like the new administration is helping us ensure that everyone has access."

The Trump administration moved to restrict even authorized immigrants' access to the health care safety net, including the "public charge" rule that allowed immigration authorities to deny green cards to applicants if they used public programs such as Medicaid. In March, Biden abandoned that rule.

KHN correspondent Julie Rovner contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Advocates for expanding Medicaid in Kansas staged a protest outside the entrance to the statehouse parking garage in Topeka in May 2019. Today, twelve states have still not expanded Medicaid. The biggest are Texas, Florida, and Georgia, but there are a few outside the South, including Wyoming and Kansas.; Credit: John Hanna/AP

There are more than 2 million people across the United States who have no option when it comes to health insurance. They're in what's known as the "coverage gap" — they don't qualify for Medicaid in their state, and make too little money to be eligible for subsidized health plans on the Affordable Care Act insurance exchanges.

Briana Wright is one of those people. She's 27, lives near Jackson, Miss., works at McDonalds, and doesn't have health insurance. So to figure out her options when she recently learned she needed to have surgery to remove her gallbladder, she called Health Help Mississippi, a nonprofit that helps people enroll in health insurances.

Because she lives in Mississippi, "I wasn't going to be eligible for Medicaid — because I don't have children [and] I'm not pregnant," she tells NPR. When she had her income checked for Healthcare.gov, it was just shy of the federal poverty line — the minimum to qualify for subsidies. "It was $74 [short]. I was like, oh wow," she says.

Wright's inability to get a subsidized policy on Healthcare.gov is related to how the Affordable Care Act was originally designed. People needing insurance who were above the poverty line were supposed to be funneled via the federal and state insurance exchanges to private policies — with federal subsidies to help make those policies affordable. People who were under the poverty line were to be funneled to a newly-expanded version of Medicaid — the public health insurance program that is jointly funded by states and the federal government. But the Supreme Court made Medicaid expansion essentially optional in 2012, and many Republican-led states declined to expand. Today, there are 12 holdout states that have not expanded Medicaid, and Mississippi is one of them.

So, Wright is still uninsured. Her gallbladder is causing her pain, but she can't afford the surgery without shuffling household bills, and risking leaving something else unpaid. "I'm stressed out about it. I don't know what I'm going to do," she says. "I'm going to just have to pay it out of pocket or get on some payment plan until it all gets paid for."

Hoping to finally find a fix for Wright and the millions like her who are in Medicaid limbo, several teams of Democratic lawmakers have recently been hashing out several options — hoping to build on the momentum of the latest Supreme Court confirmation that the ACA is here to stay.

OPTION 1: Sweet-talk the 12 holdout states

The COVID-19 relief bill passed in March included financial enticements for these 12 states to expand Medicaid. Essentially, the federal government will cover 90% of the costs of the newly eligible population, and an additional 5% of the costs of those already enrolled.

It's a good financial deal. An analysis by the nonprofit Kaiser Family Foundation estimates that the net benefit for these states would be $9.6 billion. But, so far — publicly, at least — no states have indicated they intend to take the federal government up on its offer.

"If that is not getting states to move, then that suggests that the deep root of their hesitation is not about financial constraint," says Jamila Michener, a professor of government at Cornell University and author of the book Fragmented Democracy: Medicaid Federalism And Unequal Politics.

Instead, Michener says, the reluctance among some Republican-led legislatures and governors to expand Medicaid may be a combination of partisan resistance to President Obama's signature health law, and not believing "this kind of government intervention for these groups of people is appropriate."

What's Next: When asked about progress on this front in an April press briefing, Biden's press secretary Jen Psaki said "the President is certainly supportive of — and an advocate for — states expanding Medicaid," but did not answer a follow up about whether the White House was directly reaching out to governors regarding this option.

OPTION 2: Create a federal public option to fill the gap

Some have advocated for circumventing these holdout states and creating a new, standalone federal Medicaid program that people who fall into this coverage gap could join. It would be kind of like a tailored public option just for this group.

This idea was included in Biden's 2022 budget, which says, in part: "In States that have not expanded Medicaid, the President has proposed extending coverage to millions of people by providing premium-free, Medicaid-like coverage through a Federal public option, paired with financial incentives to ensure States maintain their existing expansions."

But it wouldn't be simple. "That can be quite complex — to implement a federal program that's targeted to just these 2.2 million people across a handful of states," says Robin Rudowitz, co-director of the Medicaid program at the Kaiser Family Foundation, who wrote a recent analysis of the policy options.

It also may be a heavy lift, politically, says Michener. "Anything that expanded the footprint of the federal government and its role in subsidizing health care would be especially challenging," she says.

What's next: This idea was raised as a possible solution in a letter last month from Georgia's Democratic senators to Senate leaders, and Sen. Raphael Warnock said this week he plans to introduce legislation soon.

OPTION 3: Get around stubborn states by letting cities expand Medicaid

Instead of centralizing the approach, this next idea goes even more local. The COVER Now Act, introduced by Rep. Lloyd Doggett, D-Texas, would empower local jurisdictions to expand Medicaid. So, if you live in Austin, Texas, maybe you could get Medicaid, even if someone in Lubbock still couldn't.

The political and logistical challenges would be tough, policy analysts say. Logistically, such a plan would require counties and cities to create new infrastructure to run a Medicaid program, Rudowitz notes, and the federal government would have to oversee how well these new local programs complied with all of Medicaid's rules.

"It does not seem feasible politically," Michener says. "The legislators who would have to vote to make this possible would be ceding quite a bit of power to localities." It also might amplify geographic equity concerns, she says. People's access to health insurance would not just "be arbitrarily based on what state you live in — which is the current state of affairs — It's also going to be arbitrary based on what county you live in, based on what city you live in."

What's next: Doggett introduced the bill earlier this month. There's no guarantee it would get a vote on the House floor and — even if it did — it wouldn't survive a likely filibuster in the evenly divided Senate.

OPTION 4: Change the ACA to open up the exchanges

A fourth idea, Rudowitz says, is to change the law to remove the minimum cutoff for the private health insurance exchanges, since "right now, individuals who are below poverty are not eligible for subsidies in the marketplace." With this option, states wouldn't be paying any of the costs, since the federal government pays premium subsidies, Rudowitz says, but "there are issues around beneficiary protections, benefits, out-of-pocket costs."

What's next: This idea hasn't yet been included in any current congressional bills.

Will any of these ideas come to fruition?

Even with a variety of ideas on the table, "there's no slam dunk option, it's a tough policy issue," Rudowitz says. All of these would be complicated to pull off.

It's possible Democrats will include one of these ideas in a reconciliation bill that could pass without the threat of a Republican filibuster. But that bill has yet to be written, and what will be included is anyone's guess.

Even so, Michener says she's glad the discussion of the Medicaid coverage gap is happening, because it's sensitizing the public, as well as people in power, to the problem and potentially changing the political dynamic down the line. "Even in policy areas where you don't have any kind of guaranteed victory, it is often worth fighting the fight," she says. "Politics is a long game."

This content is from Southern California Public Radio. View the original story at SCPR.org.

Live-event spaces, like the Sound Nightclub in Los Angeles, have been waiting months for emergency relief.; Credit: Mario Tama/Getty Images

Owners of live-music venues, theaters, museums and other businesses covered under the Shuttered Venue Operators Grant, or SVOG, can expect to see money by the end of May. This is according to an update from the Small Business Administration, which has been handling the SVOG program's bumpy rollout.

An SBA spokesperson said in an email that since the portal to apply for these grants opened a week ago, 10,300 applications have been submitted (another 12,000 have been started but not completed). The vast majority of those applications were from "Live venue operators or promoters," followed by performing arts organizations and then movie theaters.

The SBA has been reviewing applications and said in a statement that "applicants will receive notice of awards this month," with disbursement by the end of May if the applicant responds in a "timely manner to the notice of award."

The SVOG program is a $16 billion emergency relief program that then-President Donald Trump signed into law in late December 2020. It was a bipartisan effort to get aid money to struggling music venues and other arts and live-event spaces that have been hit hard by the coronavirus struggles. But for an emergency relief program, it has taken months to get money in the hands of business owners holding off landlords, insurance companies and other creditors. Those owners spent early 2021 waiting on an official announcement of when they could apply for the grant money while compiling any documents and paperwork they thought they might need. Then once the application site was up and running, it crashed and was closed.

Even as large festivals roll out throughout the U.S. and bands announce tours for later in the year, many small live-event spaces are still at risk of closing. The National Independent Venue Association, one of the most vocal groups lobbying for support for live-music venues, has long stated that 90% of its members would be forced to close without any aid — which would hurt nearby bars, restaurants and shops, not to mention the large apparatus that is the live touring-arts industry.

This content is from Southern California Public Radio. View the original story at SCPR.org.

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Supporting this massive surge, the National Payments Corporation of India (NPCI), an entity for operating retail payments and settlement systems, has provided the backbone and the infrastructure to help in the faster adoption of digital systems that has deepened financial inclusion.

Sen. Elizabeth Warren holds a news conference in March. She and Sen. Bernie Sanders are leading the push to introduce a bill Tuesday that would make pandemic-related food benefits for college students permanent, and create grants for colleges to address hunger.; Credit: Chip Somodevilla/Getty Images

Democrats in the House and Senate are introducing legislation Tuesday that would make pandemic-related food benefits for college students permanent. The push is being led by Senators Elizabeth Warren, Democrat of Massachusetts and Bernie Sanders, a Vermont Independent,

In the December relief package, Congress increased the number of low-income college students eligible for Supplemental Nutrition Assistance Program (or SNAP) benefits for the duration of the pandemic. That included students who are eligible for work study, have an Expected Family Contribution of zero dollars, or qualify for a maximum Pell Grant on their federal financial aid form. According to The Century Foundation, this expansion affects about 3 million college students.

The legislation proposed Tuesday would make these changes permanent, including requiring the U.S. Education Department to notify students they may be eligible for SNAP when they fill out their student aid applications. The bill would also require the Department to collect data on hunger and food insecurity, and would create a $1 billion-a-year grant program for institutions to address hunger on campus.

"Far too many college students struggle to meet their basic needs while they get their education and the pandemic has made this problem even worse," Warren said in a statement to NPR. "As students take on a mountain of student loan debt, they shouldn't have to choose between paying tuition and eating."

The push comes amid new research that shows 39% of two-year college students are facing food insecurity; for students at 4-year schools the number affected is 29%, according to Temple University's Hope Center for College, Community and Justice.

Before the pandemic, in 2019, the U.S. Government Accountability Office issued a report on humger among college students, concluding that over a third of students don't always have enough to eat, and that federal systems already in place, including SNAP, could do a better job of helping them.

Many colleges have increased food benefits for their students, creating or expanding emergency grants, food pantries and other forms of assistance. State legislatures in several places including Virginia and Massachusetts have also moved to address issues of hunger on campus.

This content is from Southern California Public Radio. View the original story at SCPR.org.