Week of July 17–21, 2023

General Articles

• More Americans across age, gender and race are seeking mental health treatment than they were just two decades ago. Why it matters: The boom in demand reflects a growing mental health crisis and a national uptick in anxiety and depression — but also reflects healthier attitudes about therapy and more honest conversations about mental health. Pandemic-era isolation drove up depression and anxiety among Americans from all walks of life, including teen girls, parents of young kids and retirees. Read more here.
• This week, U.S. Sen. Chris Murphy (D-CT) introduced national legislation to address the loneliness epidemic. The proposed legislation, the National Strategy for Social Connection Act, would require the White House to have an Office of Social Connection Policy to advise the President and “work across federal agencies to develop effective strategies for improved social infrastructure and issue national guidelines for social connection similar to existing guidelines on sleep, nutrition, and physical activity,” according to the senator’s press release. Read more here.

Youth Mental Health

• Even before the pandemic turned the world upside down, our young people were struggling with a mental health crisis that has only grown more serious in recent years. Yet we have reason to feel optimistic that we can reverse these trends and help our children. Over the past year, we have spent countless hours meeting with those on the front lines of this crisis, and we have seen innovative approaches, thoughtful programs, and effective models across the country. Together, they form the basis of this playbook that states, policymakers, and stakeholders can use to address youth mental health challenges. Read more here.
• Hospitalizations and emergency room visits for suicide attempts and ideation rose nationally among children and teens from 2016 to 2021, a new study has found — the latest in a series of alarm bells about the state of young people’s mental health.  According to the research, published Wednesday in the journal JAMA Network Open, nearly 66% of the cases were girls, and the average age was 15. The study also revealed seasonal trends: ER visits and hospitalizations were 15% higher in April and 24% higher in October than the January rate, which the study used as a baseline because it was close to the annual average. However, 2020 was an exception both to the seasonal fluctuations and the increase in suicidality over time. Taken as a whole, the researchers said the findings indicate that the academic calendar may affect youth mental health. Read more here.

Mental Health and Aging Issues

• Rising demand for behavioral care and Medicare outpatient procedures are squeezing some of UnitedHealth Group's business segments but didn't stop the industry giant from beating Wall Street's expectations and posting earnings of $5.47 billion in Q2. Why it matters: The parent of the biggest U.S. health insurer is a bellwether for broad industry trends. Despite higher-than-expected utilization and concern about how that could drive up health costs, the increases were less than some feared, Reuters reported. Read more here.
• Older adults with vision problems may be more likely to develop dementia, a new study published in JAMA Ophthalmology has found. Researchers at the University of Michigan, Ann Arbor analyzed data from the 2021 National Health and Aging Trends Study, which showed a link between all types of vision problems — distance acuity, near acuity and contrast sensitivity — and a higher prevalence of dementia, including Alzheimer’s disease. Distance acuity (visual acuity) is a measure of the clarity or sharpness of vision from 20 feet away, according to the American Optometric Association. Read more here.
•  Rep. Linda Sánchez (D-Calif.) discussed the U.S.’s rapidly aging population and its potential strain on Medicare during a Tuesday morning event. Sánchez referred to the growing population of Americans more than 65 years old as a “gray tsunami” during The Hill’s More than Memory Loss: Caring for those with Alzheimer’s event, sponsored by Otsuka. Bob Cusack, The Hill’s editor in chief, moderated the event. Read more here.
• During Gov. Roy Cooper’s final full year in office, his administration will make a first-time, major push to benefit North Carolina’s fast-growing older population through new funding and changes in state operations according to interviews with principals and state documents. Cooper’s legislative initiative will emerge during 2024 as the result of a public-nonprofit-business collaboration called “All Ages, All Stages NC: A Roadmap for Aging and Living Well,” which is set forth in an executive order on the topic. Read more here.

The Opioid Crisis

• There are more and more news reports of how the opioid crisis has ravaged the country, and it is only accelerating. Last year alone, nearly 110,000 people died from opiate use, many from the synthetic drug fentanyl. The Centers for Disease Control and Prevention (CDC) estimates that close to a million people have died from opiate overdoses since 1999. That is so many deaths, it has contributed to a decline of the national life expectancy age. Read more here.
•  The Minnesota Poison Control System is reporting another dangerous result of the opioid epidemic: a rise in the number of Minnesota children hospitalized due to fentanyl exposure. Since January of 2022, an organization official said it’s been contacted about 66 children under age 3 requiring medical care due to exposure to opioids, including fentanyl. The number of children exposed is probably underreported, said Dr. Travis Olives, associate medical director. Read more here.

988 Hotline

• This month marks a year since 988 launched. The new, easier-to-remember number for the Suicide and Crisis Lifeline arrived at a time when the demand for mental health support is increasing across the country. Every state has 988 call centers, plus there's a national one for back-up. Iowa's two call centers are operated by Foundation 2 Crisis Services in Cedar Rapids and CommUnity Crisis Services in Iowa City who have contracts with the state Department of Health and Human Services. Read more here.

Climate Change

• A global pattern of heat waves scorching parts of Europe, Asia and the United States intensified on Tuesday, with the World Meteorological Organization warning of an increased risk of deaths linked to excessively high temperatures. Americans were facing a medley of extreme weather, from blazing heat from Texas to Southern California to smoke-choked air wafting into the Midwest from Canada's wildfires. Flood warnings were up for Vermont towns that were inundated just last week, while Tropical Storm Calvin was expected to hit the Pacific island state of Hawaii later on Tuesday. Read more here.
• As smoke from Canadian wildfires continues to endanger public health and cause hardship for tens of millions of people of all ages from New York to Missouri, we are painfully reminded of Maria Alvarez, a home care worker in Santa Paula, California. Several years ago, during the devastating Thomas Fire, Maria kept her disabled son, who depended on a ventilator, alive by manually pressing on his chest and lifting his head while the raging wildfire engulfed her community with smoke and left her without power for days. Read more here.
•  A new study from Virginia Commonwealth University published by the Center for American Progress has reported that the heat wave running rampant across the U.S. is significantly inflating health care costs. The authors of the study — an interdisciplinary group of faculty, staff and students from the university — estimated that heat events each summer are responsible for nearly 235,000 emergency department visits and over 56,000 hospital admissions for heat-related or heat-adjacent illnesses. In total, this is believed to add approximately $1 billion in health care costs across the country each summer. Read more here.

Health Insurance

• Inflation may be cooling, but high medical costs could still make consumers pay more for Affordable Care Act health insurance in 2024. Why it matters: President Biden has launched an offensive focused on lowering consumers' medical costs. Higher premiums for ACA marketplace plans could throw a wrench in the administration's messaging as Biden's re-election campaign takes off. Read more here.
• The Biden administration on Thursday asked employers to give workers who lose Medicaid coverage more time to sign up for health insurance through their jobs. Medicaid is the state- and federally funded program that covers health care costs for people with low incomes. States have resumed checks for Medicaid eligibility this year after pausing the practice during the COVID-19 pandemic. Federal officials have estimated that about 3.8 million people who lose Medicaid coverage may qualify for health insurance through their employers, which is how most people in the U.S. get coverage. Read more here.

Medicaid Redetermination

• North Carolina began kicking Medicaid participants off the rolls last month for the first time in more than three years, initiating a purge that experts fear will leave an untold number of residents without health insurance — even if they remain eligible for the program. People enrolled in Medicaid had been protected by a federal provision that prevented states from discontinuing coverage during the COVID-19 pandemic. Read more here.
• During the pandemic, federal regulations prohibited states from removing people from Medicaid, allowing access to nonstop health insurance coverage for about 3 million Texans who would’ve regularly lost coverage beginning in March 2020. But new federal funding legislation lifted these protections in April, and the state launched the process of removing people it thought would be ineligible. Half a million Texans — mainly children, but also disabled adults and pregnant women — have lost coverage since then, leaving them in limbo without access to medical treatment. Read more here.
• On March 31st, a pandemic policy that prevented states from kicking people off Medicaid came to an end. Connecticut is now in the middle of an immense undertaking to reevaluate eligibility for broad swaths of enrollees for the first time in three years. The vast majority of the roughly 274,000 people who went through unwinding in April, May and June are keeping their coverage, but the process has been stressful for individuals with Medicaid, and also for the organizations that serve them. Read more here.

Bans on Gender-Affirming Care and LGBTQ Issues

• The congressional appropriations process is shaping up to be the next battleground over gender-affirming care. Driving the news: Taxpayer funding of hormone therapies and gender-affirming surgeries would be barred under House Republicans' fiscal 2024 spending bill covering the federal health department, which is moving through Congress. If the policy is retained, Medicare and TRICARE could not cover gender-affirming care, and states choosing to cover services through Medicaid could not use federal funds to do so. Read more here.
• House Republicans voted Tuesday to eliminate funding to three LGBTQ community centers during a contentious House Appropriations subcommittee meeting that one member characterized as “political theater.” Tensions boiled over Tuesday after Rep. Tom Cole (R-Okla.) introduced an amendment to the annual funding bill covering the Departments of Transportation and Housing and Urban Development to eliminate $3.62 million in funding for three LGBTQ community centers in Pennsylvania and Massachusetts. The amendment, which Cole said Tuesday would crack down on “problematic” spending, also prohibits federal funds from being used to fly LGBTQ Pride flags outside government buildings. Read more here.
• Roberto Che Espinoza had been thinking about leaving Tennessee after the 2024 election, but in June they noticed that the state attorney general was seeking medical records on gender-affirming medical care, which Espinoza, a nonbinary transgender man, said included their own records. These choices can hurt the economic stability of queer people and their loved ones. But research and surveys suggest that the relocations may also harm the state and local economies that lose LGBTQ people — and benefit those that gain them. Read more here.
• A federal judge on Thursday temporarily blocked Arizona from enforcing a law banning transgender girls from playing on girls' school sports teams. The judge in Tucson granted a preliminary injunction to allow processing of a lawsuit filed on behalf of two transgender girls against the state's “Save Women's Sports Act,” which was passed by the Republican-controlled Legislature last year. The lawsuit argues the law violates federal Title IX, the law barring sex discrimination in schools receiving federal funds, and the equal protection clause of the U.S. Constitution. Read more here.
• The worst drug shortage in a decade is disrupting gender-affirming care, as scarce supplies of injectable estrogen prevent some transgender women from obtaining hormone therapy. Why it matters: A lack of access to estrogen products can affect trans patients in different ways: putting some through early onset menopause, reversing certain physical changes from their transition or causing them to experience anxiety and depression. The big picture: Because injectable estrogen is seldom used outside of trans health care, "manufacturers have little incentive to produce this medicine," which leads to shortages. Read more here.

Federal and State Policy

•  Legislation to fund the departments of Health and Human Services (HHS), Education, and Labor cleared a House Appropriations subcommittee by voice vote Friday, despite objections from Democrats over sharp cuts to health agency funding and anti-abortion provisions. The bill advanced smoothly with no major changes, but a much larger fight looms in the full committee. However, it doesn’t stand much of a chance in the Democratic-controlled Senate, where appropriators are crafting a separate, bipartisan bill free from any “poison pill” provisions. Read more here.
•  Credit Congress for Medicare’s recent move to fill a gaping hole in its behavioral health coverage next year. Section 4124 of the Consolidated Appropriations Act of 2023 required Medicare to start covering “intensive outpatient” mental health and substance use disorder services in 2024. The coverage—which entails nine to 19 hours of treatment services per week—is part of a “continuum of care” developed by the American Society of Addiction Medicine. Read more here.