Nearly one in five uninsured working-age adults within the 10 states that didn’t expand Medicaid under the Affordable Care Act are uninsured, based on a brand new study. evaluationare stuck in a health care limbo referred to as the “coverage gap.” That is, they make an excessive amount of money to qualify for Medicaid but not enough to qualify for financial help to purchase their very own plan on the marketplace.

In Alabama and Mississippi, greater than 1 / 4 of uninsured working-age adults lack reasonably priced access to medical insurance, based on an evaluation by the Center on Budget and Policy Priorities, a progressive think tank that studies federal and state budget policies. Overall, 1.6 million adults between the ages of 19 and 64 are affected by this case in states without medical insurance expansion.

“They all have incomes below the federal poverty line and yet have no financial support or protection,” says Gideon Lukens, senior fellow and director of research and data evaluation on the organization’s health policy team.

The evaluation also found that greater than 60% of those that fall into this gap are people of color: 35% are Latino, 24% are black, and a pair of% are Asian.

Democratic Mississippi Rep. Robert Johnson said the shortage of insurance coverage contributes to other problems in every kind of communities, resembling the closure of hospitals that must cover the prices of treating uninsured patients.

“This is not a conservative or liberal issue. It's about the people we represent in the state of Mississippi, whether they're black or white,” Johnson said in an interview. “This is a matter of life and death, not just for individuals, but for entire communities.”

How big is the coverage gap?

The Affordable Care Act, also referred to as Obamacare, went into effect in 2010, but ten states haven’t expanded Medicaid, the federal health care program for low-income people: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.

The Affordable Care Act allowed states to expand Medicaid to cover people as much as 138 percent of the federal poverty level. The cost of insuring additional people could be covered primarily by federal funds and a smaller state subsidy. People earning more could receive tax credits to subsidize the fee of medical insurance.

But within the states without expansion, many low-income people were left without reasonably priced alternatives.

Jennifer Tolbert, deputy director of the Medicaid and Uninsured program on the nonprofit health research organization KFF, told Stateline that the majority people affected by the coverage gap have jobs, but work in industries and for employers which are much less prone to offer medical insurance, resembling the service sector or construction.

“They simply do not have access to affordable health insurance and therefore fall into the so-called care gap,” says Tolbert.

In Alabama, for instance, persons are only eligible to participate for Medicaid in the event that they earn 18% or less of the federal poverty level, or about $4,678 a yr for a three-person household. But medical insurance subsidies would only apply to people earning 100% of the federal poverty level, meaning those caught within the coverage gap may very well be stuck with premiums of several hundred dollars a month in the event that they enroll for a marketplace plan.

Consider expansion

Some analysts say that despite their concerns in regards to the Affordable Care Act, the remaining states have to reconsider expanding the law to usher in appropriate federal funds and help their residents.

“Without expanding Medicaid, there is no real solution to providing some level of health insurance coverage to this population,” says James C. Capretta, a senior fellow on the American Enterprise Institute, a center-right public policy think tank.

“If we're going to have a social safety net in this country, and we should, it absolutely has to be there reliably for people at that income level,” Capretta said. “There has to be some pressure and movement to see if there's a way to completely close the coverage gap.”

In Mississippi, where Republican Governor Tate Reeves has said he would veto any bill to expand Medicaid, there was some movement. Both houses of the Mississippi legislature approved versions of a bipartisan bill earlier this yr that may have added a piece requirement to Medicaid. But the bill failed because lawmakers couldn’t agree on a final version.

“My argument to my fellow Republicans was, 'The ACA is with us. With 40 states now adopting it, it's going to stay with us,'” White told Stateline. “And if you can't get it to you for the compassion and health insurance for these low-income Mississippians, get it to you for the savings and cost benefits it brings to our health care industry and to our state's economy as a whole.”

White said the Republican caucus has seen a shift in sentiment and is more supportive of an expansion. He added that for the primary time, Mississippi's business community supports a pathway to medical insurance, which could help push a veto-proof bill through the legislature.

“We've finally seen the ice melt here,” said White. “Where that will lead in the next few years, I don't know. But I'm hopeful.”

©2024 States Newsroom. Visit stateline.org. Distributed by Tribune Content Agency, LLC.

Originally published: July 25, 2024 at 11:56 am

NEWARK – A former deputy mayor is returning to the Newark City Council to switch recently resigned Councilman Mike Bucci.

Ana Apodaca, who last served as deputy mayor in 2014 before deciding to not run for re-election, was appointed to town council on Monday.

Bucci resigned on June 27 because he could not afford his hometown. He desired to buy a house in Newark, but said he couldn’t afford the $60,000 down payment or the high cost of living within the East Bay.

The self-proclaimed “most handsome city councilman with an eyepatch ever” said his salary at a San Leandro-based construction company, in addition to the roughly $13,000 he earned annually as a city councilman, were nowhere near enough to purchase a house in town.

After playing the lottery twice per week, his luck didn't change and he decided to maneuver together with his family to Oxnard, where his grandmother lives in a condo owned by the family, he said in an interview.

Apodaca joined the Newark City Council in 2006 and in addition worked for years within the California Legislature and as a government relations manager. In 2011, she lost a bid for Newark mayor to current City Councilman Alan Nagy.

In her interview with council members this week, she said her top priorities for the rest of this 12 months's term could be to strengthen community education, support police and public safety, and address town's reasonably priced housing needs.

“I think for anyone who lives in this city, in the Bay Area, affordable housing is the most pressing issue,” Apodaca said. “We need to make sure that people like me who grew up in Newark can afford to live in Newark if they want to.”

Apodaca said she wouldn’t run for election in November but would give the seat to whomever voters select. Of the eight people vying to temporarily replace Bucci, only Apodaca and one other candidate said they’d not run for the seat in the autumn.

Hannon's motion to appoint Apodaca was seconded by Deputy Mayor Luis Freitas and passed unanimously by the council.

“I believe it's in my DNA to really give back to my community,” Apodaca said. “To give back to the city of Newark again would be an absolute honor. It was an honor to serve for these nine years and it would be an honor to serve with you again.”

Other applicants for Bucci's seat included: Phil Bloxom, a pc engineer; Daniel Cardenas, a former economic development commissioner in Fremont and founding father of a pediatric cancer research organization; Lucia Gutierrez, who formerly served on the Newark Unified School District Board; Eve Little, a parks and recreation professor at Cal State East Bay; Raju Mathew, a consultant and former manager of the Alameda County Environmental Health Department; Jason Matthew Miguel, a representative of the Santa Clara Valley Water District; and Fatima Shaikh, a freelancer and former member of Ohlone College's student government.

Using the body's own cells to fight disease – long a medical dream – is now finally a reality.

Now comes the bill.

Last month Stanford the primary hospital within the country to make use of a brand new cell therapy value $515,000 to treat a patient with advanced melanoma. A related approachThe project will cost $420,000 to $475,000 and can provide hope for patients with deadly blood cancer.

Meanwhile, cells fixed through gene therapy can slow the progression of intractable diseases akin to: B. decelerate and even stop Sickle cell anemia or beta thalassemia – on the exceptional price of $2.1 million to $4.25 million each.

Cell therapy technologist Thomas Orozco defrosts the treated immune cells of a patient with advanced melanoma. The cells are taken from the patient's tumor and enriched in a laboratory to higher fight the cancer.[/caption]

This is the longer term of medication, experts agree. But the associated fee of this recent class of medical treatment raises concerns about availability and affordability, whilst its potential grows.

“Cell and gene therapies can change the lives of thousands of people, but only if we ensure sustainable access to them for all patients,” said Sarah Emond, president of the influential organization Institute for Clinical and Economic Reviewa Boston-based nonprofit organization assesses the worth of medicines.

The prices aren’t yet prohibitive because so few persons are currently being treated. Patients must travel to specific treatment centers and aren’t referred by general practitioners. But referrals and demand should increase as more treatments are introduced to serve a broader population.

Most health insurers within the United States aren’t designed to support one-time personal therapies that provide long-term advantages at unprecedented prices.

“These are precision medicines,” he said David Miklos, director of the Stanford Bone Marrow and Cell Therapy Program, where lots of of cancer patients have been treated with CAR T-cell therapies. “It’s different than buying a pill at the CVS pharmacy that can work for everyone.”

The promise of cell and gene therapies has fascinated scientists for many years, but progress has been slow and fraught with setbacks. Now the long research journey has finally paid off as FDA-approved products are entering the clinic.

“The technology to bring it to life has finally caught up with the ideas behind it,” said the Stanford assistant professor of medication Dr. Allison Betaf Warnerwho conducts Stanford's melanoma study.

Cell-based strategies are delivering essentially the most famous cancer treatments in many years.

In an approach called chimeric antigen receptor (CAR) T-cell therapy, immune cells are collected from patients and genetically modified to higher fight lymphoma, leukemia and, more recently, multiple myeloma.

Another uses a special approach and uses tumor-infiltrating lymphocytes (TILs). These immune cells are taken from the tumor, amplified within the laboratory after which given back to the patient. In clinical studies, about 30% of patients experienced shrinkage or disappearance of the incurable melanoma tumors.

“I am very happy that it is here now. … I walked the tightrope and didn't fall off,” said a Stanford patient who asked not to be named.

Gene therapy also uses manipulated cells in which genes are replaced, deleted or inserted. Kendric Cromer, a 12-year-old boy from a suburb of Washington, DC, was born on Wednesday the world's first person with sickle cell anemia to begin FDA-approved gene therapy. Both Stanford and UCSF will offer this treatment.

Scientists are now working to expand the therapeutic repertoire to combat solid tumors, autoimmune diseases, aging, HIV and more.

“It’s just the beginning of a new era,” said the biochemist Wendell LimDirector of the UC San Francisco Cell Design Institute.

“It shows that we can take a living cell and change how it works so that it makes new decisions and performs complex actions. It processes information like a small computer,” he said. “That’s very different from a static thing, like a chemical.”

It's still early and few patients are taking advantage of these new breakthrough therapies, doctors said.

Why? It is not yet known that sick people are not referred by their community doctors, said Miklos. The treatment is risky. Or patients may live far from the country's estimated 30 “centers of excellence” such as Stanford and UCSF and are put off by travel and accommodation costs.

Payment is not guaranteed; it will be decided on a case by case basis. Medicare and MediCal cover the cost of care if it is deemed medically necessary. Emperor too.

The vast majority of private insurers cover treatments, although back-and-forth negotiations are sometimes required, said Gary Goldstein, who oversees operations for Stanford's Blood & Marrow Transplant Program.

Sticker price covers parts only – no labor, no warranty. Drug prices are not regulated like utilities are, and there is no cap on what a company can charge.

Estimates place the total cost of gene therapies over the next decade at a staggering $35 billion to $40 billion. The cost of future cell therapies that could help a wider range of patients will likely be higher.

Drugmakers argue that the prices reflect the major clinical benefits as well as the risks and uncertainties of development. They add that a one-time treatment for a chronic illness can actually save money by eliminating lifelong care.

“We have never cured patients with a single treatment,” he said Dr. Greg Allen from UCSF, which is developing immune cell therapies for notoriously difficult-to-treat tumors such as those of the pancreas and lung. “So it’s very exciting.”

For some patients, it could be their last best chance.

“I don’t believe that life has a price,” said Betof Warner of Stanford. “These are patients who have no other choice.”

If millions of people are helped, as hoped, it will put budget pressure on the federal government and larger payers, while smaller employers, state Medicaid plans and regional health insurers may find providing access financially impossible, economists warn. Health care costs are already outpacing inflation, rising 7% this year.

“It’s going to put a lot of strain on the system,” he said Edwin Park at Georgetown University's McCourt School of Public Policy. “But the issue is critical because you don’t want the high price of these therapies to result in low-income people not having access to them.”

Governments and commercial insurers are already testing the effectiveness of treatments. Some impose strict restrictions on eligibility. They demand discounts and rebates from manufacturers.

If manufacturing were done locally — making the cells at Stanford or UCSF, for example, rather than at distant pharmaceutical companies — that would reduce costs, Miklos said.

As competition increases, prices will fall, he predicted.

Meanwhile, the health system needs to focus on finding innovative payment solutions, Emond said.

One suggestion is to amortize the amounts paid by insurers over time, similar to a home mortgage. Another option is for pharmaceutical companies to provide a pro-rata reimbursement if a patient's condition does not improve – a “pay-for-performance” model. Another option can be a subscription-based approach like Netflix, where insurers pay a monthly fee to get access to the quantity of therapy needed.

“As we look to the future,” Emond said, “this is a moment when we can discuss how we can do things differently.”

Nishant Singh and Apeqsha Dudani met as students at Santa Clara University. Upon graduating, they didn't stray far.

“We never moved out,” Singh joked.

Although Singh had grown up in Mumbai and Dudani in Dubai, they both fell in love with the South Bay, spending their weekends hiking the Santa Teresa Hills or discovering new restaurants — and both decided they wanted to build a life here. They found jobs at tech companies — Singh, 30, is a data engineer and Dudani, 32, is a business analyst — and up until March, they had been renting a two-bedroom in Santa Clara, not far from a group of close college friends who also stuck around.

But the apartment started to feel small when, in January, the couple learned they were expecting a baby. With their daughter due in July, Singh and Dudani decided to take the leap and buy a home in the Bay Area. “We thought, since interest rates were high, there wouldn't be a lot of buyers,” Singh said.

Don't be so sure, their agent, Jeet Dholakia, advised them. Even with interest rates around 7%the Bay Area market was still flush with buyers, and there would be fierce competition for homes in their price range, between $1.3 and $1.5 million, just below the median home price in Santa Clara County of $1.8 million.

Singh and Dudani had a few priorities — they wanted a single-family home with at least three bedrooms and enough space to host their parents for long visits. Since both had attended public schools, they also wanted to live in a good school district. To find something that checked all their boxes, and stayed under budget, they began considering nearby cities, including San Jose and Fremont.

“That's the thing about the Bay Area — you can't get everything, but we didn't want to sacrifice things like space and school,” Singh said.

Here were the options they considered:

No. 1: Split level in Cambrian Park

This four-bedroom, two-and-a-half-bath home was built in 1966. It boasted a spacious interior — with 1,996 square feet — plus a patio and fruit trees in the backyard. The Singhs liked that it was in a coveted San Jose neighborhood — near Cambrian Park — close to good schools. But it was also on a somewhat busier street, which could have made backing their car out of the driveway difficult. They could also hear some of the street noise from inside the house. It was listed at $1,499,000.

No. 2: Home with a Sun Room in Fremont

The previous owners of this 1,434-square-foot home, built in 1962, had recently added new flooring and recessed lights, updated bathrooms and upgraded the kitchen with stainless steel appliances. The bedrooms were spacious, and it came with a bonus sunroom not included in the square footage. Unfortunately, because of the sunroom, the living room didn't get as much light. The home was located a short walk from a nearby elementary school, but far from some of their friends in Santa Clara. It was listed at $1,298,000.

No. 3: Ranch with Lots of Space in South San Jose

This four-bedroom, two-bathroom home was built in 1968 and came with limestone floors in the kitchen, a large, bright living room, and solar panels already installed on the roof. The home was in a school district that they liked, but at the south end of San Jose, it was far from their community in Santa Clara. The home was the largest option they looked at — 1,755 square feet — and was listed for $1,339,000.

So which one did they choose?

“We wanted to be on the low end — but we would bid, and then we didn't get any responses,” Singh said. “We felt like we were wasting sellers' time.”

They quickly realized that in Cambrian Park, homes would be listed at $1.5 million and then end up selling for closer to $1.7 million, which was outside of their budget. Such was the case for the split-level they looked at there, which they bid on but lost.

“It was becoming too competitive for us,” Singh said.

Dholakia, their real estate agent, advised them to look at homes around $1.3 million, then bid at $1.5 million.

After the two toured the home in South San Jose, they fell in love and decided to adjust the maximum amount they'd be willing to spend so that they might finally land a place. If that didn't work, they both agreed to pause their search for a year before they tried again.

But it never came to that. Their bid of $1,625 million won the house.

The Ranch with Lots of Space in South San Jose

Although $1.625 million was more than they'd originally hoped to spend, they scored a win with their mortgage rate. The couple had initially been quoted at a 6.37% rate for a 30-year fixed-rate mortgage, but they found a bank willing to offer 5.75% — a difference of $1,200 a month.

Two weeks ago, the couple moved in, and they are getting used to the joys of home ownership.

“We just saw these weeds start popping up,” Dudani said, pointing at some new growth in the mulch. “We didn't know what to do about weeds — we're first-time homeowners!”

They still don't have enough furniture to fit the space, but they'll spend the next few months getting the house prepared for their baby girl.

In the meantime, they're looking forward to using the space to host their friends for parties and gatherings, including a baby shower in June.

Though they'd been concerned about living so far from friends, it turns out that may not be the case.

“Now all our friends are talking about moving out here. “We have some friends who will be just 3 miles away,” Singh said. “We're excited for everyone to be so close by.”