Illinois lawmakers set aside their bitter partisan bickering Wednesday to override Republican Gov. Bruce Rauner’s partial veto of bill addressing the state’s heroin crisis.

Illinois has one of the highest rates of heroin overdose deaths in the country, and the Chicago area has led the nation in the number of emergency room visits related to heroin. And as we’ve recently reported, the heroin crisis has been growing worse as state funding for treatment programs has been cut.

The comprehensive Heroin Crisis Act would, among other things, allow the state’s Medicaid program to fully cover heroin addiction treatment.

Illinois is one of the few states that doesn’t allow Medicaid to pay for Methadone and other medication-assisted treatments. Methadone is one of a few drugs that can curb heroin cravings and treat painful withdrawal symptoms. Such medication is considered critical in helping users of heroin or other opioids overcome their addiction.

“It’s a monster, you know,” 47-year old Myron Boyd says of his heroin addiction. “It’s something that I wouldn’t wish on anyone.”

He says Medication-assisted treatment at the PEER Services treatment center in the Chicago suburb of Evanston is a vital part of Boyd’s recovery. “I feel like I’m privileged to be here,” Boyd says. “It’s been a lifesaver for me.”

The Illinois Consortium on Drug Policy estimates about 80% of those needing treatment for heroin or other opioid addictions don’t have health insurance to cover the cost of treatment. By extending Medicaid coverage to opioid addiction treatment, the federal government would have picked up much of the cost in Illinois.

But with the state in a deep budget crisis, Governor Rauner stripped out the measure to save money, as we reported last week.

Supporters call the veto shortsighted, arguing that every dollar spent on treatment saves 12 dollars in state prison, court and emergency room costs.

“In our zeal to save money, we must not forget about human life,” said State Rep. Lou Lang (D-Skokie), the chief sponsor of the Heroin Crisis Act.

Lang urged his fellow legislators Wednesday to override the governor’s veto. “Illinois is ground zero for heroin crisis in America. We’ve had more heroin deaths than any state in the nation.”

The Illinois house debate on the override measure, though brief, was emotional.

“Since this bill was passed just a few short months ago, I have attended two funerals of 25-year-olds who lost their lives to the heroin epidemic,” says State Rep. Kathleen Willis (D-Addison).

One of the funerals was of a constituent in her suburban Chicago hometown, she says, and the other was of a cousin who lived downstate. “There is not enough money that we can spend to save money,” Willis added. “It is impossible to put a price tag on it.”

Most members of the governor’s own party agree.

“Watching another kid left and right dying, overdosing over heroin, sickens me,” says Illinois House Republican Leader Jim Durkin of suburban Westchester. “It brings tears to many of our eyes and we have to do everything within our power to stop this and reverse this before it gets even more pervasive.”

As Amanda Vinicky of Illinois Public Radio reported, many drug treatment providers and advocates had feared the legislation addressing the heroin crisis would be another casualty of the bitter budget battle between Republican governor Rauner and powerful Illinois House Speaker Michael Madigan.

But the Illinois House voted 105-5 to override the governor’s veto.

“Finally people will get the treatment that they so desperately need,” says Kathie Kane-Willis, director of the Illinois Consortium on Drug Policy. “This legislation can be a model for the nation and I hope it will be.”

The override effort now moves to the Illinois Senate.

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Most women 40 and older believe they should have mammograms every year to screen for breast cancer, the latest NPR-Truven Health Analytics health poll finds.

The finding is at odds with current recommendations by the U.S. Preventive Services Task Force that women with typical risks for breast cancer have screening mammograms every two years starting at age 50 and until they turn 75.

The decision about mammograms for women in their 40s is a personal one. The task force found a small net benefit for biennial screening of women ages 40 to 49. The guidelines say women should take into account their health situation as well as their views on the benefits of early cancer detection and potential harms, such as unnecessary biopsies and surgery.

The USPSTF said there wasn’t enough evidence about the benefits from mammograms for women age 75 and up to make a recommendation.

The task force is working on an update to the mammography guidelines, which have sparked controversy since they were last revised in 2009. The thrust of the draft advice is pretty much the same as it has been, but there’s more nuanced discussion of the benefits and potential harms for women in their 40s.

The NPR-Truven Health poll found almost two-thirds of women ages 50 to 74 believe that they should have a mammogram annually. For women 40 to 49, the number drops to 56 percent. For women under 40, about 45 percent believe they should have a mammogram every year. Overall, 57 percent of women believe an annual mammogram is appropriate.

“The Task Force is happy to see that women are making informed decisions with their doctor about breast cancer screening and continue to have access to mammography screening,” Dr. Kirsten Bibbins-Domingo, vice chair of the USPSTF, told Shots in a statement emailed after she reviewed the poll’s findings. “Mammograms are an important tool in helping women avoid deaths from breast cancer. The value of mammography screening increases with age, with women ages 50 to 74 benefitting most from screening. In this age group, the evidence indicates that women get the best balance of benefits to harms when screening is done every 2 years.”

She added, “The decision to start regular mammography screening for women in their forties should be an individual one that women make in consultation with their doctors and after consideration of their health history, preferences, and how they value the potential benefits and harms of screening.”

The task force’s advice is influential, but its guidelines aren’t the only ones around. The American Cancer Society, for instance, recommends that women 40 and older “have a mammogram every year and should continue to do so for as long as they are in good health.”

After reviewing the poll’s findings, Dr. Michael Taylor, Truven’s chief medical officer, told Shots: “There needs to be more education about the problem of false positives. If you do mammography every year starting at 40, you’re going to find a lot of things that don’t matter.” There may be benefits for some women, but many will also be subjected to unnecessary biopsies and surgeries, he said. “We don’t think enough about the harms of interventions” triggered by mammography, he said.

As for the belief that annual mammograms are best, Dr. A. Mark Fendrick, a professor of internal medicine at the University of Michigan Medical School, says, “It’s much much harder to take away something that you’re already doing than it is to start a behavior from time zero.”

“More isn’t always better,” Fendrick says about screening tests, including mammograms. But there are some people with family histories of disease or who have specific genetic risk factors who should be screened more often, he says.

Overall, 48 percent of respondents were aware that the Affordable Care Act requires insurers to cover mammograms without any out-of-pocket costs.

The NPR-Truven Health Analytics Health Poll on mammograms was conducted in June. More than 3,000 women across the country were interviewed. The margin for error is plus or minus 1.8 percentage points. You can find the questions and full results of the latest poll here. For previous polls, click here.

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Dr. Bill Mahon was a young pediatrician in the early 1970s when he fell in love with the rugged coast and majestic redwoods of Mendocino County, Calif. Like other people who have moved to Mendocino from around the country, settling here for him was a personal choice that prioritized lifestyle over money.

The prospect of practicing medicine in a small community also called to him. In 1977 he left his well-paying job at Kaiser Sacramento to join a practice with two other pediatricians in Fort Bragg.

Still, the move was a risk.

“There were no guarantees coming to the coast. This was a practice that started from scratch, and I just trusted the fact that it would increase and everything would be fine,” Mahon, now 68, says. “My first month of work here I made $200. That was it.”

Over time, the private practice grew to include any patient regardless of ability to pay, says Mahon. Some patients were not insured. Many had Medi-Cal, the state’s health insurance program for lower-income residents, which — until Mahon’s office gained rural health clinic status in the 1990s — provided reimbursements that were “pretty meager.”

“Early on we actually did trades at the practice,” says Mahon, with a chuckle. “We would trade a visit for a salmon or pottery or some other commodity, which, in the end, felt good from both sides.”

For more than 35 years, Mahon examined patients day in and day out at his small clinic, next to Mendocino Coast District Hospital, the only hospital for miles. He handled everything from regular checkups to broken bones to very sick kids who might need a spinal taps or IV treatment. He got to know families closely. Going anywhere in town almost certainly involved bumping into a former patient.

“It really is the personal aspects of practice here,” says Mahon. “The connection with the parents, the connection with the kids and then how that connection spilled over into the larger community.”

Sometimes, he was roused out of bed in the middle of the night to attend to a newborn after a complicated delivery or speak with a distressed parent with an urgent question. Then those kids grew up — and many had kids of their own and brought them to see Mahon.

“I frequently tell people that I had a dream practice,” he says. “I took care of at least two generations of children. I wouldn’t trade a minute of it.”

Now Mahon is mostly retired. He only works at the hospital on call a few days a month. Families in most of the Mendocino Coast region no longer have access to a pediatrician who lives there permanently. The doctors that Mahon joined in the ’70s have long since retired, and other pediatricians have come and gone.

Until recently, a nurse practitioner and physician’s assistant at the clinic handled most cases. But with no pediatrician in the office, if a patient showed up very sick or with a complicated case, the clinic’s staff sent him to the hospital’s emergency department, which has on-call access to a pediatrician.

“This community deserves better,” says Mahon. “For me it’s rather sad. For all these years there have been resident pediatricians and now for the first time in 40 years, there is none.”

Mendocino Coast Clinics, which absorbed Mahon’s practice a few years ago, contracted an outside agency to bring in a temporary pediatrician for three months. He started last week.

“This is a stopgap measure,” says Paula Cohen, executive director at Mendocino Coast Clinics. “We would love to find someone who wants to move to this community and make it their home.”

Their search to find someone permanent has a few leads. Cohen says she interviewed an out-of-state doctor last weekend, and her staff is reviewing resumes. However, it’s hard for tiny Fort Bragg — population 7,300 — to compete with metropolitan areas when recruiting physicians.

Cohen says many physicians prefer the amenities — cultural activities, department stores, even supermarkets — of bigger cities. A physician who is married might need to look in areas that offer career opportunities for a spouse — who, if he or she works in financial services or tech, say, might not want to move to Fort Bragg.

The practice of medicine has also changed since Mahon came to the coast. Today, many young doctors don’t want to practice by themselves and independently treat the wide range of diseases and behavioral disorders in babies and children that Mahon did.

Most new physicians are educated in metropolitan areas, with a large suite of specialists available, says Janet Coffman, associate professor at the Institute for Health Policy Studies at the University of California, San Francisco.

“If you are in a rural area and the only pediatrician,” says Coffman, “people are expecting you to do a wider scope of practice. New physicians might not be prepared for that kind of medicine.”

Another big challenge is that most new doctors are looking for higher salaries to help them repay their debt from medical school. Graduates of public medical schools owed a median debt of $170,000, while private medical school graduates owed a median debt of $200,000, according to 2014 figures from the Association of American Medical Colleges. Poorer, rural areas, where many patients are on Medicaid, might not offer competitive salaries.

California could help rural communities recruit new physicians, Coffman says, by expanding programs that help doctors repay their debt if they practice in a medically underserved area. One such program in the state, the Steven M. Thompson Physician Corps Loan Repayment, offers up to $105,000 in financial assistance. Medical schools could also expand programs that train physicians for the daily challenges of practicing in a rural setting.

The issue is pressing in Mendocino County and other nearby Northern California counties, where more than half of all doctors practicing are 56 or older and nearing retirement age, according to a 2009 report by the California HealthCare Foundation. Statewide, the physician workforce is one of the oldest in the nation, with only New Mexico having a greater proportion of active physicians over 60.

Meanwhile, families in Fort Bragg say they greatly miss having a regular pediatrician they trust nearby.

Cassandra and Milo Young now drive their three children 60 winding miles inland to a pediatric practice in Ukiah. The trips usually take an entire day and represent additional costs in gas and time off work.

“It’s definitely a downfall to the area,” says Cassandra Young. She moved to the coast after working as a creative director at a large advertising firm in New York City.

“We made certain concessions to give this lifestyle to our children. We gave up the big career and department stores,” Young says. “But giving up good quality pediatric care doesn’t feel like something we should have to give up.”

She likes the pediatric practice in Ukiah well enough, she says, but misses Mahon.

“He’s just wonderful, the kind of doctor we all wish our kids could have,” Young says. “It would be amazing to get another Dr. Mahon to move out here and be our country doctor.”

This story was produced by State of Health, KQED’s health blog.

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Doctors’ practices are increasingly trying to reach their patients online. But don’t expect your doctor to “friend” you on Facebook – at least, not just yet.

Physicians generally draw a line: Public professional pages – focused on medicine, similar to those other businesses offer – are catching on. Some might email with patients. But doctors aren’t ready to share vacation photos and other more intimate details with patients, or even to advise them on medication or treatment options via private chats. They’re hesitant to blur the lines between personal lives and professional work and nervous about the privacy issues that could arise in discussing specific medical concerns on most Internet platforms.

Some of that may eventually change. One group, the American College of Obstetricians and Gynecologists, broke new ground this year in its latest social media guidelines. It declined to advise members against becoming Facebook friends, instead leaving it to physicians to decide.

“If the physician or health care provider trusts the relationships enough … we didn’t feel like it was appropriate to really try to outlaw that,” said Nathaniel DeNicola, an OB-GYN and clinical associate at the University of Pennsylvania, who helped write the ACOG guidelines.

But even the use of these professional pages raises questions: How secure are these forums for talking about often sensitive health information? When does using one complicate the doctor-patient relationship? Where should boundaries be drawn?

For patients, connecting with a physician’s office or group practice on Facebook can be a simple way to keep up with basic health news. It’s not unlike following a favorite sports team, your child’s middle school or the local grocery store.

One Texas-based obstetrics and gynecology practice, for instance, uses a public Facebook page to share tips about pregnancy and childcare, with posts ranging from suggestions on how to stay cool in the summer to new research on effective exercise for post-birth weight gain. Practices have also been known to share healthy recipes, medical research news, and scheduling details for the flu shot season.

“I have people come up to me and say, ‘I follow you on Facebook — thank you for posting this particular article. It helped me and my husband and my family,’ ” said Lisa Shaver, a primary care physician based in Portland, Ore.

But unless they’re already friends, she won’t add patients to her personal account, where, she said, she posts less health information and more cat videos.

Historically, professional groups including the American College of Physicians and American Academy of Family Physicians have advised against communicating through personal Facebook pages. The American Medical Association notes social media can be a valuable way to spread health information, but urged doctors in its 2010 guidelines to separate their personal and professional online identities to “maintain professional boundaries.”

Finding ways to use Facebook and other forms of social media to connect with patients — even if it may just be through professional pages — fits a trend in which patients seek more equal footing with their doctors, said Zack Berger, an assistant professor of medicine at the Johns Hopkins School of Medicine who studies patient-doctor relationships and social media.

It also follows what James Colbert, a hospitalist at Massachusetts-based Newton Wellesley Hospital, described as the growing consumer approach to medicine, including the notion that patients should be able to reach their physicians at all hours. Colbert is also an instructor at Harvard Medical School who researches how patients want to fit social technology into their health care.

Email can be a particularly convenient method, though it isn’t without concerns. Eva Schweber, 44, emails her doctor from a personal account and sends messages through an online portal — a more digitally secure system that is being adopted by a growing number of practices. The portal, she said, is for discussing complex, specific information. She’ll email her doctor from her personal email for less private concerns: scheduling, filling prescriptions and asking if certain symptoms might warrant a checkup.

“The unsecure email is easier, in that I can do it from my phone, my tablet, whatever,” said Schweber, of Portland, Ore.

In a recent study published in the Journal of General Internal Medicine, almost 20 percent of patient respondents reported trying to contact doctors through Facebook, and almost 40 percent through email. “Patients want to communicate with doctors [in whatever way] is convenient,” said Joy Lee, a postdoctoral research fellow at the Johns Hopkins Bloomberg School of Public Health, and the study’s lead author.

Doctors don’t yet seem to share that enthusiasm, Colbert said.

Meanwhile, security questions persist.

Social networking platforms aren’t usually digitally encrypted, increasing the odds they could get hacked or shared with third parties. The same worries hold true for other, casual forms of online communication such as email and text-messaging.

That means doctors who discuss specific health concerns with patients through those could break the Health Insurance Portability and Accountability Act, the patient privacy law.

“Those concerns are always going to be there,” said David Fleming, past president of the American College of Physicians. “How private is it when we share, when we talk to people? … Once I’ve written it or once I’ve emailed it, it’s gone, and I have no control.”

But because HIPAA was written before email and social media’s ascent, it may not address patient preferences or behavior, Colbert said. With more patients becoming comfortable using personal accounts for health needs, he said, the law perhaps deserves another look.

“Should we allow patients to be able to share or send messages without going through these privacy safeguards if they’re willing to do so? Or do we say that that’s not safe and even if patients don’t care about privacy we need to protect them,” he said. “That’s an open question.”

That public nature is a real worry for patients like Katie Cardenas, 45, who lives in Garner, N.C. She doesn’t think Facebook is secure enough for personal medical details. For sensitive information, she’ll usually send messages through a patient portal, the more secure website her doctor’s practice has set up.

Doctors could address that, several said, by using social media in other ways. These include maintaining active Twitter presences and professional Facebook pages for less-tailored health tips. That way, patients can get useful information and a sense of their doctors as people, but privacy stays intact and physicians maintain distance.

At the Minnesota-based St. Cloud Medical Group, patients can follow a public page. Doctors who are part of the practice post updates with safety tips and seasonal health reminders, or use the page to coordinate and publicize small projects, such as a week-long initiative geared to reducing children’s screen time.

Julie Anderson, a family physician who is also part of the practice, sees the value in this option, but doesn’t personally befriend patients on Facebook. Beyond patient privacy, she said, she fears blurring her personal and professional lives, or patients using that access to seek extra care when she’s off the clock.

“I’ve known colleagues that have friended somebody and have had inappropriate questions asked online, in terms of kind of abusing service,” she said. “Or abusing that … Facebook friendship, where they’re asking medical advice and you’re not even their physician.”

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Weeks before school started in Olathe, Kan., earlier this month, the town’s school district began its annual effort to get low-income students signed up for dental checkups.

When parents register at the elementary schools that serve the district’s poorest students, they are asked whether their children have a dentist. “And if they say no, we say, ‘We have a program in our school — a dentist is coming to our school this year,’ ” says health services director Cynthia Galemore.

The goal is to make dental care more accessible for low-income families. The obstacles to care aren’t limited to cost.

“A lot of times in these families dental care is not a priority,” says Galemore. “It’s not that the parents wouldn’t want to provide it, but they maybe can’t miss work to take their child to the dentist, [or] they may not have transportation.”

A lack of preventive dental care for poor children is a national problem. Medicaid and the Children’s Health Insurance Program, which cover children from low-income families, both pay for dental services. But fewer than half of children and teens enrolled in those programs received a preventive dental service last year, according to Stacey Chazin, a public health specialist with the Center for Health Care Strategies.

The participating schools in Olathe, a suburb of Kansas City, Mo., are among a few hundred across the country that offer oral health care. “What’s nice about the schools is [they’re] a place where students already go on a regular basis, whether it’s back to school night, or it’s a meet-the-teacher, or to pick up or drop off their kids,” says Chazin. In some schools, dentists provide care. In others, dental hygienists perform preventive services.

In a recent policy brief, Chazin recommends school-based oral health care as an important children’s health strategy. And, as it turns out, the federal government set goals to increase the proportion of children enrolled in Medicaid and the Children’s Health Insurance Program receiving any preventive dental service by 10 percent between 2011 and 2015.

Tooth decay is the most common chronic disease among American children, according to the American Academy of Pediatrics.

Some 25 percent of children ages 5 to 19 who live at or below the federal poverty level had untreated tooth decay, according to data from the Centers for Disease Control and Prevention. Only 12 percent of children with family incomes double that of poverty level had untreated tooth decay.

According to Chazin most school-based oral health programs focus on preventive services like cleanings, fluoride varnish and sealants – protective coatings placed over molars to prevent cavities. “The hope in all of it is that they’re referred to, and begin to get care from a dentist, where they would subsequently go for regular preventive visits and any needed treatment,” says Chazin. Medicaid and CHIP keep tallies of services performed at schools, when they are billed.

But it’s difficult to know if parents are scheduling those follow-up dentist visits. That data are hard to track, and to Chazin’s knowledge, no insurers or state health departments are taking the time to do it.

Olathe however, does have data on follow-ups. And that helped push the district to take the idea of in-school dental care one step further than most schools. At the start in 2009, the district tracked the number of follow-up appointments scheduled with dentists. The results weren’t good. Of the 339 children treated in school by dental hygiene students from the University of Missouri-Kansas City, 63 percent had tooth decay and were referred to a dentist. By the end of the school year, only 11 percent of those referred had had their parents contact a dentist’s office to schedule an appointment.

But when a clinic in town became a federally qualified health center in 2013, it opened up a new opportunity. The district now works with the clinic—which receives federal funds to provide free or low-cost care to the underserved— to bring dentists to the schools. These dentists perform the full array of services on site. It’s a win-win for the school district: Nurses no longer have to worry about parents scheduling follow-up visits, because they are scheduled at school. And the clinic provides a steady source of funding for the district’s growing number of immigrant students, some of whom don’t qualify for insurance because of their undocumented status. If a student has no insurance, the service is free.

“We used to think, ‘Oh, schools shouldn’t do this.’ We thought our job was to provide the education for the kids,” Galemore says. “We didn’t used to feed breakfast to kids at school either. Funding has been cut and cut and cut for schools, but it’s part of focusing on the whole child. We know if we have better health for that child there’s better learning.”

For this school year, the oral health program in Olathe is expanding from 10 to 12 elementary schools, and adding two high schools.

This piece comes from Side Effects Public Media, a public radio reporting collaborative that explores the impacts of place, policy and economics on health. Follow Side Effects on social media here.

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