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Health April 14, 2019

How Philadelphia Mandated Vaccinations In 1991

NPR’s Sacha Pfeiffer speaks with Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, about the last time the U.S. mandated measles vaccinations.



SACHA PFEIFFER, HOST:

Mandatory measles vaccinations have been ordered for people living in parts of Brooklyn, N.Y. That’s the order of New York City Mayor Bill de Blasio. And it was prompted by a measles outbreak in some ultra-Orthodox Jewish communities there. Vaccination rates are low in those communities, and an anti-vaccination movement is spreading there. Requiring vaccines is a rare public health move, but there is a precedent. During a 1991 outbreak in Philadelphia, city officials mandated vaccinations for children against their parents’ will. Dr. Paul Offit treated children during that outbreak. He’s director of the Vaccine Education Center at Children’s Hospital of Philadelphia. And he joins us to talk about the experience.

Dr. Offit, welcome.

PAUL OFFIT: Thank you.

PFEIFFER: In New York, Mayor de Blasio has said anyone who doesn’t comply will be fined. But he hasn’t said that people will be forced to get an injection or take a pill. In Philadelphia, was anyone actually forced to be vaccinated?

OFFIT: Yes. There’s a distinction between mandatory vaccination and compulsory vaccination. What de Blasio is asking for is mandatory vaccination, which is to say, get a vaccine. If you don’t get it, then you’ll pay some sort of societal price. You may have to pay a fine or something like that. Here in Philadelphia, we had compulsory vaccination, which is to say, your child got a vaccine whether you wanted your child to get a vaccine or not. It was a court order.

PFEIFFER: And how did Philadelphia get to that point?

OFFIT: Well, we – in that several-month period in early 1991, we had 1,400 cases of measles and nine deaths. It was a major epidemic. I mean, parents were scared to death in this city. The city became a feared destination. It was a nightmare.

PFEIFFER: You were treating children who came to the hospital with measles. What condition were those kids in?

OFFIT: Well, typically, when you’re hospitalized with measles it’s because you have severe pneumonia caused by the virus or you have a bacterial superinfection that was set up by the virus when it infected your lungs or you have severe dehydration. Those were generally the reasons children came into the hospital.

PFEIFFER: So they were – they – these kids were in tough shape.

OFFIT: Yes. And this was at the point where, actually, they were compelled to come in. This epidemic centered on two fundamentalist churches – Faith Tabernacle and First Century Gospel, which were faith-healing churches. So it wasn’t just that they didn’t immunize. They also didn’t choose medical care. And so they often let their children get very sick before, frankly, they were compelled by law to bring them to the hospital.

PFEIFFER: What did their parents tell you about why they hadn’t vaccinated their children?

OFFIT: They were profoundly of the belief that Jesus would protect their children. And they said Jesus was our doctor.

PFEIFFER: And did they also believe that vaccines could cause their kids harm? Were they skeptical about them in other ways?

OFFIT: I think they were just skeptical of modern medicine, period. They saw modern medicine as an act of man. They saw Jesus as someone who could protect their child, independent of whether or not man intervened.

PFEIFFER: In Philadelphia, when those mandatory vaccines were ordered, were there any legal challenges to them?

OFFIT: Yes. The pastor of the Faith Tabernacle Church actually did challenge that because, frankly, what he was doing was perfectly legal. We had had a religious exemption to vaccinations on the book for 10 years. There was nothing he was doing that was illegal. And so he asked the American Civil Liberties Union to represent him, but the ACLU was unwilling to take the case. They said, basically, while they believe that you are at liberty to martyr yourself to your religion, you’re not at liberty to martyr your child to your religion. So they didn’t take the case.

PFEIFFER: Given the fears that many people out there have about vaccines, do you have any qualms or concerns about mandatory vaccinations?

OFFIT: No. I think that were those fears well-founded, sure, I could understand it. I mean, if vaccines cause what they fear vaccines cause, like chronic diseases like autism or diabetes or multiple sclerosis or attention deficit disorder or hyperactivity disorder, sure. But vaccines don’t cause that, so they’re making bad decisions based on bad information that’s putting their children and other children at risk. I mean, at some point, somebody has to stand up for these children.

PFEIFFER: To take us back to present day, is there anything you think was learned from the Philadelphia experience that could be applied to New York City today?

OFFIT: Only just how bad it can get. I guess I just think we invariably fail to learn from history, which is why, occasionally, we’re condemned to repeat it. I mean, do we really need to learn that measles is a potentially fatal infection? Do we need to learn that? Before there was a measles vaccine, 500 people died every year in this country, and most of them were children. Forty-eight thousand people were hospitalized. Do we really need to keep learning that lesson? You know, we eliminated measles from this country in the year 2000. And I think not only did we largely eliminate that virus, I think we eliminated the memory of that virus. People don’t remember how sick it could make you. And that’s why, I think, they can be so cavalier about these kinds of choices.

PFEIFFER: Dr. Paul Offit is director of the Vaccine Education Center at Children’s Hospital of Philadelphia. And he treated children during a measles outbreak in Philly in 1991. Dr. Offit, thanks for talking with us.

OFFIT: Thank you.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Health April 13, 2019

Examining Sanders’ Medicare-For-All Proposal

Julie Rovner, chief Washington correspondent for Kaiser Health News, describes the latest Medicare-for-all bill by Sen. Bernie Sanders and the options for single-payer coverage proposed by lawmakers.



SCOTT SIMON, HOST:

Bernie Sanders has introduced a new version of his “Medicare for All” bill that was a cornerstone of his 2016 presidential campaign. He’s one of several Democratic candidates for president who support some form of national single-payer coverage. But is that easier said than done? Julie Rovner, chief Washington correspondent for Kaiser Health News joins us. Julie, thanks for being with us.

JULIE ROVNER: Thanks for having me.

SIMON: And what’s Senator Sanders proposing this year?

ROVNER: Well, he’s proposing similar to what he’s been proposing since the 1990s, which is basically to make Medicare, the program that now serves 50-some million elderly and disabled Americans, available to everyone and basically get rid of private health insurance at the same time. So everyone would be on Medicare – might not be the same Medicare that we know now, but they would be on a federal government-run program called Medicare that would provide much more robust benefits than most people have now either on Medicare or on their private insurance.

SIMON: More robust benefits, but would that also mean more robust taxes?

ROVNER: Yes, it almost certainly would because there would be no more private health insurance premiums, according to the – at least the proposal that we have. People wouldn’t have to pay copays or coinsurance or deductibles or, you know, the money that now gets paid out of pocket. So taxes would presumably go up to make up for that.

SIMON: A lot of Democratic candidates are running on a policy of Medicare for All. What are some of the features of the plans that we might find worth knowing about?

ROVNER: Well, the Medicare for All plans would basically get rid of private insurance, and this is of some concern for those who are worried about the political prospects. There’s 150 million people who get their insurance from a family member’s employer. That would basically go away. The entire private insurance industry would go away.

There are some other proposals that would either maintain a role for private insurance – maybe they could cover some things. That’s how some countries do it. And then there are others that make the whole thing optional. The people who wanted to go into a public plan could go into a public plan, but those who wanted to keep their private coverage could do that. That’s one of the big debates that’s going to have to happen before anybody settles on any particular plan.

SIMON: And everybody seems to want to bring down health care costs, but there’s a big but, isn’t there?

ROVNER: There is a big but. You know, we are still a free country. If they bring them down too much, you might have providers who wouldn’t want to participate, or you might have hospitals closing their doors.

I mean, at some point, yes, health care is expensive. It doesn’t have to be as expensive as it is in the United States. We pay way more for things than other countries do, but there is going to be some kind of a limit on how low you can push those prices. But remember, however much you pay for the health care, that’s how much is going to have to be then raised in federal taxes to pay for this.

SIMON: Any chance of Republican support for any of these plans?

ROVNER: It seems highly unlikely, at least at this point. This is mostly a Democratic debate about, what do Democrats think the nation’s health care should look like in the coming years and probably decades? Republicans are still kind of figuring out exactly what they would like to propose. Everybody seems to support more coverage, and they know that the status quo isn’t working. People are paying too much, and even middle-class people often can’t afford their health care. But Republicans are – seem, at the moment, happy to call this socialism and leave it at that.

SIMON: If there is an overhaul of health care, but it’s not bipartisan, does that just mean that American health care is going to go back and forth, depending on which party’s in power?

ROVNER: Well, that is the big concern. And there are a lot of Republicans who are saying, you know, we really should work together. And there is some bipartisanship going on now on issues like prescription drug prices and surprise medical bills – that people get unexpected out-of-network bills. But even those are proving difficult to find bipartisan consensus on – at least enough consensus to pass a law. So I think both sides know it would be better if they got together. They just haven’t figured out how yet.

SIMON: Julie Rovner, chief Washington correspondent for Kaiser Health News. Thanks so much.

ROVNER: Thank you.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Health April 12, 2019

Republican State Lawmakers Split Over Anti-Abortion Strategy

In the Tennessee capitol, state Rep. Matthew Hill took heat from abortion-rights proponents last month who had gathered to protest a bill he favored that would ban abortions after about six weeks’ pregnancy. That legislation was eventually thwarted in the Tennessee Senate, however, when some of his fellow Republicans voted it down, fearing the high cost of court challenges.

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Sergio Martinez-Beltran/WPLN

The new anti-abortion tilt of the U.S. Supreme Court has inspired some states to further restrict the procedure during the first trimester of pregnancy and move to outlaw abortion entirely if Roe v. Wade ever falls. But the rush to regulate has exposed division among groups and lawmakers who consider themselves staunch abortion opponents.

On Thursday, Ohio became the latest state to ban abortions after a fetal heartbeat can be detected. For a long time, Ohio Right to Life supported a more gradual approach to restrict the procedure and deemed what’s come to be called a “heartbeat bill” too radical — until this year. Restricting abortions after a fetal heartbeat can be detected basically bans the procedure after six weeks’ gestation — before many women know they’re pregnant.

“We see the Court as being much more favorable to pro-life legislation than it has been in a generation,” spokeswoman Jamieson Gordon says. “So we figured this would be a good time to pursue the heartbeat bill as the next step in our incremental approach to end abortion-on-demand.”

The Ohio law contains no exception for pregnancies that are the result of rape or incest; it does have an exception for the life of the mother.

Some say the rush to pass these bills is about lawmakers competing to get their particular state’s law before the Supreme Court. The state that helps overturn Roe v. Wade would go down in history.

More than 250 bills restricting abortions have been filed in 41 states this year, according to the Guttmacher Institute, a reproductive rights research and advocacy group.

“After the appointment of Justice [Brett] Kavanaugh, there really is just an environment in state legislatures to roll back abortion rights. And so we’re seeing these bans just fly through,” says Elizabeth Nash, who monitors state laws at Guttmacher.

But the speed of passage of some of these laws masks divisions about strategy and commitment to the cause within the anti-abortion movement.

Tennessee infighting over “heartbeat bill”

In Tennessee, for instance, there’s a philosophical split between pragmatists and idealists.

A heartbeat bill in the state has had high-profile support, including from the Tennessee’s new governor. But the Republican attorney general warned such a law would be difficult to defend in court. And several Republicans, swayed by that logic, voted no for the heartbeat bill.

“This is an issue that is extremely important to me. It’s the reason I got into politics many years ago,” Republican state Rep. Bill Dunn said as the House approved the measure over his objection earlier this year. Dunn says he wants to stop abortion, but that will require strategy. He points out that no heartbeat bill has ever been enforced. And recent laws in Iowa and Kentucky have been immediately blocked in court. The same is expected for Ohio.

“Number one, it’ll probably never save a life if we go by what’s happened in the past,” Dunn argued on the Tennessee House floor.

But it’s money that ultimately stopped the heartbeat bill this year in Tennessee (It stalled in committee this week, though the state’s Senate Judiciary Committee agreed to review the bill this summer.)

Senate Speaker Randy McNally says he’s pro-life too, but has no interest in wasting tax dollars to make a point.

Even worse, in the view of Republicans who voted against the heartbeat bill, the state could end up paying the legal fees for groups that defend abortion.

“That is a big concern,” McNally says. “We don’t want to put money in their pockets.

The last time Tennessee had a case that went to the U.S. Supreme Court, it cost roughly $1.9 million. The experience was enough to give a few anti-abortion crusaders some pause. They voted this week with Democrats for a one-year delay on a heartbeat bill, vowing to study the issue over the summer.

Name-calling in Oklahoma

Even if it doesn’t result in a case that upends abortion law, heavily Republican legislatures like Oklahoma’s want to be ready.

“If Roe v. Wade ever gets overturned, we won’t be prepared,” Republican Senate Pro Tempore Greg Treat said while explaining his so-called “trigger bill” at a committee hearing in February.

Treat’s legislation, modeled after existing laws in a handful of states, would “trigger” a state ban on abortion and make it a felony if Roe were overturned. A handful of states, including Arkansas, Kentucky, Louisiana, Mississippi, North Dakota and South Dakota, already have trigger laws on the books.

Oklahoma has some of the strictest abortion laws in the nation, such as mandatory counseling and a 72-hour waiting period. But the most conservative anti-abortion activists in the state want more immediate action. So they targeted Treat and other self-described pro-life Republicans with protests, billboards and fliers, accusing them of not being anti-abortion enough.

“I’ve been called every name in the book these past few weeks,” Treat says. “I’ve had my Christianity questioned. I’ve had a member of my own caucus hold a press conference and call me a hypocrite.”

In response, Treat abandoned the trigger bill.

Now he’s trying something else — an amendment to the state constitution that would reinforce that nothing in Oklahoma law “secures or protects” the right to abortion. But that’s still not anti-abortion enough for some.

“It’s going to add on to that legacy that we have of death and just status quo pro-life policy that does nothing,” says Republican state Sen. Justin Silk.

Not far enough in Georgia

In Georgia, a heartbeat bill passed the legislature, but has paused at Gov. Brian Kemp’s desk. Supporters of abortion rights don’t want him to sign it, of course, but some anti-abortion activists aren’t happy either.

“It really just does not go far enough in the protection of innocent human life,” says Georgia Right to Life executive director Zemmie Fleck. Fleck argues that certain exceptions in his state’s bill — for abortions after rape or incest if the woman makes a police report — make it weak.

Gov. Kemp has until May 12 to sign or veto the measure.

Cost as no object in Kentucky

The American Civil Liberties Union in Kentucky sued the day after a heartbeat bill was signed into law by Gov. Matt Bevin. But even during his annual speech to the Kentucky legislature in February, Bevin acknowledged his intent to challenge Roe v. Wade.

“Some of these will go all the way to the U.S. Supreme Court. But at the end of the day, we will prevail because we stand on the side of right and we stand on the side of life,” Bevin said.

Kentucky has become accustomed to defending abortion restrictions in court. Currently, one law that makes it a felony for a doctor to perform a common abortion in the second trimester has been suspended indefinitely.

It is unclear how much it costs Kentucky to defend abortion laws that are immediately challenged. In an emailed statement, Bevin administration spokesman Woody Maglinger writes that the state is using in-house lawyers, and hasn’t hired outside counsel. He declines to provide a cost estimate on hours spent on these cases.

“It is impossible to place a price tag on human lives,” Maglinger writes.

This story is part of a reporting partnership that includes NPR, Kaiser Health News and member stations. Blake Farmer is Nashville Public Radio’s senior health care reporter, and Jackie Fortier is senior health care reporter for StateImpact Oklahoma. Marlene Harris-Taylor at WCPN in Cleveland, Lisa Gillespie at WFPL in Louisville and Alex Olgin at WFAE in Charlotte, N.C., also contributed reporting.

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Health April 11, 2019

The Issue Of Medicare For All Is Dominating The 2020 Democratic Field

Several 2020 Democratic candidates support Medicare for All, but what would that proposal look like in action?



ARI SHAPIRO, HOST:

If there’s a single issue that’s defining the Democratic field of 2020 presidential candidates, it’s health care, Medicare for All, to be precise.

(SOUNDBITE OF ARCHIVED RECORDING)

KAMALA HARRIS: I believe the solution – and I’m – and I’m – actually feel very strongly about this – is that we need to have Medicare for All

(SOUNDBITE OF ARCHIVED RECORDING)

ELIZABETH WARREN: Medicare for All is all about…

(SOUNDBITE OF ARCHIVED RECORDING)

BETO O’ROURKE: The best way to get there is by having Medicare for All.

(SOUNDBITE OF ARCHIVED RECORDING)

BERNIE SANDERS: The strengths of a Medicare for All program…

(SOUNDBITE OF ARCHIVED RECORDING)

KIRSTEN GILLIBRAND: That’s why I am for Medicare for All.

SHAPIRO: When Vermont Senator Bernie Sanders unveiled his 2020 Medicare plan for all this week, several other Democratic presidential candidates stood alongside him.

(SOUNDBITE OF ARCHIVED RECORDING)

SANDERS: The American people want and we are going to deliver a Medicare for All single-payer system.

SHAPIRO: So what would that system look like? NPR’s health policy correspondent Alison Kodjak is here to talk us through that. Hi, Alison.

ALISON KODJAK, BYLINE: Hi, Ari.

SHAPIRO: Start with a bit of history. Where did the idea of Medicare for All begin?

KODJAK: So the idea of, like, a government-funded, universal health coverage goes way back to the Depression. Franklin Delano Roosevelt convened a committee on economic security in the midst of that economic crisis, and they advocated not only Social Security, but they wanted to include national health insurance in the system. That program failed because of opposition mostly from doctors.

(SOUNDBITE OF ARCHIVED RECORDING)

FRANKLIN D ROOSEVELT: We can never insure 100 percent of the population against 100 percent of the hazards and vicissitudes of life, but we have tried to frame a law which will give some measure of protection.

KODJAK: Thirty years later, Medicare was passed into law.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER: President and Mrs. Johnson and Vice President Humphrey arrive for ceremonies that will make the Medicare bill a part of Social Security coverage.

KODJAK: It didn’t cover everybody either. It only covered retirees.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED REPORTER: The new bill expands the 30-year-old Social Security program to provide hospital care, nursing home care, home nursing service and outpatient treatment for those over 65.

KODJAK: So universal coverage, the idea of it, has been on the table for, in one form or another, ever since the 1930s.

SHAPIRO: So, in the present day, when we hear all these Democratic presidential candidates talk about Medicare for All, what does that proposal they’re talking about right now mean?

KODJAK: That proposal that came out this week, it would eliminate private health insurance altogether, have the government be the single payer for people’s health care. Everybody would get coverage. Hospitals, if they’re private now, would stay private. Doctors would remain in the private sector. But the government would be the sole payer of health care, and everybody would get insurance.

SHAPIRO: And what would that mean for patients, especially people like you and I who get coverage through our employer right now?

KODJAK: Well, we’d no longer get coverage through our employer. We’d get it through this government health insurance plan. The benefits might be much more generous than we have now. We wouldn’t have to pay part of the premium. There would be no copayments under this plan.

But that’s a big sticking point. How do you pay for that? It would have to be through tax increases of some sort because it would increase government spending. The one thing to keep in mind is that we already pay a huge amount for health care in this country, almost $4 trillion a year.

So you’re paying one way or another. Your private insurance is expensive. An average family plan provided through employers is about $20,000 dollars a year. And that often includes copayments and deductibles.

SHAPIRO: That’s a lot of money going to the insurance companies.

KODJAK: Sure is.

SHAPIRO: What happens to them under this plan?

KODJAK: Well, that’s the big question. Senator Sanders was asked about it earlier today on CBS.

(SOUNDBITE OF ARCHIVED RECORDING)

SANDERS: Under Medicare for All, we cover all basic health care needs. I suppose if you want to make yourself look a little bit more beautiful, you want to work on that nose, your ears, they can do that.

ED O’KEEFE: So basically Blue Cross Blue Shield would be reduced to nose jobs.

SANDERS: Something like that.

KODJAK: Yeah. So if that’s the case, the insurance industry, as it stands now, would shrink quite a lot. Today, about 540,000 people work in health insurance. Now, some of those people would probably get jobs with the government, but it would be a big disruption.

SHAPIRO: Yeah. And health care is about 18 percent of the U.S. GDP. So we’re talking about a huge shake-up for the economy. What are the implications of that drastic of a change to the system?

KODJAK: Yeah, it is a huge part of the economy. Most economists don’t really see that as a good thing, that we shouldn’t be spending that much on health insurance and health care in this country. So one goal of moving to a single-payer plan like this would be to make the system less expensive. There’d be no profit motive. There’d be fewer administrative costs. Perhaps we would pay doctors or hospitals less for procedures and care. And so if that succeeded, it might cut costs, which economists would applaud. But again, there would be losers, and it would be hugely disruptive to the economy.

SHAPIRO: You mentioned Senator Sanders. Which other 2020 candidates support this and which are not so sure?

KODJAK: Well, at his side in the announcement were Senators Kirsten Gillibrand, Senator Elizabeth Warren. Cory Booker has been behind it. So has Kamala Harris. Amy Klobuchar, who’s running, has said that she would rather see incremental progress on the Affordable Care Act, protect what we have now and make it better. And there are a lot of others who stand with her and say we should just stick with what we have and improve it.

SHAPIRO: NPR health policy correspondent Alison Kodjak, thank you.

KODJAK: Thanks, Ari.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Health April 10, 2019

British Drug Maker Indivior Indicted On Fraud And Conspiracy Charges In The U.S.

The federal government is charging the maker of the addiction drug Suboxone with fraud and conspiracy in marketing the drug to doctors.



ARI SHAPIRO, HOST:

Share prices for the British drugmaker Indivior plunged today on the London Stock Exchange. The drop came on news that the U.S. Justice Department indicted the company on fraud and conspiracy charges. Indivior makes the drug Suboxone, widely used to treat people suffering from opioid addiction. Federal prosecutors now claim the company falsely marketed Suboxone as safer and less prone to abuse than cheaper generic drugs. North Country Public Radio’s Brian Mann reports.

BRIAN MANN, BYLINE: The 28-count indictment filed in a Virginia court claims Indivior executives lied when they claimed dissolvable Suboxone films placed under the tongue would be safer, harder to misuse than generic tablets that were about to come on the market. Government investigators say, in some cases, Indivior’s version of the drug was more risky. The indictment claims taxpayer-funded programs like Medicare and Medicaid were cheated out of billions of dollars. Justice Department officials declined NPR’s request for an interview. Robert Bird is a professor of business law at the University of Connecticut who follows opioid cases closely. He says this criminal indictment sends a powerful signal to a drug industry already snared in the opioid addiction crisis.

ROBERT BIRD: Not only the companies that are being indicted but also other organizations and competitors who will look at these prosecutions and say, I don’t want this to happen to me.

MANN: Indivior executives also declined to be interviewed by NPR. But company spokesperson Jennifer Ginther read from a prepared statement, denying any wrongdoing and describing the federal indictment as misguided.

JENNIFER GINTHER: Indivior’s top priority has always been the treatment of patients struggling with opioid addiction. No other company has done more to fight the opioid crisis.

MANN: This point – Indivior’s central role treating people addicted to opioids – represents a fascinating wrinkle in this case. The Justice Department has filed criminal charges against other opioid makers in the past, winning a guilty plea in a $600 million settlement from Purdue Pharma, the maker of OxyContin in 2007. But Indivior doesn’t actually make prescription painkillers. It makes drugs like Suboxone designed to treat people suffering from opioid dependency.

ALAN LESHNER: It’s a highly effective medication that we endorse in our report.

MANN: Alan Leshner chaired a panel for the National Academies of Sciences, Engineering, and Medicine that released a new study last month finding that drugs like Suboxone are being underutilized. He worries that all the bad publicity surrounding drug companies and their products will make it harder for people struggling with opioid addiction to get treatment drugs.

LESHNER: So there’s a tremendous amount of stigma surrounding everything related to addiction. And the stigma and misunderstanding has kept a tremendous number of people from getting the treatment that they need.

MANN: These recovery drugs matter because more than 100 Americans are still dying from opioid overdoses every day. But like other medications that contain opioids, Suboxone can be abused. This federal indictment claims that while Indivior downplayed the risks of their drugs, the company also boosted profits by helping create a black market connecting patients suffering from addiction with doctors writing too many prescriptions for Suboxone at too strong a dose. In its statement, Indivior rejected that claim, saying the company never deliberately diverted its product to increase sales.

The stakes here are high. If Indivior is found guilty, prosecutors say the company should forfeit at least $3 billion in penalties. Indivior and other big drugmakers, including Purdue Pharma and Johnson & Johnson, already faced hundreds of civil lawsuits stemming from the opioid crisis. Brian Mann, NPR News.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Health April 9, 2019

Porcupine Barbs For Better Wound Healing


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At first, the idea of using porcupine quills to patch up wounds sounds torturous. But, taking inspiration from the spiky rodent, researchers have begun to work on a new type of surgical staple that may be less damaging — and less painful — than current staples.

Worldwide, surgeons perform more than 4 million operations annually, usually using sutures and staples to close wounds. Yet these traditional tools designed to aid healing can create their own problems.

“We’ve been using sutures and staples for decades, and they’ve been incredibly useful,” says Jeff Karp, a bioengineer at Brigham and Women’s Hospital in Boston and professor of medicine at Harvard Medical School. “But there are challenges in terms of placing them for minimally invasive procedures.”

Surgical staples are faster to insert than sutures, which require a needle and thread, he explains. But current staples, made of metal, tear tissue on the way in and cause more damage when bent to stay in place.

The quill tip in this finger has microscopic, backward-facing barbs that make the quill hard to remove. Bioengineers think the same sort of barbs could help keep dissolvable medical staples in place until a wound heals.

Josh Cassidy/KQED


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Josh Cassidy/KQED

Karp and his team have been searching for new ways to hold tissue together.

One brainstorming session led to a discussion of a porcupine and its quill.

The North American porcupine appears cute, but it has more than 30,000 menacing quills covering much of its body, each one hollow and 2 to 3 inches long. The slow-moving herbivore uses the quills as a last-resort defense against predators.

The quills are actually specialized hairs that mostly lie flat against the animal’s body. Only when threatened will the porcupine erect them. And, contrary to a common myth, porcupines don’t shoot the quills out from their bodies.

“The wonderful thing about porcupines is that they seem to feel secure,” saidUldis Roze, emeritus biology professor at Queens College, City University of New York. “They feel like they’re not in danger, and they’re sweet.”

When the porcupine is relaxed, its other hairs and fur hide most of the quills.

When threatened, the adult porcupine displays three types of warnings before lashing out, according to Roze’s book The North American Porcupine. First, the contrasting black and white pattern of the animal’s quills and other hairs — known as aposematic coloration — is a visual warning signal. A unique pungent odor and ominous teeth are further clues that dogs, mountain lions and other potential predators should stay away.

The North American porcupine has a cute face, but it has upward of 30,000 menacing quills covering much of its body. The slow-moving herbivore uses them as a last-resort defense against predators.

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Lindsay Wildlife Experience

If that doesn’t work, a porcupine will use its powerful, spiky tail to slap at the aggressor. Each quill is held in place by its own special structure in the porcupine’s skin. Direct physical contact with a predator causes the porcupine’s skin to release the quill.

Quills from North American porcupines pack a hidden punch: microscopic, backward-facing barbs.

Covering just the needlelike tip of the quills, the barbs make removing a quill difficult, because they flare out when pulled in a direction opposite to the way they went in.

That means that if a predator gets quilled, the quill might never come out. When scientists examine the skulls of deceased mountain lions, Roze says, they often find the tips of porcupine quills embedded in the lions’ jaw bones

“The mountain lion just accepts it,” said Roze. “It’s part of the work of killing a porcupine.”

Of course, that mountain lion’s days of porcupine feasting may end forever if the quills keep it from eating or end up in the cat’s vulnerable internal organs.

This image from a scanning electron microscope homes in on the tiny barbs on the tip of a porcupine quill.

Courtesy of Woo Kyung Cho


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Courtesy of Woo Kyung Cho

Still, a quill passing through the body is far from painless — it’s excruciating — as Roze knows from personal experience. He was once quilled in his bicep while up in a tree, trying to catch a porcupine.

Despite his wife’s suggestion afterward that he immediately seek medical care, he waited two harrowing days. By that time, the quill had traveled in one direction and cleanly exited his lower arm. He kept the quill as a souvenir.

The quill’s barbs eased its penetration into his flesh. They also helped drive the quill in deeper, until it exited (though it would have been stopped by a harder material, such as bone).

It was the barbs that most interested Karp. He and his teamran experiments comparing a barbed quill to a barbless quill, measuring the forces required to insert and remove barbed spears.

In contrast to a barbless quill or a surgical staple — which tear the tissue and create gaps that are susceptible to infection — the barbed quill’s design means it does minimal damage on the way in, the researchers found.

Left: A microscopic image compares the size of a North American porcupine’s quill tip with the tip of a narrow, 18-gauge needle. Right: In a live porcupine, the partially hidden quills usually lay flat along the herbivore’s body, amidst other hairs, until and unless called into action.

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A new type of medical staple that had two barbed tips would require much less effort to place, Karp figures, and the gripping power of the barbs would hold it in position without needing to bend the staple.

Karp says he anticipates making the new staples out of biodegradable material so they will fully dissolve over time without having to be removed.

The challenge now is to re-create the full barb’s shape.

“Nature has designs that humans can’t achieve yet, at least at large scale,” Karp says. “Large-scale manufacturing is a human problem.”

But if the right technologies become available, he estimates that human testing of porcupine quill-inspired tools could begin in two to five years.

“This could be an enabler for smaller incisions to be made in a large number of surgeries,” Karp says. That would be good news for both surgeons and patients.

This post and video were produced by our friends at Deep Look, a wildlife video series from KQED and PBS Digital Studios that explores “the unseen at the very edge of our visible world.” KQED’s Josh Cassidy is the lead producer and cinematographer for Deep Look. Laura Shields works as an intern for the series.

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Health April 8, 2019

How HHS Secretary Alex Azar Reconciles Medicaid Cuts With Stopping The Spread Of HIV

HHS Secretary Alex Azar at a White House roundtable discussion of health care prices in January. Azar tells NPR his office is now in “active negotiations and discussion” with drugmakers on how to make HIV prevention medicines more available and “cost-effective.”

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In his State of the Union address this year, President Trump announced an initiative “to eliminate the HIV epidemic in the United States within 10 years.”

The man who pitched the president on this idea is Alex Azar, the Secretary of the Department of Health and Human Services.

“We have the data that tells us where we have to focus, we have the tools, we have the leadership — this is an historic opportunity,” Azar told NPR’s Ari Shapiro Monday. “I told the president about this, and he immediately grabbed onto this and saw the potential to alleviate suffering for hundreds of thousands of individuals in this country and is deeply passionate about making that happen.”

Trump’s push to end HIV in the U.S. has inspired a mix of enthusiasm and skepticism from public health officials and patient advocates. Enthusiasm, because the plan seems to be rooted in data and is led by officials who have strong credentials in regards to HIV/AIDS. Skepticism, because of the administration’s history of rolling back protections for LGBTQ people, many of whom the program will need to reach to be successful.

For instance, transgender people are three times more likely to contract HIV than the national average, according to the Centers for Disease Control and Prevention. Trump has banned transgender people from serving in the military and undone rules that allow transgender students access to bathrooms that fit their gender presentation.

Azar himself has strong Republican credentials — as a young man, he clerked for Justice Antonin Scalia. And yet he’s now touring the country promoting this plan to end HIV, which includes supporting needle exchange programs to reduce HIV infection among intravenous drug users.

“Syringe services programs aren’t necessarily the first thing that comes to mind when you think about a Republican health secretary,” Azar acknowledged at an HIV conference last month. “But we’re in a battle between sickness and health — between life and death.”

This interview has been edited for clarity and length.

This morning you toured facilities in East Boston, a neighborhood in one of 48 counties targeted in Trump’s plan. What did you learn there?

I was able to be at the East Boston Neighborhood Health Center and they have a remarkable program called Project Shine. What I was able to do is meet with the entire team that provides this type of holistic approach. It is very much what we’re going to try to do in the most impacted areas.

You find the individuals who may have HIV — get them diagnosed. Get those who are diagnosed on the HIV antiretroviral treatment — so that they have an undetectable viral load and can’t spread the disease to others, as well as live a long healthy life themselves. Get those who are most at risk of contracting HIV on a medicine called PrEP so that they dramatically reduce their chance of getting HIV. And then, finally, respond when you have clusters of outbreaks. So, just getting to see the the holistic approach there was extremely helpful for me.

Given that Medicaid is the single largest payer for medical care for people with HIV, do Republican efforts to block Medicaid expansion in high-infection states like Mississippi and Alabama undermine your efforts to get more people treatment?

The program that we have is based on the assumption that Medicaid remains as it is. …. And even were we to change Medicaid, along the lines of what the president has proposed in the budget …

Meaning the major reductions to Medicaid that are in the president’s budget?

Well, there are there are some reductions. But what it would do is actually give states tremendous flexibility. One of the challenges in the Affordable Care Act was that it prejudiced the Medicaid system very much in favor of able-bodied adults, away from the more traditional Medicaid populations of the aged, the disabled, pregnant women and children.

What we would do is restore a lot of flexibility of the states so that they could put those resources really where they’re needed. We would expect that those suffering from HIV/AIDS infection would be in the core demographic of people that you would want to make sure were covered. What we will do here, by stopping the epidemic of HIV, is have a dramatic reduction in cost for the Medicaid and Medicare programs in the future.

So one big part of your plan is expanding access to PrEP, the HIV prevention drug. Without insurance it can cost around $1,600 a month in the U.S. A generic version available overseas costs roughly $6 a month. AIDS activists say your department could ‘march in’ and break the patent that Gilead holds in order to make a generic version available to Americans. Is your agency going to pursue that?

I don’t know what you’re saying by breaking the patent. There’s no such thing as a legal right to break patents in the United States …

The Centers for Disease Control and Prevention also has a patent for PrEP, which Gilead disputes …

Well, that’s very different than breaking a patent. That would be asserting patent rights held by the CDC. So the CDC has a patent on the product and Gilead has a patent on the product. We are actually in active negotiations and discussion with Gilead right now on how we can make PrEP more available and more cost effective for individuals as part of this ending the HIV epidemic program.

I recently went to Jackson, Miss., which has one of the highest rates of HIV infection in the country. I talked to Shawn Esco, a black gay man, who told me that stigma, homophobia, and racism prevent people from seeking care, and he has very little hope. What would you say to him?

That is exactly what the president and I want to solve. I want to give him that hope. So many of the infections are happening in areas of our country where there’s intense stigma against individuals — males who have sex with men; the African-American community, Latino community, American Indian, Alaska Native communities. What’s really made this is a historic opportunity right now is we have data that show us that 50 percent of new infections are happening in 48 counties as well as the District of Columbia and Puerto Rico, and so we can focus those efforts.

We want to learn from people on the ground, as I did this morning here in East Boston. How do we reduce stigma? How do we provide a holistic approach for Shawn and others? We can get them diagnosed and get them on treatment in ways that they find acceptable — or, as one of the individuals said to me this morning, meet people where they are.

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Health April 7, 2019

Economic Ripples: Hospital Closure Hurts A Town’s Ability To Attract Retirees

Before it closed March 1, the 25-bed Columbia River Hospital, in Celina, Tenn., served the town of 1,500 residents. The closest hospital now is 18 miles from Celina — a 30-minute or more drive on mountain roads.

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Blake Farmer/WPLN

When a rural community loses its hospital, health care becomes harder to come by in an instant. But a hospital closure also shocks a small town’s economy. It shuts down one of its largest employers. It scares off heavy industry that needs an emergency room nearby. And in one Tennessee town, a lost hospital means lost hope of attracting more retirees.

Seniors, and their retirement accounts, have been viewed as potential saviors for many rural economies trying to make up for lost jobs. But the epidemic of rural hospital closures is threatening those dreams in places like Celina, Tenn.. The town of 1,500, whose 25-bed hospital closed March 1, has been trying to position itself as a retiree destination.

“I’d say, look elsewhere,” says Susan Scovel, a Seattle transplant who came with her husband in 2015.

Scovel’s despondence is especially noteworthy given that she leads the local chamber of commerce effort to attract retirees like herself. She considers the wooded hills and secluded lake to hold comparable scenic beauty to the Washington coast — with dramatically lower costs of living; she and a small committee plan getaway weekends for prospects to visit.

When she first toured the region before moving in 2015, Scovel and her husband, who had Parkinson’s, made sure to scope out the hospital, on a hill overlooking the sleepy town square. And she’s rushed to the hospital four times since he died in 2017.

“I have very high blood pressure, and they’re able to do the IVs to get it down,” Scovel says. “This is an anxiety thing since my husband died. So now — I don’t know.”

She says she can’t in good conscience advise a senior with health problems to come join her in Celina.

Susan Bailey has lived most of her life in Celina and started her nursing career at Cumberland River Hospital. She now worries that its closure will drive away the town’s remaining physicians.

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Blake Farmer/WPLN

The closure adds delays when seconds count

Celina’s Cumberland River Hospital had been on life support for years, operated by the city-owned medical center an hour away in Cookeville, which decided in late January to cut its losses after trying to find a buyer. Cookeville Regional Medical Center explains that the facility faced the grim reality for many rural providers.

“Unfortunately, many rural hospitals across the country are having a difficult time and facing the same challenges, like declining reimbursements and lower patient volumes, that Cumberland River Hospital has experienced,” CEO Paul Korth said in a written statement.

Celina became the 11th rural hospital in Tennessee to close in recent years — more than in any state but Texas. Both states have refused to expand Medicaid in a way that covers more of the working poor. Even some Republicans now say the decision to not expand Medicaid has added to the struggles of rural health care providers.

The closest hospital is now 18 miles away. That adds another 30 minutes through mountain roads for those who need an X-ray or blood work. For those in the back of an ambulance, that bit of time could make the difference between life or death.

Staff members posted photos and other memorabilia in the halls — reminders of happier times — in the weeks before its closure.

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Blake Farmer/WPLN

“We have the capability of doing a lot of advanced life support, but we’re not a hospital,” says emergency management director Natalie Boone.

The area is already limited in its ambulance service, with two of its four trucks out of service.

Once a crew is dispatched, Boone says, it’s committed to that call. Adding an hour to the turnaround time means someone else could likely call with an emergency and be told — essentially — to wait in line.

“What happens when you have that patient that doesn’t have that extra time?” Boone asks. “I can think of at least a minimum of two patients [in the last month] that did not have that time.”

Residents are bracing for cascading effects. Susan Bailey hasn’t retired yet, but she’s close. She’s spent nearly 40 years as a registered nurse, including her early career at Cumberland River.

“People say, ‘You probably just need to move or find another place to go,’ ” she says.

Closure of the hospital meant 147 nurses, aides and clerical staff had to find new jobs. The hospital was the town’s second-largest employer, after the local school system.

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Blake Farmer/WPLN

Bailey and others are concerned that losing the hospital will soon mean losing the only three physicians in town. The doctors say they plan to keep their practices going, but for how long? And what about when they retire?

“That’s a big problem,” Bailey says. “The doctors aren’t going to want to come in and open an office and have to drive 20 or 30 minutes to see their patients every single day.”

Closure of the hospital means 147 nurses, aides and clerical staff have to find new jobs. Some employees come to tears at the prospect of having to find work outside the county and are deeply sad that their hometown is losing one of its largest employers — second only to the local school system.

Dr. John McMichen is an emergency physician who would travel to Celina to work weekends at the ER and give the local doctors a break.

“I thought of Celina as maybe the Andy Griffith Show of health care,” he says.

McMichen, who also worked at the now shuttered Copper Basin Medical Center, on the other side of the state, says people at Cumberland River knew just about anyone who would walk through the door. That’s why it was attractive to retirees.

“It reminded me of a time long ago that has seemingly passed. I can’t say that it will ever come back,” he says. “I have hopes that there’s still some hope for small hospitals in that type of community. But I think the chances are becoming less of those community hospitals surviving.”

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Health April 5, 2019

Researchers Are Surprised By The Magnitude Of Venezuela’s Health Crisis

Things in Venezuela are so bad that patients who are hospitalized must bring not only their own food but also medical supplies like syringes and scalpels as well as their own soap and water, a new report says.

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Venezuela is in the midst of “a major, major emergency” when it comes to health.

That’s the view of Dr. Paul Spiegel, who edited and reviewed a new report from the Johns Hopkins Bloomberg School of Public Health and the international group Human Rights Watch. Released this week, the study outlines the enormity of the health crisis in Venezuela and calls for international action.

The health crisis began in 2012, two years after the economic crisis began in 2010. But it took a drastic turn for the worse in 2017, and the situation now is even more dismal than researchers expected.

“It is surprising, the magnitude,” says Spiegel, who is director of the Johns Hopkins Center for Humanitarian Health and a professor in the Department of International Health at the Bloomberg School. “The situation in Venezuela is dire.”

Things are so bad that, according to the report and other sources, patients who go to the hospital need to bring not only their own food but also medical supplies like syringes and scalpels as well as their own soap and water.

“The international community must respond,” Spiegel says. “Because millions of people are suffering.”

The government of Venezuela stopped publishing health statistics in 2017, so it can be difficult to track exactly how bad the crisis is. But by interviewing doctors and organizations within Venezuela, as well as migrants who recently fled the country and health officials in neighboring Colombia and Brazil, the researchers pieced together a detailed picture of the failing health system. Some of the data also come from the last official government health report, issued in 2017. (The health minister who released the report was promptly fired.)

Diseases that are preventable with vaccines are making a major comeback throughout the country. Cases of measles and diphtheria, which were rare or nonexistent before the economic crisis, have surged to 9,300 and 2,500 respectively.

Since 2009, confirmed cases of malaria increased from 36,000 to 414,000 in 2017.

The Ministry of Health report from 2017 showed that maternal mortality had shot up by 65 percent in one year — from 456 women who died in 2015 to 756 women in 2016. At the same time, infant mortality rose by 30 percent — from 8,812 children under age 1 dying in 2015 to 11,466 children the following year.

The rate of tuberculosis is the highest it has been in the country in the past four decades, with approximately 13,000 cases in 2017.

New HIV infections and AIDS-related deaths have increased sharply, the researchers write, in large part because the vast majority of HIV-positive Venezuelans no longer have access to antiretroviral medications.

A recent report from the Pan American Health Organization estimated that new HIV infections increased by 24 percent from 2010 to 2016, the last year the government published data. And nearly 9 out of 10 Venezuelans known to be living with HIV (69,308 of 79,467 people) were not receiving antiretroviral treatments.

In addition, the lack of HIV test kits may mean there are Venezuelans who are living with HIV but don’t know it.

Cáritas Venezuela, a Catholic humanitarian organization, found that the percentage of children under 5 experiencing malnutrition had increased from 10 to 17 percent from 2017 to 2018 — “a level indicative of a crisis, based on WHO standards,” the authors of the report write.

An estimated 3.4 million people — about a tenth of Venezuela’s entire population — have left the country in recent years to survive. Venezuela’s neighbors, particularly Colombia and Brazil, have seen a huge uptick in Venezuelans seeking medical care.

Health officials in those countries say that thousands of pregnant women who have arrived received no prenatal care in Venezuela. The flow of migrants includes hundreds of children suffering from malnutrition.

Despite all the headlines about Venezuela’s collapse, researchers were still surprised by the scope of the crisis.

Venezuela is a middle-income country with a previously strong infrastructure, Spiegel says. “So just to see this incredible decline in the health infrastructure in such a short period of time is quite astonishing.”

Despite the severity of the health crisis, the government continues to paint a rosy picture of its health care system — and to retaliate against anyone who reports otherwise, according to the report.

Dr. Alberto Paniz Mondolfi, who was not affiliated with the report, spoke with NPR about the situation in his home country. Paniz practices in Barquisimeto, Venezuela, and is a member of the Venezuelan National Academy of Medicine.

Paniz says he has seen children in hospitals who appear to be malnourished — and there aren’t even catheters available to hook them up to IVs. He has seen people on the streets searching the trash for food to eat. And he adds that a blackout that began on March 7 and lasted for a week has had lingering impact: Some areas still lack electricity or access to running water even now, he says.

Paniz says the report from Johns Hopkins and Human Rights Watch paints an accurate picture of the situation on the ground. “It’s a very, very timely and complete paper,” he says. He praised the thorough research and said he was “relieved” that the health crisis might finally get international attention.

So far, aid from the U.S. and other countries has been insufficient to address the crisis, the authors of this report say.

But Spiegel sees some signs of hope: Last week, President Nicolás Maduro decided to allow the International Federation of the Red Cross and Red Crescent to enter the country with medical supplies for about 650,000 people.

“It’s still a drop in the bucket compared to the 7 million or so people who are in desperate need,” Spiegel says. But he believes it is a sign that Venezuela’s leader may begin acknowledging the crisis and opening the country up to assistance.

And the good news, Spiegel says, is that once aid arrives in Venezuela, it can be distributed very quickly. “Venezuela has an infrastructure; it has very well trained people,” he says.

Paniz agrees that international assistance will be crucial to ending the crisis. “It’s a desperate call to not leave us alone,” he says. “There is no way in which Venezuela could come out of this by its own.”

Melody Schreiber (@m_scribe on Twitter) is a freelance journalist in Washington, D.C.

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Health April 4, 2019

How 128,000 Low-Income Kids Lost Health Care In Tennessee Over 2 Years

NPR’s Audie Cornish speaks with Nashville Tennessean reporter Brett Kelman about why Tennessee’s health insurance programs dropped more than 100,000 low-income children from the rolls over two years.



AUDIE CORNISH, HOST:

In Tennessee, well over 100,000 children have been cut from state health insurance in the last few years; that works out to 1 in every 8. These were children enrolled in two state programs – TennCare, the state’s Medicaid program and CoverKids, which covers low-income families that make too much money to qualify for Medicaid. Reporter Brett Kelman broke this story for The Tennessean. He’s here with us now. Welcome to the program.

BRETT KELMAN: Thank you very much. It’s an honor to be here.

CORNISH: How did this issue come to your attention?

KELMAN: There are some social justice advocates in Tennessee who have been sounding the alarm on this for quite some time. Eventually, they bent my ear enough that I went and pulled the enrollment data and checked it and realized that they were completely right; in both of these programs, there had been this just massive dive of enrollment over the past year or two.

CORNISH: What did you find was the explanation? Why were these children losing coverage?

KELMAN: What the state of Tennessee has said is that, either their families are no longer eligible – most likely because they now make too much money – or they didn’t properly respond to renewal paperwork that is sent out once a year to make sure they’re still eligible. And if you don’t return that paperwork, you are automatically disenrolled.

CORNISH: You heard from lots of parents who didn’t know that they’d lost coverage until they took their sick kids to the doctor. Can you tell us one of those stories?

KELMAN: So I actually heard from a family yesterday, after the story came out, who described their child who was born with a birth defect in her legs that prevented her from walking and was able to get surgery on one leg through TennCare and had scheduled surgery on the second leg, but on the eve of doing it, discovered they didn’t have TennCare anymore and were now looking at a bill that was several tens of thousands of dollars; and I think that sort of illustrates how abruptly these families have lost this coverage and how dumbstruck they are when it happens.

CORNISH: When you reached out to TennCare and CoverKids, what was their explanation?

KELMAN: Well, their explanation was largely that this is mostly normal. There were several years where they sort of deprioritized taking people out of this program and allowed families that they say were no longer eligible to stay in. And now they have restarted disenrolling people and expected a significant number of children to be cut from enrollment. I think there are still very large questions about how many of those families were removed because they are no longer eligible and how many were removed because they did not properly do paperwork.

CORNISH: What’s your response to people who say, look, this is the responsibility of the parents – what’s so difficult about filling out some forms?

KELMAN: Well, I have seen the packet, for one, and it’s not easy. And two, even if tens of thousands of parents drop the ball, it’s not the kids’ fault. Is that really what we want, is a state where lots and lots of kids don’t get health insurance, to which they are legally entitled, because their family didn’t fill out paperwork or the state sent that paperwork to the wrong address or it got lost in the mail or any of many possible procedural errors that could have happened somewhere in this paperwork?

CORNISH: Your story came out earlier this week, and the governor has since acknowledged this reporting. What’s been the fallout so far?

KELMAN: Governor Bill Lee has said he is going to examine TennCare and CoverKids and make sure the families who are entitled to this coverage are getting it. Also, the mayor of Chattanooga and some social justice groups in the state have begun publicizing that they are going to help families appeal or reapply because they believe there are large numbers of families in Tennessee who are entitled to this coverage and just need a little bit of guidance on how to get it back.

CORNISH: That’s reporter Brett Kelman. He covers health care for the Tennessean. Thank you so much for speaking with us.

KELMAN: I’m thrilled to do it.

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