Health

Health September 21, 2017

A Tale Of Two States: How California And Texas May Fare Under GOP Health Plan

In the GOP’s attempt to repeal the Affordable Care Act, California would lose a lot of federal funding. Texas would gain a lot in the short term, but experts worry Texas would not use the money well.

AILSA CHANG, HOST:

The Senate is taking one more stab at repealing the Affordable Care Act. Republicans say they’ll vote on what’s known as the Graham-Cassidy bill next week. Among other things, it would dramatically redistribute federal funds to states. And generally, states that expanded Medicaid stand to lose billions of dollars. The rest would see a short-term influx of funds. We’re going to hear from one of those states, Texas, in a minute. First, from KQED in San Francisco, April Dembosky explains why California would be one of the hardest hit states.

APRIL DEMBOSKY, BYLINE: The new Graham-Cassidy legislation would take money from states that have invested heavily in the Affordable Care Act, then redistribute it to other states that haven’t. Aviva Aron-Dine is with the Center on Budget and Policy Priorities.

AVIVA ARON-DINE: For a state like California or a Massachusetts or a New York, exactly the states that might be most motivated to at least try to preserve the ACA coverage gains – those are the states that would face the deepest cuts to their federal resources.

DEMBOSKY: The bill’s authors say their plan gives states more flexibility to build their own health systems. But California would lose 35 percent of its funding by 2026. That means millions of people with Medicaid and exchange plans would lose their insurance. A lot of those people are entrepreneurs and their employees. The head of the Small Business Majority in California, Mark Herbert, says the health funding cuts are bad for the economy, too.

MARK HERBERT: It would be massively destabilizing to the ability of small employers to attract talent. It would be very difficult for entrepreneurs and self-employed folks to access some level of coverage.

DEMBOSKY: Under the Affordable Care Act in California, a million and a half small business owners and employees got health coverage, and the state’s overall uninsured rate dropped by more than half. For NPR News, I’m April Dembosky in San Francisco.

ASHLEY LOPEZ, BYLINE: I’m Ashley Lopez in Austin. At first glance, it looks like Texas comes out as one of the big winners. Texas will get a windfall of $35 billion to help replace Obamacare exchanges and other programs, more than any other state. State officials get to decide how they want to spend that money. But Stacey Pogue with the Center for Public Policy Priorities in Austin says that doesn’t necessarily mean this is an improvement.

STACEY POGUE: Regardless of the size of the block grant, there’s just no assurance that it would translate into good coverage or coverage that’s affordable as what we have today.

LOPEZ: Texas already has the highest number of uninsured folks, and Pogue says the state just doesn’t have the infrastructure in place to expand coverage to more people. It didn’t expand Medicaid, and the state didn’t set up its own exchange. They used healthcare.gov.

POGUE: There’s no planning and no thought put into, how would we create affordable coverage for low-income Texans unlike the 31 states that have expanded Medicaid, have done some central planning? And Texas would be starting from scratch.

LOPEZ: She says it will also take a lot of political will to make sure the state is expanding health care. Pogue says that has been lacking among state lawmakers for years. And in order to get the block grant, states need to create something workable by 2020. For comparison, it took Massachusetts four years to set up its pre-Obamacare insurance market.

STACY WILSON: We are very concerned.

LOPEZ: That’s Stacy Wilson. She’s the president of the Children’s Hospital Association of Texas. She says this pot of money from Cassidy-Graham also doesn’t solve problems for Medicaid, 70 percent of which covers children. Wilson says that’s because the federal government would pay a fixed amount per person per capita cap, which locks in how much the state gets per Medicaid enrollee.

WILSON: We have very low per-capita costs already, and we get locked into that forever.

LOPEZ: A conservative policy group in Texas is also not happy about the bill. However, their concern is that it actually doesn’t go far enough to repeal Obamacare. For NPR News, I’m Ashley Lopez in Austin.

CHANG: This story is part of a partnership with NPR, local member stations and Kaiser Health News.

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 September 20, 2017

Hurricane Maria Leaves Hospital In Puerto Rico Running On Generator Power

NPR’s Ari Shapiro speaks to Domingo Cruz Vivaldi, an administrator at the San Jorge Children’s Hospital in San Juan, Puerto Rico as Hurricane Maria’s trajectory is affecting the island.

ARI SHAPIRO, HOST:

There is devastation in the Caribbean today, too. Hurricane Maria has hit hard. Puerto Rico is experiencing widespread flooding, and it seems the entire island has lost power. The storm just passed, and people are only beginning to figure out the full extent of the damage. Earlier today I checked in with Domingo Cruz Vivaldi. He’s administrator of the San Jorge Children’s Hospital in Puerto Rico’s capital, San Juan.

DOMINGO CRUZ VIVALDI: The hospital has been without power since 2 o’clock in the morning. It has been running with a power generator. The power generator is working fine. At this point, we have about 60 percent occupancy at the hospital. All patients are doing well. All employees are doing well. We have some damages to (unintelligible) building. The elevator went out and got some water. And so far, the hospital is working as normal as possible all things considered at this point.

SHAPIRO: Is the generator providing all the power you need, or do you have to prioritize certain things over others?

VIVALDI: No. We have a generator that provides for 100 percent of all the electrical needs, including air conditioning. That’s probably the most urgent need that we have. Once this – the hurricane passes, we should have the outside power back. Power generators are not designed to work permanently. They’re used as a temporary means. And you know, that’s probably our – short-term, our only concern.

SHAPIRO: When you say short-term, do you mean days or weeks? How long do you think you could…

VIVALDI: No, I’d say days.

SHAPIRO: Days.

VIVALDI: Based on my previous experience, you know, power generators – after a week, you know, they just start to give you some kind of trouble, either overheating or some mechanical of problem. So very short-term, you know, within the next two, three, four days at the most. Then we’ll at work immediately to get power back. Based on previous experiences as well, during the hurricane, people don’t come to the hospital. But right after the hurricane, probably tomorrow and the next coming days and weeks, we’ll have a high volume of patients coming in.

SHAPIRO: And are you ready to take in a lot more patients?

VIVALDI: Yes. We have a prepared plan, and we have employees that will rotate. And we have a supply of (unintelligible). We have supply of food. So we are OK at this time to take care of patients. Really our only concern short-term is having power back because we can only do emergency surgeries, and we cannot do anything really elective.

SHAPIRO: I know that the power grid is so fragile in Puerto Rico. More than half of the population lost power in Irma. Hurricane Maria is a direct hit. There have been projections that power might not come back for weeks or months. What would you do in that scenario?

VIVALDI: Well, that will be catastrophic. Some hospitals will have to shut down. And if we don’t get power within a week or two, I’m sure hospitals will have to shut down and will have to transfer patients to other hospitals in Puerto Rico or outside Puerto Rico.

SHAPIRO: This is a children’s hospital, and a hurricane can be scary for anyone. But I can only imagine for a sick child what this experience might be like. How are you able to comfort the patients who are there in your care?

VIVALDI: Well, we try to explain to them as best as possible what was going to happen. We also explained to them that if needed, they will be removed from the room. And they’re providing meals to the patient as well as to the companion. And we are, you know, providing for all their immediate needs. As long as the power generator doesn’t cause any problems inside the hospital, it looks pretty normal. But that’s the big concern. So that’s something that is (unintelligible) raise the voice to the government to make sure we get the proper emphasis on getting hospitals back to normal as soon as possible.

SHAPIRO: Thank you. Stay safe.

VIVALDI: Thank you.

SHAPIRO: That was Domingo Cruz Vivaldi, administrator of the San Jorge Children’s Hospital in San Juan, Puerto Rico.

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Health September 19, 2017

After 10 Years Away From Senate, Rick Santorum At Center Of Health Care Debate

The latest GOP effort to repeal the Affordable Care Act is picking up steam in the Senate. Former Pennsylvania Sen. Rick Santorum has been a key player promoting it, a decade after leaving office.

AILSA CHANG, HOST:

There’s been a lot of unexpected news in Washington lately. That includes the fact that Republicans now appear to have a real chance at repealing the Affordable Care Act. That’s in large part because of South Carolina Senator Lindsey Graham. He’s promoting a measure built around block grants. Those grants would get rid of a lot of federal mandates and instead turn money directly over to states.

(SOUNDBITE OF ARCHIVED RECORDING)

LINDSEY GRAHAM: So I believe that most Republicans like the idea of state-controlled health care – versus Washington, D.C.-controlled health care.

CHANG: Something else that’s unexpected is a key figure who’s behind this push. NPR’s Scott Detrow explains.

SCOTT DETROW, BYLINE: Last week, Lindsey Graham walked up to a lectern to talk about health care and introduced several other Republican senators.

(SOUNDBITE OF ARCHIVED RECORDING)

GRAHAM: Bill Cassidy’s going to walk you through the details. Rick Santorum’s going to tell you how history’s on our side. Ron Johnson’s going to talk about numbers ’cause that what he does (laughter). And Dean Heller’s going to tell you about why this is a good deal for Nevada and the country as a whole.

DETROW: All the names made sense except one. Rick Santorum hasn’t been a United States senator for more than a decade. The one-time Pennsylvania senator was the runner up to Mitt Romney in the 2012 Republican presidential primaries but didn’t get out of Iowa in 2016. But there he was, standing with four current GOP lawmakers and jumping in to answer questions.

(SOUNDBITE OF ARCHIVED RECORDING)

RICK SANTORUM: I’m going to just – because Bill gave a great answer. He gave an answer that I would give. But I’m not too sure he specifically answered your question so you would understand it.

DETROW: That’s because Santorum is the one who came up with the idea to begin with. The latest bill is loosely based on a major welfare overhaul Santorum helped draft back in 1996. He said both measures come down to the same basic idea.

(SOUNDBITE OF ARCHIVED RECORDING)

SANTORUM: And that is get the money out of Washington. Give it to the 50 states. Give them the flexibility to design the program. And let them treat the population that the money is designated for in a way that meets the needs of the people sitting across the table from them, not, as Lindsey said, with bureaucracies.

DETROW: Maybe none of this would be happening if Santorum hadn’t bumped into Graham in the Capitol barber shop this spring.

SANTORUM: And Lindsey was in the chair. And Lindsey said – he asked me what I was doing. And I thought to myself, well, let me bounce it off Lindsey.

DETROW: It was the early stages of the block-grant approach, which Santorum had been talking about with House Republicans. Graham and Santorum got to talking. And the two presidential also-rans were on the same page. Santorum says during his time in Washington, haircuts had never been this productive.

SANTORUM: (Laughter) It might be a first.

DETROW: Here’s a little bit about what the bill would do. It would loosen a lot of the federal requirements tied to Obamacare and turn a lot of federal funding for subsidies and Medicaid into those block grants to states. There would be less money going to states than is currently projected to be spent. And many states would see a big shift in the amount of money they’re receiving.

Obamacare defenders worry all this would lead to unstable markets and not a whole lot of protection for people with expensive medical conditions. With this bill, Santorum is back in the mix in Washington, enough that, for a brief moment, someone recently floated the idea that maybe Santorum could step in as House speaker if conservatives revolt against Paul Ryan. Santorum says he’s not interested, but he didn’t quite laugh it off as farfetched.

SANTORUM: I think that came about because we’re putting together a plan here in health care that people were looking at and, said, you know, gee, why couldn’t our leadership do something like that?

DETROW: Today, Santorum was back in the Capitol, pitching Senate Republicans on this bill, which now appears to have a shot at passing. Scott Detrow, NPR News.

(SOUNDBITE OF HOMESHAKE SONG, “GIVE IT TO ME”)

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Health September 18, 2017

As Federal Government Cuts Obamacare Ads, Private Insurer Steps Up

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Health insurance company Oscar has started its own ad campaign for the Affordable Care Act.

Oscar Health

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Oscar Health

Open enrollment for Affordable Care Act insurance doesn’t start for another six weeks. But the quirky insurance startup Oscar Health is launching an ad campaign Monday aimed at getting young people to enroll.

The company is boosting its ad spending after the Trump administration announced it would slash its ACA advertising budget by 90 percent.

On Monday morning, commuters in New York City were met with posters blanketing the subway system that showed actual Oscar customers touting the benefits of having insurance coverage.

One poster shows a pregnant woman holding her belly with a bandage on it that says “we’re covered.”

Oscar Vice President Sara Rowghani says the company is stepping up in part because the government is pulling back.

“Particularly in this year of uncertainty, it’s really important for us to be in market early and and reassure the 22 million folks that are insured that it is really important to get covered,” she tells Shots.

Rowghani says the early message focuses on reminding people about open enrollment. The ads include the dates enrollment starts and ends, with the Oscar logo much less prominent.

“What we’re really communicating is this message of getting coverage — get covered, ” she says.

The company declined to say how much it’s spending on the ads, but did say it’s a multi-million dollar campaign. It will run in the six states where Oscar does business, and will be on TV, radio and in subways and buses. That includes in New York state, where open enrollment runs from Nov. 1 through Jan. 31, 2018.

But advertising from private insurers won’t be able to match the power of the advertising in years past by the federal government, says Lori Lodes, who ran outreach for the Affordable Care Act during the Obama administration as director of Communications for the Centers for Medicare and Medicaid Services.

“The reality is there’s only so much that issuers and advocates and other folks can do from the outside, because the government, historically, has been a very trusted messenger,” she says.

Trump’s Department of Health and Human Services says it’s cutting the advertising budget for open enrollment from $100 million down to $10 million. And it will cut back on grants for navigators who help people sign up for a health plan by about 40 percent to $36 million.

The state of California, which runs its own insurance exchange, spent $110 million on advertising around its open enrollment period last year.

HHS officials say that most consumers are already aware of the Affordable Care Act and that the outreach isn’t as effective as when the law was new.

However, the agency this year has made major changes, including cutting the open enrollment period for the 35 states that use the federal website, Healthcare.gov, to six weeks from three months. Open enrollment for those customers starts on November 1 and ends December 15.

The plan is to eliminate expensive television advertising and instead focus on e-mail and text message outreach.

Lodes says that’s a bad idea.

“Television not only was the number one driver of enrollment, but it made all those other channels of communication that much more effective,” she says.

Cutting ACA Advertising by 90% is evidence-based policy … if policy goal is sabotage. https://t.co/5Y0Yt7CB0T

— Daniel Polsky (@healthecon_dan) September 1, 2017

She says the agency tracked which methods of communication were most effective and television came out on top, by far. She says all that research is available to the current HHS leadership.

Critics of the move say cutting the advertising and outreach budget while making changes to the open enrollment dates add up to an act of sabotage by Trump and Health and Human Services Secretary Tom Price, who have been vocal critics of the ACA.

“Cutting ACA Advertising by 90% is evidence-based policy … if policy goal is sabotage,” Daniel Polsky, executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania, said On Twitter.

The move fits into a pattern of actions by the Trump administration that have destabilized the health insurance markets and boosted uncertainty over the future of the program.

State officials are also concerned. At a hearing earlier this month in the Senate, several state governors said the cuts will likely lead to declines in enrollment.

“The idea that we’ll cut 90 percent of the education dollars and 40 percent of the navigator dollars when what we need to do is draw these people in, doesn’t make sense,” Montana Gov. Steve Bullock said

Gov. Charlie Baker of Massachusetts, which has run its own exchange for more than a decade, told the senators that the outreach and advertising in his state was effective. But he added that the state made adjustments along the way.

“It’s at least as important what you’re doing as what you spend it on,” he said. “We’ve tried to do things that move the needle on enrollment and drop the things that don’t.”

Oscar is the first private insurance company to step in to try to make up for government’s advertising cuts. Whether others join them — and whether they’re effective — will only be clear when open enrollment ends, and the numbers are tallied sometime early next year.

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Health September 15, 2017

After Hurricane Katrina, Many People Found New Strength

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A Houston resident walks through waist-deep water while evacuating her home after severe flooding following Hurricane Harvey in north Houston.

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Long after the floodwaters recede and the debris is cleared, the mental health impacts of disasters like hurricanes can linger.

Psychologist Jean Rhodes of the University of Massachusetts-Boston has spent more than a decade studying what happens to people years after a natural disaster — in this case, Hurricane Katrina.

She and her team had been studying the health of young parents attending community college in New Orleans starting in 2003. After Katrina hit in 2005, they found themselves with a unique opportunity: they had health data from before and after the natural disaster. The researchers were able to measure Katrina’s mental health impacts in a project called the Resilience in Survivors of Katrina Project (RISK).

Most people fare well in the long term, they found, but some are still struggling years later.

Ailsa Chang, guest host of All Things Considered, spoke with Rhodes about the project and what lesson those people’s experiences may hold for people dealing with Hurricane Harvey and Hurricane Irma. Excerpts of the interview follow, edited for length and clarity.

Interview Highlights

How did going through a major disaster like Katrina affect people’s mental health long term?

Well, here’s some good news. About 60 percent — more than 60 percent if you look at their mental health over time — have returned to where they were prior to the storm. We often hear that there are these long-term consequences. There are, for about 20 percent, we see actually their anxiety and depression went up, and it stayed up. For some there was actually an improvement, they’re actually doing better than before.

They’re doing better?

Yes, so there’s two ways in which they are doing better. Their psychological functioning, about 3 to 5 percent were doing better on indices of anxiety and depression. There’s also this other interesting unexpected finding. That’s something called post traumatic growth; this is really the flip side of post-traumatic stress. They often go hand in hand.

Stress can often precipitate changes in our perspective about life. We begin to appreciate life more and feel a personal sense of strength of having endured the trauma. We see new possibilities. We begin to value relationships over things. And really have a spiritual awakening that psychologists have begun to appreciate comes often hand in hand with post-traumatic stress.

In aftermath of Katrina, some people in the study got access to mental health care for the first time in their lives — that turned out to be crucial for them. Since then, have you see a greater push to get mental health services out to people faster after a natural disaster?

Yes, I’ve seen a much broader, more integrated mental health response to the survivors of Harvey and Irma in ways that I think are going to have long term consequences.

One of the things that we know about exposure to natural disasters is that there’s kind of this critical period where if you’re not exposed to additional stressors and you can begin to process and make sense of what happened, you can begin to heal. It’s almost like a concussion — if you are continuously hit with new stressors after the initial stressor, it makes it much harder to heal.

I think that the responses in Houston and Florida have been much quicker and have really tried to minimize additional stressors that will have long-term implications for survivors’ mental health.

You say pets were a surprisingly big factor. Why is that?

One thing that was different from Katrina is that there was a lot less pet loss. Shelters were much more open to including pets, and people weren’t put in this forced choice between staying with their pets versus evacuating. Because of that, there was less exposure and less trauma.

Five years out of Hurricane Katrina, we saw that the loss of a pet was one of the three biggest predictors of depression and anxiety. Because we didn’t have as much separation between pets and their owners, we probably will be seeing less of that particular stress.

All Things Considered associate producer Selena Simmons-Duffin contributed to this report. Greta Jochem is an intern on NPR’s Science Desk.

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Health September 14, 2017

Get Ready! Medicare Will Mail New Cards to 60 Million People

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The new Medicare cards (right) will not use Social Security numbers for identification. Instead, they will have random sequences of letters and numbers.

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Centers for Medicare & Medicaid Services /AP

It’s an administrative task for the ages.

Medicare is getting ready to issue all 60 million of its beneficiaries new cards with new ID numbers as way to combat identity theft and fraud.

The rollout begins next April, but the agency is already beginning its outreach campaign.

“We want to make this process as easy as possible for everybody involved,” said Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, on a conference call Thursday.

The agency has set up a website, is sending out handbooks to all enrollees, and has call centers ready to answer questions from beneficiaries and doctors.

Until now, Medicare used people’s Social Security numbers. But Congress in 2015 passed a law requiring the agency to change that as a way to protect seniors from identity theft. The new identifiers will be a randomly generated sequence of 11 numbers and letters.

“Changing numbers for nearly 60 million people on Medicare may be a hassle, but it’s a good idea given the bigger hassles that come with identity theft,” says Tricia Neumann, director of the Program on Medicare Policy at the Kaiser Family Foundation.

AARP has long advocated for the change because of concerns that seniors’ identities would be stolen. The group actually advises seniors not to carry their original Medicare card but only a copy with the last four digits of their Social Security number blotted out.

Congress allocated $242 million for the switchover, spread across four fiscal years.

During the transition to the new cards, “Medicare beneficiaries don’t need to do anything, other than look out for scams,” said Andrew Skolnick of AARP’s Federal Health and Family Team.

Verma says the new cards will begin to be mailed next April, and the transition will continue into 2019.

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Health September 13, 2017

Bernie Sanders Introduces 'Medicare-For-All' Health Bill

Sen. Bernie Sanders, I-Vt., introduced a bill Wednesday that would create a Medicare-for-all public health system. A number of Democrats signed on to co-sponsor the bill, showing that the party may be embracing that position more firmly.

KELLY MCEVERS, HOST:

Senator Bernie Sanders was joined by several prominent Democratic senators today announcing a plan he calls Medicare-for-All.

(SOUNDBITE OF ARCHIVED RECORDING)

BERNIE SANDERS: All of us stand before you and proudly proclaim our belief that health care in America must be a right, not a privilege.

MCEVERS: It would expand the government-run health care system for the elderly to all Americans, eventually eliminating private insurance. NPR’s Scott Detrow was at the unveiling, and he is with us now from the Capitol. Hey there, Scott.

SCOTT DETROW, BYLINE: Hey, Kelly.

MCEVERS: So tell us more about what Senator Sanders is proposing.

DETROW: So yeah, he wants to gradually get rid of private insurance companies and expand Medicare so that it covers all Americans. Right now of course it’s for age 65 and over. This plan would lower that age over the course of four years. Not only that – Sanders wants to get rid of all out-of-pocket costs – no copays, no bills – sounds very ambitious, also sounds very expensive. And you would need to raise taxes by a lot to pay for this.

MCEVERS: And Sanders himself has said before that this kind of thing can’t pass, right? And in the past, it has been the kind of thing that Democrats have even kept their distance from. So who was with him in this today?

DETROW: Right. That’s the most interesting aspect of all of this. Sanders introduced a very similar bill in 2013 – grand total of zero co-sponsors – this time around, 16. Not only that – it included just about every Senate Democrat who’s been talked about as a possible presidential candidate. You had Kamala Harris from California, Cory Booker from New Jersey. Here’s what Elizabeth Warren of Massachusetts said.

(SOUNDBITE OF ARCHIVED RECORDING)

ELIZABETH WARREN: We will not back down in our protection of the Affordable Care Act. We will defend it at every turn. But we will go further. We will go further, and we will say that in this country, everyone, everyone gets a right to basic health care.

DETROW: So it’s really looking increasingly likely that the party’s next presidential nominee would endorse a plan that looks something like this.

MCEVERS: Is it just a political statement, or is single-payer health care now a serious goal for Democrats?

DETROW: So the bill itself is probably a political statement. This is clearly not something that Mitch McConnell is going to call up for a vote in the Republican-controlled Senate. But it is part of a real trend. For decades, Republicans have been painting Democrats as the party that wants government-run health insurance. They demonize it as socialized medicine, and Democrats have tried to keep that idea at arm’s length.

But you see more and more Democrats backing either this bill or something similar, some sort of way to get what they call true universal coverage. So you’ve seen other plans to put a public option on the Affordable Care Act markets or to lower Medicare. A lot of bills like this are being introduced right now.

MCEVERS: So what do the party leaders – I mean we’ve talked about some Democrats here, but what do the party leaders who have control over the Democrats’ agenda say about this?

DETROW: It’s important to point out that not everybody is onboard. House Minority Leader Nancy Pelosi has dismissed this, saying it’s just not politically practical. And remember; she spent years wrangling votes, trying to pass Obamacare. She says it’s great as a long-term goal, but she thinks states should do it first. And that’s interesting because Democrats have a near lock on control in her home state of California. They could not pass single-payer this year. And in Sanders’ home state of Vermont, Democrats tried to do it and couldn’t.

So Pelosi and other Democrats say the focus right now should be on protecting the Affordable Care Act. Republicans are still trying to repeal it. President Trump today encouraged a new effort from a couple of Republican senators to do just that.

MCEVERS: NPR’s Scott Detrow on Capitol Hill, thank you.

DETROW: Thank you.

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Health September 12, 2017

U.S. Census Bureau Records Improvements In Income, Poverty And Health Coverage

The U.S. Census Bureau released a trio of reports Tuesday on income, poverty and health insurance coverage. All three measures showed improvement. Real median household income increased by 3.2 percent in 2016 over the previous year, and now stands at just over $59,000. The official poverty rate fell for the second year in a row to 12.7 percent.

KELLY MCEVERS, HOST:

There’s a new number out today that shows things are continuing to get better for the middle class in the long recovery from the Great Recession. The Census Bureau says the median household income rose last year to just over $59,000. And at the same time, the poverty rate was down in 2016 and fewer Americans were without health insurance. It’s the second year in a row that things have improved. With us to talk about all this is NPR economics correspondent John Ydstie. Hi, John.

JOHN YDSTIE, BYLINE: Hi, Kelly.

MCEVERS: OK, so let’s start with that median income number. Tell me more about that.

YDSTIE: Well, as you said, the median household income – that’s the yearly income of households right in the middle of the income ladder – it rose significantly to $59,039 in 2016. That’s the highest median income ever recorded, though the Census Bureau cautions the changes they’ve made in their survey make historical comparisons very difficult. And it is the second year of very strong growth in incomes. Now, that said, adjusted for inflation, middle American households are still at about the same income level as they were in 2007 just before the Great Recession. And get this, Kelly; they’re at the same level they were at the end of the tech boom in 1999. So really, when you zoom out, not much improvement in this century for those middle-income households.

MCEVERS: And we’re talking about, though, this improvement in the year 2016. Of course, that was the last year of the Obama administration. I think people will wonder, you know, is this improvement the result of Obama-era policies?

YDSTIE: Well, the folks at the Census Bureau were very careful not to credit specific administration policies. They did say that increased employment is driving these numbers. As more Americans find jobs or move into full-time work, households are seeing their incomes rise.

MCEVERS: So then who benefited from these income increases?

YDSTIE: Well, there’s some good news there, too. The increases came across the income ladder and across all age and racial groups, although the gains weren’t quite as strong at the bottom. And of course, there continue to be big levels of income inequality, and a measure of that in today’s data did not show any improvement.

MCEVERS: The census also reports that poverty declined last year, as I said. What’s behind that?

YDSTIE: Right. The number of people living in poverty declined by 2 and a half million in 2016, and the poverty rate fell to 12.7 percent. Now, a quick definition here – a family of two adults and two children officially lives in poverty if its annual income is $24,339 or less. Again, a growing economy and job creation helped lift families above that number. That said, 1 in 8 Americans continues to live in poverty. And that’s more than 40 million people in all.

MCEVERS: Wow. Did poverty go down the way median income went up across age and racial groups?

YDSTIE: Yes, it did. Only one demographic group saw poverty increase slightly. That was among people 65 and older. Now, in terms of policies that contribute to the decline in poverty in this area, the Census Bureau does provide data. It shows that programs like Social Security, the earned income tax credit and SNAP, or food stamps, do lift tens of millions of Americans out of poverty every year.

MCEVERS: These federal programs we hear so much about. Finally, there was also data today on health insurance coverage. What’s the news there?

YDSTIE: Health insurance coverage increased in 2016. 8.8 percent of Americans were without health insurance. That’s a slight improvement. Still, that means 28 million people did not have health insurance last year. And of course, with the future of the Affordable Care Act still up in the air, there’s lots of uncertainty about where those numbers will be in the future.

MCEVERS: NPR economics correspondent John Ydstie, thank you very much.

YDSTIE: You’re welcome, Kelly.

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Health September 11, 2017

Sept. 11 First Responder Fights On Behalf Of Others Who Rushed To Help

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Firefighters work beneath the vertical struts of the World Trade Center’s twin towers, in Lower Manhattan, following the attacks of Sept. 11, 2001.

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Mark Lennihan/Associated Press

Following the attacks of Sept. 11, 2001, first responders rushed to ground zero in Manhattan, where they braved dangerous conditions to rescue people buried in the rubble, retrieve the remains of the dead and clear the debris. Among them was demolition supervisor John Feal.

Feal arrived at ground zero on Sept. 12; just five days later, he was seriously injured when an 8,000-pound piece of steel fell and crushed his foot.

He became septic from the deeply infected wound, and nearly died. The accident cost Feal half his foot — and his job. His despair grew deeper when the government denied him medical compensation for his injury.

Speaking with other first responders, Feal realized that he was not alone. Not only were others also being denied money to help pay for their injuries and illnesses, but the trauma was ruining people’s lives.

“They were losing their homes,” he says. “They were getting divorced, or separated, or their kids were in rehab for drugs because Daddy or Mommy were miserable.”

Feal formed the FealGood Foundation, which advocates on behalf of emergency personnel. He also began working to pressure Congress to pass a bill that would provide compensation for medical care and monitoring for first responders. On Dec. 22, 2010, the James Zadroga 9/11 Health and Compensation Act was passed.

Looking back, Feal thinks about the injury he suffered at ground zero with mixed emotions: “At the time, it was devastating. It altered my life and I thought it was for the worst. But I look back now and it gives me a chance to show everybody how my mother raised me, so I’m thankful.”

Interview Highlights

On injuring his foot while working at ground zero

Roughly 8,000 pounds of steel crushed my left foot. … I jumped and I didn’t get all the way out of the way. It caught my left foot. The guy next to me fainted, because the blood was shooting out of my foot about 6 feet in the air. I made a tourniquet. … I took his belt off and I made a tourniquet below my knee.

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John Feal has received recognition nationally for his work helping first responders get medical compensation and other support for the trauma, illnesses and injuries they suffered from their work related to Sept 11.

Paul Morigi/Getty Images for Tuesday’s Child

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Paul Morigi/Getty Images for Tuesday’s Child

Before 9/11, in my mind, I was the world’s greatest athlete and I was John Wayne. I was that cool. I didn’t think I could even be hurt — and that was a rude awakening for me, physically and mentally. But I was able to get to safety. … By that time the fire department was there and they put a towel in front of me, I was yelling at everybody to get back to work — “I’ll be back in an hour,” you know — and it was a very humbling experience.

On remembering the moment the steel beam hit his foot

I can block out my injury. I can block out my five days there [at ground zero]. I can’t block out the smell. Probably why I don’t sleep enough. When I close my eyes, I can smell ground zero. Everybody always asks what [did] it smell like? There’s not a word invented yet that describes the smell of ground zero. … It’s a smell that I’ve never smelled before or [since]. It’s a smell of destruction, devastation, carnage. It was everything combined in one that created the smell.

It’s not just me saying this. This is other 9/11 responders and first responders or volunteers who will say the same thing. Especially this time of the year, when I shut my eyes, that smell comes back and it’s like it’s putting its hand over my mouth and nose, and it gets tough.

On the reoccurring nightmare he had after Sept. 11

This time of the year, this anniversary … it’s tough. Not just for me — it’s tough for all 9/11 responders and volunteers and survivors and people who lived and worked down in ground zero. They call these “scars” — they’re not scars, they’re scabs, and these scabs get pulled right off round this time of the year. It’s tough.

You know, when I was going to therapy back in 2002 and ’03 and ’04 and ’05, I had these same recurring nightmares … where I would see the plane crash; and one day I’d be sitting on a park bench with my dog, the plane would be driving by and I couldn’t do anything. Then it was personal. The next day I’m sitting on the park bench with my dog and I would see my mother in the window of the plane waving. Then, little by little, after doing therapy, I was able to get off the park bench and get up and, like Superman, stop the plane from crashing into the building.

On how he became an activist, working to get medical compensation for Sept. 11 first responders

When I was not only going for individual counseling, right after Sept. 11 … I started going to support groups and I started meeting other 9/11 responders. …

And then I was telling people about my experience on workmen’s comp or social security, and I started helping them. And I started going to their hearings. And then, the next thing you know, I started taking other Sept. 11 responders to somebody else’s hearings, and then the judges and the lawyers were like, “Oh here comes Feal, with his crew!”

I look back and it was primitive, but it was effective. Again, at the end of the day I don’t apologize or second guess myself, because we’re talking about human life. We’re talking about human beings who are trying to put food on their table for their kids, or pay their utilities, or put gas in their car to get to a chemotherapy appointment. So it didn’t matter what elected official or what lawyer or what judge or what doctor I pissed off, because the only thing I care about at the end of the day is helping people.

On how going to so many funerals has shaped his thoughts on death

I’m not so much into all that biblical religious stuff, but I do believe there’s a God. I believe we’re here for a purpose, and I believe when we leave there’s also a purpose. I think our energy goes to other people and our energy continues. I’m not afraid of dying, no. Listen … I went to therapy when I wanted to kill myself after getting out of the hospital; those thoughts creep up. I do have my bad days. Would I do it? No. Am I strong enough to stop myself? Yes. But I am not afraid to die, and there are times where I wish I would have died instead of a friend or somebody who left behind four kids. I begged God — my God — totake me instead of them.

On the importance of remembering the sacrifice of first responders

Most people think on this anniversary that two buildings came down that day and 2,753 innocent lives were lost [in New York City]. … But since then, about 2,000 [more] people have died because of their illnesses. They, too, are heroes. And in many ways — I talk to a lot of them — they wish they would have died that day, because what they have had to go through and fight, not only their illnesses but the bureaucracy and the poor leadership, and to see their other friends pass away from Sept. 11-related illnesses. These men and women have been through the ringer, through the mill. …

We call ourselves the greatest nation in the world. But yet we have a strange way of repeating history, and letting veterans come home from war, or 9/11 responders, or just responders now across the nation, how they sacrifice themselves and then we don’t take care of them. That’s sad.

Amy Salit and Thea Chaloner produced and edited the audio of this interview. Bridget Bentz and Molly Seavy-Nesper adapted it for the Web.

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Health September 10, 2017

Nurses, Hospitals Prepared For Hurricane Irma To Ensure Patient Care Continues

Taylor Roberts is a pediatric nurse who is waiting for Hurricane Irma to pass so she can go back to work at Golisano Children’s Hospital in Fort Myers, Fla.

MICHEL MARTIN, HOST:

Millions of Floridians did heed warnings to get out of the way of Hurricane Irma, so we wanted to know what some of their experiences have been. We were able to reach Taylor Roberts. She is a nurse in the pediatric intensive care unit of Golisano Children’s Hospital in Fort Myers. Thanks for joining us, Taylor Roberts.

TAYLOR ROBERTS: No problem.

MARTIN: So you’ve evacuated to – what? – Punta Gorda?

ROBERTS: Yeah. So we went an hour north of our home.

MARTIN: How does it look where you are?

ROBERTS: Well, it wasn’t until about a couple minutes ago, but actually, our front door just swung open. So we had to close it and lock it. And we were going to put something in front of it. But it’s pretty – it’s pretty windy now.

MARTIN: I mentioned that you’re a nurse in the pediatric intensive care unit at a children’s hospital. I was wondering, what – how does that work? How is it decided who stays and who goes?

ROBERTS: Well, we have a team A and team B. So we all sign up for whatever team we want to be on. Team B comes in before the storm so that team A can get ready. And they’ll pack up all their stuff. So they’re allowed to bring their family. They’re allowed to bring their pets. They’re there right now. They’re going to be there for the duration of the storm and until they call an all-clear. And so then they’ll send us a text or a message, and they’ll tell us the all-clear has been called. And team B is activated. And then we have to go in for however long it takes.

MARTIN: Have you ever been through something like this before?

ROBERTS: Not really.

MARTIN: Are you scared?

ROBERTS: Yeah. I mean, not for my safety right now, mostly for my home. We came here because this place is sturdier than our house is. And it’s pretty much like a waiting game. When are we going to be able to go back? When are we going to be able to know if it’s still there, you know?

MARTIN: What’s the worst part of this, for people who’ve never been through something like this?

ROBERTS: I think not knowing. Hurricanes, when they come, it’s – it could do this or it could do this. And they just have a cone. And you think, OK, I’m not in that cone, but then it can shift last second. You never know. It’s just the waiting and the hoping that you’re in the right place.

MARTIN: That’s Taylor Roberts. We reached her in Punta Gorda, Fla. She just evacuated from Fort Myers. Thanks so much for – and hang in there. We’ll keep a good thought.

ROBERTS: Thank you.

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