Latest news with #MichaelHiltzik
Gulf Today
16-07-2025
- Health
- Gulf Today
Miller says Americans will live better lives without immigrants
Michael Hiltzik, Tribune News Service Stephen Miller, the front man for President Donald Trump's deportation campaign against immigrants, took to the airwaves the other day to explain why native-born Americans will just love living in a world cleansed of undocumented workers. "What would Los Angeles look like without illegal aliens?" he asked on Fox News. "Here's what it would look like: You would be able to see a doctor in the emergency room right away, no wait time, no problems. Your kids would go to a public school that had more money than they know what to do with. Classrooms would be half the size. Students who have special needs would get all the attention that they needed. ... There would be no fentanyl, there would be no drug deaths." Etc., etc. No one can dispute that the world Miller described on Fox would be a paradise on Earth. No waiting at the ER? School districts flush with cash? No drug deaths? But that doesn't obscure that pretty much every word Miller uttered was fiction. The gist of Miller's spiel — in fact, the worldview that he has been espousing for years — is that "illegal aliens" are responsible for all those ills, and exclusively responsible. It's nothing but a Trumpian fantasy. Let's take a look, starting with overcrowding at the ER. The issue has been the focus of numerous studies and surveys. Overwhelmingly, they conclude that undocumented immigration is irrelevant to ER overcrowding. In fact, immigrants generally and undocumented immigrants in particular are less likely to get their healthcare at the emergency room than native-born Americans. In California, according to a 2014 study from UCLA, "one in five US-born adults visits the ER annually, compared with roughly one in 10 undocumented adults — approximately half the rate of US-born residents." Among the reasons, explained Nadereh Pourat, the study's lead author and director of research at the UCLA Center for Health Policy Research, was fear of being asked to provide documents. The result is that undocumented individuals avoid seeking any healthcare until they become critically ill. The UCLA study found that undocumented immigrants' average number of doctor visits per year was lower than for other cohorts: 2.3 for children and 1.7 for adults, compared with 2.8 doctor visits for US-born children and 3.2 for adults. ER overcrowding is an issue of long standing in the US, but it's not the result of an influx of undocumented immigrants. It's due to a confluence of other factors, including the tendency of even insured patients to use the ER as a primary care center, presenting with complicated or chronic ailments for which ER medicine is not well-suited. While caseloads at emergency departments have surged, their capacities are shrinking. According to a 2007 report by the National Academy of Sciences, from 1993 to 2003 the US population grew by 12%, hospital admissions by 13% and ER visits by 26%. "Not only is (emergency department) volume increasing, but patients coming to the ED are older and sicker and require more complex and time-consuming workups and treatments," the report observed. "During this same period, the United States experienced a net loss of 703 hospitals, 198,000 hospital beds, and 425 hospital EDs, mainly in response to cost-cutting measures." Trump's immigration policies during his first term suppressed the use of public healthcare facilities by undocumented immigrants and their families. The key policy was the administration's tightening of the "public charge" rule, which applies to those seeking admission to the United States or hoping to upgrade their immigration status. The rule, which has been part of US immigration policy for more than a century, allowed immigration authorities to deny entry — or deny citizenship applications of green card holders — to anyone judged to become a recipient of public assistance such as welfare (today known chiefly as Temporary Assistance for Needy Families, or TANF) or other cash assistance programs. Until Trump, healthcare programs such as Medicaid, nutrition programs such as food stamps, and subsidized housing programs weren't part of the public charge test. Even before Trump implemented the change but after a draft version leaked out, clinics serving immigrant communities across California and nationwide detected a marked drop off in patients. A clinic on the edge of Boyle Heights in Los Angeles that had been serving 12,000 patients, I reported in 2018, saw monthly patient enrollments fall by about one-third after Trump's 2016 election, and an additional 25% after the leak. President Joe Biden rescinded the Trump rule within weeks of taking office. Undocumented immigrants are sure to be less likely to access public healthcare services, such as those available at emergency rooms, as a result of Trump's rescinding "sensitive location" restrictions on immigration agents that had been in effect at least since 2011. That policy barred almost all immigration enforcement actions at schools, places of worship, funerals and weddings, public marches or rallies, and hospitals. Trump rescinded the policy on inauguration day in January. The goal was for Immigration and Customs Enforcement, or ICE, agents "to make substantial efforts to avoid unnecessarily alarming local communities," agency officials stated. Today, as public shows of force and public raids by ICE have demonstrated, instilling alarm in local communities appears to be the goal. The change in the sensitive locations policy has prompted hospital and ER managers to establish formal procedures for staff confronted with the arrival of immigration agents.
Gulf Today
29-06-2025
- Health
- Gulf Today
CDC says COVID vaccine protects pregnant women
Michael Hiltzik, Tribune News Service Here's how one of the well-laid plans of Health and Human Services Secretary Robert F. Kennedy Jr. went blooey. Earlier this month, Kennedy dismantled the all-important Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and remade it into the spearhead for his anti-vaccination campaigns. The rejiggered committee met for the first time Wednesday. Unfortunately for Kennedy's goals, the very first presentation it heard from CDC scientists involved the safety of the COVID-19 vaccine, particularly for pregnant women, infants and children. CDC studies found "no increased risk" that the Moderna and Pfizer mRNA vaccines caused adverse effects during pregnancy, Sarah Meyer, director of the CDC's Immunization Safety Office, said at the meeting, citing data from 28 analyses of 68,000 pregnant women. The data showed no increases in miscarriages, stillbirths, preterm births, major birth defects, neonatal ICU admissions, infant deaths, abnormal uterine bleeding or other pregnancy-related conditions. In fact, the CDC found that "maternal vaccination is the best proection against COVID-19 for pregnant women and infants less than six months of age," CDC immunologist Adam MacNeil told the panel. The COVID vaccines aren't approved for infants younger than six months, so maternal immunization is their only protection. That's important because Kennedy, on May 17, removed the vaccines from the recommended list for pregnant women and children. "It's common sense and it's good science" to remove the recommendation, Kennedy said in a 58-second video posted on X. "We're now one step closer to realising President Trump's promise to make America healthy again," Kennedy crowed, flanked by Marty Makary, the newly appointed commissioner of the Food and Drug Administration, and Jay Bhattacharya, the newly appointed director of the National Institutes of Health. Neither body plays a role in issuing vaccine recommendations for the government. That's the job of the CDC, which has been operating without a director, and which didn't have a representative on the video. Pediatric and obstetric organisations decried the decision, which ran counter to the findings of extensive research. "Clear benefits of maternal immunisation versus COVID in terms of dramatic reductions in maternal mortality and protecting the newborn infant ... has been detailed in the biomedical literature," vaccinologist Peter Hotez told me by email. I asked Kennedy through his agency's public information team for comment on the CDC presentation, but received no reply. On June 9, Kennedy fired all 17 members of ACIP of the immunization advisory committee and replaced them with eight handpicked members, a cadre that includes "antivaxxers, the antivax-adjacent, and the unqualified," as veteran pseudoscience debunker David Gorski noted. The COVID vaccines have been a leading target of anti-vaccine activists, including Kennedy, since they were introduced in 2021. They've been blamed for a host of purported health harms, most of which have been found by researchers to be largely imaginary. The anti-vaccine camp maintains that the vaccines weren't adequately studied before rolling them out to the general public and haven't been sufficiently monitored for adverse effects since then. The CDC officials' presentation debunked almost all these claims. Indeed, Meyer said, the COVID-19 vaccines have been subjected to "the most extensive safety monitoring programe in US history." The CDC has investigated more than 65 possible adverse effects of the vaccine, Meyer said, including heart attacks, meningitis, spontaneous abortion, seizures and hospitalisation. Other than pain at the injection site, fainting and other transitory conditions common to most vaccines, it has found evidence for one condition — myocarditis, a heart inflammation seen especially in men aged 12 to 29. That appears to be a short-term condition, with 83% of patients recovering within 90 days of onset, and more than 90% fully recovered within a year. No deaths or heart transplants are known to have occurred, the CDC data show. No confirmed cases were seen in children younger than 5. The myocarditis rate among vaccine recipients aged between 6 months and 64 years appeared to spike in 2020-22, when it seemed to be related to the original vaccine and the original booster. After the booster was reformulated, the rate among those aged 12 to 39 fell to about one case per million doses in 2024-25 — half the rate found in the general population. Despite the relative rarity of myocarditis, the condition has underpinned a campaign by anti-vaccine activists to take the vaccines off the market. Among them is Joseph Ladapo, the Florida surgeon general, who in 2022 advised males aged 18-39 not to get the COVID vaccine. His advisory earned him a crisp upbraiding from the then-heads of the FDA and CDC, who informed him by letter that "the known and potential benefits of these vaccines clearly outweigh their known and potential risks.... Not only is there no evidence of increased risk of death following mRNA vaccines, but available data have shown quite the opposite: that being up to date on vaccinations saves lives compared to individuals who did not get vaccinated."
Los Angeles Times
27-06-2025
- Politics
- Los Angeles Times
LA Times Today: Social Security is still in good shape but faces challenges — from Trump
The back and forth battle to save Social Security is never ending. That and Medicare are the two most popular government programs. Making cuts to either is the third rail of politics. But grim predictions about Social Security going broke is causing anxiety for seniors. L.A. Times columnist Michael Hiltzik joined Lisa McRee with more.
Gulf Today
09-06-2025
- Health
- Gulf Today
Study finds lifting school mask fueled COVID deaths
Michael Hiltzik, Tribune News Service Someday we Americans may stop quarreling over our response to the COVID-19 pandemic — lockdown orders, social distancing and so forth — but one category of debate may never become immune to second-guessing. That's the impact of anti-pandemic measures on schools and schoolchildren. According to popular opinion, these were almost entirely mistaken or ineffective. A newly published study from data scientists at Michigan State University knocks one pillar out from under this claim. It finds that the abrupt removal in 2022 of mandates that children wear masks in school contributed to an estimated 21,800 COVID deaths that year — a shocking 9% of the total COVID deaths in the US that year. 'We were surprised by that too,' says Scott A. Imberman, a professor of economics and education policy at Michigan State and a co-author of the paper. On reflection, he says, given the mixing of children and staff in the close quarters of a classroom, 'it's pretty easy to see how COVID could propagate to the wider community.' In February 2022, about 50% of public school children, or more than 20 million pupils, were in districts with mask mandates; then, over a period of six weeks, almost all those districts rescinded their mandates. "You can see how that would create a pretty substantial surge in infections." Most of the surge, Imberman told me, was a "spillover effect" in the communities outside the schools themselves. The Michigan State finding undermines several myths and misrepresentations about COVID spread by the right wing. These include the claim that children are virtually impervious to COVID, which has been refuted by the injury and death toll among children. A related misrepresentation was that children can't pass on the infection to adults. In fact, because many children didn't show symptoms of the infection or had only mild, flu-like symptoms, they functioned almost like an undetected fifth column in spreading the virus to adults. Among those who vociferously promoted these myths is Jay Bhattacharya, the former Stanford medical professor who is now director of the National Institutes of Health, a subagency of Robert F. Kennedy Jr.'s Department of Health and Human Services. In a July 2022 op-ed originally published in the Orange County Register, for example, Bhattacharya and a co-author asserted that 'COVID-19 is less of a threat to children than accidents or the common flu'; that's debatable, and irrelevant, since those are themselves major threats to child health. The article advocated discontinuing mask-wearing for all children, regardless of their vaccination status. But it was self-refuting, since it also acknowledged that the US Centers for Disease Control and Prevention estimated that mask mandates in school had produced 'a roughly 20% reduction in COVID-19 incidence.' The authors also acknowledged that masking in schools could help to shield adults from COVID. But they asked, 'Since when is it ethical to burden children for the benefit of adults?' That was the wrong question. Reducing COVID infections for children was certainly not a "burden" on them, but a sound public health goal. How heavy was that "burden," anyway? Bhattacharya and his co-author posited that "masking is a psychological stressor for children and disrupts learning," and "it is likely that masking exacerbates the chances that a child will experience anxiety and depression." This sounds like guesswork derived from pop psychology, since the authors didn't point to any actual research to validate their conclusions about masking. Nevertheless, they argued that the drawbacks of masking exceeded the benefits. Yet the Michigan State estimate that the removal of mask mandates in the schools contributed to 21,800 deaths in 2022 alone turns the balance of costs and benefits on its head. I asked Health and Human Services for Bhattacharya's response to the study but received no reply. Much of the mythmaking about our pandemic response — indeed, the global pandemic response — is rooted in the absurd conviction that everything we now know about COVID was self-evident from the outset. But COVID was a novel human pathogen. As I wrote in 2022, there was little consensus about how it spread, at what stage of sickness it was most contagious, or who was most susceptible. As a result, most anti-pandemic policies in 2020-22 arose from an excess of caution. Mitigation measures were uncertain, but it did make sense to limit gatherings in small spaces, i.e., classrooms. Many such steps turned out to be effective, including social distancing and, yes, mask-wearing. The subsequent hand-wringing over school closings, accordingly, has the unmistakable smell of hindsight. Not 20/20 hindsight, mind you, but hindsight clouded by ideology, partisan politics and persistent ignorance. For example, Florida Gov. Ron DeSantis, a Republican champion of letting COVID-19 freely rip through his population, crowed that the results "prove that we made the right decision" to keep schools open. Is that so? When Florida reopened its schools in August 2021 and banned remote teaching, child COVID deaths in the state more than doubled. One month into the reopenings, the heightened spread of COVID prompted districts across the state to shut down schools again and impose quarantines affecting thousands of pupils. This is how manifestly deadly decisions get redefined as "the right decision" in the partisan narrative. The Michigan State team documented the speed at which school mask mandates were dropped. The timeline begins in July 2021, when the CDC recommended universal masking in schools to enable a return to in-person instruction rather than fully remote or hybrid classes. The CDC's guidelines, the Michigan State study says, applied to all students whether they were vaccinated or not and all school districts, whatever the levels of COVID infection and transmission within their community. In the fall of 2021, about 65% of all students were subject to a state or local mask mandate. The mask mandates were highly controversial: "Many schools encountered pushback from politicians, parents, and community members" who questioned the efficacy of masking, the study relates. The districts that rejected the mandates tended to be "less urban, less diverse, and more likely to have voted for Trump in the 2020 election." On Feb. 25, 2022, the CDC eliminated its recommendation for universal school masking. Its rationale was that the exceptionally contagious Omicron variant of COVID had passed its peak and thus immunity had increased. But many districts had removed their mandates starting several weeks before the CDC revised its guidance, suggesting that the CDC was following, rather than leading, state and local preferences. The removal of mask mandates ran counter to scientific evidence that masks did indeed reduce the spread of COVID. Indeed, a study from Boston and Chelsea, Mass., found that the removal of mask mandates resulted in an increase of 45 COVID cases per 1,000 students and school staff — nearly 12,000 new cases — over the following four months. But in this particular, as in others related to pandemic policies, politics and ideology trumped the hard evidence, warping the public health response. Bhattacharya's record as an authority on pandemic measures is not encouraging. He was one of the original three authors of the "Great Barrington Declaration," a manifesto for herd immunity published in October 2020. The core of the declaration was opposition to lockdowns. Its solution was what its drafters called "focused protection" — allowing "those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk," chiefly seniors. Focused protection, the drafters wrote, would allow society to achieve herd immunity and return to normality in three to six months.
Gulf Today
01-05-2025
- Health
- Gulf Today
Inside the GOP's secret plan to destroy Medicaid
Michael Hiltzik, Tribune News Service You may have heard some of our federal lawmakers attest to their respect for Medicaid and its generally low-income enrolment base. Listen to House Speaker Mike Johnson, R-La., on Fox News a couple of weeks ago talking about the need to preserve the state-federal programme so it serves 'young single mothers down on their fortunes for a moment, the people with real disability, the elderly.' As articulated by Johnson and other GOP lawmakers, this idea seems pretty unexceptionable. Unless, that is, you examine what's really behind this declaration of service for the less fortunate among us. What they're really talking about is killing the Medicaid expansion that was passed as part of the Affordable Care Act in 2010. They have a plan to do exactly that. It's not exactly secret, but it's abstruse enough that they hope most people, who aren't fully conversant with the complexities of the programme, won't get the drift. So I'm here to explain what they're up to. To understand, you have to be aware of two facts. One is that the federal government contributes 90% of the cost of medical service for expansion enrollees. The other is that the federal match for traditional Medicaid, which principally serves low-income families with children, is lower. It varies state by state and ranges from 50% for wealthier states such as California to more than 70% for poor states such as Mississippi, Alabama and West Virginia. The idea floating around in the GOP caucus is to reduce the expansion match to each state's level for traditional Medicaid. The idea can be found in Project 2025 and in a proposal from the Paragon Health Institute, which has been funded in part by right-wing foundations, including the Koch network. Make no mistake: This is an effort aimed at destroying Medicaid expansion programmes. The healthcare of as many as 21 million Americans is at stake; that's how many people are receiving health coverage via the Medicaid expansion. 'Medicaid expansion is responsible for the largest share of the reduction of this nation's uninsured rate,' says Joan Alker, a Medicaid and children's health expert at Georgetown University. That rate fell from 16% when the ACA was passed to about 8% now. Not only would expansion enrollees be affected: Medicaid is the biggest source of federal dollars flowing to the states, coming to $616 billion for state and local governments in fiscal 2023, swamping the sum provided by the second-largest programme, the federal highway trust fund, which funneled $47.7 billion to them. The match reduction would amount to about 10% of total Medicaid funding per year. 'There would be no good way out of this for any state, no matter how rich or well-intentioned,' Alker told me. 'It's simply too much money.' Some Republicans seem to understand that implication, as well as the popularity of Medicaid among the voting public. In an April 14 letter to the House Republican leadership, 12 GOP representatives stated that they would not support any budget bill that 'includes any reduction in Medicaid coverage for vulnerable populations.' They were walking on a razor's edge, however, by also echoing Johnson in endorsing 'targeted reforms ... that divert resources away from children, seniors, individuals with disabilities, and pregnant women — those who the programme was intended to help.' Among the signers was Rep. David Valadao, R-Hanford, whose Central Valley district has 139,800 expansion enrollees, one of the largest such cadres in California. I asked Valadao's office to clarify his position but got no response. Before delving into how changing the federal match would affect Medicaid, a few more words about the partisan context. Notwithstanding Republicans' protestations of reverence for Medicaid, the truth is that they and their fellow conservatives have had their knives out for the programme virtually since its inception in 1965. They've assaulted it with lies and misrepresentations for years. As Drew Altman of the health policy think tank KFF has astutely observed, conservatives' historical disdain for Medicaid derives in part from the divergent partisan views of the programme: 'Democrats view Medicaid as a health insurance programme that helps people pay for healthcare,' he wrote. By contrast, 'Republicans view Medicaid as a government welfare programme.' Thinking of Medicaid as welfare serves an important aspect of the conservative programme, in that it makes Medicaid politically easier to cut, like all 'welfare' programmes. Ordinary Americans don't normally see these programmes as serving themselves, unlike Social Security and Medicare, which they think of as entitlements (after all, they pay for them with every paycheque). From the concept of Medicaid as welfare it's a short step to loading it with eligibility restrictions and administrative hoops to jump through; Republicans tend to picture Medicaid recipients as members of the undeserving poor, which aligns with their view of poverty as something of a moral failing. That explains another frontal attack on Medicaid mounted by the GOP: the imposition of work requirements on Medicaid enrollees. This is a popular idea among Republican lawmakers despite evidence that they fail to achieve their putative goal of encouraging poor people to find jobs. Only two states implemented work requirements when they were authorised during the first Trump administration. Both were abject failures. In Arkansas, more than 18,000 people lost their coverage during the nine months the programme was in operation, before it was blocked by federal Judge James Boasberg in 2019. (He was upheld by an appeals court, and the matter ended there.) In Georgia, state officials expected 345,000 people to apply for eligibility under its work rules; by late 2024, fewer than 4,500 people enrolled, in part because the administrative rules the state imposed were onerous. Georgia also discovered a seldom acknowledged reality about work requirements — they're immensely expensive to administer. In less than a year, Georgia taxpayers had spent $26 million on the program, almost all of it on administration instead of medical services. Work rules for Medicaid are the product of a misconception about Medicaid enrollees, which is that they're the employable unemployed. According to census figures, however, 44% of Medicaid recipients worked full time in 2023 and 20% worked part time. An additional 12% were not working because they were taking care of family at home, 10% were ill or disabled, 6% were students, and 4% were retired. Of the remaining 4%, half couldn't find work and the remaining 2% didn't give a reason. The Biden administration killed work requirements for Medicaid soon after it took office. That brings us back to Medicaid expansion. The Affordable Care Act used Medicaid to cover the poorest uninsured Americans, those with incomes up to 138% of the federal poverty level, or about $21,597 this year. The federal government would cover 100% of the new expense at first, ultimately declining to 90%, where it is now. A Supreme Court ruling made the Medicaid expansion voluntary for states; as of today, all but 10 have accepted the expansion. In those states, Medicaid eligibility was extended to childless adults for the first time.
