Health

A mom’s $97,000 question: How was her baby’s air-ambulance ride not medically necessary?

Sara England was putting together Ghostbusters costumes for Halloween when she noticed her baby wasn’t doing well.

Her 3-month-old son, Amari Vaca, had undergone open-heart surgery two months before, so she called his cardiologist, who recommended getting him checked out. England assigned Amari’s grandparents to trick-or-treat duty with his three older siblings and headed to the local emergency room.

Once England and the baby arrived at Natividad Medical Center in Salinas, California, she said, doctors could see Amari was struggling to breathe and told her that he needed specialized care immediately, from whichever of two major hospitals in the region had an opening first.

Even as they talked, Amari was declining rapidly, his mother said. Doctors put a tube down his throat and used a bag to manually push air into his lungs for over an hour to keep his oxygen levels up until he was stable enough to switch to a ventilator.

According to England, late that night, when doctors said the baby was stable enough to travel, his medical team told her that a bed had opened up at the University of California-San Francisco Medical Center and that staffers there were ready to receive him.

She, her son, and an EMT boarded a small plane around midnight. Ground ambulances carried them between the hospitals and airports.

Amari was diagnosed with respiratory syncytial virus, or RSV, and spent three weeks in the hospital before recovering and returning home.

Then the bill came.

The Patient: Amari Vaca, now 1, who was covered by a Cigna policy sponsored by his father’s employer at the time.

Medical Services: An 86-mile air-ambulance flight from Salinas to San Francisco.

Service Provider: Reach Medical Holdings, which is part of Global Medical Response, an industry giant backed by private equity investors. Global Medical Response operates in all 50 states and has said it has a total of 498 helicopters and airplanes. It is out-of-network with Amari’s Cigna plan.

Total Bill: $97,599. Cigna declined to cover any part of the bill.

What Gives: Legal safeguards are in place to protect patients from big bills for some out-of-network care, including air-ambulance rides.

Medical billing experts said the No Surprises Act, a federal law enacted in 2022, could have protected Amari’s family from receiving the $97,000 “balance bill,” leaving the insurer and the air-ambulance provider to determine fair payment according to the law. But the protections apply only to care that health plans determine is “medically necessary” — and insurers get to define what that means in each case.

According to its coverage denial letter, Cigna determined that Amari’s air-ambulance ride was not medically necessary. The insurer cited its reasoning: He could have taken a ground ambulance instead of a plane to cover the nearly 100 roadway miles between Salinas and San Francisco.

“I thought there must have been a mistake,” England said. “There’s no way we can pay this. Is this a real thing?”

In the letter, Cigna said Amari’s records did not show that other methods of transportation were “medically contraindicated or not feasible.” The health plan also noted the absence of documentation that he could not be reached by a ground ambulance for pickup or that a ground ambulance would be unfeasible because of “great distances or other obstacles.”

Lastly, it said records did not show a ground ambulance “would impede timely and appropriate medical care.”

When KFF Health News asked Cigna what records were referenced when making this decision, a spokesperson declined to respond.

Caitlin Donovan, a spokesperson for the National Patient Advocate Foundation, said that even though Amari’s bill isn’t technically in violation of the No Surprises Act, the situation is exactly what the law was designed to avoid.

“What they’re basically saying is that the parents should have opted against the advice of the physician,” Donovan said. “That’s insane. I know ‘medical necessity’ is this nebulous term, but it seems like it’s becoming a catch-all for turning down patients.”

On Feb. 5, the National Association of Emergency Medical Services Physicians said that since the No Surprises Act was enacted two years ago, it has seen a jump in claim denials based on “lack of medical necessity,” predominantly for air-ambulance transports between facilities.

In a letter to federal health officials, the group cited reasons commonly given for inappropriate medical-necessity denials observed by some of its 2,000 members, such as “the patient should have been taken elsewhere” or “the patient could have been transported by ground ambulance.”

The association urged the government to require that health plans presume medical necessity for inter-facility air transports ordered by a physician at a hospital, subject to a retrospective review.

Such decisions are often “made under dire circumstances — when a hospital is not capable of caring for or stabilizing a particular patient or lacks the clinical resources to stabilize a patient with a certain clinical diagnosis,” the group’s president, José Cabañas, wrote in the letter. “Clinical determinations made by a referring physician (or another qualified medical professional) should not be second-guessed by a plan.”

Patricia Kelmar, a health policy expert and senior director with the U.S. Public Interest Research Groups, noted, however, that hospitals could familiarize themselves with local health plans, for example, and establish protocol, so that before they call an air ambulance, they know if there are in-network alternatives and, if not, what items the plan needs to justify the claim and provide payment.

“The hospitals who live and breathe and work in our communities should be considering the individuals who come to them every day,” Kelmar said. “I understand in emergency situations you generally have a limited amount of time, but, in most situations, you should be familiar with the plans so you can work within the confines of the patient’s health insurance.”

England said Cigna’s denial particularly upset her.

“As parents, we did not make any of the decisions other than to say, yes, we’ll do that,” she said. “I don’t know how else it could have gone.”

The Resolution: England twice appealed the air-ambulance charge to the insurer, but both times Cigna rejected the claim, maintaining that “medical necessity” had not been established.

The final step of the appeals process is an external review, in which a third party evaluates the case. England said staff members at Natividad Medical Center in Salinas — which arranged Amari’s transport — declined to write an appeal letter on his behalf, explaining to her that doing so is against the facility’s policy.

Using her son’s medical records, which the Natividad staff provided, England said she is writing a letter herself to assert why the air ambulance was medically necessary.

Andrea Rosenberg, a spokesperson for Natividad Medical Center, said the hospital focuses on “maintaining the highest standards of health care and patient well-being.”

Despite receiving a waiver from England authorizing the medical center to discuss Amari’s case, Rosenberg did not respond to questions from KFF Health News, citing privacy issues. A Cigna spokesperson told KFF Health News that the insurer has in-network alternatives to the out-of-network ambulance provider, but — despite receiving a waiver authorizing Cigna to discuss Amari’s case — declined to answer other questions.

“It is disappointing that CALSTAR/REACH is attempting to collect this egregious balance from the patient’s family,” the Cigna spokesperson, Justine Sessions, said in an email, referring to the air-ambulance provider. “We are working diligently to try to resolve this for the family.”

On March 13, weeks after being contacted by KFF Health News, England said, a Cigna representative contacted her and offered assistance with her final appeal, the one reviewed by a third party. The representative also told her the insurer had attempted to contact the ambulance provider but had been unable to resolve the bill with them.

Global Medical Response, the ambulance provider, declined to comment.

England said she and her husband have set aside two hours each week for him to take care of their four kids while she shuts herself in her room and makes calls about their medical bills.

“It’s just another stress,” she said. “Another thing to get in the way of us being able to enjoy our family.”

The Takeaway: Kelmar said she encourages patients to appeal bills that seem inaccurate. Even if the plan denies it internally, push forward to an external review so someone outside the company has a chance to review, she said.

In the case of “medical necessity” denials, Kelmar recommended patients work with the medical provider to provide more information to the insurance company to underscore why an emergency transport was required.

More from Bill of the Month

Doctors who write a letter or make a call to a patient’s insurer explaining a decision can also ask for a “peer-to-peer review,” meaning they would discuss the case with a medical expert in their field.

Kelmar said patients with employer-sponsored health plans can ask their employer’s human resources department to advocate for them with the health plan. It’s in the employers’ best interest since they often pay a lot for these health plans, she said.

No matter what, Kelmar said, patients shouldn’t let fear stop them from appealing a medical bill. Patients who appeal have a high likelihood of winning, she said.

Patients with government health coverage can further appeal insurance denials by filing a complaint with the Centers for Medicare & Medicaid Services. Those who believe they have received an inappropriate bill from an out-of-network provider can call the No Surprises Act help desk at 1-800-985-3059.

Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News' free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

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Dr. Oz would still be 'pitchman for dubious miracle cures' as Center for Medicare head: report

A social media post Dr. Mehmet Oz — who Donald Trump nominated to lead the Centers for Medicaid and Medicare — published on Wednesday "suggests that he may continue to serve as pitchman for dubious miracle cures even when he’s in government," according to Rolling Stone.

While Oz's X account notes that he is a shareholder for, and serves as "global adviser" to iHerb — a "leading online store dedicated to trusted health products" — the MAGA nominee wrote, "Thanksgiving is a perfect excuse for practicing gratitude — which also happens to be a proven way to reduce stress. You can also reduce stress with adaptogens like ashwagandha from a trusted source like @iHerb. Happy Thanksgiving!"

Rolling Stone notes, "It’s not clear if or how Oz will seek to disentangle his many and significant financial ties to pharmaceutical and health tech companies to avoid conflicts of interest as the administrator of CMS, which works closely with and regulates such companies."

READ MORE: The Trump-inflicted 'national security dilemma' Biden has the power to stop: ex-FBI official

For now, the news outlet emphasizes, "it seems the TV doctor has no qualms about continuing to shill for the alternative medicine industry that made him a millionaire as he prepares to assume one of the most important jobs in public health."

Rolling Stone notes the heart surgeon has been criticized by medical experts over the years "for endorsing pseudoscience and his promotion of supplements including scam diet pills," all while "he’s earned tens of millions of dollars as a spokesman for another supplement manufacturer that has been sued by its own investors and accused of functioning as a pyramid scheme."

Furthermore, "as the Covid-19 pandemic raged, with his TV appearances guiding Trump’s response to the crisis, he touted hydroxychloroquine as a potentially effective treatment despite a lack of evidence to support the claim" — while owning "shares in a company that supplies the drug," according to the report.

READ MORE: 'Where the danger lies': Trump’s pick for AG has history of bending law for big donors

Rolling Stone's full report is available at this link (subscription required).

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A toddler got a nasal swab test but left before seeing a doctor  — the bill was $445

Ryan Wettstein Nauman was inconsolable one evening last December. After being put down for bed, the 3-year-old from Peoria, Illinois, just kept crying and crying and crying, and nothing would calm her down.

Her mother, Maggi Wettstein, remembered fearing it could be a yeast or urinary tract infection, something they had been dealing with during potty training. The urgent care centers around them were closed for the night, so around 10:30 p.m. she decided to take Ryan to the emergency room at Carle Health.

The Medical Procedure

The ER wasn’t very busy when they arrived at 10:48 p.m., Wettstein recalled. Medical records indicate they checked in and she explained Ryan’s symptoms, including an intermittent fever. The toddler was triaged and given a nasal swab test to check for covid-19 and influenza A and B.

Wettstein said they sat down and waited to be called. And they waited.

As Wettstein watched Ryan in the waiting room’s play area, she noticed her daughter had stopped crying.

In fact, she seemed fine.

So Wettstein decided to drive them home. Ryan had preschool the next day, and she figured there was no point keeping her awake for who knew how much longer and getting stuck with a big ER bill.

There was no one at the check-in desk to inform that they were leaving, Wettstein said, so they just headed home to go to bed.

Ryan went to her preschool the next day, and Wettstein said they forgot all about the ER trip for eight months.

Then the bill came.

The Final Bill

$445 for the combined covid and flu test — from an ER visit in which the patient never made it beyond the waiting room.

The Billing Problem: A Healthy Hospital Markup and Standard Insurance Rules

Even though Ryan and her mother left without seeing a doctor, the family ended up owing $298.15 after an insurance discount.

At first, Wettstein said, she couldn’t recall Ryan being tested at all. It wasn’t until she received the bill and requested her daughter’s medical records that she learned the results. (Ryan tested negative for covid and both types of flu.)

While Wettstein said the bill isn’t going to break the bank, it seemed high to her, considering Walgreens sells an at-home covid and flu combination test for $30 and can do higher-quality PCR testing for $145.

Under the public health emergency declared in 2020 for the covid pandemic, insurance companies were required to pay for covid tests without copayments or cost sharing for patients.

That requirement ended when the emergency declaration expired in May 2023. Now, it is often patients who foot the bill — and ER bills are notoriously high.

“That’s a pretty healthy markup the hospital is making on it,” Loren Adler, associate director of the Brookings Institution Center on Health Policy, told KFF Health News when contacted about Ryan’s case.

The rates the insurance companies negotiate with hospitals for various procedures are often based on multipliers of what Medicare pays, Adler said.

Lab tests are one of the few areas in which insurance companies can often pay less than Medicare, he said — the exception being when the test is performed by the hospital laboratory, which is often what happens during ER visits.

Medicare pays $142.63 for the joint test that Ryan received, but the family is on the hook for more than twice that amount, and the initial hospital charge was over three times as much.

The hospital is “utilizing their market power to make as much money as possible, and the insurance companies are not all that good at pushing back,” Adler said. A markup of a few hundred dollars is a drop in the bucket for big insurers. But for the patients who get unexpected bills, it can be a big burden.

Brittany Simon, a public relations manager for Carle Health, did not respond to specific questions but said in a statement, “We follow policies that support the safety and wellbeing of our patients, which includes the initial triage of symptomatic patients to the Emergency Department.”

While Ryan’s family would not have had to pay for a covid test during the public health emergency, it was the family’s insurer, Cigna, that did not have to pay this time, since the family had not yet met a $3,000 yearly deductible.

A Cigna representative did not respond to requests for comment.

The Resolution

Wettstein said she knew she could just pay the bill and be done with it, “but the fact that I never saw a provider, and the fact that it was just for a covid test, is mind-blowing to me.”

She contacted the hospital’s billing department to make sure the bill was correct. She explained what happened and said the hospital representative was also surprised by the size of the bill and sent it up for further review.

“‘Don’t pay this until you hear from me,’” Wettstein remembered being told.

Soon, though, she received a letter from the hospital explaining that the charge was correct and supported by documentation.

Wettstein thought she was avoiding any charges by taking Ryan home without being seen. Instead, she got a bill “that they have verified that I have to pay.”

“Like I said, it’s mind-blowing to me.”

The Takeaway

ERs are among the most expensive options for care in the nation’s health system, and the meter can start running as soon as you check in — even if you check out before receiving care.

If your issue isn’t life-threatening, consider an urgent care facility, which is often cheaper (and look for posted notices to confirm whether it’s actually an urgent care clinic). The urgent care centers near Ryan’s home were closed that evening, but some facilities stay open late or around the clock.

In some ways, Wettstein was lucky. KFF Health News’ “Bill of the Month” has received tips from other patients who left an ER after a long wait without seeing a doctor — and got slapped with a facility fee of over $1,000.

Making the decision about where to go is tough, especially in a stressful situation — such as when the patient is too young to communicate what’s wrong. Trying to figure out what’s going on physically with a 3-year-old can feel impossible.

If you decide to leave an ER without treatment, don’t just walk out. Tell the triage nurse you’re leaving. You might get lucky and avoid some charges.

Wettstein won’t think twice about taking Ryan to the pediatrician or an urgent care center the next time she’s ailing. But, Wettstein said, after getting this bill, “I’m not going to create a habit out of going to the emergency room.”

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it!

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News' free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

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Here’s what happens to your brain when you give up sugar

Anyone who knows me also knows that I have a huge sweet tooth. I always have. My friend and fellow graduate student Andrew is equally afflicted, and living in Hershey, Pennsylvania – the “Chocolate Capital of the World” – doesn’t help either of us.

But Andrew is braver than I am. Last year, he gave up sweets for Lent. I can’t say that I’m following in his footsteps this year, but if you are abstaining from sweets for Lent this year, here’s what you can expect over the next 40 days.

Sugar: natural reward, unnatural fix

In neuroscience, food is something we call a “natural reward.” In order for us to survive as a species, things like eating, having sex and nurturing others must be pleasurable to the brain so that these behaviours are reinforced and repeated.

Evolution has resulted in the mesolimbic pathway, a brain system that deciphers these natural rewards for us. When we do something pleasurable, a bundle of neurons called the ventral tegmental area uses the neurotransmitter dopamine to signal to a part of the brain called the nucleus accumbens. The connection between the nucleus accumbens and our prefrontal cortex dictates our motor movement, such as deciding whether or not to taking another bite of that delicious chocolate cake. The prefrontal cortex also activates hormones that tell our body: “Hey, this cake is really good. And I’m going to remember that for the future.”

Not all foods are equally rewarding, of course. Most of us prefer sweets over sour and bitter foods because, evolutionarily, our mesolimbic pathway reinforces that sweet things provide a healthy source of carbohydrates for our bodies. When our ancestors went scavenging for berries, for example, sour meant “not yet ripe,” while bitter meant “alert – poison!”

Fruit is one thing, but modern diets have taken on a life of their own. A decade ago, it was estimated that the average American consumed 22 teaspoons of added sugar per day, amounting to an extra 350 calories; it may well have risen since then. A few months ago, one expert suggested that the average Briton consumes 238 teaspoons of sugar each week.

Today, with convenience more important than ever in our food selections, it’s almost impossible to come across processed and prepared foods that don’t have added sugars for flavour, preservation, or both.

These added sugars are sneaky – and unbeknown to many of us, we’ve become hooked. In ways that drugs of abuse – such as nicotine, cocaine and heroin – hijack the brain’s reward pathway and make users dependent, increasing neuro-chemical and behavioural evidence suggests that sugar is addictive in the same way, too.

Sugar addiction is real

“The first few days are a little rough,” Andrew told me about his sugar-free adventure last year. “It almost feels like you’re detoxing from drugs. I found myself eating a lot of carbs to compensate for the lack of sugar.”

There are four major components of addiction: bingeing, withdrawal, craving, and cross-sensitisation (the notion that one addictive substance predisposes someone to becoming addicted to another). All of these components have been observed in animal models of addiction – for sugar, as well as drugs of abuse.

A typical experiment goes like this: rats are deprived of food for 12 hours each day, then given 12 hours of access to a sugary solution and regular chow. After a month of following this daily pattern, rats display behaviours similar to those on drugs of abuse. They’ll binge on the sugar solution in a short period of time, much more than their regular food. They also show signs of anxiety and depression during the food deprivation period. Many sugar-treated rats who are later exposed to drugs, such as cocaine and opiates, demonstrate dependent behaviours towards the drugs compared to rats who did not consume sugar beforehand.

Like drugs, sugar spikes dopamine release in the nucleus accumbens. Over the long term, regular sugar consumption actually changes the gene expression and availability of dopamine receptors in both the midbrain and frontal cortex. Specifically, sugar increases the concentration of a type of excitatory receptor called D1, but decreases another receptor type called D2, which is inhibitory. Regular sugar consumption also inhibits the action of the dopamine transporter, a protein which pumps dopamine out of the synapse and back into the neuron after firing.

In short, this means that repeated access to sugar over time leads to prolonged dopamine signalling, greater excitation of the brain’s reward pathways and a need for even more sugar to activate all of the midbrain dopamine receptors like before. The brain becomes tolerant to sugar – and more is needed to attain the same “sugar high.”

Sugar withdrawal is also real

Although these studies were conducted in rodents, it’s not far-fetched to say that the same primitive processes are occurring in the human brain, too. “The cravings never stopped, [but that was] probably psychological,” Andrew told me. “But it got easier after the first week or so.”

In a 2002 study by Carlo Colantuoni and colleagues of Princeton University, rats who had undergone a typical sugar dependence protocol then underwent “sugar withdrawal.” This was facilitated by either food deprivation or treatment with naloxone, a drug used for treating opiate addiction which binds to receptors in the brain’s reward system. Both withdrawal methods led to physical problems, including teeth chattering, paw tremors, and head shaking. Naloxone treatment also appeared to make the rats more anxious, as they spent less time on an elevated apparatus that lacked walls on either side.

Similar withdrawal experiments by others also report behaviour similar to depression in tasks such as the forced swim test. Rats in sugar withdrawal are more likely to show passive behaviours (like floating) than active behaviours (like trying to escape) when placed in water, suggesting feelings of helplessness.

A new study published by Victor Mangabeira and colleagues in this month’s Physiology & Behavior reports that sugar withdrawal is also linked to impulsive behaviour. Initially, rats were trained to receive water by pushing a lever. After training, the animals returned to their home cages and had access to a sugar solution and water, or just water alone. After 30 days, when rats were again given the opportunity to press a lever for water, those who had become dependent on sugar pressed the lever significantly more times than control animals, suggesting impulsive behaviour.

These are extreme experiments, of course. We humans aren’t depriving ourselves of food for 12 hours and then allowing ourselves to binge on soda and doughnuts at the end of the day. But these rodent studies certainly give us insight into the neuro-chemical underpinnings of sugar dependence, withdrawal, and behaviour.

Through decades of diet programmes and best-selling books, we’ve toyed with the notion of “sugar addiction” for a long time. There are accounts of those in “sugar withdrawal” describing food cravings, which can trigger relapse and impulsive eating. There are also countless articles and books about the boundless energy and new-found happiness in those who have sworn off sugar for good. But despite the ubiquity of sugar in our diets, the notion of sugar addiction is still a rather taboo topic.

Are you still motivated to give up sugar for Lent? You might wonder how long it will take until you’re free of cravings and side-effects, but there’s no answer – everyone is different and no human studies have been done on this. But after 40 days, it’s clear that Andrew had overcome the worst, likely even reversing some of his altered dopamine signalling. “I remember eating my first sweet and thinking it was too sweet,” he said. “I had to rebuild my tolerance.”

And as regulars of a local bakery in Hershey – I can assure you, readers, that he has done just that.

This article was originally published on The Conversation. Read the original article

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The 8-hour sleep myth: How I learned that everything I knew about sleep was wrong

I’ve always been at odds with sleep. Starting around adolescence, morning became a special form of hell. Long school commutes meant rising in 6am darkness, then huddling miserably near the bathroom heating vent as I struggled to wrest myself from near-paralysis. The sight of eggs turned my not-yet-wakened stomach, so I scuttled off without breakfast. In fourth grade, my mother noticed that instead of playing outside after school with the other kids, I lay zonked in front of the TV, dozing until dinner. “Lethargy of unknown cause,” pronounced the doctor.

High school trigonometry commenced at 7:50am. I flunked, stupefied with sleepiness. Only when college allowed me to schedule courses in the afternoon did the joy of learning return. My decision to opt for grad school was partly traceable to a horror of returning to the treadmill of too little sleep and exhaustion, which a 9-to-5 job would surely bring.

In my late 20s, I began to wake up often for a couple of hours in the middle of the night – a phenomenon linked to female hormonal shifts. I’ve met these vigils with dread, obsessed with lost sleep and the next day’s dysfunction. Beside my bed I stashed an arsenal of weapons against insomnia: lavender sachets, sleep CDs, and even a stuffed sheep that makes muffled ocean noises. I collected drugstore remedies -- valerian, melatonin, Nytol -- which caused me "rebound insomnia" the moment I stop taking them.

The Sleep Fairy continued to elude me.

I confessed my problem to the doctor, ashamed to fail at something so simple that babies and rodents can do it on a dime. When I asked for Ambien, she cut me a glance that made me feel like a heroin addict and lectured me on the dangers of “controlled substances.” Her offering of “sleep hygiene” bromides like reserving my bedroom solely for sleep was useless to a studio apartment-dweller.

Conventional medical wisdom dropped me at a dead end. Why did I need to use a bedroom for nothing but sleeping when no other mammal had such a requirement? When for most of history, humans didn’t either? Our ancestors crashed with beasties large and small roaming about, bodies tossing and snoring nearby, and temperatures fluctuating wildly. And yet they slept. How on earth did they do it?

A lot differently than we do, it turns out.

The 8-Hour Sleep Myth

Pursuing the truth about sleep means winding your way through a labyrinth of science, consumerism and myth. Researchers have had barely a clue about what constitutes “normal” sleep. Is it how many hours you sleep? A certain amount of time in a particular phase? The pharmaceutical industry recommends drug-induced oblivion, which, it turns out, doesn’t even work. The average time spent sleeping increases by only a few minutes with the use of prescription sleep aids. And -- surprise! -- doctors have linked sleeping pills to cancer. We have memory foam mattresses, sleep clinics, hotel pillow concierges, and countless others strategies to put us to bed. And yet we complain about sleep more than ever.

The blame for modern sleep disorders is usually laid at the doorstep of Thomas Edison, whose electric light bulb turned the night from a time of rest to one of potentially endless activity and work. Proponents of the rising industrial culture further pushed the emphasis of work over rest, and the sense of sleep as lazy indulgence.

But there’s something else, which I learned while engaged in a bout of insomnia-driven Googling. A Feb. 12, 2012 article on the BBC Web site, “The Myth of the 8-Hour Sleep,” has permanently altered the way I think about sleep. It proclaimed something that the body had always intuited, even as the mind floundered helplessly.

Turns out that psychiatrist Thomas Wehr ran an experiment back in the ‘90s in which people were thrust into darkness for 14 hours every day for a month. When their sleep regulated, a strange pattern emerged. They slept first for four hours, then woke for one or two hours before drifting off again into a second four-hour sleep.

Historian Roger Ekirch of Virginia Tech would not have been surprised by this pattern. In 2001, he published a groundbreaking paper based on 16 years of research, which revealed something quite amazing: humans did not evolve to sleep through the night in one solid chunk. Until very recently, they slept in two stages. Shazam.

In his book At Day's Close: Night in Times Past, Ekrich presents over 500 references to these two distinct sleep periods, known as the “first sleep” and the “second sleep,” culled from diaries, court records, medical manuals, anthropological studies, and literature, including The Odyssey. Like an astrolabe pointing to some forgotten star, these accounts referenced a first sleep that began two hours after dusk, followed by waking period of one or two hours and then a second sleep.

This waking period, known in some cultures as the “watch," was filled with everything from bringing in the animals to prayer. Some folks visited neighbors. Others smoked a pipe or analyzed their dreams. Often they lounged in bed to read, chat with bedfellows, or have much more refreshing sex than we modern humans have at bedtime. A 16th-century doctor’s manual prescribed sex after the first sleep as the most enjoyable variety.

But these two sleeps and their magical interim were swept away so completely that by the 20th century, they were all but forgotten.

Historian Craig Koslofsky delves into the causes of this massive shift in human behavior in his new book, Evening's Empire. He points out that before the 17th century, you’d have to be a fool to go wandering around at night, where ne’er-do-wells and cutthroats lurked on pitch-black streets. Only the wealthy had candles, and even they had little need or desire to venture from home at night. Street lighting and other trends gradually changed this, and eventually nighttime became fashionable and hanging out in bed a mark of indolence. The industrial revolution put the exclamation point on this sentence of wakefulness. By the 19th century, health pundits argued in favor of a single, uninterrupted sleep.

We have been told over and over that the eight-hour sleep is ideal. But in many cases, our bodies have been telling us something else. Since our collective memory has been erased, anxiety about nighttime wakefulness has kept us up even longer, and our eight-hour sleep mandate may have made us more prone to stress. The long period of relaxation we used to get after a hard day’s work may have been better for our peace of mind than all the yoga in Manhattan.

After learning this, I went in search of lost sleep.

Past Life Regression

“Even a soul submerged in sleep
is hard at work and helps
make something of the world.”
― Heraclitus, Fragments

What intrigued me most about the sleep research was a feeling of connection to ancient humans and to a realm beyond clock-driven, electrified industrial life, whose endless demands are more punishing than ever. Much as Werner Herzog’s documentary Cave of Forgotten Dreams pulls the viewer into the lives of ancient cave dwellers in southern France who painted the walls with marvelous images, reading about how our ancestors filled their nights with dream reflection, lovemaking and 10-to-12 hour stretches of down-time produced a strange sense of intimacy and wonder.

I’m a writer and editor who works from home, without children, so I’ve had the luxury, for the last couple of weeks, of completely relinquishing myself to a new (or quite old) way of sleeping. I’ve been working at a cognitive shift – looking upon early evening sleepiness as a gift, and plopping into bed if I feel like it. I try to view the wakeful period, if it should come, as a magical, blessed time when my email box stops flooding and the screeching horns outside my New York window subside.

Instead of heading to bed with anxiety, I’ve tried to dive in like a voluptuary, pushing away my guilt about the list of things I could be doing and letting myself become beautifully suspended between worlds. I’ve started dimming the lights a couple of hours after dusk and looking at the nighttime not as a time to pursue endless work, but to daydream, drift, putter about, and enter an almost meditative state.

The books I’ve been reading in the evening hours have been specially chosen as a link to dreamy ruminations of our ancestor’s “watch” period. Volumes like Norman O. Brown’s Love’s Body or Eduardo Galeano’s Mirrors provide the kind of reflective, incantatory experience the nighttime seems made for. Freud’s Interpretation of Dreams would be another excellent choice, and I know from experience that reading it before bedtime triggers the most vivid mental journeys.

In sleep, we slip back to a more primitive state. We go on a psychic archaeological dig. This is part of the reason that Freud proclaimed dreams to be the royal road to the unconscious and lifted his metaphors from the researchers who were sifting through the layers of ancient history on Egyptian digs, uncovering relics and forgotten memories. Ghosts flutter about us when we lie down to rest. Our waking identities dissolve, and we become creatures whose rhythms derive from the moon and the seas much more than the clock and the computer.

As we learn more, we may realize that giving sleep and rest the center stage in our lives may be as fundamental to our well-being as the way we eat and the medicines that cure us. And if we come to treasure this time of splendid relaxation, we may have much more to offer in the daytime hours.

NOW READ: Why are we so sleep deprived — and why does it matter?

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'Wasn’t Trump president at the time?' RFK Jr. mocked over saying US gov’t 'planned' COVID

Robert F. Kennedy Jr. — who President-Elect Donald Trump nominated to lead the United States Department of Health and Human Services — believes the COVID pandemic was organized by the US government.

The Bulwark's Sam Stein reported via X: "In previously unreported video, RFK Jr. said he believed the government may have planned the COVID pandemic."

Stein added: "RFK's statements raise the remarkable specter that the man who could soon lead HHS believes the department may have carried out a 'sinister' scheme to 'enslave' its own citizens—and that it was implemented under Donald Trump, the man who has chosen Kennedy for the HHS post."

READ MORE: 'Middle finger to science': Experts blast Trump’s 'single most important' healthy policy pick

Political analyst Bakari Sellers replied: "Wasn’t Donald Trump president at the time?"

The Cut election columnist Laura Bassett wrote: "Trump was president, so this is pretty awkward

The Economist defense editor Shashank Joshi added: "A government simultaneously cunning and effective enough to have clandestinely planned and executed the pandemic, but so fat and inefficient that it requires slashing by $2trn."

READ MORE: 'Republicans cannot block these nominees': Trump orders GOP Senate to 'hold the line' on Dem judges

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'Middle finger to science': Experts blast Trump’s 'single most important' healthy policy pick

Donald Trump announced on Tuesday that he nominates Dr. Mehmet Oz to lead the Centers for Medicare and Medicaid Services (CMS) Administrator.

Emphasizing, "America is facing a Healthcare Crisis," the president-elect wrote that "there may be no Physician more qualified and capable than Dr. Oz to Make America Healthy Again."

Health experts and journalists took to social media to mock the latest MAGA nomination.

READ MORE: 'Talk him out of it': Wall St. leaders expected to urge Trump to drop key campaign promise

KFF chief executive officer Drew Altman wrote: "The single most important position in health policy goes to… Dr Oz."

American Economic Liberties Project researcher Matt Stoller commented: "Dr. Oz is not a good pick for a very powerful position in charge of a trillion dollars+ of health care spending. He wants to privatize what's left of traditional Medicare and owns stock in a bunch of big health platform companies like United and CVS."

Philadelphia Inquirer columnist Will Bunch wrote: "We are all going to die."

Lawrence Gostin, O'Neill Chair in Global Health Law at Georgetown Law, added: "Dr Oz is unfit to run CMS. He peddles conspiracy theories on vaccines & fake cures. He profits from fringe medical ideas. By nominating RFK Jr & Mehmet Oz, Trump is giving his middle finger to science. Having worked for 40 years in public health, it's utterly disheartening."

READ MORE: 'Republicans cannot block these nominees': Trump orders GOP Senate to 'hold the line' on Dem judges

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'A lot of deaths': Health experts say RFK Jr. at HHS is 'a disaster waiting to happen'

President-elect Donald Trump has announced that conspiracy theorist and anti-vaccine activist Robert F. Kennedy Jr. will be his nominee to helm the Department of Heath and Human Services (HHS).

Kennedy — who ran as an independent in the 2024 presidential election before dropping out and endorsing Trump — was one of Trump's most visible surrogates in the final months of the campaign cycle, and Trump promised repeatedly to put him in a high-ranking role in his Cabinet overseeing public health. Scientists, health experts and journalists are all warning that putting Kennedy in charge of all U.S. health agencies will be harmful in myriad ways.

"RFK Jr. is one of the most dangerous, misguided, and hypocritical figures in the global 'wellness" movement,'" journalist Mike Rothschild wrote in a post to the social media platform Bluesky. "He has said that "there’s no vaccine that is safe and effective." He has no idea how science or chemistry work. This is a disaster waiting to happen."

READ MORE: (Opinion) If Trump puts RFK Jr. in charge of health, get ready for a distorted reality where global health suffers

Former U.S. Secretary of Labor Robert Reich observed that RFK Jr. — the nephew of former President John F. Kennedy — is likely to undermine his uncle's legacy, as he signed the Vaccination Assistance Act in 1962. And University of Michigan health professor Pam Herd warned that RFK Jr.'s documented opposition to childhood vaccines will create a significant risk to public health, and that future generations of children could be at risk of contracting diseases they would otherwise be protected from due to vaccines.

"The one part of the pandemic that Trump handled well was fast tracking the vaccine development," Herd wrote. "We now have someone in charge who's likely to generate new outbreaks (e.g. measles) and controls all the agencies (NIH, CDC, FDA) that are needed to address old and new outbreaks."

If he is confirmed, RFK Jr. would oversee agencies in charge of researching and developing new medicines and cures to disease. Northwestern University law professor Paul Gowder opined that there would be "a lot of deaths" if RFK Jr. was able to enact his agenda at HHS. Pulaski Institution CEO Alan Elrod lamented that all of that research may be at risk if Trump is successful in elevating RFK Jr.

"Truly remarkable what we are potentially set to squander as a nation," he wrote on Bluesky. "RFK will gut and degrade the most sophisticated public health research bodies in the world."

READ MORE: Experts worry RFK Jr's role in a Trump administration will 'erode' the 'nation's health'

Author Faine Greenwood — a researcher at the Signal Program at the Harvard Humanitarian Initiative — wasn't as convinced that RFK Jr. would be effective in dismantling public health institutions. Greenwood noted that the pharmaceutical industry has been "bathing in vast seas of money thanks to the MRNA revolution, and I do not see them letting Captain Brain Worms light that all on fire without a face-eating fight."

RFK Jr.'s nomination is jus the latest in a tumultuous week of announcements from the President-elect as he names his choices for his second term Cabinet. Dartmouth College political scientist Brendan Nyhan commented on the flurry of controversial nominations, like former Rep. Matt Gaetz (R-Fla.) for Attorney General, Fox News host Pete Hegseth for Secretary of Defense and former Rep. Tulsi Gabbard (D-Hawaii) for Director of National Intelligence.

"Just so we're clear on where we are: The President: an authoritarian who attempted a coup. A Secretary of Defense who defends war crimes. [An] Attorney General credibly accused of sex crimes A Director of National Intelligence who defends Putin and Assad. An HHS director who opposes vaccines," Nyhan wrote.

READ MORE: Veteran journalist blames Harris’ failure on 'corporate puppets' who 'stand for nothing'

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Economist Paul Krugman: How 'completely unaware' Vance is failing Trump miserably on a key issue

Under President Joe Biden, the Affordable Care Act of 2010, a.k.a. Obamacare, has enjoyed record enrollment and support. Yet 2024 GOP presidential nominee Donald Trump is once again hoping to see the ACA overturned.

During his September 10 debate with Democratic nominee Kamala Harris, Trump was asked if he had a plan for replacing or improving the ACA. And he responded, "I have concepts of a plan" — a line that, liberal economist Paul Krugman notes in a biting September 23 column for the New York Times, Trump has been "ridiculed, rightly" for.

Trump's running mate, Sen. JD Vance (R-Ohio), has tried to help Trump out on the health care issue. But Krugman argues that Vance is only making things worse for the former president.

READ MORE: 'Furious' Trump is panicked as MAGA becomes monster he no longer controls: analyst

Krugman points out that during a September 15 appearance on NBC News' "Meet the Press," Vance "called for deregulation, saying that we should 'promote some more choice in our health care system and not have a one-size-fits-all approach that puts a lot of people into the same insurance pools, into the same risk pools.'"

"Apart from anything else," Krugman observes, "he sounded like someone completely unaware of the history of health care economics and the reasons we ended up with the policies we have — someone who completely missed the debates that led to the creation of the ACA, a.k.a. Obamacare. We don't need to speculate about how his proposal, such as it is, would work, because we've seen this movie; that's exactly how health insurance worked before Obamacare went into effect in 2014, after which insurers were prevented from discriminating based on medical history."

The economist continues, "Under the pre-Obamacare system, insurers often refused to cover Americans with preexisting health conditions or required that they pay very high premiums — which meant that they effectively denied health care, in many instances, those who needed it most."

Krugman recalls that before Obamacare, "attempts to take care of Americans who couldn't get private insurance" via "government-subsidized high-risk pools" were "dismal failures: unaffordable, underfunded and covering only a small fraction of those needing help."

READ MORE: 'Worst and dumbest sentence': New Republic editor reveals key moment Trump lost the debate

The Times columnist writes, "Why would Vance stake out such an unpopular position, conveying the impression that he was speaking for Trump as well?... In any case, while Trump doesn't have a health care plan, Vance's remarks offer a pretty good preview of what he'll propose if he wins. It might be summed up, to borrow from the famous old Daily News headline, as: 'Trump to Sick Americans: Drop Dead.'"

READ MORE: Harris' new plan to lower housing costs hailed by experts: 'As monumental' as Obamacare

Paul Krugman's full New York Times column is available at this link (subscription required).


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Economist Paul Krugman slams Trump for failing miserably on a 'life-or-death issue'

During their 2024 presidential debate in Philadelphia's National Constitution Center on Tuesday night, September 10, Democratic nominee Kamala Harris relentlessly attacked her GOP rival, Donald Trump, on a variety of issues — from abortion to foreign policy to tariffs. The vice president also slammed Trump on health care, warning that he would like to abolish the Affordable Care Act of 2010, a.k.a. Obamacare, without having a viable alternative in mind.

Asked if he had a plan for replacing Obamacare, Trump replied, "I have concepts of a plan."

In a biting New York Times column published on September 12, liberal economist Paul Krugman argues that Trump's comments on healthcare during the debate underscore his weakness on a "life-or-death issue."

READ MORE: 'Worst and dumbest sentence': New Republic editor reveals key moment Trump lost the debate

"For policy wonks like me…. the most remarkable moment in the debate probably came when Trump was asked whether he had a plan for health care reform, and his answer was: 'I have concepts of a plan,'" Krugman explains. "Bear in mind that health care coverage is a crucial — in some cases, life-or-death — issue for many Americans. Furthermore, health care — unlike, say, grocery or gas prices — is an issue on which public policy can make a big difference."

Krugman continues, "In particular, the coming of the Affordable Care Act, a.k.a. Obamacare, led to a large decline in the percentage of Americans without health insurance and made an especially big difference for people with pre-existing conditions that might otherwise have made them uninsurable."

The economist goes on to say Trump has been "promising a superior alternative" to Obamacare since 2015 — and failed to come up with one.

"The only policy alternative he has ever proposed was 2017 legislation that would have more or less dismantled the ACA without a viable replacement — and which the Congressional Budget Office estimated would have increased the number of Americans without health insurance by 32 million within a few years," Krugman notes. "That legislation failed to pass the Senate — thanks in part to John McCain's bravery in breaking with his party — and helped Democrats gain the House of Representatives in 2018."

READ MORE: Trump faces increasing calls to participate in second debate

Trump, Krugman argues, is "blowing smoke" when he "claims to have even 'concepts'" for an Obamacare replacement.

Krugman writes, "So, am I saying that Trump has probably been faking it all along, that he has really never had an idea about how to improve on Obamacare? Why, yes."

READ MORE: Ex-Bush AG slams Trump’s 'serious threat to the rule of law' in bombshell Harris endorsement

Paul Krugman's full New York Times column is available at this link (subscription required).



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Walz is tackling a subject male politicians seldom 'talk openly about'

Sen. JD Vance's (R-Ohio) widely condemned "childless cat ladies" and "childless Democrats" rants of 2021 and 2022 not only deeply offended women who have decided against having kids — they also angered couples who have struggled with infertility. One of them is Minnesota Gov. Tim Walz, Vice President Kamala Harris' running mate, and his wife, Minnesota First Lady Gwen Walz.

Gov. Walz has told Vance to "mind your own damn business" when it comes to whether or not women decide to have kids — a decision that, Harris' running mate has stressed, is totally up to them. But the governor and his wife have also accused Vance of being insensitive to couples that have struggled with infertility.

Gwen Walz, at an "Educators for Harris-Walz" gathering on Friday, August 30, said of Vance, "Now, I read that JD Vance said he was really disturbed by teachers who don't have biological children. Well, for a long time, Tim and I were teachers who struggled with infertility, and we were only able to start a family because of fertility treatments. So, this is really personal for me, and I think it is for millions of Americans. We do not take kindly to folks like JD Vance telling us when or how to start our families."

READ MORE: Trump was reportedly 'stunned' and 'troubled' at wave of negative JD Vance coverage: report

During his speech at the 2024 Democratic National Convention in Chicago, Walz told attendees, "Even if you've never experienced the hell of infertility, I guarantee you know somebody who has. I remember praying each night for a call with good news, the pit in my stomach when the phone would ring, and the agony when we heard the treatments hadn't worked."

Salon's Nicole Karlis, in an article published on Labor Day 2024, notes that it's "unusual for a man in politics to talk openly about infertility" the way Gov. Walz is doing.

"Only recently has it become a more discussed topic, in part because it's difficult to separate from other discussions on reproductive rights, including abortion," Karlis observes. "As the nation witnessed in February of this year, the Alabama Supreme Court ruled that frozen embryos are 'extrauterine children' sending devastating ripple effects across the state halting IVF treatments. But experts and people who have experienced infertility directly tell Salon that one silver lining of IVF being in the limelight is that it continues to normalize and destigmatize infertility treatments."

Danette Kubanda, a mother of three who has undergone IVF (in vitro fertilization) treatments, is glad to see Tim Walz speaking out.

READ MORE: How 'Red Dawn conservatives' have formed anti-Trump alliance with 'educated suburban dads'

Kubanda told Salon, "Even though my little IVF miracles are now 11, 9 and 9, I am instantly transported back to those overwhelming feelings of despair, desperation and isolation that so many of us experience upon hearing our diagnosis. Seeing the emotion on his (Walz) and his son's faces reminded me how much these children are wanted and loved as we fought so hard to bring them into the world."

Dr. Roger Shedlin, CEO/founder of WIN, told Salon that Gov. Walz has "helped normalize the conversation" about infertility "by bringing it to a national stage in a new way."

Lauren Freeman, who underwent IVF treatments in 2020 and now has a three-year-old son, told Salon, "It's a monumental thing I went through, and I have found comfort when speaking with other women who share similar experiences. Hearing someone like Tim Walz be so open and vulnerable about him and his wife's infertility journey in such a public way is very validating and comforting."

READ MORE: Former Trump aid claims Melania is quietly rooting for Harris — here's why

Read Nicole Karlis' full report for Salon at this link.

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How a Texas program funnels millions to anti-abortion groups with little accountability

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

Year after year, while Roe v. Wade was the law of the land, Texas legislators passed measures limiting access to abortion — who could have one, how and where. And with the same cadence, they added millions of dollars to a program designed to discourage people from terminating pregnancies.

Their budget infusions for the Alternatives to Abortion program grew with almost every legislative session — first gradually, then dramatically — from $5 million starting in 2005 to $140 million after the U.S. Supreme Court overturned the right to an abortion.

Now that abortion is largely illegal in Texas, lawmakers say they have shifted the purpose of the program, and its millions of dollars, to supporting families affected by the state’s ban.

In the words of Rep. Jeff Leach, a Republican from Plano, the goal is to “provide the full support and resources of the state government … to come alongside of these thousands of women and their families who might find themselves with unexpected, unplanned pregnancies.”

But an investigation by ProPublica and CBS News found that the system that funnels a growing pot of state money to anti-abortion nonprofits has few safeguards and is riddled with waste.

Officials with the Health and Human Services Commission, which oversees the program, don’t know the specifics of how tens of millions of taxpayer dollars are being spent or whether that money is addressing families’ needs.

In some cases, taxpayers are paying these groups to distribute goods they obtained for free, allowing anti-abortion centers — which are often called “crisis pregnancy centers” and may be set up to look like clinics that perform abortions — to bill $14 to hand out a couple of donated diapers.

Distributing a single pamphlet can net the same $14 fee. The state has paid the charities millions to distribute such “educational materials” about topics including parenting and adoption; it can’t say exactly how many millions because it doesn’t collect data on the goods it’s paying for. State officials declined to provide examples of the materials by publication time, and reporters who visited pregnancy centers were turned away.

For years, Texas officials have failed to ensure spending is proper or productive.

They didn’t conduct an audit of the program in the wake of revelations in 2021 that a subcontractor had used taxpayer funds to operate a smoke shop and to buy land for hemp production.

They ramped up funding to the program in 2022 even after some contractors failed to meet their few targets for success.

After a legislative mandate passed in 2023, lawmakers ordered the commission to set up a system to measure the performance and impact of the program.

One year later, Health and Human Services says it’s “working to implement the provisions of the law.” Agency spokespeople answered some questions but declined interview requests. They said their main contractor, Texas Pregnancy Care Network, was responsible for most program oversight.

The nonprofit network receives the most funding of the program’s four contractors and oversees dozens of crisis pregnancy centers, faith-based groups and other charities that serve as subcontractors.

The network’s executive director, Nicole Neeley, said those subcontractors have broad freedom over how they spend revenue from the state. For example, they can save it or use it for building renovations.

Pregnancy Center of the Coastal Bend in Corpus Christi, for instance, built up a $1.6 million surplus from 2020 to 2022. Executive Director Jana Pinson said two years ago that she plans to use state funds to build a new facility. She did not respond to requests for comment. A ProPublica reporter visited the waterfront plot where that facility was planned and found an empty lot.

Because subcontractors are paid set fees for their services, Neeley said, “what they do with the dollars in their bank accounts is not connected” to the Thriving Texas Families program. “It is no longer taxpayer money.”

The state said those funds are, in fact, taxpayer money. “HHSC takes stewardship of taxpayer dollars, appropriated by the Legislature, very seriously by ensuring they are used for their intended purpose,” a spokesperson said.

None of that has caused lawmakers to stop the cash from flowing. In fact, last year they blocked requirements to ensure certain services were evidence-based.

Leach, one of the program’s most ardent supporters, said in an interview with ProPublica and CBS News that he would seek accountability “if taxpayer dollars aren’t being spent appropriately.” But he remained confident about the program, saying the state would keep investing in it. In fact, he said, “We’re going to double down.”

What’s more, lawmakers around the country are considering programs modeled on Alternatives to Abortion.

Last year, Tennessee lawmakers directed $20 million to fund crisis pregnancy centers and similar nonprofits. And Florida enacted a 6-week abortion ban while including in the same bill a $25 million allocation to support crisis pregnancy centers. John McNamara, a longtime leader of Texas Pregnancy Care Network, has been working to start similar networks in Kansas, Oklahoma and Iowa. He’s also reserved the name Louisiana Pregnancy Care Network.

And U.S. House Republicans are advocating for allowing federal dollars from the Temporary Assistance for Needy Families program — intended to help low-income families — to flow to pregnancy centers. In January, the House passed the legislation, and it is pending in the Senate. Rep. Elise Stefanik, R-N.Y., castigated Democrats for voting against the bill.

“That’s taking away diapers, that’s taking away resources from families who are in need,” she said in an interview with CBS News after the vote.

But, as Texas shows, more funding doesn’t necessarily pay for more diapers, formula or other support for families.

Lawmakers rebranded Alternatives to Abortion as Thriving Texas Families in 2023. The program is supposed to promote pregnancies, encourage family formation and increase economic self-sufficiency.

The state pays four contractors to run the program. The largest, which gets about 80% of the state funding, is the anti-abortion group Texas Pregnancy Care Network.

Human Coalition, which gets about 16% of the state funding, said it uses the money to provide clients with material goods, counseling, referrals to government assistance and education. Austin LifeCare, which gets about 3% of the state funding, could not be reached for comment about this story. Longview Wellness Center in East Texas, which receives less than 1% of the funds, said the state routinely audits its expenses to ensure it’s operating within guidelines.

Texas Pregnancy Care Network manages dozens of subcontractors that provide counseling and parenting classes and that distribute material aid such as diapers and formula. Parents must take a class or undergo counseling before they can get those goods.

The state can be charged $14 each time one of these subcontractors distributes items from one of several categories, including food, clothing and educational materials. That means the distribution of a couple of educational pamphlets could net the same $14 fee as a much pricier pack of diapers.

A single visit by a client to a subcontractor can result in multiple charges stacking up. Centers are eligible to collect the fees regardless of how many items are distributed or how much they are worth. One April morning, a client at McAllen Pregnancy Center, near the Texas-Mexico border, received a bag with some diapers, a baby outfit, a baby blanket, a pack of wipes, a baby brush, a snack and two pamphlets. It was not clear how much the center invoiced for these items.

McAllen Pregnancy Center and other Texas Pregnancy Care Network subcontractors were paid more than $54 million from 2021 to 2023 for distributing these items, according to records.

How much of that was for handing out pamphlets? The state said it didn’t know; it doesn’t collect data on the quantities or types of items provided to clients or whether they are essential items like diapers or just pamphlets, making it impossible for the public to know how tax dollars were spent.

Neeley said in an email that educational materials like pamphlets only accounted for 12% of the money reimbursed in this category last year, or roughly $2.4 million out of $20 million. She did not respond to questions from ProPublica and CBS News about evidence that would corroborate that number.

The way subcontractors are paid, and what they’re allowed to do with that money, raised questions among charity experts consulted for this investigation.

In the nonprofit sector, using a fee-for-service payment model for material assistance is highly unusual, said Vincent Francisco, a professor at the University of Kansas who has worked as a nonprofit administrator, evaluator and consultant over the past three decades. It “can run fast and loose if you’re not careful,” he said.

Even if nonprofits distribute items they got for free or close to it, the state will still reimburse them. Take Viola’s House, a pregnancy center and maternity home in Dallas. Records show that it pays a nearby diaper bank an administrative fee of $1,590 for about 120,000 diapers annually — just over a penny apiece. Viola’s House can then bill the state $14 for distributing a pack of diapers that cost the center just over a quarter.

But before they can get those diapers, parents must take a class. The center can also bill the state $30 for each hour of class a client attends.

Rep. Donna Howard, a Democrat from Austin, said the program could be more efficient if the state funded the diaper banks directly. Last year, she proposed diverting 2% of Thriving Texas Families’ funding directly to diaper banks, but the proposal failed.

Records show that in fiscal year 2023, Viola’s House received more than $1 million from the state in reimbursements for material support and educational items plus another $1.7 million for classes. Executive Director Thana Hickman-Simmons said Viola’s House relies on funding from an array of sources and that just a small fraction of the diapers it distributes come from the diaper bank. She said the state money “could never cover everything that we do.”

In some cases, reimbursements have created a hefty cushion in the budgets of subcontractors. The state doesn’t require them to spend the taxpayer funds they get on needy families, and Texas Pregnancy Care Network said subcontractors can spend the money as they see fit, as long as they follow Internal Revenue Service rules for nonprofits.

McAllen Pregnancy Center received $3.5 million in taxpayer money from Texas Pregnancy Care Network over three years, but it spent less than $1 million on program services, according to annual returns it filed with the IRS. Meanwhile, $2.1 million was added to the group’s assets, mostly in cash. Its executive director, Angie Arviso, asked a reporter who visited in person to submit questions in writing, but she never responded.

“This is a policy choice Texas has made,” said Samuel Brunson, associate dean for faculty research and development at the Loyola University Chicago School of Law, who researches and writes about the federal income tax and nonprofit organizations. “It has chosen to redistribute money from taxpayers to the reserve funds of private nonprofit organizations.”

Tax experts say that’s problematic. “Why would you give money to a recipient that is not spending it?” said Ge Bai, a professor of accounting and health policy at Johns Hopkins University.

The tax experts disagree with Texas Pregnancy Care Network’s argument that the money is no longer taxpayer dollars after its subcontractors are paid.

“It’s still the government buying something,” said Jason Coupet, associate professor of public management and policy at Georgia State University, who has studied efficiency in the public and nonprofit sectors. “If I were in the auditor’s office, that’s where I would start having questions.”

State legislators and regulators haven’t installed oversight protections in the program.

Three years ago, The Texas Tribune spotlighted the state’s refusal to track outcomes or seek insight into how subcontractors have spent taxpayer money.

Months later, Texas Pregnancy Care Network cut off funding to one of its biggest subcontractors after a San Antonio news outlet alleged the nonprofit had misspent money from the state.

KSAT-TV reported that the nonprofit, A New Life for a New Generation, had used Alternatives to Abortion funds for vacations and a motorcycle, and to fund a smoke shop business owned by the center’s president and CEO, Marquica Reed. It also spent $25,000 on land that was later registered by a member of Reed’s family to produce industrial hemp.

In an interview with ProPublica, a former case manager recalled how Reed would get angry if employees forgot to bill the state for a service provided to a client.

The former case manager, Bridgett Warren Campbell, said employees would buy diapers from the local Sam’s Club store, then take apart the packages. “We’d take the diapers out and give parents two to three diapers at a time, then she would bill TPCN,” said Campbell.

Reed declined to comment to a ProPublica reporter or to answer follow-up questions via email or text. Neeley, the Texas Pregnancy Care Network’s executive director, said the pregnancy center was removed from the program because its nonprofit status was in jeopardy, not because it had used money on personal spending. She said the network wasn’t responsible for monitoring how A New Life for a New Generation spent its dollars: “The power to investigate these matters of how nonprofits manage their own funds is reserved statutorily to the Texas Attorney General and the IRS.”

The Texas attorney general’s office would not say whether it has investigated the organization. Records show that after KSAT’s story, state officials referred the case to an inspector general and that the Texas Pregnancy Care Network submitted a report detailing how it monitored the subcontractor.

The state requires contractors to submit independent financial audits if they receive at least $750,000 in state money; Texas Pregnancy Care Network meets this threshold. However, its dozens of subcontractors don’t have to submit these audits — something experts in nonprofit practices said should be required. In the fiscal year before the alleged misspending came to light, A New Life for a New Generation received more than $1 million in reimbursements from the state, records show.

When ProPublica and CBS News asked how the Health and Human Services Commission detects fraud or misuse of taxpayer funds, Jennifer Ruffcorn, a commission spokesperson, said the agency “performs oversight through various methods, which may include fiscal, programmatic, and administrative monitoring, enhanced monitoring, desk reviews, financial reconciliations, on-site visits, and training and technical assistance.”

Through a spokesperson, Rob Ries, the deputy executive commissioner who oversees the program at Health and Human Services, declined to be interviewed.

The agency has never thoroughly evaluated the effectiveness of the program’s services in its nearly 20 years of existence.

It is supposed to make sure its contractors are meeting a few benchmarks: how many clients each one serves and how many they have referred to Medicaid and the Nurse-Family Partnership, a program that sends nurses to the homes of low-income first-time mothers and has been proven to reduce maternal deaths. The Nurse-Family Partnership does not receive Alternatives to Abortion funding.

In 2022, the Texas Pregnancy Care Network failed to meet two of three key benchmarks in its contract with the state: It didn’t serve enough clients and it didn’t refer enough of them to the nursing program. The state didn’t withhold or reduce its funding. McNamara disputed the first claim, saying the state changed its methodology for counting clients, and said the other benchmark was difficult to hit because too few clients qualified for the nursing program.

In May 2023, when lawmakers passed the bill rebranding the program, the state also ordered the agency to “identify indicators to measure the performance outcomes,” “require periodic reporting” and hire an outside party to conduct impact evaluations.

The agency declined to share details about its progress on those requirements except to say that it is soliciting for impact evaluation services. Records show the agency has requested bids.

Lawmakers decided last year against enacting requirements that would ensure certain services were evidence-based — proven by research to meet their goals — instead siding with an argument that they would be too onerous for smaller nonprofits.

Texas’ six-week abortion ban took effect in 2021, and more than 16,000 additional babies were born in the state the following year. Academics expect that trend to continue.

But the safety net for parents and babies is paper thin.

Texas has the lowest rate of insured women of reproductive age in the country and ranks above the national average for maternal deaths. It’s last in giving cash assistance to families living beneath the poverty line.

Mothers told reporters they are struggling to scrape together enough diapers and wipes to keep their babies clean. A San Antonio diaper bank has hundreds of families on its waitlist. Outside an Austin food pantry, lines snake around the block.

Howard, the Austin state representative, said ProPublica and CBS News’ findings show that the program needs more oversight. “It is unconscionable that a [Thriving Texas Families] provider would be allowed to keep millions in reserve when there is a tremendous need for more investment in access to health care services,” she said.

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Trump's health questioned by expert after his latest doctor refuses to reveal details

The most recent report on Donald Trump's health is being questioned by an expert on aging who would like to provide the public with answers about the "projected life span and health" of President Joe Biden and the former president who is making a third run for the Oval Office.

In a deep dive into the background of Trump's new doctor, Dr. Bruce A. Aronwald, a 64-year-old osteopathic physician, the Washington Post is reporting the New Jersey physician is a longtime member of the former president's Bedminster golf club who specializes in wealthy clients serving as a "concierge" doctor.

As the report from the Post's Michael Kranish notes, a central focus of the 2024 presidential election is the health of the 81-year-old Biden and the 77-year-old Trump, and details about Trump's health are severely lacking.

ALSO READ: A neuroscientist reveals how Trump and Biden's cognitive impairments are different

A November letter about Trump's health, written by Aronwald and released by the former president's campaign, stood in stark contrast to a White House report on Biden's health, with the Post reporting it lacked "specifics like blood pressure and medications, the letter had just three paragraphswithout specific numbers proclaiming that Trump was in 'excellent health' and had 'exceptional' cognitive ability. It did not disclose Trump’s weight."

An attempt by the Post to ask for more specifics was rebuffed after a visit to the doctor's office, with the doctor explaining, "There is no need for President Trump to release another medical report in addition to the one he recently made public. The President is strong physically and sharp cognitively, and he’s in excellent health overall.”

According to S. Jay Olshansky, "the lead author of a 2020 report in the journal Active Aging" on the relative health of Biden and Trump, there is not enough information to adequately address the former president's health status four years later.

"In his Nov. 23 letter about Trump’s health, Aronwald said he had conducted the most recent examination of Trump on Sept. 13, 2023. While not providing any specific numbers or names of prescription medication, Aronwald wrote that Trump’s 'overall health is excellent,' that his physical exams were 'well within the normal range and his cognitive exams were exceptional.' The letter also said that Trump’s cardiovascular studies were normal and cancer tests were negative," the report states.

According to aging expert Olshansky, "the full medical records are extraordinarily valuable. They tell a story about health prospects for survival going forward. You can’t really do a thorough assessment of life span and health span without the medical records.”

As for Aronwald, Ira Monka, the president of the American Osteopathic Association, stated he is well regarded in his field, telling the Post, his colleague is a "top concierge doctor," adding, "You get to that point, you could not get there if you were not a solid fundamentally strong primary care doctor.”

You can read more here.

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Economist Paul Krugman: 'Millions of Americans' will lose healthcare if Trump wins

The United States remains the only major developed country that lacks universal healthcare. But thanks to the Affordable Care Act of 2010, a.k.a. Obamacare, the number of Americans without health insurance is much lower than what it was 15 or 20 years ago.

On Wednesday, October 24, the Biden Administration announced that more than 21 million Americans signed up for health plans for 2024 via the ACA's insurance marketplaces. Obamacare is enjoying record enrollment at a time when 2024 GOP presidential frontrunner Donald Trump is once again threatening to abolish it.

In an official statement, President Joe Biden, declared, "The American people have made it clear: they don't want the Affordable Care Act weakened and repealed — they want it strengthened and protected."

POLL: Should Trump be allowed to hold office again?

Liberal economist Paul Krugman, in his January 25 column for the New York Times, argues that Biden "deserves some political reward" for increasing Obamacare enrollment and warns that Trump will try to kill the increasingly popular program if he wins the 2024 presidential election.

Although the ACA, Krugman writes, still has some room for improvement, it has "led to big gains in health insurance coverage."

"Trump tried but failed to repeal Obamacare in 2017, and the backlash to that effort helped Democrats win control of the House the next year," Krugman explains. "Trump was nonetheless able to create some erosion in the program — for example, by cutting off funds for 'navigators' that help people enroll."

The economist continues, "That erosion has now been decisively reversed.… America still doesn't have the universal coverage that is standard in other wealthy nations, but some states, including Massachusetts and New York, have gotten close. And this gain, unlike some of the other good things happening, is all on Biden, who both restored aid to people seeking health coverage and enhanced a key aspect of the system."

READ MORE: Trump's call to repeal Obamacare blasted as 'outlandish' as signups hit new record high

Krugman goes on to say that health care needs to be a "big issue in the 2024 election."

"Biden has made health insurance coverage more accessible and more affordable for millions of Americans," Krugman argues. "If Trump wins, however, he will try again to do away with Obamacare; he has said as much, and this time, he could very well succeed. He promises to replace it with something 'MUCH BETTER.'"

The Times columnist continues, "I guess this depends on your definition of better. In 2017, the Congressional Budget Office estimated that Trump's health plan would raise the number of uninsured by 32 million within a decade; that number would probably be larger today. So, one more reminder of how much is at stake this year."

READ MORE: 'Wrongheaded campaign': Why Trump's latest proposal is an 'unequivocal boon to Democrats'

Paul Krugman's full New York Times column is available at this link (subscription required).


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Mary Lou Retton’s explanation of health insurance takes some somersaults

Former Olympic gymnast Mary Lou Retton spoke out last week on the NBC “Today” show about what she said was a rare pneumonia that almost killed her and resulted in an expensive, monthlong hospital stay. It was a shocking reveal. One key comment jumped out for those who follow health policy: Retton said she was uninsured, blaming that lack of coverage on 30 orthopedic surgeries that count as “preexisting conditions,” a divorce, and her poor finances. “I just couldn’t afford it,” Retton told host Hoda Kotb, who did not challenge the assertion. Retton, who after winning the gold medal in 1984 beca...

‘I am just waiting to die’: Social Security clawbacks drive some into homelessness

More than a year after the federal government first cut off her disability benefits, Denise Woods drives nightly to strip malls, truck stops, and parking lots around Savannah, Georgia, looking for a safe place to sleep in her Chevy. Woods, 51, said she had rented a three-bedroom house she shared with her adult son and grandson until March 2022, when the government terminated her disability payments without notice. According to letters sent by the Social Security Administration, the agency determined it had been overpaying Woods and demanded she send back nearly $58,000. Woods couldn’t come up ...

Why the CDC has recommended new Covid boosters for all

Everyone over the age of 6 months should get the latest covid-19 booster, a federal expert panel recommended Tuesday after hearing an estimate that universal vaccination could prevent 100,000 more hospitalizations each year than if only the elderly were vaccinated. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted 13-1 for the motion after months of debate about whether to limit its recommendation to high-risk groups. A day earlier, the FDA approved the new booster, stating it was safe and effective at protecting against the covid variants curr...

Marjorie Taylor Greene: God is punishing 'brainwashed' Burning Man attendees

United States Representative Marjorie Taylor Greene (R-Georgia) suggested to Info Wars' chief conspiracy theorist Alex Jones on Sunday that attendees trapped in mud at the annual Burning Man electronic music festival are being punished by "God" and "brainwashed" to blame climate change for the freak flooding that struck the event over the weekend.

"But I really believe that the next thing is going to be this climate change crisis. They're going to create it into an emergency and Alex I wanna talk about Burning Man for a minute. We are watching, you know, from a distance, there are approximately like 73 or 75,000 people in Nevada..." Greene began, though Jones quickly interrupted.

"And they're locked in there from the floods, and I'm glad, I look, I, I, just was gonna raise that," Jones said. "They literally did a mock sacrifice and all this and then it flooded with these tornadoes. And it was — sorry. Go ahead."

POLL: Should Trump be allowed to hold office again?

Greene proceeded, "Well, you know, God has a way of making sure everyone knows who God is. I'll say that about that. But let's talk about what is happening with these people. So, there's 73-75,000 in the Nevada desert right now at this Burning Man. They're locked in. They're not allowed to leave and they're basically probably being brainwashed that climate change is the cause of it, it's the root of all evil, and it's going to destroy the Earth. And they're, they're feeling the panic."

Jones claimed in response, "The media is saying that. 'Oh, this is because you didn't know about climate change.'"

Greene continued, "Yes. So, what's going to happen, Alex? It's the same thing, the same way they launch any kind of movement. After this is over at Burning Man, and these 75,000 people disperse and they go back home, they're gonna have these stories to tell about how terrible it is and how we have to do everything possible to stop climate change, it's caused by humans, and it's carbon. And it's the amount of carbon we put out. It's manufacturing. It's our, it's our gas and diesel engines. It's, it's, you know, agriculture. I mean, you know, AOC wants to get rid of cattle. Even population. 'We have too many humans putting out too much carbon.' You're going to start hearing all this stuff and this is going to build. And I believe this is the left's new lie they're going to put on the American people and try to get everyone behind and create it to where, 'Remember AOC and the left and many others saying that the Earth is going to literally explode in a ball of fire. We're gonna all die. It's gonna be the end of the world?' This is what they're brainwashing people to believe."

Jones added, "2030. I totally agree, and now Biden says he's set to announce a new climate emergency that Klaus Schwab said three years ago they'd do after COVID. So they literally cut our resources off and make it fancy."

READ MORE: Marjorie Taylor Greene sums up the GOP's cognitive dissonance on climate change in a single tweet

Greene and Jones then exchanged debunked ideas about what is destabilizing planetary climate systems.

"Well, let's be realistic though. The climate changes. It's been changing since the beginning of time," Greene asserted. "Since God created the Earth, the climate has changed. And that is the reality because we live on — our planet is, is, is moving. It's rotating through our galaxy."

Jones interjected, "The only constant is change."

Greene pressed on, "It always changes. It rotates around the Sun. It moves through the galaxy. Our galaxy rotates through the universe. Of course, our climate is going to change! But does that mean people are causing it? No. Does that mean we have to raise taxes to stop it? No, absolutely not. Does that mean we have to bow down to a globalist government? Absolutely not."

READ MORE: Marjorie Taylor Greene calls Muslims 'snakes' in misleading tweet about protests in France

Jones joked, "As if they can stop it anyways."

Greene concurred, "They can't stop it."

Jones concluded, "It's all the Sun, as you said, so."

According to the National Aeronautics and Space Administration:

The Sun can influence Earth's climate, but it isn't responsible for the warming trend we’ve seen over recent decades. The Sun is a giver of life; it helps keep the planet warm enough for us to survive. We know subtle changes in Earth's orbit around the Sun are responsible for the comings and goings of the ice ages. But the warming we've seen in recent decades is too rapid to be linked to changes in Earth's orbit and too large to be caused by solar activity.

One of the 'smoking guns' that tells us the Sun is not causing global warming comes from looking at the amount of solar energy that hits the top of the atmosphere. Since 1978, scientists have been tracking this using sensors on satellites, which tell us that there has been no upward trend in the amount of solar energy reaching our planet.

A second smoking gun is that if the Sun were responsible for global warming, we would expect to see warming throughout all layers of the atmosphere, from the surface to the upper atmosphere (stratosphere). But what we actually see is warming at the surface and cooling in the stratosphere. This is consistent with the warming being caused by a buildup of heat-trapping gases near Earth's surface, and not by the Sun getting 'hotter.'

Watch the clip below or at this link.

READ MORE: MTG’s boyfriend slams opponents as 'classless trash' after Iowa and Georgia voters give her the finger

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Trump recalls presidency as a 'fantastic time' when 'everything worked'

Former President Donald Trump reminisced about his White House tenure on Sunday, gloating in a post to his Truth Social microblogging platform that his single term was a "fantastic time" when "everything worked" for the American people.

Trump wrote at 9:14 a.m.:

Great poll numbers because people want a return to the Trump years when everything worked, the Border was the strongest ever, no Inflation, jobs, jobs, jobs, Energy Independent and soon Dominant, low taxes and regulations, strong military, no Russia and Ukraine, no China and their threats. We defeated 100% of the ISIS Kalifat. Greatest economy EVER. What a fantastic time for America. BRING BACK THE REAL USA. Bring back strength, bring back TRUMP!

On October 8th, 2021, FactCheck.org published its final report card on Trump's presidency, and his claims today do not align with the data:

  • The economy lost 2.9 million jobs. The unemployment rate increased by 1.6 percentage points to 6.3%.
  • Paychecks grew faster than inflation. Average weekly earnings for all workers were up 8.7% after inflation.
  • After-tax corporate profits went up, and the stock market set new records. The S&P 500 index rose 67.8%.
  • The international trade deficit Trump promised to reduce went up. The US trade deficit in goods and services in 2020 was the highest since 2008 and increased 40.5% from 2016.
  • The number of people lacking health insurance rose by 3 million.
  • The federal debt held by the public went up, from $14.4 trillion to $21.6 trillion.
  • Home prices rose 27.5%, and the homeownership rate increased 2.1 percentage points to 65.8%.
  • Illegal immigration increased. Apprehensions at the Southwest border rose 14.7% last year compared with 2016.
  • Coal production declined 26.5%, and coal-mining jobs dropped by 16.7%. Carbon emissions from energy consumption dropped 11.5%.
  • Handgun production rose 12.5% last year compared with 2016, setting a new record.
  • The murder rate last year rose to the highest level since 1997.
  • Trump filled one-third of the Supreme Court, nearly 30% of the appellate court seats and a quarter of District Court seats.

POLL: Should Trump be allowed to hold office again?

Trump's assertion that "we defeated 100% of the ISIS Kalifat" (which he misspelled) is questionable, based upon conflicting remarks from Trump. Roll Call noted in 2019 that after Trump twice tweeted that the ISIS caliphate had been annihilated, he privately acknowledged that the real figure was "70 percent."

Meanwhile, FactCheck stressed in its review that "even before the COVID-19 pandemic, the US economy began slowing down. The real (inflation-adjusted) gross domestic product went up in Trump's first two years, peaking at an estimated 2.9% in 2018 — the highest since 2005. But the economy grew only 2.3% in 2019 and the bottom fell out in 2020. The real GDP declined 3.4% in 2020 from the previous year. It was the largest drop since 1947, when the nation's economy declined 11.6% after years of economic expansion fueled by World War II. As a candidate and president, Trump promised the nation's economy would grow on an annual basis by 4% to 6%. But it never topped 3%."

FactCheck pointed out that "murders and aggravated assaults shot up dramatically under Trump, while most other types of crime declined. In his inaugural address, Trump darkly portrayed America as a country mired in poverty, drugs and crime. 'This American carnage stops right here and stops right now,' he promised. But quite the contrary, the FBI's annual Crime in the United States report, released Sept. 27, shows 4,157 more homicides were committed in 2020 than in 2016, when Trump was elected. That translates to a murder rate per 100,000 people of 6.5 in 2020, an increase of 1.1 points since 2016. The 2020 rate was the highest since 1997, though still well below the peak 10.2 rate recorded in 1980."

READ MORE: Bob Woodward: Trump’s 'failure to protect the people' showed he views 'democracy as enemy territory'

Moreover, the national debt ballooned by nearly $8 trillion under Trump, despite his campaign pledge to eliminate it.

"Trump made no progress in erasing the debt, which the then-presidential candidate once said he could probably do in eight years," per FactCheck. "Rather, the amount the federal government has borrowed from the public went up by 50% during Trump's time in office — from $14.4 trillion on the day he was inaugurated to $21.6 trillion the day his successor was sworn in. Likewise, the debt as a percentage of the economy also grew under Trump, rising from 76.2% of GDP in fiscal year 2016 to 100.1% of GDP in fiscal year 2020, according to figures from the Office of Management and Budget."

Trump was also impeached. Twice.

The first time was for his 2019 attempt to coax Ukrainian President Volodymyr Zelenskyy into providing damaging information on then-Democratic presidential candidate Joe Biden. The second occurred following Trump's incitement of the deadly January 6th, 2021 insurrection at the United States Capitol after he lost the 2020 election. For that, in 2023, Trump would become the first commander-in-chief to be indicted for allegedly running a criminal conspiracy to topple the federal government and remain in power.

READ MORE: Trump’s Truth Social merger facing 'catastrophic threat' as deadline looms: report

View FactCheck's assessment at this link. Roll Call's is here.

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How Ron DeSantis is taking advantage of Hurricane Idalia

The way that Florida Governor Ron DeSantis portrayed himself managing the response to Hurricane Idalia's impact on the Sunshine State could provide his distressed 2024 White House bid its "best opportunity for a reset," according to a Saturday analysis by Emily Mahony of The Tampa Bay Times

Through "a photo of him sitting in a Florida-style Situation Room," an appearance on Fox News, and an "on-camera interview with Weather Channel meteorologist Jim Cantore," DeSantis crafted "a snapshot of an executive hard at work during a crisis," Mahoney writes, noting, "They are also a departure from the churn of news about his struggling presidential campaign. Hurricane Idalia may provide DeSantis with the best opportunity for a reset yet, after weeks of more artificial ones attempted by his campaign, including staff shakeups and messaging pivots."

Mahoney explains that "all the free media coverage of DeSantis during the storm added up to the equivalent of $17 million worth of paid ad time, according to The Messenger, which cited a media tracking service. That TV time is even more crucial after DeSantis' campaign burned through much of its cash in the second quarter of this year, prompting his operation to rely heavily on a super PAC with the ability to raise unlimited funds."

POLL: Should Trump be allowed to hold office again?

As pro-DeSantis political action committees were "quietly at work" finalizing plans for an "ad blitz in Iowa and New Hampshire between Labor Day and Halloween," Mahoney continues, "Idalia provided a respite from negative coverage" of DeSantis' attempt to secure the Republican Party's nomination.

And while "how much it gives him a positive boost remains to be seen," Mahoney says, "it wouldn't be the first time" that a natural disaster has benefited DeSantis.

"Last year during his reelection bid, the catastrophic Hurricane Ian was largely viewed as the knockout hit to the campaign of his longshot Democratic challenger, Charlie Crist. After that storm, DeSantis held a news conference with President Joe Biden, during which the Democratic president praised DeSantis’ response, leaving Crist with little room to criticize the governor," Mahoney recalls.

"Of course, the dynamics of 2024 are far from comparable to DeSantis' 2022 reelection, when he was the heavy favorite and at one point had more than 80 times more campaign money than his opponent," Mahoney adds, stressing, "This time, DeSantis is running from far behind, with former President Donald Trump dominating the Republican primary field.

READ MORE: DeSantis’ school voucher program gives parents taxpayer dollars for PlayStations and paddleboards

View Mahoney's full report at this link.

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Artificial intelligence may influence whether you can get pain medication

Elizabeth Amirault had never heard of a Narx Score. But she said she learned last year the tool had been used to track her medication use. During an August 2022 visit to a hospital in Fort Wayne, Indiana, Amirault told a nurse practitioner she was in severe pain, she said. She received a puzzling response. “Your Narx Score is so high, I can’t give you any narcotics,” she recalled the man saying, as she waited for an MRI before a hip replacement. Tools like Narx Scores are used to help medical providers review controlled substance prescriptions. They influence, and can limit, the prescribing of...

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