Bill of the Month: Critically ill woman skips ER after spouse’s costly stitches : Shots

Jason Dean received six stitches and a tetanus shot after he cut his knee in May. In August, his wife, DeeAnn, feared going to the same emergency room where he was treated, delaying her diagnosis of Rocky Mountain spotted fever.

Blake Farmer/WPLN News


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Blake Farmer/WPLN News


Jason Dean received six stitches and a tetanus shot after he cut his knee in May. In August, his wife, DeeAnn, feared going to the same emergency room where he was treated, delaying her diagnosis of Rocky Mountain spotted fever.

Blake Farmer/WPLN News

Jason and DeeAnn Dean recently relocated to her hometown of Dellrose, Tenn., where she grew up on a farm. Both in their late 40s, they’re trying to start a green dream business that combines organic farming with a health and wellness consulting company. They want to inspire people to grow their own food in this fertile rolling farmland just north of the border with Alabama.

Until the business fully launches, Jason is working in construction. In May, he was injured on the job site when a piece of sheet metal slipped and caught him on the kneecap. He bled quite a bit. After closing the wound with a butterfly bandage, he thought that might be enough. But on his drive home, he figured it would be best to have a professional stitch it up.

It was late in the day, and the emergency room seemed the best option since his doctor’s office was closed. He and DeeAnn had opted for a health plan with lower monthly payments and a high deductible. So he knew the cost of care wouldn’t be cheap — and he was right. When the bills for thousands of dollars came, they were shocked. They were in the midst of fighting them in August when DeeAnn started feeling as bad as she has ever felt.

“I haven’t eaten. I’m not drinking. I have a horrible fever. I can’t get out of bed. I’m shaking,” she said.

She was pretty sure she had contracted COVID-19 — the delta variant was surging across the South. She was kicking herself for putting off vaccination. She got tested and the result was negative. The next day, she visited a doctor who said her condition was bad enough to go to the ER — but she regarded that option as financially perilous.

“That is fear,” said DeeAnn. “If they charged Jason this much, what would they charge me?”

She was terrified of a potential bill from the same ER in Pulaski, Tenn., that had treated her husband. So even though she was deliriously ill, she hit the road in search of cheaper treatment, asking her parents to drive her. They headed south. The first stop was an ER in Huntsville, Ala., but it was so full of COVID-19 patients that she would have had to wait all day. Then they drove north nearly an hour to Maury Regional Medical Center, a public hospital in Columbia, Tenn., where she was

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Biden’s plan to add dental coverage to Medicare faces pushback : Shots

Like many seniors, William Stork of Cedar Hill, Mo., lacks dental insurance and doesn’t want to pay $1,000 for a tooth extraction he needs. Health advocates see President Biden’s Build Back Better agenda as a once-in-a-generation opportunity to provide dental coverage to people like Stork who are on Medicare. An unlikely adversary: the American Dental Association.

Joe Martinez for Kaiser Health News


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Joe Martinez for Kaiser Health News


Like many seniors, William Stork of Cedar Hill, Mo., lacks dental insurance and doesn’t want to pay $1,000 for a tooth extraction he needs. Health advocates see President Biden’s Build Back Better agenda as a once-in-a-generation opportunity to provide dental coverage to people like Stork who are on Medicare. An unlikely adversary: the American Dental Association.

Joe Martinez for Kaiser Health News

William Stork needs a tooth out. That’s what the 71-year-old retired truck driver’s dentist told him during a recent checkup.

That kind of extraction requires an oral surgeon, which could cost him around $1,000 because, like most seniors, Stork does not have dental insurance, and Medicare won’t cover his dental bills. Between Social Security and his pension from the Teamsters union, Stork says, he is able to live comfortably in Cedar Hill, Mo., about 30 miles southwest of St. Louis.

But that $1,000 cost is significant enough that he has decided to wait until the tooth absolutely must come out.

Stork’s predicament is at the heart of a long-simmering rift within the dental profession that has reemerged as a battle over how to add dental coverage to Medicare, the public insurance program for people 65 and older — if a benefit can pass at all.

A once-in-a-generation opportunity

Health equity advocates see President Biden’s Build Back Better agenda as a once-in-a-generation opportunity to provide dental coverage for those on Medicare, nearly half of whom did not visit a dentist in 2018 — well before the pandemic paused dental appointments for many people. The rates were even higher for Black (68%), Hispanic (61%) and low-income (73%) seniors.

The coverage was left out of a new framework announced by Biden on Thursday, but proponents still hope they can get the coverage in a final agreement. Complicating their push is a debate over how many of the nation’s more than 60 million Medicare beneficiaries should receive it.

Advocates of dental coverage for everyone on Medicare find themselves up against an unlikely adversary: the American Dental Association, which is backing an alternative plan that would give dental benefits only to low-income Medicare recipients.

Medicare has excluded dental (and vision and hearing) coverage since its inception in 1965. That exclusion was by design: The dental profession has long fought to keep itself separate from the traditional medical system in order to preserve the field’s autonomy.

Dental care and health are intertwined

More recently, however, dentists have stressed the link between oral and overall health. Most infamously, the 2007 death of a 12-year-old boy that might have been prevented by an $80

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Filipino American caregivers reflect on COVID trauma and healing : Shots

Left to right: Filipino American health care workers Karen Cantor, Karen Shoker, and John Paul Atienza were among many who cared for COVID patients in the early days of the pandemic.

Rosem Morton


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Rosem Morton


Left to right: Filipino American health care workers Karen Cantor, Karen Shoker, and John Paul Atienza were among many who cared for COVID patients in the early days of the pandemic.

Rosem Morton

In the spring of 2020 Glenn Magpili, 42, got sick with COVID. The first wave of the pandemic had flooded New York area hospitals and Magpili, an emergency room nurse in Manhattan, fell ill in the same hospital where he’d been caring for patients sick with the coronavirus. Then, he was intubated.

“When I woke up, I thought I was just asleep for a couple of days,” he recalls. “They told me it was almost four weeks.”

Magpili recovered but counts himself “one of the lucky ones. There were so many Filipino nurses who got sick,” he says.

I work as a nurse, too — I was born in Manila and immigrated to the U.S. with my family when my mom was recruited to teach here. I was 16. My interest in caring and service led me to nursing; my interest in storytelling led me to photography.

For Filipino Americans like Magpili and me working in all aspects of health care, being so close to a new and devastating virus in the early days of the pandemic has taken a disproportionate toll.

Filipinos and Filipino Americans make up just 4% of registered nurses in the U.S., but account for nearly a third of all COVID-related deaths among registered nurses, according to one study.

The history of Filipino nurses working in the U.S. goes back many decades as Americans established U.S.-style nursing schools in the Philippines during the U.S. occupation and colonization of the early 1900s. When the U.S. has faced nursing shortages after World War II and more recently, Filipinos have answered the call.

And it’s not just nurses. Doctors, respiratory and physical therapists and other health workers from the Philippines have come to the U.S. for medical training and jobs. When the pandemic happened, I knew my Filipino community would be heavily affected. Many of us ended up on the front lines caring for critical COVID-19 patients while watching colleagues and family members fall sick.

I want Filipinos to be seen beyond the statistics. I want people to see their faces, hear their diverse stories and learn about their sacrifices. It is important. These are people who have always contributed to the health and wellness of this country.

Here are some of their stories from the first devastating surge in New York City — and how they made it through. We’ve edited the conversations for length and clarity.

Bea Leal
Bea Leal

Dr. Bea Leal, 33, internal medicine physician

I grew up in the Philippines in a family of doctors. My mom, my mom’s sisters, my cousins and my

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Rise of syphilis in the U.S reflects neglect of long-term public health funding : Shots

Mai Yang, a communicable disease specialist, searches for Angelica, a 27 year-old pregnant woman who tested positive for syphilis, in order to get her treated before she delivers her baby.

Talia Herman for ProPublica


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Talia Herman for ProPublica


Mai Yang, a communicable disease specialist, searches for Angelica, a 27 year-old pregnant woman who tested positive for syphilis, in order to get her treated before she delivers her baby.

Talia Herman for ProPublica

When Mai Yang is looking for a patient, she travels light. She dresses deliberately — not too formal, so she won’t be mistaken for a police officer; not too casual, so people will look past her tiny 4-foot-10 stature and youthful face and trust her with sensitive health information. Always, she wears closed-toed shoes, “just in case I need to run.”

This story comes from ProPublica, a nonprofit newsroom that investigates abuses of power. Sign up to receive their biggest stories as soon as they’re published.

Yang carries a stack of cards issued by the Centers for Disease Control and Prevention that show what happens when the Treponema pallidum bacteria invades a patient’s body. There’s a photo of an angry red sore on a penis. There’s one of a tongue, marred by mucus-lined lesions. And there’s one of a newborn baby, its belly, torso and thighs dotted in a rash, its mouth open, as if caught midcry.

It was because of the prospect of one such baby that Yang found herself walking through a homeless encampment on a blazing July day in Huron, Calif., an hour’s drive southwest of her office at the Fresno County Department of Public Health.

She was looking for a pregnant woman named Angelica, whose visit to a community clinic had triggered a report to the health department’s sexually transmitted disease program. Angelica had tested positive for syphilis. If she was not treated, her baby could end up like the one in the picture or worse — there was a 40% chance the baby would die.

Yang knew, though, that if she helped Angelica get treated with three weekly shots of penicillin at least 30 days before she gave birth, it was likely that the infection would be wiped out and her baby would be born without any symptoms at all. Every case of congenital syphilis, when a baby is born with the disease, is avoidable. Each is considered a “sentinel event,” a warning that the public health system is failing.

The alarms are now clamoring. In the United States, more than 129,800 syphilis cases were recorded in 2019, double the case count of five years prior. In the same time period, cases of congenital syphilis quadrupled: 1,870 babies were born with the disease; 128 died. Case counts from 2020 are still being finalized, but the CDC has said that reported cases of congenital syphilis have already exceeded the prior year. Black, Hispanic and Native American babies are disproportionately at risk.

Yang drives to Huron, a rural town an hour

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How to find the best health insurance plan for you and your family : Shots

A long document labeled "health insurance" turns into waves as the document stretches across the screen. Two people in a small boat ride the "waves" of the document, fishing for the jargon like "deductible" and "copayment."

If you’re buying health insurance outside a job-based plan, you’re in luck this fall. After years of cutbacks and — some say sabotage — of the Affordable Care Act during the Trump administration, the Biden administration is pulling out the stops to help people find good health plans on HealthCare.gov right now — the open enrollment period starts this week. You will have more time to sign up, more free help choosing a plan, and a greater likelihood you’ll be eligible for subsidies to help keep down the costs of a health plan you buy via the ACA marketplace.

Still, picking health insurance can be hard work, even if you’re choosing a plan through your employer. There are a lot of confusing terms, and the process forces you to think hard about your health and your finances. Plus you have to navigate all of it on a deadline, often with only a few-week period to explore your options and make decisions.

Whether you’re aging out of your parent’s plan and picking one for the first time, or you’re in a plan that no longer works for you and you’re ready to switch things up, or you’re uninsured and want to see if you have any workable options, there’s good news. Asking yourself a few simple questions can help you zero in on the right plan from all those on the market.

Here are some tips on where to look and how to get trustworthy advice and help if you need it.

Tip #1: Know where to go

It’s not always obvious where to look for health insurance. “In this country it is a truly wacky patchwork quilt of options,” says Sabrina Corlette, who co-directs the Center on Health Insurance Reform at Georgetown University.

If you’re 65 or older, you’re eligible for Medicare. It’s a federally run program — the government pays for much of your health care. You might also be eligible if you have certain disabilities. For those already enrolled in Medicare or in a Medicare Advantage plan, the open enrollment period to switch up your supplemental health and prescription drug plans for 2022 runs through Dec. 7 this year.

For those under age 65, Corlette says, “the vast majority of us get our coverage through our employer. The employer typically will cover between 70% and 90% of your premium costs, which is pretty nice.” Check with your supervisor or your company’s human resources department to find out what, if any, plans are available to you through your job.

Then there’s Medicaid, the health insurance program for people with low incomes, that covers around 80 million people — nearly one in four Americans. It’s funded by both the federal and state governments, but run by each state, so whether you’re eligible depends on where you live.

For practically everyone else, the place to go is Healthcare.gov, where you can shop for insurance in the marketplaces created by the Affordable Care Act, also known

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Once practically empty, ERs struggle with a surge of pent-up sickness : Shots

An ambulance crew weaves a gurney through the halls of Sparrow Hospital’s emergency department in Lansing, Michigan. Overcrowding has forced the staff to triage patients, putting some in the waiting rooms and treating others on stretchers and chairs in the halls.

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Lester Graham/Michigan Radio


An ambulance crew weaves a gurney through the halls of Sparrow Hospital’s emergency department in Lansing, Michigan. Overcrowding has forced the staff to triage patients, putting some in the waiting rooms and treating others on stretchers and chairs in the halls.

Lester Graham/Michigan Radio

Inside the emergency department at Sparrow Hospital in Lansing, Mich., staff members are struggling to care for patients who are showing up much sicker than they’ve ever seen.

Tiffani Dusang, the emergency room’s nursing director, practically vibrates with pent-up anxiety, looking at all the patients lying on a long line of stretchers pushed up against the beige walls of the hospital’s hallways. “It’s hard to watch,” she says in her warm Texan twang.

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But there’s nothing she can do. The ER’s 72 rooms are already filled.

“I always feel very, very bad when I walk down the hallway and see that people are in pain or needing to sleep or needing quiet. But they have to be in the hallway with, as you can see, 10 or 15 people walking by every minute.”

It’s a stark contrast to where this emergency department — and thousands others — were at the start of the coronavirus pandemic. Except for initial hot spots like New York City, many ERs across the U.S. were often eerily empty in the spring of 2020. Terrified of contracting COVID-19, people who were sick with other things did their best to stay away from hospitals. Visits to emergency departments dropped to half their normal levels, according to the Epic Health Research Network, and didn’t fully rebound until the summer of 2021.

But now, they’re too full. Even in parts of the country where COVID-19 isn’t overwhelming the health system, patients are showing up to the ER sicker than they were before the pandemic, their diseases more advanced and in need of more complicated care.

Months of treatment delays have exacerbated chronic conditions and worsened symptoms. Doctors and nurses say the severity of illness ranges widely and includes abdominal pain, respiratory problems, blood clots, heart conditions and suicide attempts, among others.

Tiffani Dusang is the director of emergency and forensic nursing at Sparrow Hospital. As overworked nurses leave, she struggles to staff every shift and works hard to keep remaining nurses from burning out.

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Tiffani Dusang is the director of emergency and forensic nursing at Sparrow Hospital. As overworked nurses leave, she struggles to staff every shift and works hard to keep remaining nurses from burning out.

Lester Graham/Michigan Radio

But there’s nowhere to put them all. Emergency departments are ideally meant to be brief ports in a storm, with patients staying just

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