Louisiana Legislature examines proposal to offer TOPS to some medical students
Louisiana students who qualify for TOPS tuition awards but attend college out of state could still get that money if they decide to return home for medical or dental school. The legislature is considering a measure to lure them back home, but with conditions.
House Bill 275 by Rep. Stephanie Berault, R-Slidell, would require those students to pay back the aid unless they work full time in their field in Louisiana for at least three consecutive years after graduation.
The proposal is aimed at addressing a physician shortage in Louisiana, where the Cicero Institute reports 60 out of 64 parishes have a shortage of health care professionals.
The bill has the support of Gov. Jeff Landry and was unanimously approved Wednesday by the House Education Committee.
TOPS, short for the Taylor Opportunity Program for Students, is a merit-based scholarship program that helps Louisiana students attend in-state colleges and universities.
About 34 new medical and dental school students each year will qualify for TOPS under the legislation, according to a cost estimate for the bill. The cost will gradually increase over four years, when it is forecasted to level out at about $1.3 million annually.
Berault has also proposed House Bill 539, which would create a student loan repayment program for doctors who practice in Louisiana's rural areas. It has not yet been scheduled for a hearing.
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The national suicide hotline for LGBTQ+ youth went dead. States are scrambling to help
This is a KFF Health News story. On July 17, the option went dead for LGBTQ+ youth to access specialized mental health support from the national 988 Suicide & Crisis Lifeline. The Substance Abuse and Mental Health Services Administration said a month earlier that it would no longer "silo" services and would instead "focus on serving all help seekers." That meant the elimination of the "Press 3" option, the dedicated line answered by staff specifically trained to handle LGBTQ+ youth facing mental health issues ranging from anxiety to thoughts of suicide. Now, states such as California, Colorado, Illinois and Nevada are scrambling to backfill LGBTQ+ crisis support through training, fees and other initiatives in response to what advocates say is the Trump administration's hostile stance toward this group. In his first day back in the White House, President Donald Trump issued an executive order recognizing only two sexes, male and female, and while campaigning, he condemned gender ideology as "toxic poison." And the administration omitted "T" for transgender and "Q" for queer or questioning in announcing the elimination of the 988 Press 3 option. "Since the election, we've seen a clear increase in young people feeling devalued, erased, uncertain about their future, and seeing resources taken away," said Becca Nordeen, senior vice president of crisis intervention at The Trevor Project, a national suicide prevention and crisis intervention nonprofit for LGBTQ+ youth. Nordeen and other advocates for at-risk kids who helped staff the dedicated line said it has never been more critical for what The Trevor Project estimates are 5.2 million LGBTQ+ people ages 13-24 across the U.S. About 39% of LGBTQ+ young people seriously consider attempting suicide each year, including roughly half of transgender and nonbinary young people, according to a 2023 survey, reflecting a disproportionately high rate of risk. The use of the dedicated line for LGBTQ+ youth had steadily increased, according to data from the federal substance abuse agency, with nearly 1.6 million calls, texts or online chats since its rollout in October 2022, out of approximately 16.7 million contacts to the general line. The Press 3 option reached record monthly highs in May and June. In 2024, contacts to the line peaked in November, the month of the election. Call-takers on the general 988 line do not necessarily have the specialized training that the staff on the Press 3 line had, causing fear among LGBTQ+ advocates that they don't have the right context or language to support youth experiencing crises related to sexuality and gender. If a counselor doesn't know what the concept of coming out is, or being outed, or the increased likelihood of family rejection and how those bring stressors and anxiety, it can inadvertently prevent the trust from being immediately built," said Mark Henson, The Trevor Project's interim vice president of advocacy and government affairs, adding that creating that trust at the beginning of calls was a critical "bridge for a youth in crisis to go forward." The White House's Office of Management and Budget did not immediately respond to questions about why the Press 3 option was shut down, but spokesperson Rachel Cauley told NBC News that the department's budget would not "grant taxpayer money to a chat service where children are encouraged to embrace radical gender ideology by 'counselors' without consent or knowledge of their parents." Emily Hilliard, a spokesperson for the Department of Health and Human Services, said in a statement: "Continued funding of the Press 3 option threatened to put the entire 988 Suicide & Crisis Lifeline in danger of massive reductions in service." When someone calls 988, they are routed to a local crisis center if they are calling from a cellphone carrier that uses "georouting" -- a process that routes calls based on approximate areas -- unless they select one of the specialized services offered through the national network. While the Press 3 option is officially no longer part of that menu of options, which includes Spanish-language and veterans' services, states can step in to increase training for their local crisis centers or establish their own options for specialized services. California is among the states attempting to fill the new service gap, with Democratic Gov. Gavin Newsom's office announcing a partnership with The Trevor Project to provide training on LGBTQ+ youth issues for the crisis counselors in the state who answer calls to the general 988 crisis line. The state signed a $700,000 contract with the organization for the training program. The Trevor Project's Henson said the details still need to be figured out, including evaluating the training needs of California's current 988 counselors. The partnership comes as the organization's own 24/7 crisis line for LGBTQ+ youth faces a crisis of its own: The Trevor Project was one of several providers paid by the federal government to staff the Press 3 option, and the elimination of the service cut the organization's capacity significantly, according to Henson. Gordon Coombes, director of Colorado's 988 hotline, said staff there are increasing outreach to let the public know that the general 988 service hasn't gone away, even with the loss of the Press 3 option, and that its call-takers welcome calls from the LGBTQ+ population. Staff are promoting services at concerts, community events, and Rockies baseball games. Coombes said the Colorado Behavioral Health Administration contracts with Solari Crisis & Human Services to answer 988 calls, and that the training had already been equipping call-takers on the general line to support LGBTQ+ young people. The state supports the 988 services via a 7-cent annual fee on cellphone lines. Coombes said the department requested an increase in the fee to bolster its services. While the additional funds would benefit all 988 operations, the request was made in part because of the elimination of the Press 3 option, he said. Nevada plans to ensure that all 988 crisis counselors get training on working with LGBTQ+ callers, according to state health department spokesperson Daniel Vezmar. Vezmar said Nevada's $50 million investment in a new call center last November would help increase call capacity, and that the state's Division of Public and Behavioral Health would monitor the impact of the closure of the Press 3 option and make changes as needed. The Illinois Department of Human Services announced after the Press 3 option's termination that it was working to train existing call center counselors on supporting LGBTQ+ youth and promoting related affirming messages and imagery in its outreach about the 988 line. A July increase in a state telecommunications tax will help fund expanded efforts, and the agency is exploring additional financial options to fill in the new gap. Kelly Crosbie, director of North Carolina's Division of Mental Health, Developmental Disabilities and Substance Use Services, said the division has recently invested in partnerships with community organizations to increase mental health support for marginalized groups, including LGBTQ+ populations, through the state's 988 call center and other programs. "We've wanted to make sure we were beefing up the services," Crosbie said, noting that North Carolina's Republican legislature continues to restrict health care for transgender youth. Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness, said Congress could put the funding for the LGBTQ+ line in any final appropriations bill it passes. She also said states could individually codify permanent funding for an LGBTQ+ option, the way Washington state has created and funded a "Press 4" option for its Native American population to reach crisis counselors who are tribal members or descendants trained in cultural practices. The state created the option by carving out some of its 988 funding. No state has publicly announced a plan to make such an investment for LGBTQ+ populations. Federal lawmakers from both sides of the aisle have spoken out against the closure of the LGBTQ+ 988 option and urged that it be reinstated. At a July press conference alongside Democratic colleagues, Rep. Mike Lawler, a Republican who represents part of New York's Hudson Valley, said he and Republican Rep. Young Kim of Orange County, California, wrote to Health and Human Services Secretary Robert F. Kennedy Jr., urging him to reverse course and keep the LGBTQ+ line. "What we must agree on is that when a child is in crisis -- when they are alone, when they are afraid, when they are unsure of where to turn to, when they are contemplating suicide — they need access to help right away," Lawler said. "Regardless of where you stand on these issues, as Americans, as people, we must all agree there is purpose and worth to each and every life." If you or someone you know is struggling with thoughts of suicide -- free, confidential help is available 24 hours a day, 7 days a week. Call or text the national lifeline at 988.
Miami Herald
11-08-2025
- Miami Herald
Even in states that fought Obamacare, Trump's new law poses health consequences
GOP lawmakers in the 10 states that refused the Affordable Care Act's Medicaid expansion for over a decade have argued their conservative approach to growing government programs would pay off in the long run. Instead, the Republican-passed budget law that includes many of President Donald Trump's priorities will pose at least as big a burden on patients and hospitals in the expansion holdout states as in the 40 states that have extended Medicaid coverage to more low-income adults, hospital executives and other officials warn. For instance, Georgia, with a population of just over 11 million, will see as many people lose insurance coverage sold through ACA marketplaces as will California, with more than triple the population, according to estimates by KFF, a health information nonprofit that includes KFF Health News. The new law imposes additional paperwork requirements on Obamacare enrollees, slashes the time they have each year to sign up, and cuts funding for navigators who help them shop for plans. Those changes, all of which will erode enrollment, are expected to have far more impact in states like Florida and Texas than in California because a higher proportion of residents in non-expansion states are enrolled in ACA plans. The budget law, which Republicans called the 'One Big Beautiful Bill,' will cause sweeping changes to health care across the country as it trims federal spending on Medicaid by more than $1 trillion over the next decade. The program covers more than 71 million people with low incomes and disabilities. Ten million people will lose coverage over the next decade due to the law, according to the nonpartisan Congressional Budget Office. Many of its provisions are focused on the 40 states that expanded Medicaid under the ACA, which added millions more low-income adults to the rolls. But the consequences are not confined to those states. A proposal from conservatives to cut more generous federal payments for people added to Medicaid by the ACA expansion didn't make it into the law. 'Politicians in non-expansion states should be furious about that,' said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank. The number of people losing coverage could accelerate in non-expansion states if enhanced federal subsidies for Obamacare plans expire at the end of the year, driving up premiums as early as January and adding to the rolls of uninsured. KFF estimates as many as 2.2 million people could become uninsured just in Florida, a state where lawmakers refused to expand Medicaid and, partly as a result, now leads the nation in ACA enrollment. For people like Francoise Cham of Miami, who has Obamacare coverage, the Republican policy changes could be life-altering. Before she had insurance, the 62-year-old single mom said she would donate blood just to get her cholesterol checked. Once a year, she'd splurge for a wellness exam at Planned Parenthood. She expects to make about $28,000 this year and currently pays about $100 a month for an ACA plan to cover herself and her daughter, and even that strains her budget. Cham choked up describing the 'safety net' that health insurance has afforded her — and at the prospect of being unable to afford coverage if premiums spike at the end of the year. 'Obamacare has been my lifesaver,' she said. If the enhanced ACA subsidies aren't extended, 'everyone will be hit hard,' said Cindy Mann, a health policy expert with Manatt Health, a consulting and legal firm, and a former deputy administrator for the Centers for Medicare & Medicaid Services. 'But a state that hasn't expanded Medicaid will have marketplace people enrolling at lower income levels,' she said. 'So, a greater share of residents are reliant on the marketplace.' Though GOP lawmakers may try to cut Medicaid even more this year, for now the states that expanded Medicaid largely appear to have made a smart decision, while states that haven't are facing similar financial pressures without any upside, said health policy experts and hospital industry observers. KFF Health News reached out to the governors of the 10 states that have not fully expanded Medicaid to see if the budget legislation made them regret that decision or made them more open to expansion. Spokespeople for Republican Gov. Henry McMaster of South Carolina and Republican Gov. Brian Kemp of Georgia did not indicate whether their states are considering Medicaid expansion. Brandon Charochak, a spokesperson for McMaster's office, said South Carolina's Medicaid program focuses on 'low-income children and families and disabled individuals,' adding, 'The state's Medicaid program does not anticipate a large impact on the agency's Medicaid population.' Enrollment in ACA marketplace plans nationwide has more than doubled since 2020 to 24.3 million. If enhanced subsidies expire, premiums for Obamacare coverage would rise by more than 75% on average, according to an analysis by KFF. Some insurers are already signaling they plan to charge more. The CBO estimates that allowing enhanced subsidies to expire will increase the number of people without health insurance by 4.2 million by 2034, compared with a permanent extension. That would come on top of the coverage losses caused by Trump's budget law. 'That is problematic and scary for us,' said Eric Boley, president of the Wyoming Hospital Association. He said his state, which did not expand Medicaid, has a relatively small population and hasn't been the most attractive for insurance providers — few companies currently offer plans on the ACA exchange — and he worried any increase in the uninsured rate would 'collapse the insurance market.' As the uninsured rate rises in non-expansion states and the budget law's Medicaid cuts loom, lawmakers say state funds will not backfill the loss of federal dollars, including in states that have refused to expand Medicaid. Those states got slightly favorable treatment under the law, but it's not enough, said Grace Hoge, press secretary for Kansas Gov. Laura Kelly, a Democrat who favors Medicaid expansion but who has been rebuffed by GOP state legislators. 'Kansans' ability to access affordable healthcare will be harmed,' Hoge said in an email. 'Kansas, nor our rural hospitals, will not be able to make up for these cuts.' For hospital leaders in other states that have refused full Medicaid expansion, the budget law poses another test by limiting financing arrangements states leveraged to make higher Medicaid payments to doctors and hospitals. Beginning in 2028, the law will reduce those payments by 10 percentage points each year until they are closer to what Medicare pays. Richard Roberson, president of the Mississippi Hospital Association, said the state's use of what's called directed payments in 2023 helped raise its Medicaid reimbursements to hospitals and other health institutions from $500 million a year to $1.5 billion a year. He said higher rates helped Mississippi's rural hospitals stay open. 'That payment program has just been a lifeline,' Roberson said. The budget law includes a $50 billion fund intended to insulate rural hospitals and clinics from its changes to Medicaid and the ACA. But a KFF analysis found it would offset only about one-third of the cuts to Medicaid in rural areas. Trump encouraged Florida, Tennessee, and Texas to continue refusing Medicaid expansion in his first term, when his administration gave them an unusual 10-year extension for financing programs known as uncompensated care pools, which generate billions of dollars to pay hospitals for treating the uninsured, said Allison Orris, director of Medicaid policy for the left-leaning think tank Center on Budget and Policy Priorities. 'Those were very clearly a decision from the first Trump administration to say, 'You get a lot of money for an uncompensated care pool instead of expanding Medicaid,'' she said. Those funds are not affected by Trump's new tax-and-spending law. But they do not help patients the way insurance coverage would, Orris said. 'This is paying hospitals, but it's not giving people health care,' she said. 'It's not giving people prevention.' States such as Florida, Georgia, and Mississippi have not only turned down the additional federal funding that Medicaid expansion brings, but most of the remaining non-expansion states spend less than the national average per Medicaid enrollee, provide fewer or less generous benefits, and cover fewer categories of low-income Americans. Mary Mayhew, president of the Florida Hospital Association, said the state's Medicaid program does not adequately cover children, older people, and people with disabilities because reimbursement rates are too low. 'Children don't have timely access to dentists,' she said. 'Expectant moms don't have access nearby to an OB-GYN. We've had labor and delivery units close in Florida.' She said the law will cost states more in the long run. 'The health care outcomes for the individuals we serve will deteriorate,' Mayhew said. 'That's going to lead to higher cost, more spending, more dependency on the emergency department.' 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.
CBS News
07-08-2025
- CBS News
Patient numbers at NIH hospital have dropped under Trump, jeopardizing care
The number of people receiving treatment at the National Institutes of Health Clinical Center — the renowned research hospital that cares for patients with rare or life-threatening diseases — has tumbled under the second Trump administration, according to government documents and interviews with current and former NIH employees. NIH documents viewed by KFF Health News show a pronounced decline in patients at the 200-bed hospital from February through April, a time that coincides with the Department of Health and Human Services' mass firings of government employees, the gutting of scientific research, and the administration's broad crackdown on immigration. The average number of patients being treated daily during that time hovered between 60 and 80, with the April numbers falling to the lower end of that range. By contrast, in October, about 80 patients per day on average were at the hospital. The number of cancer clinical trial participants at the hospital as of July was down about 20% from last year, one NIH cancer scientist said. KFF Health News agreed not to identify the scientist and others who participated in this article who were not authorized to speak to the press and feared retaliation. The numbers "really don't look too good," Pius Aiyelawo, acting CEO of the clinical center, said during a May 23 meeting of the NIH Clinical Center Research Hospital Board. As of April 30, the average number of patients in the hospital per day had declined by 5.7% compared with the same period a year ago. Adults and children with cancer, people who need bone marrow transplants, and people with rare diseases or infections are among the patients who receive care at no charge at the NIH hospital, according to former officials. Clinicians there provide potentially lifesaving treatments as part of clinical trials, often to people who have run out of options. Research at the hospital has also led to breakthroughs about cancer, traumatic brain injury, and AIDS, among other ailments. James Gilman, a physician who was CEO of the clinical center from 2017 until retiring in January, said the center has driven important advances against disease "that couldn't have happened anywhere else." Former officials said the drop in patients this year is a consequence of the upheaval the Trump administration has caused at the NIH, the world's largest public funder of scientific research. Current and former employees say an exodus of clinicians, scientists, and other staffers has limited how many patients can be treated. Morale has tanked because of widespread firings and the administration's cancellation of grants that funded research into health disparities, vaccines, the health of LGBTQ+ people, and more. Contracts have been cut, and scientists have seen delays in getting essential supplies for clinical research. "Every day seems to be some type of breaking point," one NIH worker said. During the May board meeting, a video of which KFF Health News viewed, Aiyelawo attributed the decrease in patients coming to the hospital to the departure of NIH investigators — the researchers on studies — and less patient recruitment. He also noted 11 recent departures of clinical center staffers. They included Christine Grady, a nurse who led the center's bioethics department and the wife of Anthony Fauci, the former head of the NIH's infectious diseases institute who became a lightning rod for conservatives during the COVID-19 pandemic. HHS has fired more than 1,200 NIH employees this year as part of its purge of the federal workforce, but the true number of departures is almost certainly higher. Others have opted for early retirement or quit because they opposed the Trump administration's orders. Gilman said the NIH hospital relies on a "very complex ecosystem and network to find patients who are not too sick" to potentially be enrolled in a clinical trial. When researchers leave, "those patients are lost," he said. The clinical center's 2025 annual report said there were roughly 1,500 research studies underway in 2024, including studies focused on cancer, infectious disease, heart and lung conditions, and blood disorders. Clinical trials accounted for about half. The National Cancer Institute — which is the largest of the NIH's 27 institutes and has been crippled by cuts and chaos this year — typically has the most patients needing inpatient care, Gilman said. "What has happened here since January has been a pretty traumatic time for that ecosystem," he said, "and there are pieces of it that will take a long time to rebuild, if indeed they get a chance to rebuild." During the May board meeting, Aiyelawo said NIH Director Jay Bhattacharya "is very aware" that fewer people are getting treated at the hospital "and we're doing everything we can to be able to get those numbers up." The drop in patients this year isn't isolated to people needing inpatient care, NIH documents show. As of the end of April, outpatient visits were down 8.5% compared with the same period in the prior fiscal year. The number of new patients overall had declined by 6.7%, to about 3,370 people. In response to questions, HHS spokesperson Andrew Nixon wrote in an emailed statement that the clinical center "remains fully operational and continues to provide world-class clinical research and patient care. Every day, patients from across the country and around the globe come here to participate in cutting-edge studies that drive scientific discovery and improve health outcomes." "As the crown jewel of research and discovery, the Clinical Center is a top priority" under Bhattacharya's leadership, Nixon said. "We are committed to fully leveraging its capabilities as the nation's hub for clinical research innovation. Our focus remains on empowering the research community and advancing the critical mission of making medical breakthroughs possible right here on the NIH campus." Even before President Trump began his second term, the hospital had struggled with lagging patient numbers. Before the pandemic, it averaged more than 110 patients daily. Those numbers plummeted starting in 2020, government documents show. During the 2022 fiscal year, there were about 73 patients, on average, in the hospital per day. While yearly figures have increased since then, they have not gone back to pre-pandemic levels. NIH documents show that the hospital saw an average of roughly 81 patients per day during fiscal 2024, which ended in September. Still, one NIH worker said: "This is a manufactured crisis. COVID was not." The federal government has also moved to tighten rules surrounding visitors from abroad, which likely limits how many people living in the U.S. without legal status would come to the NIH for care. Before Mr. Trump, officials developed a new visitor policy for the NIH that required people who aren't U.S. citizens or legal permanent residents to register online before arriving. But its implementation was delayed, Gilman said. It did not launch until late January, after President Joe Biden was no longer in office and around the time the Trump administration began its deportation operation. The Department of Homeland Security has carried out widespread raids and arrests and allowed immigration authorities unprecedented access to various federal data sources — including tax information and Medicaid recipients' personal data — as part of its immigration enforcement efforts. The clinical center's most recent annual report said around 600 patients in 2024 were from abroad. Now "international patients are terrified to come," said one recently departed clinician. "They don't know what will happen to them." 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 — the independent source for health policy research, polling, and journalism.
