Maine lawmakers renew push for rape kit tracking system, plus requiring backlog testing
A photo of Leda Health's at-home sexual assault evidence collection kits. (via Leda Health)
In light of known backlogs of untested rape kits but in unknown numbers, a bipartisan group of lawmakers are pushing to establish a statewide tracking system that would also ensure survivors know the status of their kits.
Maine is one of few states without a statewide rape kit tracking system.
An effort to create one last year ultimately failed due to end of session procedural scuffles. Some counties recently received funding to create local systems, though recipients are concerned the money could be at risk of being cut by Elon Musk's Department of Government Efficiency.
Last year, the Maine Coalition Against Sexual Assault received a $90,000 federal grant to fund a pilot program to track rape kits in Kennebec and Penobscot counties.
Separately, Cumberland County received a three-year $2.5 million grant from the U.S. Department of Justice to help with tracking rape kits. This grant is a first for the state under the National Sexual Assault Kit Initiative. The District Attorney's Office estimates that there are 500 untested kits in Cumberland County alone.
The U.S. Office of Management and Budget had listed the National Sexual Assault Kit Initiative, State Domestic Violence and Sexual Assault Coalitions and Sexual Assault Forensic Exam Training and Services, among others, as programs whose funding would be freezed, before walking the widespread freeze back amid legal challenges.
'Given the uncertainty of federal grants and whether this funding will be released to Cumberland County, the state legislature should act now to ensure reform is funded and expeditiously implemented,' said Rebecca Boulos, executive director of Maine Public Health Association, the state's largest association for public health professionals.
Members of the Legislature's Judiciary Committee on Wednesday also heard another bipartisan proposal to get ahead of an issue cropping up around the country: companies marketing self-administered rape kits as a viable alternative to state forensic examinations.
They're not, prosecutors, law enforcement and lawmakers said, and instead weaken a survivor's path to justice.
Boulos testified in favor of a bill that would establish a statewide sexual assault forensic examination kit tracking system, LD 549, sponsored by Sen. Rick Bennett (R-Oxford) and a group of bipartisan lawmakers.
Currently, 36 states and Washington D.C. have passed legislation calling for statewide inventories of such kits, commonly called 'rape kits.'
These preserve evidence left behind during an assault through a forensic medical examination, which typically takes four to six hours, that survivors can choose to undergo immediately after a sexual assault. DNA evidence from these kits can then be used to solve and prevent crimes.
The Legislature passed an earlier iteration of this bill last year, however LD 2129 failed to become law as it was among the dozens of bills Democratic Gov. Janet Mills refused to sign when they were sent to her desk after statutory adjournment.
'It was a really bitter pill,' said Rep. Valli Geiger (D-Rockland) of that outcome. Geiger sponsored LD 2129 and is the lead co-sponsor of the bill this session.
Because of the time that has now passed, this year's version is slightly different, Geiger explained. The bill last session aimed to create an inventory and tracking system. The legislation this session would do that but also require testing backlogged kits.
'When I was a 17-year-old college freshman,' Geiger said, 'I was invited to the dorm room of a fellow student, a cute boy with red hair and freckles. When I tried to leave, he slammed me up against a wall and sexually assaulted me.'
She did not seek out medical care. She did not report the assault. She did not tell anyone about it for fifteen years.
'I would like to say that in the 50 years since that assault happened that things have changed,' Geiger said. 'But I cannot.'
About 6,000 people call the Sexual Assault Hot Line annually in Maine. Roughly 400 Forensic Sexual Assault kits are requested from the Maine Crime Lab annually. Less than 20% of those kits are returned to the Crime Lab for testing.
'Why are so few requested? We don t know,' Geiger said. 'Why so few returned? We don't know. How many completed but untested kits are sitting in hospitals, police stations, rape crisis centers or district attorney offices? We don't know.'
Several recommendations from local and national groups preceded these legislative proposals.
Joyful Heart Foundation, a national advocacy group founded by 'Law & Order: SVU' actress Mariska Hargitay, has been instrumental in passing state-level rape kit reform. In 2016, the nonprofit published proposed reforms to help states address testing backlog and provide more transparency for survivors.
Maine is now the only state that hasn't adopted at least one of the reforms, Burcu Sagiroglu, policy and advocacy manager for the nonprofit, wrote in testimony submitted to the committee.
Additionally, through a state grant, the Maine Coalition Against Sexual Assault in partnership with the Muskie School of Public Policy completed a statewide study on the status of these kits in Maine. In 2018, those finding led to several recommendations, including creating a statewide rape kit tracking system, an inventory of untested kits and state funding for testing backlogged rape kits, among others.
If the bill is passed this year, by June 1, 2026, law enforcement agencies that receive or store kits would be required to complete an inventory of all kits in its possession and report those findings to the department, which would then be tasked with compiling that information and presenting a comprehensive report to the Legislature and governor by Jan. 1, 2027.
It would also call for testing backlogged kits.
Also by Jan. 1, 2027, and every five years after that, all completed kits that identify an alleged victim and are being stored by a law enforcement agency would be required to be transferred to the Maine State Police Crime Laboratory and processed on a rolling basis.
Some raised concern about how the rolling component would impact those who submit kits anonymously, specifically whether processing the information would threaten anonymity, and lawmakers floated the option of exempting anonymous kits.
Bennett, the bill sponsor, urged committee members to find a way to make the fiscal note for the bill as low as possible to make it more feasible to pass as an emergency measure outside the state budget. However, both Bennett and Geiger said reducing costs could be a challenge because the Maine Crime Lab already lacks physical space and the market for trained forensic examiners is tight.
The bill last session had a total cost of $349,572 for the biennium.
When this bill was presented last year, municipal officials asked police chiefs about the burden of a proposed indefinite hold on this type of sensitive material, but officials found that most law enforcement agencies already held onto rape kits indefinitely because of local policy, according to Rebecca Graham, who submitted testimony on behalf of the Maine Municipal Association.
'This process places no additional burden on municipal police,' she said. 'However, the current process and lack of centralized data does impede the ability of victims to locate which agency is holding their kit or for an agency to assist a victim.'
Jason Moen, chief of the Auburn Police Department and the President of the Maine Chiefs of Police Association, echoed this point in his testimony in support of the bill, which he said would strengthen Maine's enforcement of sexual assault laws.
'Victims of sexual assault have experienced unimaginable harm,' Moen said. 'We want to ensure that these survivors can easily access real-time data about the status of their own kits, while also getting valuable data statewide on the journey of these kits as they move from healthcare facilities to law enforcement agencies and eventually to the state crime lab.'
Like the bill sponsor's, Moen cautioned that the Maine Crime Lab will need adequate funding to make this work feasible.
'The worst thing that could happen to sexual assault survivors is provide an unrealistic expectation that they will have reliable access to their kits, only to have processing stalled due to the lack of needed supports for the Crime Lab to carry out this mission,' Moen said.
LD 412, proposed by Rep. Ellie Sato (D-Gorham), would prohibit the sale and distribution of self-administered rape kits as a violation of the Maine Unfair Trade Practices Act.
'First and foremost, this bill is a consumer protection issue,' Sato told the Judiciary Committee on Wednesday.
These kits are rarely, if ever, admissible in court, all those who testified said, due to chain of custody issues and other collection errors likely to occur because survivors do not have the training and skills required of sexual assault forensic examiners.
'This is a prosecutor's nightmare,' Shira Burns from the Maine Prosecutors Association said of the self-administered kits.
These kits also do not offer emergency medical care that may be needed when a sexual assault occurs, such as treatment or monitoring after strangulation, Sato added.
Maryland and Washington have passed similar bills banning these kits. One of the companies that sell these kits, Leda, challenged Washington's ban but the law was upheld in federal court.
Rep. David Sinclair (D-Bath) said he was worried about survivors in service deserts, arguably much of the rural state, and questioned whether it would be better to regulate these kits rather than prohibit them.
'While it's true that many survivors face barriers to seeking professional forensic exams, whether due to distance, fear of law enforcement or personal trauma, these kits do not resolve those challenges,' said Senate President Mattie Daughtry (D-Brunswick), one of the bill co-sponsors. 'In fact, they add new risks. The evidence collected is not legally admissible, or properly preserved, unknowingly weakening their case.'
Instead, Daughty, Burns and others argued Maine should focus more on expanding the capacity of procedures proven effective.
'We keep putting the criminal justice system on the back of the victims,' Burns said. 'We need to stop and start going the other way.'
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Boston Globe
8 hours ago
- Boston Globe
The research lost because of Trump's NIH cuts
The NIH has rarely revoked funding once it has been awarded. Out of the tens of thousands of grants overseen by the institution Then Donald Trump was reelected. Advertisement Since his January inauguration, his administration has terminated more than 1,450 grants, withholding more than $750 million in funds; officials have said they are curbing wasteful spending and 'unscientific' research. The Department of Government Efficiency gave the agency 'The decision to terminate certain grants is part of a deliberate effort to ensure taxpayer dollars prioritize high-impact, urgent science,' said Andrew G. Nixon, the director of communications for the Department of Health and Human Services. He did not respond to questions about the terminated grants or how patients may be impacted, but he said, 'Many discontinued projects were duplicative or misaligned with NIH's core mission. NIH remains focused on supporting rigorous biomedical research that delivers real results — not radical ideology.' Advertisement Targeted projects, however, were seeking cures for future pandemics, examining the causes of dementia and trying to prevent HIV transmission. The mass cancellation of grants in response to political policy shifts has no precedent, former and current NIH officials told ProPublica. It threatens the stability of the institution and the scientific enterprise of the nation at large. Hundreds of current and former NIH staffers It has been difficult for scientists and journalists to convey the enormity of what has happened these past few months and what it portends for the years and decades to come. News organizations have chronicled cuts to individual projects and sought to quantify the effects of lost spending on broad fields of study. To gain a deeper understanding of the toll, ProPublica reached out to more than 500 researchers, scientists and investigators whose grants were terminated. More than 150 responded to share their experiences, which reveal consequences that experts say run counter to scientific logic and even common sense. They spoke of the tremendous waste generated by an effort intended to save money — years of government-funded research that may never be published, blood samples in danger of spoiling before they can be analyzed. Advertisement Work to address disparities in health, once considered so critical to medical advancement that it was Researchers catalogued many fears — about the questions they won't get to answer, the cures they will fail to find and the colleagues they will lose to more supportive countries. But most of all, they said they worried about the people who, because of these cuts, will die. Research Frozen The NIH often awards funding in multiyear grants, giving scientists the time and intellectual freedom to pursue their work uninterrupted. They plan experiments, hire staff and make equipment purchases on long timelines. Now, studies can't be completed. Papers can't be published. Years of research may be lost and millions of dollars wasted. After the Supreme Court overturned the constitutional right to abortion, demographer Diana Greene Foster set out to study the outcomes of pregnant patients who showed up in emergency departments. She wanted to know whether state restrictions were causing delays in care. 'This needs to be answered for courts to consider the evidence,' said Foster, a professor at the University of California, San Francisco. 'Every day that goes by, people are potentially at risk.' Less than one year into a five-year NIH grant, she had arrived at some early findings: 'Abortion bans don't stop very many people from getting abortions,' she said. 'Bans actually cause people to have their abortions later in pregnancy.' For those who live in states with bans, she found, second-trimester abortions increased from 8% of procedures to 17%, requiring more complex interventions to end their pregnancies and increasing their risk of complications. Advertisement But before the data could be published, the NIH informed her on March 21 that the grant was terminated. It was no longer in line with agency priorities, a letter stated, specifying that studies on 'gender identity' 'ignore, rather than seriously examine, biological realities.' The termination left Foster confused. 'They are wrong that studying gender minority populations is not important,' she said. 'But my study is not about gender identity. It is relevant to anyone who is pregnant, regardless of how they identify.' Foster had to pause her research while she searched for other funding. 'This was clearly a politically motivated cut,' she said. ProPublica heard from more than 70 researchers who said that they were unable to continue their projects due to the terminations. 'Two and a half years into a three-year grant, and to all of a sudden stop and not fully be able to answer the original questions, it's just a waste.' Ethan Moitra, associate professor at Brown University, who was researching whether brief therapy can improve mental health for LGBTQ+ people. 'We are now scrambling to figure out if there are parts we can continue or salvage.' Julia Marcus, associate professor at Harvard Medical School, who was researching whether HIV prevention medicine can be made available over the counter. 'To build trust between health care providers, health researchers in communities takes decades of work, and scientists have already done the work. Now this is going to be depleted.' Jesus Ramirez-Valles, professor at the University of California, San Francisco, who was examining how HIV impacts the physical and mental health of gay men as they age. Advertisement Patient Studies Interrupted In addition to jeopardizing data, terminating a grant in the middle of an active study may worsen participants' conditions and put them at higher risk of death. A single daily pill can nearly eliminate the risk of contracting HIV — but only when taken as prescribed. Black and Latino men who have sex with men have more than a Working with community clinics across Mississippi, Washington, D.C., and Rhode Island, Brown University professors Amy Nunn and Dr. Philip Chan set out to examine The study provides aggressive case management to help patients navigate the health care system and stay on the treatment, known as pre-exposure prophylaxis or PrEP, which is available in both oral and injectable forms. Workers provide patients with reminders, help them get coverage and even pick up their medicine. In 2023, the researchers received about $3.7 million in NIH funding for five years of work. Their team was just starting to gather data that showed the program's efficacy when the grant was terminated. 'This is science that had really great chances of having a huge impact, and all of a sudden, it's cut off at the knee,' Nunn said. Advertisement Chan told ProPublica that he worries that the patients in their study could be harmed by the cut. 'There's no doubt that some of them are going to not stay on PrEP,' said Chan, 'and that some of them are going to get HIV.' At least 30 researchers told ProPublica that the termination of their grant forced them to end clinical research or a trial abruptly, leaving participants in limbo. 'We cannot assay the blood samples that we have collected and paid participants for. A total waste of the money and resources that went into collecting the data.' Sarah Whitton, professor at the University of Cincinnati, who was identifying risk factors for mental illness and suicidality for young LGBTQ+ women. 'We have also had to quickly scramble to keep the study going unfunded to avoid having to stop the treatment and clinical trial for those already enrolled.' Tiffany Brown, assistant professor at Auburn University, who was developing an eating disorder treatment for LGBTQ+ patients. 'With a clinical trial, if you can't follow participants to the end, you have no information, because the whole point is to see whether there's change from beginning to end.' Katie Biello, professor and chair of epidemiology at Brown University's School of Public Health, who was trying to improve adherence to medication protocols for adolescents with HIV in Brazil. Disparities Disregarded The Trump administration has banned the NIH from funding grants with a perceived connection to 'diversity, equity and inclusion,' alleging that such projects may be discriminatory. Caught up in the wave of terminations is work seeking to understand why some populations — including women and sexual, racial or ethnic minorities — may be more at risk of certain disorders or diseases. Despite preventative vaccines and improved screening, more than 4,000 women die every year from cervical cancer. Black and Hispanic women are more likely than their white peers to be diagnosed, and often at later stages. After more than a decade of studying cancer care disparities, epidemiologist Adana Llanos found that the ZIP code in which a woman received care often plays a pivotal role in how she fares. And in 2023, Llanos and her colleagues were awarded a multiyear NIH grant to further examine inequities, specifically in cervical cancer care and who survives it. Even though their work targets the women most at risk, Llanos said their research, like most health equity research, will increase our understanding of cervical cancer more broadly. 'This work has the potential to improve cancer outcomes for everyone, no matter what you identify as, no matter what your characteristics are,' she said. Last year, her team began to recruit a cohort of 960 women who had been diagnosed with cervical cancer to track their patterns of care and outcomes. But in March, after the researchers had enrolled about 200 participants, the NIH terminated the funding. Llanos paused enrollment. The cancellation felt like a betrayal of her study's participants, she said. Llanos had spent years developing relationships with community groups and cancer patients, gaining their trust so they would feel comfortable sharing their treatment experiences. 'We've made commitments to them,' she said. More than 550 of the terminated grants were focused on health disparities or inequities, attempting to understand why some groups have different health outcomes. 'If you cannot identify groups that are higher risk, it seems like just really bad science. That's sort of the basics of how you try to conquer a disease.' Carl Latkin, professor at Johns Hopkins University's Bloomberg School of Public Health, who was analyzing the comorbidities of people who have HIV and those at risk for getting it. 'Health disparities are just going to get larger, and real folks are going to die.' Marguerita Lightfoot, professor at the Oregon Health & Science University–Portland State University School of Public Health, who was studying the value of guaranteed income and financial mentoring to Black youth. 'It's a major principle of epidemiology to target work towards the people who are being disproportionately affected. Now we're being told that we cannot mention them in our research.' Dr. Matthew Spinelli, assistant professor at the University of California, San Francisco, who was working to prevent sexually transmitted infections with common antibiotics. LGBTQ+ People Targeted One of Trump's first executive orders was a directive In response to a lawsuit, a federal judge issued an injunction barring the administration from Gay, lesbian and bisexual adults are over three times more likely to consider suicide than their heterosexual peers. Few studies have aimed to figure out how to prevent this. Last year, Lauren Forrest, an assistant professor of psychology at the University of Oregon, received a multiyear grant to do so, focusing on LGBTQ+ people who live in rural areas where access to specialized care may be more limited. She was planning to recruit dozens of participants. But on March 21, she received a notification from the NIH that her grant was terminated because it did not 'effectuate' the agency's priorities, citing its connection to 'gender identity.' 'The way they're going about deciding which grants will or won't be terminated, it's not about scientific rigor,' she said. 'It's about literally actively discriminating against health-disparity populations.' Forrest has been forced to reduce the hours of her research staff, and she now risks losing key lab personnel who may have to seek other employment due to the cuts. 'There is no way to recover the lost time, research continuity or training value once disrupted,' she said. She worries most about the deaths that could have been prevented. 'People are going to be harmed because of this,' she said. More than 300 of the grants terminated by the NIH were focused on LGBTQ+ health care. About 40 of those grants were researching ways to prevent suicide in adults and youth. 'We have a paper that's ready to go out that shows lesbian women are almost 3 times as likely to have a stillbirth compared to their heterosexual peers. That's such an avoidable, horrible outcome to happen, and that paper may never be published.' Brittany Charlton, associate professor at Harvard Medical School, who was quantifying obstetrical outcomes for lesbian, gay and bisexual women. 'It is devastating to have state-sanctioned dehumanization and exclusion. I am afraid for what these messages will do to the mental health of youth who are told they don't matter or, for some, that they don't even exist by parts of society.' Dr. Sarah Goff, professor at the University of Massachusetts, Amherst, who was studying how to improve the delivery of mental health care to LGBTQ+ youth. 'I honestly burst into tears. The evidence we would have gained from this work will not exist.' Kirsty Clark, assistant professor at Vanderbilt University, who was finding best practices for preventing suicide in LGBTQ+ preteens. Losing a Generation The grant terminations and subsequent instability have created a lost generation of scientists, dozens of researchers told ProPublica — cutting off an established pipeline at all stages of researchers' careers. Universities are trimming the number of openings in postdoctoral and graduate programs. Young researchers are struggling to find funding to initiate studies or open new laboratories. And some scientists are opting to pursue opportunities abroad. Dr. Lauren Harasymiw was a medical resident in a neonatal intensive care unit when an infant took a turn for the worse. Born at only 23 weeks gestation — the edge of viability — the baby girl experienced a hemorrhage within the ventricles of her brain. 'What does this mean for her?' Harasymiw recalls asking her attending physician. The supervisor didn't know. 'The field of neonatology has made incredible strides over the last decades in helping our babies survive,' Harasymiw said. 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However, he added that 'while fostering the next generation of scientists is essential, effective leadership requires clear focus: prioritizing research that is impactful and results-driven over duplicative or low-yield programs.' Dr. Sallie Permar, who runs the program and is chair of pediatrics at Weill Cornell Medicine, was perplexed by the cut; the program seemed to be in line with the administration's focus on combating chronic disease in children. 'That's exactly what we're training these scholars to do,' she said. More than 50 researchers told ProPublica that the funding cuts would harm the next generation of scholars, discouraging them from practicing in the United States. 'We have a generation of researchers that were planning to focus on these questions that are now either scared or don't have funding to continue their training, or both.' Mandi Pratt-Chapman, associate center director for community outreach, engagement and equity at the George Washington Cancer Center, who was identifying best practices for collecting data about LGBTQ+ people at small and rural cancer centers. 'Admissions for graduate school have been downsized to a point where prospective students are giving up on pursuing a Ph.D.' Tigist Tamir, assistant professor at the University of North Carolina at Chapel Hill, who received a career development grant and was studying how oxidative stress is regulated in breast cancer and obesity. 'I already know several researchers on the job search who ended up taking faculty positions in Canada instead of the U.S.' Dr. Benjamin Solomon, instructor of immunology and allergy in the department of pediatrics at Stanford Medical School, who received a career development grant and was examining rare genetic immune diseases in children .
Miami Herald
10 hours ago
- Miami Herald
US Could Make Childbirth Free, To Tackle Falling Birth Rates
America could make childbirth free for privately-insured families, in an effort to tackle declining birth rates. The bipartisan Supporting Healthy Moms and Babies Act, which would designate maternity care as an essential health benefit under the Affordable Care Act, was introduced in the Senate in May. If passed, insurance companies would be required to cover all childbirth-related expenses, including prenatal care, ultrasounds, delivery and postpartum care, without any co-pays or deductibles. Medicaid, America's government‐funded health insurance program, already covers these costs. Democratic New York Senator Kirsten Gillibrand, who has cosponsored the bill, told Newsweek: "Even with insurance, the costs associated with having a baby can be astronomical, and expenses are even greater for women who have health complications during pregnancy, a high-deductible insurance plan, or gaps in their coverage. By requiring insurance companies to fully cover care throughout pregnancy and a year postpartum, this bill will make childbirth more affordable for families." It comes amid growing concerns about America's population. Fertility rates are projected to average 1.6 births per woman over the next three decades, according to the Congressional Budget Office's latest forecast released this year. This number is well below the replacement level of 2.1 births per woman required to maintain a stable population without immigration. The Donald Trump administration has made this issue one of its priorities, the White House exploring giving women a "baby bonus" of $5,000, according to an April New York Times report. Many trying to tackle this global issue have called for public health policies and financial plans to help make it easier for couples to have children in society. The financial crisis and its effect on housing, inflation and pay is generally named as a major contributor to people's decisions to delay having children, to have fewer children or not to have them at all. Republican Mississippi Senator Cindy Hyde-Smith, who introduced the bill along with Gillibrand, Democratic Virginia Senator Time Kaine and Republican Missouri Senator Josh Hawley, said she hopes her bill will help change this. "Bringing a child into the world is costly enough without piling on cost-share fees that saddle many mothers and families with debt. This legislation would take away some of the burden for childbearing generations," she said in May. "By relieving financial stresses associated with pregnancy and childbirth, hopefully more families will be encouraged to embrace the beautiful gift and responsibility of parenthood." Pregnancy, childbirth and postpartum care average a total of $18,865 with average out-of-pocket payments totaling $2,854, according to KFF, a nonpartisan health policy research organization, based on data from claims between 2018 and 2022. Financial concerns are repeatedly cited as a reason for not having children. Indeed, just a few days ago, the United Nations Population Fund warned of a global birth rate crisis, after finding that one in five had not had or did not expect to have the number of children they wanted. Some 39 percent said this was because of financial limitations. But Suzanne Bell, who studies fertility and related behaviors with the Johns Hopkins Bloomberg School of Public Health, said that while "making childbirth cheaper or free is incredibly important," she does not think it will effect the birth rate. "The cost of raising a child, in particular the cost of child care, is very high and far outweighs the cost of childbirth," she told Newsweek. "We desperately need policies that support families with the cost of child care, especially families with low incomes." Beth Jarosz, a senior program director U.S. programs at the Population Reference Bureau, agreed that "reducing health care costs is important, but may not be enough to move the needle on births." "The cost of childbirth is just one of the many costs of having a child, and people are also reeling from the much bigger costs of child care, housing, and other necessities," she told Newsweek. Theodore D Cosco, a research fellow at the University of Oxford's Institute of Population Aging, called the bill "a step in the right direction" but said the same as Bell and Jarosz. "Parents generally aren't deciding whether to have children based on a $3,000 delivery bill, they're looking at the hundreds of thousands of dollars spent actually raising the child," he told Newsweek. But he added: "The policy certainly carries some symbolic weight, signaling bipartisan support for families and could potentially help build momentum for broader reforms, such as child care subsidies or paid parental leave." The other concern is that, while financial concerns are generally accepted as a major contributor to declining birth rates, they are not the lone cause. Bell said that even the policies she calls for "are also unlikely to increase the birth rate, as evidence from other countries with much more supportive policies suggest." Norway is considered a global leader in parental leave and child care policies, and the United Nations International Children's Fund (UNICEF) ranks it among the top countries for family-friendly policies. But it too is facing a birth rate crisis. Norway offers parents 12 months of shared paid leave for birth and an additional year each afterward. It also made kindergarten (similar to a U.S. day care) a statutory right for all children aged one or older in 2008. The government subsidizes the policy to make it possible for "women and men to combine work and family life," as Norway's former Minister of Children, Equality, and Social Inclusion Solveig Horne said at a parental leave event in 2016. And yet, Norway's fertility rate has dropped dramatically from 1.98 children per woman in 2009 to 1.44 children per woman in 2024, according to official figures. The rate for 2023 (1.40) was the lowest ever recorded fertility rate in the country. Financial barriers "are only part of the picture," Cosco said, "psychological, cultural, and structural factors matter too." Newsweek spoke to several experts about Norway specifically, who all cited recent culture changes. For example, "young adults are more likely to live alone" and "young couples split up more frequently than before," Rannveig Kaldager Hart, a senior researcher at the Norwegian Institute of Public Health's Centre for Fertility and Health said. He went on to speak about "intensive parenting," which refers to the modern parenting style in which parents invest time, money and energy into creating successful adults. The expectations of this parenting style "may cause some to postpone or have fewer children than they otherwise would," Hart said. Nevertheless, backers of the American bill seem to believe that it may be part of the solution. "Being pro-family means fostering an economy that makes it feasible to raise a child. But too often, parents find themselves dealing with sky-high medical bills following the birth of a child. This legislation would eliminate out-of-pocket maternity costs for families with private health insurance and prohibit private carriers from imposing cost-sharing on beneficiaries, empowering parents to focus on what matters most," said Hawley. Related Articles Warning Of Global Birth Rate 'Crisis' After Study Of 14 CountriesChina Makes Childbirth Change Amid Falling Birth RateTrump Administration To Give $1,000 Boost to All Newborn BabiesMore Gen Z Delay Having Kids Than Millennials Amid Birth Rate Decline Fears 2025 NEWSWEEK DIGITAL LLC.
Yahoo
13 hours ago
- Yahoo
Twin federal proposals threaten provider taxes, key source of Medicaid funding for states
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For instance, California has netted an estimated $8.8 billion this fiscal year from its tax on managed care plans and took in about $5.9 billion last year from hospitals. California Democrats are already facing a $12 billion deficit, and they have drawn political fire for scaling back some key health care policies, including full Medi-Cal coverage for immigrants without permanent legal status. And a loss of provider tax revenue could add billions to the current deficit, forcing state lawmakers to make even more unpopular cuts to Medi-Cal benefits. 'If Republicans move this extreme MAGA proposal forward, millions will lose coverage, hospitals will close, and safety nets could collapse under the weight,' Gov. Gavin Newsom, a Democrat, said in a statement, referring to President Donald Trump's 'Make America Great Again' movement. The proposals are also a threat to Proposition 35, a ballot initiative California voters approved last November to make permanent the tax on managed care organizations, or MCOs, and dedicate some of its proceeds to raise the pay of doctors and other providers who treat Medi-Cal patients. All states except Alaska have at least one provider tax on managed care plans, hospitals, nursing homes, emergency ground transportation, or other types of health care businesses. The federal government spends billions of dollars a year matching these taxes, which generally lead to more money for providers, helping them balance lower Medicaid reimbursement rates while allowing states to protect against economic downturns and budget constraints. New York, Massachusetts, and Michigan would also be among the states hit hard by Republicans' drive to scale back provider taxes, which allow states to boost their share of Medicaid spending to receive increased federal Medicaid funds. In a May 12 statement announcing its proposed rule, CMS described a 'loophole' as 'money laundering,' and said California had financed coverage for over 1.6 million 'illegal immigrants' with the proceeds from its MCO tax. CMS said its proposal would save more than $30 billion over five years. 'This proposed rule stops the shell game and ensures federal Medicaid dollars go where they're needed most — to pay for health care for vulnerable Americans who rely on this program, not to plug state budget holes or bankroll benefits for noncitizens,' Mehmet Oz, the CMS administrator, said in the statement. Medicaid allows coverage for noncitizens who are legally present and have been in the country for at least five years. And California uses state money to pay for almost all of the Medi-Cal coverage for immigrants who are not in the country legally. California, New York, Michigan, and Massachusetts together account for more than 95% of the 'federal taxpayer losses' from the loophole in provider taxes, CMS said. But nearly every state would feel some impact, especially under the provisions in the reconciliation bill, which are more restrictive than the CMS proposal. None of it is a done deal. The CMS proposal, published May 15, has not been adopted yet, and the reconciliation bill is likely to be altered significantly in the Senate. But the restrictions being contemplated would be far-reaching. A report by Michigan's Department of Health and Human Services, ordered by Democratic Gov. Gretchen Whitmer, found that a reduction of revenue from the state's hospital tax could 'destabilize hospital finances, particularly in rural and safety-net facilities, and increase the risk of service cuts or closures.' Losing revenue from the state's MCO tax 'would likely require substantial cuts, tax increases, or reductions in coverage and access to care,' it said. CMS declined to respond to questions about its proposed rule. The Republicans' House-passed reconciliation bill, though not the CMS proposal, also prohibits any new provider taxes or increases to existing ones. The American Hospital Association, which represents nearly 5,000 hospitals and health systems nationwide, said the proposed moratorium on new or increased provider taxes could force states 'to make significant cuts to Medicaid to balance their budgets, including reducing eligibility, eliminating or limiting benefits, and reducing already low payment rates for providers.' Because provider taxes draw matching federal dollars, Washington has a say in how they are implemented. And the Republicans who run the federal government are looking to spend far fewer of those dollars. In California, the insurers that pay the MCO tax are reimbursed for the portion levied on their Medi-Cal enrollment. That helps explain why the tax rate on Medi-Cal enrollment is sharply higher than on commercial enrollment. Over 99% of the tax money the insurers pay comes from their Medi-Cal business, which means most of the state's insurers get back almost all the tax they pay. That imbalance, which CMS describes as a loophole, is one of the main things Republicans are trying to change. If either the CMS rule or the corresponding provisions in the House reconciliation bill were enacted, states would be required to levy provider taxes equally on Medicaid and commercial business to draw federal dollars. California would likely be unable to raise the commercial rates to the level of the Medi-Cal ones, because state law constrains the legislature's ability to do so. The only way to comply with the rule would be to lower the tax rate on Medi-Cal enrollment, which would sharply reduce revenue. CMS has warned California and other states for years, including under the Biden administration, that it was considering significant changes to MCO and other provider taxes. Those warnings were never realized. But the risk may be greater this time, some observers say, because the proposed changes are echoed in the House-passed reconciliation bill and intertwined with a broader Republican strategy — and set of proposals — to cut Medicaid spending by close to $800 billion. 'All of these proposals move in the same direction: fewer people enrolled, less generous Medicaid programs over time,' said Edwin Park, a research professor at Georgetown University's McCourt School of Public Policy. California's MCO tax is expected to net California $13.9 billion over the next two fiscal years, according to January estimates. The state's hospital tax is expected to bring in an estimated $9 billion this year, up sharply from last year, according to the Department of Health Care Services, which runs Medi-Cal. Losing a significant slice of that revenue on top of other Medicaid cuts in the House reconciliation bill 'all adds up to be potentially a super serious impact on Medi-Cal and the California state budget overall,' said Kayla Kitson, a senior policy fellow at the California Budget & Policy Center. And it's not only California that will feel the pain. 'All states are going to be hurt by this," Park said. Wolfson writes for KFF Health News, 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. Sign up for our Wide Shot newsletter to get the latest entertainment business news, analysis and insights. This story originally appeared in Los Angeles Times.
