I co-wrote the anonymous HHS report on pediatric gender medicine
In May, the Department of Health and Human Services published a comprehensive review of treatments for gender dysphoria in minors that was swiftly criticized, in part because the names of its authors were withheld.
I am one of the authors. As Health and Human Services said upon publication, the review is going through the peer review process, for which anonymity is preferred. My co-authors and I discussed additional reasons for anonymity, including that disclosure might distract attention from the review's content or lead to personal attacks or professional penalties. Those who have raised concerns about the field of pediatric gender medicine are well aware of the risks to reputations or careers.
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Yahoo
23 minutes ago
- Yahoo
‘No Colon, Still Rollin'': Cass Bargell, US scrum-half and ostomy advocate, sets sights on World Cup
A few years ago, Cass Bargell gave a Ted Talk at Harvard, the same university where she studied integrative biology and played scrum-half, helping the Crimson to a national 15s title and earning nominations for US player of the year. Onstage, visibly nervous, she clutched a rugby ball as if for emotional support. 'I dropped the ball,' she says, laughing. 'They edited it out.' Bargell didn't drop the ball with her talk, which offered a compelling account of her traumatic experience with ulcerative colitis and her extraordinary recovery. It all began in late 2020, with alarming symptoms. Bargell kept playing through quickening pain but eventually, in November 2021, underwent ileostomy surgery to remove her colon and create a stoma, an opening in her abdomen to allow waste to pass. Just a few months later Bargell was back playing rugby, the sport she found as a middle-schooler in Summit, Colorado, as aggressive as ever but now wearing an ostomy bag. The title of her Ted Talk sums up her determination and her emergence as an advocate for life after surgery: No Colon, Still Rollin'. She has told her remarkable tale many times, including to former NFL Man of the Year and fellow patient Rolf Benirschke, for The Phoenix, official magazine of the United Ostomy Associations of America. But now, at 25 and eight times capped, Bargell is about to step onto the biggest stage of all – the 2025 Women's Rugby World Cup in England, where the US kick-off against the hosts on Friday. Speaking to the Guardian, she said that though life with an ostomy had not 'gotten any easier … I think I've gotten a lot better at handling it. 'I think some things have actually gotten harder, in some ways. The longer I've had it, the more it feels like this daunting thing that's gonna go on for ever. And I think I have, like, those big emotional moments, but I'm a lot better at handling it day to day. I don't think about my bag and I know how to change it much faster now. I know how to handle my supplies.' Related: World Cup final to be most attended women's rugby match in history after ticket sellout Bargell's play gives no clues of her extra burden. In Washington in July against Fiji, as the Americans struggled to hold a narrowing lead, the 5ft 4in dynamo forced two crucial turnovers, stealing Fijiana ball at the ruck. Turning to the nearest reporter to ask 'Who's that flanker the Eagles brought on?', the Guardian was swiftly enlightened: not only was Bargell not a forward, but also, 'that's nothing: she plays with an ostomy bag.' Asked if that played on her mind during games, she said: 'No, I don't think about it. But I'm really lucky that I'm supported by my coaches too. 'When I'm playing and I get hit in the bag, I don't feel anything, I don't think anything. I just put the ball back strongly. But if we're in training and we're doing a drill … where we come up and hit each other and then backpedal, reload, come up at each other again, backpedal, reload, just like working on the constant up and back, as the attacker I was just getting hit straight in the bag over and over and over, and I was like, this never happens to me in a game, and I'm really uncomfortable. 'I wasn't hurt from it or anything. I just was like, that's wearing my bag down more than I need. And my coaches are like, perfect. 'No problem. You'll hold the pad next time.' So then everyone was in the line and I just had a [tackle] pad, and it was fine. 'So it's not like I love getting hit in the bag repetitively. It's just that when it happens, it's not a big deal. I also feel like my right fend has gotten much stronger since I got my ostomy. I don't like people getting that close, so when I can avoid it, I do.' She laughs again, and switches from hand-offs to helping hands, saluting the influence of Ilona Maher, the US center, Olympic sevens medalist and social media star who has fired global interest in the women's game. 'Ilona, the version you see on the internet is how she is,' Bargell says. 'She's, like, a fun, big personality. And also everything she says about there needs to be more stars [in women's rugby] and we need to lift more women up, she lives that and walks it with us. She's helped me so much with sharing my story, with all the social media stuff and everything she talks about in that world. 'On the field, she's fast and she's powerful and she's strong and she can pass, and she brings so much to our team. I love training with her. She's also a really strong organizer, which I don't think people can always see, but she does communicate a lot and helps us all.' Bargell, Maher and the rest of the Eagles may need all the help they can get on Friday: England are favorites to win the World Cup, having crushed rivals France in their final warm-up while the US lost to Canada, another title contender. Looking at that game, Bargell identified a failing familiar from the meeting with Fiji in DC: a strong start not maintained. 'The first half felt easy,' says Bargell, who will start on the bench behind Olivia Ortiz on Friday. 'It felt like that's what we practiced in training, and it was just about executing it. 'We've been working a lot on finding our energy right after half-time and being able to come out and start the second half the way we started the first half, because it really wasn't like we weren't surprising ourselves with what we were doing that first half. It was what we practiced. And so it's just about finding a way to keep that energy throughout the whole game.' 'We really rise' Bargell is one of many Eagles who this year played in Women's Elite Rugby, the semi-pro league which has just completed its first season, with Bargell turning out for the Boston Banshees while working as a data analyst for the Crohn's and Colitis Foundation. She speaks favorably of WER as a step up from the amateur game, if not at the level of Premiership Women's Rugby, where senior Eagles including Ortiz play, where Maher shone for Bristol, and in which England's Red Roses ply their fearsome trade. 'I think an interesting part about our team is that we really rise,' Bargell says. 'We rise to the occasion. And so I know we'll rise [against England]. 'It's an incredible opportunity to be a part of that opening match at all, and I know everyone's really excited for it. We've honestly just been focused on building our own systems. It's not like these past three weeks were only focused on England.' True: Australia and Samoa also await, two wins most likely needed to make the quarter-finals. Australia offer the sterner test. In Perth in May, the Wallaroos downed the Eagles, 29-17. Bargell remains confident. 'We all believe we have a lot of threats, and like who we are as players,' she says. 'And so if we can bring our team together in that way, then we can compete.'
CBS News
25 minutes ago
- CBS News
Native Americans want to avoid past Medicaid enrollment snafus as work requirements loom
Jonnell Wieder earned too much money at her job to keep her Medicaid coverage when the COVID-19 public health emergency ended in 2023 and states resumed checking whether people were eligible for the program. But she was reassured by the knowledge that Medicaid would provide postpartum coverage for her and her daughter, Oakleigh McDonald, who was born in July of that year. Wieder is a member of the Confederated Salish and Kootenai Tribes in Montana and can access some health services for free through her tribe's health clinics. But funding is limited, so, like a lot of Native American people, she relied on Medicaid for herself and Oakleigh. Months before Oakleigh's first birthday, the date when Wieder's postpartum coverage would come to an end, Wieder completed and returned paperwork to enroll her daughter in Healthy Montana Kids, the state's version of the Children's Health Insurance Program. But her paperwork, caught up in the lengthy delays and processing times for applications, did not go through. "As soon as she turned 1, they cut her off completely," Wieder said. It took six months for Wieder to get Oakleigh covered again through Healthy Montana Kids. Before health workers in her tribe stepped in to help her resubmit her application, Wieder repeatedly called the state's health department. She said she would dial the call center when she arrived at her job in the morning and go about her work while waiting on hold, only for the call to be dropped by the end of the day. "Never did I talk to anybody," she said. Wieder and Oakleigh's experience is an example of the chaos for eligible Medicaid beneficiaries caused by the process known as the "unwinding," which led to millions of people in the U.S. losing coverage due to paperwork or other procedural issues. Now, tribal health leaders fear their communities will experience more health coverage disruptions when new federal Medicaid work and eligibility requirements are implemented by the start of 2027. The tax-and-spending law that President Trump signed this summer exempts Native Americans from the new requirement that some people work or do another qualifying activity a minimum number of hours each month to be eligible for Medicaid, as well as from more frequent eligibility checks. But as Wieder and her daughter's experience shows, they are not exempt from getting caught up in procedural disenrollments that could reemerge as states implement the new rules. "We also know from the unwinding that that just doesn't always play out necessarily correctly in practice," said Joan Alker, who leads Georgetown University's Center for Children and Families. "There's a lot to worry about." The new law is projected to increase the number of people who are uninsured by 10 million. The lessons of the unwinding suggest that "deep trouble" lies ahead for Native Americans who rely on Medicaid, according to Alker. Mr. Trump's new law changes Medicaid rules to require some recipients ages 19 to 64 to log 80 hours of work or other qualifying activities per month. It also requires states to recheck those recipients' eligibility every six months, instead of annually. Both of these changes will be effective by the end of next year. The Congressional Budget Office estimated in July that the law would reduce federal Medicaid spending by more than $900 billion over a decade. In addition, more than 4 million people enrolled in health plans through the Affordable Care Act marketplace are projected to become uninsured if Congress allows pandemic-era enhanced premium tax credits to expire at the end of the year. Wieder said she was lucky that the tribe covered costs and her daughter's care wasn't interrupted in the six months she didn't have health insurance. Citizens of federally recognized tribes in the U.S. can access some free health services through the Indian Health Service, the federal agency responsible for providing health care to Native Americans and Alaska Natives. But free care is limited because Congress has historically failed to fully fund the Indian Health Service. Tribal health systems rely heavily on Medicaid to fill that gap. Native Americans are enrolled in Medicaid at higher rates than the White population and have higher rates of chronic illnesses, die more from preventable diseases, and have less access to care. Medicaid is the largest third-party payer to the Indian Health Service and other tribal health facilities and organizations. Accounting for about two-thirds of the outside revenue the Indian Health Service collects, it helps tribal health organizations pay their staff, maintain or expand services, and build infrastructure. Tribal leaders say protecting Medicaid for Indian Country is a responsibility Congress and the federal government must fulfill as part of their trust and treaty obligations to tribes. The Trump administration prevented states from disenrolling most Medicaid recipients for the duration of the public health emergency starting in 2020. After those eligibility checks resumed in 2023, nearly 27 million people nationwide were disenrolled from Medicaid during the unwinding, according to an analysis by the Government Accountability Office published in June. The majority of disenrollments — about 70% — occurred for procedural reasons, according to the federal Centers for Medicare & Medicaid Services. CMS did not require state agencies to collect race and ethnicity data for their reporting during the unwinding, making it difficult to determine how many Native American and Alaska Native enrollees lost coverage. The lack of data to show how the unwinding affected the population makes it difficult to identify disparities and create policies to address them, said Latoya Hill, senior policy manager with KFF's Racial Equity and Health Policy program. KFF is a health information nonprofit that includes KFF Health News. The National Council of Urban Indian Health, which advocates on public health issues for Native Americans living in urban parts of the nation, analyzed the Census Bureau's 2022 American Community Survey and KFF data in an effort to understand how disenrollment affected tribes. The council estimated more than 850,000 Native Americans had lost coverage as of May 2024. About 2.7 million Native Americans and Alaska Natives were enrolled in Medicaid in 2022, according to the council. The National Indian Health Board, a nonprofit that represents and advocates for federally recognized tribes, has been working with federal Medicaid officials to ensure that state agencies are prepared to implement the exemptions. "We learned a lot of lessons about state capacity during the unwinding," said Winn Davis, congressional relations director for the National Indian Health Board. Nevada health officials say they plan to apply lessons learned during the unwinding and launch a public education campaign on the Medicaid changes in the new federal law. "A lot of this will depend on anticipated federal guidance regarding the implementation of those new rules," said Stacie Weeks, director of the Nevada Health Authority. Staff at the Fallon Tribal Health Center in Nevada have become authorized representatives for some of their patients. This means that tribal citizens' Medicaid paperwork is sent to the health center, allowing staff to notify individuals and help them fill it out. Davis said the unwinding process showed that Native American enrollees are uniquely vulnerable to procedural disenrollment. The new law's exemption of Native Americans from work requirements and more frequent eligibility checks is the "bare minimum" to ensure unnecessary disenrollments are avoided as part of trust and treaty obligations, Davis said. The GAO said the process of determining whether individuals are eligible for Medicaid is "complex" and "vulnerable to error" in a 2024 report on the unwinding. "The resumption of Medicaid eligibility redeterminations on such a large scale further compounded this complexity," the report said. It highlighted weaknesses across state systems. By April 2024, federal Medicaid officials had found nearly all states were out of compliance with redetermination requirements, according to the GAO. Eligible people lost their coverage, the accountability office said, highlighting the need to improve federal oversight. In Texas, for example, federal Medicaid officials found that 100,000 eligible people had been disenrolled due to, for example, the state system's failure to process their completed renewal forms or miscalculation of the length of women's postpartum coverage. Some states were not conducting ex parte renewals, in which a person's Medicaid coverage is automatically renewed based on existing information available to the state. That reduces the chance that paperwork is sent to the wrong address, because the recipient doesn't need to complete or return renewal forms. But poorly conducted ex parte renewals can lead to procedural disenrollments, too. More than 100,000 people in Nevada were disenrolled by September 2023 through the ex parte process. The state had been conducting the ex parte renewals at the household level, rather than by individual beneficiary, resulting in the disenrollment of still-eligible children because their parents were no longer eligible. Ninety-three percent of disenrollments in the state were for procedural reasons — the highest in the nation, according to KFF. Another issue the federal agency identified was that some state agencies were not giving enrollees the opportunity to submit their renewal paperwork through all means available, including mail, phone, online, and in person. State agencies also identified challenges they faced during the unwinding, including an unprecedented volume of eligibility redeterminations, insufficient staffing and training, and a lack of response from enrollees who may not have been aware of the unwinding. Native Americans and Alaska Natives have unique challenges in maintaining their coverage. Communities in rural parts of the nation experience issues with receiving and sending mail. Some Native Americans on reservations may not have street addresses. Others may not have permanent housing or change addresses frequently. In Alaska, mail service is often disrupted by severe weather. Another issue is the lack of reliable internet service on remote reservations. Tribal health leaders and patient benefit coordinators said some tribal citizens did not receive their redetermination paperwork or struggled to fill it out and send it back to their state Medicaid agency. Although the unwinding is over, many challenges persist. Tribal health workers in Montana, Oklahoma, and South Dakota said some eligible patients who lost Medicaid during the unwinding had still not been reenrolled as of this spring. "Even today, we're still in the trenches of getting individuals that had been disenrolled back onto Medicaid," said Rachel Arthur, executive director of the Indian Family Health Clinic in Great Falls, Montana, in May. Arthur said staff at the clinic realized early in the unwinding that their patients were not receiving their redetermination notices in the mail. The clinic is identifying people who fell off Medicaid during the unwinding and helping them fill out applications. Marlena Farnes, who was a patient benefit coordinator at the Indian Family Health Clinic during the Medicaid unwinding, said she tried for months to help an older patient with a chronic health condition get back on Medicaid. He had completed and returned his paperwork but still received a notice that his coverage had lapsed. After many calls to the state Medicaid office, Farnes said, state officials told her the patient's application had been lost. Another patient went to the emergency room multiple times while uninsured, Arthur said. "I felt like if our patients weren't helped with follow-up, and that advocacy piece, their applications were not being seen," Farnes said. She is now the behavioral health director at the clinic. Montana was one of five states where more than 50% of enrollees lost coverage during the unwinding, according to the GAO. The other states are Idaho, Oklahoma, Texas, and Utah. About 68% of Montanans who lost coverage were disenrolled for procedural reasons. In Oklahoma, eligibility redeterminations remain challenging to process, said Yvonne Myers, a Medicaid and Affordable Care Act consultant for Citizen Potawatomi Nation Health Services. That's causing more frequent coverage lapses, she said. Myers said she thinks Republican claims of "waste, fraud, and abuse" are overstated. "I challenge some of them to try to go through an eligibility process," Myers said. "The way they're going about it is making it for more hoops to jump through, which ultimately will cause people to fall off." The unwinding showed that state systems can struggle to respond quickly to changes in Medicaid, leading to preventable erroneous disenrollments. Individuals were often in the dark about their applications and struggled to reach state offices for answers. Tribal leaders and health experts are raising concerns that those issues will continue and worsen as states implement the requirements of the new law. Georgia, the only state with an active Medicaid work requirement program, has shown that the changes can be difficult for individuals to navigate and costly for a state to implement. More than 100,000 people have applied for Georgia's Pathways program, but only about 8,600 were enrolled as of the end of July. Alker, of Georgetown, said Congress took the wrong lesson from the unwinding in adding more restrictions and red tape. "It will make unwinding pale in comparison in terms of the number of folks that are going to lose coverage," Alker said. This article was published with the support of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, assisted by grants from The Commonwealth Fund. 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.
Yahoo
27 minutes ago
- Yahoo
UnitedHealth (UNH) Board Approves Quarterly Dividend
UnitedHealth Group Incorporated (NYSE:UNH) is one of the 9 Best NYSE Stocks to Buy According to Hedge Funds. On August 13, UnitedHealth Group Incorporated (NYSE:UNH) announced that its board of directors declared a cash dividend of $2.21 per share. This dividend will be paid on September 23, 2025, to all common stock shareholders of record as of the close of business on September 15, 2025. Previously, in June 2025, UnitedHealth Group Incorporated (NYSE:UNH) raised its quarterly dividend rate by 5% to $2.21. Ken Wolter/ During the second quarter of 2025, UnitedHealth Group Incorporated (NYSE:UNH) returned $4.5 billion to shareholders in the form of dividends and share repurchases. The company's annualized return on equity for the first half of 2025 was 20.6% UnitedHealth Group Incorporated (NYSE:UNH) is an American health insurance and healthcare services company. While we acknowledge the potential of UNH as an investment, we believe certain AI stocks offer greater upside potential and carry less downside risk. If you're looking for an extremely undervalued AI stock that also stands to benefit significantly from Trump-era tariffs and the onshoring trend, see our free report on the best short-term AI stock. READ NEXT: 11 Best Revenue Growth Stocks to Buy Now and 14 Best Aggressive Growth Stocks to Buy According to Analysts. Disclosure: None. This article is originally published at Insider Monkey.
