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May 16 2024 KFF Health News

For much of his young life, Jorge Sanchez regularly gasped for air, at times coughing so violently that he'd almost throw up. His mother whisked him to the emergency room late at night and slept with him to make sure he didn't stop breathing.

"He's had these problems since he was born, and I couldn't figure out what was triggering his asthma," Fabiola Sandoval said of her son, Jorge, now 4. "It's so hard when your child is hurting. I was willing to try anything."

In January, community health workers visited Sandoval's home in Turlock, a city in California's Central Valley where dust from fruit and nut orchards billows through the air. They scoured Sandoval's home for hazards and explained that harsh cleaning products, air fresheners, and airborne dust and pesticides can trigger an asthma attack.

The team also provided Sandoval with air purifiers, a special vacuum cleaner that can suck dust out of the air, hypoallergenic mattress covers, and a humidity sensor — goods that retail for hundreds of dollars. Within a few months, Jorge was breathing easier and was able to run and play outside.

The in-home consultation and supplies were paid for by Medi-Cal, California's Medicaid health insurance program for low-income residents. Gov. Gavin Newsom is spearheading an ambitious $12 billion experiment to transform Medi-Cal into both a health insurer and a social services provider, one that relies not only on doctors and nurses, but also community health workers and nonprofit groups that offer dozens of services, including delivering healthy meals and helping homeless people pay for housing.

These groups are redefining health care in California as they compete with businesses for a share of the money, and become a new arm of the sprawling Medi-Cal bureaucracy that serves nearly 15 million low-income residents on an annual budget of $158 billion.

But worker shortages, negotiations with health insurance companies, and learning to navigate complex billing and technology systems have hamstrung the community groups' ability to deliver the new services: Now into the third year of the ambitious five-year experiment, only a small fraction of eligible patients have received benefits.

"This is still so new, and everyone is just overwhelmed at this point, so it's slow-going," said Kevin Hamilton, a senior director at the Central California Asthma Collaborative.

The collaborative has served about 3,650 patients, including Sandoval, in eight counties since early 2022, he said. It has years of experience with Medi-Cal patients in the Central Valley and has received about $1.5 million of the new initiative's money.

By contrast, CalOptima Health, Orange County's primary Medi-Cal insurer, is new to offering asthma benefits and has signed up 58 patients so far.

"Asthma services are so difficult to get going" because the nonprofit infrastructure for these services is virtually nonexistent, said Kelly Bruno-Nelson, CalOptima's executive director for Medi-Cal. "We need more community-based organizations on board because they're the ones who can serve a population that nobody wants to deal with."

Newsom, a Democrat in his second term, says his signature health care initiative, known as CalAIM, seeks to reduce the cost of caring for the state's sickest and most vulnerable patients, including homeless Californians, foster children, former inmates, and people battling addiction disorders.

In addition to in-home asthma remediation, CalAIM offers 13 broad categories of social services, plus a benefit connecting eligible patients with one-on-one care managers to help them obtain anything they need to get healthier, from grocery shopping to finding a job.

The 25 managed-care insurance companies participating in Medi-Cal can choose which services they offer, and contract with community groups to provide them. Insurers have hammered out about 4,300 large and small contracts with nonprofits and businesses.

So far, about 103,000 Medi-Cal patients have received CalAIM services and roughly 160,000 have been assigned personal care managers, according to state data, a sliver of the hundreds of thousands of patients who likely qualify.

"We're all new to health care, and a lot of this is such a foreign concept," said Helena Lopez, executive director of A Greater Hope, a nonprofit organization providing social services in Riverside and San Bernardino counties, such as handing out baseball cleats to children to help them be active.

Tiffany Sickler runs Koinonia Family Services, which offers California foster children mental health and other types of care, and even helped a patient pay off parking tickets. But the program is struggling on a shoestring budget.

"If you want to do this, you have to learn all these new systems. It's been a huge learning curve, and very time-consuming and frustrating, especially without adequate funding," she said.

Brandon Richards, a Newsom spokesperson, defended CalAIM, saying that it was "on the cutting edge of health care" and that the state was working to increase "awareness of these new services and support."

For nonprofits and businesses, CalAIM is a money-making opportunity — one that top state health officials hope to make permanent. Health insurers, which receive hefty payments from the state to serve more people and offer new services, share a portion with service providers. Related StoriesStudy links higher-potency cannabis use in youth to increased risk of psychotic experiencesUncovering the psychological toll of entrenched school practices on childrenClinical trial in Seattle aims to transform treatment approaches for pediatric IBD

In some places, community groups are competing with national corporations for the new funding, such as Mom's Meals, an Iowa-based company that delivers prepared meals across the United States.

Mom's Meals has an advantage over neighborhood nonprofit groups because it has long served seniors on Medicare and was able to immediately start offering the CalAIM benefit of home-delivered meals for patients with chronic diseases. But even Mom's Meals isn't reaching everyone who qualifies, because doctors and patients don't always know it's an option, said Catherine Macpherson, the company's chief nutrition officer.

"Utilization is not as high as it should be yet," she said. "But we were well positioned, because we already had departments to do billing and contracting with health care."

Middleman companies also have their eye on the billions of CalAIM dollars and are popping up to assist small organizations to go up against established ones like Mom's Meals. For instance, the New York-based Nonprofit Finance Fund is advising homeless service providers how to get more contracts and expand benefits.

Full Circle Health Network, with 70 member organizations, is helping smaller nonprofit groups develop and deliver services primarily for families and foster children. Full Circle has signed a deal with Kaiser Permanente, allowing the health care giant to access its network of community groups.

"We're allowing organizations to launch these benefits much faster than they've been able to do and to reach more vulnerable people," said Camille Schraeder, chief executive of Full Circle. "Many of these are grassroots organizations that have the trust and expertise on the ground, but they're new to health care."

One of the biggest challenges community groups face is hiring workers, who are key to finding eligible patients and persuading them to participate.

Kathryn Phillips, a workforce expert at the California Health Care Foundation, said there isn't enough seed money for community groups to hire workers and pay for new technology platforms. "They bring the trust that is needed, the cultural competency, the diversity of languages," she said. "But there needs to be more funding and reimbursement to build this workforce."

Health insurers say they are trying to increase the workforce. For instance, L.A. Care Health Plan, the largest Medi-Cal insurer in California, has given $66 million to community organizations for hiring and other CalAIM needs, said Sameer Amin, the group's chief medical officer.

"They don't have the staffing to do all this stuff, so we're helping with that all while teaching them how to build up their health care infrastructure," he said. "Everyone wants a win, but this isn't going to be successful overnight."

In the Central Valley, Jorge Sanchez is one of the lucky early beneficiaries of CalAIM.

His mother credits the trust she established with community health workers, who spent many hours over multiple visits to teach her how to control her son's asthma.

"I used to love cleaning with bleach" but learned it can trigger breathing problems, Sandoval said.

Since she implemented the health workers' recommendations, Sandoval has been able to let Jorge sleep alone at night for the first time in four years.

"Having this program and all the things available is amazing," said Sandoval, as she pointed to the dirty dust cup in her new vacuum cleaner. "Now my son doesn't have as many asthma attacks and he can run around and be a normal kid."

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

This article was reprinted from khn.org, 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. Source:

KFF Health News

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Entertainment

Rappers Bob Vylan sue Irish broadcaster RTE over claim lead singer led ‘antisemitic chants’ at Glastonbury gig

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Rappers Bob Vylan sue Irish broadcaster RTE over claim lead singer led 'antisemitic chants' at Glastonbury gig

Punk-rap duo Bob Vylan are suing Irish national broadcaster RTE for defamation, claiming it misrepresented chants led by the band when they played this year’s Glastonbury festival.

The group, which performed at Dublin’s Vicar Street last month, claim they were defamed in a report by RTE News that said the lead singer led antisemitic chants when they played the Somerset festival in June.

During their performance, singer Pascal Robinson-Foster, whose stage name is Bobby Vylan, led a chant of “death, death, to the IDF [Israel Defence Forces]”.

File pic: PA
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File pic: PA

Pic: PA
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Pic: PA

It provoked widespread criticism of the artist, including from Glastonbury organiser Emily Eavis, and the BBC, which live streamed their show.

Phoenix Law launched legal action on behalf of Robinson-Foster and drummer Wade Laurence George at Ireland’s High Court on Monday, according to court records.

The firm said: “The proceedings arise from a broadcast aired by RTE News following Bob Vylan’s performance at Glastonbury Festival on 28 June 2025.

“During this broadcast, comments were made alleging that the lead singer of Bob Vylan led antisemitic chants. These allegations are categorically denied by our clients and are entirely untrue.”

More on Glastonbury

Phoenix Law said Bob Vylan had made statements expressing support for Palestinian self-determination and criticising military actions by the IDF (Israel Defence Forces).

His comments did not target Jewish people or express hatred towards any group, the firm said, suggesting they were “politically charged but not antisemitic in nature”.

Solicitor Darragh Mackin said the pair “are no stranger to utilising their freedom of expression to speak out against the genocide in Gaza“.

Mr Mackin said there was “a fundamental distinction between speaking critically about the role of the Israeli state forces, and being antisemitic”.

“The former is speech within the confines of political expression, whereas the latter is a form of hatred directed towards Jewish people,” he added.

Read more on Sky News:
Who are Bob Vylan?

The BBC apologised, including to the Jewish community, and said it regretted not pulling the live stream of the set and promised not to live stream “high-risk” acts in future.

It partially upheld complaints made over the broadcast, accepting the live stream broke the corporation’s editorial guidelines.

Ofcom’s chief executive, Dame Melanie Dawes, said the BBC needed to “get a grip quicker” on handling such controversies and complete its internal reports and investigations sooner.

Last month, the Metropolitan Police said detectives would take no further action over similar alleged chants made at a Bob Vylan gig in London in May.

The individual was not arrested but an investigation was ongoing, the Met said.

Avon and Somerset Police said a man, in his 30s, understood to be Mr Robinson-Foster, had voluntarily attended an interview in relation to the band’s Glastonbury performance. Enquiries are ongoing, the force said on Tuesday.

The US condemned the act’s “hateful tirade”, revoking their visas, while several festivals cancelled their upcoming appearances.

Speaking to Louis Theroux in October, Bobby Vylan said he had no regrets about the chants and would do it again “tomorrow”.

Sky News has contacted RTE for comment.

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Sports

Do college sports need a CBA? Some ADs are starting to think so

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Do college sports need a CBA? Some ADs are starting to think so

After another week of frustrating setbacks, at the end of a frustrating year trying to bring stability to their industry, a growing number of college athletic directors say they are interested in exploring a once-unthinkable option: collective bargaining with their players.

Dozens of athletic directors will gather in Las Vegas over the next few days for an annual conference. They had hoped to be raising toasts to the U.S. House of Representatives. But for the second time in three months, House members balked last week at voting on a bill that would give the NCAA protection from antitrust lawsuits and employment threats. So instead, they will be greeted by one of the Strip’s specialties: the cold-slap realization of needing a better plan.

“I’m not sure I can sit back today and say I’m really proud of what we’ve become,” Boise State athletic director Jeramiah Dickey told ESPN late last week. “There is a solution. We just have to work together to find it, and maybe collective bargaining is it.”

Athletic directors see only two paths to a future in which the college sports industry can enforce rules and defend them in court: Either Congress grants them an exemption from antitrust laws, or they collectively bargain with athletes. As Dickey said, and others have echoed quietly in the past several days, it has become irresponsible to continue to hope for an antitrust bailout without at least fully kicking the tires on the other option.

“If Congress ends up solving it for us, and it ends up being a healthy solution I’ll be the first one to do cartwheels down the street,” said Tennessee athletic director Danny White when speaking to ESPN about his interest in collective bargaining months ago. “But what are the chances they get it right when the NCAA couldn’t even get it right? We should be solving it ourselves.”

Some athletic directors thought they had solved their era of relative lawlessness back in July. The NCAA and its schools agreed to pay $2.8 billion in the House settlement to purchase a very expensive set of guardrails meant to put a cap on how much teams could spend to acquire players. The schools also agreed to fund the College Sports Commission, a new agency created by the settlement to police those restrictions.

But without an antitrust exemption, any school or player who doesn’t like a punishment they receive for bursting through those guardrails can file a lawsuit and give themselves a pretty good chance of wiggling out of a penalty. The CSC’s plan — crafted largely by leaders of the Power 4 conferences — to enforce those rules without an antitrust exemption was to get all their schools to sign a promise that they wouldn’t file any such lawsuits. On the same day that Congress’ attempt crumbled last week, seven state attorneys general angrily encouraged their schools not to sign the CSC’s proposed agreement.

In the wake of the attorneys general’s opposition, a loose deadline to sign the agreement came and went, with many schools declining to participate. So, college football is steamrolling toward another transfer portal season without any sheriff that has the legal backing to police how teams spend money on building their rosters.

That’s why college sports fans have heard head football coaches like Lane Kiffin openly describe how they negotiated for the biggest player payroll possible in a system where all teams are supposed to be capped at the same $20.5 million limit. Right now, the rules aren’t real. The stability promised as part of the House settlement doesn’t appear to be imminent. Meanwhile, the tab for potential damages in future antitrust lawsuits continues to grow larger with each passing day.

Collective bargaining isn’t easy, either. Under the current law, players would need to be employees to negotiate a legally binding deal. The NCAA and most campus leaders are adamantly opposed to turning athletes into employees for several reasons, including the added costs and infrastructure it would require.

The industry would need to make tough decisions about which college athletes should be able to bargain and how to divide them into logical groups. Should the players be divided by conference? Should all football players negotiate together? What entity would sit across from them at the bargaining table?

On Monday, Athletes.Org, a group that has been working for two years to become college sports’ version of a players’ union, published a 35-page proposal for what an agreement might look like. Their goal was to show it is possible to answer the thorny, in-the-weeds questions that have led many leaders in college sports to quickly dismiss collective bargaining as a viable option.

Multiple athletic directors and a sitting university president are taking the proposal seriously — a milestone for one of the several upstart entities working to gain credibility as a representative for college athletes. Syracuse chancellor and president Kent Syverud said Monday that he has long felt the best way forward for college sports is a negotiation where athletes have “a real collective voice in setting the rules.”

“[This template] is an important step toward that kind of partnership-based framework,” he said in a statement released with AO’s plan. “… I’m encouraged to see this conversation happening more openly, so everyone can fully understand what’s at stake.”

White, the Tennessee athletic director, has also spent years working with lawyers to craft a collective bargaining option. In his plan, the top brands in college football would form a single private company, which could then employ players. He says that would provide a solution in states where employees of public institutions are not legally allowed to unionize.

“I don’t understand why everyone’s so afraid of employment status,” White said. “We have kids all over our campus that have jobs. … We have kids in our athletic department that are also students here that work in our equipment room, and they have employee status. How that became a dirty word, I don’t get it.”

White said athletes could be split into groups by sport to negotiate for a percentage of the revenue they help to generate.

The result could be expensive for schools. Then again, paying lawyers and lobbyists isn’t cheap either. The NCAA and the four power conferences combined to spend more than $9 million on lobbyists between 2021 and 2024, the latest year where public data is available. That’s a relatively small figure compared to the fees and penalties they could face if they continue to lose antitrust cases in federal court.

“I’m not smart enough to say [collective bargaining] is the only answer or the best answer,” Dickey said. “But I think the onus is on us to at least curiously question: How do you set something up that can be sustainable? What currently is happening is not.”

Players and coaches are frustrated with the current system, wanting to negotiate salaries and build rosters with a clear idea of what rules will actually be enforced. Dickey says fans are frustrated as they invest energy and money into their favorite teams without understanding what the future holds. And athletic directors, who want to plan a yearly budget and help direct their employees, are frustrated too.

“It has been very difficult on campus. I can’t emphasize that enough,” White said. “It’s been brutal in a lot of ways. It continues to be as we try to navigate these waters without a clear-cut solution.”

This week White and Dickey won’t be alone in their frustration. They’ll be among a growing group of peers who are pushing to explore a new solution.

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Science

Massive Sunspot Complex on the Sun Raises Risk of Strong Solar Storms

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A massive sunspot complex has appeared on the Sun, covering an area comparable to the legendary Carrington Event region. Known as AR 4294-96, the active cluster features highly tangled magnetic fields that could unleash powerful solar flares and geomagnetic storms, potentially disrupting satellites, power grids, and global communications if Earth-directed eruptions oc…

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