SEATTLE -- Proveedores de atención para personas en hogares de cuidados y comunitarios están observando de cerca al Congreso mientras los congresistas consideran parte del paquete de conciliación presupuestaria que impulsaría los fondos para estos servicios.

Conocida como la Ley de Mejores Cuidados Mejores Trabajos, la medida asignaría $400 mil millones para ampliar el acceso a los servicios de Medicaid desde hogares de cuidados y comunidades.

Estos servicios ayudan a las personas mayores y las personas con discapacidades intelectuales y del desarrollo a vivir de forma independiente.

Scott Livengood dirige Alpha Supported Living Services, que atiende a personas en los condados de King, Snohomish y Spokane. Él dice que, debido a la escasez de fondos, los empleados de nivel inicial ganan cerca del salario mínimo.

Livengood opina, "Atraer gente nueva al campo es muy desafiante, especialmente cuando no solo compite con otros, sino que realmente compite con puestos de comida rápida y otros puestos de cajero que ofrecen entre $18 y $20 por hora para comenzar. Entonces, es realmente un desafío."

Además, dice que la rotación en los servicios de apoyo de vida ha sido de alrededor del 50%, y la pandemia ha presentado desafíos de seguridad adicionales. La Ley de Better Care Better Jobs es copatrocinada por los senadores del estado de Washington y cinco de los miembros de la Cámara de Representantes de Estados Unidos.

Livengood expresa que, excluyendo recibir más dinero de estímulo federal, el estado de Washington tiene una de las igualaciones federales más bajas para los servicios de Medicaid en hogares de cuidados y comunidades, alrededor del 50%. También asegura que si la medida en el Congreso proporciona un aumento del 10%, podría aumentar los salarios y hacer una diferencia para los trabajadores.

"Comenzando con lo que está más rápido, que es un salario digno para nuestros empleados. Lo hemos estado monitoreando muy de cerca porque vemos que realmente podria abordar el problema de la fuerza laboral, de la rotación que estamos viendo, y simplemente estabilizar los servicios para las personas a las que apoyamos", comentó también el Señor Livengood.

Él dice que su agencia atiende principalmente a personas que necesitan atención las 24 horas. Y para los clientes en el espectro del autismo, agrega, la continuidad de la atención es especialmente importante. Livengood cree que la financiación adicional podría transformar estos trabajos en carreras para los empleados y reducir la rotación.

"Los clientes recibirían un cuidado constante con empleados que los conocen muy bien, habiendo trabajado con ellos durante años, en lugar de una rotación continua de personas que trabajan con ellos", agregó más adelante el director de Alpha Supported Living Services.

After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.