DENVER – Health care advocates are warning that a new rule proposed by the Trump administration could effectively block children's access to health, dental and mental services.

The rule would make it easier to deny immigrants legal status by expanding the definition of what it means to be a public charge, or dependent on government programs.

Sarah McAfee, director of communications at Center for Health Progress, says the move already is having a chilling effect, and notes many families with U.S. citizen children have stopped accessing health care.

"Parents are afraid to enroll in any of these public benefit programs, and so it is already having an impact on children's health, which has long-term impacts on their future," she states.

McAfee says parents' and children's health are inextricably linked, because children are far more likely to get care if their parents have coverage.

She adds it's critical for children to have regular access to pediatricians and says early life relationships with caregivers help lay a foundation for healthy development as children get older.

Proponents of the rule change argue it will promote immigrant self-sufficiency and save taxpayers money.

A recent Cato Institute report found that native born Americans are more likely to tap government programs than immigrants.

McAfee says safety net programs such as Medicaid are important investments, because when health care needs go unmet, it makes it a lot harder for children to grow up to be healthy, contributing adults.

"Immigrants contribute enormous amounts to our culture, to our economy, to our communities,” she stresses. “They pay much more in tax dollars than they use in public benefits."

The public charge rule would primarily impact documented immigrants and their families, as people without documentation are not eligible for most government programs.

McAfee says her group and others are encouraging people concerned about the rule's potential impact on children to submit comments at Regulations.gov. Comments must be received before Dec. 10.


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North Carolina must increase its crisis response capacity for long-term success, according to a new report by the mental-health policy group Inseparable. The report analyzes 988 crisis lifeline responses in every state and proposes improvements.

One key area it says requires attention in North Carolina is the need for more crisis-response mobile units and beds. Kelly Crosbie, director of the Division of Mental Health, Developmental Disabilities and Substance Use Services at the North Carolina Department of Health and Human Services, acknowledged this challenge and said funding from the General Assembly is addressing the need.

"So, now we have 19 'urgent cares' opening across the state," she said. "In the community crisis center space, we've added about 64 new beds for adults and 44 new beds for children."

The report shows an 81% call capacity rate, with a recommended goal of 90%. Crosbie said current numbers are higher, with call capacity at 98% and calls being answered in about 14 seconds. North Carolina's 988 line receives around 8,000 calls monthly.

In order to sustain this progress for the long term, Crosbie said, the 988 system will need sustainable funding.

"We really need insurers to recognize this as an appropriate level of care and to cover it. So they all cover 'urgent cares' now, right? Folks who go to an urgent care, and you have Aetna or Blue Cross, they're going to cover it," she said. "You go to a mental-health 'urgent care'; that should be covered as well."

Angela Kimball, chief advocacy officer for the group Inseparable, said the report calls on state legislatures to focus on creating sustainable funding sources and accountability measures for their crisis response systems.

"By having these accountability pieces," she said, "this allows legislators to oversee the system over the long haul, and to set up the structures for continuous learning, continuous system improvement."

She said data collection, annual reporting and coordination between the 988 and 911 systems are ways states can make them more accountable.

New York doctors are advising people how to stay healthy in the summer heat.

Temperatures across the state will reach the high 80s and mid-90s in the coming days. Some climatologists estimate 2024 will overtake 2023 as the hottest year on record, and New York's average temperature has risen 3 degrees since the 1970s.

Dr. Steven Foulis, a physician at
UBMD Primary Care, said people need to always stay hydrated.

"When you sweat, you lose a good deal of salts and other solutes through the sweat," he said, "so being able to replete those with whether it be a sports drink or really, any drink that has electrolytes in it will be an important thing to replete what your body is losing during warm days."

Foulis said people need to wear sunscreen when they're outdoors, since some aren't aware of the risks direct sun exposure poses. However, he added, this shouldn't stop anyone from getting away from their screens to enjoy the outdoors. New York Gov. Kathy Hochul's "Get Offline, Get Outside" campaign champions this by making all state park pools free this summer.

Not staying hydrated can lead to heat stroke or heat exhaustion, in turn leading to an emergency room visit. A Centers for Disease Control and Prevention study finds heat-related ER visits rose in 2023.

Dr. Donna O'Shea, chief medical officer for population health at UnitedHealthcare, said virtual care can help you decide whether a situation is serious enough to seek emergency care.

"You can decide, with a knowledgeable caregiver, 'Do I need more?' Most of the time, if it's related to hydration and heat stroke, if you're able to keep fluids down, virtual care can help determine how much, how long to wait before you go to the emergency room," she said. "Same thing even for sunburns or for bike safety."

She added that using virtual care can be a less time-consuming and less expensive option than going directly to a hospital. While telehealth can cost around $50, an in-person emergency room visit can cost around $2,700.

Health experts are urging residents to stay hydrated and stay out of the sun during peak periods, especially during the heat wave that is gripping parts of Kentucky and the rest of the United States.

According to the Centers for Disease Control and Prevention, older adults, young children, and people with chronic diseases are at highest risk for heat-related illness. But the heat also poses dangers to healthy people, especially during prolonged or strenuous activities in hot weather.

Donna O'Shea, chief medical officer for population health and value-based care at UnitedHealthcare, said people use health-care services a lot more on very hot days, and hospitals report a spike in emergency-room visits.

"And so one thing we do want people to remember," she said, "is that virtual care can help people connect with a health-care professional, 24/7 from their home when they have concerns that arise."

The Department of Health and Human Services has said extreme heat can trigger asthma and chronic obstructive pulmonary disease in some people. Blazing heat can also pose risks for people struggling with mental-health issues, and can worsen acute psychiatric and substance-use symptoms.

Dr. Rob Tagher, president of the American Academy of Pediatrics' Kentucky chapter, said noticeable symptoms of dehydration or heat stroke can include irritability, lethargy or fussiness in toddlers. He explained that it's important to ensure small children stay hydrated.

"I always tell adults that are taking care of kids and toddlers that if you're uncomfortable, the child is much more uncomfortable than you with regards to temperature," he said.

Tagher added that pediatricians often see an influx of young patients with insect bites, poison ivy and other summer rashes. Because there aren't many treatment options available other than waiting for the rash to resolve and trying to alleviate itching, he said prevention is key.

"Knowing which plants to stay away from," he said, "good observation and parenting to keep kids away from more dangerous plants, keeping them away from dawn and dusk, when the mosquitoes and bugs are a lot worse."