With costs growing, health care is set to be a major theme in Olympia this year.

Sam Hatzenbeler, health policy associate for the Economic Opportunity Institute, said state lawmakers have made progress, but care is still becoming increasingly unaffordable.

Hatzenbeler pointed out some Washingtonians have to make tough decisions.

"They're forced to choose between getting needed medical care and buying food, putting food on the table, paying rent, paying their car bill," Hatzenbeler outlined. "People shouldn't be forced to choose between these necessary pieces of being a human."

Across the U.S., the average worker's premium contribution has increased almost 300% over the past two decades. And Americans spend more than $1,500 each year on prescription drugs.

To tackle drug prices, state lawmakers hope to establish the Prescription Drug Affordability Board. Lawmakers approved a similar board in 2020, but Gov. Jay Inslee vetoed it because of its price tag. The Senate version of the bill had a public hearing this week.

Another measure, Senate Bill 5688, would give the attorney general oversight to ensure market consolidations don't result in increased cost.

Hatzenbeler noted the attorney general also would ensure care is not restricted.

"For example, some Catholic mergers and acquisitions have resulted in reduced access to reproductive care, gender-affirming care, end-of-life care, things like that," Hatzenbeler explained. "We want to make sure that consolidations don't result in this diminishing of care."

The bill includes a health equity assessment as well. It had a public hearing this week.

Hatzenbeler added another important provision to her organization is in the budget, and would increase funding for health care to immigrants. She reported 105,000 immigrants in the state lack health care.

Hatzenbeler emphasized low-income people, people of color and front-line workers in particular have shouldered a disproportionate impact from the pandemic.

"We have an opportunity this session to correct some of those long-standing inequities," Hatzenbeler asserted. "And make sure that health care is not only more affordable and higher quality for those people who are disproportionately impacted, but for all of us."

The National Institutes of Health has begun a nationwide research project to better understand how to prevent and treat what's become known as "long" COVID, as well as determine who's at risk.

The COVID-19 virus has affected millions of Americans, but most people have recuperated from the illness - at least initially. However, doctors say thousands who thought they were done later develop "long" COVID, weeks and even months after the initial symptoms are gone. "Long-haulers," as they're called, often experience heart and lung problems, fatigue and cognitive issues such as "brain fog," according to NIH neurologist Dr. Walter Koroshetz, director of the National Institute of Neurological Disorders and Stroke and a co-director of the study.

"We really don't understand why that is occurring," he said. "So the RECOVER initiative - Research COVID to Enhance Recovery - is trying to understand why this is happening and with that understanding to develop treatments that can help these folks."

The University of Utah is one of more than 80 sites in 30 states that are part of the study. People of all races, ethnicities, genders, ages and locations are needed. To volunteer, look online at RecoverCOVID.org.

One of the study's primary goals, Koroshetz said, is to understand why some some people get long-haul symptoms and others do not.

"The most important group is people who are acutely infected by a very recent infection," he said. "We want to study how people recover after COVID so we can compare the recovery process and people who do a good job recovering, versus those who do a poor job and end up with persistent symptoms."

Koroshetz said researchers know the importance of getting a wide variety of people to share their experiences.

"The real heroes are the subjects who enroll in this study," he said. "The people who are having trouble enroll, I think, because they want to understand what's wrong with them and they want to contribute to the knowledge. We also need people who do it for purely altruistic reasons, the people who are not having trouble."

He said volunteers can expect a phone call from a study representative to gather basic demographic information, ask about your experience with COVID-19 and why you want to be part of the study.

As the pandemic began, the federal government waived certain certification requirements for nurse aides to help with health-care worker shortages. As those waivers are set to end, the federal government is allowing New York and other states to "grandfather" in those nurse aides without having met the pre-pandemic requirements.

The initial training waiver aimed to give nursing homes staffing flexibility to address the pandemic, but Richard Mollot, executive director of the Long Term Care Community Coalition, said it hasn't addressed the industry's underlying burnout issue.

"Federal studies, our studies, have shown that they understaff," he said, "and they exploit the workforce and they count on a workforce that is going to be constantly replenish-able."

Mollot said a return to mandating training hours would help both staff and residents. He contended that nursing homes and long-term care facilities need to invest in proper staffing levels and fair pay for their workforce. As part of the grandfathering process, New York is granting credit for nearly half of a nurse aide's required training hours if they've worked for either 30 days or 150 hours.

In April, the Center for Medicare and Medicaid Services announced it would be phasing the training requirements back in and new nurses will need to meet pre-pandemic requirements. The federal agency acknowledged that waiving requirements gave nursing homes flexibility, but it also led in some cases to poor resident care.

Eric Carlson, directing attorney for the group Justice in Aging, said formal training helps nurse aides build a range of skills to better care for residents.

"It is unfair and inaccurate to just pretend that nurse aides just need to put food in front of people and help them wash up a little bit," he said. "It is much, much more than that, and nursing-facility residents need high-quality care."

A bill now in Congress would extend the training waiver and provide a path to allow using hours on the job to count toward training requirements. Its backers say relaxing training standards would help get more people into the health-care industry. It hasn't been voted on by either the House or Senate.

May marks both Mental Health Awareness Month and Military Appreciation Month. In Pennsylvania, officials want to ensure that veterans know mental-health and substance-use resources are available.

Pennsylvania is home to nearly 800,000 military veterans, the fourth-largest veteran population in the country.

Rick Hamp, special assistant to the deputy adjutant general for veteran affairs at the state Department of Military and Veterans Affairs, leads military suicide-prevention efforts in the state. He said veterans sometimes can face stigma if they speak openly about struggles with anxiety or depression. Knowing a loved one supports them can help, Hamp said.

"Always be there for your family members and for those around you," he said. "You know what's normal for a person, and if they don't look normal, don't be afraid to ask the question, 'Are you OK?' That is the start of helping a person. And be ready when they reply, 'No, I'm not.'"

The state recently launched PA VETConnect, a community-based outreach program for veterans to find behavioral and mental-health services and employment opportunities. Veterans in crisis or those who know one can call the Veterans Crisis Line at 800-273-8255 and press 1.

Dr. Rhonda Randall, executive vice president and chief medical officer at United Healthcare, agreed it's important to look out for signs of mental-health challenges in loved ones. That may mean an uncharacteristic disinterest in activities they usually enjoy, a change in sleep patterns or mentioning feelings of hopelessness. She added that it's important for people to seek help from a trusted health professional.

"Mental health is part of our health," she said. "It's a conversation you should be having with your primary-care physician when you go get your annual checkups, especially if you already have an established relationship. And it can be a really good place to start, and also take into context your other medical conditions."

According to the 2022 America's Health Rankings Senior Report from United Health Foundation, drug-related deaths increased by 149% for older adults in Pennsylvania over a 10-year period. Seventy-six percent of Pennsylvania's veterans are age 55 or older.