An analysis of mobile health clinics launched in the Detroit metro area during the pandemic finds it's a model that can deliver health screenings and health care and could be replicated in other communities.

The Wayne Health Mobile Units are specially equipped vans with medical equipment and professionals. They began as testing sites for front-line workers in the early days of COVID-19, out of a partnership between Wayne State University and Ford Motor Co. Over time, they transitioned to what Dr. Phillip Levy, a professor of emergency medicine and assistant vice president for translational science and clinical research innovation at Wayne state and chief innovation officer for Wayne State University Physician Group, called a "vision of patient-centric, portable population health."

"If they have comorbidities and need doctors' appointments or health care," said Levy, who runs the program, "can we provide linkages around that? If they have food insecurity, can we help them get food access, so that we can really be delivering on the holistic approaches that are needed in order to keep this person healthy and avoid complications?"

Levy noted they have a Patient Portal for folks to register online, but appointments are not necessary, and they don't require insurance or identification - which can be barriers to care. He added that bringing care into communities also reduces the barriers of transportation time and cost.

Beyond testing and treatment for COVID, Levy said the Mobile Health Units do blood screenings for high cholesterol, diabetes and kidney disease and provide prevention infrastructure - as well as blood pressure screenings for hypertension. He said they also are building out HIV screening and treatment, and have started working with the state's needle-exchange program.

"Can we use these vehicles to reach vulnerable communities of IV drug users," he said, "not to distribute needles alone, but to test for HIV and hepatitis C and B, and provide medical linkages to care?"

Levy pointed out that 40% to 50% of the people who visit the Mobile Health Units come from areas where the social vulnerability index is extremely high. For other communities looking to replicate the program, he said building trust over time is important, and can be done with the help of faith groups and community-based organizations.

"Communities know that when the Wayne Health vans come, they're not coming for one time, they're going to be there, maybe for several days in a row," he said. "But we're going to be back over and over again, providing these resources to community members."

Experts warn health insurance premiums could rise an average of $1,000 a year for more than 2 million Californians who buy coverage on the individual marketplace, unless Congress extends subsidies from the Inflation Reduction Act.

The nonprofit Health Access California has federal data by congressional district.

Rachel Linn Gish, director of communications for the advocacy group, said for example, 140,000 people in the Central Valley alone benefit from the subsidies.

"As Congress is considering taking action to make these federal subsidies permanent, we want to make sure that Congress members know just how their constituents are going to be impacted by these health care decisions that they're about to make," Gish emphasized.

Linn Gish wants Congress to take up the issue soon because CoveredCA is working now to set rates for 2026. At a recent Senate Finance Committee hearing, Sen. Mike Crapo, R-Idaho, criticized the Inflation Reduction Act, which passed without a single Republican vote and said permanently extending the subsidies would contribute $325 billion to the federal deficit over 10 years.

A recent report from the University of California-Berkeley and the University of California-Los Angeles found enhanced tax credits through the Inflation Reduction Act save Californians $1.7 billion per year.

Gish pointed out the federal dollars have allowed state funds to flow toward programs to zero out deductibles and eliminate copays on many CoveredCA plans.

"If we lose the federal support for the premium help, then we may need to shift state dollars to backfill that," Gish cautioned. "Therefore consumers could also see spikes in their deductibles and other out-of-pocket costs for health care."

A recent study from UC Berkeley and UCLA predicted an additional 69,000 Californians could become uninsured due to increased premium costs if federal subsidies are allowed to expire next year.

Montana's expanded Medicaid program is set to expire next year. People who rely on it are calling on lawmakers for an extension but opponents argued Medicaid was never meant to be a long-term option for most people.

The Montana Legislature voted during its last session to expand the state's Medicaid program to cover an additional 85,000 people.

Megan Martin, a small-business owner and mother in Helena who relies on Medicaid, said she is out of health care options if the state does not extend it.

"I have looked and have been told that I could get health care off of our federal marketplace, which I don't qualify for," Martin explained. "That's terrifying because I don't make a ton of money, being a small-business owner. So, not having any other option is scary."

Gov. Greg Gianforte has not been clear on whether he supports an expansion but has said Medicaid should be a temporary program to help people get back on their feet. Data from KFF Health News show 9% fewer Montanans are covered under Medicaid now than before the pandemic.

Montana's Medicaid expansion is largely funded under the federal Affordable Care Act but is administered by the state, which is why expansion takes a legislative vote. Martin pointed out like many Montanans, she is working multiple jobs just to keep up with her family's cost of living, let alone being able to afford health care.

"How many more jobs do I have to get? How much more hustling do I have to do? How much more money do I have to put in my pocket, in order to make sure that we're all healthy?," Martin asked. "Nobody should have to worry about that, at the end of the day."

The Legislature is scheduled to consider extending the Medicaid expansion when lawmakers convene in January.


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A recent foodborne illness outbreak linked to deli meats is putting the spotlight on how these foods are regulated.

The listeria outbreak in Boar's Head products has led to 10 deaths and at least 59 people sickened across the country.

Jovana Kovacevic, associate professor of food science and technology at Oregon State University, said it is important to know listeria is prevalent in the natural environment. Kovacevic pointed out the United States has a zero-tolerance testing system for listeria, which is different from other countries and, counterintuitively, might do more harm than good than a system testing for certain levels of the bacteria.

"It would encourage industry to sample more," Kovacevic asserted. "And once they find positives, it would help them act before the food becomes contaminated and before any contaminated foods end up in the commerce."

Kovacevic pointed out listeria is most harmful for vulnerable populations, such as pregnant people, older people and those with compromised immune systems. Members of Congress recently wrote a letter to the U.S. Department of Agriculture over its concern that the agency wasn't able to prevent the outbreak.

But Kovacevic noted there has been progress on how the USDA and the Food and Drug Administration, which also monitors food safety in some situations, prevent foodborne illnesses. Still, she argued there is room for improvement.

"Standardizing our approach to listeria probably we would benefit from it," Kovacevic contended. "Consumers would benefit and the industry would benefit in terms of having the ability to look openly for listeria as opposed to fearing if they find any positive what's going to happen."

Kovacevic added there are ways consumers can prevent outbreaks, such as storing meats at the proper temperatures and cooking them thoroughly.

"There's just certain foods that are higher risk foods," Kovacevic explained. "If you're in that vulnerable group, you want to avoid those foods. So, we really need to do better to engage consumers in these discussions."


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