Today is National Healthcare Decisions Day, a day when everyone is encouraged to review their end-of-life planning. The 2024 Alzheimer's Association annual report predicts that the number of Americans 65 and older who are living with the most common form of dementia will double from nearly 7 million to 14 million patients by 2050.

Jessica Empeño, national director of clinical engagement with the end-of-life advocacy group Compassion & Choices, said legal matters are just part of the equation.

"The most important part is to have conversations about what matters most to you, what your wishes are, and share those things, not only with your family and your loved ones but with your health-care team," she explained.

People may want to put in writing who they want to be able to make decisions on their behalf once dementia progresses. They might consider whether in the future they would be OK with things like artificial hydration or nutrition, aggressive treatments or surgeries.

Compassion & Choices' website offers a free End of Life Decisions tool and a Dementia Values & Priorities Tool that helps people communicate and document their future health-care wishes, both for those who have early-stage dementia or those who just want to be prepared for the possibility.

Angela Schultz, California state advocacy director for Compassion & Choices, said people need to make a plan sooner rather than later.

"We just did recent polling, and 93% of Americans said that having an advanced directive and a health-care proxy and sharing that with your doctor is very important. But only 37% of Americans have done that," she said.

National Healthcare Decisions Day falls on April 16th, the day after tax day. It is a reference to the famous quote from Benajmin Franklin that "In this world, nothing is certain but death and taxes."

The Kentucky Cabinet for Health and Family Services is reporting a second confirmed measles case in March, in a child who was traveling through the state while seeking treatment.

The first reported case this year occurred in an adult Kentucky resident in February. Measles is a highly contagious respiratory virus spread through the air that can cause serious health complications.

Cody Kemmer, communications coordinator with Kentucky Voices for Health, said declining vaccination rates in the state have allowed measles to start spreading again.

"Kentucky already had one of the lowest MMR coverages in the nation, and that brings us to our lowest coverage in seven years," said Kemmer. "In fact, we've got lower statewide coverage than some of those states that are currently experiencing outbreaks, so we are vulnerable."

The Centers for Disease Control and Prevention said as of May 1, 935 confirmed measles cases have been reported nationwide. Nearly all involve people who were unvaccinated or unsure about their vaccination status.

According to state data, vaccination rates among Kentucky kindergartners have dropped to levels lower than before the pandemic.

Kemmer said the disruption caused by COVID-19 set many families off track.

"With the pandemic, many families fell behind on their routine checkups and wellness visits," said Kemmer. "That delay created a lag in staying current with the CDC schedule for recommended vaccines."

He added that the end of the school year is a good time to start making doctor's appointments, especially for new families navigating immunization schedules.

"We want to encourage families to be proactive and make an immunization plan for their family," said Kemmer. "Staying on track with those recommended immunizations, like the MMR vaccine, lets families enjoy their summer."

A recent poll by the health policy research organization KFF found nearly a quarter of participants believed false claims about measles vaccinations and have not had their child vaccinated.



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Groups advocating for better access to health care have introduced what they call "Care4All California," a package of 13 bills designed to shore up the health system as the state braces for the possibility of huge cuts in federal funding for Medi-Cal.

The bills aim to get more people insured, connect them to care and make health care more affordable.

Chris Noble, organizing director for the nonprofit Health Access California, explained the group's priorities.

"It's crucial that our State Legislature shows their commitment to advancing a universal, affordable and equitable health care system," Noble emphasized. "This year's package of legislative and budget priorities requires no interventions by the federal government and should be adopted to safeguard our health care system in case there are federal attacks."

One bill would make sure people with Medicare supplemental insurance cannot be penalized for having preexisting conditions. Another would require hospitals to prescreen all patients to see if they are eligible for discounted or charity care programs. A third bill would allow undocumented people access to health plans on the CoveredCA exchange. Opponents cited cost concerns.

Noble emphasized the bills build on the progress California has made to lower its uninsured rate.

"These priorities will continue to cover gaps within our health care system, ensure that when people are denied or delayed care, there's certain accountability, or ensure that folks are getting access to accurate and up-to-date provider directories," Noble outlined.

Advocates have also made a number of budget requests, including one to give kids who qualify for Medi-Cal continuous coverage from birth to age 5, rather than making their parents reapply every year.

As Republican lawmakers in Washington, D.C., consider cuts to Medicaid, a new report has found thousands of veterans in Virginia could be affected.

Virginia passed Medicaid expansion in 2018, which broadened who qualified for the program, including people under 65 and without children who make 138% or less of the federal poverty level. The report by The Commonwealth Institute showed more than 47,000 Virginia veterans receive health coverage through Medicaid.

Freddy Mejia, policy director at the institute, said work requirements or cuts to the Medicaid expansion would increase barriers to Virginians' access to health care.

"We just kind of want to raise the profile of how federal cuts to Medicaid could impact not only hundreds of thousands of Virginians, nearly 629,000 Virginians that have health coverage through Medicaid expansion, but also to veterans in particular here in Virginia," Mejia outlined.

Rep. Mike Johnson, R-La., the Speaker of the House, has said the Medicaid expansion under the Affordable Care Act allowed people who did not truly need the benefit to enroll. Republicans have called for major cuts in spending across the federal government but are split on which entitlement programs should be trimmed, and by how much.

Virginia is one of eight states with what is known as an automatic trigger law in place, where states would immediately end their expansion if the federal government lowers its funding of the Medicaid expansion below 90%.

Mejia argued veterans in the Commonwealth would get caught up in the cuts.

"If the federal government decides to reduce funding for Medicaid expansion by even 1%, our state law means that it would automatically end Medicaid expansion," Mejia pointed out. "That would immediately throw potentially thousands of veterans off of coverage."

More than 20% of Virginians access health care through Medicaid.


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