Some anesthesiologists hope this is the year Tennessee passes legislation to allow Certified Anesthesiologist Assistants to practice in the state.

Assistants are authorized to work in 20 states but not in Tennessee.

Sasi Duggirala, certified anesthesiologist assistant and managing partner at Harmony Anesthesia in Atlanta, a former Tennessean, said the state's shortage of anesthesiologists as well as Certified Registered Nurse Anesthetists delays surgeries. He is advocating for licensure of certified assistants to increase the number of anesthesia providers, saying it would ultimately improve patient care.

"After coming out of COVID, there's been just a huge backlog on necessary procedures and surgeries that need to be done," Duggirala pointed out. "The mid-level anesthetist coming only from CRNA pool is just not enough to fill that gap."

Last year, Senate Bill 453 would have allowed certified assistants to practice in Tennessee but the bill stalled in the House. Some Tennessee Certified Registered Nurse Anesthetists opposed it, claiming the assistants lack the comprehensive training of nurse anesthetists. Backers want to see the bill reintroduced.

David Ryan Diehl, certified anesthesiologist assistant at Diehl Anesthesia in Atlanta, explained his son was born with a congenital disorder requiring prosthetics. The family receives support from the Jordan Thomas Foundation in Nashville. Diehl said new legislation would allow him to practice anesthesiology in Tennessee.

"Legislation needs to be passed that allows us to practice there, to bill insurance, Medicare, Medicaid, all those types of things, and for the groups to be reimbursed," Diehl outlined. "Also for us to be insured there as well, to practice."

Dr. Richard Duncan, orthopedic surgeon and medical director of the Center for Advanced Bone and Joint Surgery at Watauga Orthopedics in Johnson City, Tennessee, pointed out both Certified Registered Nurse Anesthetists and Certified Anesthesiologist Assistants can administer anesthesia during surgeries. He highlighted their extensive training, and suggested Tennessee institutions could offer such training as an additional educational benefit.

"A Certified Anesthesia Assistant is a person that has a bachelor's degree with some prerequisites that they have to have, and testing that they do," Duncan explained. "Once they're admitted into their training, it's 24 to 28 months of didactic training, and then clinical training."

Duncan added the critical shortage of anesthesia providers affects hospitals, surgery centers and patient care across the board.


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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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