“The entirety of abortion rights history is a history of doctors appearing in court to represent their own interests and the interests of pregnant people,” said Elizabeth Sepper, a law professor at the University of Texas-Austin.

But in July, in a Texas courtroom, the case for abortion was made by women themselves who had been denied abortions and sued the state to clarify the exceptions to its ban, which makes it illegal to perform an abortion unless a patient is facing death or “substantial impairment of a major bodily function.” The aspiring mothers described in vivid, harrowing detail how the state’s abortion ban had endangered their health, traumatized them, and, in the case of Samantha Casiano, forced her to carry and give birth to a baby girl without a formed skull or brain only to watch her die a tortured death four hours later.

“She was gasping for air,” Casiano testified on the witness stand. She described how her baby turned purple and her eyeballs were bleeding. “I just kept telling myself and my baby that ‘I’m so sorry that this has happened to you.’ I felt so bad. She had no mercy. There was no mercy there for her.”

Casiano had been denied an abortion months earlier after she found out her baby had anencephaly, a fatal condition. She had wanted her daughter, whom she named Halo, to be spared from suffering and to “go to rest sooner.” She described abortion as an act of compassion, mercy, and love.

For decades, Christian anti-abortion groups have deployed ultrasound fetal images and grisly photos of what they say are aborted fetuses on highway billboards, protest signs, and online ads to garner sympathy for “unborn children” and advance their religious and political aims. But the Texas hearing, for the first time since the early 1970s, according to legal scholars and historians, trained the camera upward, away from the high-resolution fetal images to the faces of sympathetic women who say they suffered grievously under the state’s abortion ban.

Women have long shared abortion stories privately, and at public speak-outs, through #ShoutYourAbortion and the nonprofit group WeTestify. But the formality of the Austin courtroom focused unblinking attention on their experiences. The black-robed judge and court stenographer leaned in to hear plaintiffs as their testimony under oath was recorded for a national television audience. It put anti-abortion activists on the defensive.

“We’re in this moment where all of the stories are coming out and it’s raw,” said Greer Donley, an associate professor of law at the University of Pittsburgh School of Law. “All of these secrets — abortion, miscarriage, the blurring of miscarriage and abortion — that’s something people viscerally appreciate now.”

Before the Supreme Court’s conservative majority eliminated a federal right to abortion last June, polls showed that nationwide support for abortion care was “pathetically stagnant,” Donley said. Compare that stagnation, she said, to the support for same-sex marriage rights, which broadened as gay people and their families shared their stories publicly.

“Storytelling is the future,” Donley said. “That’s how you change hearts and minds.”

The pregnancy complications and medical emergencies described by the plaintiffs both “subvert ideas about motherhood” and “support ideas about motherhood,” said Mary Ziegler, a professor of law at the University of California-Davis who has written books about the history of abortion.

Soon after the Supreme Court held that women had the right to abortion in 1973, the anti-abortion movement began a concerted effort to narrow that newly established constitutional right. Movement leaders spoke in gruesome detail about abortions later in pregnancy, coining medically inaccurate phrases, such as “partial-birth abortion,” that infused the language of the abortion debate with emotional and provocative imagery.

“Usually, the story is women versus fetuses, and that people having abortions are selfish or don’t care,” Ziegler said. “But these women in court are saying, ‘What was best for my child was the abortion. I was denied that, but so was my child.’”

Some Catholics and conservative Christians who oppose abortion proffer the notion of “natural womanhood,” Ziegler said — the religious belief that God created women to complement men, and “that abortion is forcing women to be like men” and “disrupts nature.”

That belief was expressed by Ingrid Skop, a Texas OB-GYN who opposes abortion and testified last month as an expert witness for the state. When asked on the stand about Casiano’s description of watching her baby die, Skop said inducing a birth is “a much more holistic way to progress through the grieving process than to dismember your child and not have a way to grieve.”

Infant deaths have spiked in Texas since the government mandated births of nonviable pregnancies. In September 2021, Texas banned abortions after six weeks of pregnancy and then instituted a prohibition on all abortions from the moment of fertilization unless a woman was experiencing “a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy.” The Texas law makes no exception for nonviable pregnancies.

In 2022, preliminary infant mortality data from the Texas Department of State Health Services, first obtained by CNN, showed a 21.6% increase in infant deaths caused by severe genetic and birth defects. That increase reversed a 15% decline in infant deaths from 2014 to 2021.

The case in Austin comes as abortion rights and civil liberties groups and state Democratic parties are mounting a series of legal and electoral challenges to the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, which overturned Roe last summer. In November, Ohio voters will take up a proposed constitutional amendment that would ensure “every individual has a right to make and carry out one’s reproductive decisions.” Litigation against abortion bans is ongoing in at least 17 states, according to KFF.

A new poll by the nonpartisan research firm PerryUndem that explored the impact of a “viability limit” on support for abortion ballot measures found that voters were 15 percentage points more likely to support ballot measures when they contained no government regulations on abortion over those that restricted abortion later in pregnancy.

The Texas lawsuit has highlighted the myriad reasons women and their families (at least two husbands were in the Austin courtroom) require abortion care throughout an entire pregnancy, Donley said.

In considering doing away with any limits on abortion, “we don’t have to trust that women are perfect, benevolent mothers,” Donley said. “We just have to believe they are rational actors.”

After 24 weeks, most abortions require induced birth, she added. “So, we’re imagining a person who, for no good reason, endured the burdens of pregnancy, watched her body change completely, and went through labor and delivery of a stillborn baby just because she couldn’t get around to an abortion earlier? People have abortions late because horrible things happen.”

Texas District Judge Jessica Mangrum on Aug. 4 ruled in favor of the plaintiffs, but the Texas attorney general has appealed the decision, blocking the order. The state’s assistant attorney general, Amy Pletscher, had asked the court to dismiss the case. She told Mangrum that the “plaintiffs sustained their alleged injuries as a direct result of their own medical providers failing them.”

But while the outcome of the case is uncertain, legal scholars said it marked the beginning of a new strategy for the abortion rights movement in the United States.

“We had a 50-year fight to get rid of Roe,” Ziegler said. “This is the beginning of the 50-year fight to get rid Dobbs.”

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New Orleans Emergency Medical Services has been busy this summer, responding to heat-related emergency calls and transporting patients to nearby hospitals.

At the city’s main ambulance depot, the concrete parking lot seemed to magnify the sweltering heat, circulating the air like a convection oven. Capt. Janick Lewis and Lt. Titus Carriere demonstrated there how they can load a stretcher into an ambulance using an automated loading system. Lewis wiped sweat from his brow as the loading arm whirred and hummed, raising the stretcher into the ambulance — “unit,” in official terminology.

But mechanical assistance isn’t the best thing about the upgraded vehicles. “The nicest thing about being assigned a brand-new unit is it has a brand-new air conditioning system,” Lewis said.

The new AC is much more than a luxury for the hard-working crews. They need the extra cooling power to help save lives.

“The No. 1 thing you do take care of somebody is get them out of the heat, get them somewhere cool,” Lewis said. “So the No. 1 thing we spend our time worrying about in the summertime is keeping the truck cool.”

Like much of the country, New Orleans has been embroiled in a heat wave for weeks. As a result, New Orleans EMS is responding to more calls for heat-related conditions than ever before, Lewis said. During the third week of July, the city’s public EMS crews responded to 29 heat-related calls — more than triple what they handled during the same period last year.

Scientists say dangerous heat levels — and the stress they put on human bodies and medical systems — will likely keep increasing. Health systems nationwide face serious funding and staffing challenges that could make it harder to keep up.

New Orleans EMS is no exception. In April, it reported operating with only 60% of its needed staff. The city’s chief of EMS has called for increased funding for higher wages to attract more workers. Local private ambulance services like Acadian Ambulance Services pay staffers between $50 and $70 per hour. The city’s EMS department can’t compete.

Lewis said they’re making do with the resources they have and prioritizing one-time expenses like new ambulances to help them meet the challenges they’re facing.

“We’re going to provide the care everybody needs, regardless of how hot it gets,” Lewis said. “We’d love to have all the help in the world, but we’re getting the job done with what we have right now.”

When a human being is exposed to high levels of heat for too long, their core body temperature rises. Once core body temperature exceeds 100 degrees Fahrenheit, hyperthermia can develop. If not quickly addressed, that can prompt an escalating cascade of health problems.

The first stage is heat exhaustion, Carriere explained: “That means you’re hot, you may have an elevated temp, but you also have what’s called diaphoresis, which means your body is sweating, is still trying to compensate and cool yourself off.” You’ll also likely have other symptoms like weakness, dizziness, or a headache.

Carriere said that if a person can quickly get out of the heat and into an air-conditioned place, generally they’ll recover from heat exhaustion on their own. Otherwise, their core temperature will continue to rise.

As internal body temperature approaches 104 degrees, people start to suffer from heatstroke.

“Once you move to heatstroke, your body stops compensating,” Carriere said. “You stop sweating. You’re hot. You’re dry. And your organs are basically frying themselves from the inside out.”

When a person stops sweating, it becomes even harder for the body to cool itself down. During heatstroke, people may experience other severe symptoms like an altered state of mind, confusion, and a rapid, erratic pulse. They may even lose consciousness.

Without medical intervention, heatstroke can be deadly. EMS responders start treatment immediately after they arrive on the scene. “We’ll get them on a gurney, get them into the unit, start removing their clothing, and put ice packs wherever applicable to try to cool them down,” said Carriere.

Once a heatstroke patient is loaded into the ambulance, the crew races them to a nearby hospital, Carriere said. At University Medical Center, New Orleans’ largest hospital, doctors and nurses will continue efforts to quickly lower the person’s body temperature and replace fluids by IV, if necessary.

“When the patient ends up at the hospital, we’re going to continue that cooling process,” said Jeffrey Elder, medical director for emergency management at UMC. “We’re going to put them in an ice water bath,” and, he added, “we may use some misting fans and some cold fluids to get their body temperature down to a reasonable temperature while we’re supporting all the other bodily functions.”

Getting a patient’s core temperature down as quickly as possible is what will ultimately save their life. One way doctors can speed that along is by burying a patient in ice. In some parts of the country, doctors have placed patients inside body bags prepacked with pounds of ice. Body bags are especially useful in these cases because they are waterproof and designed to closely fit the human form.

UMC’s emergency room doesn’t use body bags, but during the summer staffers keep bags of ice ready at all times.

“On the stretcher, we’ll use some of the sheets as kind of a barrier,” Elder said. “And while they’re on the stretcher, we’ll just put the ice on them right then and there.” Hospital staffers will continue to work to cool a patient down until their temperature gets below 100.

Elder said that while it always gets hot in New Orleans during the summer, his emergency room has been treating more heat-related illnesses in 2023 than ever before. A few patients have died from the heat. UMC has been struggling with staffing challenges since the beginning of the pandemic, just like many other hospital systems elsewhere. But to prepare for an influx of patients with heat-related illnesses, UMC has prioritized staffing of the emergency department, Elder said.

Across the country, meteorological events like heat waves and heat domes will become more frequent and intense in the future, according to the Centers for Disease Control and Prevention.

“Extreme summer heat is increasing in the United States,” said Claudia Brown, a health scientist with the CDC’s Climate and Health Program. “And climate projections are indicating that extreme heat events will be more frequent and intense in the coming decades.”

Health infrastructure will be challenged to keep up to treat patients suffering from extreme heat exposure. In New Orleans, both first responders and doctors say they expect to see more patients with heat-related illnesses.

“We haven’t even gotten to the hottest part yet, which is typically August to September,” said Carriere. “So I’m expecting it to get pretty bad.”

This article is from a partnership that includes Gulf States Newsroom, NPR, and KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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During her time in the Florida Legislature, Cruz had supported a new law allowing the use of treated wastewater in local water systems. But many Tampa residents were staunchly opposed to a plan by their water utility to do just that, and Cruz was forced to backtrack, with her spokesperson asserting she had never favored the type of complete water reuse known as “toilet to tap.” She lost anyway, and the water plan has been canceled.

Tampa’s showdown may be a harbinger of things to come as climate change and drought cause water shortages in many parts of the country. With few alternatives for expanding supply, cities and states are rapidly adding recycled water to their portfolios and expanding the ways in which it can be used. Researchers say it’s safe — and that it’s essential to move past the 20th century notion that wastewater must stay flushed.

“There is no reason to only use water once,” said Peter Fiske, director of the National Alliance for Water Innovation at the Lawrence Berkeley National Laboratory. “We’ve got to be more clever with the water we’ve got.”

But proponents are still fighting an uphill battle to overcome the “yuck” factor. A recent study found that reused water is not only safe but that it’s actually cleaner than conventionally sourced water — yet acceptance is “hindered by perceptions of poor water quality and potential health threats.”

Several projects were canceled in California in the 1990s because of such worries. In San Gabriel, Miller Brewing Company opposed a water reclamation project when people started joking about “beer aged in porcelain.”

“You have to have a lot of education in a community to say why [recycled water] is needed” and what experts are doing to ensure the safety of the water, said Noelle George, the Texas managing director for the trade association WateReuse.

Many forms of water reuse have long been routine. Water from yard sprinklers, for example, soaks into the groundwater. Or, if it is processed in a treatment plant, it goes into a river or lake, where it’s used again. Municipalities and others often treat a form of wastewater known as gray water to use for irrigation.

But in the world of water reuse, the gold standard is known as direct potable reuse — cleaning wastewater, including sewage, to drinking water standards.

With DPR systems, the water from showers, sinks, and toilets first goes to a conventional treatment plant, where it is disinfected with chemicals and aeration. Then it gets a second scrubbing in a multistage process that first uses a bioreactor to break down nitrogen compounds, then employs microfiltration to clean out particles and reverse osmosis to remove viruses, bacteria, and salts. Finally, hydrogen peroxide is added and the water goes through an ultraviolet light processing, which is supposed to kill any contaminants that are left.

Experts say the water that emerges at the end of this process is so clean it has no taste, and that minerals must be added to give the water flavor. It’s also free of a little-known health hazard; chlorine, often used to disinfect conventional water, can react with organic material in the water to create chloroform, exposure to which can cause negative health effects.

Big Spring, Texas, is the only place in the country with a DPR municipal water system, in which all wastewater is treated and sent back to the tap. Another notable DPR system is the Changi Water Reclamation Plant in Singapore, which cleans 237 million gallons each day.

In Tampa, intense opposition focused on the high cost of the water treatment and the possible presence of pharmaceuticals, hormones, and so-called forever chemicals, known as PFAS.

“We have never thought that it was necessary to drink wastewater,” said Gary Gibbons, the vice chair of the Tampa Bay Sierra Club, in September 2022. He said the project, which the city referred to by the acronym PURE, would result in contaminants in the drinking water and the groundwater aquifer.

Experts reject these concerns as uninformed and say properly treated wastewater is safer than a lot of conventional drinking water sources.

“I would almost rather have an advanced treatment plant of the type used for potable water recycling than water that comes from a river that has several cities and farms and industries upstream that are discharging into it,” said David L. Sedlak, an expert on potable reuse at the University of California-Berkeley.

With higher temperatures and long-term pressure on water sources including aquifers and mountain snowpacks, a lot more water reuse is coming.

In Texas, the state permits DPR plants on a case-by-case basis, and the city of El Paso is building one that’s slated to be online by 2026. Colorado last year began allowing DPR. In California, regulations spelling out the approach to DPR should be ready by the end of this year, with some cities setting goals of recycling all water by 2035. Florida and Arizona are also moving to expand direct potable reuse.

There’s also a lot of activity around what’s known as indirect potable reuse. Orange County, California, has the world’s largest IPR facility, which cleans 130 million gallons of water a day to irrigation standards, passes it through advanced purification, and finally injects it into groundwater, which serves as an environmental buffer. The water is then piped to all municipal users.

San Francisco is pioneering another approach. Since 2015, the San Francisco Public Utilities Commission, which operates the dams, reservoirs, and aqueducts that deliver water from the Sierra Nevada to the city, has required all buildings over 100,000 square feet be equipped for recycling gray water. The downtown Salesforce Tower has its own recycling plant: Sinks, laundry machines, and showers drain into the basement recycling system, and the water is then reused for flushing toilets and irrigation, saving about 30,000 gallons a day.

“We don’t need to flush toilets with drinking water,” said Fiske, noting that toilets make up about 30% of all water use.

San Francisco water officials are studying the feasibility and safety of cleaning all wastewater to potable standards at the building level. The headquarters of the water utility has a blackwater system called the Living Machine that uses engineered wetlands in the sidewalks around the building to treat wastewater, cutting water use by two-thirds. (Blackwater systems recycle water from toilets; gray water systems reuse water from all other drains.)

Some experts see a day when buildings will not have to be hooked up to external sewer and water systems at all, with advanced recycling systems augmented by rainwater. For the moment, though, educational campaigns are still needed to bring recycled water into the mainstream.

Epic Cleantec, which created a recycling system for a new San Francisco apartment tower, thought beer might help. The company last year teamed up with a local brewery to produce beer from recycled water. The Epic OneWater Brew by Devil’s Canyon Brewing isn’t sold; rather, it’s a demonstration product, given away and served at events.

While people might not want to drink recycled water, they will usually try the beer.

“We made beer out of recycled water, because we’re trying to change the conversation,” said Aaron Tartakovsky, CEO of Epic Cleantec. “We’re fundamentally trying to help people rethink how our communities handle water.”

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After emergency surgery to remove the mass, along with her ovaries, uterus, fallopian tubes, and appendix, Hughes said, she saw an Instagram post in which a woman with uterine cancer linked her condition to chemical hair straighteners.

“I almost fell over,” she said from her home in Smyrna, Georgia.

When Hughes was about 4, her mother began applying a chemical straightener, or relaxer, to her hair every six to eight weeks. “It burned, and it smelled awful,” Hughes recalled. “But it was just part of our routine to ‘deal with my hair.’”

The routine continued until she went to college and met other Black women who wore their hair naturally. Soon, Hughes quit relaxers.

Social and economic pressures have long compelled Black girls and women to straighten their hair to conform to Eurocentric beauty standards. But chemical straighteners are stinky and costly and sometimes cause painful scalp burns. Mounting evidence now shows they could be a health hazard.

Relaxers can contain carcinogens, like formaldehyde-releasing agents, phthalates, and other endocrine-disrupting compounds, according to National Institutes of Health studies. The compounds can mimic the body’s hormones and have been linked to breast, uterine, and ovarian cancers, studies show.

African American women’s often frequent and lifelong application of chemical relaxers to their hair and scalp might explain why hormone-related cancers kill disproportionately more Black than white women, say researchers and cancer doctors.

“What’s in these products is harmful,” said Tamarra James-Todd, an epidemiology professor at the Harvard T.H. Chan School of Public Health, who has studied straightening products for the past 20 years.

She believes manufacturers, policymakers, and physicians should warn consumers that relaxers might cause cancer and other health problems.

But regulators have been slow to act, physicians have been reluctant to take up the cause, and racism continues to dictate fashion standards that make it tough for women to quit relaxers, products so addictive they’re known as “creamy crack.”

Michelle Obama straightened her hair when Barack served as president because she believed Americans were “not ready” to see her in braids, the former first lady said after leaving the White House. The U.S. military still prohibited popular Black hairstyles like dreadlocks and twists while the nation’s first Black president was in office.

California in 2019 became the first of nearly two dozen states to ban race-based hair discrimination. Last year, the U.S. House of Representatives passed similar legislation, known as the CROWN Act, for Creating a Respectful and Open World for Natural Hair. But the bill failed in the Senate.

The need for legislation underscores the challenges Black girls and women face at school and in the workplace.

“You have to pick your struggles,” said Atlanta-based surgical oncologist Ryland Gore. She informs her breast cancer patients about the increased cancer risk from relaxers. Despite her knowledge, however, Gore continues to use chemical straighteners on her own hair, as she has since she was about 7 years old.

“Your hair tells a story,” she said.

In conversations with patients, Gore sometimes also talks about how African American women once wove messages into their braids about the route to take on the Underground Railroad as they sought freedom from slavery.

“It’s just a deep discussion,” one that touches on culture, history, and research into current hairstyling practices, she said. “The data is out there. So patients should be warned, and then they can make a decision.”

The first hint of a connection between hair products and health issues surfaced in the 1990s. Doctors began seeing signs of sexual maturation in Black babies and young girls who developed breasts and pubic hair after using shampoo containing estrogen or placental extract. When the girls stopped using the shampoo, the hair and breast development receded, according to a study published in the journal Clinical Pediatrics in 1998.

Since then, James-Todd and other researchers have linked chemicals in hair products to a variety of health issues more prevalent among Black women — from early puberty to preterm birth, obesity, and diabetes.

In recent years, researchers have focused on a possible connection between ingredients in chemical relaxers and hormone-related cancers, like the one Hughes developed, which tend to be more aggressive and deadly in Black women.

A 2017 study found white women who used chemical relaxers were nearly twice as likely to develop breast cancer as those who did not use them. Because the vast majority of the Black study participants used relaxers, researchers could not effectively test the association in Black women, said lead author Adana Llanos, an associate professor of epidemiology at Columbia University’s Mailman School of Public Health.

Researchers did test it in 2020.

The so-called Sister Study, a landmark National Institute of Environmental Health Sciences investigation into the causes of breast cancer and related diseases, followed 50,000 U.S. women whose sisters had been diagnosed with breast cancer and who were cancer-free when they enrolled. Regardless of race, women who reported using relaxers in the prior year were 18% more likely to be diagnosed with breast cancer. Those who used relaxers at least every five to eight weeks had a 31% higher breast cancer risk.

Nearly 75% of the Black sisters used relaxers in the prior year, compared with only 3% of the non-Hispanic white sisters. Three-quarters of Black women also self-reported using the straighteners as adolescents, and frequent use of chemical straighteners during adolescence raised the risk of pre-menopausal breast cancer, a 2021 NIH-funded study in the International Journal of Cancer found.

Another 2021 analysis of the Sister Study data showed sisters who self-reported that they frequently used relaxers or pressing products doubled their ovarian cancer risk. In 2022, another study found frequent use more than doubled uterine cancer risk.

After researchers discovered the link with uterine cancer, some called for policy changes and other measures to reduce exposure to chemical relaxers.

“It is time to intervene,” Llanos and her colleagues wrote in a Journal of the National Cancer Institute editorial accompanying the uterine cancer analysis. While acknowledging the need for more research, they issued a “call for action.”

No one can say that using permanent hair straighteners will give you cancer, Llanos said in an interview. “That’s not how cancer works,” she said, noting that some smokers never develop lung cancer, despite tobacco use being a known risk factor.

The body of research linking hair straighteners and cancer is more limited, said Llanos, who quit using chemical relaxers 15 years ago. But, she asked rhetorically, “Do we need to do the research for 50 more years to know that chemical relaxers are harmful?”

Charlotte Gamble, a gynecological oncologist whose Washington, D.C., practice includes Black women with uterine and ovarian cancer, said she and her colleagues see the uterine cancer study findings as worthy of further exploration — but not yet worthy of discussion with patients.

“The jury’s out for me personally,” she said. “There’s so much more data that’s needed.”

Meanwhile, James-Todd and other researchers believe they have built a solid body of evidence.

“There are enough things we do know to begin taking action, developing interventions, providing useful information to clinicians and patients and the general public,” said Traci Bethea, an assistant professor in the Office of Minority Health and Health Disparities Research at Georgetown University.

Responsibility for regulating personal-care products, including chemical hair straighteners and hair dyes — which also have been linked to hormone-related cancers — lies with the Food and Drug Administration. But the FDA does not subject personal-care products to the same approval process it uses for food and drugs. The FDA restricts only 11 categories of chemicals used in cosmetics, while concerns about health effects have prompted the European Union to restrict the use of at least 2,400 substances.

In March, Reps. Ayanna Pressley (D-Mass.) and Shontel Brown (D-Ohio) asked the FDA to investigate the potential health threat posed by chemical relaxers. An FDA representative said the agency would look into it.

Natural hairstyles are enjoying a resurgence among Black girls and women, but many continue to rely on the creamy crack, said Dede Teteh, an assistant professor of public health at Chapman University.

She had her first straightening perm at 8 and has struggled to withdraw from relaxers as an adult, said Teteh, who now wears locs. Not long ago, she considered chemically straightening her hair for an academic job interview because she didn’t want her hair to “be a hindrance” when she appeared before white professors.

Teteh led “The Cost of Beauty,” a hair-health research project published in 2017. She and her team interviewed 91 Black women in Southern California. Some became “combative” at the idea of quitting relaxers and claimed “everything can cause cancer.”

Their reactions speak to the challenges Black women face in America, Teteh said.

“It’s not that people do not want to hear the information related to their health,” she said. “But they want people to share the information in a way that it’s really empathetic to the plight of being Black here in the United States.”

Kara Nelson of KFF Health News contributed to this report.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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Consumers should realize that such “medical identity” fraud can happen in several ways, from a large-scale breach to individual theft of someone’s data.

Just ask Evelyn Miller. The first sign something was amiss was a text Miller received from an Emory University Hospital emergency department informing her that her wait time to be seen was 30 minutes to 1 hour. That’s weird, she thought. She no longer lives in Atlanta and hadn’t used that hospital system in years. Then she got a second text, similar to the first. Must be spam, she thought.

When she got a call the next day from an Emory staffer named Michael to discuss the diagnostic results from her ER visit, she knew something was definitely wrong. “It amazed me someone could get registered with another person’s name and no ID was checked or anything,” Miller said.

And while the name and date of birth the staffer had on record for her were correct, Miller’s address was not. She now lives in Blairsville, Georgia, a few hours north of Atlanta. Michael said he’d correct the problem. The next week, she got a bill from Emory for more than $3,600.

After an unsatisfactory conversation with someone in the hospital’s billing department, Miller sent a letter to the hospital’s privacy officer. Miller recalled writing: “I think there’s something going on, that someone is using my information, and the visit and the charges appear to be fraudulent.”

When contacted, Emory Healthcare spokesperson Janet Christenbury declined to comment on Miller’s case specifically but did say, “We take these matters seriously and work with our teams to ensure our processes and procedures are followed.”

Miller, 63, a retired health care administrator, was savvier than many about what might have occurred. The average person may have no idea a problem like this can arise until long after a theft occurs.

“The majority of victims find out when they’re trying to move on with their lives, if bills have gone to collections,” said Eva Velasquez, president and CEO of the Identity Theft Resource Center, a nonprofit that provides free assistance to victims of identity theft. Someone may apply for a mortgage, for example, and learn their credit is ruined due to unpaid medical bills for care they didn’t receive.

It’s a double whammy. Unlike other forms of identity fraud, medical identity thieves may steal not only their victims’ personal data — Social Security number, date of birth, address — but also information about their medical records and care, potentially putting their health at risk.

“Sometimes people can’t get their prescriptions, if their records are mixed with someone else’s,” Velasquez said. “Maybe you won’t be able to get treatment that you need. There are serious implications.”

A theft may affect just one person whose insurance card gets stolen or “borrowed” to pay for health care, or it may result from a data breach, as HCA Healthcare experienced. Such large-scale breaches are more likely to be used in financial fraud schemes than to get medical care, experts say.

Compared with other types of identity fraud, medical identity theft is rare. In 2022, for example, the Federal Trade Commission received 27,821 reports of medical identity theft, while reports for identity theft related to new credit card accounts totaled more than 400,000.

Medical identity theft also presents itself in different ways.

One Thief, One Victim

If someone gets ahold of another person’s health insurance number and driver’s license or other ID, they may be able to use it to receive medical services in someone else’s name.

Busy hospital emergency departments may make an attractive target for fraudsters. Procedures typically require patients to present insurance and photo identification information at check-in, said Rade Vukmir, an emergency physician in Pittsburgh and a spokesperson for the American College of Emergency Physicians. But these facilities also don’t want to put people off from getting care, and people who are uninsured or disadvantaged might not have those documents.

“We want to treat that population,” he said. “We’re America’s safety net. We always provide care.”

Medical identity theft can happen if someone loses a wallet with their insurance card in it, for example, or a piece of mail from their insurer goes astray. But it doesn’t occur only among strangers. The victim often knows the thief and may even be in on the “friendly fraud,” as it’s called. According to one study, nearly half of people who failed to report medical identity theft said it was because they knew the thief.

For example, one person might have a higher copayment for emergency department visits, Vukmir said, so they let a family member, such as a cousin or a sibling, use their insurance card to get medical care.

“Usually, in those cases, it wasn’t an emergency,” said Vukmir.

Gangs of Thieves, Millions of Victims

In 2022, 707 health care data breaches affected nearly 52 million patients, according to an analysis of data from the Department of Health and Human Services’ Office for Civil Rights by the HIPAA Journal, which tracks compliance with health care data privacy law. Under federal law, health care organizations must notify individuals when their medical data has been exposed through a breach.

The largest health care data breach to date occurred in 2015, when nearly 80 million Anthem records were exposed. Though the 2022 figures for incidents among all health plans were slightly lower than the year before, there has been a clear upward trend in recent years in breaches, which are typically caused by hacking or IT incidents.

The American Hospital Association is “very concerned” about foreign-based hacking groups from countries like Russia, China, North Korea, and Iran, said John Riggi, the national adviser for cybersecurity and risk for the American Hospital Association.

Riggi said the personal information in people’s medical records may be sold in bulk to criminals who create phony providers to submit fraudulent claims on a mass scale that can result in hundreds of millions of dollars in Medicaid, Medicare, or other insurance fraud. Or they may use the information to create fake identities to apply for loans, mortgages, or credit cards.

“They flee with the money, and the individual is left to deal with it,” Riggi said.

Health plans could take lessons from the financial services industry to detect red flags, Riggi said. Financial institutions have sophisticated algorithms to identify purchasing and other patterns that are out of the ordinary, Riggi said. In health care, such mechanisms could be used to flag claims in which a provider is located more than 1,000 miles from where a patient lives, for example, or sees a patient for conditions that don’t jibe with their age or health status.

AHIP, an insurance industry trade group, didn’t respond to requests for comment.

What Consumers Can Do

Consumers should generally monitor the notices and bills they receive from insurers and providers and contact them immediately about anything suspicious.

In Miller’s case, it’s unclear whether her problem was due to an administrative snafu, such as another patient with the same name, or medical identity theft. But within a month of her initial call, the hospital removed the charges and assured her that her medical record had been disentangled from the other patient’s.

Other steps to take:

• Go to the FTC’s identity theft site to learn about next steps and file an identity theft report, if appropriate.
• If someone has used your name, contact every provider who may have been involved and ask for a copy of your medical records, then report any errors to your medical providers.
• Notify your health plan’s fraud department and send a copy of the FTC identity theft report.
• File free fraud alerts with the three major credit reporting agencies and get free credit reports from them. Consider filing a police report. If your health plan offers free credit or identity theft monitoring following a breach, take advantage of it.

“It’s best to proceed as if your data has been compromised and will be for sale,” said Velasquez, whose organization offers free assistance in recovering from identity theft. “Don’t be afraid to ask for help.”

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After the heartache of more than a dozen miscarriages, Anya Cook was 16 weeks along. She and husband Derick Cook spent a Sunday last December sharing the news with his parents and looking at cribs.

As they left a restaurant in Coral Springs, Florida, that evening, Cook’s water broke. Her husband rushed her to the nearest emergency room.

Cook, 36, still believed the baby they had nicknamed “Bunny” could be saved. Doctors told her she would miscarry in the next 24 hours, she said, and that the fetus was too premature to survive.

The early rupturing of her amniotic sac left Cook at risk of infection and complications including hemorrhaging. But her pregnancy was beyond Florida’s then-15-week restriction on abortion and an ultrasound showed the fetus still had a detectable heart rate, according to hospital records Cook shared with the Tampa Bay Times.

Though Florida’s law allowed abortions to protect the health of the mother, Cook said, a doctor told her he would be risking his license if he induced labor, essentially performing an abortion. He gave her two antibiotic injections to reduce the risk of infection and sent her home, she said.

“I told him, ‘You’re leaving me to die,’” she said.

Every state that bans or restricts abortions has an exception to protect the health of the mother. Allowing abortions in such cases — or in the case of rape or incest —  makes abortion legislation more palatable to a majority of the American public, who, polls show, don’t support outright bans. When Florida lawmakers this year approved tightening the 15-week ban to a six-week limit, they added exceptions for rape, incest, and human trafficking to the existing exemptions to protect the health of the mother.

But recent history in other states suggests that few women will be able to take advantage of such exceptions if Florida’s new law, on hold while tied up by legal challenges, is upheld by the state Supreme Court. There is also concern that patients with pregnancy complications are being denied care.

In Alabama and Mississippi, which adopted stricter bans with some exceptions following the U.S. Supreme Court’s overturning of Roe v. Wade in June 2022, no abortions have been reported since July 2022, according to WeCount, a reporting effort organized by the abortion rights group Society of Family Planning. The project uses data from clinics, hospitals, and telemedicine providers and excludes from its tally cases in which women traveled to other states for abortions or obtained abortion pills.

In Texas, 13 women who had pregnancy complications sued the state’s medical board after being denied abortions, testifying the state’s strict restrictions put their lives in jeopardy. 

Women’s health advocates fear Florida is headed in the same direction — and that more expectant mothers’ lives will be put at risk.

“Exceptions are a rhetorical trick, really,” said Laurie Bertram Roberts, executive director of the Mississippi Reproductive Freedom Fund, a group that supports abortion rights. “They’re essentially a tool for Republican lawmakers to say, ‘There, those of you who worry that so-called good abortions won’t be available to you.”

State Sen. Erin Grall, a Republican who sponsored the bill for Florida’s six-week ban, said that her legislation has exceptions “to acknowledge some women experience unexpected pregnancy due to the heinous criminal acts committed by others, and to suggest the exceptions are window dressing is factually incorrect.”

Data Doesn’t Tell the Full Story

More than 82,000 abortions were performed in Florida last year, according to data compiled by the Florida Agency for Health Care Administration.

Those included 115 cases in which rape was cited as the reason for the abortion and seven that cited incest. No reported abortions were linked to human trafficking.

If Florida’s six-week ban moves forward, rape and incest victims would have to provide their doctor a copy of a restraining order, police report, medical record, court order, or other documentation to get an abortion after that window.

However, two-thirds of sexual assault victims do not report the crime, studies show, meaning no police report would exist. An estimated 8 in 10 rapes are committed by someone known to the victim, often leaving victims afraid of reprisals if they report the crime.

Florida has a long-established law allowing abortions when a fetus has fatal abnormalities. But no exceptions exist for serious genetic defects, deformities, or abnormalities, which were cited as the reason for 578 abortions in the state last year.

Roughly 60% were done in the second trimester, when tests like fetal echocardiograms or maternal serum screens are typically performed. The result of those tests would arrive too late if Florida’s six-week ban is upheld.

It’s not clear how many women who had abortions last year in Florida would have had their health endangered if their pregnancies had continued.

Pregnancy and labor carry serious health risks such as hypertension, hemorrhaging, and blood clots. More than 1,200 women died from causes related to pregnancy or childbirth in the United States in 2021. In Florida in 2020, 21 pregnancy-related parental deaths occurred for every 100,000 live births — and the rate of death among pregnant Black expectant mothers was more than double.

A May study by the Texas Policy Evaluation Project at the University of Texas-Austin identified dozens of cases in 14 states, including Florida, where poor care due to abortion restrictions led to preventable complications and hospitalizations. Some of those patients nearly died. 

“Health care providers described feeling moral distress when they were unable to provide evidence-based care, and some reported considering moving their practices to a state where abortion remains legal,” the study states.

The American College of Obstetricians and Gynecologists in 2022 warned that doctors must be able to make evidence-based decisions without “fear of prosecution, loss of license, or fines.”

Grall, the GOP state senator, said Florida has long-established laws to protect the life of the mother so there should be no confusion when an abortion is necessary.

“Florida should always be a state in which the life of the mother is protected and any doctor, hospital, or lawyers who seek to take a crystal-clear statute and try to muddy its interpretation to score political points should face the appropriate punishment,” she said.

A June KFF poll found that 61% of OB-GYNs who practice in states with abortion restrictions are concerned about the legal risk when deciding whether to perform an abortion.

“It doesn’t make any medical sense,” said Jennifer Griffin, a Tampa physician who provides abortions. “These politicians are not making policy based on science; they’re based on religion.”

‘I Went to a Really Dark Place’

Cook, the woman whose water broke 16 weeks into her pregnancy, barely slept that night, she said, after being refused treatment at Broward Health Coral Springs hospital.

The more she read online about her condition, the more convinced she became that she was going to die.

“I went to a really dark place,” she said.

Her miscarriage came when she was at a late-morning hair salon appointment. She rushed to the bathroom.

“I put my hands on my knees and I heard my daughter hit the toilet,” she said. Cook couldn’t bring herself to look down.

Her husband called 911. She told him she needed help to deliver the placenta she felt hanging from her womb.

He pulled some of the organ out with his bare hands, she said. There was a pop when the umbilical cord came away, Cook said.

Blood was gushing over the white porcelain toilet. A nurse who happened to be at the salon told Cook to squeeze her body as tightly as she could.

An ambulance rushed Cook to Memorial Hospital Miramar. Part of her placenta was still inside her. When doctors removed it, she began bleeding profusely, hospital records show. Doctors estimated she lost more than half a gallon of blood, an amount that can be fatal.

Cook ended up in intensive care. She needed four units of blood and was put on a ventilator, records show.

Doctors feared they would have to remove her uterus, which would mean she could never have a child, Cook said. Instead, they blocked some of the blood vessels and inserted a medical balloon to stem bleeding.

She stayed in the hospital for five days.

In May, Cook said, she was interviewed by officials from the Florida Agency for Health Care Administration and recounted her story about the limited care she received at Broward Health Coral Springs the night her water broke. She said they told her they are reviewing the hospital’s handling of her emergency. Spokesperson Bailey Smith said the agency cannot comment on ongoing investigations.

Jennifer Smith, Broward Health’s vice president for corporate communications and marketing, said in an email that the hospital’s handling of the case was appropriate. She said that the emergency physician contacted Cook’s OB-GYN, who recommended the antibiotic treatment. Cook was instructed to see her doctor that day or return to the emergency room if her condition worsened, Smith said.

“We empathize with Ms. Cook and the millions of women who annually suffer the unimaginable loss of miscarriage; however, we cannot speculate on whether Ms. Cook complied with the discharge instructions to see her private OB-GYN physician the same day of her discharge,” Smith said.

But Cook said she had already called her OB-GYN before she went to the hospital initially and it was after 2 a.m. when she was discharged. She miscarried around midday later that day.

“It’s absurd how they’re still trying to defend it,” she said.

Bunny was conceived through in vitro fertilization. That pregnancy was the furthest along Cook had ever been.

“To make it this far and lose her like that, it was really traumatic,” she said.

Cook has a stepson, but she isn’t ready to give up trying to have a biological child. She is still angry about her experience.

“I think about my niece and my future children,” said Cook, who is the oldest of six sisters. “I can’t imagine my sisters or any female family members having to go through this.”

This article was produced in partnership with the Tampa Bay Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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• Click here to hear Orozco Rodriguez on “The Indy”
• Read Orozco Rodriguez’ “Foster Kids in Casino Hotels? It Happened in Rural Nevada Amid Widespread Foster Home Shortages”

KFF Health News former senior editor Andy Miller discussed taxation rules for nonprofit hospitals on WUGA’s “The Georgia Health Report” on July 21. He also discussed vaccination funding cuts on WUGA’s “The Georgia Health Report” on July 14.

• Click here to hear Miller on “The Georgia Health Report”
• Read Miller’s ““As Nonprofit Hospitals Reap Big Tax Breaks, States Scrutinize Their Required Charity Spending”“

• Click here to hear Miller on “The Georgia Health Report”
• Read Miller’s “CDC to Reduce Funding for States’ Child Vaccination Programs”

KFF Health News correspondent Darius Tahir discussed how a combination of covid-19 lawsuits and media coverage keeps misinformation churning on American Public Media’s “Marketplace Morning Report” on July 24.

• Click here to hear Tahir on the “Marketplace Morning Report”
• Read Tahir’s “How a Combination of Covid Lawsuits and Media Coverage Keeps Misinformation Churning”

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The Republican governor signed House Bill 2127 — known as the Texas Regulatory Consistency Act but dubbed the “Death Star” by critics — the same month the state saw at least 13 heat-related deaths amid a scorching heat wave that’s on track to break records.

The measure, heavily backed by business and building sectors, was designed to replace “the regulatory patchwork” of county and municipal rules across the state “with a single set of predictable, consistent regulations,” according to a fact sheet circulated by its supporters. That means cities would no longer have the authority to enforce local ordinances related to agriculture, natural resources, finance, and labor; and local protections against extreme heat, such as water break requirements, would be rolled back.

The group of about three dozen people stood in the early-afternoon sun and held signs that read “Working Shouldn’t Be a Death Sentence,” “Water Breaks = Basic Right,” and “People Over Profits,” sweating and squinting. In the nation’s capital, the heat index had already reached 91 degrees. But protesters were focused on the plight of employees working in their even-hotter home state, where the thermostat had been reaching triple digits.

Rep. Greg Casar (D-Texas), who organized this week’s protest, joined more than 100 other U.S. legislators in signing a letter urging acting Labor Secretary Julie Su to continue the development and implementation of federal standards for rest and water breaks to prevent occupational heat illness and death.

Casar, along with others in the group, including members of San Juan, Texas-based La Unión del Pueblo Entero and civil rights activist Dolores Huerta, didn’t eat or drink from 10:30 a.m. to 6:30 p.m., both to push for national action to reverse Abbott’s law and as a sign of solidarity with Texas employees, especially those who work outside.

“A basic thing like the right to a water break, a basic thing like being able to go to work and know that working is not a death sentence, is the baseline of what our democracy should be able to do,” Casar said, with sweat dripping from his forehead.

Huerta, 93, who worked alongside the legendary labor activist Cesar Chávez to create organizations like La Unión, reminded the crowd that in the 1960s farmworkers in California went on strike to protest poor and dangerous working conditions, including the lack of job security, bathroom access, and water during the day.

“This is such a cruel thing,” Huerta said.

A steady stream of lawmakers came by to express support for the rally, including House Minority Leader Rep. Hakeem Jeffries of New York and well-known progressives like Sen. Bernie Sanders (I-Vt.), Rep. Alexandria Ocasio-Cortez (D-N.Y.), and other members of “The Squad,” a small group of liberal House Democrats. And from California, another state in the midst of a heat wave, Democratic Reps. Katie Porter, who is running for the Senate, and Ro Khanna also made appearances. California is among those states that have rules in place to protect workers from extreme heat.

Rep. Joaquin Castro (D-Texas) was in attendance and challenged Abbott to spend a day without water. “One day in the governor’s mansion, the air-conditioned governor’s mansion, without water,” he said. “Or better yet, one day with the folks who are out in the fields, the folks who are out on top of roofs, the folks who are at construction sites.”

At the front of the crowd were Jasmine and Daisy Granillo, younger sisters of Roendy Granillo, a construction worker of Fort Worth, Texas, who died in July 2015 from heat exhaustion. He was 25 and was installing hardwood flooring in a house without ventilation. The temperature was in the high 90s, he was wearing extra layers of protection because of the chemicals in the wood, and his request for a water break was denied. “My parents were told that his organs were cooked from the inside,” Jasmine said.

On the day Roendy passed away, he told his sisters he would take them to the flea market when he came home from work. He didn’t come home. They’re now committed to making sure others don’t suffer from heat exhaustion as he did. “I know that a simple water break, a simple water break, could have prevented his death,” Jasmine told KFF Health News.

This is the second time Jasmine and her family have rallied for water breaks for outdoor workers. After her brother died, she and others pushed the Dallas City Council in 2015 to pass an ordinance establishing 10-minute rest breaks every four hours for construction workers. In 2010, Austin passed its own such rule. Abbott’s law, set to take effect Sept. 1, will dissolve those ordinances and prohibit local governments from passing similar ones.

The protesters gathered at the Capitol steps also said they worried that corporate interests would try to block the national rule from seeing the light of day. “They delay them as long as they can until they die a slow death, and we’re here today to make sure that doesn’t happen,” Casar said.

Taylor Critendon, a registered nurse who specializes in critical care at Ascension Seton Medical Center in Austin, attended the event to monitor the congressman’s vitals and keep an eye on the group’s well-being. She said she has been treating more patients because of heat exhaustion than before. “It’s definitely taking a toll on our community,” she said.

She emphasized that not drinking enough water while outside in hot temperatures can cause someone’s heart rate to rise and blood pressure to drop. Often, patients start to feel weak and faint and lose blood flow, she said, referencing the body’s internal mechanism to cool itself down. People shouldn’t wait to experience these symptoms before drinking water.

“When you’re thirsty, then you’re already farther down the line of dehydration,” Critendon said, explaining why outside workers need regular water breaks. “You can’t really wait until your body says, ‘Oh, I’m thirsty,’ because by that time it’s already late.”

Tania Chavez Camacho, president and executive director of La Unión del Pueblo Entero, also participated in the daylong hunger and thirst strike. The union has historically protected the rights of migrant farmworkers in South Texas but has more recently expanded to include others, such as construction workers.

“We’ve been here for just about an hour,” she said. “We’re sweating” and “it’s really, really hot,” she added. “Can you imagine what it is like for construction workers every single day?”

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After her weight began climbing in high school, she spent years losing 50 or 100 pounds then gaining it back. Morris, 78, was at her heaviest in her mid-40s, standing 5 feet 10½ inches and weighing 310 pounds. The Pittsburgh resident has had diabetes for more than 40 years.

Managing her weight was a losing battle until Morris’ doctor prescribed a Type 2 diabetes medication, Ozempic, four months ago. It’s one in a new category of medications changing how ordinary people as well as medical experts think about obesity, a condition that affects nearly 4 in 10 people 60 and older.

The drugs include Ozempic’s sister medication, Wegovy, a weight loss drug with identical ingredients, which the FDA approved in 2021, and Mounjaro, approved as a diabetes treatment in 2022. (Ozempic was approved for diabetes in 2017.) Several other drugs are in development.

The medications reduce feelings of hunger, generate a sensation of fullness, and have been shown to help people lose an average of 15% or more of their weight.

“It takes your appetite right away. I wasn’t hungry at all and I lost weight like mad,” said Morris, who has shed 40 pounds.

But how these medications will affect older adults in the long run isn’t well understood. (Patients need to remain on the drugs permanently or risk regaining the weight they’ve lost.)

Will they help prevent cardiovascular disease and other chronic illnesses in obese older adults? Will they reduce rates of disability and improve people’s ability to move and manage daily tasks? Will they enhance people’s lives and alleviate symptoms associated with obesity-related chronic illnesses?

Unfortunately, clinical trials of the medications haven’t included significant numbers of people ages 65 and older, leaving gaps in the available data.

While the drugs appear to be safe — the most common side effects are nausea, diarrhea, vomiting, constipation, and stomach pain — “they’ve only been on the market for a few years and caution is still needed,” said Mitchell Lazar, founding director of the Institute for Diabetes, Obesity and Metabolism at the University of Pennsylvania Perelman School of Medicine.

Given these uncertainties, how are experts approaching the use of the new obesity medications in older people? As might be expected, opinions and practices vary. But several themes emerged in nearly two dozen interviews.

The first was frustration with limited access to the drugs. Because Medicare doesn’t cover weight loss medications and they can cost more than $10,000 a year, seniors’ ability to get the new drugs is restricted.

There is an exception: Medicare will cover Ozempic and Mounjaro if an older adult has diabetes, because the insurance program pays for diabetes therapies.

“We need Medicare to cover these drugs,” said Shauna Matilda Assadzandi, a geriatrician at the University of Pittsburgh who cares for Morris. Recently, she said, she tried to persuade a Medicare Advantage plan representative to authorize Wegovy for a patient with high blood pressure and cholesterol who was gaining weight rapidly.

“I’m just waiting for this patient’s blood sugar to rise to a level where diabetes can be diagnosed. Wouldn’t it make sense to intervene now?” she remembered saying. The representative’s answer: “No. We have to follow the rules.”

Seeking to change that, a bipartisan group of lawmakers has reintroduced the Treat and Reduce Obesity Act, which would require Medicare to cover weight loss drugs. But the proposal, which had been considered previously, has languished amid concerns over enormous potential costs for Medicare.

If all beneficiaries with an obesity diagnosis took brand-name semaglutide drugs (the new class of medications), annual costs would top $13.5 billion, according to a recent analysis in The New England Journal of Medicine. If all older obese adults on Medicare — a significantly larger population — took them, the cost would exceed the total spent on Medicare’s Part D drug program, which was $145 billion in 2019.

Laurie Rich, 63, of Canton, Massachusetts, was caught off guard by Medicare’s policies, which have applied to her since she qualified for Social Security Disability Insurance in December. Before that, Rich took Wegovy and another weight loss medication — both covered by private insurance — and she’d lost nearly 42 pounds. Now, Rich can’t get Wegovy and she’s regained 14 pounds.

“I haven’t changed my eating. The only thing that’s different is that some signal in my brain is telling me I’m hungry all the time,” Rich told me. “I feel horrible.” She knows that if she gains more weight, her care will cost much more.

While acknowledging difficult policy decisions that lie ahead, experts voiced considerable agreement on which older adults should take these drugs.

Generally, the medications are recommended for people with a body mass index over 30 (the World Health Organization’s definition of obesity) and those with a BMI of 27 or above and at least one obesity-related condition, such as diabetes, high blood pressure, or high cholesterol. There are no guidelines for their use in people 65 and older. (BMI is calculated based on a person’s weight and height.)

But those recommendations are problematic because BMI can under- or overestimate older adults’ body fat, the most problematic feature of obesity, noted Rodolfo Galindo, director of the Comprehensive Diabetes Center at the University of Miami Health System.

Dennis Kerrigan, director of weight management at Henry Ford Health in Michigan, a system with five hospitals, suggests physicians also examine waist circumference in older patients because abdominal fat puts them at higher risk than fat carried in the hips or buttocks. (For men, a waist over 40 inches is of concern; for women, 35 is the threshold.)

Fatima Stanford, an obesity medicine scientist at Massachusetts General Hospital, said the new drugs are “best suited for older patients who have clinical evidence of obesity,” such as elevated cholesterol or blood sugar, and people with serious obesity-related conditions such as osteoarthritis or heart disease.

Since going on Mounjaro three months ago, Muriel Branch, 73, of Perryville, Arkansas, has lost 40 pounds and stopped taking three medications as her health has improved. “I feel real good about myself,” she told me.

When adults with obesity lose weight, their risk of dying is reduced by up to 15%, according to Dinesh Edem, Branch’s doctor and the director of the medical weight management program at the University of Arkansas for Medical Sciences.

Still, weight loss alone should not be recommended to older adults, because it entails the loss of muscle mass as well as fat, experts agree. And with aging, the shrinkage of muscle mass that starts earlier in life accelerates, contributing to falls, weakness, the loss of functioning, and the onset of frailty.

Between ages 60 and 70, about 12% of muscle mass falls away, researchers estimate; after 80, it reaches 30%.

To preserve muscle mass, seniors losing weight should be prescribed physical activity — both aerobic exercise and strength training, experts agree.

Also, as older adults taking weight loss drugs eat less, “it’s critically important that their diet includes adequate protein and calcium to preserve bone and muscle mass,” said Anne Newman, director of the Center for Aging and Population Health at the University of Pittsburgh.

Ongoing monitoring of older adults having gastrointestinal side effects is needed to ensure they’re getting enough food and water, said Jamy Ard, co-director of Wake Forest Baptist Health’s Weight Management Center.

Generally, the goal for older adults should be to lose 1 to 2 pounds a week, with attention to diet and exercise accompanying medication management.

“My concern is, once we put patients on these obesity drugs, are we supporting lifestyle changes that will maintain their health? Medication alone won’t be sufficient; we will still need to address behaviors,” said Sukhpreet Singh, system medical director at Henry Ford’s weight management program.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit kffhealthnews.org/columnists to submit your requests or tips.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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2023 will likely be remembered as the summer Arizona sizzled, Vermont got swamped, and nearly the entire Eastern Seaboard, along with huge swaths of the Midwest, choked on wildfire smoke from Canada. Still, none of that has been enough to prompt policymakers in Washington to act on climate issues.

Meanwhile, at a public court hearing, a group of women in Texas took the stand to share wrenching stories about their inability to get care for pregnancy complications, even though they should have been exempt from restrictions under the state’s strict abortion ban.

This week’s panelists are Julie Rovner of KFF Health News, Rachel Cohrs of Stat, Shefali Luthra of The 19th, and Alice Miranda Ollstein of Politico.

Panelists

Among the takeaways from this week’s episode:

• Tensions over abortion access between the medical and legal communities are coming to the fore in the courts, as doctors beg for clarification about bans on the procedure — and conservative state officials argue that the law is clear enough. The risk of being hauled into court and forced to defend even medically justified care could be enough to discourage a doctor from providing abortion care.
• Conservative states are targeting a Biden administration effort to update federal privacy protections, which would make it more difficult for law enforcement to obtain information about individuals who travel outside a state where abortion is restricted for the procedure. Patient privacy is also under scrutiny in Nebraska, where a case involving a terminated pregnancy is further illuminating how willing tech companies like Meta are to share user data with authorities.
• And religious freedom laws are being cited in arguments challenging abortion bans, with plaintiffs alleging the restrictions infringe on their religious rights. The argument appears to have legs, as early challenges are being permitted to move forward in the courts.
• On Capitol Hill, key Senate Democrats are holding up the confirmation process of President Joe Biden’s nominee as director of the National Institutes of Health to press for stronger drug pricing reforms and an end to the revolving-door practice of government officials going to work for private industry.
• And shortages of key cancer drugs are intensifying concerns about drug supplies and drawing attention in Congress. But Republicans are skeptical about increasing the FDA’s authority — and supply-chain issues just aren’t that politically compelling.

Also this week, Rovner interviews Meena Seshamani, director of the Center for Medicare at the Centers for Medicare & Medicaid Services at the Department of Health and Human Services.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Los Angeles Times’ “Opinion: Crushing Medical Debt Is Turning Americans Against Their Doctors,” by KFF Health News’ Noam N. Levey.

Rachel Cohrs: The New York Times’ “They Lost Their Legs. Doctors and Health Care Giants Profited,” by Katie Thomas, Jessica Silver-Greenberg, and Robert Gebeloff.

Alice Miranda Ollstein: The Atlantic’s “What Happened When Oregon Decriminalized Hard Drugs,” by Jim Hinch.

Shefali Luthra: KFF Health News’ “Medical Exiles: Families Flee States Amid Crackdown on Transgender Care,” by Bram Sable-Smith, Daniel Chang, Jazmin Orozco Rodriguez, and Sandy West.

Also mentioned in this week’s episode:

• Stat’s “From Rapid Cooling Body Bags to ‘Prescriptions’ for AC, Doctors Prepare for a Future of Extreme Heat,” by Karen Pennar.
• Politico’s “The Sleeper Legal Strategy That Could Topple Abortion Bans,” by Alice Miranda Ollstein.

KFF Health News’ ‘What the Health?’Episode Title: Let’s Talk About the WeatherEpisode Number: 306Published: July 20, 2023

[Editor’s note: This transcript, generated using transcription software, has been edited for style and clarity.]