The 60-bed safety-net residential treatment center in Santa Fe Springs, run by Los Angeles Centers for Alcohol and Drug Abuse, has a dedicated detox room, on-site physicians and nurses, substance abuse counselors, licensed therapists, and other practitioners. It offers group counseling as well as individual and family therapy, and it endorses the use of medications for addiction treatment, such as buprenorphine and naltrexone, which are increasingly considered the gold standard.

Willard Sexton, a staff member and former Allen House patient, says the most important part of his job is speaking with each resident daily. Most of them, like him, came to treatment straight from jail or prison, and he knows as well as anybody how stressful it is to stop using.

“It’s similar to grief and loss,” says Sexton, 35. “The drug was their best friend for a long time.” Interacting with them, he says, helps him in his own ongoing recovery.

At a time when drug use is among the nation’s gravest public health crises, a visit to the Allen House offers key lessons: Addiction is a chronic illness requiring constant vigilance, there’s no one-and-done solution, and relapses are part of the journey to recovery. Peer mentoring is an invaluable element of drug counseling, since people who have plodded the difficult path from dependence to sobriety understand the mindset of patients on a visceral level.

And most importantly for those who feel despair in the grip of addiction, there is hope. “Recovery happens,” says Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association of California. “Every single day people come into treatment and succeed in addressing their substance use disorders.”

Drug-related overdoses kill almost as many Californians as lung cancer, more than diabetes, and two to three times as many as car accidents, according to a report by California Health Policy Strategies, a Sacramento consulting group. The report showed there were about 11 times as many fentanyl-related deaths in 2021 as in 2017, accounting for more than half of overdose fatalities. And addiction can ruin lives even if it doesn’t end them.

But proper care for substance use disorders can still be hard to find. Experts in the field say residential treatment beds are in short supply. A pandemic-driven shortage of health care workers has hit the drug treatment world. Unscrupulous operators, with an eye on their bottom lines, may take advantage of people desperate for any answer. Commercial insurers often deny treatment requests or propose cheaper alternatives.

Some treatment programs shun anti-addiction medications that have proven effective. Physicians, nurse practitioners, and other providers with the requisite training can prescribe these drugs in California, but too few seem willing or able to do so — though that could change now that federal law no longer requires them to get a special waiver.

A page on the website of the Substance Abuse and Mental Health Services Administration (www.samhsa.gov) allows you to find practitioners in your area who treat patients with buprenorphine.

There’s no one-size-fits-all solution for addiction. Treatment can differ depending on the substance — opioids, alcohol, or methamphetamine, for example. And people with substance use problems come from all walks of life: Some are straight off the streets or out of jail or may have serious mental or medical conditions that require additional care. Others may be otherwise healthy with good jobs and insurance. If a clinic tries to sell you on a standardized treatment program, cross the place off your list.

And if someone tells you that after one stint in their program you or a loved one will be drug-free for life, run the other way. For many people, addiction is a chronic condition that ebbs and flows over many years. Too often, patients in the throes of an overdose are revived and then discharged with no follow-up.

“If we talked about treating other chronic illnesses like diabetes or asthma in the same way we often approach treating substance use, people would think we were crazy or would sue the doctor for malpractice,” says Bradley Stein, a psychiatrist and senior physician policy researcher at the Rand Corp.

Finding the treatment that is right for you or a loved one will take legwork.

Whether it should be a residential or outpatient program depends on multiple factors. People who need to be shielded from exposure to a dealer or a toxic domestic situation, require detox, or have mental health or medical conditions on top of their drug use generally are better off in a residential setting, says Randolph Holmes, medical director of the Los Angeles Centers for Alcohol and Drug Abuse. Outpatient settings are more suitable for people with stable lives and better health or those transitioning from residential treatment, he says.

The cost of treatment can vary widely depending on duration and the patient’s circumstances. In some cases, it can reach tens or hundreds of thousands of dollars.

Various websites allow you to search for nearby addiction treatment. The Substance Abuse and Mental Health Services Administration has a treatment locator at www.findtreatment.gov, or you can call its help line at 800-662-HELP (4347). Shatterproof (www.shatterproof.org) is another source for finding treatment. In California, the Department of Health Care Services publishes a list of substance use help lines by county.

If you’re on Medi-Cal, California’s version of the federal Medicaid program for low-income residents, your county is a good place to start. It can point you to several options, at least in more populous areas. Almost all patients with the Los Angeles Centers for Alcohol and Drug Abuse, for example, are Medi-Cal enrollees.

If you have commercial insurance, call your health plan first. Parity laws require insurers to cover substance use treatment, though they often find reasons not to provide the treatment your provider recommends. If your plan denies you treatment you think you need, you can file an appeal. The Department of Managed Health Care (www.dmhc.ca.gov), the state’s primary health plan regulator, has a help line (888-466-2219) that can assist in appealing your case. Or you can do it online. If the department does not regulate your plan, it can steer you in the right direction.

And remember that recovery is a long-term commitment.

When Sexton first started using in his early 20s, his drug of choice was meth. He later started smoking it with heroin and fentanyl mixed in, he says.

Several years ago, Sexton spent 45 days in residential rehab and got clean. Then he started seeing a woman who was addicted to heroin. He thought he’d help her get sober but ended up doing drugs with her instead. He landed in jail for two months, and a judge ordered him back into residential drug treatment.

Sexton says he continues to actively pursue his recovery even as he helps others do the same. “There are bumps in the road, but I feel like I’m in a Range Rover,” he says. “I’m not going to spill my coffee.”

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

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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You will likely hear and see public messages over the coming weeks urging you to update your contact information. Heed them.

Then, sometime between now and next spring, you’ll probably receive mail from the agency that administers Medi-Cal in your county telling you if you are still eligible for the safety-net health insurance program or asking for more information about your employment status, income, and household size. An information request would likely come in a bright-yellow envelope containing a roughly 20-page form about six weeks before the start of your renewal month.

Be on the alert: Medi-Cal is warning about scammers who have been contacting enrollees and requesting a fee to help people renew coverage. Don’t fall for it. No payment is required to renew your coverage.

But be sure to open your mail and respond to any official request for personal information. And be aware that updating your information could push you off Medi-Cal if your income has risen or if you have access to other insurance.

If you need help with any of this, especially that daunting renewal form, keep reading.

Medi-Cal, the state’s version of the Medicaid health insurance program for low-income residents, has embarked on a 14-month effort to reexamine the eligibility of its nearly 15.8 million members. It is part of the massive “unwinding” being undertaken by all state Medicaid programs after three pandemic years during which their rolls swelled. States had agreed, in exchange for extra funding from the feds, not to boot anyone except in cases such as fraud, death, or a move out of state.

On April 1, Medicaid restarted the annual eligibility checks that had been the norm before the pandemic. It will be the biggest shake-up in U.S. health coverage since the Affordable Care Act, though it cuts the opposite way: Between 8 million and 24 million people will likely be bounced from Medicaid nationally, including an estimated 2 million to 3 million in California.

To minimize the number of enrollees dropped unnecessarily, California’s Department of Health Care Services, which runs Medi-Cal, has launched a $25 million advertising and outreach campaign that will send messages in 19 languages. The department is enlisting the assistance of nearly everyone who has contact with Medi-Cal enrollees: county offices, health plans, medical providers, advocacy groups, and volunteers. And it got $146 million in supplemental funding to help counties cope with the unprecedented number of renewal decisions.

But some patient advocates, health plan executives, and community clinic administrators worry it will not be enough to help all enrollees who could lose coverage if they can’t be reached or don’t respond — especially transient and homeless people and those with language or cultural barriers.

Less than two months before the start of the unwinding, multiple counties, including Fresno and Sacramento, reported staffing shortages and the need to train eligibility workers.

Laura Sheckler, deputy director of policy at the California Primary Care Association, which represents about 1,300 community clinics statewide, says the nearly $60 million in state funds earmarked for “navigators” to assist Medi-Cal enrollees is not enough for her group’s members to provide all the help that will be needed. The association has asked lawmakers for another $60 million.

Some Medi-Cal members already know where they stand. Anthony Kelley, a 53-year-old single dad, is one of them. Kelley, who lives with his 14-year-old son, Nicholas, in Pacifica, California, temporarily lost his job as a driver for a concrete company in the early days of the pandemic and signed up for Medi-Cal. He got his job back about a month later, along with access to employer-sponsored health coverage, but he has stayed on Medi-Cal for the past three years. His son has been on Medi-Cal since he was born.

When San Mateo County sent Kelley a renewal form, he called and was told his $58,000 annual income likely meant he and his son would lose Medi-Cal coverage. Now, he’s waiting for that to happen.

“It sucks for my son,” Kelley says, adding that he fears Nicholas could lose his doctors. “But we’ll deal with it.”

If you are anxious or uncertain about what you need to do, don’t fret. Help is available.

You can call or visit your local Medi-Cal office to update your personal information or ask for assistance. The Department of Health Care Services (www.dhcs.ca.gov) lists on its website all county Medi-Cal agencies, with addresses, phone numbers, and links. You can also call Medi-Cal’s help line (800-541-5555).

If you want to avoid potentially long lines or telephone hold times, consider signing up for an account at www.benefitscal.com or www.mybenefitscalwin.org. Doing so will allow you to update your personal and financial information online and find your renewal date.

Another great resource is the Health Consumer Alliance (888‑804‑3536 or www.healthconsumer.org), which can help you navigate the complexities of renewal, or contest a termination decision you think is unwarranted. Community clinics, which provide care for nearly one-third of Medi-Cal enrollees, often have navigators on-site who can help fill out forms and answer questions. L.A. Care, the largest Medi-Cal health plan, has 11 centers across Los Angeles County that will offer help to anyone who needs it, not just its members. Fresno County has 14 such centers. Check with your health plan for similar resources.

Under a state law, SB 260, if you are bumped off Medi-Cal but still have income low enough to qualify for an insurance subsidy through Covered California, the state’s insurance marketplace, you will be auto-enrolled in a plan the exchange deems to be the best value at the lowest cost. Once notified of the plan selection, you will have 30 days to accept it, choose another plan, or decline coverage altogether.

“This doesn’t need to be all doom and gloom for people who have Medi-Cal,” says David Kane, a senior attorney at the Western Center on Law & Poverty.

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

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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The federal government recently fixed a controversial Treasury Department rule tied to the Affordable Care Act that denied assistance to many families whose workplace coverage busted their budgets.

Because of the so-called family glitch, if a worker had access to employee-only coverage deemed affordable under federal guidelines, a spouse or dependents could not get help to buy a health plan through Covered California, the state’s ACA insurance marketplace, even if it was not affordable to put them on the employer plan.

This affected an estimated 5.1 million people nationally, more than half of them children, since employers often contribute only to an employee’s premium, leaving workers to pay full fare for other family members.

Under a new rule that took effect Dec. 12, if the cost of having you and your family on a workplace plan exceeds an affordability threshold — set at 9.12% of household income for 2023 — your spouse and dependents could qualify for financial aid to purchase insurance through Covered California. Affordability will be determined by how much you would have to pay to have them — and you — on your employer’s cheapest health plan.

ACA insurance subsidies come in the form of federal tax credits that can be taken upfront or settled with the IRS when you file your taxes the following year.

Estimates from the UCLA Center for Health Policy Research and the UC Berkeley Labor Center show that 391,000 Californians previously excluded from subsidies in Covered California would be eligible for them under the new rule. Of those, an estimated 149,000 would likely enroll in a Covered California plan. Those switching from an employer-sponsored plan would save an average of $1,478 per person this year, according to the two centers.

“Fixing the family glitch is a critical step in really delivering on the promise of the ACA,” says Jessica Altman, executive director of Covered California. “If you don’t have affordable coverage from another source, the marketplace is where you should be able to come for affordable coverage.”

So, if you are paying too much to cover your family members on your employer’s health plan, it is definitely worth finding out whether you can get a tax credit to help pay their premiums on a Covered California plan. But finding the answer is complicated and will take considerable legwork.

If you have steady employment, last year’s income will probably be a good proxy for 2023, adding any pay raise you expect in the coming year. You’ll also need to calculate how much you would pay for your employer’s lowest-cost health plan — both for employee-only coverage and for family coverage. If the cost for you alone is under the 9.12% threshold, you will not qualify for a subsidized Covered California plan, even if your spouse and dependents do. That means a family could be split between two policies, with separate deductibles and different provider networks.

You also need to determine whether the lowest-cost plan offered by your employer meets the minimum coverage standard under the ACA. That means it must cover at least 60% of your total allowed medical expenses during the year and provide sufficient coverage for hospital and physician services. If it does not meet those requirements, you and your family might be able to get a subsidized plan through Covered California, depending on your income.

If two spouses have access to employer coverage, you’ll need to perform this exercise for both options.

Is your head spinning yet? You’re not alone.

“This stuff is just really complicated,” says Kevin Knauss, an insurance agent in Granite Bay. “And how can we possibly expect families that are doing all kinds of different things — kids, Christmas — to really focus on this stuff?”

But don’t ignore the new rule, because you could be leaving money on the table. Covered California has a worksheet to help calculate your eligibility for subsidies. Your human resources department might be willing to help you fill it out. Or you could seek professional help, whether an insurance agent or other certified enroller. You wouldn’t need to pay a penny for either.

To find an insurance agent or certified enroller, log on to Covered California’s website (www.coveredca.com) and click on the “Support” tab. Or call 800-300-1506. Covered California has a very useful FAQ all about the fix to the family glitch.

The enrollment period for 2023 coverage started on Nov. 1 and runs through Jan. 31. If you buy coverage this month, it will start on Feb. 1.

The family glitch fix isn’t the only new thing with Covered California. Starting this year, you can put a dependent parent or stepparent on your health plan, as long as they are not eligible for or enrolled in Medicare.

And, in case you missed it, Congress extended through 2025 the supplemental tax credits that increase aid to people who were already getting some before and are available to many middle-class households that did not previously qualify for financial assistance.

The idea behind the expanded financial help is to limit the amount people spend on health care premiums to no more than 8.5% of household income, no matter how much money they make.

Knauss said he talked to a man in Marin County who was seeking a Covered California health plan for his family of four and qualified for a monthly subsidy of $1,400, even though he makes $200,000 a year. Being over 60 and living in Northern California, an expensive region, pushed his family’s premium to a level that opened the door for significant financial assistance, Knauss said.

If you are already enrolled in Covered California, don’t simply renew coverage for this year. Prices and provider networks can change from year to year, and there might be a new, cheaper option in your region. So shop around.

And whether you are new or returning to Covered California, know what your medical needs are likely to be. If you have a condition that requires intensive services, you might consider paying a higher premium in exchange for lower deductibles and coinsurance when you seek care.

Happy hunting.

Jessica Altman is the daughter of Drew Altman, who is president and CEO of KFF. KHN is an editorially independent program of KFF.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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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If you feel the way I do, the answer is neither. I cringe at the thought of my body burning up at well over 1,000 degrees Fahrenheit or being pumped full of toxic chemicals and spending the rest of eternity in a cramped box 6 feet underground.

So here’s another question: How do you feel about having your body reduced to compost and used to plant a tree, grow flowers, or repair depleted soil in a forest?

Human composting doesn’t mean you’re tossed into a bin with potato peels, crushed eggshells, and coffee grounds. Rather, you’d be placed in a metal or wooden vessel, enveloped by organic materials such as wood chips, alfalfa, and straw, and then slowly reduced to a nutrient-packed soil. The process can take six weeks to six months depending on the methods used.

I don’t know about you, but I like the sound of that (at least compared with those other two options).

“I never felt like I had an option that works for me until now,” says Assembly member Cristina Garcia (D-Bell Gardens). She authored a bill, signed last month by Gov. Gavin Newsom, to legalize human composting in California.

California becomes the fifth state to allow this method of body disposal, commonly known by the more scientific-sounding name “natural organic reduction.” Colorado, Oregon, Vermont, and Washington have legalized the practice, and legislation is pending in several other states.

The California law takes effect in 2027, allowing time for regulators to establish the rules that will govern human composting in the state.

But it’s never too early to start planning for your death.

Heather Andersen, a 68-year-old consultant and former hospice nurse in Seattle, says she has already chosen to be composted when she dies because it is much easier on the environment than burial or cremation.

“We’re actually enhancing the Earth rather than taking away from it,” she says. And there’s a spiritual dimension to her decision, she says, since she’ll be “going back to being part of the whole cycle of life.”

Andersen, who is in good health, purchased a prepaid composting plan from Recompose, a Seattle-based green funeral home whose founder, Katrina Spade, is widely viewed as a pioneer of natural organic reduction for humans.

One naturally reduced human body can yield anywhere from 250 to 1,000 pounds of soil depending on the method used and the type and volume of organic materials mixed with the body. That’s enough to fill several wheelbarrows or the bed of a pickup. Once the process is complete, many families take a small box of the soil and donate the rest to conservation projects or flower farms.

Of course, being composted after death is not for everybody. For example, the California Catholic Conference objects to the new law. The methods involved, it said in a statement, “reduce the human body to a disposable commodity, and we should instead seek options that uphold respect for both our natural world and the dignity of the deceased person.”

Those who have chosen to have their bodies composted are generally motivated by ecological concerns.

With natural organic reduction, ”what we are in fact doing is taking everything that continues to be alive in a human body after the human being leaves it and turning it into something that can actually nurture the planet,” says Holly Blue Hawkins, of Santa Cruz County, whose Last Respects Consulting offers death planning services.

After death, the human body retains numerous elements and minerals that are nourishing to plants, including carbon, calcium, magnesium, nitrogen, and phosphorus.

Traditional burials pose many problems. The formaldehyde in embalming fluid puts funeral workers at risk for problems such as an irregular heartbeat, a dangerous buildup of fluid in the lungs, and, over time, cancer. Moreover, the toxic substances in embalming fluid can leach into the soil.

Not to mention that there just isn’t enough land in cemeteries for everyone to have their own plot indefinitely into the future.

Cremation, on the other hand, emits numerous pollutants that are harmful to humans, as well as millions of tons of carbon dioxide every year. And the percentage of people choosing cremation is growing fast, primarily because it is cheaper than a burial. Cremation is projected to account for 59% of body disposals this year and 79% by 2040, according to the National Funeral Directors Association. With about 3 million Americans dying each year, that’s a lot of bodies burning up.

Human composting has emerged only recently as an alternative to burial and cremation.

Since Recompose opened in December 2020, the company has composted fewer than 200 bodies. “Obviously, that’s a tiny fraction of the people who die in Washington state,” Spade says. But 1,200 customers have prepaid for natural organic reduction, which she believes is a sign of its growing appeal.

Many funeral entrepreneurs view human composting as a significant business opportunity in a $20 billion industry.

“Our owners have been holding discussions about expanding across the country as more states legalize it,” says David Heckel, advance planning consultant at The Natural Funeral in Lafayette, Colorado.

Return Home, a green funeral home in Auburn, Washington, encourages website visitors to “join the #idratherbecompost movement” and fill out a form letter urging their state legislators to legalize human composting.

Dying isn’t cheap, and composting is no exception. The cost of natural organic reduction ranges from $3,000 to just under $8,000, depending on which company you choose. The companies typically offer on-site ceremonies for an extra charge. That compares with an average funeral cost of just under $7,000 for a cremation and just over $9,400 for a traditional burial with a casket and vault.

Recompose, Return Home, The Natural Funeral, and Earth Funeral, of Auburn, Washington, all say they plan to set up shop in California after the new law takes effect. But Californians who want to return to the Earth as compost don’t have to wait until 2027.

All those companies offer prepaid plans and will arrange transport to their facilities out of state, for an extra fee, if you or your loved one dies before they are up and running in California — or if you live in a state where natural organic reduction is not legal. They will typically mail you or your family a small box of the resulting compost.

Another option is Herland Forest, a nonprofit cemetery in rural Washington, which charges $3,000. It has no plans for expanding to California but accepts bodies from other states with an extra fee for transport.

Call around and compare prices and methods. See what kind of vibe you get.

If the idea of human composting leaves you cold, whether for religious, personal, or family reasons, don’t worry. No one is forcing you to nourish a tree. “I’m not taking anything away,” Garcia says. “I’m just expanding the options that we have.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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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We all have pandemic fatigue. Even people who should know better have let precautionary measures slide. If you are sensing a mea culpa on the way, I won’t disappoint.

I confess I have been far less cautious over the past couple of months than I was early on. I have left home without a mask on a trip to the grocery or pharmacy, and instead of returning to get one, I’ve walked in unmasked, telling myself I’d be there for only a short time.

In June, I took a 12-hour trans-Atlantic flight on which virtually no passengers or crew members were masked. I wore my mask initially, a snug-fitting KN95. But after eating, I kinda sorta forgot to put it back on. In July, with covid clearly surging, I hosted a birthday party for my daughter without asking guests to test themselves before coming to the house.

And there’s more where that came from.

Whether through luck or booster-bolstered immunity, I have managed to evade the virus. But worrisome reports about the BA.5 omicron subvariant — which has spread like a California wildfire, in part because it can circumvent some defenses afforded by vaccines and prior infections — have provided the head-butt I needed to shore up my behavior.

I didn’t actually violate any rules in the situations I described above, because none were in place. Public mandates — such as masking and requiring that people be vaccinated to enter restaurants, gyms, and other indoor venues — have been so bitterly politicized that returning to them now, especially in an election year, would be like trying to cram a genie back in the bottle. I think many of us are coming to terms with a future in which keeping covid at bay will hinge on personal responsibility.

Most of California is in the high-risk covid transmission category, as determined by the Centers for Disease Control and Prevention. Yet even in pandemic-smacked L.A. County, reporting thousands of new infections a day and a double-digit rate of positive tests that is well into the danger zone, serious resistance emerged as health officials recently discussed — and ultimately shelved — a plan to reinstate a mask mandate. Multiple cities in the county, including Beverly Hills, Long Beach, and Pasadena, said they would not enforce it. Business owners openly questioned whether they would ask their employees to impose such a rule on unwilling and sometimes hostile patrons.

Kathryn Barger, a member of the county Board of Supervisors, wrote in an open letter to constituents that “masking mandates are polarizing and are unenforceable.” A better way to go, she said, would be “trusting the public to make personal COVID-19 prevention decisions to keep themselves and their loved ones safe, promoting the efficacy of vaccines and boosters, and investing in equitable access to COVID-19 treatments.”

Let’s face it: Covid is with us for the foreseeable future, and we can only speculate about other variants that might blindside us down the road or how many times we can chance reinfection without risking lasting damage to our health. Given this inconvenient truth, now is an excellent time to adopt everyday habits that reduce our risk of contagion — and not just from covid.

“There will continue to be cases of covid-19 for decades and centuries, the same way there have been for influenza,” says Dr. Saahir Khan, an infectious disease specialist at Keck Medicine of USC. In many Asian countries, he notes, there’s a culture “where every winter when these viruses are circulating at a high level, people wear masks in public places. And I think that has to become part of the culture here.”

The covid complacency that has overtaken so many of us is in large ways a credit to the vaccines and treatments that have sharply reduced the severity of illness from an infection. But the current vaccines have proved far less protective against infection itself, especially when faced with the evasive mechanisms exhibited by BA.5.

Shira Shafir, an associate professor of epidemiology at UCLA’s Fielding School of Public Health, experienced that disconcerting reality firsthand. When I called to interview her for this column, she was at home with covid. Shafir’s 70-year-old mother had been planning to visit from Arizona, so she and her husband opted to test themselves and their young son. Their son tested positive, and they told her mom not to come.

“My son had no symptoms,” Shafir says. “We only tested him because my mother was coming to visit — and thank goodness we did, because otherwise my mother would have been exposed and in all certainty would have gotten infected.”

The next day, Shafir tested positive, and the day after that, her husband did. Both she and her husband are boosted, and their son, who participated in a Pfizer vaccine trial for children under 5, has received three shots.

A starting point for developing your covid defensive strategy is determining how much transmission is happening in your community. If you are in an area of high prevalence, as more than 45% of U.S. counties were in late July, significant caution is warranted. An easy way to find out is by consulting this CDC webpage, which will show you which category your county is in. You can also follow your local health department on social media.

Another good measure is purely anecdotal: “If you know a lot of people right now who have covid, it means there’s a lot of covid,” Shafir says.

I know of at least 10 people, both friends and professional contacts, who have been infected in the past few weeks, all vaccinated and boosted. And that has set off the alarm bells I needed to reacquaint myself with basic safety measures.

Among them: Wear a mask in indoor public spaces and crowded outdoor ones. If you are at high risk of serious illness, avoid those places, and find alternatives such as curbside pickup and home delivery.

If you want to host a dinner party, ask guests to take a rapid home test before they come over. If you are taking an airplane, put on a mask the moment you enter the airport, and at a minimum keep it on until the plane is in the air and then again when you land.

If you test positive, follow these guidelines: Isolate from people for at least five days after your first symptoms or a positive test result. You can end isolation after the fifth day if you have a negative test, no fever, and your symptoms are improving.

If you are one of those people who don’t worry about covid because you don’t believe it will make you terribly sick, remember this: The course of the illness can still be highly unpredictable and includes some chance of ending up with long covid, which can leave you with brain fog, shortness of breath, and heart damage.

If you’re not convinced by any of that, then at least have some consideration for neighbors, co-workers, and relatives who may be older and sicker than you.

“That is what concerns me,” says USC’s Khan. “I want to make sure society is doing its best to protect those people.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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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This story can be republished for free (details).

It goes like this: You find multiple providers in your plan’s directory, and you call them. All of them. Alas, the number is wrong; or the doctor has moved, or retired, or isn’t accepting new patients; or the next available appointment is three months away. Or perhaps the provider simply is not in your network.

Despite a spate of state and federal regulations that require more accurate health plan directories, they can still contain numerous errors and are often maddeningly outdated.

Flawed directories not only impede our ability to get care but also signal that health insurers aren’t meeting requirements to provide timely care — even if they tell regulators they are.

Worse, patients who rely on erroneous directory information can end up facing inflated bills from doctors or hospitals that turn out to be outside their network.

In 2016, California implemented a law to regulate the accuracy of provider directories. The state was trying to address long-standing problems, illustrated by an embarrassing debacle in 2014, when Covered California, the insurance marketplace that the state formed after the passage of the Affordable Care Act, was forced to pull its error-riddled directory within its first year.

Also in 2016, the federal Centers for Medicare & Medicaid Services demanded more accurate directories for Medicare Advantage health plans and policies sold through the federal ACA marketplace. And the federal No Surprises Act, which took effect this year, extends similar rules to employer-based and individual health plans.

California law and the federal No Surprises Act stipulate that patients who rely on information in their provider directories and end up unwittingly seeing doctors outside their networks cannot be required to pay more than they would have paid for an in-network provider.

Unfortunately, inaccurate directories continue to plague our health care system.

A study published in June in the Journal of Health Politics, Policy and Law analyzed data from the California Department of Managed Health Care on directory accuracy and timely access to care. It found that in the best case, consumers could get timely appointments in urgent cases with just 54% of the doctors listed in a directory. In the worst case: 28%. For general care appointments, the best case was 64% and the worst case 35%.

A key takeaway, the authors write, is that “even progressive and pro-consumer legislation and regulations have effectively failed to offer substantial protection for consumers.”

Few people know this better than Dan O’Neill. The San Francisco health care executive called local primary care doctors listed in the directory of his health plan, through a major national carrier, and could not get an appointment. Nobody he talked to could tell him whether UCSF Health, one of the city’s premier health systems, was in his network.

“I spent close to a week trying to solve this problem and eventually had to give up and pay the $75 copay to go to urgent care because it was the only option,” O’Neill says. “I now live a seven- or eight-minute walk from the main UCSF buildings, and to this day, I have no idea whether they are in my network or not, which is crazy because I do this professionally.”

Consumer health advocates say insurers are not taking directory accuracy seriously. “We have health plans with millions of enrollees and hundreds of millions in reserves,” says Beth Capell, a lobbyist for Sacramento-based Health Access California. “These people have the resources to do this if they thought it was a priority.”

Industry analysts and academic researchers say it’s more complicated than that.

Health plans contract with hundreds of thousands of providers and must constantly hound them to send updates. Are they still with the same practice? At the same address? Accepting new patients?

For doctors and other practitioners, responding to such surveys — sometimes from dozens of health plans — is hardly at the top of their to-do list. Insurers typically offer multiple health plans, each with a different constellation of providers, who don’t always know which ones they’re in.

The law gives insurers some leverage to induce providers to respond, and a whole industry has sprung up around collecting provider updates through a centralized portal and selling the information to health plans. The inaccuracy problem remains, however. Health plans and providers often have outdated data systems that don’t communicate with each other.

A significant improvement in health plan directories will require “more connectivity and interoperability,” says Simon Haeder, an associate professor at Texas A&M University’s School of Public Health and a co-author of the study on directory accuracy and timely access.

Until that day comes, you will need to fend for yourself. Be diligent when using your health plan’s provider directory. You should use it as your first stop — or to check whether a doctor recommended by a friend is in your network.

Remember the laws that say you can’t be charged out-of-network rates if the doctor you visit was listed in your health plan’s directory? You’ll have to prove that was the case. So take a screenshot of the directory showing the provider’s name and save it. Then, call the doctor’s office to double-check. Take notes and get the name of the person you talked to. If there’s a discrepancy, call your health plan, too.

If you find an inaccurate entry, report it to your health plan. California law requires plans to provide instructions for consumers to do that. If you are in a commercial health plan, your policy is likely regulated by the Department of Managed Health Care. You can lodge a complaint through the department (888-466-2219 or www.healthhelp.ca.gov). Since California’s law on provider directories took effect, the department has helped resolve 279 complaints, said spokesperson Rachel Arrezola.

If your plan has a different regulator, the department can point you in the right direction.

If you are one of the roughly 6 million Californians in a federally regulated employer or union plan and you get a big out-of-network bill from a doctor who was listed in your health plan directory, you can file an appeal through the office set up for that purpose (800-985-3059 or www.cms.gov/nosurprises).

Ultimately, efforts to improve the accuracy of provider directories are part of a broader push for greater transparency of health care prices and easier access to patient records. All of that will require a more open information superhighway.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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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Small income changes can cause people’s eligibility to shift, but when bad information is typed into a computer system shared by the two programs — or accurate information is deleted from it — enrollees can get big headaches.

Long-standing tension between the state, which oversees Medi-Cal, and county officials who do the nitty-gritty work of determining eligibility and enrolling those who qualify doesn’t help. And, sometimes, people applying for coverage unwittingly answer questions in a way that causes eligibility officers to switch them from one program to the other.

Legal aid attorneys, patient advocates, and insurance agents say computer glitches are not as common today as they were in the several years after California’s 2013 launch of ACA coverage. The exchange was new and millions of people were newly eligible for Medi-Cal. State officials have tackled computer glitches and other problems as they’ve arisen.

But eliminating all human and computer errors isn’t possible.

Just ask Andrea Veltman, who received a notice in December that her subsidized Covered California health plan was being terminated. The letter directed the 57-year-old Oakland resident to apply for Medi-Cal. When she called the program, she learned that Medi-Cal coverage for her 25-year-old son, Merlin, was also being terminated. He needed to reapply.

Veltman, who owns a landscaping business, was confused. She made some calls and found out that a Medi-Cal eligibility officer had logged into both of their accounts and somehow the two accounts had been merged into one. All her husband’s information was deleted, her business was removed, her son’s income was zeroed out, and some of his income was attributed to her.

No one contacted her to verify the changes.

Veltman doesn’t know whether human or computer error was to blame. She suspects that a review of the accounts was triggered when her son applied for food assistance and listed her as a contact person.

“Even if something triggers them to look at it, they still have to verify it is accurate information — and it was so incredibly wrong,” she says. “And that’s just not OK. Why don’t they just ask me?”

Veltman’s son didn’t regain his Medi-Cal coverage until mid-May. Her Covered California coverage was quickly restored in late December, but then the same thing happened in late April. She learned last week that her Covered California coverage was set to be reinstated this month, but she doesn’t know yet whether she will be retroactively covered for treatments in May.

Kevin Knauss, an insurance agent in Granite Bay, says he has heard of similar complaints in recent months from residents in Alameda, Los Angeles, Orange, San Diego, and Santa Barbara counties. “These are calls about information getting messed up in the computer that affects their eligibility,” he says.

Perhaps the most egregious aspect of Veltman’s case is that her son’s Medi-Cal termination violated a rule that prevents people from being disenrolled from Medicaid during the federal public health emergency that was declared at the start of the covid-19 pandemic.

“This shouldn’t be happening. It’s against the rules during the pandemic,” says Jack Dailey, an attorney at the Legal Aid Society of San Diego. “We tell people to push back immediately, and they will get reinstated immediately.”

The rule, which suspends the annual reviews normally conducted to determine enrollees’ eligibility, has enabled many Californians to maintain their Medi-Cal coverage during the pandemic. Those reviews will resume after the public health emergency ends, and millions of people could lose Medi-Cal coverage. The public health emergency is scheduled to expire July 15, but it is almost certain to be extended.

Medi-Cal took months to effectively implement the procedures required to comply with the rule. During several months in 2020, 131,000 enrollees were mistakenly dropped from coverage but were ultimately reinstated, according to the state Department of Health Care Services, which administers Medi-Cal. And such incidents have slowed sharply since.

They have “definitely been less of a problem in the last year or so,” says Skyler Rosellini, a senior attorney at the National Health Law Program. “But they still pop up.”

In the unlikely event this kind of mistake happens to you, a quick call to your county eligibility office might sort things out. You can find a list of county offices on the Department of Health Care Services website (www.dhcs.ca.gov).

If that doesn’t work, or if your patience wears thin, you can get advice and legal help from the Health Consumer Alliance (888‑804‑3536 or www.healthconsumer.org). Insurance agents can also bring lots of expertise to help resolve your problem. You can find agents through the California Agents and Health Insurance Professionals group (www.cahu.org/find-a-member).

If you still don’t get satisfaction, you can request a “fair hearing” before an administrative law judge through the state Department of Social Services (call 855-795-0634 or fill out a request online).

You can also ask for a fair hearing to resolve a dispute over eligibility for a subsidized Covered California health plan or to contest the amount of tax credits you are granted to help pay your premium.

But before you do that, call the marketplace’s customer service line (800-300-1506) to try to fix your problem. Covered California also has an ombudsperson (888-726-0840 or ombuds@covered.ca.gov).

Finally, Veltman has some practical advice: Keep the income information that you submit, or take a screenshot of it — otherwise, you’ll have to calculate everything again if it is erased.

“Also, just keep calling,” she says, “because they sometimes tell you, ‘We’re going to call you back,’ and that almost never happens.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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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Unauthorized immigrants over age 49 who fall below certain income thresholds are now eligible for full coverage by Medi-Cal, California’s version of Medicaid, the federal-state partnership that provides health insurance to low-income people.

Unauthorized immigrants of all ages account for 40% of the state’s approximately 3.2 million uninsured residents. Official estimates put the number of newly eligible people as high as 235,000. Those who sign up will join more than 220,000 unauthorized immigrants ages 25 and under already enrolled in Medi-Cal.

And if Gov. Gavin Newsom gets his way, which seems entirely plausible considering the state’s rosy financial outlook, California could allow all remaining low-income unauthorized immigrants — an estimated 700,000 people — to join Medi-Cal by 2024, or sooner.

As I have explained previously, Medi-Cal has some well-known problems. But it is still far better than no insurance at all. Read on to learn about the new benefits and how you can enroll if you are eligible.

Under current law, all unauthorized immigrants who meet the financial criteria can get limited Medi-Cal coverage, including emergency and pregnancy services and, in some cases, long-term care. But when they sign up for full Medi-Cal, they get comprehensive coverage that includes primary care, prescription drugs, mental health care, dental and eye care, eyeglasses, and much more. That’s no small thing for people who are getting gray.

“This is a key moment when you want to incorporate all these aging undocumented immigrants into the health care system,” says Arturo Vargas Bustamante, a professor of health policy and management at UCLA’s Fielding School of Public Health. If you let their chronic conditions go unattended, he says, they’ll just end up in the emergency room and be more expensive to treat.

He calls it “a responsible way of investing.”

As Bustamante points out, it’s no longer the case that immigrants come to work temporarily in the United States and then return to their home countries. They are staying, raising families, and growing old in this country. And unauthorized immigrants play an important role in the labor force, paying an estimated $3.2 billion in state and local taxes a year in California and $11.7 billion nationally. Nobody benefits if they’re too sick to work.

While it will take time to roll out the new benefits, the task will be made easier by the fact that the vast majority of unauthorized immigrants who will become eligible for full coverage are already signed up for limited Medi-Cal benefits — so the state has contact information for them.

Those already in limited Medi-Cal will be automatically upgraded to full-scope Medi-Cal. Assuming their contact details are current, they will receive packets in the mail explaining their expanded benefits and prompting them to choose a health plan and a primary care provider.

“We expect to see people who are already enrolled in restricted-scope Medi-Cal go into full-scope Medi-Cal right away,” says Ronald Coleman, managing director of policy at the California Pan-Ethnic Health Network, a nonprofit that promotes health access for communities of color. “The question is: Will they understand their benefits and know how to navigate the system?”

Those who are not signed up for restricted Medi-Cal may not be easily identified and, given cultural and language barriers, could be difficult to convince.

The Department of Health Care Services, which administers Medi-Cal, is working with county officials, consumer advocates, and the state health insurance exchange, Covered California, to reach eligible immigrants. It has published notices with frequently asked questions in multiple languages. And the agency has an “older adult expansion” page on its website, available in English and Spanish.

Advocates have also been gearing up. The California Pan-Ethnic Health Network, for example, is sponsoring legislation, AB 2680, which would direct $30 million to community groups to conduct outreach and enrollment for people in underserved communities who are eligible for Medi-Cal. A similar program expires in June. Separately, the network is seeking an additional $15 million specifically for unauthorized adult immigrants, says Monika Lee, a spokesperson for the organization.

Even as advocates and health officials spread the word about the new eligibility rules, they expect to encounter deep distrust from immigrants who vividly remember the Trump administration’s public charge rule, which stoked fear that applying for public benefits might harm their immigration status or even lead to deportation. With elections looming, many fear those days are not entirely in the past.

“What advocates are trying to do on the ground is explain what county offices do with their information. It’s not shared with immigration,” says Tiffany Huyenh-Cho, a senior attorney at Justice in Aging. “We’re really trying to allay some of those concerns people still have.”

Modesto resident Alina Arzola, a 64-year-old unauthorized immigrant who came from Guanajuato, Mexico, says she is not afraid of the immigration police. She is hesitant to sign up for Medi-Cal for a different reason: She fears the quality of the care is not very good.

“Economically, perhaps it would help me,” she says. But she says she has not heard good things from her 87-year-old mother, who is a U.S. citizen and a Medi-Cal enrollee. In December 2020, her mom had surgery scheduled to remove her cataracts. It was all confirmed, Arzola recalls, but when her mom arrived, the doctor wasn’t there. He never showed up.

Arzola, who has diabetes, gets primary care at St. Luke’s Family Practice, a clinic in Modesto that treats uninsured people at no charge. But the clinic is not allowed to provide free care to people who are able to obtain affordable insurance — and that means that Arzola will soon no longer be able to go to the clinic, which she deeply regrets.

So she will likely bite the bullet and sign up for Medi-Cal.

“I’m sure it wouldn’t be convenient for me to be without medical care,” Arzola says, “so I don’t have any alternative.”

The Department of Health Care Services and other resources are available to help you or a loved one learn about the new Medi-Cal benefits for older immigrants, including how to sign up and how to choose a health plan and provider.

The Health Consumer Alliance (888‑804‑3536 or www.healthconsumer.org) provides free consultations and has offices across the state. It also has a fact sheet — available in English, Spanish, Vietnamese, and multiple other languages — that explains the Medi-Cal expansion to older adults. It provides contact information for enrollment, whether through your county welfare office, Covered California, or your local community clinic.

The Latino Coalition for a Healthy California (916-448-3234 or www.lchc.org) offers a toolkit and fact sheets in English and Spanish. The advocacy groups Health Access and the California Immigrant Policy Center have put out a joint FAQ in English and Spanish.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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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A few weeks ago, state regulators imposed a record $55 million in fines on L.A. Care, California’s largest Medi-Cal managed-care plan, for failing to ensure adequate care and allowing treatment delays that threatened enrollees’ health. Patient advocates hope the move signals stricter enforcement against other Medi-Cal insurers, which have many of the same shortcomings for which the regulators just fined L.A. Care.

Twenty-five managed-care plans across the state provide care for nearly 12 million of the more than 14 million Californians enrolled in Medi-Cal, and the state is often accused of failing to hold the plans accountable for subpar care. Medi-Cal members are among the state’s most vulnerable people: They can face language and cultural barriers and have disproportionately high rates of chronic illness.

The state Department of Health Care Services, which runs Medi-Cal, is drafting a new managed-care contract, scheduled to take effect in 2024, that officials say will improve care by holding participating health plans to higher standards. The state hopes to reduce health disparities and improve health outcomes by tightening surveillance and enforcement.

“They are trying to do more, and that’s really positive,” says Abbi Coursolle, senior attorney at the National Health Law Program in Los Angeles. “Obviously, they have a lot more to do.”

DHCS and the state Department of Managed Health Care, which also regulates Medi-Cal managed-care plans, launched coordinated investigations of L.A. Care, based in part on a 2020 Los Angeles Times report that highlighted long, sometimes deadly, delays in care at facilities run by the Los Angeles County Department of Health Services. That agency operates the county’s public safety-net system and contracts with L.A. Care to provide care for hundreds of thousands of the health plan’s members. In their investigations, state regulators also relied on information that L.A. Care reported to them.

That they relied on these sources, Coursolle says, raises questions about the effectiveness of their own surveillance and auditing.

On March 4, the Department of Managed Health Care hit L.A. Care with a $35 million penalty — more than triple its highest previous fine. The Department of Health Care Services levied $20 million, nearly eight times its earlier record.

The state cited L.A. Care for more than 100,000 violations, including late responses to patient complaints and appeals, delayed or denied authorizations for necessary medical care, and failure to ensure the county health services agency complied with patient care regulations. The California Department of Public Health, which regulates hospitals and other health care institutions, didn’t respond to a question about whether it’s investigating any of the county’s medical facilities.

In announcing the fines, state agency directors said: “The magnitude of L.A. Care’s violations, which has resulted in harm to its members, requires immediate action.” The health plan has 2.4 million Medi-Cal enrollees.

“The recent enforcement action against L.A. Care signals that DHCS intends to exercise our authorities to protect our Medi-Cal enrollees,” department spokesperson Anthony Cava told me in an email.

L.A. Care’s CEO, John Baackes, says the plan is not contesting the findings. “What we are contesting is the amount of the fines, which we believe are unreasonable,” Baackes said. The dispute could take months, or even years, to settle.

In a statement released after the fines were announced, L.A. Care noted Medi-Cal’s notoriously low payments to providers and said the penalties create “yet another financial hurdle for a public health plan that is a crucial part of the health care safety net.”

Although L.A. Care has generated millions of dollars in profits in recent years, it reported a loss of $132 million in fiscal year 2020. But the plan can weather the fines. At the end of last year, its tangible net equity — a key measure of solvency — was seven times as high as the minimum required by law.

The violations described by regulators are painfully familiar to Theresa Grant, a Culver City resident I wrote about late last year who has struggled to find relief from a debilitating pain in her rib cage. The violations are “horrific,” she says, “and I think it’s very true.”

But she believes the specialist physicians who have been unable or unwilling to help her deserve a big share of the blame. “You know how long I’ve been dealing with my problem,” she told me. “It’s been over a year now, and not a damn thing is being done.”

Despite the significant penalties levied on L.A. Care, consumer advocates and some state lawmakers think California needs the authority to levy even larger ones.

A bill sponsored by the consumer advocacy group Health Access would increase many of the fines that state health plan regulators can impose at least tenfold. Supporters say the legislation, SB 858, is needed because the amount the department can legally levy on health plans hasn’t been raised in some cases since 1975.

“We want to make sure that insurance companies do not view these fines as just the cost of doing business,” says the bill’s author, state Sen. Scott Wiener (D-San Francisco). “By raising them, they become less a cost of business and more an actual incentive to follow the law.”

The fines imposed on L.A. Care are outliers because of their size, which was determined in part by the sheer number of violations. “For every fine like that, there are many that are dramatically lower,” Wiener says. “I wouldn’t want to rely on one case and say, ‘Oh, no problem, because they got a big fine.’”

Another important factor in holding health plans’ feet to the fire, Wiener says, is consumer complaints, which can help bring problems to the attention of regulators — and to the plans themselves.

But a report last year by KFF showed that consumer appeals of denied care are exceedingly rare.

If you have a problem with your health plan or want to appeal a delay or denial of coverage, a good place to start is the Department of Managed Health Care (888-466-2219 or HealthHelp.ca.gov).

The state also has an ombudsman for Medi-Cal managed care (888-452-8609 or MMCDOmbudsmanOffice@dhcs.ca.gov).

You can also try the Health Consumer Alliance (888-804-3536 or www.healthconsumer.org), which assists people in public and private health plans. It offers free advice, provides legal services, and can help you get your documents in order for an appeal.

Regulators and health plans alike frequently say they are working on behalf of the patient. So if you’re not getting the care you need, stand up and be part of the solution.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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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But a sizable minority — nearly 17 million U.S. residents, including me — has its own special quandary. Our initial vaccine was Johnson & Johnson, which was just one shot, and that has many of us confused. Are we fully vaccinated, even with a booster, or should we get a third shot to catch up with the 92 million vaccinees who got two doses of Pfizer or Moderna early on and have since been boosted? Since J&J has largely disappeared from the public eye, actionable information is in scarce supply — not to mention that the guidance is constantly shifting, for everybody.

On April 4, 2021, I dutifully traveled across Los Angeles to line up for my J&J shot at a mass vaccination site. Like many of my J&J brethren, I was following the advice of public health officials to take the first available vaccine.

At the time, J&J was kind of a cool newcomer among covid-19 vaccines. The protection it provided against illness, though apparently less than that afforded by the so-called messenger RNA (mRNA) vaccines from Pfizer and Moderna, seemed sufficient to ward off serious illness.

And while those vaccines required two shots, J&J was billed as “one and done” — a big advantage for people with needle phobia and for transient populations, including farmworkers, people living in homelessness, and inmates in county jails. Its easy storage requirements, compared with the deep freeze needed to handle the Pfizer and Moderna vaccines, also made it a good choice for remote rural populations.

But just days after I got my shot, the reputation of J&J entered what would prove to be a disastrous tailspin, with news of the vaccine’s link to a rare but potentially deadly blood clotting disorder. That prompted federal health officials to hit the pause button on it, only to clear it 10 days later and then reverse course in December by recommending the Moderna and Pfizer vaccines over J&J’s, mainly because of studies that intensified the blood clot concern.

In the interim, J&J was plagued by production snafus and concerns about its vaccine’s efficacy. Research showed a disproportionate share of breakthrough infections among J&J vaccinees during a covid surge on Cape Cod last summer. State data from California covering most of 2021 paints a similar picture, not only for infections but also for hospitalizations and deaths.

With J&J seemingly destined to be a benchwarmer among covid vaccines in the U.S., it often has been left out of public discourse and guidance on covid.

“Very little J&J vaccine is currently being used, which is part of the reason that people don’t talk about it very much anymore,” says Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center in Nashville, Tennessee.

When the Biden administration first recommended boosters in August, it initially excluded J&J vaccinees, citing a lag in the data.

No wonder the citizens of J&J Nation have been feeling a bit like neglected stepchildren.

“I wish I had chosen something that more people had received so I could get more information,” says Leah Justman, a 39-year-old resident of Los Angeles, who preferred the J&J shot last April because she was breastfeeding her newborn baby at the time, was nervous about the new mRNA technology, and thought J&J was “more similar to getting a regular vaccine.”

Now, she says, she feels as if there’s a bit of a stigma attached to being a J&Jer: “When I go to restaurants or show that I’m vaccinated, people are like, ‘Oh my God, you got J&J.’ It’s almost like a joke, where people think, ‘Thank God I didn’t get it.’”

In December, Justman got the half-dose Moderna booster recommended by the Centers for Disease Control and Prevention. That leaves her behind the curve compared with Moderna and Pfizer recipients who received two full doses initially and a booster later on. She worries about how long she will be protected and what her next move should be.

There appears to be a growing consensus in scientific circles that one shot of J&J was never enough and that it could account for the lower efficacy compared with the mRNA vaccines.

“A lot of us believe it should have been a two-dose vaccine all along,” says Bradley Pollock, associate dean for public health sciences at the UC Davis School of Medicine. In coming months, he says, “it is entirely possible that they’re going to say a three-dose schedule is full vaccination.”

That got me thinking about whether I am fully vaccinated. Factoring in the half-dose Moderna booster I received in late October, I’m still behind those who’ve had three Pfizer or Moderna shots.

I’ve spoken to several J&J vaccinees who, thinking similar thoughts, sought a second booster even though the current federal guideline for J&J vaccinees calls for just one mRNA booster, two months or more after the initial vaccination.

I recently went online to book an appointment for a second Moderna booster. On my first try, I got a message from the pharmacy saying I wasn’t eligible. A second pharmacy allowed me to book a slot, but I canceled at the last minute after receiving dissuasive emails (albeit mild ones) from two of my expert sources.

“It’s not as quantitative as you’re making it out to be,” wrote Dr. George Rutherford, a professor of epidemiology at UCSF. The J&J and mRNA vaccines work differently, he said, “so it’s not like one J&J plus one Moderna equals 1.5 Pfizer doses. I don’t think it will make you sick, but I’d just sit tight. Omicron is going away.”

New research suggests that as few as two covid shots could be enough to protect most people from serious illness and death for many months, or even years.

If you are among the nearly 17 million J&J people and have had a booster, consider standing pat like I finally did. But if you haven’t had a booster yet, do so ASAP. It seems clear, or at least as clear as anything can be where covid is concerned, that if you are vaccinated and boosted, your risk of developing severe illness is very low.

New federal guidance allows for a second booster if your immune system is compromised by, for example, cancer treatment, HIV, or an organ transplant. If you’re not immunocompromised but are worried about weak protection, you can try to persuade a pharmacist or the staffers at a vaccination site to give you another shot. It won’t be easy, but it’s possible. Or talk to your doctor, who may be willing to prescribe one.

Now that I’ve spent most of this column pointing out the problems with the J&J vaccine, it’s only fair that I say a few positive things about it.

First, even though it appears to be less effective than the Pfizer and Moderna shots, the J&J vaccine still provides a high degree of protection against serious illness and is vastly preferable to no vaccine. J&J, which is cheaper than the mRNA vaccines and easier to transport, also has a critical role to play in low-income countries with large rural populations and poor transportation infrastructure.

Even in the United States, where use of the J&J shot has declined sharply, it’s helpful to have the vaccine in stock. It’s a good alternative for those who are anxious about the mRNA shots and would otherwise not get vaccinated.

And it’s always possible that demand for it could return. The mRNA vaccines carry a risk of heart inflammation for young men, a side effect that appears to be short term in most cases. But if future studies show it can lead to permanent damage or even death, “that would make the J&J vaccine potentially at least as attractive, if not more attractive,” says Dr. Walter Orenstein, a professor of epidemiology at Emory University in Atlanta.

The vaccines are still new, many clinical trials have yet to yield unambiguous results, and every new variant throws doubt on data collected when a different strain was dominant.

“It may turn out to be true that three doses or two doses and a variant-focused booster are going to turn out to be best. We don’t know yet,” says Dr. Gregory Poland, director and founder of the Mayo Clinic’s Vaccine Research Group in Rochester, Minnesota. “And the way things have been going, we will barely be getting the answers to those questions, and more time will have passed, and a new variant will arrive.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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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This story can be republished for free (details).