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STDs have been on the rise. Who should pick up the tab for testing?

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STDs have been on the rise. Who should pick up the tab for testing?

Inside the glassy waiting room of a Hollywood clinic, a 33-year-old man sat and listened for his number to be called over the beats of a Mariah Carey song.

“It’s just really easy. You don’t have to make an appointment,” said the man, who comes to the AIDS Healthcare Foundation clinic every two or three months to get tested for sexually transmitted diseases.

Nor does he get asked about his health insurance, which has sometimes been a frustration elsewhere. “And I like the discretion,” added the man, who declined to give his name. “You don’t want people in your business.”

For months, the AIDS Healthcare Foundation has been resisting a push from Los Angeles County for such providers to ask people if they have insurance that can cover costs related to STD tests, a step that the Department of Public Health says is needed in order to spare public dollars for more services.

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The Health Department has long contracted with community organizations to test people for sexually transmitted diseases. In the past, the county shouldered all the costs of processing those tests at a county lab.

County officials said that for several years, their contracts have included a requirement for groups to check if clients have a “third-party payer” that could foot the bill for testing, such as public or private insurance.

Many groups had already started doing so before the county stopped routinely covering the costs of laboratory testing in January, the department said.

If someone has no insurance to cover such testing costs, the organizations can have the county pay for it, although they cannot exceed the overall amount of money allotted to them under their contracts.

Getting insurers to pay for testing has been a strategy for strapped public health departments around the country, seen as a crucial way to offset the costs of providing free care to the uninsured and other needed services as federal funding to combat sexually transmitted diseases has fallen short of the need. L.A. County Public Health said it was hunting for “as many revenue streams as possible” to ramp up STD efforts.

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“This type of work cannot just be exclusively publicly funded,” said Dr. Rita Singhal, the department’s chief medical officer and director of the disease control bureau. “The more revenue for this effort, the better.” In the past, the department said it spent between $1.1 million and $2.3 million annually on testing for STDs.

But some local groups focused on sexual health argue that the change undermines their push to make STD testing easy and routine. Across the country, syphilis and gonorrhea have been on the rise — a longtime trend exacerbated by the interruption of preventative services as health agencies grappled with COVID-19. L.A. County has seen a persistent rise in STDs over the last decade, although there are some early signs of progress.

“If you’re trying to control a disease that’s spiking, you have to take away any deterrents, any obstacles” to routine screening, said Michael Weinstein, president of the AIDS Healthcare Foundation.

Dr. Ward Carpenter, chief health officer for the Los Angeles LGBT Center, said health providers want people to get tested regularly even if they have no symptoms, and “the harder that is, the more barriers that are in place, the less likely people are to do that.”

Among the concerns: Young adults who are on the health plans of their parents may not want to hand over insurance information, fearing their tests could show up in paperwork seen by their families. Such privacy concerns could also affect people who are insured through a spouse, Carpenter said. And clients who are “underinsured” may get stuck with a bill later, he said, and decide to stop getting regularly tested.

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California lawmakers are considering legislation, Assembly Bill 1645, that would prohibit insurance plans from imposing out-of-pocket costs for recommended screenings for sexually transmitted diseases. L.A. County Public Health said it was backing that bill and “exploring as many models as possible to reduce the impact of health insurance screening,” including the use of technology to smooth the process.

Dr. Jeffrey Klausner, a USC Keck School of Medicine professor and formerly an STD prevention director in San Francisco, was nonetheless concerned by the county’s move, calling it “a penny saved, a pound foolish.”

“It’s going to come back and bite them,” Klausner said. “There will be a decrease in testing … particularly among the most vulnerable groups and young people.”

So far, L.A. County Public Health said its early data suggest STD testing has not fallen this year compared with last. Nearly 12,000 tests were reported to the county between January and March — a similar volume to the past — and the department believes the total amount of testing by community groups is likely higher because some are not being reported to the county.

The county agency said it was too early to tell whether it is spending less on testing, but it expects insurers to pick up more costs over time.

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The move was welcomed by Dr. Tony Mills, chief executive of the Men’s Health Foundation, which also contracts with the county. Most people in California are eligible for some kind of health coverage, Mills said, and asking about it provides an opportunity to connect patients to coverage and other care.

If people are uneasy about a test showing up on paperwork for a shared plan, “we can easily get around” that issue by tapping other funds, he said. But L.A. County needs to be “the payer of last resort. … That’s going to save more money for the county to use on other things that are integrally important.”

“It’s just asking the providers to do a little bit more work,” Mills said.

The Health Department said that to boost the number of people screened and treated for STDs, it needs to support a range of screening models, including home testing and street medicine teams. Mario Pérez, director of its division of HIV and STD programs, said that to make a dent in the STD crisis, the department wants most community groups to screen 10,000 to 20,000 people each annually.

“If you want to support that level of volume, having multiple revenue streams at your disposal becomes very important,” he said.

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One survey of more than 4,000 patients at STD clinics found that more than half had some kind of health insurance coverage, and 57% of those who were insured were willing to use it for their visit.

Among those waiting at the AIDS Healthcare Foundation clinic on a recent afternoon was Walter, a 32-year-old who said he liked going to the Hollywood site because his visits usually took less than a half hour.

He used to get routinely tested at an urgent care facility, but stopped when it no longer accepted his insurance. Still, he wasn’t fazed by the idea of being asked for insurance information in the future.

“For me, it’s not a deterrent or a big deal,” he said.

Another patient named Joe sought out the Hollywood clinic after getting results back from a test he had taken in the U.K. Even asking people about insurance will discourage people from STD testing and treatment, said the 26-year-old, who had been worried about obstacles he might face to getting treatment as a foreign tourist.
“It will put fear in people, and as soon as you start doing that, people stop doing it,” he said.

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Federal funding for preventing STDs has barely budged in the last decade, resulting in STD programs losing about 40% of their buying power and forcing them to rely more heavily on other funds, said Stephanie Arnold Pang, senior director of policy and government relations for the National Coalition of STD Directors.

A survey of public health departments found the vast majority were billing Medicaid for STD services and more than two thirds billed private third-party payers. San Francisco City Clinic, a public clinic focused on sexual health, will bill Medi-Cal — the California Medicaid program — if a patient has it, but doesn’t bill private insurance or charge patients, according to the San Francisco Department of Public Health.

“It makes a lot of sense that jurisdictions are looking to have folks use insurance because it is another payer source in a system that’s very challenged,” Pang said.

But doing so has on-the-ground impacts: Carpenter, at the LGBT Center, said the organization had to hire more staff to collect billing information and testing takes longer as a result.

The AIDS Healthcare Foundation advertises free testing without an appointment and wants to get people in and out within an hour, Weinstein said. That speedy, walk-in model “will go out the window” if it has to screen everyone for insurance, he said.

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Weinstein, an outspoken figure whose group has clashed with the county and other government agencies in court, said in late August that his group would not ask clients for information about third-party payers.

The Public Health Department, however, said the AHF had indicated to the county that it would begin screening clients for insurance. In response, the AHF said it would screen existing clients — people who are already AHF patients — when they come in for testing, but not “all individuals who walk in to our testing sites.”

Under the county contracts, groups can turn to the county to cover lab costs for such testing only after they have checked that patients don’t have insurance they could bill instead. The AHF said it expects an increase of at least $1 million annually in lab costs as a result of the county rule.

The Public Health Department said it was continuing to work with the AHF on adjusting to the change, as well as with any other groups “to review and resolve any unintended consequences tied to this approach.” It has been hammering out a spending plan for an added $10 million allocated by the county for STD services, including efforts to “cover critical program elements not covered by” other payers.

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Cluster of farmworkers diagnosed with rare animal-borne disease in Ventura County

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Cluster of farmworkers diagnosed with rare animal-borne disease in Ventura County

A cluster of workers at Ventura County berry farms have been diagnosed with a rare disease often transmitted through sick animals’ urine, according to a public health advisory distributed to local doctors by county health officials Tuesday.

The bacterial infection, leptospirosis, has resulted in severe symptoms for some workers, including meningitis, an inflammation of the brain lining and spinal cord. Symptoms for mild cases included headaches and fevers.

The disease, which can be fatal, rarely spreads from human to human, according to the U.S. Centers for Disease Control and Prevention.

Ventura County Public Health has not given an official case count but said it had not identified any cases outside of the agriculture sector. The county’s agriculture commissioner was aware of 18 cases, the Ventura County Star reported.

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The health department said it was first contacted by a local physician in October, who reported an unusual trend in symptoms among hospital patients.

After launching an investigation, the department identified leptospirosis as a probable cause of the illness and found most patients worked on caneberry farms that utilize hoop houses — greenhouse structures to shelter the crops.

As the investigation to identify any additional cases and the exact sources of exposure continues, Ventura County Public Health has asked healthcare providers to consider a leptospirosis diagnosis for sick agricultural workers, particularly berry harvesters.

Rodents are a common source and transmitter of disease, though other mammals — including livestock, cats and dogs — can transmit it as well.

The disease is spread through bodily fluids, such as urine, and is often contracted through cuts and abrasions that contact contaminated water and soil, where the bacteria can survive for months.

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Humans can also contract the illness through contaminated food; however, the county health agency has found no known health risks to the general public, including through the contact or consumption of caneberries such as raspberries and blackberries.

Symptom onset typically occurs between two and 30 days after exposure, and symptoms can last for months if untreated, according to the CDC.

The illness often begins with mild symptoms, with fevers, chills, vomiting and headaches. Some cases can then enter a second, more severe phase that can result in kidney or liver failure.

Ventura County Public Health recommends agriculture and berry harvesters regularly rinse any cuts with soap and water and cover them with bandages. They also recommend wearing waterproof clothing and protection while working outdoors, including gloves and long-sleeve shirts and pants.

While there is no evidence of spread to the larger community, according to the department, residents should wash hands frequently and work to control rodents around their property if possible.

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Pet owners can consult a veterinarian about leptospirosis vaccinations and should keep pets away from ponds, lakes and other natural bodies of water.

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Political stress: Can you stay engaged without sacrificing your mental health?

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Political stress: Can you stay engaged without sacrificing your mental health?

It’s been two weeks since Donald Trump won the presidential election, but Stacey Lamirand’s brain hasn’t stopped churning.

“I still think about the election all the time,” said the 60-year-old Bay Area resident, who wanted a Kamala Harris victory so badly that she flew to Pennsylvania and knocked on voters’ doors in the final days of the campaign. “I honestly don’t know what to do about that.”

Neither do the psychologists and political scientists who have been tracking the country’s slide toward toxic levels of partisanship.

Fully 69% of U.S. adults found the presidential election a significant source of stress in their lives, the American Psychological Assn. said in its latest Stress in America report.

The distress was present across the political spectrum, with 80% of Republicans, 79% of Democrats and 73% of independents surveyed saying they were stressed about the country’s future.

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That’s unhealthy for the body politic — and for voters themselves. Stress can cause muscle tension, headaches, sleep problems and loss of appetite. Chronic stress can inflict more serious damage to the immune system and make people more vulnerable to heart attacks, strokes, diabetes, infertility, clinical anxiety, depression and other ailments.

In most circumstances, the sound medical advice is to disengage from the source of stress, therapists said. But when stress is coming from politics, that prescription pits the health of the individual against the health of the nation.

“I’m worried about people totally withdrawing from politics because it’s unpleasant,” said Aaron Weinschenk, a political scientist at the University of Wisconsin–Green Bay who studies political behavior and elections. “We don’t want them to do that. But we also don’t want them to feel sick.”

Modern life is full of stressors of all kinds: paying bills, pleasing difficult bosses, getting along with frenemies, caring for children or aging parents (or both).

The stress that stems from politics isn’t fundamentally different from other kinds of stress. What’s unique about it is the way it encompasses and enhances other sources of stress, said Brett Ford, a social psychologist at the University of Toronto who studies the link between emotions and political engagement.

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For instance, she said, elections have the potential to make everyday stressors like money and health concerns more difficult to manage as candidates debate policies that could raise the price of gas or cut off access to certain kinds of medical care.

Layered on top of that is the fact that political disagreements have morphed into moral conflicts that are perceived as pitting good against evil.

“When someone comes into power who is not on the same page as you morally, that can hit very deeply,” Ford said.

Partisanship and polarization have raised the stakes as well. Voters who feel a strong connection to a political party become more invested in its success. That can make a loss at the ballot box feel like a personal defeat, she said.

There’s also the fact that we have limited control over the outcome of an election. A patient with heart disease can improve their prognosis by taking medicine, changing their diet, getting more exercise or quitting smoking. But a person with political stress is largely at the mercy of others.

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“Politics is many forms of stress all rolled into one,” Ford said.

Weinschenk observed this firsthand the day after the election.

“I could feel it when I went into my classroom,” said the professor, whose research has found that people with political anxiety aren’t necessarily anxious in general. “I have a student who’s transgender and a couple of students who are gay. Their emotional state was so closed down.”

That’s almost to be expected in a place like Wisconsin, whose swing-state status caused residents to be bombarded with political messages. The more campaign ads a person is exposed to, the greater the risk of being diagnosed with anxiety, depression or another psychological ailment, according to a 2022 study in the journal PLOS One.

Political messages seem designed to keep voters “emotionally on edge,” said Vaile Wright, a licensed psychologist in Villa Park, Ill., and a member of the APA’s Stress in America team.

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“It encourages emotion to drive our decision-making behavior, as opposed to logic,” Wright said. “When we’re really emotionally stimulated, it makes it so much more challenging to have civil conversation. For politicians, I think that’s powerful, because emotions can be very easily manipulated.”

Making voters feel anxious is a tried-and-true way to grab their attention, said Christopher Ojeda, a political scientist at UC Merced who studies mental health and politics.

“Feelings of anxiety can be mobilizing, definitely,” he said. “That’s why politicians make fear appeals — they want people to get engaged.”

On the other hand, “feelings of depression are demobilizing and take you out of the political system,” said Ojeda, author of “The Sad Citizen: How Politics is Depressing and Why it Matters.”

“What [these feelings] can tell you is, ‘Things aren’t going the way I want them to. Maybe I need to step back,’” he said.

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Genessa Krasnow has been seeing a lot of that since the election.

The Seattle entrepreneur, who also campaigned for Harris, said it grates on her to see people laughing in restaurants “as if nothing had happened.” At a recent book club meeting, her fellow group members were willing to let her vent about politics for five minutes, but they weren’t interested in discussing ways they could counteract the incoming president.

“They’re in a state of disengagement,” said Krasnow, who is 56. She, meanwhile, is looking for new ways to reach young voters.

“I am exhausted. I am so sad,” she said. “But I don’t believe that disengaging is the answer.”

That’s the fundamental trade-off, Ojeda said, and there’s no one-size-fits-all solution.

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“Everyone has to make a decision about how much engagement they can tolerate without undermining their psychological well-being,” he said.

Lamirand took steps to protect her mental health by cutting social media ties with people whose values aren’t aligned with hers. But she will remain politically active and expects to volunteer for phone-banking duty soon.

“Doing something is the only thing that allows me to feel better,” Lamirand said. “It allows me to feel some level of control.”

Ideally, Ford said, people would not have to choose between being politically active and preserving their mental health. She is investigating ways to help people feel hopeful, inspired and compassionate about political challenges, since these emotions can motivate action without triggering stress and anxiety.

“We want to counteract this pattern where the more involved you are, the worse you are,” Ford said.

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The benefits would be felt across the political spectrum. In the APA survey, similar shares of Democrats, Republicans and independents agreed with statements like, “It causes me stress that politicians aren’t talking about the things that are most important to me,” and, “The political climate has caused strain between my family members and me.”

“Both sides are very invested in this country, and that is a good thing,” Wright said. “Antipathy and hopelessness really doesn’t serve us in the long run.”

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Video: SpaceX Unable to Recover Booster Stage During Sixth Test Flight

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Video: SpaceX Unable to Recover Booster Stage During Sixth Test Flight

President-elect Donald Trump joined Elon Musk in Texas and watched the launch from a nearby location on Tuesday. While the Starship’s giant booster stage was unable to repeat a “chopsticks” landing, the vehicle’s upper stage successfully splashed down in the Indian Ocean.

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