WEST CHESTER, Pa. — Disinformation has long been a feature of American politics. Mudslinging, smear campaigns, dirty tricks. Yet wading through the muck ahead of this year’s midterm elections in one fiercely contested state, Pennsylvania, shows just how thoroughly it now warps the American democratic process.
In July, a tweet made the rounds spreading a falsehood about voting. “BREAKING: Pennsylvania will not be accepting mail-in ballots,” declared someone using an account called the Donald J. Trump Tracker.
In September, mysterious letters began arriving in mailboxes in Chester County, on the old Main Line west of Philadelphia, falsely telling people that their votes might not have been counted in the last election.
No, the Democratic candidate for United States Senate, Lt. Gov. John Fetterman, does not have tattoos of the Crips, the notorious street gang from Los Angeles, as Newt Gingrich said on Fox.
contentious primaries, Pennsylvanians have experienced a deluge of false or misleading posts, photographs and videos on social media, as well as increasingly partisan, bitter and at times unhinged claims on television, radio and live streams to a degree that no one recalled seeing before.
“I’m not saying the politics was ever, you know, perfect,” Michael Nutter, the mayor of Philadelphia from 2008 to 2016, said in an interview, lamenting the seemingly bottomless depth of the problem.
“I think what’s changed is you go back 100 years and you’d have had to put a whole lot more effort into spreading lies,” he said. “Now, you can just push a button.”
A lot of attention has focused on a stroke that Mr. Fetterman suffered in May, just as he clinched the Democratic nomination. The stroke left him with an auditory processing disorder, a condition that affects the brain’s ability to filter and interpret sounds, which Republicans have said makes him unfit for office. His speech has also become more halting, and he stumbles over his words, as he did multiple times in the debate last week against his Republican opponent, Mehmet Oz, the television personality known as Dr. Oz.
Opponents used his verbal gaffes in misleading ways. A video montage by a Republican campaign operative, Greg Price, exaggerated the effects of the stroke, while a Twitter account impersonating BuzzFeed falsely claimed that Mr. Fetterman had apologized for urinating on a campaign staffer. Mr. Price did not respond to requests for comment.
Other false claims have, again, questioned the machines that count votes, while a recent flurry of posts on Telegram, the app created in Russia, have incorrectly accused the state’s top election official of not complying with legal rulings about mail-in ballots. ActiveFence, a cybersecurity company, said that these claims have spread across platforms, garnering tens of thousands of impressions.
Jill Greene, the state representative for Common Cause, the national good-government organization, said that the many unfounded and untruthful claims posed a challenge for voters.
pledged to remove or marginalize false posts ahead of the midterms.
A doctored post on Facebook, to cite one of scores of examples, showed Mr. Oz kneeling to kiss the star of Donald J. Trump along the Hollywood Walk of Fame. (In the original, he was kissing his own star.)
being repeatedly told that the American election process is deeply corrupted.
In fact, Mr. Mastriano’s candidacy has from its inception been propelled by his role in disputing the 2020 presidential election lost by Mr. Trump.
county by county, but election experts say they do not reflect factors as benign as changes in addresses.
“They’re in search of solutions to a problem that doesn’t exist,” Kyle Miller, a Navy veteran and state representative for Protect Democracy, a national advocacy organization, said in an interview in Harrisburg. “They are basing this on faulty data and internet rumors.”
Some Republican lawmakers have leaned on false claims to call for changes to rules about mail-in ballots and other measures intended to make it easier for people to vote. Several counties have already reversed some of the decisions, including the number and location of drop boxes for ballots.
Mr. Miller, among others, warned that the flurry of false claims about balloting could be a trial run for challenging the results of the presidential election in 2024, in which Pennsylvania could again be a crucial swing state.
In Chester County, a largely white region that borders Delaware and Maryland that is roughly split between Republicans and Democrats, the effort to sow confusion came the old-fashioned way: in the mail.
Letters dated Sept. 12 began arriving in mailboxes across the county, warning people that their votes in the 2020 presidential election might not have counted. “Because you have a track record of consistently voting, we find it unusual that your record indicates that you did not vote,” the letter, which was unsigned, said.
The sender called itself “Data Insights,” based in the county seat of West Chester, though no known record of such a company exists, according to county officials. The letters did include copies of the recipients’ voting records. The letters urged recipients to write to the county commissioners or attend the commission’s meetings in the county seat of West Chester, in September and October. Dozens of recipients did.
The county administrator, Robert J. Kagel, tried to assure them that their votes were actually counted. He urged anyone concerned to contact the county’s voter services department.
Even so, at county meetings in September and October, speaker after speaker lined up to question the letter and the ballot process generally — and to air an array of grievances and conspiracy theories.
They included the discredited claims of the film “2000 Mules” that operatives have been stuffing boxes for mail-in ballots. One attendee warned that votes were being tabulated by the Communist Party of China or the World Economic Forum.
“I don’t know where my vote is,” another resident, Barbara Ellis of Berwyn, told the commissioners in October. “I don’t know if it was manipulated in the machines, in another country.”
As of Oct. 20, 59 people in Chester County had contacted officials with concerns raised in the letter, but in each case, it was determined that the voters’ ballots had been cast and counted, said Rebecca Brain, a county spokesman.
Who exactly sent the letters remains a mystery, which only fuels more conspiracy theories.
“It seems very official,” Charlotte Valyo, the chairwoman of the Democratic Party in the county, said of the letter. She described it as part of “an ongoing, constant campaign to undermine the confidence in our voting system.” The county’s Republican Party did not respond to a request for comment.
Disinformation may not be the only cause of the deepening partisan chasm in the state — or the nation — but it has undoubtedly worsened it. The danger, Ms. Valyo warned, was discouraging voting by sowing distrust in the ability of election officials to tally the votes.
“People might think, ‘Why bother, if they’re that messed up?’”
On the morning of July 8, former President Donald J. Trump took to Truth Social, a social media platform he founded with people close to him, to claim that he had in fact won the 2020 presidential vote in Wisconsin, despite all evidence to the contrary.
Barely 8,000 people shared that missive on Truth Social, a far cry from the hundreds of thousands of responses his posts on Facebook and Twitter had regularly generated before those services suspended his megaphones after the deadly riot on Capitol Hill on Jan. 6, 2021.
And yet Mr. Trump’s baseless claim pulsed through the public consciousness anyway. It jumped from his app to other social media platforms — not to mention podcasts, talk radio or television.
Within 48 hours of Mr. Trump’s post, more than one million people saw his claim on at least dozen other media. It appeared on Facebook and Twitter, from which he has been banished, but also YouTube, Gab, Parler and Telegram, according to an analysis by The New York Times.
gone mainstream among Republican Party members, driving state and county officials to impose new restrictions on casting ballots, often based on mere conspiracy theories percolating in right-wing media.
Voters must now sift through not only an ever-growing torrent of lies and falsehoods about candidates and their policies, but also information on when and where to vote. Officials appointed or elected in the name of fighting voter fraud have put themselves in the position to refuse to certify outcomes that are not to their liking.
a primary battleground in today’s fight against disinformation. A report last month by NewsGuard, an organization that tracks the problem online, showed that nearly 20 percent of videos presented as search results on TikTok contained false or misleading information on topics such as school shootings and Russia’s war in Ukraine.
continued to amplify “election denialism” in ways that undermined trust in the democratic system.
Another challenge is the proliferation of alternative platforms for those falsehoods and even more extreme views.
new survey by the Pew Research Center found that 15 percent of prominent accounts on those seven platforms had previously been banished from others like Twitter and Facebook.
F.B.I. raid on Mar-a-Lago thrust his latest pronouncements into the eye of the political storm once again.
study of Truth Social by Media Matters for America, a left-leaning media monitoring group, examined how the platform had become a home for some of the most fringe conspiracy theories. Mr. Trump, who began posting on the platform in April, has increasingly amplified content from QAnon, the online conspiracy theory.
He has shared posts from QAnon accounts more than 130 times. QAnon believers promote a vast and complex conspiracy that centers on Mr. Trump as a leader battling a cabal of Democratic Party pedophiles. Echoes of such views reverberated through Republican election campaigns across the country during this year’s primaries.
Ms. Jankowicz, the disinformation expert, said the nation’s social and political divisions had churned the waves of disinformation.
The controversies over how best to respond to the Covid-19 pandemic deepened distrust of government and medical experts, especially among conservatives. Mr. Trump’s refusal to accept the outcome of the 2020 election led to, but did not end with, the Capitol Hill violence.
“They should have brought us together,” Ms. Jankowicz said, referring to the pandemic and the riots. “I thought perhaps they could be kind of this convening power, but they were not.”
“We’re getting more and more older people who lived through this experiment with do-it-yourself pensions, and they’re coming into this age group without the same kind of incomes that older people have,” said Teresa Ghilarducci, an economics professor at the New School who specializes in retirement policy. “I don’t think it’s a blip.”
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Even though the share of elderly people officially below the poverty line is low by historical standards in the United States, it remains among the highest in the developed world, according to the Organization for Economic Cooperation and Development. The average poverty rate for older Americans also masks far higher shares among more vulnerable groups, with nearly one in five Black and Hispanic women 65 or older falling below the official poverty threshold in 2021. It’s higher for single people, too — a reality forced on hundreds of thousands of older Americans whose spouses died of Covid-19.
The poverty rate is also not a bright line when it comes to financial hardship. It doesn’t take into account debt, which more seniors have accumulated since the Great Recession. Moreover, nearly one in four people 65 or older make less than 150 percent of the federal poverty line, or $19,494 on average for those living alone. Another measure, developed by the Gerontology Institute at the University of Massachusetts Boston and called the Elder Index, finds that it takes $22,476 for a single older person in good health with no mortgage to cover basic needs, with the cost escalating for renters and those with health problems.
“To some extent we’re splitting hairs when we talk about people who fall just above and just below, because they’re all struggling,” said Jan Mutchler, a demographer at the University of Massachusetts at Boston who helped devise the Elder Index. “The assumptions that go into what we’re calling hardship are just flawed.”
That’s true for Juanita Brown, 77, who lives on her own in Galax, a small town in Virginia’s Blue Ridge Mountains. A farmer’s daughter, she worked as a nanny, and then a certified nursing assistant, and then a preschool teacher. Her husband worked in the local textile industry, and after raising two children, they had built a substantial nest egg.
But then Ms. Brown’s mother developed Alzheimer’s disease and couldn’t support herself. Ms. Brown stopped working to take care of her, which cost another $500 per month in expenses. Her husband got prostate cancer, which required extended trips to the hospital in Winston-Salem, N.C.
The average household in Ghana is paying two-thirds more than it did last year for diesel, flour and other necessities. In Egypt, wheat is so expensive that the government has fallen half a billion dollars short of its budget for a bread subsidy it provides to its citizens. And Sri Lanka, already struggling to control a political crisis, is running out of fuel, food and medical supplies.
A strong dollar is making the problems worse.
Compared with other currencies, the U.S. dollar is the strongest it has been in two decades. It is rising because the Federal Reserve has increased interest rates sharply to combat inflation and because America’s economic health is better than most. Together, these factors have attracted investors from all over the world. Sometimes they simply buy dollars, but even if investors buy other assets, like government bonds, they need dollars to do so — in each case pushing up the currency’s value.
That strength has become much of the world’s weakness. The dollar is the de facto currency for global trade, and its steep rise is squeezing dozens of lower-income nations, chiefly those that rely heavily on imports of food and oil and borrow in dollars to fund them.
But much of the damage is already behind us.
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“We are in a fragile situation,” Mr. El-Erian said. “Country after country is flashing amber, and some are already flashing red.”
Many lower-income countries were already struggling during the pandemic.
Roughly 22 million people in Ghana, or a third of its population, reported a decline in their income between April 2020 and May 2021, according to a survey from the World Bank and Unicef. Adults in almost half of the households with children surveyed said they were skipping a meal because they didn’t have enough money. Almost three-quarters said the prices of major food items had increased.
Then came Russia’s invasion of Ukraine. The war between two of the world’s largest exporters of food and energy led to a big surge in prices, especially for importers like Ghana. Consumer prices have gone up 30 percent for the year through June, according to data from the research firm Moody’s Analytics. For household essentials, annual inflation has reached 60 percent or more this year, the S&P data shows.
To illustrate this, consider the price of a barrel of oil in dollars versus the Ghanaian cedi. At the beginning of October last year, the price of oil stood at $78.52 per barrel, rising to nearly $130 per barrel in March before falling back to $87.96 at the beginning of this month, a one-year increase of 12 percent in dollar terms. Over the same period, the Ghanaian cedi has weakened over 40 percent against the dollar, meaning that the same barrel of oil that cost roughly 475 cedi a year ago now costs over 900 cedi, almost twice as much.
Adding to the problem are large state-funded subsidies, some taken on or increased through the pandemic, that are now weighing on government finances.
Ghana’s president cut fuel taxes in November 2021, losing roughly $22 million in projected revenue for the government — the latest available numbers.
In Egypt, spending on what the government refers to as “supply commodities,” almost all of which is wheat for its long-running bread subsidy, is expected to come in at around 7 percent of all government spending this year, 12 percent higher — or more than half a billion dollars — than the government budgeted.
As costs ballooned throughout the pandemic, governments took on more debt. Ghana’s public debt grew to nearly $60 billion from roughly $40 billion at the end of 2019, or to nearly 80 percent of its gross domestic product from around 63 percent, according to Moody’s.
It’s one of four countries listed by S&P, alongside Pakistan, Nigeria and Sri Lanka, where interest payments alone account for more than half of the government’s revenues.
“We can’t forget that this is happening on the back end of a once-in-a-century pandemic in which governments, to try and support families as best they could, did borrow more,” said Frank Gill, an analyst at S&P. “This is a shock following up on another shock.”
In May, Sri Lanka defaulted on its government debt for the first time in its history. Over the past month, the governments of Egypt, Pakistan and Ghana have all reached out to the International Monetary Fund for a bailout as they struggle to meet their debt financing needs, no longer able to turn to international investors for more money.
“I don’t think there is a lot of appetite to lend money to some of these countries,” said Brian Weinstein, co-head of credit trading at Bank of America. “They are incredibly vulnerable at the moment.”
That vulnerability is already reflected in the bond market.
In 2016, Ghana borrowed $1 billion for 10 years, paying an interest rate of just over 8 percent. As the country’s financial position has worsened and investors have backed away, the yield — indicative of what it would now cost Ghana to borrow money until 2026 — has risen to above 35 percent.
It’s an untenable cost of debt for a country in Ghana’s situation. And Ghana is not alone. For bonds that also mature in 2026, yields for Pakistan have reached almost 40 percent.
“We have concerns where any country has yields that calls into question their ability to refinance in public markets,” said Charles Cohen, deputy division chief of monetary and capital market departments at IMF.
The risk of a sovereign debt crisis in some emerging markets is “very, very high,” said Jesse Rogers, an economist at Moody’s Analytics. Mr. Rogers likened the current situation to the debt crises that crushed Latin America in the 1980s — the last time the Fed sought to quell soaring inflation.
Already this year, more than $80 billion has been withdrawn from mutual funds and exchange-traded funds — two popular types of investment products — that buy emerging market bonds, according to EPFR Global, a data provider. As investors sell, the United States is often the beneficiary, further strengthening the dollar.
“It’s by far the worst year for outflows the market has ever seen,” said Pramol Dhawan, head of emerging markets at Pimco.
Even citizens in some of these countries are trying to exchange their money for dollars, fearful of what’s to come and of further currency depreciation — yet inadvertently also contributing to it.
“For pockets of emerging markets, this is a really challenging backdrop and one of the most challenging backdrops we have faced for many years,” Mr. Dhawan said.
LOUGHTON, England — After nearly two decades of renting in one of the world’s most expensive cities, the Szostek family began the week almost certain that they would finally own a home.
Transplants to London who fell in love as housemates, Laetitia Anne, an operations manager from France and her husband, Maciej Szostek, a chef from Poland, had long dreamed of being homeowners. They had waited out the uncertain pandemic years and worked overtime shifts to save up for the deposit for a mortgage on a three-bedroom apartment in a neighborhood outside London. Their 13-year-old twins were excited they could finally paint the walls.
That was before British financial markets were upended, with the pound briefly hitting a record low against the dollar on Monday and interest rates soaring so rapidly that the Bank of England was forced to intervene to restore order. The economic situation was so volatile that some mortgage lenders temporarily withdrew many products.
By Tuesday evening, the Szostek family learned the bad news: The loan that they were close to securing had fallen through. Suddenly, they were scrambling to find another lender as interest rates climb higher.
loss of purchasing power over time, meaning your dollar will not go as far tomorrow as it did today. It is typically expressed as the annual change in prices for everyday goods and services such as food, furniture, apparel, transportation and toys.
What causes inflation? It can be the result of rising consumer demand. But inflation can also rise and fall based on developments that have little to do with economic conditions, such as limited oil production and supply chain problems.
Is inflation bad? It depends on the circumstances. Fast price increases spell trouble, but moderate price gains can lead to higher wages and job growth.
Can inflation affect the stock market? Rapid inflation typically spells trouble for stocks. Financial assets in general have historically fared badly during inflation booms, while tangible assets like houses have held their value better.
Rising home prices and income inequality priced many out of the market, but for strivers who aspired to homeownership, the latest ruptures to the economy hit hard. The release of the new government’s sweeping plan for debt-funded tax cuts led to a big uptick in interest rates this week that roiled the mortgage market. Many homeowners are calculating their potential future mortgage payments with alarm, amid soaring energy and food prices and a general cost-of-living crisis.
Before they were informed they were no longer eligible, the family had been in the final stages of applying for a five-year fixed-rate mortgage on an apartment priced at £519,000, or around $576,000, in the leafy parish of Loughton, a town about 40 minutes north of London by train where the streets fill with students in the afternoon and the properties span from lower-end apartments to million-pound mansions.
according to the Financial Conduct Authority. And more than a third of all mortgages are on fixed rates that expire within the next two years, most likely exposing those borrowers to higher rates, too. By contrast, the vast majority of mortgages in the United States are locked in for 30-year fixed terms.
And the abrupt surge in interest rates could threaten to set off a housing market crisis, analysts at Oxford Economics wrote in a note on Friday, adding that if mortgage rates stayed at the levels now being offered, that would suggest that house prices were around 30 percent overvalued “based on the affordability of mortgage payment.”
“This just adds a significant further strain to finances in the order of hundreds of pounds a month,” said David Sturrock, a senior research economist at the Institute for Fiscal Studies, adding that the squeeze on household budgets will affect the broader economy.
Uncertainty and even panic was clear this week, with many homeowners seeking financial advice. Mortgage brokers said they were receiving a higher volume of inquiries than normal from people stressed about refinancing their loans.
“You can feel the fear in people’s voices,” said Caroline Opie, a mortgage broker working with Ms. Anne who said she had not seen this level of worry in a long time. One couple this week even called her the morning of their wedding, she said, to set an appointment to refinance their mortgage next week.
the war in Ukraine. “Something has got to give,” he said. “Prices are too high anyway.”
To save for the deposit, Mr. Szostek, 37, picked up construction shifts and cleaning jobs when restaurants closed during Covid-19 lockdowns. A £5,000 inheritance from Ms. Anne’s grandfather went into their deposit fund. At a 3.99 percent interest rate, the mortgage repayments were set to be about £2,200 a month.
“I wanted to feel at home for real,” said Ms. Anne, adding she would have been the first in her family to own a property. Mr. Szostek called it “a lifelong dream.”
On Wednesday night, that dream still seemed in reach: The mortgage dealer Ms. Opie had found another loan, which they rushed to apply for.
The higher interest rate — 4.6 percent — will mean their new monthly mortgage payment will be £2,400, the upper limit of what the Szostek family can afford. Still, they felt lucky to secure anything at all, hoping it will mean their promises to their children — of bigger bedrooms, more space, freedom to decorate how they like — will materialize.
They would wait to celebrate, Mr. Szostek said, until they had the keys in hand.
LAGOS, Portugal — The Bam Bam Beach Bitcoin bar, on an uncrowded beach in southwestern Portugal, is the meeting place.
To get there, you drive past a boat harbor, oceanside hotels and apartment buildings, then park near a sleepy seafood restaurant and walk down a wooden path that cuts through a sand dune. Yellow Bitcoin flags blow in the wind. The conversations about cryptocurrencies and a decentralized future flow.
“People always doubt when to buy, when to sell,” said Didi Taihuttu, a Dutch investor who moved to town this summer and is one of Bam Bam’s owners. “We solve that by being all in.”
melted down, and crypto companies like the experimental bank Celsius Network declared bankruptcy as fears over the global economy yanked down values of the risky assets. Thousands of investors were hurt by the crash. The price of Bitcoin, which peaked at more than $68,000 last year, remains off by more than 70 percent.
But in this Portuguese seaside idyll, confidence in cryptocurrencies is undimmed. Every Friday, 20 or so visitors from Europe and beyond gather at Bam Bam to share their unwavering faith in digital currencies. Their buoyancy and cheer endure across Portugal and in other crypto hubs around the world, such as Puerto Rico and Cyprus.
In beach towns like Ericeira and Lagos, shops and restaurants show their acceptance of digital currencies by taking Bitcoin as payment. Lisbon, the capital, has become a hub for crypto-related start-ups such as Utrust, a cryptocurrency payment platform, and Immunefi, a company that identifies security vulnerabilities in decentralized networks.
“Portugal should be the Silicon Valley of Bitcoin,” Mr. Taihuttu said. “It has all the ingredients.”
news outlets covered his family’s story, Mr. Taihuttu’s social media following swelled, turning him into an influencer and a source of investment advice. A documentary film crew has followed him on and off for the past 18 months. This summer, he settled in Portugal and quickly became something of an ambassador for its crypto scene.
He has goals to turn Meia Praia, the beach where Bam Bam is located, into “Bitcoin Beach.” He is shopping for property to create a community nearby for fellow believers.
“You prove that it is possible to run some part of the world, even if it’s just one,” said Mr. Taihuttu, with a Jack Daniel’s and Coke in hand. He has shoulder-length black hair and wore a tank top that showcased his tan and tattoos (including one on his forearm of the Bitcoin symbol).
Ms. Bestandig was among those who Mr. Taihuttu drew to Portugal.
collapse of Mt. Gox, a Tokyo-based virtual currency exchange that declared bankruptcy in 2014 after huge, unexplained losses of Bitcoin.
If cryptocurrency prices do not recover, “a lot of them will have to go back to work again,” Clinton Donnelly, an American tax lawyer specializing in cryptocurrencies, said of some of those gathered at Bam Bam.
Even so, Mr. Donnelly and other bar regulars said their belief in crypto remained unshaken.
Thomas Roessler, wearing a black Bitcoin shirt and drinking a beer “inspired by” the currency, said he had come with his wife and two young children to decide whether to move to Portugal from Germany. He first invested in Bitcoin in 2014 and, more recently, sold a small rental apartment in Germany to invest even more.
Mr. Roessler was concerned about the drop in crypto values but said he was convinced the market would rebound. Moving to Portugal could lower his taxes and give his family the chance to buy affordable property in a warm climate, he said. They had come to the bar to learn from others who had made the move.
“We have not met a lot of people who live this way,” Mr. Roessler said. Then he bought another round of drinks and paid for them with Bitcoin.
RICHMOND, Va. — In late July, Norman Otey was rushed by ambulance to Richmond Community Hospital. The 63-year-old was doubled over in pain and babbling incoherently. Blood tests suggested septic shock, a grave emergency that required the resources and expertise of an intensive care unit.
But Richmond Community, a struggling hospital in a predominantly Black neighborhood, had closed its I.C.U. in 2017.
It took several hours for Mr. Otey to be transported to another hospital, according to his sister, Linda Jones-Smith. He deteriorated on the way there, and later died of sepsis. Two people who cared for Mr. Otey said the delay had most likely contributed to his death.
the hospital’s financial data.
More than half of all hospitals in the United States are set up as nonprofits, a designation that allows them to make money but avoid paying taxes. Although Bon Secours has taken a financial hit this year like many other hospital systems, the chain made nearly $1 billion in profit last year at its 50 hospitals in the United States and Ireland and was sitting on more than $9 billion in cash reserves. It avoids at least $440 million in federal, state and local taxes every year that it would otherwise have to pay, according to an analysis by the Lown Institute, a nonpartisan think tank.
In exchange for the tax breaks, the Internal Revenue Service requires nonprofit hospitals to provide a benefit to their communities. But an investigation by The New York Times found that many of the country’s largest nonprofit hospital systems have drifted far from their charitable roots. The hospitals operate like for-profit companies, fixating on revenue targets and expansions into affluent suburbs.
borrowing tricks from business consultants, have trained staff to squeeze payments from poor patients who should be eligible for free care.
John M. Starcher Jr., made about $6 million in 2020, according to the most recent tax filings.
“Our mission is clear — to extend the compassionate ministry of Jesus by improving the health and well-being of our communities and bring good help to those in need, especially people who are poor, dying and underserved,” the spokeswoman, Maureen Richmond, said. Bon Secours did not comment on Mr. Otey’s case.
In interviews, doctors, nurses and former executives said the hospital had been given short shrift, and pointed to a decade-old development deal with the city of Richmond as another example.
In 2012, the city agreed to lease land to Bon Secours at far below market value on the condition that the chain expand Richmond Community’s facilities. Instead, Bon Secours focused on building a luxury apartment and office complex. The hospital system waited a decade to build the promised medical offices next to Richmond Community, breaking ground only this year.
‘Glorified Emergency Room’
founded in 1907 by Black doctors who were not allowed to work at the white hospitals across town. In the 1930s, Dr. Jackson’s grandfather, Dr. Isaiah Jackson, mortgaged his house to help pay for an expansion of the hospital. His father, also a doctor, would take his children to the hospital’s fund-raising telethons.
Cassandra Newby-Alexander at Norfolk State University.
got its first supermarket.
according to research done by Virginia Commonwealth University. The public bus route to St. Mary’s, a large Bon Secours facility in the northwest part of the city, takes more than an hour. There is no public transportation from the East End to Memorial Regional, nine miles away.
“It became impossible for me to send people to the advanced heart valve clinic at St. Mary’s,” said Dr. Michael Kelly, a cardiologist who worked at Richmond Community until Bon Secours scaled back the specialty service in 2019. He said he had driven some patients to the clinic in his own car.
Richmond Community has the feel of an urgent-care clinic, with a small waiting room and a tan brick facade. The contrast with Bon Secours’s nearby hospitals is striking.
At the chain’s St. Francis Medical Center, an Italianate-style compound in a suburb 18 miles from Community, golf carts shuttle patients from the lobby entrance, past a marble fountain, to their cars.
after the section of the federal law that authorized it, allows hospitals to buy drugs from manufacturers at a discount — roughly half the average sales price. The hospitals are then allowed to charge patients’ insurers a much higher price for the same drugs.
The theory behind the law was that nonprofit hospitals would invest the savings in their communities. But the 340B program came with few rules. Hospitals did not have to disclose how much money they made from sales of the discounted drugs. And they were not required to use the revenues to help the underserved patients who qualified them for the program in the first place.
In 2019, more than 2,500 nonprofit and government-owned hospitals participated in the program, or more than half of all hospitals in the country, according to the independent Medicare Payment Advisory Commission.
in wealthier neighborhoods, where patients with generous private insurance could receive expensive drugs, but on paper make the clinics extensions of poor hospitals to take advantage of 340B.
to a price list that hospitals are required to publish. That is nearly $22,000 profit on a single vial. Adults need two vials per treatment course.
work has shown that hospitals participating in the 340B program have increasingly opened clinics in wealthier areas since the mid-2000s.
were unveiling a major economic deal that would bring $40 million to Richmond, add 200 jobs and keep the Washington team — now known as the Commanders — in the state for summer training.
The deal had three main parts. Bon Secours would get naming rights and help the team build a training camp and medical offices on a lot next to Richmond’s science museum.
The city would lease Bon Secours a prime piece of real estate that the chain had long coveted for $5,000 a year. The parcel was on the city’s west side, next to St. Mary’s, where Bon Secours wanted to build medical offices and a nursing school.
Finally, the nonprofit’s executives promised city leaders that they would build a 25,000-square-foot medical office building next to Richmond Community Hospital. Bon Secours also said it would hire 75 local workers and build a fitness center.
“It’s going to be a quick timetable, but I think we can accomplish it,” the mayor at the time, Dwight C. Jones, said at the news conference.
Today, physical therapy and doctors’ offices overlook the football field at the training center.
On the west side of Richmond, Bon Secours dropped its plans to build a nursing school. Instead, it worked with a real estate developer to build luxury apartments on the site, and delayed its plans to build medical offices. Residents at The Crest at Westhampton Commons, part of the $73 million project, can swim in a saltwater pool and work out on communal Peloton bicycles. On the ground floor, an upscale Mexican restaurant serves cucumber jalapeño margaritas and a Drybar offers salon blowouts.
have said they plan to house mental health, hospice and other services there.
a cardiologist and an expert on racial disparities in amputation, said many people in poor, nonwhite communities faced similar delays in getting the procedure. “I am not surprised by what’s transpired with this patient at all,” he said.
Because Ms. Scarborough does not drive, her nephew must take time off work every time she visits the vascular surgeon, whose office is 10 miles from her home. Richmond Community would have been a five-minute walk. Bon Secours did not comment on her case.
“They have good doctors over there,” Ms. Scarborough said of the neighborhood hospital. “But there does need to be more facilities and services over there for our community, for us.”
Canutillo Independent School District and Kingsville Independent School District try to get a handle on mental health care for students in need.
The old saying is “everything is bigger in Texas” — including its problems.
Mental health ranks atop.
In the wake of the Uvalde massacre, conservative politicians are waving away talk of gun control and stressing that mental health is the real culprit. And in boastful Texas, mental health is a big problem.
Mental Health America ranks Texas dead last in access to mental health care. The Kaiser Family Health Foundation found that Texans suffer depression at higher-than-average rates.
In data released by the Texas Education Agency, more than half of Lone Star schools don’t have a psychologist or access to telehealth.
Texas has also opted out of Medicaid expansion under the Affordable Care Act. In various studies, that amounts to tens of billions of dollars in federal funding, which could insure more than a million Texans and provide reimbursements for mental health professionals.
Canutillo Independent School District is north of El Paso, Texas. It’s like Uvalde, with a supermajority Hispanic population and a mental health desert. It’s chief concern is access for those services for its 6,200 students
“So, one of the things that is most important is social workers, counselors and prevention specialists working together,” social worker Rosario Olivera said.
The school district is Title I funded, meaning more than 40% of its students fall below the poverty line.
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Administrators grappled with various problems across 10 schools, like how to get students access to medical care and in a pandemic, access to mental health and more counselors.
“We do the best we can do to service children of highest need,” Olivera continued. “However, it’s the same thing as with counselors. The ratio is very high.”
In Canutillo, it meant a pilot program of bringing in social workers and social work interns from the University of Texas El Paso.
“For every campus that has 350 students, you need one counselor. The majority of our campuses have 500 and above,” Canutillo Independent School District Director of Student Support Services Monica Reyes said.
Another glaring indicator in mental health access is poverty.
“This is typically what you’ll see: A mobile home with six or seven family members in it,” said Francisco Mendez with Familia Triunfadores.
In the colonias of San Elizario, access to mental health is a question of whether there are any therapists close by. But oftentimes, the answer is no.
“It’s really difficult for them,” Mendez said. “They’ll have to drive at least 35 miles to El Paso.”
In Kingsville, Texas, the schools have one mental health professional for more than 2,800 students.
Tracy Warren is a licensed school specialist psychologist, or LSSP. She’s an intern completing her doctorate. The challenge for Kingsville Independent School District is holding on to her and getting more people like her.
“We are trying to let everybody know how important mental health is and that if we don’t have the mental health foundation, the education is not going to take place,” Warren said.
She is the front line. The school district leans on nonprofits to help kids outside of class.
“There are a lot more anxious students this year than I’ve ever seen,” Warren continued. “We actually had a student that was at one of our campuses — he’s 4, going into Pre-K. First day of school, he stopped outside to count the police cars that he can see to ensure that he was safe before he came into school.”
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The small school district’s leader, Superintendent Cissy Reynolds-Perez, says more mental health professionals and counselors need to be trained to work in rural schools.
“It’s very difficult because not everybody wants to come out to this area,” she said. “You know, you have your metropolitan areas, which I’m not saying it’s easier, but there are more resources there.”
At nearby Texas A&M Kingsville, the school has opened an institute for rural mental health.
Steve Bain is the director of the Rural Mental Health Institute. His goal is to create a mental health graduate student counselor pipeline direct to public schools.
“We have an opportunity now to reverse this trend of being last, or toward the last, in terms of accessibility of mental health services,” he said. “Only about 25% of students in K-12 who suffer from depression are getting mental health services. And depression has increased among our student population in the last five to eight years, significantly so.”
In Texas, licensed school specialty psychologists and social workers can be mental health caregivers to emotionally fraught kids, but there is a catch.
“Texas Education Agency has not recognized social workers as TEA employees yet, per se. We don’t have a specific job description, like teachers or counselors do,” Olivera said.
That means school districts miss out on funding and insurance reimbursements when social workers provide mental health care for kids.
Newsy’s mental health initiative “America’s Breakdown: Confronting Our Mental Health Crisis” brings you deeply personal and thoughtfully told stories on the state of mental health care in the U.S. Click here to learn more.
The ban replaced Indiana laws that prohibited abortions after the 20th week of pregnancy and restricted them after the 13th week.
An Indiana judge on Thursday blocked the state’s abortion ban from being enforced, putting the new law on hold as abortion clinic operators argue that it violates the state constitution.
Owen County Judge Kelsey Hanlon issued a preliminary injunction against the ban that took effect one week ago. The injunction was sought by abortion clinic operators who argued in a lawsuit that the state constitution protects access to the medical procedure.
The ban was approved by the state’s Republican-dominated Legislature on Aug. 5 and signed by GOP Gov. Eric Holcomb. That made Indiana the first state to enact tighter abortion restrictions since the U.S. Supreme Court eliminated federal abortion protections by overturning Roe v. Wade in June.
The judge wrote “there is reasonable likelihood that this significant restriction of personal autonomy offends the liberty guarantees of the Indiana Constitution” and that the clinics will prevail in the lawsuit. The order prevents the state from enforcing the ban pending a trial on the merits of the lawsuit.
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The state attorney general’s office and top Republican legislative leaders didn’t immediately comment on the order.
The ban, which includes limited exceptions, replaced Indiana laws that generally prohibited abortions after the 20th week of pregnancy and tightly restricted them after the 13th week.
The American Civil Liberties Union of Indiana, which is representing the abortion clinics, filed the lawsuit Aug. 31 and argued the ban would “prohibit the overwhelming majority of abortions in Indiana and, as such, will have a devastating and irreparable impact on the plaintiffs and, more importantly, their patients and clients.”
Ken Falk, the ACLU of Indiana’s legal director, pointed to the state constitution’s declaration of rights including “life, liberty and the pursuit of happiness” in arguing before the judge on Monday that it included a right to privacy and to make decisions on whether to have children.
The state attorney general’s office said the court should uphold the ban, calling arguments against it based on a “novel, unwritten, historically unsupported right to abortion” in the state constitution.
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“The constitutional text nowhere mentions abortion, and Indiana has prohibited or heavily regulated abortion by statute since 1835 — before, during, and after the time when the 1851 Indiana Constitution was drafted, debated, and ratified,” the office said in a court filing.
The Indiana abortion ban includes exceptions allowing abortions in cases of rape and incest, before 10 weeks post-fertilization; to protect the life and physical health of the pregnant person; and if a fetus is diagnosed with a lethal anomaly.
The new law also prohibited abortion clinics from providing any abortion care, leaving such services solely to hospitals or outpatient surgical centers owned by hospitals.
The lawsuit was filed in southern Indiana’s Monroe County, which includes the liberal-leaning city of Bloomington and Indiana University’s main campus, but two elected Democratic judges from that county declined to handle the case without stating any reasons.
Hanlon, a Republican from neighboring Owen County, accepted appointment as special judge. Hanlon, who was first elected as a judge in 2014, was among three finalists that the state Judicial Nominating Commission selected in July for appointment to the state appeals court, but the governor last week named a different judge to the position.
Parents are sharing their tragedies in hopes of reducing suicide in Colorado. It’s the No. 1 cause of death for kids and young adults in the state.
Vicky Goodwin says February 4, 2021, is the day her world changed forever.
“It was a Thursday morning. I got up, took my dog for a walk. I remember walking in,” she said. “Then, I walked down the hall to Jonathan’s room and opened the door, and he wasn’t in his bed, and I walked into his room and then I found him.”
Jonathan Goodwin was just 15.
“Jonathan was incredibly bright, funny, quirky, a wonderful friend. He was a twin. He and his brother were really close,” Goodwin continued.
But for reasons he kept hidden, Jonathan took his own life. His mom says nobody knows why.
“It doesn’t matter how it happens. It doesn’t matter if there were signs or if there weren’t signs,” Goodwin said. “It’s just, you know, losing a child is as bad as every parent thinks that it would be.”
In the U.S., the rate of young people dying by suicide increased nearly 60% between 2007 and 2018. Researchers say trends are especially alarming among Black youth.
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In Goodwin’s home state of Colorado, suicide is the No. 1 cause of death for kids and young adults.
COVID-19 turned life upside down. Teens — already under the usual adolescent pressures of life, school, social media— are now dealing with a year-and-a-half of chronic pandemic stress.
“I’ve never seen anything like this,” Children’s Hospital Colorado Clinical Child Psychologist Jenna Glover said. “I’ve never seen this number of children who need help in mental health services. And I’ve never seen this many kids be in acute crisis.”
It’s gotten so bad that in 2021, for the first time in its 117-year history, Children’s Hospital Colorado declared a “state of emergency” for youth mental health.
“We’re seeing lots of kids come in with depression and anxiety, really nervous about starting the school year,” Glover continued. “So, real sense of hopelessness and not knowing how to solve their problems other than, ‘I just got to get out of this.'”
Experts say the reasons behind the nationwide jump in teen suicide over the last decade are varied and hard to pin down. Social media, money or family problems, even fear of school shootings and worry about climate change can all add up.
Making it worse, says Glover, is a shortage of professional help.
“There are not enough mental health services,” she said. “Catching kids early on — screening them in pediatrician offices, screening them at school and when they have just the beginnings of symptoms, getting them into preventative programs, and doing immediate intervention, so they don’t show up at the emergency department — we just need more of that.”
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Short of professional help, experts say one of the most effective ways to prevent suicide is to talk about it.
“It is the most common myth that asking about suicide will increase it,” Glover said. “What we know is asking about suicide will absolutely decrease the risk of it and it keeps your kids safe.”
If teens are reluctant to talk to adults, the hope is they’ll talk to other teens.
Marin McKinney is a teen ambassador for a suicide prevention group called Robbie’s Hope, giving advice to other kids and adults, too.
“It’s OK to not be OK,” Marin said. “And a lot of us … we do go through bad days and tough situations. But there’s always someone out there who wants to listen and talk to you. … I would tell a parent to not overreact or overcomplicate the situation.”
Kari Eckert and her husband started Robbie’s Hope after losing their son in 2018.
Their home in Golden, Colorado, is now headquarters for an all-out effort to get kids and adults help to prevent suicide. They do everything from producing free guides on how to talk about it to lobbying state lawmakers for new laws. Several states, including Colorado, now allow teens to miss school to take a mental health day.
“Just really really good tips and it’s written by teens. … Kids bring this to the table and say, ‘It’s important to me. I shouldn’t have to lie about why I can’t be in school today,'” Eckert said. “We aren’t just about saying that teen suicide is a problem. We want to bring resources to this … We want to reduce teen suicide rates by 50% by 2028. That’s a big goal.”
For now, Goodwin is taking things day by day, hoping that being open about her tragedy helps other parents to not feel so alone.
“I guess focusing on something positive, focusing on the gift that we have — the gift that we had — with him makes the hard days a lot easier,” she said. “Secrets are toxic. And we felt that the only way that we could make losing a child worse is by passing that burden on to our other children, and being open and choosing to talk about it has been, I think, good for all of us. We just want to help one family.”
Newsy’s mental health initiative “America’s Breakdown: Confronting Our Mental Health Crisis” brings you deeply personal and thoughtfully told stories on the state of mental health care in the U.S. Click here to learn more.