“Remote work and remote-work options are something that our community has been advocating for for decades, and it’s a little frustrating that for decades corporate America was saying it’s too complicated, we’ll lose productivity, and now suddenly it’s like, sure, let’s do it,” said Charles-Edouard Catherine, director of corporate and government relations for the National Organization on Disability.
Still, he said the shift is a welcome one. For Mr. Catherine, who is blind, not needing to commute to work means not coming home with cuts on his forehead and bruises on his leg. And for people with more serious mobility limitations, remote work is the only option.
Many employers are now scaling back remote work and are encouraging or requiring employees to return to the office. But experts expect remote and hybrid work to remain much more common and more widely accepted than it was before the pandemic. That may make it easier for disabled employees to continue to work remotely.
The pandemic may also reshape the legal landscape. In the past, employers often resisted offering remote work as an accommodation to disabled workers, and judges rarely required them to do so. But that may change now that so many companies were able to adapt to remote work in 2020, said Arlene S. Kanter, director of the Disability Law and Policy Program at the Syracuse University law school.
“If other people can show that they can perform their work well at home, as they did during Covid, then people with disabilities, as a matter of accommodation, shouldn’t be denied that right,” Ms. Kanter said.
Ms. Kanter and other experts caution that not all people with disabilities want to work remotely. And many jobs cannot be done from home. A disproportionate share of workers with disabilities are employed in retail and other industries where remote work is uncommon. Despite recent gains, people with disabilities are still far less likely to have jobs, and more likely to live in poverty, than people without them.
“When we say it’s historically high, that’s absolutely true, but we don’t want to send the wrong message and give ourselves a pat on the back,” Mr. Catherine said. “Because we’re still twice as likely to be unemployed and we’re still underpaid when we’re lucky enough to be employed.”
“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 Federal Reserve has embarked on an aggressive campaign to raise interest rates as it tries to tame the most rapid inflation in decades, an effort the central bank sees as necessary to restore price stability in the United States.
But what the Fed does at home reverberates across the globe, and its actions are raising the risks of a global recession while causing economic and financial pain in many developing countries.
Other central banks in advanced economies, from Australia to the eurozone, are also lifting rates rapidly to fight their inflation. And as the Fed’s higher interest rates attract money to the United States — pumping up the value of the dollar — emerging-market economies are being forced to raise their own borrowing costs to try to stabilize their currencies to the extent possible.
Altogether, it is a worldwide push toward more expensive money unlike anything seen before in the 21st century, one that is likely to have serious ramifications.
warned the damage could be particularly acute in poorer nations. Developing economies had already been dealing with a cost-of-living crisis because of soaring food and fuel prices, and now their American imports are growing steadily more expensive as the dollar marches higher.
The Fed’s moves have spurred market volatility and worries about financial stability, as higher rates elevate the value of the U.S. dollar, making it harder for emerging-market borrowers to pay back their dollar-denominated debt.
It is a recipe for globe-spanning turmoil and even recession. Despite that, the Fed is poised to continue raising interest rates. That’s because the Fed, like central banks around the world, is in charge of domestic economy goals: It’s supposed to keep inflation slow and steady while fostering maximum employment. While occasionally called “central banker to the world” because of the dollar’s foremost position, the Fed goes about its day-to-day business with its eye squarely on America.
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.
The threat facing the global economy — including the Fed’s role in it — is expected to dominate the conversation next week as economists and government officials convene in Washington for the annual meeting of the International Monetary Fund and World Bank.
In a speech at Georgetown University on Thursday, Kristalina Georgieva, the managing director of the I.M.F., offered a grim assessment of the world economy and the tightrope that central banks are walking.
“Not tightening enough would cause inflation to become de-anchored and entrenched — which would require future interest rates to be much higher and more sustained, causing massive harm on growth and massive harm on people,” Ms. Georgieva said. “On the other hand, tightening monetary policy too much and too fast — and doing so in a synchronized manner across countries — could push many economies into prolonged recession.”
Noting that inflation remains stubbornly high and broad-based, she added: “Central banks have to continue to respond.”
The World Bank warned last month that simultaneous interest-rate increases around the world could trigger a global recession next year, causing financial crises in developing economies. It urged central banks in advanced economies to be mindful of the cross-border “spillover effects.”
“To achieve low inflation rates, currency stability and faster growth, policymakers could shift their focus from reducing consumption to boosting production,” David Malpass, the World Bank president, said.
Trade and Development Report said.
So far, major central banks have shown little appetite for stopping their inflation-busting campaigns. The Fed, which has made five rate increases this year, has signaled that it plans to raise borrowing costs even higher. Most officials expect to increase rates by at least another 1.25 percentage points this year, taking the policy rate to a range of 4.25 to 4.5 percent from the current 3 to 3.25 percent.
Even economies that are facing a pronounced slowdown have been lifting borrowing costs. The European Central Bank raised rates three-quarters of a point last month, even though the continent is approaching a dark winter of slowing growth and crushing energy costs.
according to the World Bank. Food costs in particular have driven millions further into extreme poverty, exacerbating hunger and malnutrition. As the dollar surge makes a range of imports pricier for emerging markets, that situation could worsen, even as the possibility of financial upheaval increases.
“Low-income developing countries in particular face serious risks from food insecurity and debt distress,” Ngozi Okonjo-Iweala, director-general of the World Trade Organization, said during a news conference this week.
Understand Inflation and How It Affects You
In Africa, officials have been urging the I.M.F. and Group of 20 nations to provide more emergency assistance and debt relief amid inflation and rising interest rates.
“This unprecedented shock further destabilizes the weakest economies and makes their need for liquidity even more pressing, to mitigate the effects of widespread inflation and to support the most vulnerable households and social strata, especially young people and women,” Macky Sall, chairman of the African Union, told leaders at the United Nations General Assembly in September.
To be sure, central bankers in big developed economies like the United States are aware that they are barreling over other economies with their policies. And although they are focused on domestic goals, a severe weakening abroad could pave the way for less aggressive policy because of its implications for their own economic outlooks.
Waning demand from abroad could ease pressure on supply chains and reduce prices. If central bankers decide that such a chain reaction is likely to weigh on their own business activity and inflation, it may give them more room to slow their policy changes.
“The global tightening cycle is something that the Fed has to take into account,” said Megan Greene, global chief economist for the Kroll consulting firm. “They’re interested in what is going on in the rest of the world, inasmuch as it affects their ability to achieve their targets.”
his statement.
But many global economic officials — including those at the Fed — remain focused on very high inflation. Investors expect them to make another large rate increase when they meet on Nov. 1-2.
“We’re very attentive” to international spillovers to both emerging markets and advanced economies, Lisa D. Cook, a Fed governor, said during a question-and-answer session on Thursday. “But our mandate is domestic. So we’re very focused on inflation as it evolves in this country.”
Raghuram Rajan, a former head of India’s central bank and now an economist at the University of Chicago, has in the past pushed the Fed to take foreign conditions into account as it sets policy. He still thinks that measures like bond-buying should be pursued with an eye on global spillovers.
But amid high inflation, he said, central banks are required to pay attention to their own mandates to achieve price stability — even if that makes for a stronger dollar, weaker currencies and more pain abroad.
“The basic problem is that the world of monetary policy dances to the Fed’s tune,” Mr. Rajan said, later adding: “This is a problem with no easy solutions.”
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.”
The incident was the deadliest so far as a surging number of Lebanese, Syrians, and Palestinians have been trying to flee Lebanon by sea to Europe.
Thousands of Palestinians held prayers on a small soccer field in a refugee camp in northern Lebanon on Saturday, to mourn one of the scores of migrants who died after their boat sank off Syria’s coast this week, even as others vowed to undertake the same perilous voyage.
Abdul-Al Abdul-Al, 24, kissed his father goodbye Tuesday before boarding a crowded boat leaving from a nearby town seeking a better life in Europe. It was his 14th attempt to flee the crisis-hit Mediterranean country, this time ending with the return of his dead body. He was to be buried in the camp where he was born, his father, Omar, told The Associated Press during the funeral procession.
The head of al-Basel Hospital in Syria’s coastal city of Tartus said Saturday that the death toll has reached 89, adding that of the 20 others who were receiving treatment at the medical center, six were discharged.
The Lebanese army announced Saturday that troops have detained the man who allegedly organized the deadly trip.
The incident was the deadliest so far as a surging number of Lebanese, Syrians, and Palestinians have been trying to flee Lebanon by sea to Europe in search of jobs and stability. In Lebanon, tens of thousands have lost their jobs while the the national currency has dropped more than 90% in value, eradicating the purchasing power of thousands of families and pulling three-quarters of the population into poverty.
Alongside 1 million Syrian refugees, the small country of Lebanon is home to tens of thousands of Palestinian refugees and their descendants. Many live in the dozen refugee camps that are scattered around the country. Palestinians suffer wide discrimination in Lebanon where they are deprived from doing specific jobs or own property and since the end of the 1975-90 civil war many have migrated.
After noon prayers were held at Nahr el-Bared, hundreds of people gathered in a yard used to play football where Abdul-Al’s coffin was placed in the middle. Prayers were held before the body was carried to a nearby cemetery where thousands of people had gathered to witness the young man being laid to rest.
Omar Abdul-Al said that his son had tried to leave Lebanon before but did not succeed as sometimes the migrant boats he took had technical problems or faced high seas. Sometimes he had to swim back to shore, the man said.
“We don’t want to live here anymore. We want to leave,” said Omar Abdul-Al, adding that he encouraged his late son to leave and now he is encouraging his four other sons to leave Lebanon. He added that his sons are all well educated but they cannot find jobs.
“We are passing through a severe crisis. There is no medication or bread or anything,” the father said. He added that many other Palestinians were planning to go on the boat but it did not fit more people.
Another relative of Abdul-Al screamed that “there is a disaster in Nahr el-Bared” saying that there are about 30 people missing from the camp who were on the boat. He said people are selling their homes and cars in order to go.
Several others have been buried since Friday.
There were conflicting reports on how many people were on board the boat when it sank, with some saying at least 120. Details about the ship, such as its size and capacity, were also not clear.
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In the aftermath of the disaster, the Lebanese army said troops stormed Friday the homes of several suspected smugglers, detaining eight people involved in trafficking people abroad.
Residents in northern Lebanon say that people pay about $6,000 for an adult and $3,000 for a child to reach Europe.
At the morgue, Omar Abdel-Al said he found his son’s body “intact” though it was difficult to identify many of the dozens of other corpses kept there.
“Anyone that comes with a boat, people are ready to go,” he said.
In 2018, senior executives at one of the country’s largest nonprofit hospital chains, Providence, were frustrated. They were spending hundreds of millions of dollars providing free health care to patients. It was eating into their bottom line.
The executives, led by Providence’s chief financial officer at the time, devised a solution: a program called Rev-Up.
Rev-Up provided Providence’s employees with a detailed playbook for wringing money out of patients — even those who were supposed to receive free care because of their low incomes, a New York Times investigation found.
nonprofits like Providence. They enjoy lucrative tax exemptions; Providence avoids more than $1 billion a year in taxes. In exchange, the Internal Revenue Service requires them to provide services, such as free care for the poor, that benefit the communities in which they operate.
But in recent decades, many of the hospitals have become virtually indistinguishable from for-profit companies, adopting an unrelenting focus on the bottom line and straying from their traditional charitable missions.
focused on investments in rich communities at the expense of poorer ones.
And, as Providence illustrates, some hospital systems have not only reduced their emphasis on providing free care to the poor but also developed elaborate systems to convert needy patients into sources of revenue. The result, in the case of Providence, is that thousands of poor patients were saddled with debts that they never should have owed, The Times found.
provide. That was below the average of 2 percent for nonprofit hospitals nationwide, according to an analysis of hospital financial records by Ge Bai, a professor at the Johns Hopkins Bloomberg School of Public Health.
Ten states, however, have adopted their own laws that specify which patients, based on their income and family size, qualify for free or discounted care. Among them is Washington, where Providence is based. All hospitals in the state must provide free care for anyone who makes under 300 percent of the federal poverty level. For a family of four, that threshold is $83,250 a year.
In February, Bob Ferguson, the state’s attorney general, accused Providence of violating state law, in part by using debt collectors to pursue more than 55,000 patient accounts. The suit alleged that Providence wrongly claimed those patients owed a total of more than $73 million.
Providence, which is fighting the lawsuit, has said it will stop using debt collectors to pursue money from low-income patients who should qualify for free care in Washington.
But The Times found that the problems extend beyond Washington. In interviews, patients in California and Oregon who qualified for free care said they had been charged thousands of dollars and then harassed by collection agents. Many saw their credit scores ruined. Others had to cut back on groceries to pay what Providence claimed they owed. In both states, nonprofit hospitals are required by law to provide low-income patients with free or discounted care.
“I felt a little betrayed,” said Bev Kolpin, 57, who had worked as a sonogram technician at a Providence hospital in Oregon. Then she went on unpaid leave to have surgery to remove a cyst. The hospital billed her $8,000 even though she was eligible for discounted care, she said. “I had worked for them and given them so much, and they didn’t give me anything.” (The hospital forgave her debt only after a lawyer contacted Providence on Ms. Kolpin’s behalf.)
was a single room with four beds. The hospital charged patients $1 a day, not including extras like whiskey.
Patients rarely paid in cash, sometimes offering chickens, ducks and blankets in exchange for care.
At the time, hospitals in the United States were set up to do what Providence did — provide inexpensive care to the poor. Wealthier people usually hired doctors to treat them at home.
wrote to the Senate in 2005.
Some hospital executives have embraced the comparison to for-profit companies. Dr. Rod Hochman, Providence’s chief executive, told an industry publication in 2021 that “‘nonprofit health care’ is a misnomer.”
“It is tax-exempt health care,” he said. “It still makes profits.”
Those profits, he added, support the hospital’s mission. “Every dollar we make is going to go right back into Seattle, Portland, Los Angeles, Alaska and Montana.”
Since Dr. Hochman took over in 2013, Providence has become a financial powerhouse. Last year, it earned $1.2 billion in profits through investments. (So far this year, Providence has lost money.)
Providence also owes some of its wealth to its nonprofit status. In 2019, the latest year available, Providence received roughly $1.2 billion in federal, state and local tax breaks, according to the Lown Institute, a think tank that studies health care.
a speech by the Rev. Dr. Martin Luther King Jr.: “If it falls your lot to be a street sweeper, sweep streets like Michelangelo painted pictures.”
Ms. Tizon, the spokeswoman for Providence, said the intent of Rev-Up was “not to target or pressure those in financial distress.” Instead, she said, “it aimed to provide patients with greater pricing transparency.”
“We recognize the tone of the training materials developed by McKinsey was not consistent with our values,” she said, adding that Providence modified the materials “to ensure we are communicating with each patient with compassion and respect.”
But employees who were responsible for collecting money from patients said the aggressive tactics went beyond the scripts provided by McKinsey. In some Providence collection departments, wall-mounted charts shaped like oversize thermometers tracked employees’ progress toward hitting their monthly collection goals, the current and former Providence employees said.
On Halloween at one of Providence’s hospitals, an employee dressed up as a wrestler named Rev-Up Ricky, according to the Washington lawsuit. Another costume featured a giant cardboard dollar sign with “How” printed on top of it, referring to the way the staff was supposed to ask patients how, not whether, they would pay. Ms. Tizon said such costumes were “not the culture we strive for.”
financial assistance policy, his low income qualified him for free care.
In early 2021, Mr. Aguirre said, he received a bill from Providence for $4,394.45. He told Providence that he could not afford to pay.
Providence sent his account to Harris & Harris, a debt collection company. Mr. Aguirre said that Harris & Harris employees had called him repeatedly for weeks and that the ordeal made him wary of going to Providence again.
“I try my best not to go to their emergency room even though my daughters have gotten sick, and I got sick,” Mr. Aguirre said, noting that one of his daughters needed a biopsy and that he had trouble breathing when he had Covid. “I have this big fear in me.”
That is the outcome that hospitals like Providence may be hoping for, said Dean A. Zerbe, who investigated nonprofit hospitals when he worked for the Senate Finance Committee under Senator Charles E. Grassley, Republican of Iowa.
“They just want to make sure that they never come back to that hospital and they tell all their friends never to go back to that hospital,” Mr. Zerbe said.
The Everett Daily Herald, Providence forgave her bill and refunded the payments she had made.
In June, she got another letter from Providence. This one asked her to donate money to the hospital: “No gift is too small to make a meaningful impact.”
Following a Script ‘Like Robots’
In 2019, Vanessa Weller, a single mother who is a manager at a Wendy’s restaurant in Anchorage, went to Providence Alaska Medical Center, the state’s largest hospital.
She was 24 weeks pregnant and experiencing severe abdominal pains. “Let this just be cramps,” she recalled telling herself.
Ms. Weller was in labor. She gave birth via cesarean section to a boy who weighed barely a pound. She named him Isaiah. As she was lying in bed, pain radiating across her abdomen, she said, a hospital employee asked how she would like to pay. She replied that she had applied for Medicaid, which she hoped would cover the bill.
After five days in the hospital, Isaiah died.
Then Ms. Weller got caught up in Providence’s new, revenue-boosting policies.
The phone calls began about a month after she left the hospital. Ms. Weller remembers panicking when Providence employees told her what she owed: $125,000, or about four times her annual salary.
She said she had repeatedly told Providence that she was already stretched thin as a single mother with a toddler. Providence’s representatives asked if she could pay half the amount. On later calls, she said, she was offered a payment plan.
“It was like they were following some script,” she said. “Like robots.”
Later that year, a Providence executive questioned why Ms. Weller had a balance, given her low income, according to emails disclosed in Washington’s litigation with Providence. A colleague replied that her debts previously would have been forgiven but that Providence’s new policy meant that “balances after Medicaid are being excluded from presumptive charity process.”
Ms. Weller said she had to change her phone number to make the calls stop. Her credit score plummeted from a decent 650 to a lousy 400. She has not paid any of her bill.
Susan C. Beachy and Beena Raghavendran contributed research.
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.
NYC schools will provide a first-ever citywide office to support students in foster care, something parents and local officials have called for.
Justine and Keyong are nine and eight years old. Both of them are excited to begin a new school year, and both of them are in foster care.
NEWSY’S AXEL TURCIOS: Why are you excited?
JUSTINE RAMOS: because I get to meet new people. I’m moving to a new grade.
Despite their young ages, behind their smiles they’ve had traumatic lives.
The children’s foster care mother, Luisa Contreras, said Justine and Keyong were removed from their homes and placed in the foster care system at very young ages.
Justine has lived in eight different homes and Keyong has been in foster care since he was a baby.
Erika Palmer is the supervising attorney at Advocates For Children.
“There’s probably hundreds of students like that who are in similar circumstances,” said Palmer.
The Office of Elementary and Secondary Education said nationwide there are over 270,0000 students in foster care.
7,000 of those were in New York City alone, as of December 2021.
Recent data from New York City’s mayor’s office shows 43% of public-school students in foster care complete high school graduation on time, compared to 81% of their peers outside the system.
“They’re also much more likely to struggle with mental health challenges because of all the trauma that they’ve experienced. And all of those things compound and make it difficult for young people to complete their education,” said Palmer.
For the first time in New York, the Department of Education is introducing a city-wide central office to support students in foster care.
It will fill nine newly created positions including six that will serve students in foster care and at least two supporting students and kids in temporary housing. The ninth position is yet to be named. It comes in response to relentless pleas from families, advocates, and local officials.
The findings in New York City also show that foster care students are much more likely to be suspended from school than other students.
Palmer said there’s a misperception about these children being bad kids. She adds that their behavior is impacted by the instability in their lives.
“We see students that, you know, have had to change schools in may or they have to change schools right before the end of the semester and then don’t earn credit for that semester, have to repeat all of their classes. They get very frustrated,” said Palmer.
Rita Joseph is a New York City councilwoman.
“By having a support office that supports their needs, those needs will be met,” said Joseph.
She has relentlessly urged the school system to establish an office dedicated to supporting these students.
“It’s important to have a point person that can guide them through this, through the system as they register, transportation support, mental health support, and working with agents, the agency that placed them in those schools to make sure that we’re meeting the needs of the whole child,” said Joseph.
A child may end up in the foster care system as a result of parent neglect, poverty and substance abuse by the parents.
Advocates also complain the Department of Education often does not provide federally mandated transportation.
“When school is about to start there are always issues. Sometimes it takes the school two to three weeks to assign them a bus. Right now, I only have her route, but the boy still doesn’t have a bus assigned,” said Contreras.
Councilwoman Joseph was a foster parent herself. She said her youngest foster care son wasn’t able to take a school bus because no routes were available to his school. He was instead given a metro card.
Newsy has reached out to the Department of Education several times but have not received a response.
Joseph later decided to adopt both kids.
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TURCIOS: What’s the greatest satisfaction there is left to you being a foster care mother? I imagine your children. But the experience.
RITA JOSEPH: I fell in love with these two boys the day I met them. And when I found out they wanted me to adopt them, it was — it was very emotional for me. So I am their mom forever. These they changed my life. I’m inspired by them. I fight even more on behalf of foster children because of them.
Meanwhile in the Bronx, Contreras tries everything in her power to make sure Justine and Keyong are happy. Both have been in her care for about a year.
“They call me mommy all the time. I try to give them the love they need,” she said.
Contreras is finalizing the paperwork to adopt both kids — her children, as she calls them.
TURCIOS: Are you happy about that?
KEYONG: Yes!
JUSTINE: I want to help the community.
Justine wants to be a cop and Keyong wants to be a doctor.
A specific city in Oregon has seen a huge amount of growth in the Hispanic community.
It’s almost 7 o’clock at night and Rosa Ramirez has had a fruitful day. Today her sales were good, but Ramirez says it isn’t always this way.
Rosa Ramirez moved to Oregon from El Salvador.
She sells pupusas that she makes at a market in Hillsboro, Oregon. It’s a traditional dish from her home country of El Salvador.
Ramirez says she was pregnant when she almost died at a shooting during the civil war in her country.
Her unborn child did not survive. Heartbroken, she left El Salvador in 1992. Oregon has been her home for the last 30 years.
“When I came here there was almost no one who spoke Spanish. Only English, and it was difficult for me because I was a nanny, and I was working for people who only spoke English and then I started fighting with the language,” said Ramirez.
She is one of the almost 600,000 Latinos living in the state.
According to the 2020 Census, Oregon’s Latino population grew by more than 30% in the last ten years.
Latinos are now the largest minority group in the state and their numbers have grown faster than the national rate in each of the last three decades.
Maria Caballero Rubio is the executive director of Centro Cultural in Washington County.
“That just shows that we are making a mark and we are growing. And I think people are acknowledging that we are a growing population,” said Rubio.
She has seen steady growth since her farmworker family settled in Washington County in 1969. They migrated from Durango, Mexico.
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“Maybe eight years ago, the only flags we had up here were the Mexican flag, because a lot of people were from, [or] have their ethnicity from Mexico. And then we had the American flag. But then the more that we started having visitors, they would say to me, you know, ‘where’s my flag?’ so, we decided that we would bring in the flag for people who’ve come to visit,” said Rubio.
Caballero says that the thriving Latino population is starting to rise out of the fields and into professional jobs.
“We had jobs in farm work or we had farms, jobs in in landscaping and those kinds of things. But more and more, as our communities have stayed here and the next generations have grown up and they become educated, they are coming back as professionals,” she continued.
More than half of Oregon’s Latino population is in three counties: Multnomah, Washington and Marion. There the Latino communities grew by at least 25% in the last decades.
“We are becoming more visible now, I have to say. Ten years ago, you couldn’t find an elected official here in Washington County or the Portland metro area that was Latino,” said Rubio.
In fact, Carmen Rubio became Portland’s first Latino city commissioner in 2020. She is Maria’s daughter.
Maria says the younger population may cause a shift in politics as more become eligible to vote when they turn 18.
NEWSY’S AXEL TURCIOS: There’s more representation in the Latino community, in the state legislature, city councils, more Latinos getting into office, representing these growing communities across the state. Will this last?
MARIA CABALLERO RUBIO: I think so. I think it will last. We’re going to move forward and we’re going to continue making change, you know, social and systems changes that need to happen because of the historic disenfranchisement of people of color.
The state once legally banned Black people.
“But, you know, department heads and managers and, you know, police chiefs and all of those. I think that they have not — they have not taken steps to be more inclusive in terms of recruiting and making it more more available to people of color to apply it. That’s an area that we still lack,” said Rubio.
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The increase in the Latino population here in Oregon has also been propelled by new waves of migrants. One of those waves is Venezuelan migration, fleeing poverty and the government in their country. According to the American Community Survey, there are more than 1,400 Venezuelans living in the state of Oregon.
Giselle Rincon is the president and co-founder of Venezuela’s Voice in Oregon.
“Everybody’s struggling to find food, medical supplies or jobs, especially safety,” said Rincon. She says the new Venezuelan migrants are facing new challenges.
“Mostly access to education, how to find a job, how to navigate the system, where to apply. Most of the Venezuelans are professionals and they want to help prosper the economy of Oregon.”
“I think our new generations are becoming more involved. They are, you know, getting an education,” said Jaime Miranda, the owner of M&M Marketplace.
Back at the Hillsboro market, Miranda says he was one of only a few Mexican immigrants in his neighborhood when he moved from Chihuahua, Mexico in 1985. He was 10 years old.
He went to college and has owned this Latino market for 22 years. He started it with only 12 vendors and now the establishment has 66.
TURCIOS: How do you think the new generations of Latinos are shifting culture here in Oregon?
JAIME MIRANDA: You know, from migrant workers to people who are starting their businesses, own their homes, they are getting a career, an education. So, we are definitely shifting to that second generation where they are integrated, and they understand how to navigate the system and be part of the community as a whole.
“Now you see more Hispanics than before. Before, you didn’t see any Hispanics. Hispanics were very rare to find here in Oregon,” said Ramirez.
As for Rosa, she says she carries El Salvador in her heart, but she’s beyond grateful to the United States, a nation that gave her a new life and optimism about the next generation.
In Montana, the youth suicide rate between 2011 and 2020 was more than double the national rate for the same age group.
Montana is known for its wide open spaces, craggy mountains and fresh, clear water.
But for all its beauty, it’s also known for a devastating epidemic.
The youth suicide rate in Montana between 2011 and 2020 was more than double the national rate for the same age group.
The reasons behind the statistic are a complicated, cultural issue. A March 2022 report released by the state cites vitamin D deficiencies, altitude, social isolation and access to firearms as just a few of the reasons. It also shows 1 in 5 Montana kids live more than 100% below the federal poverty line. And the state has a high concentration of American Indians, who experience higher rates of suicide.
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Kelley Edwards is the program director for Youth Aware of Mental Health (YAM) at Montana State University’s Center for Mental Health Research and Recovery. She knows firsthand what teen suicide can do to a community.
“I lived it. My co-workers lived it. My students lived it,” she said.
Edwards used to teach high school in Helena, Montana, where seven students in her school died by suicide in a three-year span.
“It will never leave me what that was like,” Edwards said.
Helena High School administrators knew something needed to happen, and they found the solution in Sweden, which is home to Youth Aware of Mental Health.
“Helena School District was instrumental in bringing YAM to the United States, because they recognized the seriousness of the problem and wanted to do something about it,” Edwards said.
YAM started in 2014 with the goal of bringing down teen suicide rates.
A randomly-controlled trial with 11,000 participants showed it reduced suicide ideation and attempts by about 50%. New cases of depression fell by about 30% in kids participating.
The program is in 16 countries and its trainers are traveling the world to expand even more.
Edwards is a program manager and also teaches it.
“I’ve had kids say right after a session either, ‘I’m really, really depressed,’ or possibly, even, they’ve said, ‘I’m suicidal.’ And they are. They’ve said, ‘I’m really, really worried about a friend,'” Edwards shared.
Designed for kids between 13 and 18 years old, the program consists of five five-hour sessions over three weeks, which dive into mental health literacy, role playing and identifying stressors and resources.
“We need to get to the point where our students are comfortable with mental health knowledge, and what to do when your normal coping skills are not working or where it gets too severe that you would need professional help,” Edwards said.
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But as Edwards knows, that’s not easy in rural places, like her native Montana — especially now.
“I grew up in Denton, Montana.For students in rural areas that may not have access to anything … The best that we can provide at this point is starting with just having someone to talk to,” Edwards said. “It’s not ideal by any means. But that is where we’re at, unfortunately.”
Mary Windecker runs the advocacy group Behavioral Health Alliance of Montana. She, and so many other mental health professionals, are taking their concerns to state and federal leaders. They’re trying to get more attention and funding on this issue.
“Overall in the United States, we’re failing our children. That’s true by every metric you could possibly measure,” Windecker said.
And beyond Montana, people in the field of mental health are working to do what they can to help the next generation before it’s too late.
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.
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