President Donald Trump is urging some of his colleagues to "not mess with Medicaid," even as hard-liners call for steeper cuts to the health care program covering more than 2 million Arizonans. The proposed cuts would affect some of the most vulnerable, including in rural areas.

A new report from Georgetown University's Center for Children and Families found Arizona is among the top 10 states with the highest percentage of rural women of childbearing age covered by Medicaid.

Jennifer J. Burns, director of government relations for the Children's Action Alliance, said Medicaid is vital and warned if Congress passes the cuts, it will jeopardize Arizona's already strained rural health care system.

"It doesn't take much for them not to be able to do labor and delivery," Burns pointed out. "We've faced a crisis of that down in Nogales just a couple years ago, where they were losing all of their doctors that could provide labor and delivery services at Holy Cross Hospital."

The report showed in recent years, many rural hospitals across the country have had to close their doors and the majority of those still open are not able to offer obstetric care.

Joan Alker, executive director of the Georgetown University Center for Children and Families, said lawmakers could be looking at making the largest cuts in Medicaid's history. Alker explained while much of the focus has been on low-income people who could lose coverage, cuts could also hurt hospitals' finances, especially those serving rural patients.

"It doesn't matter who their health insurer is. If they have private insurance, employer insurance, but there's no facility, then they can't safely give birth," Alker stressed. "That's why these issues are so consequential."

The report found while most women of childbearing age live in metropolitan areas, a higher share of rural women in the age group rely on Medicaid.

Asian Americans, Native Hawaiian and Pacific Islanders are a rapidly growing population in California and across the nation - but as they age, research indicates they're less likely to use hospice care or be familiar with end-of-life options.

Nationwide, the group makes up about 6% of the population - and 15% in California - but like many minorities, they face greater health-care disparities.

Ben de Guzman, director of the Office on Asian and Pacific Islander Affairs in the Washington, D.C., mayor's office and the son of Filipino immigrants, said cultural beliefs can hinder conversations about death and dying, and language also is a barrier.

"Because our communities don't speak English at the same rates as other communities do, being able to talk to doctors is a problem," he said, adding that also applies to "health insurers, especially within the context of death-or-dying legislation."

It's estimated more than 100 languages are spoken within Asian American and Pacific Islander communities. Many have participated in celebrations this month to mark AANHPI Heritage Month.

Those in AANHPI communities typically live at home as they age, rather than in long-term care facilities or nursing homes. After working with the Diverse Elders Coalition, de Guzman said he got involved with the Compassion and Choices advocacy group to learn more about how different ethnic groups approach hospice and palliative care.

"There's a lot of cultural stigma that people have particularly around end-of-life care, different perceptions of death, that are informed by the cultural expectations and the cultural understandings our folks have around aging," he said.

Conversations about death and dying between the AANHPI generations are easier than even a few decades ago, de Guzman said.

"We've been translating for our parents for 40 years," he said, "so we're better prepared to have these conversations than the community overall was 40 years ago."

California's End of Life Option Act, often called "death with dignity," took effect in 2016.


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As Women's Health Month winds down, experts in alcohol abuse are speaking out about an increase in binge drinking among women over the past five years.

A recent study from the Journal of the American Medical Association found that women are now binge drinking more than men for the first time in history.

Joanne Hawes - director of clinical operations with the Betty Ford Center in Rancho Mirage, California - explained that women's bodies make them more vulnerable to excessive alcohol consumption.

"Alcohol is actually ingested differently for women, and can affect them more quickly," said Hawes. "So women tend to have health issues more quickly than men. Things like liver damage or brain atrophies, even heart disease."

Alcoholics Anonymous says 38% of their clients are women, and the proportion has been rising in recent years.

Data from the National Institutes of Health show that nearly one in three young women aged 18 to 25 binge drink on a regular basis.

Hawes added that the stress of holding down a job and caring for children during the COVID lockdown contributed to a rise in alcohol abuse among women.

Dr. Lisa Saul, chief medical officer for women's health at UnitedHealthcare, said heavy drinking among women has surged by 41% since the pandemic, heightening the risk of cancer.

"Alcohol is a carcinogen," said Saul, "and we know that it is linked to at least six types of cancer, including breast and colorectal cancer."

Many employee assistance programs offer help to find treatment. The National Institutes of Health lists alcohol addiction resources on its website, Rethinking Drinking.

Florida's new law banning fluoride in public water systems has drawn sharp criticism from dental professionals, who cite decades of evidence supporting its safety and effectiveness in preventing tooth decay.

Dr. Jeff Ottley, president of the Florida Dental Association, warned that the change will lead to a rise in cavities, particularly among children and underserved populations.

"Over the next two to three years, we will see an increase in the number of cavities, particularly in children and older adults who take multiple medications, which cause dry mouth," he said. "Those older adults will start getting cavities along the roof surfaces of their teeth and under existing restorations, like crowns and fillings."

Backers of the ban, including libertarian groups and some GOP legislators, have argued that "fluoride is a choice" and have recommended topical treatments, such as toothpaste, over what they claimed to be "mass medication."

Ottley stressed that fluoride occurs naturally in water, and the ban eliminates adjustments that allow cities to reach optimal levels for dental health.

He also predicted severe consequences, especially for Florida's Medicaid system and rural communities.

"The Medicaid system in Florida already has the lowest reimbursement rate across the country," he said, "and so you're going to have an influx in the number of kids looking, and parents looking to treat their kids who are on Medicaid, and the providers just aren't going to be there."

Ottley warned that higher Medicaid payments will be needed to attract dental-care providers, which he said could lead to ballooning costs.

His interim advice for parents: Seek prescription fluoride vitamins, and everyone should maintain rigorous brushing and flossing routines, cut their sugar intake and avoid post-brushing snacks before bed.


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