It's not because we're getting tons more care — it's because prices rise so fast

By CELIA LLOPIS-JEPSEN <a href="https://www.kcur.org/news/2022-01-24/yes-more-and-more-of-your-paycheck-goes-to-health-care-in-kansas-and-missouri-heres-why">Kansas News Service</a>

People expect a lower cost of living in the middle of the country. 
It’s one of the perks of picking, say, Wichita over Washington, D.C.

But when it comes to health care, <a href="https://www.nerdwallet.com/cost-of-living-calculator/compare/washington-arlington-alexandria-dc-va-vs-wichita-ks" target="_blank">not even choosing a cheaper part of the country</a> can shield you from the pain of American medical prices.

Kansas
 and Missouri count among the five states where people with work-based 
insurance face average premiums and deductibles topping $9,000 a year.

In Missouri, deductibles are so high that economists at the <a href="https://www.commonwealthfund.org/about-us" target="_blank">Commonwealth Fund</a> consider the average middle-income earner there underinsured.

Why underinsured? Because when deductibles add up to 5% or more of a person’s income, they start skipping out on health care.

“And when people do get care, they often accumulate a lot of medical 
debt,” economist Sara Collins said. “That has financial ramifications 
for families.”

Collins is vice president at the Commonwealth Fund,
 where she directs its program on insurance coverage and access to 
health care.

In a new report, the organization dug into a federal survey of more than 40,000 employers.

Families
 in Kansas who get their insurance through work pay 36% of the premiums 
themselves. In Missouri, 33%. The average American family pays 29%.

“It’s
 really hard to imagine how we continue to allow this to happen,” 
Wichita physician Justin Moore said after reading the new research. 
“Every incentive in health care … is aligned to increase the amount of 
money that we take out of people’s pockets.”

Moore is medical 
director of the Kansas Business Group on Health – an insurance-buying 
coalition that brings together 35 very different businesses.

Some 
have just a few hundred employees. Others have tens of thousands. Yet 
all wrestle with how to curb what seems like the unstoppable rise of 
medical and insurance prices so that they can provide affordable 
prescriptions and quality health care to employees.

It’s one of the country’s most pressing puzzles. <a href="https://www.commonwealthfund.org/publications/2021/oct/testimony-current-status-employer-health-insurance-coverage-united-states" target="_blank">More than half</a> of Americans not old enough for Medicare get health insurance through work.

A recent study by the <a href="https://healthcostinstitute.org/images/pdfs/HCCI_2019_Health_Care_Cost_and_Utilization_Report.pdf" target="_blank">Health Care Cost Institute</a> found spending per person with employer health insurance grew more than 20% over five years.

That’s
 nearly three times the pace of broader economic inflation. And most of 
this increase isn’t attributable to people getting more care and 
medications.

Instead, two-thirds of the problem comes simply from price hikes.

Imagine walking into a grocery store. You fill your cart with what feels like about $50 worth of groceries.

Only,
 you’re scared to walk to the front of the store and pay, because you 
know the total might actually come to $100 or $200. If you’re unlucky, 
maybe $500.

Even worse, you won’t get to return that gallon of milk to the shelves once you see on the bill that they priced it at $20.

That’s American health care. It’s hard to know what to expect.

“Health
 care costs are so random across the country,” Collins said. “There’s 
not a lot of relationship between prices and what it actually costs to 
deliver a service.”

A study by the <a href="https://www.kcur.org/news/2020-09-25/employers-compared-notes-on-secret-prices-at-kansas-hospitals-to-boost-their-leverage-on-costs" target="_blank">RAND Corporation</a>
 think tank suggests some Kansas City hospitals rank among the most 
expensive in the country. RAND looked at prices paid by employer health 
plans that volunteered the information.

When the Kansas Health Institute <a href="https://www.kcur.org/news/2021-06-29/kansas-knows-what-hospitals-get-paid-but-says-it-cant-tell-a-group-that-compares-prices-nationally" target="_blank">analyzed the same data</a>, it found something else interesting: Prices vary widely within Kansas. A visit to the emergency room that costs $150 in south-central Kansas can cost $700 in the Kansas City area.

Yes, the cost of labor varies across the state, a partial explanation.

But
 the institute says Medicare, for example, would only pay 10% more for 
those services in Kansas City compared to what it would pay in 
south-central Kansas. (Medicare factors in regional cost differences.)

The
 health care industry takes home more each year at a rate much faster 
than growth in the national per-capita gross domestic product, the 
Health Care Cost Institute found.

Insurance companies, 
brokers/consultants, pharmacy benefit managers and other insurance 
administrators hired to help employers navigate the health industry and 
strike good deals struggle to beat back the increases.

Investigative journalists have <a href="https://www.npr.org/sections/health-shots/2018/05/25/613685732/why-your-health-insurer-doesnt-care-about-your-big-bills" target="_blank">uncovered evidence</a> that they sometimes contribute to the problem. Just one reason: Higher bills can mean higher profits.

And
 so as medical prices and insurance premiums go up, employers pass more 
of the cost to workers, and simultaneously suppress worker wages.

Premiums and deductibles in Kansas and Missouri now typically add up to around 12% of median income.

The
 situation is bad for the middle class, but low-income earners have it 
worse. The Commonwealth study found they shell out far more for their 
premiums than higher earners.

Some companies raise deductibles in 
an effort to slow the growing premiums. In its own surveys, the Kansas 
Business Group on Health sometimes sees family deductibles as high as 
$12,000 to $17,000 per year.

“We’re seeing this steady trend 
toward higher deductibles,” Moore said. And “companies are contributing 
fairly little to things like flexible spending accounts or health care 
spending accounts.”

Collins has more bad news for the typical worker.

“They’re not only spending more on their premiums and their deductible,” she said, “their wages are being held down.”

That is, employers don’t necessarily pass their entire annual increase in health care spending directly to
 employees. They foot part of the increase themselves, too. But this 
cuts into the same pot of money that might otherwise have gone toward 
pay raises.

This tradeoff hasn’t panned out well for Americans.

Researchers
 from Harvard and Stanford universities who dug into more than a 
decade’s worth of credit reports from across the U.S. found <a href="https://jamanetwork.com/journals/jama/article-abstract/2782187" target="_blank">medical debt</a> has become the top source of work for collections agencies.

It accounted for more than all other kinds of debt in collections combined.

In a 2020 survey, Commonwealth found <a href="https://www.commonwealthfund.org/publications/issue-briefs/2020/aug/looming-crisis-health-coverage-2020-biennial" target="_blank">more than 40%</a> of underinsured people skipped or delayed medical care or medications for fear of the bills.

Policymakers
 and politicians debate a wide range of solutions, but party politics, 
ideological disagreements and lobbyists with deep pockets make passing 
any reform more than tricky.

It took Congress years to legislate against the health industry phenomenon known as “<a href="https://www.kcur.org/news/2020-01-07/getting-health-care-in-kansas-your-odds-may-be-worse-here-that-youll-get-a-surprise-bill" target="_blank">surprise bills</a>” – and that was a bipartisan issue with a significant public outcry for action.

The Biden administration packed a raft of health care measures into its now-stalled Build Back Better Act.

This
 includes continuing the temporary pandemic-related expansion of 
insurance marketplace subsidies that passed Congress last year and that 
led to <a href="https://www.cnbc.com/2022/01/18/obamacare-enrollment-hits-record-high-after-biden-makes-changes.html" target="_blank">record-high enrollment</a>
 in marketplace plans. It also includes temporarily offering private 
health coverage to certain low-income earners who would qualify for 
Medicaid if they didn’t live in states like Kansas that don’t allow them
 to.

But some of the ideas on the table don’t tackle the underlying and longer-term problem, Collins said: Prices.

“You’re
 still left paying for these prices that don’t really coincide with the 
cost of delivery,” she said. “That’s a much bigger issue in terms of the
 country being able to afford health care generally.”

Some policymakers propose rolling out state or federal <a href="https://www.healthinsurance.org/glossary/public-option/" target="_blank">public health insurance options</a>
 available to people beyond those who already qualify for Medicare or 
Medicaid. A few states have just recently passed laws to that end.

Meanwhile, a small number of Kansas companies have begun trekking down other paths in search of savings.

Some have joined coalitions that negotiate prescription drug prices directly to cut <a href="https://www.kcur.org/news/2021-08-13/kansas-investigates-obscure-but-powerful-part-of-the-drug-supply-chain-pharmacy-middlemen" target="_blank">pharmacy middlemen</a> out of the cost equation. Others have hired middlemen that import drugs from abroad for much less than Americans normally pay.

Still others turned their backs on brokers who receive <a href="https://www.propublica.org/article/health-insurance-brokers-cost-commissions-bonuses" target="_blank">undisclosed perks</a>
 — ranging from fancy vacations to cold cash — from insurance companies 
for hawking their wares. Some employers opted instead for brokers who 
shun conflicts of interest.

A third bucket of strategies involves 
cutting insurance companies out of the equation by contracting directly 
with primary care doctors to see employees (often for a monthly fee), or
 setting rates directly with hospitals.

Absent solutions at the state and federal level, Moore says businesses need to rock the boat on their own.

“In
 the short term, I think that’s where it is,” he said. “Employers 
looking past their traditional relationship with an insurance company, a
 broker, a pharmacy benefit manager. And just looking for solutions.”

Celia
 Llopis-Jepsen reports on consumer health for the Kansas News Service. 
You can follow her on Twitter @celia_LJ or email her at celia@kcur.org.

<figure>
 <img src="https://media.eaglewebservices.com/public/2022/1/1643124695745.png" alt="Celia Llopis-Jepsen / Kansas News Service" />
 <figcaption>Celia Llopis-Jepsen / Kansas News Service</figcaption>
 </figure><h2>It's not because we're getting tons more care — it's because prices rise so fast</h2>By CELIA LLOPIS-JEPSEN <a href="https://www.kcur.org/news/2022-01-24/yes-more-and-more-of-your-paycheck-goes-to-health-care-in-kansas-and-missouri-heres-why">Kansas News Service</a>People expect a lower cost of living in the middle of the country. 
It’s one of the perks of picking, say, Wichita over Washington, D.C.But when it comes to health care, <a href="https://www.nerdwallet.com/cost-of-living-calculator/compare/washington-arlington-alexandria-dc-va-vs-wichita-ks" target="_blank">not even choosing a cheaper part of the country</a> can shield you from the pain of American medical prices.Kansas
 and Missouri count among the five states where people with work-based 
insurance face average premiums and deductibles topping $9,000 a year.In Missouri, deductibles are so high that economists at the <a href="https://www.commonwealthfund.org/about-us" target="_blank">Commonwealth Fund</a> consider the average middle-income earner there underinsured.Why underinsured? Because when deductibles add up to 5% or more of a person’s income, they start skipping out on health care.<figure>
 <img src="https://media.eaglewebservices.com/public/2022/1/1643124775767.png" alt="" />
 <figcaption></figcaption>
 </figure>“And when people do get care, they often accumulate a lot of medical 
debt,” economist Sara Collins said. “That has financial ramifications 
for families.”Collins is vice president at the Commonwealth Fund,
 where she directs its program on insurance coverage and access to 
health care.In a new report, the organization dug into a federal survey of more than 40,000 employers.Families
 in Kansas who get their insurance through work pay 36% of the premiums 
themselves. In Missouri, 33%. The average American family pays 29%.“It’s
 really hard to imagine how we continue to allow this to happen,” 
Wichita physician Justin Moore said after reading the new research. 
“Every incentive in health care … is aligned to increase the amount of 
money that we take out of people’s pockets.”Moore is medical 
director of the Kansas Business Group on Health – an insurance-buying 
coalition that brings together 35 very different businesses.Some 
have just a few hundred employees. Others have tens of thousands. Yet 
all wrestle with how to curb what seems like the unstoppable rise of 
medical and insurance prices so that they can provide affordable 
prescriptions and quality health care to employees.<figure>
 <img src="https://media.eaglewebservices.com/public/2020/9/1601308401778.png" alt="This story is part of the series, Bills of Health. Do you have a medical bill from Kansas that you want to share with a reporter? Email celia@kcur.org." />
 <figcaption>This story is part of the series, Bills of Health. Do you have a medical bill from Kansas that you want to share with a reporter? Email celia@kcur.org.</figcaption>
 </figure>It’s one of the country’s most pressing puzzles. <a href="https://www.commonwealthfund.org/publications/2021/oct/testimony-current-status-employer-health-insurance-coverage-united-states" target="_blank">More than half</a> of Americans not old enough for Medicare get health insurance through work.A recent study by the <a href="https://healthcostinstitute.org/images/pdfs/HCCI_2019_Health_Care_Cost_and_Utilization_Report.pdf" target="_blank">Health Care Cost Institute</a> found spending per person with employer health insurance grew more than 20% over five years.That’s
 nearly three times the pace of broader economic inflation. And most of 
this increase isn’t attributable to people getting more care and 
medications.Instead, two-thirds of the problem comes simply from price hikes. <h2>The disconnect between prices and costs</h2>Imagine walking into a grocery store. You fill your cart with what feels like about $50 worth of groceries.Only,
 you’re scared to walk to the front of the store and pay, because you 
know the total might actually come to $100 or $200. If you’re unlucky, 
maybe $500.Even worse, you won’t get to return that gallon of milk to the shelves once you see on the bill that they priced it at $20.That’s American health care. It’s hard to know what to expect.“Health
 care costs are so random across the country,” Collins said. “There’s 
not a lot of relationship between prices and what it actually costs to 
deliver a service.”A study by the <a href="https://www.kcur.org/news/2020-09-25/employers-compared-notes-on-secret-prices-at-kansas-hospitals-to-boost-their-leverage-on-costs" target="_blank">RAND Corporation</a>
 think tank suggests some Kansas City hospitals rank among the most 
expensive in the country. RAND looked at prices paid by employer health 
plans that volunteered the information.When the Kansas Health Institute <a href="https://www.kcur.org/news/2021-06-29/kansas-knows-what-hospitals-get-paid-but-says-it-cant-tell-a-group-that-compares-prices-nationally" target="_blank">analyzed the same data</a>, it found something else interesting: Prices vary widely within Kansas. A visit to the emergency room that costs $150 in south-central Kansas can cost $700 in the Kansas City area.Yes, the cost of labor varies across the state, a partial explanation.But
 the institute says Medicare, for example, would only pay 10% more for 
those services in Kansas City compared to what it would pay in 
south-central Kansas. (Medicare factors in regional cost differences.) <h2>How businesses cope</h2>The
 health care industry takes home more each year at a rate much faster 
than growth in the national per-capita gross domestic product, the 
Health Care Cost Institute found.Insurance companies, 
brokers/consultants, pharmacy benefit managers and other insurance 
administrators hired to help employers navigate the health industry and 
strike good deals struggle to beat back the increases.Investigative journalists have <a href="https://www.npr.org/sections/health-shots/2018/05/25/613685732/why-your-health-insurer-doesnt-care-about-your-big-bills" target="_blank">uncovered evidence</a> that they sometimes contribute to the problem. Just one reason: Higher bills can mean higher profits.And
 so as medical prices and insurance premiums go up, employers pass more 
of the cost to workers, and simultaneously suppress worker wages.Premiums and deductibles in Kansas and Missouri now typically add up to around 12% of median income.The
 situation is bad for the middle class, but low-income earners have it 
worse. The Commonwealth study found they shell out far more for their 
premiums than higher earners.Some companies raise deductibles in 
an effort to slow the growing premiums. In its own surveys, the Kansas 
Business Group on Health sometimes sees family deductibles as high as 
$12,000 to $17,000 per year.“We’re seeing this steady trend 
toward higher deductibles,” Moore said. And “companies are contributing 
fairly little to things like flexible spending accounts or health care 
spending accounts.”Collins has more bad news for the typical worker.“They’re not only spending more on their premiums and their deductible,” she said, “their wages are being held down.”That is, employers don’t necessarily pass their entire annual increase in health care spending directly to
 employees. They foot part of the increase themselves, too. But this 
cuts into the same pot of money that might otherwise have gone toward 
pay raises.This tradeoff hasn’t panned out well for Americans.Researchers
 from Harvard and Stanford universities who dug into more than a 
decade’s worth of credit reports from across the U.S. found <a href="https://jamanetwork.com/journals/jama/article-abstract/2782187" target="_blank">medical debt</a> has become the top source of work for collections agencies.It accounted for more than all other kinds of debt in collections combined.In a 2020 survey, Commonwealth found <a href="https://www.commonwealthfund.org/publications/issue-briefs/2020/aug/looming-crisis-health-coverage-2020-biennial" target="_blank">more than 40%</a> of underinsured people skipped or delayed medical care or medications for fear of the bills. <h2>Proposals on the table</h2>Policymakers
 and politicians debate a wide range of solutions, but party politics, 
ideological disagreements and lobbyists with deep pockets make passing 
any reform more than tricky.It took Congress years to legislate against the health industry phenomenon known as “<a href="https://www.kcur.org/news/2020-01-07/getting-health-care-in-kansas-your-odds-may-be-worse-here-that-youll-get-a-surprise-bill" target="_blank">surprise bills</a>” – and that was a bipartisan issue with a significant public outcry for action.The Biden administration packed a raft of health care measures into its now-stalled Build Back Better Act.This
 includes continuing the temporary pandemic-related expansion of 
insurance marketplace subsidies that passed Congress last year and that 
led to <a href="https://www.cnbc.com/2022/01/18/obamacare-enrollment-hits-record-high-after-biden-makes-changes.html" target="_blank">record-high enrollment</a>
 in marketplace plans. It also includes temporarily offering private 
health coverage to certain low-income earners who would qualify for 
Medicaid if they didn’t live in states like Kansas that don’t allow them
 to.But some of the ideas on the table don’t tackle the underlying and longer-term problem, Collins said: Prices.“You’re
 still left paying for these prices that don’t really coincide with the 
cost of delivery,” she said. “That’s a much bigger issue in terms of the
 country being able to afford health care generally.”Some policymakers propose rolling out state or federal <a href="https://www.healthinsurance.org/glossary/public-option/" target="_blank">public health insurance options</a>
 available to people beyond those who already qualify for Medicare or 
Medicaid. A few states have just recently passed laws to that end.Meanwhile, a small number of Kansas companies have begun trekking down other paths in search of savings.Some have joined coalitions that negotiate prescription drug prices directly to cut <a href="https://www.kcur.org/news/2021-08-13/kansas-investigates-obscure-but-powerful-part-of-the-drug-supply-chain-pharmacy-middlemen" target="_blank">pharmacy middlemen</a> out of the cost equation. Others have hired middlemen that import drugs from abroad for much less than Americans normally pay.Still others turned their backs on brokers who receive <a href="https://www.propublica.org/article/health-insurance-brokers-cost-commissions-bonuses" target="_blank">undisclosed perks</a>
 — ranging from fancy vacations to cold cash — from insurance companies 
for hawking their wares. Some employers opted instead for brokers who 
shun conflicts of interest.A third bucket of strategies involves 
cutting insurance companies out of the equation by contracting directly 
with primary care doctors to see employees (often for a monthly fee), or
 setting rates directly with hospitals.Absent solutions at the state and federal level, Moore says businesses need to rock the boat on their own.“In
 the short term, I think that’s where it is,” he said. “Employers 
looking past their traditional relationship with an insurance company, a
 broker, a pharmacy benefit manager. And just looking for solutions.”Celia
 Llopis-Jepsen reports on consumer health for the Kansas News Service. 
You can follow her on Twitter @celia_LJ or email her at celia@kcur.org.

Yes, more of your paycheck goes to health care in Kan. and Mo. Here's why

By ERIC BERGER <a href="https://khn.org/news/article/with-a-vaccine-mandate-looming-nursing-homes-face-more-staffing-problems/">Kaiser Health News</a>

ST. CHARLES, Mo. — Jamie Smith, a staffing agency nurse who loves end-of-life care, said she has been warmly welcomed by staffers and residents at Frontier Health &amp; Rehabilitation in this conservative St. Louis suburb.

That’s even though she has not been vaccinated against covid-19.

But leaders of the nursing home, where 22 residents died from covid 
before vaccines were available, likely won’t be able to employ 
unvaccinated people like Smith for much longer. The <a href="https://khn.org/news/article/supreme-court-vaccine-mandate-ruling/">U.S. Supreme Court</a> on Jan. 13 upheld a <a href="https://www.govinfo.gov/content/pkg/FR-2021-11-05/pdf/2021-23831.pdf">federal mandate</a>
 requiring health care workers at facilities that receive Medicaid or 
Medicare funding to be fully vaccinated. If all staffers — excluding 
those with approved religious or medical exemptions — aren’t fully 
vaccinated, the facility will lose that money.

Health care sites in Missouri and other states that challenged the 
federal requirement have until March 15 for their staffs to be fully 
vaccinated, according to the Centers for Medicare &amp; Medicaid 
Services, while facilities in states that didn’t sue to block the 
mandate have a Feb. 28 deadline.

That poses a challenge for Frontier and its residents because the 
nursing home already doesn’t have enough staffers. And it is in the 
state with the lowest rate of fully vaccinated nursing home health care 
workers, 67% as of Jan. 9, according to CMS data. Frontier’s reported 
staff vaccination rate was just 30% at the start of the year.

That compares with a national rate of 81%, according to the federal data.

Although the mandate ensures that unvaccinated staff members are not 
caring for some of the people most vulnerable to the virus, not enough 
workers are willing to take the low-paying, challenging jobs. If they 
quit to avoid getting shots or are fired because they won’t get them, 
nursing home residents might not be any safer — because of lack of care.

“Obviously we need good staff members to take care of residents, but 
the residents need to be safe as well,” said Marjorie Moore, who 
supports the mandate and is executive director of Voyce, a St. Louis 
nonprofit that advocates for nursing home residents and their families.

“A person who lives in their own home has the chance to say, ‘I don’t
 want somebody in my home who isn’t vaccinated,’” she added. “In a 
nursing home, they don’t have the opportunity to say, ‘I don’t want 
somebody who is unvaccinated coming up and feeding me.’”

The problem of inadequate staffing at nursing homes predates the pandemic, and it’s gotten worse.

In March 2020, 3.3 million people were employed at U.S. nursing homes
 and residential care facilities, according to the Bureau of Labor 
Statistics. In December 2021, that number had dropped to 2.9 million, a 
loss of 400,000 workers.

Nursing home operators can’t find enough staffers because they often 
don’t pay much. The mean hourly wage for nursing assistants in Missouri 
was $13.33 in 2020, according to the statistics bureau. And the homes 
require employees to take on a slew of responsibilities, including 
feeding residents, changing adult diapers, and caring for residents who 
have dementia and may become combative.

Nursing assistants “can typically find a job with better pay that is less physically and emotionally demanding,” said <a href="https://www.urmc.rochester.edu/people/26750101-brian-e-mcgarry">Brian McGarry</a>,
 a University of Rochester professor who studies long-term care. 
“Somebody’s life and dignity is in your hands, and it’s a huge 
responsibility, and you are not getting paid commensurate with that 
responsibility.”

Those downsides of the job often lead to significant turnover. In 2017-18, <a href="https://anderson-review.ucla.edu/codifying-the-nursing-home-industrys-elusive-alarming-turnover-rates/">the turnover rate</a> among nursing home employees in Missouri was 138%, the fourth-highest in the country, according to a <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00957">study in the journal Health Affairs</a>. Frontier had a rate of more than 300%, according to Huizi Yu, one of the study’s authors.

The nursing home’s management declined to comment.

Smith, the nurse who works for a health care staffing agency, said 
she has not been vaccinated against covid because she had a rare cancer 
in 2017 and is “very particular about what I put in my body.”

She said, “I’m not sure if I would be able to get it just to keep a job.”

But, she noted in a text message, “I still practice safely.”

And, indeed, no Frontier residents have died from covid since the 
outbreak at the start of the pandemic, according to the federal data. 
But the center reported having seven new confirmed cases among its 
residents and 10 new cases among its staff as of Jan. 9. At the 
beginning of the year, 89% of residents were fully vaccinated against 
covid.

Low vaccination levels among staffers place residents at greater risk, according to a <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2115674">recent analysis</a>
 in The New England Journal of Medicine. Facilities in high-covid 
counties with an average staff vaccination rate of approximately 30% had
 nearly three times as many covid deaths among residents as facilities 
where about 82% of employees were vaccinated, the analysis found.

“An unvaccinated or low-vaccinated staff, I think, pretty clearly 
puts residents at risk — even if they are vaccinated,” said McGarry, one
 of the analysis’s authors.

The vaccination rate has increased from fewer than half of Missouri 
nursing home staff members when President Joe Biden announced the 
mandate for nursing homes Aug. 18 to about two-thirds of staffers now, 
according to the federal data.

Like Frontier, Northview Village does not have enough staffers, and 
most people who work there have not been vaccinated. The facility — a 
nursing home in a predominantly Black, low-income north St. Louis 
neighborhood — held a vaccination drive in December to increase its 
roughly 20% staff vaccination rate, but the numbers did not rise, 
according to the federal data. And only half of residents were fully 
vaccinated.

The Northview management declined to comment.

Kimberly Watkins, a technician who works to keep Northview residents 
active, was reluctant to get any of the shots, in part because she heard
 the conspiracy theory that they contained a tracking chip. But she said
 she decided to go ahead and get vaccinated because she has asthma and 
high blood pressure. Co-workers told her their doctors said that they 
didn’t need the vaccine or that they may be allergic to it.

Now with the mandate taking effect, Moore, of the nonprofit Voyce, thinks most local nursing home staffers will comply.

She highlighted Mary, Queen and Mother Center, a Catholic nonprofit 
nursing home in St. Louis County, that announced its own mandate in 
August. Before its Sept. 30 deadline, the nursing home saw its staff 
vaccination rate increase from 67% to 92%, with the remainder being 
those with a medical or religious exemption, according to the 
organization. The facility retained almost all its staff.

Not everyone is worried about nursing home staffers being vaccinated, in part reflecting the community around them. Just <a href="https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/data/public-health/vaccine-county.php">55% of Missourians</a> are fully vaccinated.

“I’m not into forcing stuff on people,” said Antuan Diltz, a St. 
Louis firefighter whose mother is a 64-year-old retired nurse with 
dementia and diabetes living at Frontier. She received the vaccine; 
Diltz had not.

But others, like Bill Talton, who have family at Frontier hope more 
staffers will get the shots. Talton, a 77-year-old retired computer 
programmer, said he is happy with the care his younger brother, who has 
dementia, has received, although he sometimes couldn’t visit him during 
covid-related lockdowns.

“It’s kind of late in the game,” said Talton, who is fully vaccinated and received a booster. “They’ll get it done — I hope.”

KHN data editor Holly K. Hacker contributed to this report.

<figure>
 <img src="https://media.eaglewebservices.com/public/2022/1/1643123004196.png" alt="Nursing homes in Missouri like Frontier Health &amp; Rehabilitation in St. Charles risk losing funding from Medicaid and Medicare if their employees are not fully vaccinated by March 15. (Eric Berger for KHN)" />
 <figcaption>Nursing homes in Missouri like Frontier Health &amp; Rehabilitation in St. Charles risk losing funding from Medicaid and Medicare if their employees are not fully vaccinated by March 15. (Eric Berger for KHN)</figcaption>
 </figure>By ERIC BERGER <a href="https://khn.org/news/article/with-a-vaccine-mandate-looming-nursing-homes-face-more-staffing-problems/">Kaiser Health News</a>ST. CHARLES, Mo. — Jamie Smith, a staffing agency nurse who loves end-of-life care, said she has been warmly welcomed by staffers and residents at Frontier Health &amp; Rehabilitation in this conservative St. Louis suburb.That’s even though she has not been vaccinated against covid-19.But leaders of the nursing home, where 22 residents died from covid 
before vaccines were available, likely won’t be able to employ 
unvaccinated people like Smith for much longer. The <a href="https://khn.org/news/article/supreme-court-vaccine-mandate-ruling/">U.S. Supreme Court</a> on Jan. 13 upheld a <a href="https://www.govinfo.gov/content/pkg/FR-2021-11-05/pdf/2021-23831.pdf">federal mandate</a>
 requiring health care workers at facilities that receive Medicaid or 
Medicare funding to be fully vaccinated. If all staffers — excluding 
those with approved religious or medical exemptions — aren’t fully 
vaccinated, the facility will lose that money.Health care sites in Missouri and other states that challenged the 
federal requirement have until March 15 for their staffs to be fully 
vaccinated, according to the Centers for Medicare &amp; Medicaid 
Services, while facilities in states that didn’t sue to block the 
mandate have a Feb. 28 deadline.That poses a challenge for Frontier and its residents because the 
nursing home already doesn’t have enough staffers. And it is in the 
state with the lowest rate of fully vaccinated nursing home health care 
workers, 67% as of Jan. 9, according to CMS data. Frontier’s reported 
staff vaccination rate was just 30% at the start of the year.That compares with a national rate of 81%, according to the federal data.<div><iframe title="Nursing Home Staff Vaccination Rates Vary Widely" aria-label="Map" id="datawrapper-chart-hs29A" src="https://datawrapper.dwcdn.net/hs29A/10/" scrolling="no" frameborder="0" style="width: 0; min-width: 100% !important; border: none;" height="686"></div>Although the mandate ensures that unvaccinated staff members are not 
caring for some of the people most vulnerable to the virus, not enough 
workers are willing to take the low-paying, challenging jobs. If they 
quit to avoid getting shots or are fired because they won’t get them, 
nursing home residents might not be any safer — because of lack of care.“Obviously we need good staff members to take care of residents, but 
the residents need to be safe as well,” said Marjorie Moore, who 
supports the mandate and is executive director of Voyce, a St. Louis 
nonprofit that advocates for nursing home residents and their families.“A person who lives in their own home has the chance to say, ‘I don’t
 want somebody in my home who isn’t vaccinated,’” she added. “In a 
nursing home, they don’t have the opportunity to say, ‘I don’t want 
somebody who is unvaccinated coming up and feeding me.’”The problem of inadequate staffing at nursing homes predates the pandemic, and it’s gotten worse.In March 2020, 3.3 million people were employed at U.S. nursing homes
 and residential care facilities, according to the Bureau of Labor 
Statistics. In December 2021, that number had dropped to 2.9 million, a 
loss of 400,000 workers.Nursing home operators can’t find enough staffers because they often 
don’t pay much. The mean hourly wage for nursing assistants in Missouri 
was $13.33 in 2020, according to the statistics bureau. And the homes 
require employees to take on a slew of responsibilities, including 
feeding residents, changing adult diapers, and caring for residents who 
have dementia and may become combative.Nursing assistants “can typically find a job with better pay that is less physically and emotionally demanding,” said <a href="https://www.urmc.rochester.edu/people/26750101-brian-e-mcgarry">Brian McGarry</a>,
 a University of Rochester professor who studies long-term care. 
“Somebody’s life and dignity is in your hands, and it’s a huge 
responsibility, and you are not getting paid commensurate with that 
responsibility.”Those downsides of the job often lead to significant turnover. In 2017-18, <a href="https://anderson-review.ucla.edu/codifying-the-nursing-home-industrys-elusive-alarming-turnover-rates/">the turnover rate</a> among nursing home employees in Missouri was 138%, the fourth-highest in the country, according to a <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00957">study in the journal Health Affairs</a>. Frontier had a rate of more than 300%, according to Huizi Yu, one of the study’s authors.The nursing home’s management declined to comment.Smith, the nurse who works for a health care staffing agency, said 
she has not been vaccinated against covid because she had a rare cancer 
in 2017 and is “very particular about what I put in my body.”She said, “I’m not sure if I would be able to get it just to keep a job.”But, she noted in a text message, “I still practice safely.”And, indeed, no Frontier residents have died from covid since the 
outbreak at the start of the pandemic, according to the federal data. 
But the center reported having seven new confirmed cases among its 
residents and 10 new cases among its staff as of Jan. 9. At the 
beginning of the year, 89% of residents were fully vaccinated against 
covid.Low vaccination levels among staffers place residents at greater risk, according to a <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2115674">recent analysis</a>
 in The New England Journal of Medicine. Facilities in high-covid 
counties with an average staff vaccination rate of approximately 30% had
 nearly three times as many covid deaths among residents as facilities 
where about 82% of employees were vaccinated, the analysis found.“An unvaccinated or low-vaccinated staff, I think, pretty clearly 
puts residents at risk — even if they are vaccinated,” said McGarry, one
 of the analysis’s authors.The vaccination rate has increased from fewer than half of Missouri 
nursing home staff members when President Joe Biden announced the 
mandate for nursing homes Aug. 18 to about two-thirds of staffers now, 
according to the federal data.Like Frontier, Northview Village does not have enough staffers, and 
most people who work there have not been vaccinated. The facility — a 
nursing home in a predominantly Black, low-income north St. Louis 
neighborhood — held a vaccination drive in December to increase its 
roughly 20% staff vaccination rate, but the numbers did not rise, 
according to the federal data. And only half of residents were fully 
vaccinated.The Northview management declined to comment.Kimberly Watkins, a technician who works to keep Northview residents 
active, was reluctant to get any of the shots, in part because she heard
 the conspiracy theory that they contained a tracking chip. But she said
 she decided to go ahead and get vaccinated because she has asthma and 
high blood pressure. Co-workers told her their doctors said that they 
didn’t need the vaccine or that they may be allergic to it.Now with the mandate taking effect, Moore, of the nonprofit Voyce, thinks most local nursing home staffers will comply.She highlighted Mary, Queen and Mother Center, a Catholic nonprofit 
nursing home in St. Louis County, that announced its own mandate in 
August. Before its Sept. 30 deadline, the nursing home saw its staff 
vaccination rate increase from 67% to 92%, with the remainder being 
those with a medical or religious exemption, according to the 
organization. The facility retained almost all its staff.Not everyone is worried about nursing home staffers being vaccinated, in part reflecting the community around them. Just <a href="https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/data/public-health/vaccine-county.php">55% of Missourians</a> are fully vaccinated.“I’m not into forcing stuff on people,” said Antuan Diltz, a St. 
Louis firefighter whose mother is a 64-year-old retired nurse with 
dementia and diabetes living at Frontier. She received the vaccine; 
Diltz had not.But others, like Bill Talton, who have family at Frontier hope more 
staffers will get the shots. Talton, a 77-year-old retired computer 
programmer, said he is happy with the care his younger brother, who has 
dementia, has received, although he sometimes couldn’t visit him during 
covid-related lockdowns.“It’s kind of late in the game,” said Talton, who is fully vaccinated and received a booster. “They’ll get it done — I hope.”KHN data editor Holly K. Hacker contributed to this report.

With vaccine mandate looming, nursing homes face staffing crisis

WASHINGTON (AP) — The Biden administration has issued its first clean energy loan guarantee, reviving an Obama-era program that helped launch the country’s first utility-scale wind and solar farms a decade ago but has largely gone dormant in recent years.

The Energy Department said it would&nbsp;<a href="https://www.energy.gov/lpo/articles/open-business-lpo-issues-new-conditional-commitment-loan-guarantee" target="_blank">guarantee up to $1 billion in loans to help a Nebraska company scale up production of “clean” hydrogen</a>&nbsp;to convert natural gas into commercial products used in manufacturing and agriculture.

The revived loan program is part of President Joe Biden’s efforts to slash planet-warming greenhouse gas emissions in half by 2030, amid legislative gridlock that has stalled a $2 trillion package of social and environmental initiatives. It’s among the tools he can use without new legislation.

Under President Barack Obama, the program boosted Tesla’s efforts to become a behemoth in electric cars, but it stumbled after the&nbsp;<a href="https://apnews.com/article/barack-obama-archive-economic-stimulus-30189ac3d2eb4daf926f2575cf6d0874">California solar company Solyndra failed&nbsp;</a>soon after receiving federal aid a decade ago, costing taxpayers more than $500 million. Republicans and other critics seized on Solyndra as an example of wasteful spending under Obama’s stimulus program.

The aid to Lincoln-based Monolith Inc. is the program’s first non-nuclear loan guarantee since 2016.

Monolith produces “carbon black,” a powdery substance that enhances tires and other rubber products, and hydrogen used in ammonia-based fertilizer.

Monolith says it can create both products while vastly shrinking their greenhouse gas emissions. The company plans to use the Energy Department guarantee to finance a major expansion of its existing Hallam, Nebraska, plant that produces hydrogen and carbon black.

Energy Secretary Jennifer Granholm hailed the announcement as a sign the once-high profile loan program is back in business and ready to support deployment of clean energy, from biofuels to nuclear power and offshore wind.

“Advanced, clean production technology like Monolith’s are the types of impactful projects that support not just sustainability, but economic growth and clean energy jobs for the American people,” Granholm said.

Monolith will use the loan guarantees to “develop the innovation needed to help lead the clean energy transition, while also creating high-paying green jobs and strengthening our nation’s supply chain,” said Rob Hanson, the company’s co-founder and CEO.

Jigar Shah, who took over as director of the loan program office last year, said the program has drawn over 70 applications valued at more than $60 billion. The new bipartisan infrastructure law expanded the program’s authority and broadened the pool of eligible borrowers. The agency has access to roughly $40 billion in loan authority and expects to make an array of loan commitments in 2022, Shah said.

While&nbsp;<a href="https://apnews.com/article/technology-business-steven-chu-8ddaf26f98424eae9dbf733da62c1427">Tesla</a>&nbsp;and Solyndra are the best known examples, the loan office manages over 30 projects worth more than $30 billion and generates $500 million in interest income for the federal government every year, Shah said.

“We have a track record of our projects being winners,″ he said in an interview. “And I know that we get a lot of press on the ones who don’t succeed,″ but the program has suffered just over $1 billion in losses since 2011, or roughly 3.3% of its investment, a figure Shah said is on par with commercial banks.

“Many people think we’re not taking enough risk,″ he said. ”But we’re in line with the best of the best.″

Some companies that apply for assistance “want the Loan Program Office to be sort of your fairy godmother in Cinderella, where you show up in rags and I create a carriage for you out of a pumpkin and turn all the mice into horses and all that stuff,″ Shah said. “But it’s just not the way it works.″

A former clean-energy entrepreneur who founded the SunEdison solar company, Shah said he understands the mindset of loan applicants —“you sell the dream, right?” — but says his job as a government official is to provide a reality check even as he offers assistance.

“Tell me how you’re going to make the mice into horses, and pumpkins into a carriage and the rags into a beautiful dress,″ he said, continuing the metaphor. “What processes and procedures have you learned to put in place? How are you going to protect my money?″

The loan guarantee program “is not intended to be a subsidy. It’s intended to be market-rate debt,″ Shah said.

Monolith is the first-ever commercial-scale project to deploy a technology known as methane pyrolysis, which converts natural gas into carbon black and hydrogen. While carbon black typically emits large volumes of carbon dioxide and other gases, Monolith says its technologies aim to reduce greenhouse gases by up to 80% compared to traditional production.

Robert Howarth, professor of ecology and environmental biology at Cornell University, said he is “highly skeptical that this can be done with low emissions,″ adding that he was “very disappointed” at the Energy Department’s action.

“I very much doubt that emission reductions will be anywhere near that large when the upstream fugitive methane emissions are included,″ Howarth said in an email.

Howarth and Stanford professor Mark Jacobson published a research paper last year questioning climate benefits of so-called blue hydrogen produced from natural gas. “Emissions from blue hydrogen are worse than if one simply burned natural gas for the energy instead,″ Howarth said.

Shah called Howarth a friend, but said he is confident Monolith can meets its projections on carbon pollution.

“Even with the worst case scenario, and methane leakage, we still have 80% reduction in greenhouse gas emissions versus the business as usual processes,″ he said.

Monolith said it would create about 1,000 jobs to support expansion of its hydrogen plant

Goodyear Tire &amp; Rubber Co., one of two tiremakers that has signed a letter of intent to purchase the carbon black, said in a statement it was “excited” to work with Monolith to reduce its carbon footprint.

“As the only U.S.-headquartered tire manufacturer, it’s especially rewarding to be at the connection point of significant U.S. innovation with Monolith” and the Energy Department, said Richard Kramer, Goodyear’s chairman and CEO.

<figure>
 <img src="https://media.eaglewebservices.com/public/2022/1/1643137209562.png" alt="The revived loan program is part of President Joe Biden’s efforts to slash planet-warming greenhouse gas emissions in half by 2030-White House photo" />
 <figcaption>The revived loan program is part of President Joe Biden’s efforts to slash planet-warming greenhouse gas emissions in half by 2030-White House photo</figcaption>
 </figure>WASHINGTON (AP) — The Biden administration has issued its first clean energy loan guarantee, reviving an Obama-era program that helped launch the country’s first utility-scale wind and solar farms a decade ago but has largely gone dormant in recent years.The Energy Department said it would&nbsp;<a href="https://www.energy.gov/lpo/articles/open-business-lpo-issues-new-conditional-commitment-loan-guarantee" target="_blank">guarantee up to $1 billion in loans to help a Nebraska company scale up production of “clean” hydrogen</a>&nbsp;to convert natural gas into commercial products used in manufacturing and agriculture.The revived loan program is part of President Joe Biden’s efforts to slash planet-warming greenhouse gas emissions in half by 2030, amid legislative gridlock that has stalled a $2 trillion package of social and environmental initiatives. It’s among the tools he can use without new legislation.Under President Barack Obama, the program boosted Tesla’s efforts to become a behemoth in electric cars, but it stumbled after the&nbsp;<a href="https://apnews.com/article/barack-obama-archive-economic-stimulus-30189ac3d2eb4daf926f2575cf6d0874">California solar company Solyndra failed&nbsp;</a>soon after receiving federal aid a decade ago, costing taxpayers more than $500 million. Republicans and other critics seized on Solyndra as an example of wasteful spending under Obama’s stimulus program.The aid to Lincoln-based Monolith Inc. is the program’s first non-nuclear loan guarantee since 2016.Monolith produces “carbon black,” a powdery substance that enhances tires and other rubber products, and hydrogen used in ammonia-based fertilizer.Monolith says it can create both products while vastly shrinking their greenhouse gas emissions. The company plans to use the Energy Department guarantee to finance a major expansion of its existing Hallam, Nebraska, plant that produces hydrogen and carbon black.Energy Secretary Jennifer Granholm hailed the announcement as a sign the once-high profile loan program is back in business and ready to support deployment of clean energy, from biofuels to nuclear power and offshore wind.“Advanced, clean production technology like Monolith’s are the types of impactful projects that support not just sustainability, but economic growth and clean energy jobs for the American people,” Granholm said.Monolith will use the loan guarantees to “develop the innovation needed to help lead the clean energy transition, while also creating high-paying green jobs and strengthening our nation’s supply chain,” said Rob Hanson, the company’s co-founder and CEO.Jigar Shah, who took over as director of the loan program office last year, said the program has drawn over 70 applications valued at more than $60 billion. The new bipartisan infrastructure law expanded the program’s authority and broadened the pool of eligible borrowers. The agency has access to roughly $40 billion in loan authority and expects to make an array of loan commitments in 2022, Shah said.While&nbsp;<a href="https://apnews.com/article/technology-business-steven-chu-8ddaf26f98424eae9dbf733da62c1427">Tesla</a>&nbsp;and Solyndra are the best known examples, the loan office manages over 30 projects worth more than $30 billion and generates $500 million in interest income for the federal government every year, Shah said.“We have a track record of our projects being winners,″ he said in an interview. “And I know that we get a lot of press on the ones who don’t succeed,″ but the program has suffered just over $1 billion in losses since 2011, or roughly 3.3% of its investment, a figure Shah said is on par with commercial banks.“Many people think we’re not taking enough risk,″ he said. ”But we’re in line with the best of the best.″Some companies that apply for assistance “want the Loan Program Office to be sort of your fairy godmother in Cinderella, where you show up in rags and I create a carriage for you out of a pumpkin and turn all the mice into horses and all that stuff,″ Shah said. “But it’s just not the way it works.″A former clean-energy entrepreneur who founded the SunEdison solar company, Shah said he understands the mindset of loan applicants —“you sell the dream, right?” — but says his job as a government official is to provide a reality check even as he offers assistance.“Tell me how you’re going to make the mice into horses, and pumpkins into a carriage and the rags into a beautiful dress,″ he said, continuing the metaphor. “What processes and procedures have you learned to put in place? How are you going to protect my money?″The loan guarantee program “is not intended to be a subsidy. It’s intended to be market-rate debt,″ Shah said.Monolith is the first-ever commercial-scale project to deploy a technology known as methane pyrolysis, which converts natural gas into carbon black and hydrogen. While carbon black typically emits large volumes of carbon dioxide and other gases, Monolith says its technologies aim to reduce greenhouse gases by up to 80% compared to traditional production.Robert Howarth, professor of ecology and environmental biology at Cornell University, said he is “highly skeptical that this can be done with low emissions,″ adding that he was “very disappointed” at the Energy Department’s action.“I very much doubt that emission reductions will be anywhere near that large when the upstream fugitive methane emissions are included,″ Howarth said in an email.Howarth and Stanford professor Mark Jacobson published a research paper last year questioning climate benefits of so-called blue hydrogen produced from natural gas. “Emissions from blue hydrogen are worse than if one simply burned natural gas for the energy instead,″ Howarth said.Shah called Howarth a friend, but said he is confident Monolith can meets its projections on carbon pollution.“Even with the worst case scenario, and methane leakage, we still have 80% reduction in greenhouse gas emissions versus the business as usual processes,″ he said.Monolith said it would create about 1,000 jobs to support expansion of its hydrogen plantGoodyear Tire &amp; Rubber Co., one of two tiremakers that has signed a letter of intent to purchase the carbon black, said in a statement it was “excited” to work with Monolith to reduce its carbon footprint.“As the only U.S.-headquartered tire manufacturer, it’s especially rewarding to be at the connection point of significant U.S. innovation with Monolith” and the Energy Department, said Richard Kramer, Goodyear’s chairman and CEO.

Biden revives 'clean energy' program with $1B loan guarantee

Pfizer is enrolling healthy adults to test a reformulated COVID-19 vaccine that matches the hugely contagious&nbsp;<a href="https://apnews.com/article/how-can-i-protect-myself-from-omicron-variant-c4e5662a36708a594c454b171ab93bd0">omicron variant</a>, to see how it compares with the original shots.

Pfizer and its partner BioNTech announced the study on Tuesday.

COVID-19 vaccine-makers have been updating their shots to better match omicron in case global health authorities decide the change is needed.

Omicron is more likely than previous variants to cause infection even in people who’ve been vaccinated, but it’s not yet clear that a change to the vaccine recipe will be ordered. Among the issues regulators are weighing: Some of the first places to face an omicron surge already are seeing the mutant wane — and there’s no way to know if the next variant that arises will resemble omicron or be totally different.

The original vaccines still offer good protection against severe illness and death. Studies in the U.S. and elsewhere have made clear that adding a booster dose strengthens that protection and improves the chances of avoiding even a milder infection.

“We recognize the need to be prepared in the event this protection wanes over time and to potentially help address omicron and new variants in the future,” Kathrin Jansen, Pfizer’s vaccine research chief, said in a statement.

The new U.S. study will include up to 1,420 volunteers ages 18 to 55 to test the updated omicron-based shots for use as a booster or for primary vaccinations. Researchers will examine the tweaked vaccine’s safety and how it revs up the immune system in comparison to the original shots.

Full study results will take many months as volunteers receive multiple vaccine doses — and as researchers measure how long virus-fighting antibodies remain at high levels after an omicron-adapted dose versus the regular booster.

Pfizer’s CEO told CNBC earlier this month that the company could have some omicron-matched doses ready as early as March. But doing what the company calls “at-risk” manufacturing doesn’t mean those doses will be rolled out to the public. Pfizer and other vaccine makers also have brewed and tested experimental doses to match previous variants, changes that ultimately weren’t needed but offered valuable practice at tweaking the recipe.

For the new study, one group of about 600 volunteers who received two doses of the current Pfizer vaccine three to six months ago will receive either one or two omicron-based shots as boosters. Another 600 who have already gotten three regular doses of the Pfizer vaccine will be given a fourth dose of either the regular vaccine or the omicron-matched version.

The study also will enroll some unvaccinated volunteers who will receive three doses of the omicron-based vaccine.

Pfizer plans to produce 4 billion vaccine doses in 2022, and said Tuesday the amount isn’t expected to change if an omicron-adapted version is needed.

<figure>
 <img src="https://media.eaglewebservices.com/public/2020/11/1604926559777.png" alt="Pfizer and its partner BioNTech announced the study on Tuesday.-photo courtesy Pfizer" />
 <figcaption>Pfizer and its partner BioNTech announced the study on Tuesday.-photo courtesy Pfizer</figcaption>
 </figure>By LAURAN NEERGAARD, Associated PressPfizer is enrolling healthy adults to test a reformulated COVID-19 vaccine that matches the hugely contagious&nbsp;<a href="https://apnews.com/article/how-can-i-protect-myself-from-omicron-variant-c4e5662a36708a594c454b171ab93bd0">omicron variant</a>, to see how it compares with the original shots.Pfizer and its partner BioNTech announced the study on Tuesday.COVID-19 vaccine-makers have been updating their shots to better match omicron in case global health authorities decide the change is needed.Omicron is more likely than previous variants to cause infection even in people who’ve been vaccinated, but it’s not yet clear that a change to the vaccine recipe will be ordered. Among the issues regulators are weighing: Some of the first places to face an omicron surge already are seeing the mutant wane — and there’s no way to know if the next variant that arises will resemble omicron or be totally different.The original vaccines still offer good protection against severe illness and death. Studies in the U.S. and elsewhere have made clear that adding a booster dose strengthens that protection and improves the chances of avoiding even a milder infection.“We recognize the need to be prepared in the event this protection wanes over time and to potentially help address omicron and new variants in the future,” Kathrin Jansen, Pfizer’s vaccine research chief, said in a statement.The new U.S. study will include up to 1,420 volunteers ages 18 to 55 to test the updated omicron-based shots for use as a booster or for primary vaccinations. Researchers will examine the tweaked vaccine’s safety and how it revs up the immune system in comparison to the original shots.Full study results will take many months as volunteers receive multiple vaccine doses — and as researchers measure how long virus-fighting antibodies remain at high levels after an omicron-adapted dose versus the regular booster.Pfizer’s CEO told CNBC earlier this month that the company could have some omicron-matched doses ready as early as March. But doing what the company calls “at-risk” manufacturing doesn’t mean those doses will be rolled out to the public. Pfizer and other vaccine makers also have brewed and tested experimental doses to match previous variants, changes that ultimately weren’t needed but offered valuable practice at tweaking the recipe.For the new study, one group of about 600 volunteers who received two doses of the current Pfizer vaccine three to six months ago will receive either one or two omicron-based shots as boosters. Another 600 who have already gotten three regular doses of the Pfizer vaccine will be given a fourth dose of either the regular vaccine or the omicron-matched version.The study also will enroll some unvaccinated volunteers who will receive three doses of the omicron-based vaccine.Pfizer plans to produce 4 billion vaccine doses in 2022, and said Tuesday the amount isn’t expected to change if an omicron-adapted version is needed.___

Pfizer begins testing omicron-matched COVID shots in adults

KANSAS CITY(AP) — Police in Kansas City are investigating the city’s latest shooting death after officers found a woman fatally wounded on a sidewalk early Tuesday.

The shooting happened around 12:30 a.m. Tuesday in the northeastern section of the city, police said in a news release. Officers called to the scene found the woman unresponsive on a sidewalk with a gunshot wound. Paramedics declared her dead at the scene.

Her name was not immediately released. Police have not announced any arrests or suspects in the case.

Detectives were canvassing the area for witnesses, and and crime scene officials were processing the scene for evidence.

<figure>
 <img src="https://media.eaglewebservices.com/public/2022/1/1643129663292.png" alt="Police on the scene of the investigation early Tuesday -photo courtesy KMBC" />
 <figcaption>Police on the scene of the investigation early Tuesday -photo courtesy KMBC</figcaption>
 </figure>KANSAS CITY(AP) — Police in Kansas City are investigating the city’s latest shooting death after officers found a woman fatally wounded on a sidewalk early Tuesday.The shooting happened around 12:30 a.m. Tuesday in the northeastern section of the city, police said in a news release. Officers called to the scene found the woman unresponsive on a sidewalk with a gunshot wound. Paramedics declared her dead at the scene.Her name was not immediately released. Police have not announced any arrests or suspects in the case.Detectives were canvassing the area for witnesses, and and crime scene officials were processing the scene for evidence.

Police find woman fatally wounded on sidewalk in Kansas City

RENO COUNTY—Law enforcement authorities are investigating a Kansas felon on new charges after a Monday arrest.

On Monday evening, police stopped a vehicle driven by 29-year-old Derek Jaquez in the 500 Block of East 6th Street in Hutchinson, according to a media release. Police called in a K-9 unit to check for drugs.&nbsp;A search of the vehicle turned up ten pounds of marijuana in the back seat of the vehicle.

Officers took Jaquez into custody on requested charges of of possession of marijuana with intent to distribute, possession of drug paraphernalia and driving while suspended.&nbsp;&nbsp;

Jaquez has previous convictions for burglary and aggravated battery, according to the Kansas Department of Corrections.

<figure>
 <img src="https://media.eaglewebservices.com/public/2022/1/1643126166073.png" alt="Jaquez has previous convictions for burglary and aggravated battery, according to the Kansas Department of Corrections." />
 <figcaption>Jaquez has previous convictions for burglary and aggravated battery, according to the Kansas Department of Corrections.</figcaption>
 </figure>RENO COUNTY—Law enforcement authorities are investigating a Kansas felon on new charges after a Monday arrest.On Monday evening, police stopped a vehicle driven by 29-year-old Derek Jaquez in the 500 Block of East 6th Street in Hutchinson, according to a media release. Police called in a K-9 unit to check for drugs.&nbsp;A search of the vehicle turned up ten pounds of marijuana in the back seat of the vehicle.<figure>
 <img src="https://media.eaglewebservices.com/public/2022/1/1643121971581.jpeg" alt="Photo Hutchinson Police" />
 <figcaption>Photo Hutchinson Police</figcaption>
 </figure>Officers took Jaquez into custody on requested charges of of possession of marijuana with intent to distribute, possession of drug paraphernalia and driving while suspended.&nbsp;&nbsp;Jaquez has previous convictions for burglary and aggravated battery, according to the Kansas Department of Corrections.

Police arrest Kansas felon after K9 finds 10 pounds of marijuana

By TIM CARPENTER <a href="https://kansasreflector.com/2022/01/22/legislative-auditors-skeptical-prairiefire-development-can-pay-off-64-8m-in-bond-debt/">Kansas Reflector</a>

TOPEKA — The Overland Park 
retail, office, hotel and residential development attached to the 
Prairiefire museum struggles to attract out-of-state tourists and could 
default on $64.8 million in bond debt issued through a state economic 
development program under scrutiny by the Legislature.

Auditors with the Legislature said their analysis of the Prairiefire 
project built with capital raised through issuance in 2012 of Sales Tax 
Revenue Bonds, or STAR bonds, indicated the project wasn’t generating 
enough sales tax revenue to repay debts in the required 20-year period. 
Originally, $64.9 million in bonds were issued for the project. Debt 
remaining to be paid: $64.8 million.

Auditors predicted it could take until 2046 or 2104 to produce 
sufficient sales tax revenue to retire the Prairiefire obligations held 
by the city of Overland Park.

“They are in danger of default,” said Andy Brienzo, of the 
Legislature’s audit division. “We can’t say that definitively. There is 
some additional development that is slated to happen.”

Bob North, general counsel with the Kansas Department of Commerce, 
said he didn’t share skepticism of auditors but also couldn’t guarantee 
success of Prairiefire, which includes a museum for traveling natural 
history exhibits. The commerce department has approved 19 STAR bond 
projects since the 1990s for Atchison, Garden City, Salina, Wichita, 
Topeka, Goddard, Manhattan and other cities.

He said museums, racetracks, sports facilities and other venues build
 with of $1.1 billion in bond proceeds were intended to raise the 
quality of life for benefit of Kansans and to attract tourists to the 
state. He said the objective of STAR bonds wasn’t simply generation of 
tax revenue.

“If they were, we’d take our money and build a bunch of Walmarts,” 
North said. “The goal of STAR bonds is to create attractions that are 
going to bring visitors to the state.”

The House and Senate commerce committees this week invited the Kansas
 Division of Legislative Post Audit to outline findings of a 2021 audit 
of STAR bond initiatives. Auditors discovered only three projects 
outside of the mega-development at Village West in Wyandotte County that
 fulfilled the objective of elevating tourism.

“STAR bonds are a very, very effective and strong economic 
development tool,” North said. “They’ve worked well in most instances. 
I’m not going to tell you every project is perfect.”

Rep. Kristey Williams, an Augusta Republican, said she was 
disappointed with the quality of information submitted to the state by 
STAR bond recipients.

“As we look at the annual reports that were submitted to the 
Department of Commerce,” she said, “some of it doesn’t give real data. 
It might say visitation went up 30%. Well, 30% from what number?”

Sen. Jeff Pittman, D-Leavenworth, said the assessment of STAR bonds 
by legislative auditors was “a particularly narrow evaluation.” It was 
based on estimates of out-of-state visitors and documentation of sales 
tax revenue but didn’t take into account other evidence of economic 
development such as the multiplier effect of those new businesses, he 
said.

“I have some issues with some of this,” Pittman said.

The latest STAR bond annual report submitted to the Legislature by 
the Department of Commerce pointed to success of Children’s Mercy Park 
where the Sporting Kansas City professional soccer team plays. It’s 
become one of the state’s top tourist destinations.

To build the MLS soccer complex, $150 million in STAR bonds were 
issued in 2010. That debt was paid off in less than seven years.

Jake Reid, president and chief executive officer of Sporting Kansas 
City, said the franchise derived significant benefit from the STAR bond 
law and the private-public partnership with the Unified Government of 
Wyandotte County and the state of Kansas.

“We’re the second-smallest market in our league, yet we often times 
consistently punch above our weight class in terms of on-field results 
as well as the business results,” Reid said. “On average, we drive over 
600,000 per year through Children’s Mercy Park.”

<figure>
 <img src="https://media.eaglewebservices.com/public/2022/1/1643043754354.png" alt="The Kansas Legislature’s auditors say the Prairiefire development in Overland Park financed with $65 million in STAR bonds issued under a state program is in jeopardy of defaulting on debt because it won’t likely retire the bonds in the required 20 years. (Screen capture/Kansas Department of Commerce report)" />
 <figcaption>The Kansas Legislature’s auditors say the Prairiefire development in Overland Park financed with $65 million in STAR bonds issued under a state program is in jeopardy of defaulting on debt because it won’t likely retire the bonds in the required 20 years. (Screen capture/Kansas Department of Commerce report)</figcaption>
 </figure>By TIM CARPENTER <a href="https://kansasreflector.com/2022/01/22/legislative-auditors-skeptical-prairiefire-development-can-pay-off-64-8m-in-bond-debt/">Kansas Reflector</a>TOPEKA — The Overland Park 
retail, office, hotel and residential development attached to the 
Prairiefire museum struggles to attract out-of-state tourists and could 
default on $64.8 million in bond debt issued through a state economic 
development program under scrutiny by the Legislature.Auditors with the Legislature said their analysis of the Prairiefire 
project built with capital raised through issuance in 2012 of Sales Tax 
Revenue Bonds, or STAR bonds, indicated the project wasn’t generating 
enough sales tax revenue to repay debts in the required 20-year period. 
Originally, $64.9 million in bonds were issued for the project. Debt 
remaining to be paid: $64.8 million.Auditors predicted it could take until 2046 or 2104 to produce 
sufficient sales tax revenue to retire the Prairiefire obligations held 
by the city of Overland Park.“They are in danger of default,” said Andy Brienzo, of the 
Legislature’s audit division. “We can’t say that definitively. There is 
some additional development that is slated to happen.”Bob North, general counsel with the Kansas Department of Commerce, 
said he didn’t share skepticism of auditors but also couldn’t guarantee 
success of Prairiefire, which includes a museum for traveling natural 
history exhibits. The commerce department has approved 19 STAR bond 
projects since the 1990s for Atchison, Garden City, Salina, Wichita, 
Topeka, Goddard, Manhattan and other cities.He said museums, racetracks, sports facilities and other venues build
 with of $1.1 billion in bond proceeds were intended to raise the 
quality of life for benefit of Kansans and to attract tourists to the 
state. He said the objective of STAR bonds wasn’t simply generation of 
tax revenue.“If they were, we’d take our money and build a bunch of Walmarts,” 
North said. “The goal of STAR bonds is to create attractions that are 
going to bring visitors to the state.”The House and Senate commerce committees this week invited the Kansas
 Division of Legislative Post Audit to outline findings of a 2021 audit 
of STAR bond initiatives. Auditors discovered only three projects 
outside of the mega-development at Village West in Wyandotte County that
 fulfilled the objective of elevating tourism.“STAR bonds are a very, very effective and strong economic 
development tool,” North said. “They’ve worked well in most instances. 
I’m not going to tell you every project is perfect.”Rep. Kristey Williams, an Augusta Republican, said she was 
disappointed with the quality of information submitted to the state by 
STAR bond recipients.“As we look at the annual reports that were submitted to the 
Department of Commerce,” she said, “some of it doesn’t give real data. 
It might say visitation went up 30%. Well, 30% from what number?”Sen. Jeff Pittman, D-Leavenworth, said the assessment of STAR bonds 
by legislative auditors was “a particularly narrow evaluation.” It was 
based on estimates of out-of-state visitors and documentation of sales 
tax revenue but didn’t take into account other evidence of economic 
development such as the multiplier effect of those new businesses, he 
said.“I have some issues with some of this,” Pittman said.The latest STAR bond annual report submitted to the Legislature by 
the Department of Commerce pointed to success of Children’s Mercy Park 
where the Sporting Kansas City professional soccer team plays. It’s 
become one of the state’s top tourist destinations.To build the MLS soccer complex, $150 million in STAR bonds were 
issued in 2010. That debt was paid off in less than seven years.Jake Reid, president and chief executive officer of Sporting Kansas 
City, said the franchise derived significant benefit from the STAR bond 
law and the private-public partnership with the Unified Government of 
Wyandotte County and the state of Kansas.“We’re the second-smallest market in our league, yet we often times 
consistently punch above our weight class in terms of on-field results 
as well as the business results,” Reid said. “On average, we drive over 
600,000 per year through Children’s Mercy Park.”

Auditors skeptical KC-area development can pay off $64.8M in bond debt

SEDGWICK COUNTY—Law enforcement authorities are investigating a suspect in connection with an officer involved shooting in Wichita.

Just before 1:30a.m. Monday, a Sedgwick County sheriff’s deputy observed the driver of a red Lexus later identified as 26-year-old Kory Anziana of Wichita  commit a traffic violation near the intersection of Pawnee and Meridian in Wichita, according to Sheriff's Lt. Benjamin Blick.

 The deputy attempted to stop the Lexus and Anziana fled in the vehicle. The pursuit lasted approximately six minutes with the top speeds reported near 70 MPH. The pursuit ended when the Lexus became high-centered in the parking lot of the Regency Inn at 6125 W Kellogg Drive in Wichita.

Anziana shot at the pursuing deputy and two deputies returned fire. No one was struck by any of the gunfire. He then fled into an occupied room at the Regency Inn. One of the occupants of the room was able to communicate with motel staff and eventually law enforcement through a messenger app. Eventually, the occupants of the room walked out on their own. At approximately 8:25a.m. the deputies arrested Anziana.

He is being held on requested charges of Aggravated Assault, Criminal Possession of a Firearm, Flee and Elude, Drug charges and three outstanding arrest warrants, according to Lt. Blick.&nbsp;Anziana has previous conviction that include theft and for drugs, according to the Kansas Dept. of Corrections.

<figure>
 <img src="https://media.eaglewebservices.com/public/2022/1/1643045344587.png" alt="Law enforcement on the scene of the standoff early Monday -photo courtesy KWCH" />
 <figcaption>Law enforcement on the scene of the standoff early Monday -photo courtesy KWCH</figcaption>
 </figure>SEDGWICK COUNTY—Law enforcement authorities are investigating a suspect in connection with an officer involved shooting in Wichita.Just before 1:30a.m. Monday, a Sedgwick County sheriff’s deputy observed the driver of a red Lexus later identified as 26-year-old Kory Anziana of Wichita commit a traffic violation near the intersection of Pawnee and Meridian in Wichita, according to Sheriff's Lt. Benjamin Blick. The deputy attempted to stop the Lexus and Anziana fled in the vehicle. The pursuit lasted approximately six minutes with the top speeds reported near 70 MPH. The pursuit ended when the Lexus became high-centered in the parking lot of the Regency Inn at 6125 W Kellogg Drive in Wichita.<figure>
 <img src="https://media.eaglewebservices.com/public/2022/1/1643074033843.png" alt="Anziana- has previous conviction that include theft and for drugs, according to the Kansas Dept. of Corrections- photo Sedgwick Co." />
 <figcaption>Anziana- has previous conviction that include theft and for drugs, according to the Kansas Dept. of Corrections- photo Sedgwick Co.</figcaption>
 </figure>Anziana shot at the pursuing deputy and two deputies returned fire. No one was struck by any of the gunfire. He then fled into an occupied room at the Regency Inn. One of the occupants of the room was able to communicate with motel staff and eventually law enforcement through a messenger app. Eventually, the occupants of the room walked out on their own. At approximately 8:25a.m. the deputies arrested Anziana.He is being held on requested charges of Aggravated Assault, Criminal Possession of a Firearm, Flee and Elude, Drug charges and three outstanding arrest warrants, according to Lt. Blick.&nbsp;Anziana has previous conviction that include theft and for drugs, according to the Kansas Dept. of Corrections.

Sheriff: Kan. felon identified as suspect in deputy shooting, standoff

WASHINGTON (AP) — The Pentagon ordered 8,500 troops on higher alert Monday to potentially deploy to Europe as part of a NATO “response force” amid growing concern that Russia could soon make a military move on Ukraine. President Joe Biden consulted with key European leaders, underscoring U.S. solidarity with allies there.

Putting the U.S.-based troops on heightened alert for Europe suggested diminishing hope that Russian President Vladimir Putin will back away from what Biden himself has said looks like a threat to invade neighboring Ukraine.

At stake, beyond the future of Ukraine, is the credibility of a NATO alliance that is central to U.S. defense strategy but that Putin views as a Cold War relic and a threat to Russian security. For Biden, the crisis represents a major test of his ability to forge a united&nbsp;<a href="https://apnews.com/article/russia-ukraine-russia-vladimir-putin-soviet-union-europe-32b8a914ad4debba6c3231738a5f5a36">allied stance against Putin.</a>

Pentagon press secretary John Kirby said about 8,500 U.S.-based troops are being put on alert for possible deployment — not to Ukraine but to NATO territory in Eastern Europe as part of an alliance force meant to signal a unified commitment to deter any wider Putin aggression.

<a href="https://apnews.com/article/russia-ukraine-europe-britain-intelligence-claims-8342b5b5aafd6a095d2e427d3e4201c5">Russia denies it is planning an invasion.</a>&nbsp;It says Western accusations are merely a cover for NATO’s own planned provocations. Recent days have seen high-stakes diplomacy that has failed to reach any breakthrough, and key players in the drama are making moves that suggest fear of imminent war. Biden has sought to strike a balance between actions meant to deter Putin and those that might provide the Russian leader with an opening to use the huge force he has assembled at Ukraine’s border.

Biden held an 80-minute video call with several European leaders on the Russian military buildup and potential responses to an invasion.

“I had a very, very, very good meeting -- total unanimity with all the European leaders,” Biden told reporters at the White House. “We’ll talk about it later.”

The White House said the leaders emphasized their desire for a diplomatic solution to the crisis but also discussed efforts to deter further Russian aggression, “including preparations to impose massive consequences and severe economic costs on Russia for such actions as well as to reinforce security on NATO’s eastern flank.”

A day earlier, the State Department had ordered the families of all American personnel at the U.S. Embassy in Kyiv to leave the country, and it said that nonessential embassy staff could leave at U.S. government expense.

Ukraine’s Foreign Ministry spokesman, Oleg Nikolenko, said that U.S. decision was “a premature step” and a sign of “excessive caution.” He said Russia was sowing panic among Ukrainians and foreigners in order to destabilize Ukraine.

Britain said it, too, was withdrawing some diplomats and dependents from its Kyiv Embassy. Prime Minister Boris Johnson said an invasion was not inevitable but “the intelligence is pretty gloomy.”

Ordering even a modest number of American troops to be ready for potential deployment to Europe is meant to demonstrate U.S. resolve to support its NATO allies, particularly those in Eastern Europe who feel threatened by Russia and worry that Putin could put them in his crosshairs.

“What this is about is reassurance to our NATO allies,” Kirby told a Pentagon news conference, adding that no troops are intended for deployment to Ukraine, which is not a member of the alliance but has been assured by Washington of continued U.S. political support and arms supplies.

The Pentagon’s move, which was done at Biden’s direction and on Defense Secretary Lloyd Austin’s recommendation, is being made in tandem with actions by other NATO member governments to bolster a defensive presence in Eastern European nations. Denmark, for example, is sending a frigate and F-16 warplanes to Lithuania; Spain is sending four fighter jets to Bulgaria and three ships to the Black Sea to join NATO naval forces, and France stands ready to send troops to Romania.

In a statement prior to Kirby’s announcement, NATO said the Netherlands plans to send two F-35 fighter aircraft to Bulgaria in April and is putting a ship and land-based units on standby for NATO’s Response Force.

NATO has not made a decision to activate the Response Force, which consists of about 40,000 troops from multiple nations. That force was enhanced in 2014 — the year Russia seized Ukraine’s Crimea Peninsula and intervened in support of pro-Russian separatists in eastern Ukraine — by creating a “spearhead force” of about 20,000 troops on extra-high alert within the larger Response Force.

If NATO does decide to activate the Response Force, the United States will contribute a range of military units, Kirby said.

“It is a NATO call to make,” Kirby said. “For our part, we wanted to make sure that we were ready in case that call should come. And that means making sure that units that would contribute to it are as ready as they can be on as short a notice as possible.”

He said some units will be ordered to be ready to deploy on as little as five days’ notice. Among the 8,500 troops, an unspecified number could be sent to Europe for purposes other than supporting the NATO Response Force, he said. Without providing details, he said they might be deployed “if other situations develop.”

Prior to the U.S. announcement, NATO issued a statement summing up moves already described by member countries. Restating them under the NATO banner appeared aimed at showing resolve. The West is ramping up its rhetoric in the information war that has accompanied the&nbsp;<a href="https://apnews.com/article/russia-ukraine-russia-vladimir-putin-soviet-union-europe-32b8a914ad4debba6c3231738a5f5a36">Ukraine standoff</a>.

Russia has&nbsp;<a href="https://apnews.com/article/russia-ukraine-europe-vladimir-putin-moscow-united-states-5fbc86c84dfeb604ebe12e47a753bdcb">massed an estimated 100,000 troops near Ukraine’s border,</a>&nbsp;demanding that NATO promise it will never allow Ukraine to join and that other actions, such as stationing alliance troops in former Soviet bloc countries, be curtailed.

NATO said Monday it is bolstering its deterrence in the Baltic Sea region.

The alliance will “take all necessary measures to protect and defend all allies,” Secretary-General Jens Stoltenberg said. “We will always respond to any deterioration of our security environment, including through strengthening our collective defense.”

In Moscow, Kremlin spokesman Dmitry Peskov said it was NATO and the U.S. who were behind the escalating tensions, not Russia.

“All this is happening not because of what we, Russia, are doing. This is happening because of what NATO, the U.S. are doing,” Peskov told reporters.

The NATO announcement came as European Union foreign ministers sought to put on their own fresh display of unity in support of Ukraine, and paper over concerns about divisions on the best way to confront any Russian aggression.