Experts worry older patients could be exposed to ‘catastrophic’ costs and interrupted access to care.

BY:&nbsp;<a href="https://stateline.org/author/avollers/">ANNA CLAIRE VOLLERS</a> <a href="https://stateline.org/">Stateline</a>

HUNTSVILLE, Ala. — Libby and Andrew Potter usually ignore the avalanche of Medicare Advantage ads that land in the mailbox at their home in Huntsville, Alabama, each fall as Medicare’s open enrollment period begins.

Libby, a retired middle school librarian, has what she considers good health insurance through the state employee health plan. Andrew has insurance through his job as a university professor and plans to join Libby’s insurance when he retires next year.

But this year, a few days before open enrollment began, a letter arrived from UnitedHealthcare, informing the Potters that the region’s largest hospital system would no longer be considered in-network for Libby’s Medicare Advantage plan.

The Potters spent the next couple of weeks worried and unsure what to do. It seemed incredible that 14 area hospitals, including the area’s only Level 1 trauma center, could suddenly become much, much more expensive.

“We were being very careful in how we go up and down stairs,” Libby joked.

Medicare is the federal health insurance program for people over 65 and those with certain disabilities. Medicare Advantage is a version of Medicare run by private insurance companies that contract with the government. These plans typically offer extra benefits, such as dental, vision and prescription drug coverage, that aren’t included with traditional Medicare.&nbsp;<a href="https://www.medpac.gov/wp-content/uploads/2024/03/Mar24_Ch12_MedPAC_Report_To_Congress_SEC.pdf" target="_blank">More than half</a>&nbsp;of eligible Medicare beneficiaries now get their coverage through private Medicare Advantage plans.

But this year, as Medicare’s open enrollment season kicks off, more than 1 million patients will have to shop for new health insurance. Facing financial and federal regulatory pressures, many insurers are pulling their Medicare Advantage plans from counties and states they’ve deemed unprofitable. Meanwhile, large health systems in states including Alabama, Minnesota and Vermont have cut ties with some Medicare Advantage plans.

It’s a situation that’s alarmed state insurance regulators, who are fielding questions from older adults concerned about their hospitals and doctors withdrawing from their Medicare Advantage plans. Last month, the National Association of Insurance Commissioners sent&nbsp;<a href="https://content.naic.org/sites/default/files/inline-files/FINAL%20MA%20SEP%20CMS%20Letter%20Sept%202024.pdf" target="_blank">a letter</a>&nbsp;to the federal Centers for Medicare &amp; Medicaid Services asking for guidance.

“Beneficiaries are faced with either paying the increased out-of-network costs or rescheduling their necessary medical services with another provider who may not have prompt availability,” the insurance commissioners’ group wrote. “A delay in access to medically necessary services is likely to result in harm.”

The Potters eventually learned that Libby’s copayments at the hospital would remain the same whether or not the hospital was in-network for the state educators’ Medicare Advantage plan. But those with other UnitedHealthcare Medicare Advantage plans will have to pay more — or find another plan.

“When a contract leaves the market, that can threaten continuity of care and access to care,” said Dr. Amal Trivedi, professor of health services, policy and practice at the Brown University School of Public Health. “The beneficiary will have to choose a new plan, and each of these plans is going to have a different benefit structure, different provider network, different prior authorization policies and different [prescription drug] formularies.

“The worry is that’s going to affect their out-of-pocket costs, expose them to catastrophic spending, or compromise their access to care.”

Insurance giants such as UnitedHealthcare have been aggressively pushing enrollment in their Medicaid Advantage plans for the past several years, luring customers with perks and bonuses not available through traditional Medicare. These plans tend to have low or even no monthly premiums and offer extra benefits such as vision and dental coverage, gym memberships, transportation to medical appointments, and even debit cards for medical supplies.

And they’re simple: They provide all of a person’s coverage in one plan, unlike traditional Medicare, under which people must get separate prescription drug coverage and supplemental coverage.

But there are trade-offs. Medicare Advantage plans often have a limited network of hospitals and physicians. And while the premiums are typically low, enrollees could end up&nbsp;<a href="https://www.ncoa.org/article/what-is-the-difference-between-medicare-advantage-and-medigap/#:~:text=You%20could%20end,with%20Original%20Medicare)." target="_blank">paying more in the long run</a>&nbsp;in copays and deductibles if they develop a serious illness.

Medicare Advantage programs also are&nbsp;<a href="https://www.kff.org/medicare/issue-brief/use-of-prior-authorization-in-medicare-advantage-exceeded-46-million-requests-in-2022/#:~:text=Virtually%20all%20enrollees%20in%20Medicare%20Advantage%20(99%25)%20are%20required%20to%20obtain%20prior%20authorization%20for%20some%20services%20%E2%80%93%20most%20commonly%2C%20higher%20cost%20services%2C%20such%20as%20inpatient%20hospital%20stays%2C%20skilled%20nursing%20facility%20stays%2C%20and%20chemotherapy.%20This%20contrasts%20with%20traditional%20Medicare" target="_blank">more likely than traditional Medicare</a>&nbsp;to require prior authorization for hospital stays and other high-cost services. The plans’ prior authorization requirements have&nbsp;<a href="https://www.nytimes.com/2024/05/25/science/medicare-seniors-authorization.html" target="_blank">prompted increased scrutiny</a>&nbsp;in recent years. A congressional investigation by Democratic Senate staff released this month, for example, found the nation’s largest Medicare Advantage insurers&nbsp;<a href="https://www.hsgac.senate.gov/wp-content/uploads/2024.10.17-PSI-Majority-Staff-Report-on-Medicare-Advantage.pdf" target="_blank">denied a quarter of all prior authorization requests</a>&nbsp;for post-acute care in nursing homes, rehab hospitals and long-term care.

Medicare Advantage is popular among large employers, many of which are&nbsp;<a href="https://www.kff.org/medicare/issue-brief/10-reasons-why-medicare-advantage-enrollment-is-growing-and-why-it-matters/#:~:text=A%20growing%20share%20of%20large%20employers%20are%20shifting%20their%20Medicare%2Dage%20retirees%20into%20Medicare%20Advantage%20plans%20for%20both%20Medicare%20and%20supplemental%20benefits" target="_blank">shifting their Medicare-age retirees</a>&nbsp;into these plans. And&nbsp;<a href="https://www.kff.org/medicare/issue-brief/in-2024-a-majority-of-states-offer-medicare-advantage-plans-to-their-state-retirees-with-13-offering-medicare-advantage-exclusively/" target="_blank">most states</a>&nbsp;offer Medicare Advantage plans to retired state employees; in 13 states, it’s the only option. In some of those 13 states, retirees forfeit their health benefits in perpetuity if they choose coverage under traditional Medicare.

North Carolina Treasurer Dale Folwell, whose office administers the state health plan, said its Medicare Advantage plan is popular.

“What we hear from our retirees, is that they are grateful and happy to have such a great offering as a result of their retirement benefit,” the Republican said. “That’s why nearly 89% of our retirees over age 65 have availed themselves of the [Medicare Advantage] product we offer them.”

This year, the handful of insurance giants that dominate the Medicare Advantage market have said they’re scaling back or eliminating plans, to shed members and boost sagging profits. They&nbsp;<a href="https://s2.q4cdn.com/447711729/files/doc_financials/2024/q1/CVS-1Q24-Earnings-Transcript.pdf" target="_blank">blame</a>&nbsp;new federal changes to their reimbursements, including&nbsp;<a href="https://www.axios.com/2024/04/02/medicare-advantage-insurer-pay" target="_blank">a small cut to their base payments</a>, and say patients are using more medical services and benefits than they anticipated.

Though most companies haven’t released data on specific counties where they’re making cuts, plans are reportedly shuttering in states such as&nbsp;<a href="https://pfsinsurance.com/news/wellcare-080524" target="_blank">Alabama</a>,&nbsp;<a href="https://pfsinsurance.com/news/wellcare-080524" target="_blank">Massachusetts</a>,&nbsp;<a href="https://www.beckerspayer.com/payer/bcbs-kansas-city-exiting-medicare-advantage-market.html" target="_blank">Missouri</a>,&nbsp;<a href="https://www.concordmonitor.com/harvard-pilgrim-medicare-new-hampshire-57353658" target="_blank">New Hampshire</a>,&nbsp;<a href="https://pfsinsurance.com/news/wellcare-080524" target="_blank">New Mexico</a>,&nbsp;<a href="https://www.dmagazine.com/healthcare-business/2024/09/southwestern-health-resources-to-sunset-medicare-advantage-health-plan-amid-layoffs/" target="_blank">Texas</a>&nbsp;and&nbsp;<a href="https://vtdigger.org/2024/10/03/2-medicare-advantage-plans-will-no-longer-be-available-in-vermont-in-2025/" target="_blank">Vermont</a>, affecting hundreds of thousands of older adults. Experts say the reasons why a company might find certain markets unprofitable are complex, but can include demographics, availability of providers and plans that are already in the market.

“[T]he industry broadly is going to be trimming benefits and in some cases significantly, and exiting from certain counties that aren’t profitable,” Aetna’s former President Brian Kane&nbsp;<a href="https://s2.q4cdn.com/447711729/files/doc_financials/2024/q1/CVS-1Q24-Earnings-Transcript.pdf" target="_blank">told shareholders</a>&nbsp;on an earnings call in May, before he left his position. Aetna, a subsidiary of CVS Health, is the third-largest Medicare Advantage insurer in the nation. “I think that’s an industry issue and I think it’s clearly an Aetna focus as well.”

Executives at CVS Health, Aetna’s parent company, told shareholders the priority for its Medicare Advantage program would be improving profit margins rather than increasing the number of enrollees.

They have not announced publicly which counties will lose Medicare Advantage plans, but noted their changes could&nbsp;<a href="https://www.statnews.com/2024/05/14/cvs-aetna-medicare-advantage-cut-benefits/?utm_campaign=health_care_inc&amp;utm_medium=email&amp;_hsenc=p2ANqtz-_KG6jNdcCYt_b2-JXr0SMQbogbV_XDMgmCvnUjnWW5m_UsBvalMlvUPozxIsPXvn9C126pFPAlA2qO2jZszULKf47ccg&amp;_hsmi=307746331&amp;utm_content=307746331&amp;utm_source=hs_email" target="_blank">push out 10% of their membership</a>, meaning up to 420,000 patients could be forced to shop for a different plan.

Even with the decline in the number of plans available next year, “there are still a lot of plans and people have a lot of options,” said Jeannie Fuglesten Biniek, associate director of the Medicare policy program at KFF, a health policy research organization. Next year, the average Medicare beneficiary will have access to 34 Medicare Advantage plans that include drug coverage, down from 36 this year, she said.

But that average masks wide variation across states and even counties in how many plans are available.

“There are a handful of counties, more than in previous years, where all Medicare Advantage plans exited and those look to be predominantly rural counties,” said Fuglesten Biniek. “We’re talking fortyish counties out of 3,000. For those people in those counties, that matters, but overall, it’s a smaller number.”

Experts say there isn’t enough data available yet to know whether the plan exits are concentrated in certain states or counties.

But research has shown that Medicare Advantage plans that enroll higher shares of Black beneficiaries are&nbsp;<a href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2797677#:~:text=enrolled%20a%20greater%20proportion%20of%20Black%20(21.9%25%20vs%2014.3%25%2C%20P%E2%80%89%3C%E2%80%89.001)%20beneficiaries" target="_blank">more likely to be terminated</a>, said Trivedi, of Brown University. Black enrollees have&nbsp;<a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.13977" target="_blank">more lower-quality Medicare Advantage plans</a>&nbsp;available in their counties of residence than white enrollees, research shows; terminated contracts tend to&nbsp;<a href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2797677#:~:text=Terminated%20contracts%20tended%20to%20have%20lower%20quality" target="_blank">have lower-quality ratings</a>.

“The consequence is that contract terminations in Medicare Advantage seem to have a disproportionate effect on Black beneficiaries because their contracts are more likely to be terminated,” Trivedi said.

A&nbsp;<a href="https://www.kff.org/medicare/report/disparities-in-health-measures-by-race-and-ethnicity-among-beneficiaries-in-medicare-advantage-a-review-of-the-literature/" target="_blank">disproportionate share</a>&nbsp;of Medicare Advantage beneficiaries are Black, Hispanic, and Asian and Pacific Islander. These patients&nbsp;<a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9923792/#:~:text=African%20American%20and%20Hispanic%20Medicare%20beneficiaries%20tend%20to%20have%20lower,et%20al.%2C%202019)." target="_blank">tend to have lower incomes</a>&nbsp;than white beneficiaries, and may by drawn by the lower upfront costs of Medicare Advantage plans.

“[Insurers] like to frame it as, ‘People are choosing us because we’re awesome,’” said Brandon Novick, program outreach assistant at the Center for Economic and Policy Research. “But it’s because financially it makes more sense in the short term” for people with limited incomes.

Meanwhile,&nbsp;<a href="https://www.beckershospitalreview.com/finance/15-health-systems-dropping-medicare-advantage-plans-2024.html" target="_blank">at least 28 health systems</a>&nbsp;in 21 states have stopped accepting some Medicare Advantage plans this year, according to an analysis from Becker’s Hospital Review, an industry publication.

Health systems have cited delayed reimbursements, cumbersome prior authorization requirements and high rates of patient claim denials for their decisions to drop Medicare Advantage plans. Nearly 1 in 5 health systems&nbsp;<a href="https://www.hfma.org/wp-content/uploads/2024/03/Overview-2024-CFO-Pain-Points-Study.pdf" target="_blank">stopped accepting one or more Medicare Advantage plan</a>s last year, according to a report by the Healthcare Financial Management Association.

For retirees like Libby and Andrew Potter, losing access to trusted doctors and hospitals can mean going longer without needed medical care. Finding a new doctor and getting an appointment can take months, particularly for specialists. And for older adults living in rural areas, losing an in-network hospital or physician can mean choosing between a long drive for care or high out-of-pocket costs.

“There are really important access-to-care issues when providers no longer contract with your Medicare Advantage plan,” Trivedi said.

He said the sheer number of plans and differences in benefits might be overwhelming for older adults.

“To sort through all of that when somebody also may have frailty or cognitive impairment, that’s a really tough ask,” Trivedi said. “I study health policy for a living and it’d be hard for me to sort through 40 different options.”

<figure>
 <img src="https://media.eaglewebservices.com/public/2024/10/1729516122048.jpeg" alt="Andrew and Libby Potter look over the letter they received in October, telling them that their region’s largest hospital system would no longer be considered in-network for Libby’s Medicare Advantage policy. The Potters live in Huntsville, Ala., where Libby is a retired middle school librarian and Andrew is a professor at a state university. Anna Claire Vollers/Stateline" />
 <figcaption>Andrew and Libby Potter look over the letter they received in October, telling them that their region’s largest hospital system would no longer be considered in-network for Libby’s Medicare Advantage policy. The Potters live in Huntsville, Ala., where Libby is a retired middle school librarian and Andrew is a professor at a state university. Anna Claire Vollers/Stateline</figcaption>
 </figure><h2>Experts worry older patients could be exposed to ‘catastrophic’ costs and interrupted access to care.</h2>BY:&nbsp;<a href="https://stateline.org/author/avollers/">ANNA CLAIRE VOLLERS</a> <a href="https://stateline.org/">Stateline</a> HUNTSVILLE, Ala. — Libby and Andrew Potter usually ignore the avalanche of Medicare Advantage ads that land in the mailbox at their home in Huntsville, Alabama, each fall as Medicare’s open enrollment period begins.Libby, a retired middle school librarian, has what she considers good health insurance through the state employee health plan. Andrew has insurance through his job as a university professor and plans to join Libby’s insurance when he retires next year.But this year, a few days before open enrollment began, a letter arrived from UnitedHealthcare, informing the Potters that the region’s largest hospital system would no longer be considered in-network for Libby’s Medicare Advantage plan.The Potters spent the next couple of weeks worried and unsure what to do. It seemed incredible that 14 area hospitals, including the area’s only Level 1 trauma center, could suddenly become much, much more expensive.“We were being very careful in how we go up and down stairs,” Libby joked.Medicare is the federal health insurance program for people over 65 and those with certain disabilities. Medicare Advantage is a version of Medicare run by private insurance companies that contract with the government. These plans typically offer extra benefits, such as dental, vision and prescription drug coverage, that aren’t included with traditional Medicare.&nbsp;<a href="https://www.medpac.gov/wp-content/uploads/2024/03/Mar24_Ch12_MedPAC_Report_To_Congress_SEC.pdf" target="_blank">More than half</a>&nbsp;of eligible Medicare beneficiaries now get their coverage through private Medicare Advantage plans.But this year, as Medicare’s open enrollment season kicks off, more than 1 million patients will have to shop for new health insurance. Facing financial and federal regulatory pressures, many insurers are pulling their Medicare Advantage plans from counties and states they’ve deemed unprofitable. Meanwhile, large health systems in states including Alabama, Minnesota and Vermont have cut ties with some Medicare Advantage plans.It’s a situation that’s alarmed state insurance regulators, who are fielding questions from older adults concerned about their hospitals and doctors withdrawing from their Medicare Advantage plans. Last month, the National Association of Insurance Commissioners sent&nbsp;<a href="https://content.naic.org/sites/default/files/inline-files/FINAL%20MA%20SEP%20CMS%20Letter%20Sept%202024.pdf" target="_blank">a letter</a>&nbsp;to the federal Centers for Medicare &amp; Medicaid Services asking for guidance.“Beneficiaries are faced with either paying the increased out-of-network costs or rescheduling their necessary medical services with another provider who may not have prompt availability,” the insurance commissioners’ group wrote. “A delay in access to medically necessary services is likely to result in harm.”The Potters eventually learned that Libby’s copayments at the hospital would remain the same whether or not the hospital was in-network for the state educators’ Medicare Advantage plan. But those with other UnitedHealthcare Medicare Advantage plans will have to pay more — or find another plan.“When a contract leaves the market, that can threaten continuity of care and access to care,” said Dr. Amal Trivedi, professor of health services, policy and practice at the Brown University School of Public Health. “The beneficiary will have to choose a new plan, and each of these plans is going to have a different benefit structure, different provider network, different prior authorization policies and different [prescription drug] formularies.“The worry is that’s going to affect their out-of-pocket costs, expose them to catastrophic spending, or compromise their access to care.”<h2>How we got here</h2>Insurance giants such as UnitedHealthcare have been aggressively pushing enrollment in their Medicaid Advantage plans for the past several years, luring customers with perks and bonuses not available through traditional Medicare. These plans tend to have low or even no monthly premiums and offer extra benefits such as vision and dental coverage, gym memberships, transportation to medical appointments, and even debit cards for medical supplies.And they’re simple: They provide all of a person’s coverage in one plan, unlike traditional Medicare, under which people must get separate prescription drug coverage and supplemental coverage.But there are trade-offs. Medicare Advantage plans often have a limited network of hospitals and physicians. And while the premiums are typically low, enrollees could end up&nbsp;<a href="https://www.ncoa.org/article/what-is-the-difference-between-medicare-advantage-and-medigap/#:~:text=You%20could%20end,with%20Original%20Medicare)." target="_blank">paying more in the long run</a>&nbsp;in copays and deductibles if they develop a serious illness.Medicare Advantage programs also are&nbsp;<a href="https://www.kff.org/medicare/issue-brief/use-of-prior-authorization-in-medicare-advantage-exceeded-46-million-requests-in-2022/#:~:text=Virtually%20all%20enrollees%20in%20Medicare%20Advantage%20(99%25)%20are%20required%20to%20obtain%20prior%20authorization%20for%20some%20services%20%E2%80%93%20most%20commonly%2C%20higher%20cost%20services%2C%20such%20as%20inpatient%20hospital%20stays%2C%20skilled%20nursing%20facility%20stays%2C%20and%20chemotherapy.%20This%20contrasts%20with%20traditional%20Medicare" target="_blank">more likely than traditional Medicare</a>&nbsp;to require prior authorization for hospital stays and other high-cost services. The plans’ prior authorization requirements have&nbsp;<a href="https://www.nytimes.com/2024/05/25/science/medicare-seniors-authorization.html" target="_blank">prompted increased scrutiny</a>&nbsp;in recent years. A congressional investigation by Democratic Senate staff released this month, for example, found the nation’s largest Medicare Advantage insurers&nbsp;<a href="https://www.hsgac.senate.gov/wp-content/uploads/2024.10.17-PSI-Majority-Staff-Report-on-Medicare-Advantage.pdf" target="_blank">denied a quarter of all prior authorization requests</a>&nbsp;for post-acute care in nursing homes, rehab hospitals and long-term care.Medicare Advantage is popular among large employers, many of which are&nbsp;<a href="https://www.kff.org/medicare/issue-brief/10-reasons-why-medicare-advantage-enrollment-is-growing-and-why-it-matters/#:~:text=A%20growing%20share%20of%20large%20employers%20are%20shifting%20their%20Medicare%2Dage%20retirees%20into%20Medicare%20Advantage%20plans%20for%20both%20Medicare%20and%20supplemental%20benefits" target="_blank">shifting their Medicare-age retirees</a>&nbsp;into these plans. And&nbsp;<a href="https://www.kff.org/medicare/issue-brief/in-2024-a-majority-of-states-offer-medicare-advantage-plans-to-their-state-retirees-with-13-offering-medicare-advantage-exclusively/" target="_blank">most states</a>&nbsp;offer Medicare Advantage plans to retired state employees; in 13 states, it’s the only option. In some of those 13 states, retirees forfeit their health benefits in perpetuity if they choose coverage under traditional Medicare.North Carolina Treasurer Dale Folwell, whose office administers the state health plan, said its Medicare Advantage plan is popular.“What we hear from our retirees, is that they are grateful and happy to have such a great offering as a result of their retirement benefit,” the Republican said. “That’s why nearly 89% of our retirees over age 65 have availed themselves of the [Medicare Advantage] product we offer them.”<h2>Insurers retreat</h2>This year, the handful of insurance giants that dominate the Medicare Advantage market have said they’re scaling back or eliminating plans, to shed members and boost sagging profits. They&nbsp;<a href="https://s2.q4cdn.com/447711729/files/doc_financials/2024/q1/CVS-1Q24-Earnings-Transcript.pdf" target="_blank">blame</a>&nbsp;new federal changes to their reimbursements, including&nbsp;<a href="https://www.axios.com/2024/04/02/medicare-advantage-insurer-pay" target="_blank">a small cut to their base payments</a>, and say patients are using more medical services and benefits than they anticipated.Though most companies haven’t released data on specific counties where they’re making cuts, plans are reportedly shuttering in states such as&nbsp;<a href="https://pfsinsurance.com/news/wellcare-080524" target="_blank">Alabama</a>,&nbsp;<a href="https://pfsinsurance.com/news/wellcare-080524" target="_blank">Massachusetts</a>,&nbsp;<a href="https://www.beckerspayer.com/payer/bcbs-kansas-city-exiting-medicare-advantage-market.html" target="_blank">Missouri</a>,&nbsp;<a href="https://www.concordmonitor.com/harvard-pilgrim-medicare-new-hampshire-57353658" target="_blank">New Hampshire</a>,&nbsp;<a href="https://pfsinsurance.com/news/wellcare-080524" target="_blank">New Mexico</a>,&nbsp;<a href="https://www.dmagazine.com/healthcare-business/2024/09/southwestern-health-resources-to-sunset-medicare-advantage-health-plan-amid-layoffs/" target="_blank">Texas</a>&nbsp;and&nbsp;<a href="https://vtdigger.org/2024/10/03/2-medicare-advantage-plans-will-no-longer-be-available-in-vermont-in-2025/" target="_blank">Vermont</a>, affecting hundreds of thousands of older adults. Experts say the reasons why a company might find certain markets unprofitable are complex, but can include demographics, availability of providers and plans that are already in the market.“[T]he industry broadly is going to be trimming benefits and in some cases significantly, and exiting from certain counties that aren’t profitable,” Aetna’s former President Brian Kane&nbsp;<a href="https://s2.q4cdn.com/447711729/files/doc_financials/2024/q1/CVS-1Q24-Earnings-Transcript.pdf" target="_blank">told shareholders</a>&nbsp;on an earnings call in May, before he left his position. Aetna, a subsidiary of CVS Health, is the third-largest Medicare Advantage insurer in the nation. “I think that’s an industry issue and I think it’s clearly an Aetna focus as well.”Executives at CVS Health, Aetna’s parent company, told shareholders the priority for its Medicare Advantage program would be improving profit margins rather than increasing the number of enrollees.They have not announced publicly which counties will lose Medicare Advantage plans, but noted their changes could&nbsp;<a href="https://www.statnews.com/2024/05/14/cvs-aetna-medicare-advantage-cut-benefits/?utm_campaign=health_care_inc&amp;utm_medium=email&amp;_hsenc=p2ANqtz-_KG6jNdcCYt_b2-JXr0SMQbogbV_XDMgmCvnUjnWW5m_UsBvalMlvUPozxIsPXvn9C126pFPAlA2qO2jZszULKf47ccg&amp;_hsmi=307746331&amp;utm_content=307746331&amp;utm_source=hs_email" target="_blank">push out 10% of their membership</a>, meaning up to 420,000 patients could be forced to shop for a different plan.<h2>Canceled plans</h2>Even with the decline in the number of plans available next year, “there are still a lot of plans and people have a lot of options,” said Jeannie Fuglesten Biniek, associate director of the Medicare policy program at KFF, a health policy research organization. Next year, the average Medicare beneficiary will have access to 34 Medicare Advantage plans that include drug coverage, down from 36 this year, she said.But that average masks wide variation across states and even counties in how many plans are available.“There are a handful of counties, more than in previous years, where all Medicare Advantage plans exited and those look to be predominantly rural counties,” said Fuglesten Biniek. “We’re talking fortyish counties out of 3,000. For those people in those counties, that matters, but overall, it’s a smaller number.”Experts say there isn’t enough data available yet to know whether the plan exits are concentrated in certain states or counties.But research has shown that Medicare Advantage plans that enroll higher shares of Black beneficiaries are&nbsp;<a href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2797677#:~:text=enrolled%20a%20greater%20proportion%20of%20Black%20(21.9%25%20vs%2014.3%25%2C%20P%E2%80%89%3C%E2%80%89.001)%20beneficiaries" target="_blank">more likely to be terminated</a>, said Trivedi, of Brown University. Black enrollees have&nbsp;<a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.13977" target="_blank">more lower-quality Medicare Advantage plans</a>&nbsp;available in their counties of residence than white enrollees, research shows; terminated contracts tend to&nbsp;<a href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2797677#:~:text=Terminated%20contracts%20tended%20to%20have%20lower%20quality" target="_blank">have lower-quality ratings</a>.“The consequence is that contract terminations in Medicare Advantage seem to have a disproportionate effect on Black beneficiaries because their contracts are more likely to be terminated,” Trivedi said.A&nbsp;<a href="https://www.kff.org/medicare/report/disparities-in-health-measures-by-race-and-ethnicity-among-beneficiaries-in-medicare-advantage-a-review-of-the-literature/" target="_blank">disproportionate share</a>&nbsp;of Medicare Advantage beneficiaries are Black, Hispanic, and Asian and Pacific Islander. These patients&nbsp;<a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9923792/#:~:text=African%20American%20and%20Hispanic%20Medicare%20beneficiaries%20tend%20to%20have%20lower,et%20al.%2C%202019)." target="_blank">tend to have lower incomes</a>&nbsp;than white beneficiaries, and may by drawn by the lower upfront costs of Medicare Advantage plans.“[Insurers] like to frame it as, ‘People are choosing us because we’re awesome,’” said Brandon Novick, program outreach assistant at the Center for Economic and Policy Research. “But it’s because financially it makes more sense in the short term” for people with limited incomes.Meanwhile,&nbsp;<a href="https://www.beckershospitalreview.com/finance/15-health-systems-dropping-medicare-advantage-plans-2024.html" target="_blank">at least 28 health systems</a>&nbsp;in 21 states have stopped accepting some Medicare Advantage plans this year, according to an analysis from Becker’s Hospital Review, an industry publication.Health systems have cited delayed reimbursements, cumbersome prior authorization requirements and high rates of patient claim denials for their decisions to drop Medicare Advantage plans. Nearly 1 in 5 health systems&nbsp;<a href="https://www.hfma.org/wp-content/uploads/2024/03/Overview-2024-CFO-Pain-Points-Study.pdf" target="_blank">stopped accepting one or more Medicare Advantage plan</a>s last year, according to a report by the Healthcare Financial Management Association.<h2>‘A tough ask’</h2>For retirees like Libby and Andrew Potter, losing access to trusted doctors and hospitals can mean going longer without needed medical care. Finding a new doctor and getting an appointment can take months, particularly for specialists. And for older adults living in rural areas, losing an in-network hospital or physician can mean choosing between a long drive for care or high out-of-pocket costs.“There are really important access-to-care issues when providers no longer contract with your Medicare Advantage plan,” Trivedi said.He said the sheer number of plans and differences in benefits might be overwhelming for older adults.“To sort through all of that when somebody also may have frailty or cognitive impairment, that’s a really tough ask,” Trivedi said. “I study health policy for a living and it’d be hard for me to sort through 40 different options.”

1 million+ patients lose coverage as insurers, hospitals drop Medicare Advantage

WASHINGTON (AP) — A child psychiatrist who altered a first-day-of-school photo he saw on Facebook to make a group of girls appear nude. A U.S. Army soldier accused of creating images depicting children he knew being sexually abused. A software engineer charged with generating hyper-realistic sexually explicit images of children.

Law enforcement agencies across the U.S. are cracking down on a&nbsp;<a href="https://apnews.com/article/ai-artificial-intelligence-child-sexual-abuse-c8f17de56d41f05f55286eb6177138d2">troubling spread of child sexual abuse imagery</a>&nbsp;created through artificial intelligence technology — from manipulated photos of real children to graphic depictions of computer-generated kids. Justice Department officials say they're aggressively going after offenders who exploit AI tools, while&nbsp;<a href="https://apnews.com/article/south-dakota-xylazine-deepfakes-crime-marty-jackley-4167be99dfb79861835a5190472d61b3">states are racing</a>&nbsp;to ensure people generating “deepfakes” and other harmful imagery of kids can be prosecuted under their laws.

“We’ve got to signal early and often that it is a crime, that it will be investigated and prosecuted when the evidence supports it,” Steven Grocki, who leads the Justice Department's Child Exploitation and Obscenity Section, said in an interview with The Associated Press. “And if you’re sitting there thinking otherwise, you fundamentally are wrong. And it’s only a matter of time before somebody holds you accountable.”

The Justice Department says existing federal laws clearly apply to such content, and recently brought what’s believed to be the first federal case involving purely AI-generated imagery — meaning the children depicted are not real but virtual. In another case, federal authorities in August arrested a U.S. soldier stationed in Alaska accused of running innocent pictures of real children he knew through an AI chatbot to make the images sexually explicit.

The prosecutions come as child advocates are urgently working to curb the misuse of technology to prevent a flood of disturbing images officials fear could make it harder to rescue real victims. Law enforcement officials worry investigators will waste time and resources trying to identify and track down exploited children who don’t really exist.

Lawmakers, meanwhile, are passing a flurry of legislation to ensure local prosecutors can bring charges under state laws for AI-generated “deepfakes” and other sexually explicit images of kids. Governors in more than a dozen states have signed laws this year cracking down on digitally created or altered child sexual abuse imagery, according to a review by The National Center for Missing &amp; Exploited Children.

“We’re playing catch-up as law enforcement to a technology that, frankly, is moving far faster than we are," said Ventura County, California District Attorney Erik Nasarenko.

Nasarenko pushed legislation&nbsp;<a href="https://apnews.com/article/ai-deepfakes-children-abuse-7dcf5c566e2a297567f1e148ac2074a4">signed last month</a>&nbsp;by Gov. Gavin Newsom which makes clear that AI-generated child sexual abuse material is illegal under California law. Nasarenko said his office could not prosecute eight cases involving AI-generated content between last December and mid-September because California's law had required prosecutors to prove the imagery depicted a real child.

AI-generated child sexual abuse images can be used to groom children, law enforcement officials say. And even if they aren’t physically abused, kids can be deeply impacted when their image is morphed to appear sexually explicit.

“I felt like a part of me had been taken away. Even though I was not physically violated,” said 17-year-old Kaylin Hayman, who starred on the Disney Channel show “Just Roll with It” and helped push the California bill after she became a victim of “deepfake” imagery.

Hayman testified last year at the federal trial of the man who digitally superimposed her face and those of other child actors onto bodies performing sex acts. He was sentenced in May to more than 14 years in prison.

Open-source AI-models that users can download on their computers are known to be favored by offenders, who can further train or modify the tools to churn out explicit depictions of children, experts say. Abusers trade tips in dark web communities about how to manipulate AI tools to create such content, officials say.

<a href="https://apnews.com/article/generative-ai-illegal-images-child-abuse-3081a81fa79e2a39b67c11201cfd085f">A report last year</a>&nbsp;by the Stanford Internet Observatory found that a research dataset that was the source for leading AI image-makers such as Stable Diffusion contained links to sexually explicit images of kids, contributing to the ease with which some tools have been able to produce harmful imagery. The dataset was taken down, and researchers later said&nbsp;<a href="https://apnews.com/article/ai-image-generators-child-sexual-abuse-laion-stable-diffusion-2652b0f4245fb28ced1cf74c60a8d9f0">they deleted</a>&nbsp;more than 2,000 weblinks to suspected child sexual abuse imagery from it.

Top technology companies, including Google, OpenAI and Stability AI, have agreed to work with anti-child sexual abuse organization Thorn&nbsp;<a href="https://www.thorn.org/blog/generative-ai-principles/">to combat the spread</a>&nbsp;of child sexual abuse images.

But experts say more should have been done at the outset to prevent misuse before the technology became widely available. And steps companies are taking now to make it harder to abuse future versions of AI tools "will do little to prevent" offenders from running older versions of models on their computer “without detection," a Justice Department prosecutor noted in recent court papers.

“Time was not spent on making the products safe, as opposed to efficient, and it's very hard to do after the fact — as we’ve seen,” said David Thiel, the Stanford Internet Observatory's chief technologist.

The National Center for Missing &amp; Exploited Children's CyberTipline last year received about 4,700 reports of content involving AI technology — a small fraction of the more than 36 million total reports of suspected child sexual exploitation. By October of this year, the group was fielding about 450 reports per month of AI-involved content, said Yiota Souras, the group’s chief legal officer.

Those numbers may be an undercount, however, as the images are so realistic it's often difficult to tell whether they were AI-generated, experts say.

“Investigators are spending hours just trying to determine if an image actually depicts a real minor or if it’s AI-generated,” said Rikole Kelly, deputy Ventura County district attorney, who helped write the California bill. “It used to be that there were some really clear indicators ... with the advances in AI technology, that’s just not the case anymore.”

Justice Department officials say they already have the tools under federal law to go after offenders for such imagery.

The U.S. Supreme Court in&nbsp;<a href="https://www.heraldnet.com/news/supreme-court-strikes-down-ban-on-virtual-child-pornography/">2002 struck down a federal ban</a>&nbsp;on virtual child sexual abuse material. But a federal law signed the following year bans the production of visual depictions, including drawings, of children engaged in sexually explicit conduct that are deemed “obscene.” That law, which the Justice Department says has been used in the past to charge cartoon imagery of child sexual abuse, specifically notes there's no requirement “that the minor depicted actually exist.”

The Justice Department brought that charge in May against a Wisconsin software engineer accused of using AI tool Stable Diffusion to create photorealistic images of children engaged in sexually explicit conduct, and was caught after he sent some to a 15-year-old boy through a direct message on Instagram, authorities say. The man's lawyer, who is pushing to dismiss the charges on First Amendment grounds, declined further comment on the allegations in an email to the AP.

A spokesperson for Stability AI said that man is accused of using an earlier version of the tool that was released by another company, Runway ML. Stability AI says that it has “invested in proactive features to prevent the misuse of AI for the production of harmful content” since taking over the exclusive development of the models. A spokesperson for Runway ML didn't immediately respond to a request for comment from the AP.

In cases involving “deepfakes,” when a real child's photo has been digitally altered to make them sexually explicit, the Justice Department is bringing charges under the federal “child pornography" law. In one case, a North Carolina child psychiatrist who used an AI application to digitally “undress” girls posing on the first day of school in a decades-old photo shared on Facebook was convicted of federal charges last year.

WASHINGTON (AP) — A child psychiatrist who altered a first-day-of-school photo he saw on Facebook to make a group of girls appear nude. A U.S. Army soldier accused of creating images depicting children he knew being sexually abused. A software engineer charged with generating hyper-realistic sexually explicit images of children.Law enforcement agencies across the U.S. are cracking down on a&nbsp;<a href="https://apnews.com/article/ai-artificial-intelligence-child-sexual-abuse-c8f17de56d41f05f55286eb6177138d2">troubling spread of child sexual abuse imagery</a>&nbsp;created through artificial intelligence technology — from manipulated photos of real children to graphic depictions of computer-generated kids. Justice Department officials say they're aggressively going after offenders who exploit AI tools, while&nbsp;<a href="https://apnews.com/article/south-dakota-xylazine-deepfakes-crime-marty-jackley-4167be99dfb79861835a5190472d61b3">states are racing</a>&nbsp;to ensure people generating “deepfakes” and other harmful imagery of kids can be prosecuted under their laws.“We’ve got to signal early and often that it is a crime, that it will be investigated and prosecuted when the evidence supports it,” Steven Grocki, who leads the Justice Department's Child Exploitation and Obscenity Section, said in an interview with The Associated Press. “And if you’re sitting there thinking otherwise, you fundamentally are wrong. And it’s only a matter of time before somebody holds you accountable.”The Justice Department says existing federal laws clearly apply to such content, and recently brought what’s believed to be the first federal case involving purely AI-generated imagery — meaning the children depicted are not real but virtual. In another case, federal authorities in August arrested a U.S. soldier stationed in Alaska accused of running innocent pictures of real children he knew through an AI chatbot to make the images sexually explicit.<h2>Trying to catch up to technology</h2>The prosecutions come as child advocates are urgently working to curb the misuse of technology to prevent a flood of disturbing images officials fear could make it harder to rescue real victims. Law enforcement officials worry investigators will waste time and resources trying to identify and track down exploited children who don’t really exist.Lawmakers, meanwhile, are passing a flurry of legislation to ensure local prosecutors can bring charges under state laws for AI-generated “deepfakes” and other sexually explicit images of kids. Governors in more than a dozen states have signed laws this year cracking down on digitally created or altered child sexual abuse imagery, according to a review by The National Center for Missing &amp; Exploited Children.“We’re playing catch-up as law enforcement to a technology that, frankly, is moving far faster than we are," said Ventura County, California District Attorney Erik Nasarenko.Nasarenko pushed legislation&nbsp;<a href="https://apnews.com/article/ai-deepfakes-children-abuse-7dcf5c566e2a297567f1e148ac2074a4">signed last month</a>&nbsp;by Gov. Gavin Newsom which makes clear that AI-generated child sexual abuse material is illegal under California law. Nasarenko said his office could not prosecute eight cases involving AI-generated content between last December and mid-September because California's law had required prosecutors to prove the imagery depicted a real child.AI-generated child sexual abuse images can be used to groom children, law enforcement officials say. And even if they aren’t physically abused, kids can be deeply impacted when their image is morphed to appear sexually explicit.“I felt like a part of me had been taken away. Even though I was not physically violated,” said 17-year-old Kaylin Hayman, who starred on the Disney Channel show “Just Roll with It” and helped push the California bill after she became a victim of “deepfake” imagery.Hayman testified last year at the federal trial of the man who digitally superimposed her face and those of other child actors onto bodies performing sex acts. He was sentenced in May to more than 14 years in prison.Open-source AI-models that users can download on their computers are known to be favored by offenders, who can further train or modify the tools to churn out explicit depictions of children, experts say. Abusers trade tips in dark web communities about how to manipulate AI tools to create such content, officials say.<a href="https://apnews.com/article/generative-ai-illegal-images-child-abuse-3081a81fa79e2a39b67c11201cfd085f">A report last year</a>&nbsp;by the Stanford Internet Observatory found that a research dataset that was the source for leading AI image-makers such as Stable Diffusion contained links to sexually explicit images of kids, contributing to the ease with which some tools have been able to produce harmful imagery. The dataset was taken down, and researchers later said&nbsp;<a href="https://apnews.com/article/ai-image-generators-child-sexual-abuse-laion-stable-diffusion-2652b0f4245fb28ced1cf74c60a8d9f0">they deleted</a>&nbsp;more than 2,000 weblinks to suspected child sexual abuse imagery from it.Top technology companies, including Google, OpenAI and Stability AI, have agreed to work with anti-child sexual abuse organization Thorn&nbsp;<a href="https://www.thorn.org/blog/generative-ai-principles/">to combat the spread</a>&nbsp;of child sexual abuse images.But experts say more should have been done at the outset to prevent misuse before the technology became widely available. And steps companies are taking now to make it harder to abuse future versions of AI tools "will do little to prevent" offenders from running older versions of models on their computer “without detection," a Justice Department prosecutor noted in recent court papers.“Time was not spent on making the products safe, as opposed to efficient, and it's very hard to do after the fact — as we’ve seen,” said David Thiel, the Stanford Internet Observatory's chief technologist.<h2>AI images get more realistic</h2>The National Center for Missing &amp; Exploited Children's CyberTipline last year received about 4,700 reports of content involving AI technology — a small fraction of the more than 36 million total reports of suspected child sexual exploitation. By October of this year, the group was fielding about 450 reports per month of AI-involved content, said Yiota Souras, the group’s chief legal officer.Those numbers may be an undercount, however, as the images are so realistic it's often difficult to tell whether they were AI-generated, experts say.“Investigators are spending hours just trying to determine if an image actually depicts a real minor or if it’s AI-generated,” said Rikole Kelly, deputy Ventura County district attorney, who helped write the California bill. “It used to be that there were some really clear indicators ... with the advances in AI technology, that’s just not the case anymore.”Justice Department officials say they already have the tools under federal law to go after offenders for such imagery.The U.S. Supreme Court in&nbsp;<a href="https://www.heraldnet.com/news/supreme-court-strikes-down-ban-on-virtual-child-pornography/">2002 struck down a federal ban</a>&nbsp;on virtual child sexual abuse material. But a federal law signed the following year bans the production of visual depictions, including drawings, of children engaged in sexually explicit conduct that are deemed “obscene.” That law, which the Justice Department says has been used in the past to charge cartoon imagery of child sexual abuse, specifically notes there's no requirement “that the minor depicted actually exist.”The Justice Department brought that charge in May against a Wisconsin software engineer accused of using AI tool Stable Diffusion to create photorealistic images of children engaged in sexually explicit conduct, and was caught after he sent some to a 15-year-old boy through a direct message on Instagram, authorities say. The man's lawyer, who is pushing to dismiss the charges on First Amendment grounds, declined further comment on the allegations in an email to the AP.A spokesperson for Stability AI said that man is accused of using an earlier version of the tool that was released by another company, Runway ML. Stability AI says that it has “invested in proactive features to prevent the misuse of AI for the production of harmful content” since taking over the exclusive development of the models. A spokesperson for Runway ML didn't immediately respond to a request for comment from the AP.In cases involving “deepfakes,” when a real child's photo has been digitally altered to make them sexually explicit, the Justice Department is bringing charges under the federal “child pornography" law. In one case, a North Carolina child psychiatrist who used an AI application to digitally “undress” girls posing on the first day of school in a decades-old photo shared on Facebook was convicted of federal charges last year.

AI-generated child sexual abuse images are spreading. Law enforcement is racing to stop them

VATICAN CITY (AP) — Pope Francis' yearslong process to&nbsp;<a href="https://apnews.com/article/vatican-pope-reform-women-lgbtq-f8b42b57dcf7ef77dbd3f406780217ed">reform the Catholic Church</a>&nbsp;closed Saturday with recommendations that fell short of giving women more equity as hoped, but reflected the pope’s aims for a church that at least listens more to its followers.

In a significant move, the pope said he would not issue a teaching document from the recommendations, which called for women to be allowed all opportunities that Church law already provides while leaving open the contentious question of permitting women to be ordained as deacons.

As a result, it remains unclear what if any authority or impact the synod’s final recommendations will have, given the purpose of the exercise was to provide the pope with specific proposals on reform.

“In this time of war, we must be witnesses to peace” and give an example of living with differences, the pope said in explaining his decision.

Francis said he would continue to listen to the bishops' counsel, adding “this is not a classic way of endlessly delaying decisions."

Deacons perform many of the same functions as priests, such as presiding over baptisms, weddings and funerals, but they cannot celebrate Mass. Advocates say allowing women to be deacons would help offset the shortage of priests. Opponents say it would signal the start of a slippery slope toward ordaining women to the all-male priesthood that Francis has repeatedly reaffirmed.

Earlier this week, the Vatican's top doctrinal officer, Cardinal Victor Manuel Fernandez, told the extraordinary assembly of 368 bishops and laypeople — including women — that Francis had said the moment “is not ripe” for allowing ordination of women as deacons. He did not respond directly to a request to define what would determine “ripeness” for a greater role for women.

The multi-year synod process had sparked great hopes for change, especially for women, who have long complained that they are treated as second-class citizens in the church. Women are barred from the church's highest ministerial positions, yet do the lion’s share of the work running Catholic hospitals and schools and passing the faith onto future generations.

Speaking to the synod on Thursday, Fernandez explained that a special working group would continue beyond the closing of the meeting, but that its focus would be on discussing the&nbsp;<a href="https://apnews.com/article/vatican-reform-women-synod-catholic-church-a6131cb8409f5bc91411f35b493652de">role of women in the church</a>&nbsp;— not in the diaconate, or the office of deacon. He added that while working with women in previous pastoral roles, “most did not ask for or want the diaconate, which would be cumbersome for their lay work.”

The meeting asked for “full implementation of all the opportunities already provided for in Canon Law with regard to the role of women, particularly in those places where they remain under-explored.” It leaves open “the question of women's access to diaconal ministry.”

It was the most contested paragraph of the final document, with 258 votes for and 97 against. It was not clear if the “no” votes were because the language went too far or not far enough.

Phyllis Zagano, a leading scholar on women deacons, said the "no” votes could indicate it is time for a decision to be made.

The outcome is a disappointment for Catholics who have been campaigning for recognition that women share a spiritual calling that is no different than a man’s. They also noted that despite the inclusion of women in the synodal process, the working group that is guiding discussions on women’s role is being run by the Roman curia, operating outside the synod.

“I think the final document will be received with much disappointment and frustration by many women around the world who are hoping for concrete changes,'' said Kate McElwee, the executive director of the Women’s Ordination Conference.

While she acknowledged a “cultural shift,” she said "the pace of that shift is perhaps too slow for many women.”

Gay rights activists also expressed disappointment, noting the failure to include LGBTQ+ issues in the final documents. “The laity of the church must now become louder and more vigorous than ever in advocating for reform,'' said Francis DeBernardo, executive director of New Ways Ministry.

The&nbsp;<a href="https://apnews.com/article/vatican-women-synod-pope-bfe024ad3234a9511738b9fd5c598ef7">first phase of the synod process</a>&nbsp;ended last year by concluding it was “urgent” to guarantee fuller participation by women in church governance positions, and calling for theological and pastoral research to continue about allowing women to be deacons.

If before the synod the idea of allowing women to be deacons was a fringe proposal pushed by Western progressives, the idea gained attention during the debate. It became something of a litmus test of how far the church was going to go, or not, to address demands of women for greater equality and representation in the church's highest ranks.

<figure>
 <img src="https://media.eaglewebservices.com/public/2024/6/1718390317432.png" alt="File photo Pope Francis courtesy CSPAN" />
 <figcaption>File photo Pope Francis courtesy CSPAN</figcaption>
 </figure>VATICAN CITY (AP) — Pope Francis' yearslong process to&nbsp;<a href="https://apnews.com/article/vatican-pope-reform-women-lgbtq-f8b42b57dcf7ef77dbd3f406780217ed">reform the Catholic Church</a>&nbsp;closed Saturday with recommendations that fell short of giving women more equity as hoped, but reflected the pope’s aims for a church that at least listens more to its followers.In a significant move, the pope said he would not issue a teaching document from the recommendations, which called for women to be allowed all opportunities that Church law already provides while leaving open the contentious question of permitting women to be ordained as deacons.As a result, it remains unclear what if any authority or impact the synod’s final recommendations will have, given the purpose of the exercise was to provide the pope with specific proposals on reform.“In this time of war, we must be witnesses to peace” and give an example of living with differences, the pope said in explaining his decision.Francis said he would continue to listen to the bishops' counsel, adding “this is not a classic way of endlessly delaying decisions."Deacons perform many of the same functions as priests, such as presiding over baptisms, weddings and funerals, but they cannot celebrate Mass. Advocates say allowing women to be deacons would help offset the shortage of priests. Opponents say it would signal the start of a slippery slope toward ordaining women to the all-male priesthood that Francis has repeatedly reaffirmed.Earlier this week, the Vatican's top doctrinal officer, Cardinal Victor Manuel Fernandez, told the extraordinary assembly of 368 bishops and laypeople — including women — that Francis had said the moment “is not ripe” for allowing ordination of women as deacons. He did not respond directly to a request to define what would determine “ripeness” for a greater role for women.The multi-year synod process had sparked great hopes for change, especially for women, who have long complained that they are treated as second-class citizens in the church. Women are barred from the church's highest ministerial positions, yet do the lion’s share of the work running Catholic hospitals and schools and passing the faith onto future generations.Speaking to the synod on Thursday, Fernandez explained that a special working group would continue beyond the closing of the meeting, but that its focus would be on discussing the&nbsp;<a href="https://apnews.com/article/vatican-reform-women-synod-catholic-church-a6131cb8409f5bc91411f35b493652de">role of women in the church</a>&nbsp;— not in the diaconate, or the office of deacon. He added that while working with women in previous pastoral roles, “most did not ask for or want the diaconate, which would be cumbersome for their lay work.”The meeting asked for “full implementation of all the opportunities already provided for in Canon Law with regard to the role of women, particularly in those places where they remain under-explored.” It leaves open “the question of women's access to diaconal ministry.”It was the most contested paragraph of the final document, with 258 votes for and 97 against. It was not clear if the “no” votes were because the language went too far or not far enough.Phyllis Zagano, a leading scholar on women deacons, said the "no” votes could indicate it is time for a decision to be made.The outcome is a disappointment for Catholics who have been campaigning for recognition that women share a spiritual calling that is no different than a man’s. They also noted that despite the inclusion of women in the synodal process, the working group that is guiding discussions on women’s role is being run by the Roman curia, operating outside the synod.“I think the final document will be received with much disappointment and frustration by many women around the world who are hoping for concrete changes,'' said Kate McElwee, the executive director of the Women’s Ordination Conference.While she acknowledged a “cultural shift,” she said "the pace of that shift is perhaps too slow for many women.”Gay rights activists also expressed disappointment, noting the failure to include LGBTQ+ issues in the final documents. “The laity of the church must now become louder and more vigorous than ever in advocating for reform,'' said Francis DeBernardo, executive director of New Ways Ministry.The&nbsp;<a href="https://apnews.com/article/vatican-women-synod-pope-bfe024ad3234a9511738b9fd5c598ef7">first phase of the synod process</a>&nbsp;ended last year by concluding it was “urgent” to guarantee fuller participation by women in church governance positions, and calling for theological and pastoral research to continue about allowing women to be deacons.If before the synod the idea of allowing women to be deacons was a fringe proposal pushed by Western progressives, the idea gained attention during the debate. It became something of a litmus test of how far the church was going to go, or not, to address demands of women for greater equality and representation in the church's highest ranks.

Pope Francis' Catholic church reform process ends without giving more equity to women

KANSAS CITY —&nbsp;&nbsp;Law enforcement continue working to identify a suspect in a bank robbery that occurred Oct. 21 at the Hawthorn Bank,&nbsp;17430 E. 39th Street in Independence, Missouri, according to the Federal Bureau of Investigation.

The suspect entered the bank, approached the teller, made a verbal demand for cash, and brandished a firearm. The suspect fled the bank with an undisclosed amount of cash on a blue sports bike

According to reports, the suspect is described as older white male, approximately 5-foot-6 to 5-foot-9 tall,&nbsp; short grey hair, black leather jacket with patches, dark pants, grey sneakers dark head covering, Blue surgical mask.

Anyone with info can report a tip online at&nbsp;<a href="https://t.co/49eEgggFOb" target="_blank">http://tips.fbi.gov</a>.

<figure>
 <img src="https://media.eaglewebservices.com/public/2024/10/1730033811704.png" alt="Photo FBI Kansas City" />
 <figcaption>Photo FBI Kansas City</figcaption>
 </figure>KANSAS CITY —&nbsp;&nbsp;Law enforcement continue working to identify a suspect in a bank robbery that occurred Oct. 21 at the Hawthorn Bank,&nbsp;17430 E. 39th Street in Independence, Missouri, according to the Federal Bureau of Investigation.The suspect entered the bank, approached the teller, made a verbal demand for cash, and brandished a firearm. The suspect fled the bank with an undisclosed amount of cash on a blue sports bikeAccording to reports, the suspect is described as older white male, approximately 5-foot-6 to 5-foot-9 tall,&nbsp; short grey hair, black leather jacket with patches, dark pants, grey sneakers dark head covering, Blue surgical mask.Anyone with info can report a tip online at&nbsp;<a href="https://t.co/49eEgggFOb" target="_blank">http://tips.fbi.gov</a>.

Search continues for suspect who fled KC bank robbery on sports bike

KALAMAZOO, Mich. (AP) —&nbsp;<a href="https://apnews.com/hub/michelle-obama">Michelle Obama</a>&nbsp;challenged men to support&nbsp;<a href="https://apnews.com/hub/kamala-harris">Kamala Harris</a>&nbsp;' bid to be America's first female president, warning at a rally in Michigan on Saturday that women's lives would be at risk if Donald Trump returned to the White House.

The former first lady described the assault on&nbsp;<a href="https://apnews.com/article/abortion-supreme-court-ruling-texas-georgia-5c5d73c45274f90d40f7a4a07f00a27a">abortion rights</a>&nbsp;as the harbinger of dangerous limitations on healthcare for women. Some men may be tempted to vote for Trump because of their anger at the slow pace of progress, Obama said, but “your rage does not exist in a vacuum.”

”If we don’t get this election right, your wife, your daughter, your mother, we as women will become collateral damage to your rage,” Obama said. “So are you as men prepared to look into the eyes of the women and children you love and tell them you supported this assault on our safety?”

The rally in Kalamazoo was Obama’s first appearance on the campaign trail since she spoke at the Democratic National Convention over the summer, and her remarks were searing and passionate in their support of Harris.

“By every measure, she has demonstrated that she’s ready,” the former first lady said. “The real question is, as a country, are we ready for this moment?”

Obama added, “Do not buy into the lies that we do not know who Kamala is or what she stands for. This is somebody who understands you, all of you.”

Although Obama has been a reluctant campaigner over the years, she showed no hesitation on Saturday as her speech stretched from the political to the personal. Obama said she fears for the country and struggles to understand why the presidential race remains close.

“I lay awake at night wondering, 'What in the world is going on?'” she said.

Her voice vibrating with emotion, Obama talked about the struggle for women to understand and care for their own bodies, whether it’s their menstrual cycles or menopause. And she spoke about the dangers of childbirth, when a split-second decision can mean the difference between life and death for a mother and her baby.

“I am asking y’all from the core of my being to take our lives seriously," Obama pleaded.

Harris took the stage after Obama and promised the crowd that she would keep their interests in mind — unlike Trump, who she accused of only being interested in himself.

“There is a yearning in our country for a president who sees the people, not just looking in the mirror all the time, but sees the people, who gets you and who will fight for you," she said.

After the rally, Harris went to Trak Houz Bar &amp; Grill with Michigan Gov. Gretchen Whitmer, where they drank a locally brewed beer.

“I want to have whatever she's having,” Harris said.

The politicians chatted and took photos with people at the bar. When they approached a table of young women, one of them burst into tears.

Before arriving in Kalamazoo, Harris visited a local doctor's office in Portage to talk with health care providers and medical students about the impact of abortion restrictions. One of them said they have patients visiting from other parts of the country where there are strict limitations on abortion, and another said she's worried that people won't want to practice in important areas of medicine because of fears about government intrusion.

“We are looking at a health care crisis in America that is affecting people of every background and gender," Harris told reporters before visiting the doctor's office.

Harris appeared with Beyoncé&nbsp;<a href="https://apnews.com/article/kamala-harris-abortion-rights-2024-election-democrats-f228eedd3308dab2e1125fdf6029a4a2">on Friday in Houston</a>, and she campaigned with former President Barack Obama and Bruce Springsteen&nbsp;<a href="https://apnews.com/article/harris-obama-springsteen-perry-mix-master-atlanta-1ef1c592180db8fcbe0d0480248f9fe6">on Thursday in Atlanta.</a>

It's a level of celebrity clout that surpasses anything that Trump, the Republican nominee, has been able to marshal this year. But there's no guarantee that will help Harris in the close race for the White House. In 2016, Hillary Clinton lost to Trump despite firing up her crowds with musical performances and Democratic allies.

Trump brushed off Harris' attempt to harness star power for her campaign.

“Kamala is at a dance party with Beyoncé,” the former president said Friday in Traverse City, Michigan. Trump&nbsp;<a href="https://apnews.com/article/trump-harris-presidential-election-detroit-michigan-ee1dbcb59eaddd8b006ce57aad77c37e">held a rally in Novi</a>, a suburb of Detroit, on Saturday before a later event in State College, Pennsylvania.

Saturday is the first day that early in-person voting became available across Michigan. More than 1.4 million ballots have already been submitted, representing 20% of registered voters.

When Clinton was running against Trump, Michelle Obama inspired Democrats with the slogan “when they go low, we go high.”

But this year, at the Democratic National Convention in Chicago, she adopted&nbsp;<a href="https://apnews.com/article/democratic-national-convention-harris-biden-obama-ffb55cee591f8f162ad77b5d6b91152b">a more biting approach</a>. She accused Trump of "doubling down on ugly, misogynistic, racist lies as a substitute for real ideas and solutions that will actually make people’s lives better.”

While Harris was with Obama in Michigan, President Joe Biden visited the Laborers’ International Union of North America in Pittsburgh. He mentioned that Harris once walked a picket line with the United Auto Workers — “she has a backbone like a ramrod” — while Trump has undermined organized labor.

“He views unions as getting in the way of the accumulation of wealth for individuals," Biden said. “It’s in labor’s interest to defeat Donald Trump, more than any other race you’ve been in.”

Biden's remarks to the mostly male audience referenced the gender divide that has been a consistent feature of this year's presidential race.

Speaking on Trump, Biden said, "I’m just gonna say straight up, he’s a loser as a man.”

He also said that women deserve more opportunities than they've received in the past.

“They can do anything any man can do, including be president of the United States of America," Biden said.

<figure>
 <img src="https://media.eaglewebservices.com/public/2024/10/1729994005608.png" alt="Image courtesy CSPAN" />
 <figcaption>Image courtesy CSPAN</figcaption>
 </figure>KALAMAZOO, Mich. (AP) —&nbsp;<a href="https://apnews.com/hub/michelle-obama">Michelle Obama</a>&nbsp;challenged men to support&nbsp;<a href="https://apnews.com/hub/kamala-harris">Kamala Harris</a>&nbsp;' bid to be America's first female president, warning at a rally in Michigan on Saturday that women's lives would be at risk if Donald Trump returned to the White House.<div><blockquote class="twitter-tweet">.<a href="https://twitter.com/MichelleObama?ref_src=twsrc%5Etfw">@MichelleObama</a>: &quot;I am asking y&#39;all from the core of my being to take our lives seriously. Please do not put our lives in the hands of politicians, mostly men, who have no clue or do not care about what we as women are going through...Please do not hand our fates over to the… <a href="https://t.co/XGrnOlDeC8">pic.twitter.com/XGrnOlDeC8</a>&mdash; CSPAN (@cspan) <a href="https://twitter.com/cspan/status/1850332497323667881?ref_src=twsrc%5Etfw">October 27, 2024</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script></div>The former first lady described the assault on&nbsp;<a href="https://apnews.com/article/abortion-supreme-court-ruling-texas-georgia-5c5d73c45274f90d40f7a4a07f00a27a">abortion rights</a>&nbsp;as the harbinger of dangerous limitations on healthcare for women. Some men may be tempted to vote for Trump because of their anger at the slow pace of progress, Obama said, but “your rage does not exist in a vacuum.””If we don’t get this election right, your wife, your daughter, your mother, we as women will become collateral damage to your rage,” Obama said. “So are you as men prepared to look into the eyes of the women and children you love and tell them you supported this assault on our safety?”<div><blockquote class="twitter-tweet">.<a href="https://twitter.com/MichelleObama?ref_src=twsrc%5Etfw">@MichelleObama</a>: &quot;I am praying that those of us contemplating voting for Trump or not voting at all will snap out of whatever fog we are in...I am worried that we will blow this opportunity to finally turn the page on the ugliness once and for all.&quot; <a href="https://t.co/TYPbINKmge">pic.twitter.com/TYPbINKmge</a>&mdash; CSPAN (@cspan) <a href="https://twitter.com/cspan/status/1850331506121851001?ref_src=twsrc%5Etfw">October 27, 2024</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script></div>The rally in Kalamazoo was Obama’s first appearance on the campaign trail since she spoke at the Democratic National Convention over the summer, and her remarks were searing and passionate in their support of Harris.“By every measure, she has demonstrated that she’s ready,” the former first lady said. “The real question is, as a country, are we ready for this moment?”Obama added, “Do not buy into the lies that we do not know who Kamala is or what she stands for. This is somebody who understands you, all of you.”Although Obama has been a reluctant campaigner over the years, she showed no hesitation on Saturday as her speech stretched from the political to the personal. Obama said she fears for the country and struggles to understand why the presidential race remains close.“I lay awake at night wondering, 'What in the world is going on?'” she said.Her voice vibrating with emotion, Obama talked about the struggle for women to understand and care for their own bodies, whether it’s their menstrual cycles or menopause. And she spoke about the dangers of childbirth, when a split-second decision can mean the difference between life and death for a mother and her baby.“I am asking y’all from the core of my being to take our lives seriously," Obama pleaded.Harris took the stage after Obama and promised the crowd that she would keep their interests in mind — unlike Trump, who she accused of only being interested in himself.“There is a yearning in our country for a president who sees the people, not just looking in the mirror all the time, but sees the people, who gets you and who will fight for you," she said.After the rally, Harris went to Trak Houz Bar &amp; Grill with Michigan Gov. Gretchen Whitmer, where they drank a locally brewed beer.“I want to have whatever she's having,” Harris said.The politicians chatted and took photos with people at the bar. When they approached a table of young women, one of them burst into tears.Before arriving in Kalamazoo, Harris visited a local doctor's office in Portage to talk with health care providers and medical students about the impact of abortion restrictions. One of them said they have patients visiting from other parts of the country where there are strict limitations on abortion, and another said she's worried that people won't want to practice in important areas of medicine because of fears about government intrusion.“We are looking at a health care crisis in America that is affecting people of every background and gender," Harris told reporters before visiting the doctor's office.Harris appeared with Beyoncé&nbsp;<a href="https://apnews.com/article/kamala-harris-abortion-rights-2024-election-democrats-f228eedd3308dab2e1125fdf6029a4a2">on Friday in Houston</a>, and she campaigned with former President Barack Obama and Bruce Springsteen&nbsp;<a href="https://apnews.com/article/harris-obama-springsteen-perry-mix-master-atlanta-1ef1c592180db8fcbe0d0480248f9fe6">on Thursday in Atlanta.</a>It's a level of celebrity clout that surpasses anything that Trump, the Republican nominee, has been able to marshal this year. But there's no guarantee that will help Harris in the close race for the White House. In 2016, Hillary Clinton lost to Trump despite firing up her crowds with musical performances and Democratic allies.Trump brushed off Harris' attempt to harness star power for her campaign.“Kamala is at a dance party with Beyoncé,” the former president said Friday in Traverse City, Michigan. Trump&nbsp;<a href="https://apnews.com/article/trump-harris-presidential-election-detroit-michigan-ee1dbcb59eaddd8b006ce57aad77c37e">held a rally in Novi</a>, a suburb of Detroit, on Saturday before a later event in State College, Pennsylvania.Saturday is the first day that early in-person voting became available across Michigan. More than 1.4 million ballots have already been submitted, representing 20% of registered voters.When Clinton was running against Trump, Michelle Obama inspired Democrats with the slogan “when they go low, we go high.”But this year, at the Democratic National Convention in Chicago, she adopted&nbsp;<a href="https://apnews.com/article/democratic-national-convention-harris-biden-obama-ffb55cee591f8f162ad77b5d6b91152b">a more biting approach</a>. She accused Trump of "doubling down on ugly, misogynistic, racist lies as a substitute for real ideas and solutions that will actually make people’s lives better.”While Harris was with Obama in Michigan, President Joe Biden visited the Laborers’ International Union of North America in Pittsburgh. He mentioned that Harris once walked a picket line with the United Auto Workers — “she has a backbone like a ramrod” — while Trump has undermined organized labor.“He views unions as getting in the way of the accumulation of wealth for individuals," Biden said. “It’s in labor’s interest to defeat Donald Trump, more than any other race you’ve been in.”Biden's remarks to the mostly male audience referenced the gender divide that has been a consistent feature of this year's presidential race.Speaking on Trump, Biden said, "I’m just gonna say straight up, he’s a loser as a man.”He also said that women deserve more opportunities than they've received in the past.“They can do anything any man can do, including be president of the United States of America," Biden said.

🎥'Take our lives seriously,' Michelle Obama pleads as she rallies for Harris in Michigan

NEW YORK (AP) — Donald Trump is finally getting his Madison Square Garden moment.

With just over a week to go before Election Day, the former president will take the stage at one of the country's most iconic venues, hosting a hometown rally to deliver his campaign's closing message against Democratic Vice President Kamala Harris.

"Madison Square Garden is the center of the universe," said Trump campaign senior adviser Jason Miller, noting the venue's storied history hosting events including the 1971 "Fight of the Century."

The rally is one of a series of detours Trump has made from battleground states, including a recent rally in Coachella, California — best known for the famous music festival named after the town — and one over the summer on the Jersey Shore. This summer he campaigned in the South Bronx.

While some Democrats and TV pundits have questioned Trump's decision to hold what they dismiss as vanity events, the rally guarantees Trump what he most craves: the spotlight, wall-to-wall coverage and a national audience.

Along with trying to energize his base, Trump's campaign has been trying to court the few remaining undecided voters, many of whom don't get their news from traditional outlets.

To reach them, Trump has spent hours appearing on popular podcasts. And his campaign has worked to create viral moments like his visit last weekend to a McDonald's restaurant, where he made fries and served supporters through the drive-thru window. Video of the stop posted by his campaign has been viewed more than 40 million times on TikTok alone.

"He's not just going to be speaking to the attendees inside Madison Square Garden. There will be people tuning in from battleground states all across the country," said former U.S. Rep. Lee Zeldin, a New York Republican and ally of the former president, who said Trump has been talking about holding an event at the venue since the start of his campaign.

Harris has also traveled to non-battleground states for major events intended to drive a national message. She appeared in Houston Friday with music superstar Beyoncé to speak about reproductive rights, and will deliver her own closing argument Tuesday from the Ellipse in Washington, where Trump spoke ahead of the Jan. 6, 2021 Capitol riot.

Trump will be joined at the rally by supporters including Tesla and SpaceX CEO Elon Musk, who has spent tens of millions of dollars to boost his campaign.

Trump often compares himself to the country's greatest entertainers. The former reality TV star has long talked about wanting to hold a rally at the venue dubbed "The World's Most Famous Arena," raising the idea in interviews and private conversations.

"New York is part of his DNA. Madison Square Garden is part of his DNA," said New York State Republican Chairman Ed Cox.

While Trump continues to insist the rally is part of his effort to win New York — a state President Joe Biden carried four years ago with more than 60% of the vote — he's made clear it's also personal.

"It's the New York, but it's also, you know, it's MSG, it's Madison Square Garden," Trump said during a recent radio interview. "Guys like you and I, that means a lot, those words. Madison Square Garden, right? Don't you think so? ... It's a very big stop."

The venue also has a history in politics, hosting events with Dwight Eisenhower and Franklin D. Roosevelt. In 1962, John F. Kennedy Jr. held a birthday celebration at the stadium where Marilyn Monroe famously sang "Happy Birthday to You, Mr. President."

But if there's one bit of Garden history Trump might want to replicate, it's when Grover Cleveland accepted his party's nomination in 1892, three years after leaving the White House. He went on to win the election, becoming the first and only president to serve two non-consecutive terms.

House control could run through New York's suburbs

Beyond the national spotlight and the appeal of appearing on one of the world's most famous stages, Republicans in the state say the rally will also help down-ballot candidates.

New York is home to a handful of competitive congressional races that could determine which party controls the House next year.

Zeldin ran unsuccessfully for governor in 2022, but did better than expected, driving turnout in competitive districts that helped House Republicans win a tiny majority. That underscored, he said, the importance of the top of the ticket doing as well as possible. He said the Garden event is sure to be featured on newscasts in areas with high-stakes races like suburban Long Island, where Trump held a packed, raucous rally last month.

Trump will also use the stop as a major fundraising opportunity as he continues to seriously lag Harris in the money race.

A native returns to the city that made him and convicted him

New York has not voted for a Republican for president in 40 years. But that hasn't stopped Trump from continuing to insist he believes he can win.

"We think there's a chance," he said on "The Brian Kilmeade Show" earlier this week, pointing to frustrations over an influx of migrants to the city and concerns over crime.

Trump routinely uses his hometown as a foil before audiences in other states, painting a dark vision of the city that bears little resemblance to reality. He's cast it as crime-ridden and overrun by violent, immigrant gangs who have taken over Fifth and Madison avenues and occupied Times Square.

Trump has a complicated history with the place where he built his business empire and that made him a tabloid and reality TV star. Its residents indicted him last year on 34 felony counts of falsifying business records. He was found guilty in that case, and also found liable in civil court for business fraud and sexual abuse.

Associated Press writer Michelle L. Price in Novi, Michigan, contributed to this report.

<figure>
 <img src="https://media.eaglewebservices.com/public/2024/10/1730025413603.png" alt="Donald Trump walks off stage in Michigan on Saturday to greet his supporters-image courtesy Margo Martin Deputy Director of Communications" />
 <figcaption>Donald Trump walks off stage in Michigan on Saturday to greet his supporters-image courtesy Margo Martin Deputy Director of Communications</figcaption>
 </figure>By JILL COLVIN &nbsp;Associated PressNEW YORK (AP) — Donald Trump is finally getting his Madison Square Garden moment.With just over a week to go before Election Day, the former president will take the stage at one of the country's most iconic venues, hosting a hometown rally to deliver his campaign's closing message against Democratic Vice President Kamala Harris."Madison Square Garden is the center of the universe," said Trump campaign senior adviser Jason Miller, noting the venue's storied history hosting events including the 1971 "Fight of the Century."The rally is one of a series of detours Trump has made from battleground states, including a recent rally in Coachella, California — best known for the famous music festival named after the town — and one over the summer on the Jersey Shore. This summer he campaigned in the South Bronx.While some Democrats and TV pundits have questioned Trump's decision to hold what they dismiss as vanity events, the rally guarantees Trump what he most craves: the spotlight, wall-to-wall coverage and a national audience.Along with trying to energize his base, Trump's campaign has been trying to court the few remaining undecided voters, many of whom don't get their news from traditional outlets.To reach them, Trump has spent hours appearing on popular podcasts. And his campaign has worked to create viral moments like his visit last weekend to a McDonald's restaurant, where he made fries and served supporters through the drive-thru window. Video of the stop posted by his campaign has been viewed more than 40 million times on TikTok alone."He's not just going to be speaking to the attendees inside Madison Square Garden. There will be people tuning in from battleground states all across the country," said former U.S. Rep. Lee Zeldin, a New York Republican and ally of the former president, who said Trump has been talking about holding an event at the venue since the start of his campaign.Harris has also traveled to non-battleground states for major events intended to drive a national message. She appeared in Houston Friday with music superstar Beyoncé to speak about reproductive rights, and will deliver her own closing argument Tuesday from the Ellipse in Washington, where Trump spoke ahead of the Jan. 6, 2021 Capitol riot.Trump will be joined at the rally by supporters including Tesla and SpaceX CEO Elon Musk, who has spent tens of millions of dollars to boost his campaign.'The world's most famous arena'Trump often compares himself to the country's greatest entertainers. The former reality TV star has long talked about wanting to hold a rally at the venue dubbed "The World's Most Famous Arena," raising the idea in interviews and private conversations."New York is part of his DNA. Madison Square Garden is part of his DNA," said New York State Republican Chairman Ed Cox.While Trump continues to insist the rally is part of his effort to win New York — a state President Joe Biden carried four years ago with more than 60% of the vote — he's made clear it's also personal."It's the New York, but it's also, you know, it's MSG, it's Madison Square Garden," Trump said during a recent radio interview. "Guys like you and I, that means a lot, those words. Madison Square Garden, right? Don't you think so? ... It's a very big stop."The venue also has a history in politics, hosting events with Dwight Eisenhower and Franklin D. Roosevelt. In 1962, John F. Kennedy Jr. held a birthday celebration at the stadium where Marilyn Monroe famously sang "Happy Birthday to You, Mr. President."But if there's one bit of Garden history Trump might want to replicate, it's when Grover Cleveland accepted his party's nomination in 1892, three years after leaving the White House. He went on to win the election, becoming the first and only president to serve two non-consecutive terms.House control could run through New York's suburbsBeyond the national spotlight and the appeal of appearing on one of the world's most famous stages, Republicans in the state say the rally will also help down-ballot candidates.New York is home to a handful of competitive congressional races that could determine which party controls the House next year.Zeldin ran unsuccessfully for governor in 2022, but did better than expected, driving turnout in competitive districts that helped House Republicans win a tiny majority. That underscored, he said, the importance of the top of the ticket doing as well as possible. He said the Garden event is sure to be featured on newscasts in areas with high-stakes races like suburban Long Island, where Trump held a packed, raucous rally last month.Trump will also use the stop as a major fundraising opportunity as he continues to seriously lag Harris in the money race.A native returns to the city that made him and convicted himNew York has not voted for a Republican for president in 40 years. But that hasn't stopped Trump from continuing to insist he believes he can win."We think there's a chance," he said on "The Brian Kilmeade Show" earlier this week, pointing to frustrations over an influx of migrants to the city and concerns over crime.Trump routinely uses his hometown as a foil before audiences in other states, painting a dark vision of the city that bears little resemblance to reality. He's cast it as crime-ridden and overrun by violent, immigrant gangs who have taken over Fifth and Madison avenues and occupied Times Square.Trump has a complicated history with the place where he built his business empire and that made him a tabloid and reality TV star. Its residents indicted him last year on 34 felony counts of falsifying business records. He was found guilty in that case, and also found liable in civil court for business fraud and sexual abuse.___Associated Press writer Michelle L. Price in Novi, Michigan, contributed to this report.

Trump veers away from swing states for his Madison Square Garden moment

JOHNSON COUNTY—A Kansas man is going to prison for violent child sex crimes.

This week, Judge T. Kelly Ryan sentenced 36-year-old Timothy Ryan Hugo to Life without the possibility of parole for 25-years for aggravated indecent liberties, rape of a child under 14 and aggravated criminal sodomy, according to the Johnson County District Attorney's office. The crimes were committed in 2019, according to online jail records.

In July, a jury found Hugo guilty of two counts of aggravated indecent liberties, two counts of rape of a child under 14 and aggravated sodomy. He has in the Johnson County Detention Center since October 2021, according to online jail records.&nbsp;

<figure>
 <img src="https://media.eaglewebservices.com/public/2024/7/1722275116463.png" alt="Hugo-photo Johnson Co." />
 <figcaption>Hugo-photo Johnson Co.</figcaption>
 </figure>JOHNSON COUNTY—A Kansas man is going to prison for violent child sex crimes.This week, Judge T. Kelly Ryan sentenced 36-year-old Timothy Ryan Hugo to Life without the possibility of parole for 25-years for aggravated indecent liberties, rape of a child under 14 and aggravated criminal sodomy, according to the Johnson County District Attorney's office. The crimes were committed in 2019, according to online jail records.He registered a sex offender this week.In July, a jury found Hugo guilty of two counts of aggravated indecent liberties, two counts of rape of a child under 14 and aggravated sodomy. He has in the Johnson County Detention Center since October 2021, according to online jail records.&nbsp;

Kansas man going to prison for violent child sex crimes

GRANT COUNTY, Nebraska —Law enforcement are investigating a Kansas man on drug allegations after a traffic stop.

Just after 5:30 p.m. October 24, while working traffic North of Hyannis on Hwy 61, a Grant County Deputy stopped a Kansas registered vehicle traveling south bound doing 75 mph in a 60 mph zone, according to a media release.

An investigation revealed a 38- year old man from Wichita was in possession of suspected large quantities of cocaine, methamphetamines, marijuana, cash and paraphernalia.

With the assistance of Nebraska State Patrol and Box Butte County Sheriff's Office, the man was arrested for multiple drug charges and transported to the Box Butte County Jail without incident.

<figure>
 <img src="https://media.eaglewebservices.com/public/2024/10/1729785025424.jpeg" alt="Photos Grant Co. Sheriff" />
 <figcaption>Photos Grant Co. Sheriff</figcaption>
 </figure>GRANT COUNTY, Nebraska —Law enforcement are investigating a Kansas man on drug allegations after a traffic stop.<figure>
 <img src="https://media.eaglewebservices.com/public/2024/10/1729785041197.jpeg" alt="" />
 <figcaption></figcaption>
 </figure>Just after 5:30 p.m. October 24, while working traffic North of Hyannis on Hwy 61, a Grant County Deputy stopped a Kansas registered vehicle traveling south bound doing 75 mph in a 60 mph zone, according to a media release.<figure>
 <img src="https://media.eaglewebservices.com/public/2024/10/1729785056243.jpeg" alt="" />
 <figcaption></figcaption>
 </figure>An investigation revealed a 38- year old man from Wichita was in possession of suspected large quantities of cocaine, methamphetamines, marijuana, cash and paraphernalia.With the assistance of Nebraska State Patrol and Box Butte County Sheriff's Office, the man was arrested for multiple drug charges and transported to the Box Butte County Jail without incident.

Kan. man, driving 75mph in a 60,  caught with large quantities of cocaine

SEDGWICK COUNTY —Police have received reports about people standing in medians and intersections around Wichita, asking for money for a young girl named Carla, who they claim passed away from leukemia.

On Saturday, officers questioned one individual who couldn’t provide any additional photos, even though he claimed Carla was his niece. He said he came from out of state to Wichita on a friend’s suggestion.

After investigating, police discovered the Tulsa Police Department had reported a similar scam involving identical signs with a different photo. "Please be aware—this appears to be a scam."

<figure>
 <img src="https://media.eaglewebservices.com/public/2024/10/1729979470928.png" alt="Photo Wichita Police" />
 <figcaption>Photo Wichita Police</figcaption>
 </figure>SEDGWICK COUNTY —Police have received reports about people standing in medians and intersections around Wichita, asking for money for a young girl named Carla, who they claim passed away from leukemia.On Saturday, officers questioned one individual who couldn’t provide any additional photos, even though he claimed Carla was his niece. He said he came from out of state to Wichita on a friend’s suggestion.After investigating, police discovered the Tulsa Police Department had reported a similar scam involving identical signs with a different photo. "Please be aware—this appears to be a scam."

Police in Kansas alert public to leukemia fundraising scam

TOPEKA —A Kansas man pleaded guilty this week to preparing and filing false income tax returns on behalf of his clients, according to the United State's Attorney.

According to court documents and statements made in court, Hophine Bwosinde, of Lenexa, operated Ambroseli Professional Services, a tax preparation business. From 2018 through 2022, Bwosinde prepared and filed false tax returns on behalf of his clients by either inflating legitimate business expenses or by claiming losses related to fake businesses. In addition, Bwosinde falsely reported negative income on clients’ returns. These false items caused his clients to significantly underreport their income to the IRS, which reduced the amount of taxes the clients owed and generated refunds for many to which they were not entitled.

In total, Bwosinde caused a total tax loss exceeding $1.5 million.

A sentencing hearing will take place on Feb. 18, 2025. Bwosinde faces a maximum penalty of three years in prison. He also faces a period of supervised release, restitution and monetary penalties. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

TOPEKA —A Kansas man pleaded guilty this week to preparing and filing false income tax returns on behalf of his clients, according to the United State's Attorney.According to court documents and statements made in court, Hophine Bwosinde, of Lenexa, operated Ambroseli Professional Services, a tax preparation business. From 2018 through 2022, Bwosinde prepared and filed false tax returns on behalf of his clients by either inflating legitimate business expenses or by claiming losses related to fake businesses. In addition, Bwosinde falsely reported negative income on clients’ returns. These false items caused his clients to significantly underreport their income to the IRS, which reduced the amount of taxes the clients owed and generated refunds for many to which they were not entitled.In total, Bwosinde caused a total tax loss exceeding $1.5 million.A sentencing hearing will take place on Feb. 18, 2025. Bwosinde faces a maximum penalty of three years in prison. He also faces a period of supervised release, restitution and monetary penalties. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Kan. tax preparer faces prison time for filing false returns for clients

NEW YORK (AP) — Health officials said Thursday that there's no evidence bird flu is spreading between people after investigating a mysterious infection in Missouri.

The illness reported last month was different from the 30 other bird flu infections in people in the U.S. so far this year. Those cases have been in farmworkers who had contact with infected dairy cows or chickens.

There was no known contact with an infected animal in the Missouri case, but health officials said Thursday that’s the only remaining explanation.

"There is no evidence of person-to-person transmission,” said Dr. Demetre Daskalakis of the Centers for Disease Control and Prevention.

The H5N1 bird flu&nbsp;<a href="https://apnews.com/article/bird-flu-humans-animals-deaths-ae01d3717783f0cf41e23f3fedb97017">has been spreading widely</a>&nbsp;in the U.S. among wild birds, poultry, cows and a number of other animals. Its growing presence increases the chances that people will be exposed, and potentially catch it, officials say.

The most recent of the 31 confirmed human cases are two workers at a commercial egg farm in Franklin County, in southeast Washington state. The rest: 15 in California, 10 in Colorado, two in Michigan, one in Texas and the unusual one in Missouri. Symptoms have been mostly mild, including eye redness.

Few details have been released about the Missouri case. The person had preexisting health problems and was hospitalized in late August. The patient was given a test for flu that was positive for influenza A, a broad virus category. Further testing found partial genetic sequences similar to bird flu viruses from U.S. dairy cows.

Because the Missouri person did not work at a farm and had no known contact with an infected animal, health officials have been looking into the possibility it had come from another person with an undetected infection. That kind of spread would be a worrisome sign the virus might be turning into a more common threat to humans.

They did complicated blood testing of the patient, five hospital workers, and a person described as a “household contact” of the patient — looking for antibodies that would serve as proof of a past infection. The household contact got a stomach illness at the same time as the patient, but was not initially tested.

On Thursday, CDC officials said test results were negative for the health care workers. The patient and the household contact showed signs of past infection in one round of testing, but not in others. Neither met the World Health Organization's blood testing threshold for a bird flu case. The household contact is not part of the U.S. tally.

Since they both got sick at the same time, officials believe the patient and the contact were exposed together to some unknown animal or animal product — ruling out spread of the virus from one of them to the other, Daskalakis said.

<figure>
 <img src="https://media.eaglewebservices.com/public/2024/9/1725718440042.png" alt="CDC image" />
 <figcaption>CDC image</figcaption>
 </figure>NEW YORK (AP) — Health officials said Thursday that there's no evidence bird flu is spreading between people after investigating a mysterious infection in Missouri.The illness reported last month was different from the 30 other bird flu infections in people in the U.S. so far this year. Those cases have been in farmworkers who had contact with infected dairy cows or chickens.There was no known contact with an infected animal in the Missouri case, but health officials said Thursday that’s the only remaining explanation."There is no evidence of person-to-person transmission,” said Dr. Demetre Daskalakis of the Centers for Disease Control and Prevention.The H5N1 bird flu&nbsp;<a href="https://apnews.com/article/bird-flu-humans-animals-deaths-ae01d3717783f0cf41e23f3fedb97017">has been spreading widely</a>&nbsp;in the U.S. among wild birds, poultry, cows and a number of other animals. Its growing presence increases the chances that people will be exposed, and potentially catch it, officials say.The most recent of the 31 confirmed human cases are two workers at a commercial egg farm in Franklin County, in southeast Washington state. The rest: 15 in California, 10 in Colorado, two in Michigan, one in Texas and the unusual one in Missouri. Symptoms have been mostly mild, including eye redness.Few details have been released about the Missouri case. The person had preexisting health problems and was hospitalized in late August. The patient was given a test for flu that was positive for influenza A, a broad virus category. Further testing found partial genetic sequences similar to bird flu viruses from U.S. dairy cows.Because the Missouri person did not work at a farm and had no known contact with an infected animal, health officials have been looking into the possibility it had come from another person with an undetected infection. That kind of spread would be a worrisome sign the virus might be turning into a more common threat to humans.They did complicated blood testing of the patient, five hospital workers, and a person described as a “household contact” of the patient — looking for antibodies that would serve as proof of a past infection. The household contact got a stomach illness at the same time as the patient, but was not initially tested.On Thursday, CDC officials said test results were negative for the health care workers. The patient and the household contact showed signs of past infection in one round of testing, but not in others. Neither met the World Health Organization's blood testing threshold for a bird flu case. The household contact is not part of the U.S. tally.Since they both got sick at the same time, officials believe the patient and the contact were exposed together to some unknown animal or animal product — ruling out spread of the virus from one of them to the other, Daskalakis said.

Health officials update on bird flu spreading between people 

BAGHDAD –&nbsp;During the early morning of Oct. 22, Iraqi Security Forces (ISF), enabled by Coalition Forces as part of Combined Joint Task Force-Operation Inherent Resolve (CJTF-OIR), conducted strikes and follow raids on multiple ISIS locations in Central Iraq, targeting several senior ISIS leaders and killing at least seven ISIS operatives, according to a media release from the U.S. Central Command.

 During the Iraqi-led operation, two U.S. military personnel were wounded while assisting Iraqi forces with site exploitation. They are in stable condition.&nbsp; U.S. officials have released no additional details on them.

 Also as previously released, Iraqi Security Forces, enabled by&nbsp;Combined Joint Task Force-Operation Inherent Resolve, conducted precision airstrikes in Northeastern Iraq, Oct. 14-15, that killed four members of ISIS, including an ISIS senior leader. Both Iraqi-led strikes were conducted to disrupt and degrade ISIS attack networks in Iraq.&nbsp;

Also in the past week, U.S. Central Command (CENTCOM) forces successfully destroyed 15 drones, Land Attack Cruise Missiles and Surface-to-Air Missiles in the CENTCOM area of responsibility (AOR). T

These Iranian-supplied weapons, launched episodically by the Houthis and Iranian-Aligned Militia Groups (IAMGs) over several days during the week, posed a significant risk to United States, allies, and partner forces, as well as civilians in the region. The weapons systems were downed by a combination of U.S. Air Force and U.S. Navy assets deployed to the region.

<figure>
 <img src="https://media.eaglewebservices.com/public/2024/2/1707001115180.png" alt="File photo U.S. Central Command&nbsp;" />
 <figcaption>File photo U.S. Central Command&nbsp;</figcaption>
 </figure>BAGHDAD –&nbsp;During the early morning of Oct. 22, Iraqi Security Forces (ISF), enabled by Coalition Forces as part of Combined Joint Task Force-Operation Inherent Resolve (CJTF-OIR), conducted strikes and follow raids on multiple ISIS locations in Central Iraq, targeting several senior ISIS leaders and killing at least seven ISIS operatives, according to a media release from the U.S. Central Command. During the Iraqi-led operation, two U.S. military personnel were wounded while assisting Iraqi forces with site exploitation. They are in stable condition.&nbsp; U.S. officials have released no additional details on them. Also as previously released, Iraqi Security Forces, enabled by&nbsp;Combined Joint Task Force-Operation Inherent Resolve, conducted precision airstrikes in Northeastern Iraq, Oct. 14-15, that killed four members of ISIS, including an ISIS senior leader. Both Iraqi-led strikes were conducted to disrupt and degrade ISIS attack networks in Iraq.&nbsp;Also in the past week, U.S. Central Command (CENTCOM) forces successfully destroyed 15 drones, Land Attack Cruise Missiles and Surface-to-Air Missiles in the CENTCOM area of responsibility (AOR). TThese Iranian-supplied weapons, launched episodically by the Houthis and Iranian-Aligned Militia Groups (IAMGs) over several days during the week, posed a significant risk to United States, allies, and partner forces, as well as civilians in the region. The weapons systems were downed by a combination of U.S. Air Force and U.S. Navy assets deployed to the region.

U.S. military personnel injured during raid in Iraq continue recovery

<a href="https://newsroom.ap.org/home/search/?query=byline:%22JONEL%20ALECCIA%22&amp;mediaType=text&amp;st=keyword&amp;sortOrder=newest">By JONEL ALECCIA AP Health Writer</a>

A&nbsp;<a href="https://apnews.com/article/mcdonalds-e-coli-outbreak-sick-onions-d4a37726f2669016decedcf9f928a9d9">deadly outbreak of E. coli poisoning</a>&nbsp;tied to McDonald's Quarter Pounders has expanded, with at least 75 people sick in 13 states, federal health officials said Friday.

A total of 22 people have now been hospitalized, and two have developed a dangerous kidney disease complication, the Centers for Disease Control and Prevention said. One person has died in Colorado.

No definitive source of&nbsp;<a href="https://apnews.com/article/mcdonalds-boars-head-ecoli-listeria-food-safety-1256564e2ec8baf6a96b27c7102e833e">the outbreak</a>&nbsp;has been identified, officials with the U.S. Food and Drug Administration said. Early information analyzed by the FDA showed that uncooked slivered onions used on the burgers “are a likely source of contamination,” the agency said.

<figure>
 <img src="https://media.eaglewebservices.com/public/2024/10/1729872051879.png" alt="CDC image" />
 <figcaption>CDC image</figcaption>
 </figure><a href="https://newsroom.ap.org/home/search/?query=byline:%22JONEL%20ALECCIA%22&amp;mediaType=text&amp;st=keyword&amp;sortOrder=newest">By JONEL ALECCIA AP Health Writer</a>A&nbsp;<a href="https://apnews.com/article/mcdonalds-e-coli-outbreak-sick-onions-d4a37726f2669016decedcf9f928a9d9">deadly outbreak of E. coli poisoning</a>&nbsp;tied to McDonald's Quarter Pounders has expanded, with at least 75 people sick in 13 states, federal health officials said Friday.A total of 22 people have now been hospitalized, and two have developed a dangerous kidney disease complication, the Centers for Disease Control and Prevention said. One person has died in Colorado.<figure>
 <img src="https://media.eaglewebservices.com/public/2024/10/1729882011911.png" alt="CDC map" />
 <figcaption>CDC map</figcaption>
 </figure>No definitive source of&nbsp;<a href="https://apnews.com/article/mcdonalds-boars-head-ecoli-listeria-food-safety-1256564e2ec8baf6a96b27c7102e833e">the outbreak</a>&nbsp;has been identified, officials with the U.S. Food and Drug Administration said. Early information analyzed by the FDA showed that uncooked slivered onions used on the burgers “are a likely source of contamination,” the agency said.<a href="https://apnews.com/article/mcdonalds-outbreak-e-coli-onions-2bc3fc2d4198d9a5bad52c0028316165">McDonald’s has confirmed</a>&nbsp;that Taylor Farms, a California-based produce company, was the supplier of the fresh onions used in the restaurants involved in the outbreak, and that they had come from a facility in Colorado Springs, Colorado.“We have made the decision to stop sourcing onions from Taylor Farms’ Colorado Springs facility indefinitely,” McDonald's said in a statement released late Friday.Taylor Farms said Friday it had preemptively recalled yellow onions sent to its customers from its Colorado facility and continues to work with the CDC and the FDA as they investigate.“It saddens us to see the illnesses and affected individuals and families,” from the outbreak, the family-owned company said.McDonald's pulled the Quarter Pounder burger from menus in several states — mostly in the Midwest and Mountain states — when the outbreak was announced Tuesday. McDonald's said Friday that slivered onions from the Colorado Springs facility were distributed to approximately 900 of its restaurants, including some in transportation hubs like airports.The new cases reported Friday were a sharp increase from the original tally of 49 in 10 states. Most illnesses were reported in Colorado, with 26 cases. At least 13 people were sickened in Montana, 11 in Nebraska, 5 each in New Mexico and Utah, 4 each in Missouri and Wyoming, two in Michigan and one each in Iowa, Kansas, Oregon, Wisconsin and Washington, the CDC reported.McDonald's said Friday it didn't pull the Quarter Pounder from any additional restaurants due to the increase in the CDC's illness count. The company noted that some cases in states outside the original region were tied to travel.The CDC said some people who got sick reported traveling to other states before their symptoms started. At least three people said they ate at McDonald's during their travel. Illnesses were reported between Sept. 27 and Oct. 11.Taylor Farms notified its customers directly about the onion recall but did not tell the public about it, an FDA official said. Companies often issue press releases and the FDA sends public notifications for recalls, but they are not required.While it remains unclear if the recalled onions were the source of the outbreak, several other fast-food restaurants — including Taco Bell, Pizza Hut, KFC and Burger King — pulled onions from some menus in certain areas this week.Restaurant Brands International, which owns Burger King, said that 5% of its restaurants use whole onions distributed by Taylor Farms’ Colorado facility. They are washed, peeled and sliced by employees.Even though it wasn’t contacted by health officials and it had no indications of illness, Restaurant Brands said it asked the restaurants that received onions from the Colorado facility to get rid of them.The outbreak involves infections&nbsp;<a href="https://apnews.com/article/e-coli-mcdonalds-outbreak-bacteria-quarter-pounder-080847096a6b7062b4fb17037393fc99">with E. coli 0157:H7, a type of bacteria</a>&nbsp;that produces a dangerous toxin. It causes about 74,000 infections in the U.S. annually, leading to more than 2,000 hospitalizations and 61 deaths each year, according to CDC.People sickened in the outbreak have already moved to sue McDonald's, according to court records. According to her lawsuit, Clarissa DeBock ate food from a local McDonald's in Nebraska on Sept. 18, fell ill on Sept. 23 and sought emergency care two days later before she was diagnosed with an E. coli infection.Symptoms of E. coli poisoning can occur quickly, within a day or two of eating contaminated food. They typically include fever, vomiting, diarrhea or bloody diarrhea and signs of dehydration — little or no peeing, increased thirst and dizziness. The infection is especially dangerous for children younger than 5, people who are elderly, pregnant or who have weakened immune systems.___