MARSHFIELD, Mo. (AP) — A man who pleaded guilty to&nbsp;<a href="https://apnews.com/article/2026496a05084124bd4c08111eaa9a83">stuffing his wife’s body in a freezer</a>&nbsp;more than six years ago has been sentenced to 25 years in prison.

Larry Dinwiddie, 59, of Marshfield, Mo., was sentenced Monday after he pleaded guilty in November to second-degree murder in the death of Cynthia Dinwiddie,&nbsp;<a href="https://www.kfvs12.com/2022/01/24/judge-sentences-marshfield-mo-man-killing-wife-stuffing-body-freezer/">television station KYTV reported</a>.

In exchange for his plea, prosecutors dropped a count of abandoning a corpse. Investigators have said they found the body of his wife, Cynthia, locked in a freezer in an abandoned storage unit in November 2019 and that her body had been there since 2015.

Investigators have said her death resulted from domestic violence. Dinwiddie admitted to killing his wife with a hammer during an argument, according to court records. He never reported her missing.

<figure>
 <img src="https://media.eaglewebservices.com/public/2019/11/1574898507140.png" alt="Dinwiddie-photo Marshall Co. Sheriff" />
 <figcaption>Dinwiddie-photo Marshall Co. Sheriff</figcaption>
 </figure>MARSHFIELD, Mo. (AP) — A man who pleaded guilty to&nbsp;<a href="https://apnews.com/article/2026496a05084124bd4c08111eaa9a83">stuffing his wife’s body in a freezer</a>&nbsp;more than six years ago has been sentenced to 25 years in prison.Larry Dinwiddie, 59, of Marshfield, Mo., was sentenced Monday after he pleaded guilty in November to second-degree murder in the death of Cynthia Dinwiddie,&nbsp;<a href="https://www.kfvs12.com/2022/01/24/judge-sentences-marshfield-mo-man-killing-wife-stuffing-body-freezer/">television station KYTV reported</a>.In exchange for his plea, prosecutors dropped a count of abandoning a corpse. Investigators have said they found the body of his wife, Cynthia, locked in a freezer in an abandoned storage unit in November 2019 and that her body had been there since 2015.Investigators have said her death resulted from domestic violence. Dinwiddie admitted to killing his wife with a hammer during an argument, according to court records. He never reported her missing.

Man who stuffed wife's body in freezer sentenced to prison

SHAWNEE COUNTY—Law enforcement authorities are investigating a violent assault and have a suspect in custody.

Just after 7:30 p.m. Monday, police responded to a residence in the 6500 Block of SW 26th Ct. in Topeka in reference to an assault. At the home officers located an adult victim suffering from serious injuries after having been assaulted by a family member.

The victim was transported to a local hospital for treatment.

Shortly after 9:00 p.m., an officer located the suspect later identified as&nbsp;Colby Fincham, 31 of Topeka, sitting in his vehicle in the parking lot of Walmart located at 2600 NW Rochester Road. 

Fincham refused to get out of his car, so numerous officers were utilized to safely handle the situation. After just under an hour of communicating with him, he complied with commands and was taken into custody. 

Police transported Fincham to the Shawnee County Department of Corrections and he is being held on requested charges of Aggravated Battery, Aggravated Burglary, Violation of a PFA, Stalking, Theft, Criminal Damage, Interference and Possession of Cocaine.

<figure>
 <img src="https://media.eaglewebservices.com/public/2022/1/1643110970677.png" alt="Fincham photo Shawnee Co." />
 <figcaption>Fincham photo Shawnee Co.</figcaption>
 </figure>SHAWNEE COUNTY—Law enforcement authorities are investigating a violent assault and have a suspect in custody.Just after 7:30 p.m. Monday, police responded to a residence in the 6500 Block of SW 26th Ct. in Topeka in reference to an assault. At the home officers located an adult victim suffering from serious injuries after having been assaulted by a family member.The victim was transported to a local hospital for treatment.Shortly after 9:00 p.m., an officer located the suspect later identified as&nbsp;Colby Fincham, 31 of Topeka, sitting in his vehicle in the parking lot of Walmart located at 2600 NW Rochester Road. Fincham refused to get out of his car, so numerous officers were utilized to safely handle the situation. After just under an hour of communicating with him, he complied with commands and was taken into custody. Police transported Fincham to the Shawnee County Department of Corrections and he is being held on requested charges of Aggravated Battery, Aggravated Burglary, Violation of a PFA, Stalking, Theft, Criminal Damage, Interference and Possession of Cocaine.

Kansas man accused of violent attack, stalking 

By HEATHER HOLLINGSWORTH, Associated Press

Gov. Laura Kelly has ordered the Kansas agency that oversees foster care to investigate the death of a 17-year-old who was restrained face down for more than 30 minutes last fall at a Wichita juvenile intake center after his foster father called begging for help because the teen was hallucinating.

“This situation is tragic, and we must find a way to ensure something like this never happens again,” Kelly said in a written statement calling for the Kansas Department for Children and Families to review the case of Cedric Lofton and see if policies needed to be changed.

Her comments come one week after Sedgwick County District Attorney Marc Bennett expressed concerns about the handling of Lofton’s case when he announced that he&nbsp;<a href="https://apnews.com/article/wichita-kansas-a51f619b8b196987e74b046ac399680c">wouldn’t file any criminal charges</a>. He said he struggled with whether an involuntary manslaughter charge was justified, but concluded that the state’s&nbsp;<a href="https://apnews.com/article/kansas-wichita-topeka-legislature-gun-politics-6f61a926a56353a4b22ffecf90c46be3">“stand-your-ground” law</a>&nbsp;prevented him from pursuing it because staff members were protecting themselves.

Kelly also said she was looking forward to hearing recommendations from Bennett, the Legislature and advocates on ways to clarify or modify the law.

DCF spokesman Mike Deines didn’t immediately respond to an email request from The Associated Press seeking comment.

According to Bennett’s report, Lofton’s mental health got markedly worse after the teen attended his grandmother’s funeral. Lofton’s family expressed concern to the foster father that Cedric “was having either a mental breakdown and, or he was having an onset of schizophrenia.”

And one of his foster brothers later told investigators that Lofton had complained that there were kids in his class at school that were robots who were trying to kill him, the report said.

At the urging of the case manager, the foster father drove Lofton to a mental health provider, but he walked away. When Lofton returned home in the pre-dawn hours of on Sept. 24, the case worker told the foster father to not let the teen into the house and to call police.

Bennett wrote in his report: “Whether the State of Kansas should accept a foster care system that responds to a foster father’s expression of concern that his foster son is in mental distress by telling the man, don’t let him in the house and call the police -- is a legitimate question. A question, in fact, that may well demand answers.”

Police who arrived at the home spent nearly an hour trying to convince Lofton to go to a hospital for mental health treatment. But Lofton refused, telling officers he was concerned about people trying to kill him, the report said.

When officers tried to escort the 5-foot-10, 135-pound Lofton to the patrol car, Lofton struck and kicked at them, the report said. They ultimately restrained him in something called the WRAP, a device comprised of a locking shoulder harness, leg restraints and ankle straps.

A sergeant said in an interview that he believed Lofton was too combative to take to the hospital. But at least one officer involved can be heard saying on a body camera recording that he thought the teen should have been taken there and not to the Sedgwick County Juvenile Intake and Assessment Center.

Once at the center, Lofton scuffled with staff after the WRAP restraint was removed.&nbsp;<a href="https://apnews.com/article/kansas-wichita-72306786c90addb96280d1738d931ad8">Surveillance video&nbsp;</a>released Friday shows him punching one of the juvenile detention employees in the head.

Bennett’s report said staff shackled Lofton’s ankles and put him on his stomach on the floor. His report said Cedric was “mumbling” at times, repeated that he was Jesus and saying staff should kill themselves and that he would “hex” them. Staff noticed he wasn’t breathing after they called to arrange for Lofton to be taken to a hospital for a mental health evaluation. Paramedics rushed to the scene, but Lofton died two days later.

By HEATHER HOLLINGSWORTH, Associated PressGov. Laura Kelly has ordered the Kansas agency that oversees foster care to investigate the death of a 17-year-old who was restrained face down for more than 30 minutes last fall at a Wichita juvenile intake center after his foster father called begging for help because the teen was hallucinating.<div><iframe width="560" height="315" src="https://www.youtube.com/embed/cxlFYiAFil4" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe></div>“This situation is tragic, and we must find a way to ensure something like this never happens again,” Kelly said in a written statement calling for the Kansas Department for Children and Families to review the case of Cedric Lofton and see if policies needed to be changed.Her comments come one week after Sedgwick County District Attorney Marc Bennett expressed concerns about the handling of Lofton’s case when he announced that he&nbsp;<a href="https://apnews.com/article/wichita-kansas-a51f619b8b196987e74b046ac399680c">wouldn’t file any criminal charges</a>. He said he struggled with whether an involuntary manslaughter charge was justified, but concluded that the state’s&nbsp;<a href="https://apnews.com/article/kansas-wichita-topeka-legislature-gun-politics-6f61a926a56353a4b22ffecf90c46be3">“stand-your-ground” law</a>&nbsp;prevented him from pursuing it because staff members were protecting themselves.Kelly also said she was looking forward to hearing recommendations from Bennett, the Legislature and advocates on ways to clarify or modify the law.DCF spokesman Mike Deines didn’t immediately respond to an email request from The Associated Press seeking comment.According to Bennett’s report, Lofton’s mental health got markedly worse after the teen attended his grandmother’s funeral. Lofton’s family expressed concern to the foster father that Cedric “was having either a mental breakdown and, or he was having an onset of schizophrenia.”And one of his foster brothers later told investigators that Lofton had complained that there were kids in his class at school that were robots who were trying to kill him, the report said.At the urging of the case manager, the foster father drove Lofton to a mental health provider, but he walked away. When Lofton returned home in the pre-dawn hours of on Sept. 24, the case worker told the foster father to not let the teen into the house and to call police.Bennett wrote in his report: “Whether the State of Kansas should accept a foster care system that responds to a foster father’s expression of concern that his foster son is in mental distress by telling the man, don’t let him in the house and call the police -- is a legitimate question. A question, in fact, that may well demand answers.”Police who arrived at the home spent nearly an hour trying to convince Lofton to go to a hospital for mental health treatment. But Lofton refused, telling officers he was concerned about people trying to kill him, the report said.When officers tried to escort the 5-foot-10, 135-pound Lofton to the patrol car, Lofton struck and kicked at them, the report said. They ultimately restrained him in something called the WRAP, a device comprised of a locking shoulder harness, leg restraints and ankle straps.A sergeant said in an interview that he believed Lofton was too combative to take to the hospital. But at least one officer involved can be heard saying on a body camera recording that he thought the teen should have been taken there and not to the Sedgwick County Juvenile Intake and Assessment Center.Once at the center, Lofton scuffled with staff after the WRAP restraint was removed.&nbsp;<a href="https://apnews.com/article/kansas-wichita-72306786c90addb96280d1738d931ad8">Surveillance video&nbsp;</a>released Friday shows him punching one of the juvenile detention employees in the head.Bennett’s report said staff shackled Lofton’s ankles and put him on his stomach on the floor. His report said Cedric was “mumbling” at times, repeated that he was Jesus and saying staff should kill themselves and that he would “hex” them. Staff noticed he wasn’t breathing after they called to arrange for Lofton to be taken to a hospital for a mental health evaluation. Paramedics rushed to the scene, but Lofton died two days later.

Kan. governor calls for investigation into teen's custody death

KINGMAN COUNTY—A Kansas man died in an accident just after 10:30a.m. Tuesday in Kingman County.

The Kansas Highway Patrol reported a 2006 Nissan Altima driven by Oliver T. Wilson, 43, Wichita, was eastbound on Kansas 42 one mile west of Norwich.

The car traveled left of center in a no passing zone and struck a westbound cement truck driven by Justin M. Strunk, 43, Colwich, head-on.

Wilson was pronounce dead at the scene and was transported to the Sedegwick County Forensics Center. Strunk was not injured. Wilson was not wearing a seat belt, according to the KHP.

KINGMAN COUNTY—A Kansas man died in an accident just after 10:30a.m. Tuesday in Kingman County.The Kansas Highway Patrol reported a 2006 Nissan Altima driven by Oliver T. Wilson, 43, Wichita, was eastbound on Kansas 42 one mile west of Norwich.The car traveled left of center in a no passing zone and struck a westbound cement truck driven by Justin M. Strunk, 43, Colwich, head-on.Wilson was pronounce dead at the scene and was transported to the Sedegwick County Forensics Center. Strunk was not injured. Wilson was not wearing a seat belt, according to the KHP.

Kansas man dies after head-on crash with a cement truck

The Biden administration has officially withdrawn a rule that would have required workers at big companies to get vaccinated or face regular COVID testing requirements.

The Occupational Safety and Health Administration confirmed the withdrawal Tuesday. But the agency said it still strongly encourages workers to get vaccinated.

In early November, OSHA announced a vaccine-or-test mandate for companies with at least 100 employees. The rule __ which would have impacted more than 80 million U.S. workers __ was originally set to go into effect on Jan. 4.

But numerous states and business groups challenged the rule in court. On Jan. 13, the Supreme Court halted the plan. In a 6-3 ruling, the court’s conservative majority concluded that OSHA had overstepped its authority.

“OSHA has never before imposed such a mandate. Nor has Congress,″ the court’s majority wrote. ”Indeed, although Congress has enacted significant legislation addressing the COVID-19 pandemic, it has declined to enact any measure similar to what OSHA has promulgated here."

The justices left in place a vaccine mandate for health care providers who receive federal Medicare or Medicaid funding. That rule affects 10.4 million workers.

OSHA indicated that the rule could return in some form. While it is no longer an enforceable standard, it remains a proposed rule, OSHA said. In the meantime, the agency said it will prioritize the health care mandate.

<figure>
 <img src="https://media.eaglewebservices.com/public/2022/1/1642678724173.png" alt="The Occupational Safety and Health Administration confirmed the withdrawal Tuesday. But the agency said it still strongly encourages workers to get vaccinated-White House photo" />
 <figcaption>The Occupational Safety and Health Administration confirmed the withdrawal Tuesday. But the agency said it still strongly encourages workers to get vaccinated-White House photo</figcaption>
 </figure>By DEE-ANN DURBIN, AP Business WriterThe Biden administration has officially withdrawn a rule that would have required workers at big companies to get vaccinated or face regular COVID testing requirements.The Occupational Safety and Health Administration confirmed the withdrawal Tuesday. But the agency said it still strongly encourages workers to get vaccinated.In early November, OSHA announced a vaccine-or-test mandate for companies with at least 100 employees. The rule __ which would have impacted more than 80 million U.S. workers __ was originally set to go into effect on Jan. 4.But numerous states and business groups challenged the rule in court. On Jan. 13, the Supreme Court halted the plan. In a 6-3 ruling, the court’s conservative majority concluded that OSHA had overstepped its authority.“OSHA has never before imposed such a mandate. Nor has Congress,″ the court’s majority wrote. ”Indeed, although Congress has enacted significant legislation addressing the COVID-19 pandemic, it has declined to enact any measure similar to what OSHA has promulgated here."The justices left in place a vaccine mandate for health care providers who receive federal Medicare or Medicaid funding. That rule affects 10.4 million workers.OSHA indicated that the rule could return in some form. While it is no longer an enforceable standard, it remains a proposed rule, OSHA said. In the meantime, the agency said it will prioritize the health care mandate.

Biden administration officially withdraws vaccine rule

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Collins has more bad news for the typical worker.

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

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

This tradeoff hasn’t panned out well for Americans.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The nursing home’s management declined to comment.

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

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

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

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

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

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

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

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

The Northview management declined to comment.

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

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

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

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

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

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

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

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

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

With vaccine mandate looming, nursing homes face staffing crisis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pfizer and its partner BioNTech announced the study on Tuesday.

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

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

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

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

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

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

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

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

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

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

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

Pfizer begins testing omicron-matched COVID shots in adults

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

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

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

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

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

Police find woman fatally wounded on sidewalk in Kansas City

My wife and I own a small catering business. We have a few big corporations as clients, and our company has been very successful over the last two or three years. Now, we are planning to build a house. I was wondering what you think about how much should be spent on the land itself versus the construction of the actual house.&nbsp;

When the whole thing is done, the payment you end up with shouldn’t be more than 25% of your take-home pay on a 15-year, fixed-rate loan. The ratio of land to&nbsp;<a href="https://www.ramseysolutions.com/real-estate/mortgage-calculator">house</a>&nbsp;can vary, and that part’s up to you. If you’re buying a big piece of land, you’re probably going to have a higher ratio of land cost to home cost than if you bought a simple lot and put a really nice home there.

Generally, a standard subdivision lot is going to be around 20% of the total price. If you spend $100,000 on the lot, you’ll end up with a total project cost of about a half-million. Now, keep in mind that’s just a fairly standard ratio. It’s not a rule.

The only rule here is my rule about mortgage payments. Again, no more than 25% of your&nbsp;<a href="https://www.ramseysolutions.com/budgeting/guide-to-budgeting">take-home pay</a>&nbsp;on a fixed-rate, 15-year note. Otherwise, you can end up house poor. And when you’re house poor, it takes away your ability to save, build wealth, and give.

Having a big house and a lot of land is cool if you can afford it, Lee. But it’s not worth it if it’s financially stressful and prevents you from living your best life!

*&nbsp;<a href="https://www.ramseysolutions.com/">Dave Ramsey</a>&nbsp;is a seven-time #1 national best-selling author, personal finance expert, and host ofThe Ramsey Show, heard by more than 18 million listeners each week. He&nbsp;has appeared on Good Morning America, CBS This Morning, Today Show, Fox News, CNN, Fox Business, and many more. Since 1992, Dave has helped people regain control of their money, build wealth and enhance their lives. He also serves as CEO for Ramsey Solutions.

<figure>
 <img src="https://media.eaglewebservices.com/public/2021/10/1635524005597.png" alt="Ramsey" />
 <figcaption>Ramsey</figcaption>
 </figure>Dear Dave,My wife and I own a small catering business. We have a few big corporations as clients, and our company has been very successful over the last two or three years. Now, we are planning to build a house. I was wondering what you think about how much should be spent on the land itself versus the construction of the actual house.&nbsp;LeeDear Lee,When the whole thing is done, the payment you end up with shouldn’t be more than 25% of your take-home pay on a 15-year, fixed-rate loan. The ratio of land to&nbsp;<a href="https://www.ramseysolutions.com/real-estate/mortgage-calculator">house</a>&nbsp;can vary, and that part’s up to you. If you’re buying a big piece of land, you’re probably going to have a higher ratio of land cost to home cost than if you bought a simple lot and put a really nice home there.Generally, a standard subdivision lot is going to be around 20% of the total price. If you spend $100,000 on the lot, you’ll end up with a total project cost of about a half-million. Now, keep in mind that’s just a fairly standard ratio. It’s not a rule.The only rule here is my rule about mortgage payments. Again, no more than 25% of your&nbsp;<a href="https://www.ramseysolutions.com/budgeting/guide-to-budgeting">take-home pay</a>&nbsp;on a fixed-rate, 15-year note. Otherwise, you can end up house poor. And when you’re house poor, it takes away your ability to save, build wealth, and give.Having a big house and a lot of land is cool if you can afford it, Lee. But it’s not worth it if it’s financially stressful and prevents you from living your best life!— Dave*&nbsp;<a href="https://www.ramseysolutions.com/">Dave Ramsey</a>&nbsp;is a seven-time #1 national best-selling author, personal finance expert, and host ofThe Ramsey Show, heard by more than 18 million listeners each week. He&nbsp;has appeared on Good Morning America, CBS This Morning, Today Show, Fox News, CNN, Fox Business, and many more. Since 1992, Dave has helped people regain control of their money, build wealth and enhance their lives. He also serves as CEO for Ramsey Solutions.

DAVE SAYS: How much dirt, and how much house?

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

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

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

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

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