The bill includes a provision that has the power to curb the expansion of gas infrastructure in New York. “Why put new gas pipes in the ground for new construction, when we’ve already passed laws saying we should be moving away from using gas?” the bill’s sponsor Senator Liz Krueger told City Limits. 

As New York lawmakers debate how to spend billions in the state’s budget, due in early April, environmental groups have joined forces to get a big ticket bill incorporated into the final plan: the New York Heat Act.

If it gets included, the bill passes automatically and then waits for the governor’s signature to officially become law. The Senate passed the bill last week, so if it fails to make the budget it could still become law as long as the Assembly gives it their own vote of approval before the session ends in June.

But environmental groups want it to go through as quickly as possible, and here’s why: it would stop utility companies from building out more polluting gas infrastructure under the premise that they are legally obligated to serve gas in New York. The state’s public service law currently requires gas utilities to provide service to all customers who request it.

“The utilities are absolutely using the obligation to serve as an excuse to continue to expand the gas system and to continue to invest in gas instead of more cost effective [green] alternatives,” said Jessica Azulay, program director of the environmental justice coalition Alliance for a Green Economy (AGREE).

Although natural gas is a fossil fuel that heavily contributes to climate change, gas utilities say building more gas infrastructure is necessary to deliver reliable energy to customers, and have joined forces with unions in criticizing the bill.

They say it would cost jobs in the industry, and that it’s too risky to force homeowners to shift to electricity produced from renewable sources because they are still scarce on the market. Just 27 to 29 percent of the state’s electricity currently comes from renewable energy. 

But advocates argue that the money spent to lay out more gas infrastructure could be diverted towards advancing clean energy projects instead. The move could bolster the green economy, creating jobs and helping the state reach its climate goals.

Five years ago New York passed the Climate Leadership and Community Protection Act (CLPCA), which requires the state to phase out the use of climate change-inducing fossil fuels like gas and have 70 percent of its power come from renewable energy by 2030.

Despite that, gas utilities have continued expanding. They have spent nearly $5 billion to maintain and expand gas infrastructure since the CLCPA’s passage, and plan to spend a total of $28 billion by 2043, according to a report by the Building Decarbonization Coalition.

“Why put new gas pipes in the ground for new construction, when we’ve already passed laws saying we should be moving away from using gas?” the bill’s sponsor Senator Liz Krueger told City Limits. 

“New York Heat helps us speed along the process [of moving off of gas] which is crucial because climate change is accelerating and we’re fighting against time,” she added.

Overriding the Climate Act

The NY Heat Act would do a variety of things, like cap the utility bills of low- and middle-income New Yorkers so that they don’t exceed 6 percent of a household’s income.

The legislation is would also get rid of the 100 foot rule, a legal requirement for utility companies to provide gas service at no charge to anyone who wants it and lives within 100 feet of an existing line. Nixing the rule would save New Yorkers up to $200 million annually, advocates say, since the cost for these hookups are baked into the rates utilities charge paying customers.

But NY Heat also includes an arguably more important clause: it changes the language in the public service law that obligates utilities to serve their customers gas.

The law says that “gas, electric and steam service” must be provided “to all residential customers” because it is necessary for preserving “the health and general welfare” of the population and is “in the public interest.”

NY Heat would amend that rule by getting rid of the word “gas” to open utility companies up to offering non-polluting energy alternatives to customers. The provision would also add that providing such services is necessary for “the achievement of the state’s climate justice and emission reduction mandates.”

“Right now, our existing public service law is actually not in alignment with our state’s climate goals because of this preference for gas,” said Liz Moran, policy advocate at the environmental group EarthJustice.

Environmentalists say the Public Service Commission (PSC), the regulatory agency that keeps the utilities in check, has used the public service law to override the state’s Climate Act when gas expansion projects get contested by environmental activists. 

“The PSC’s interpretation has been that they must follow their obligation to serve gas and to provide free gas hookups under the 100 foot rule over the [state’s climate act]. And it’s very frustrating because both of these laws should be valid,” Azulay from AGREE told City Limits.

In an emailed statement, the Public Service Commission said that it “takes its role in meeting the requirements outlined in the Climate Act seriously, while upholding its statutory objectives to ensure safe and reliable service at just and reasonable rates.”

The Commission also pointed out that utilities are required by law to provide gas service and not other alternatives and claims that any expansion projects aimed at keeping gas flowing in a safe, reliable manner, must be approved.

A spokesperson for National Grid, one of the largest utility companies in New York, told City Limits in an email that they are not against making changes to their obligation to serve new customers. But,”we are opposed to changing the obligation to serve existing customers who must retain robust protections to ensure reliable and affordable energy to heat their homes and businesses,” the spokesperson added.

Azulay argues, however, that it’s possible to both provide reliable energy to customers while still following the state’s climate mandates. 

“NY Heat harmonizes the public service law with the climate act by encouraging utility companies to substitute gas pipes for [clean energy] alternatives that ensure we’re moving people off of the [gas] system,” Azulay explained.

So when utility companies need to swap out old gas pipes that are prone to leaks with new ones, the NY Heat Act would come into play and encourage utility companies to look into using less polluting options instead. Green solutions to heating and cooling homes include installing environmentally friendly heat pumps or laying down the water pipes needed to connect multiple buildings to sources of thermal energy deep underground. 

Advocates say that by trading in gas hookups for clean energy in entire neighborhoods, utility companies would help “decarbonize”—or stop buildings from releasing the carbon emissions that lead to climate change—at a larger scale.

“I really see the change in the obligation to serve as the most important provision at the heart of this bill,” said Allison Considine, senior campaign manager at the environmental group Building Decarbonization Coalition (BDC). “It just unlocks the ability to invest in neighborhood scale decarbonisation efforts in a way that avoids this spiral of increasing costs spent on the gas system.” 

In New York state it costs anywhere from $3 million to $10 million to replace one mile of “leak prone pipe,” according to the Building Decarbonization Coalition. Since residents are all connected to the same gas system, the cost of maintaining gas infrastructure is baked into everyone’s energy bills.

“It’s just going to be cheaper to stop spending that money on gas maintenance and start spending it on providing people with heat pumps and electric stoves. And with the added benefit that we’ll be using less energy overall with those technologies because they are so much more efficient and we will also have cleaner air to boot,” said Considine.

“But unfortunately because the fossil fuel industry wants to stay alive, it’s been in their best interest to obscure that,” she added.

Push back

The fossil fuel industry has joined forces with labor unions to stop the NY Heat from passing.

New Yorkers for Affordable Energy, an association whose members include utility companies like National Grid and National Fuel, said in a press release earlier this year that the legislation “threatens good paying union jobs at a time when our state can ill afford such losses.”

It would “raise rates, cost jobs and eliminate consumer energy choice in NY,” the association said in a social media post last week, when the group held a press conference with several Republican state senators opposing the bill.

The national union, American Federation of Labor and Congress of Industrial Organizations (AFL-CIO), has also come out against it. In an emailed statement, they highlighted the need for the legislation to include more “robust labor standards” and said New York can’t get off gas until the renewable energy sector is further developed.

“It is premature to consider this measure until clean energy development meets the needs of all New Yorkers. This includes ensuring workers in the fossil fuel industry, manufacturing, and other energy-intensive sectors are protected,” said Mario Cilento, president of the New York State AFL-CIO.

Senator Krueger told City Limits she understands the concerns of those who fear losing their jobs to a changing market. “But we’ll continue to say, and most unions agree with us by the way, that there are more opportunities for good union jobs in a green economy than in the current economy,” Krueger said.

Despite the opposition, the bill has gained momentum in Albany this legislative session. It passed the Senate last week and made it into Gov. Kathy Hochul’s budget proposal, although not in its entirety—she nixed the part ensuring that utility bills do not exceed 6 percent of household incomes.

“Governor Hochul’s Executive Budget makes record-setting investments in New York’s future while ensuring the state remains on a stable long-term fiscal trajectory, and she will work with the Legislature to craft a final budget that achieves these goals,” a spokesperson said.

Meanwhile the Assembly, which failed to pass the bill last year, has yet to weigh in this session—but Krueger is hopeful they won’t stop the bill in its tracks this time around.

“There are many assembly members, who are very strong advocates for the bill, coming to press conferences and rallies,” the senator said. 

The legislation would be in line with other efforts by the state to move away from the use of fossil fuels. A ban on gas stoves in new construction that will take effect starting in 2026 has faced similar resistance from the gas industry.

“So frankly, the problem is that gas oil companies are busy putting out false information about New York Heat as they are doing on a number of other environmental bills,” she added.“In general, anything that moves us into a greener electric world is a threat to companies whose money is made on oil and gas systems for sure.” 

To reach the reporter behind this story, contact Mariana@citylimits.org. To reach the editor, contact Jeanmarie@citylimits.org

Want to republish this story? Find City Limits’ reprint policy here.

Michael Scaturro | KFF Health News (TNS)

Online stores sprang up during the COVID-19 pandemic’s telehealth boom touting testosterone as a cure-all for men’s age-related illnesses — despite FDA rules issued years ago restricting such “low testosterone” advertising.

In ads on Google, Facebook, and elsewhere, testosterone telemedicine websites may promise a quick fix for sluggishness and low libido in men. But evidence for that is lacking, physicians said, and the midlife malaise for which testosterone is being touted as a solution is more likely caused by chronic medical conditions, poor diet, or a sedentary lifestyle. In fact, doctors urge caution— and the FDA recommends that all testosterone supplements carry a warning that they may increase the risk of heart attack and stroke.

Valid medical reasons do exist for treating some men with testosterone. The hormone as a medication has existed for decades, and today’s patients include men with hypogonadism, some transgender men who use it to help transition physically, and, sometimes, women dealing with menopausal symptoms. It has also been used for decades by bodybuilders and athletes to enhance strength.

However, online dispensaries can overplay the idea of what is sometimes called “male menopause,” or even “manopause,” to drive sales of highly profitable testosterone-boosting injectables, often ignoring safety guidelines that should prevent healthy men from using the hormone. Some of the websites target military veterans.

“I have seen ads online that do cross the line,” said Steven Nissen, a physician and the chief academic officer for the Heart, Vascular, and Thoracic Institute at the Cleveland Clinic. “For mood and low energy, prescribing testosterone provides little to no benefit. They are promoting testosterone for indications that are not on the label.”

Testosterone telehealth websites almost all cite one study published in 2002 by New England Research Institutes scientists who found testosterone levels drop 1% a year in men over 40. Stefan Schlatt, director of the Center for Reproductive Medicine and Andrology at the University of Muenster in Germany, said the data behind the statistic included older men in deteriorating health whose levels declined because of illnesses.

“Healthy men do not show a drop,” he said.

That 2002 study led to a flood of “low-T” ads on U.S. television — ads that were later banned by the FDA in a 2015 ruling that accused the pharmaceutical industry of exaggerating the low-T phenomenon to scare men into buying drugs. According to another study, the market for testosterone supplements stood at $1.85 billion in 2023.

The deluge of ads “has fueled demand for a largely uninsured product, allowing for high markups,” said Geoffrey Joyce, director of health policy at the USC Schaeffer Center for Health Policy & Economics and a research associate at the National Bureau of Economic Research. “The primary driver is manufactured demand.”

Barbara Mintzes, a professor of evidence-based pharmaceutical policy at the University of Sydney’s Charles Perkins Centre in Australia, said low testosterone should really be seen as a sign of a condition that needs to be treated. She said diabetes, heart disease, high blood pressure, obesity, exposure to toxic chemicals like PFAS, and stress can all reduce testosterone levels.

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Several websites reviewed by KFF Health News brand themselves as news and fitness magazines, with advertisements embedded in articles steering readers toward order forms for testosterone replacement therapy, shorthanded as TRT. The sites’ prices for TRT range from $120 to $135 a month, not including initial mail-back blood tests for around $60. Some sites promise increased libido and reduced stomach fat.

Male Excel’s ads on Google, for example, say TRT “improves mood” and “restores vitality.” And its site says testosterone treatment will provide “muscular definition,” “weight loss,” “explosive drive,” “deeper sleep,” and “restored energy” above a link to a free assessment on its online telehealth platform. Craig Larsen, the company’s CEO, did not reply to several attempts to contact him by phone and email.

Both Male Excel and Hone Health are among the sites that pitch to military veterans. Hone Health included a video of a veteran who said he was refused testosterone treatment by a Department of Veterans Affairs hospital.

Saad Alam, CEO and co-founder of Hone, said that his company is what he called a “conservative” player in the market. He said that Hone prescribes only to men who are hypogonadal and tests men every 90 days, unlike other companies that operate telehealth websites as what he called a “cash grab.”

“I agree that patients should be treated by their doctors. But the U.S. medical system isn’t at a point where it can service men who have this problem, and some endocrinologists would rather treat patients who are higher-profit,” Hone said. “That’s why people are coming to us.”

One popular form of TRT is injectable testosterone cypionate. According to the Medicare average sales price database, it costs $0.027 per milligram. Online purveyors who sell the drug directly to consumers in 200 mg/mL vials for an average price of $129 per month are charging the equivalent of $1.55 per mg — a markup of more than 50 times the average Medicare price.

According to a 2022 study, the TRT telehealth websites create a way to circumvent doctors who refuse to prescribe the hormone. In that study, Justin Dubin, a urologist at the Memorial Healthcare System in Florida, posed as an online mystery shopper. He reported an above-normal testosterone level, and stated his desire to start a family, even though such therapy can curb sperm production. But six of the seven unnamed online TRT clinics prescribed him testosterone via a medical professional.

“And that’s concerning,” Dubin said. “Telemedicine helps men with hypogonadism who might be too embarrassed to discuss erectile dysfunction. But we need to do a better job of understanding the appropriateness of care.”

Still, while the FDA doesn’t allow off-label marketing, it does allow such off-label prescriptions.

Off-label use of testosterone replacement has become especially commonplace among veterans. And among male service members who received TRT in 2017, fewer than half met the clinical practice guidelines, according to a report by the U.S. military.

Phil Palmer, a 41-year-old Marine Corps veteran who lives outside Charleston, South Carolina, said he pays out-of-pocket for bloodwork and prescriptions for a pellet skin-implant form of testosterone and for clomiphene, a drug that can help counter the male infertility that is a side effect of testosterone treatment. He said the treatment appeals to him and other veterans dealing with the aftermath of military service.

“The environment we served in and stress levels have a lot to do with it,” Palmer said. “We were exposed to burn pits. The military doesn’t teach you to eat well — we ate a lot of processed food.”

In medical settings, TRT can speed recovery of soldiers who have bone density issues or spinal cord injuries, said Mark Peterson, a professor of physical medicine and rehabilitation at the University of Michigan Medical School. But, he said, “for men in the normal-T range, using an online prescription to buy testosterone to reduce stomach fat can be counterproductive.”

Those who use it also risk having to take testosterone medication indefinitely, because TRT can cause the body to cease its own production of the hormone.

Palmer, who founded a nonprofit that helps veterans heal through exercise, nutrition, and mentorship, said the medication has been helpful for him but urges fellow veterans to seek care from their doctors rather than what he called “bro science” websites touting testosterone.

“It’s not a magic pill,” he said.

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Phil Galewitz and Holly K. Hacker | (TNS) KFF Health News

Billy Abbott, a retired Army medic, wakes at 6 every morning, steps on the bathroom scale, and uses a cuff to take his blood pressure.

The devices send those measurements electronically to his doctor in Gulf Shores, Alabama, and a health technology company based in New York, to help him control his high blood pressure.

Nurses with the company, Cadence, remotely monitor his readings along with the vital signs of about 17,000 other patients around the nation. They call patients regularly and follow up if anything appears awry. If needed, they can change a patient’s medication or dosage without first alerting their doctor.

Abbott, 85, said he likes that someone is watching out for him outside his regular doctor appointments. “More doctors should recommend this to their patients,” he said.

Increasingly, they are.

Dozens of tech companies have streamed in, pushing their remote monitoring service to primary care doctors as a way to keep tabs on patients with chronic illnesses and free up appointment time, and as a new source of Medicare revenue.

But some experts say remote monitoring’s huge growth — spurred on during the covid-19 pandemic, when patients were hesitant to sit in crowded doctors’ waiting rooms — has outpaced oversight and evidence of how the technology is best used.

“It is the wild West where any patient can get it if a doctor decides it is reasonable or necessary,” said Caroline Reignley, a partner with the law firm McDermott Will & Emery who advises health providers.

In 2019, Medicare made it easier for doctors to bill for monitoring routine vital signs such as blood pressure, weight, and blood sugar. Previously, Medicare coverage for remote monitoring was limited to certain patients, such as those with a pacemaker.

Medicare also began allowing physicians to get paid for the service even when the monitoring is done by clinical staff who work in different places than the physician — an adjustment advocated by telemedicine companies.

In just the first two full years, remote monitoring services billed to Medicare grew from fewer than 134,000 to 2.4 million in 2021, according to federal records analyzed by KFF Health News.

Total Medicare payments for the four most common billing codes for remote monitoring rose from $5.5 million in 2019 to $101.4 million in 2021, the latest year for which data is available.

Part of the allure is that Medicare will pay for remote monitoring indefinitely regardless of patients’ health conditions as long as their doctors believe it will help.

For doctors with 2,000 to 3,000 patients, the money can add up quickly, with Medicare paying an average of about $100 a month per patient for the monitoring, plus more for setting up the device, several companies confirmed.

Medicare enrollees may face 20% in cost sharing for the devices and monthly monitoring, though certain private plans through Medicare Advantage and Medicare supplement policies may cover those costs. The government allowed insurers to waive the patient cost sharing during the pandemic.

About 400 doctors and other providers repeatedly billed Medicare for remote patient monitoring in 2019. Two years later, that had mushroomed to about 3,700 providers, according to Medicare data analyzed by KFF Health News. (The data tracks providers who billed more than 10 patients for at least one type of remote monitoring.)

Federal law enforcement officials say they are conducting investigations after a surge in complaints about some remote patient monitoring companies but would not provide details.

The Department of Health and Human Services’ Office of Inspector General in November issued a consumer alert about companies signing up Medicare enrollees without their doctors’ knowledge: “Unscrupulous companies are signing up Medicare enrollees for this service, regardless of medical necessity,” and bill Medicare even when no monitoring occurs.

In a statement to KFF Health News, Meena Seshamani, director of the federal Center for Medicare, part of the Centers for Medicare & Medicaid Services, did not say how CMS is ensuring only patients who can benefit from remote monitoring receive it. She said the agency balances the need to give patients access to emerging technology that can improve health outcomes with the need to combat fraud and make proper payments to providers.

While some small studies show remote monitoring can improve patient outcomes, researchers say it is unclear which patients are helped most and how long they need to be monitored.

“The research evidence is not as robust as we would like to show that it is beneficial,” said Ateev Mehrotra, a Harvard Medical School researcher.

A January report by the Bipartisan Policy Center, a Washington, D.C.-based think tank, warned about “a lack of robust evidence on the optimal use of remote monitoring” and said some policy and medical experts “question whether we are effectively ‘rightsizing’ the use of these services, ensuring access for patients who need it most, and spending health care dollars in effective ways.”

Denton Shanks, a medical director at the American Academy of Family Physicians, said remote monitoring helps patients manage their diseases and helps physician practices be more efficient. He has used it for the past two years as a doctor at the University of Kansas Health System.

It has worked well, he said, though sometimes it can be challenging to persuade patients to sign up if they have to pay for it.

“For the vast majority of patients, once they are enrolled, they see a benefit, and we see a benefit as their vital signs come in the normal range,” Shanks said.

The size of the market is tantalizing.

About two-thirds of the more than 66 million Medicare beneficiaries have high blood pressure, the most common metric monitored remotely, according to physicians and the monitoring companies.

“The patient need is so enormous,” Cadence CEO Chris Altchek said. The company has about 40 nurses, medical assistants, and other providers monitoring patients in 17 states. He said patients enrolled in remote monitoring experience a 40% reduction in emergency room visits. Cadence says 82% of its patients use the devices at least once every two days.

Timothy Mott, a family physician in Foley, Alabama, said valuable appointment times in his office open up as patients who previously needed vital signs to be checked there turn to remote monitoring.

Cadence nurses regularly contact Mott’s patients and monitor their readings and make changes as needed.

“I was concerned early on whether they were going to make the right decisions with our patients,” Mott said. “But over time the dosage changes or changes in medication they are making are following the best guidelines on effectiveness.”

At the six-month mark, about 75% of patients have stayed with the monitoring, Mott said.

The advantages are apparent even to some providers who do not get paid by Medicare to offer the service. Frederick Health, a Maryland health system, provides remote monitoring to 364 high-risk patients and estimates the program saves the nonprofit system $10 million a year by reducing hospital admissions and ER visits. That estimate is based on comparisons of patients’ Medicare claims before they started the program and after, said Lisa Hogan, who runs the program.

The hospital pays for the program and does not bill Medicare, she said.

___

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

The Wild aren’t giving up on getting Marcus Foligno back this season.

With 10 games to play and an eight-point deficit to overcome, the Wild need all hands on deck for an increasingly impossible, last-ditch run at an NHL playoff berth, and they’re hoping Foligno will be available for Saturday afternoon’s puck drop against Vegas at Xcel Energy Center.

Foligno has been slowed and/or sidelined by a groin injury for the better part of two months, scratched for 14 of the next 21 games, including Thursday night’s 3-1 victory over San Jose.

“It’s lingering with him,” coach John Hynes said after Thursday’s game.

Asked if the team had decided to shut Foligno down, the coach said, “Not right now, no.”

Foligno and Kirill Kaprizov were held out of a practice Friday at the X for what Hynes called maintenance, and Ryan Hartman took an optional. Hynes said Kaprizov and Hartman will play Saturday, but it was unclear whether Foligno would skate in a must-win, 2:30 p.m. puck drop against Vegas.

“I’ll probably talk to the trainers a little bit more and just see where he’s at,” Hynes said. “Obviously, with a 2:30 game, there wouldn’t be an opportunity for a (morning) skate or anything like that. I’ll probably know more (Friday) afternoon, for sure, whether he’ll go or not.”

Foligno, 32, signed a four-year contract extension during fall camp. He has played in 55 of the Wild’s 72 games so far this season and has 10 goals and 22 points with a plus/minus ratio of +10.

Certainly, the Wild need all of their best players on the ice as the season winds down, but their window to make their fourth straight postseason tournament is so small that the team could decide to just start Foligno’s offseason.

Currently 10th in the West, Minnesota earned a big two points on Thursday, but they were all but negated when ninth-place St. Louis beat Calgary and Vegas won at Winnipeg to jump Los Angeles for seventh place.

Minnesota can earn a maximum of 99 points, so even if the Wild were to win their final 10 games in regulation, they would be eliminated as soon as two of the three teams ahead of them — Vegas (88), Los Angeles (87) and St. Louis (82) — earned 100. Every Wild loss brings that finish line two points closer.

Since Jan. 25, the Wild have played 10 four-point games against close conference rivals, and gone 4-4-2 — and never once gotten higher than ninth place. So, while the Wild have played a few “biggest” games of the year already, Saturday’s game against the Golden Knights is as close to an elimination game as Minnesota has faced.

And Vegas is hot, on a five-game points streak (4-0-1). Saturday’s game will wrap up a four-game road trip for the Knights, and the teams meet again April 12th in Las Vegas. To make that game relevant, the Wild essentially have to win on Saturday.

“You’re trying to win every night, obviously. These are a little bit more important,” said winger Matt Boldy, who scored his 25th goal of the season on Thursday. “We’ve gotta get these points to push to try to get in that spot, but you can’t stress about them. I think that doesn’t end up helping, if you sit there and you’re just constantly stressing and worrying.

“It comes down to the guys in our locker room playing the right way and finding a way to win.”

Minnesota is 1-0 against the Knights so far, winning 5-3 on Feb. 12 in Las Vegas.

“Obviously, we know (Saturday will) be a game that’s highly contested,” Hynes said. “They’re a good team, they have a lot to play for, and we’re continuing to push.”

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