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Empty shelves or unaffordable food: Tunisia’s crisis deepens



(AP Photo/Hassene Dridi)

TUNIS, Tunisia (AP) — Tunisians have been hit with soaring food prices and shortages of basic staples in recent weeks, threatening to turn simmering discontent in the North African country — the cradle of the Arab Spring protests — into larger turmoil.

Sugar, vegetable oil, rice and even bottled water periodically disappear from supermarkets and grocery stores. People stand in line for hours for these food essentials that have long been subsidized and are now increasingly available in rations only. When they do appear on the shelves, many people cannot afford to pay the staggering price for them.

“I came to shop and found people fighting to buy and the prices were very high,” said shopper Amina Hamdi, 63, despairing at trying to buy basic goods.

“It is not possible to live without food,” said Aicha during a recent shopping trip to the fish and meat market in Tunis. “We can live without furniture, construction material, but we have to eat.” She only gave her first name for fear of persecution by police for speaking out.

The government has blamed speculators, black market hoarders and the war in Ukraine, but economic experts say the government’s own budget crisis, and its inability to negotiate a long-sought loan from the International Monetary Fund, have added to Tunisia’s troubles.

Fights sometimes break out at food market queues, and scattered protests and sporadic clashes with police over rising prices and shortages have occurred around the country. In a suburb of the capital, Tunis, a young itinerant fruit vendor recently killed himself after police seized the scales he used to weigh his wares.

His act of desperation revived memories of the 2010 self-immolation of another Tunisian vendor, Mohamed Bouazizi, which prompted protests that led to the ouster of long-time dictator Zine El Abidine Ben Ali, and provoked similar uprisings around the Arab world.

The Ministry of Commerce promised last month that shortages would ease, announcing the import of 20,000 tons of sugar from India to be available in time for Mouled, the birthday of the Prophet Muhammad. But the night before the holiday, citizens formed long lines in front of supermarkets in the hope of getting a package of sugar, an essential food to prepare traditional dishes for the religious holiday.

Food isn’t the only thing in short supply. Lacking energy resources like those in neighboring Libya and Algeria, Tunisia relies heavily on imports, and its long-running economic troubles mean it has limited leverage on international markets to secure the goods it needs.

Inflation has reached a record rate of 9.1%, the highest in three decades, according to the National Institute of Statistics.

The Central Bank of Tunisia (BCT) added a hit by increasing bank fees and interest rates, hindering access to consumer loans.

In Douar Hicher, an impoverished suburb on the outskirts of Tunis considered a barometer of popular discontent, hundreds of people took to the streets at night last month to denounce the deterioration of their living conditions.

With cries of “work, freedom, dignity” — the flagship slogan of the 2010-2011 revolution — demonstrators blocked the town’s main artery by setting fire to tires, braving the police who sprayed tear gas to disperse them.

“Enough of speeches and promises, people are gripped by hunger and poverty,” read a banner erected by the demonstrators, their anger at the government and political elites palpable.

After sacking the prime minister and dissolving parliament, President Kaïs Saied has granted himself sweeping powers over the past year. He said the moves were necessary to save the country amid protracted political and economic crisis, and many Tunisians welcomed them, but critics and Western allies say the power grab jeopardizes Tunisia’s young democracy.

Saied attributes the scarcity of food products and the rise in prices to ”speculators” and those who hold a monopoly on goods they store in illegal depots. He suggested that his main political rivals, the Islamist movement Ennahdha, had some role, which the party firmly denies.

In a statement, the Salvation Front, a coalition of five opposition parties and several independent groups, called the demonstrations a sign of “a general explosion and the collapse of the social and political order.”

The general secretary of the powerful trade union UGTT, Noureddine Taboubi, blames the state’s overburdened budget.

The government is currently negotiating a $2 billion to $4 billion loan with the IMF to cope with a budget deficit aggravated by the COVID-19 pandemic and the fallout from Russia’s war in Ukraine. A high-ranking Tunisian delegation went to Washington on Saturday in the hope of finalizing a deal.

In return, Tunisia will have to commit to painful reforms, including shrinking the public administration sector — one of the world’s largest — which eats up about a third of the state budget. The IMF is also demanding the gradual lifting of subsidies and the privatization of state-owned enterprises, which implies massive layoffs and a worsening of unemployment, already at 18% according to the latest World Bank figures

The Tunisian Forum for Economic and Social Rights, an NGO that closely monitors migration, says 507 Tunisian migrants have died or gone missing so far in 2022 as they attempt the perilous crossing of the Mediterranean Sea.

According to National Guard spokesman Houssameddine Jebabli, the coast guard thwarted more than 1,500 attempts at illegal migration to Italy from January to September 2022, involving entire families including nearly 2,500 children.


AdventHealth’s mental health expert gives advice to families as children return to school



ORLANDO, Fla. (FNN) – Dr. Tina Gurnani, a board certified pediatric and adolescent psychiatrist at AdventHealth for Children is a mental health expert gives advice to families as children return to school.

Half of all mental health illnesses begin by age 14, yet only one out of three parents regularly discuss mental health with their children, according to AdventHealth research. And for those who suffer, it can take up to 11 years to get a diagnosis and seek treatment.

Dr. Gurnani spoke about what children are facing, what parents can be on the lookout for as their kids head back to class and how AdventHealth for Children’s “Be a Mindleader” campaign can spark life-saving conversations around mental health.

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Biden administration urges states to slow down on dropping people from Medicaid



FILE - Health and Human Services Secretary Xavier Becerra speaks during a meeting with a task force on reproductive health care access in the Roosevelt Room of the White House, April 12, 2023, in Washington. The Biden administration on Monday, June 12, urged states to slow down their purge of Medicaid rolls, citing concerns that large numbers of lower-income people are losing health care coverage because of administrative reasons. “I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that State Medicaid offices have the power to prevent or mitigate,” Becerra wrote in a letter Monday to governors. (AP Photo/Evan Vucci, File)

JEFFERSON CITY, Mo. (AP) — The Biden administration on Monday urged states to slow down their purge of Medicaid rolls, citing concerns that large numbers of lower-income people are losing health care coverage due to administrative reasons.

The nation’s Medicaid rolls swelled during the coronavirus pandemic as states were prohibited from ending people’s coverage. But that came to a halt in April, and states now must re-evaluate recipients’ eligibility — just as they had been regularly required to do before the pandemic.

In some states, about half of those whose Medicaid renewal cases were decided in April or May have lost their coverage, according to data submitted to the Centers for Medicare & Medicaid Services and obtained by The Associated Press. The primary cause is what CMS describes as “procedural reasons,” such as the failure to return forms.

“I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that State Medicaid offices have the power to prevent or mitigate,” Health and Human Services Secretary Secretary Xavier Becerra wrote in a letter Monday to governors.

Instead of immediately dropping people who haven’t responded by a deadline, federal officials are encouraging state Medicaid agencies to delay procedural terminations for one month while conducting additional targeted outreach to Medicaid recipients. Among other things, they’re also encouraging states to allow providers of managed health care plans to help people submit Medicaid renewal forms.

Nobody “should lose coverage simply because they changed addresses, didn’t receive a form, or didn’t have enough information about the renewal process,” Becerra said in a statement.

States are moving at different paces to conduct Medicaid eligibility determinations. Some haven’t dropped anyone from their rolls yet while others already have removed tens of thousands of people.

Among 18 states that reported preliminary data to CMS, about 45% of those whose renewals were due in April kept their Medicaid coverage, about 31% lost coverage and about 24% were still being processed. Of those that lost coverage, 4-out-of-5 were for procedural reasons, according to the U.S. Department of Health and Human Services.

In Arkansas, Florida, Idaho, New Hampshire and Oklahoma, about half or more of those whose eligibility cases were completed in April or May lost their Medicaid coverage, according data reviewed by the AP. Those figures may appear high because some states frontloaded the process, starting with people already deemed unlikely to remain eligible.

CMS officials have specifically highlighted concerns about Arkansas, which has dropped well over 100,000 Medicaid recipients, mostly for not returning renewal forms or requested information.

Arkansas officials said they are following a timeline under a 2021 law that requires the state to complete its redeterminations within six months of the end of the public health emergency. They said Medicaid recipients receive multiple notices — as well as texts, emails and phone calls, when possible — before being dropped. Some people probably don’t respond because they know they are no longer eligible, the state Department of Human Services said.

Republican Gov. Sarah Huckabee Sanders has dismissed criticism of the state’s redetermination process, saying Arkansas is merely getting the program back to its pre-pandemic coverage intentions.

But health care advocates said it’s particularly concerning when states have large numbers of people removed from Medicaid for not responding to re-enrollment notices.

“People who are procedurally disenrolled often are not going to realize they’ve lost coverage until they show up for a medical appointment or they go to fill their prescription and are told you no longer have insurance coverage,” said Allie Gardner, a senior research associate at the Georgetown University Center for Children and Families.

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Nevada GOP governor signs transgender health bills while vetoing another, bucking party trends



CARSON CITY, Nev. (AP) — Nevada Republican Gov. Joe Lombardo signed two bills related to transgender rights and vetoed another, bucking trends from other Republican governors who have pushed anti-transgender rhetoric and policies throughout the country.

The former Clark County Sheriff’s signing of a bill on Monday requiring health insurance companies including Medicaid to cover all gender-affirming surgeries was the third major bill related to transgender health and civil rights to reach his desk.

Another bill he signed earlier this month requires the states’ Department of Corrections to adopt mental and medical health standards for transgender and gender-nonconforming people inside the state’s prisons, including cultural competency training for guards.

Democratic-controlled Legislatures like Nevada’s have moved several bills protecting transgender health care, civil rights and legal protections including a half dozen states from Oregon to Colorado. But Lombardo’s signature comes as Republican governors throughout the country have curtailed transgender-related rights and medical procedures, widening the gap between the Republican base and the only Republican to unseat a Democratic incumbent governor in the 2022 midterms.

“Nevada has for a very long time been a live-and-let-live type of state,” said transgender rights advocate Brooke Maylath, who worked on all three bills. “And I’m glad to see that this governor has not been hijacked by the divisiveness that we’ve seen in other states.”

Still, Maylath criticized Lombardo for vetoing a bill earlier this month that would have protected providers of gender-affirming services from losing their medical license and prohibited the executive branch from assisting in out-of-state prosecution. She said that the absence of those protections would exacerbate Nevada’s already-existing provider shortage.

In his veto message, Lombardo said the bill would hinder his office’s ability to “be certain that all gender-affirming care related to minors comports with State law,” and to ensure public health and safety standards.

Lombardo’s latest signature for the bill requiring health insurance companies to cover all gender-affirming surgeries comes after Oregon’s Democratic governor signed a nearly-identical law in May.

Lombardo garnered criticized from many his own party after the bill signing, including from Nevada’s Republican National Committeewoman Sigal Chattah, who called him a “laughingstock across the nation” in a tweet.

“I implore people to read the bill in its entirety,” Lombardo said on Tuesday at a press gaggle for another bill signing, adding that it mainly shores up already-existing protections. “And you will see it’s not as draconian or detrimental or immoral as people are portraying it to be.”

Democratic Senator Melanie Scheible, one of the bill’s sponsors, had framed the legislation as a way to save the state money due to potential losses in lawsuits against state Medicaid. She cited a 2015 declaration from the state’s division of insurance that prohibits the denial of medically necessary care on the basis of gender identity.

“The idea is to clear up any ambiguity and to put the answer in the statute, instead of waiting for an answer from a court,” Scheible said in an interview earlier in the session.

Many credit the declaration as to why more major gender-affirming surgeries are increasingly deemed “medically necessary” rather than “cosmetic” in Nevada by insurance companies, thus making more gender-affirming surgeries covered.

Still, many procedures — hair transplants, facial feminization surgery and voice modification among them — are often still classified as “cosmetic” despite their role in treating gender dysphoria, regarded as a medical condition that results in severe distress because of a mismatch between gender identity and gender assigned at birth.

Proponents have said the bill does more to enshrine existing rights rather than expand coverage that would already be mandated when brought through the appeals process or the courts because of the 2015 insurance mandate. Opponents largely worried about potential costs to Medicaid and to health insurance agencies, as well as having opposition to gender-affirming surgeries as a whole, particularly for younger patients.

It passed along party lines in the state Senate and Assembly, with Republicans opposed.

Lombardo also bucked party trends earlier this month when he signed another bill into law that further codified already-existing protections that ensure commissions that oversee medical licenses do not discipline or disqualify doctors who provide abortions.

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