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WASHINGTON — More than two months after a door plug panel blew off a Boeing 737 Max 9 jet in midair, the top federal safety investigator says Boeing still has not provided key information that could shed light on what went wrong.

National Transportation Safety Board chair Jennifer Homendy told the Senate Commerce Committee on Wednesday that Boeing has not revealed who was responsible for failing to reattach the door plug properly at the company’s factory near Seattle.

“It’s absurd that two months later, we don’t have that,” Homendy said.

The NTSB said in its preliminary report last month that four key bolts which are supposed to hold the door plug in place were missing when the plane left Boeing’s factory last year. The report found the door plug was opened to allow for repair work on misdrilled rivets on the fuselage while the plane was being assembled.

But Homendy says the NTSB is still unable to determine who opened and closed the door plug.

“Boeing has not provided us with documents and information we have requested numerous times,” Homendy told the committee.

“Are you telling us that even two months later you still do not know who actually opened the door plug?,” asked Senator Ted Cruz (R-Texas), the committee’s ranking member.

“That’s correct, Senator. We don’t know,” Homendy replied. “And it’s not for lack of trying.”

After looking through emails and text messages, Homendy said investigators believe the work on the door plug took place on two days in mid-September.

The NTSB has asked Boeing to provide documentation of when it was performed and by whom, Homendy said. But Boeing has told investigators that “they can’t find it,” she said.

Investigators have also been seeking the names of the 25 Boeing employees who are part of the team that opens and closes door plugs. But so far, Homendy says the plane-maker has not provided those names.

A Boeing spokesman disputed Homendy’s account in an emailed statement to NPR. “Since the first moments following the Alaska Airlines Flight 1282 accident, we have worked proactively and transparently to fully support the NTSB’s investigation,” said Boeing’s Connor Greenwood.

“Early in the investigation, we provided the NTSB with names of Boeing employees, including door specialists, who we believed would have relevant information. We have now provided the full list of individuals on the 737 door team, in response to a recent request,” Greenwood said.

Mounting frustration with the company seemed to cross party lines at Wednesday’s hearing.

Senator Maria Cantwell (D-Wash.), the committee’s chair, called Boeing’s lack of cooperation “beyond disappointing.”

Senator Cruz called the company’s response to investigators “unacceptable.” He asked the NTSB to report back in a week to say whether Boeing had agreed to share the names and documents that investigator’s requested.

The senators on this committee have not forgotten how Boeing initially deflected responsibility after two 737 Max 8 crashes in 2018 and 2019 killed 346 people.

It’s possible that the records the NTSB is seeking now do not exist, Homendy said. If they don’t, that would raise serious questions about the company’s quality control practices, she said.

“We have been informed that they have a procedure to maintain documents on when work is performed and including when door plugs are open, closed or removed,” she said. “We have not been able to verify that. And without that information, that raises concerns about quality assurance, quality management, safety management systems within Boeing.”

Boeing also acknowledged the possibility that the documents the NTSB is seeking may not exist.

“If the door plug removal was undocumented there would be no documentation to share,” Greenwood said in his statement. “We will continue to cooperate fully and transparently with the NTSB’s investigation.”

Regulators at the Federal Aviation Administration are also concerned about what they’ve called “systemic quality-control issues” at Boeing and its suppliers. They’ve given the company until late May to come up with a plan to address those problems.

Copyright 2024 NPR. To see more, visit https://www.npr.org.

A biotech company that hopes to resurrect extinct species said Wednesday that it has reached an important milestone: the creation of a long-sought kind of stem cell for the closest living relative of the woolly mammoth.

“This is probably the most significant step in the early stages of this project,” said George Church, a geneticist at Harvard University and the Massachusetts Institute of Technology who co-founded Colossal Biosciences in Dallas.

The woolly mammoth was a big, shaggy species of elephant that roamed the tundra before going extinct thousands of years ago. Colossal has been working to bring the mammoth, the dodo bird and other extinct species back to life using the latest cloning and genetic engineering techniques.

And now the company says scientists have for the first time created induced pluripotent stem cells for the mammoth’s closest living relative: Asian elephants. The company plans to describe the work in a scientific paper that will be posted on the bioRxiv preprint server. It hasn’t been peer-reviewed, but the company says that’s in progress.

A steppingstone from modern elephant to mammoth

The achievement is still far from the ultimate goal of creating herds of giant hairy beasts roaming in the wild again, but Church said it’s a major step. “This is kind of like asking Neil Armstrong if he plans to go to Mars — kind of misses the point he just landed on the moon on Apollo 11,” Church said.

Scientists can now try to use cloning techniques and gene editing to manipulate the cells in the hopes of someday creating elephants with key traits of mammoths, such as their heavy coats and the layers of fat that enabled them to survive in cold climates.

“We don’t necessarily need to bring back a perfect genome of a mammoth, because we want one that has certain things that mammoths didn’t have. Like we want them to be resistant to the herpesvirus that is causing a huge fraction of infant elephants to die,” Church said.

Technical possibility raises ethical concerns

But some scientists object to the whole idea of trying to revive extinct animals.

“What are you going to get out of this?” asked Karl Flessa, a professor of geosciences at the University of Arizona. “First of all, I think you’re going to get a bit of a freak show in a zoo somewhere. And then if you’re going to release a herd into the Arctic tundra, is that herd going to go marching off to its second extinction in the face of global warming?”

“I think it’s irresponsible,” Flessa added.

But Church and his colleagues defended the project.

“Some people think it’s a bad idea because there will be only one lonely cold-adapted elephant. That’s not our intention,” Church said. “It’s to have them fully socialized in large herds. Some people think it’s a bad idea because it takes money away from conservation efforts, when in fact we’re injecting money into conservation efforts.”

Church said the woolly mammoth program could lead to new ways to protect endangered species like Asian elephants by expanding their habitat and helping scientists study the animals.

Researchers say the work will advance conservation

“We’re very, very excited that we have derived the first elephant induced pluripotent stem cells,” said Eriona Hysolli, who heads Colossal’s mammoth project. “These cells will benefit the elephant conservation community just as much as being engineered to bring back the woolly mammoth.”

Reintroducing elephants with woolly mammoth traits could also help fight global warming by restoring ecosystems in ways that would help reduce the amount of carbon being released into the atmosphere, Church said.

Some scientists say the creation of the specialized elephant stem cells is a noteworthy scientific achievement.

“Producing induced pluripotent stems has proved to be very difficult for some species — notoriously the elephant,” said Oliver Ryder, director of conservation genetics at the San Diego Zoo Wildlife Alliance. “It’s a great advancement to have been able to accomplish this for elephants.”

The cells can be used to study the biology, reproduction and health of elephants, he said.

“It opens up new possibilities for conserving species’ genetic diversity, preventing extinction and contributing to the sustainability of species,” Ryder said. “There’s an enormous potential.”

While that may be true, others argue that using the cells to try to bring back mammoths is misguided.

“What I find troubling is bringing back some sort of a surrogate that is part- mammoth, part-elephant,” said Joseph Bennett, an associate professor of biology at Carleton University in Ottawa, Canada. “Bringing that back as something that would somehow be portrayed as conservation would be a difficult sell on my part.”

Others agree.

“There are so many species going extinct today. We’re actually not going to be able to help any of them if we’re thinking about the woolly mammoth. We need to focus on the species here today. Living animals versus fossils is really where our focus should be,” said Gabriela Mastromonaco, senior director of wildlife science at the Toronto Zoo. “It’s just a distraction.”

Copyright 2024 NPR. To see more, visit https://www.npr.org.

Opill, the first oral contraceptive pill to be available without a prescription in the U.S., has shipped to retailers nationwide. It will be sold online and in the family planning aisle of drugstores, convenience stores and supermarkets later this month, the manufacturer announced Monday.

The drug itself has been around for decades, but manufacturers have been working nine years toward making it available over the counter. Here’s what else to know about Opill.

What’s in it?

Opill is a daily progestin-only pill, meaning there’s no estrogen in it. That’s why this kind of pill is sometimes called a mini-pill.

This isn’t a new kind of birth control pill. The drug substance was originally approved for prescription use in 1973, according to the Food and Drug Administration. But this is the first birth control pill that has been approved for use without a prescription from a health care provider.

“We have been working on it for nine years and got approval in July 2023 from the FDA to move forward. And it’s been kind of full-steam ahead since that day,” says Triona Schmelter, an executive at Perrigo, which manufactures Opill.

Is it safe? And does it work?

Yes. Like many other oral contraceptives, it’s 98% effective at preventing pregnancy if taken correctly. It should start to work 48 hours after taking the first dose. Potential side effects include headaches, bloating and cramping.

The FDA convened its panel of outside experts to advise it on this approval back in May, and the panel voted unanimously in favor of approval.

They said that the labeling alone was enough for people to be able to use Opill correctly without a doctor’s help.

“The progestin-only pill has an extremely high safety profile, and virtually no one can have a health concern using a progestin-only pill,” Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington School of Medicine, told NPR in July when Opill was first approved by the FDA.

Where will it be sold?

Major retailers will sell Opill where you’d typically find condoms and pregnancy tests.

“Today we start shipping Opill to our retailers for their brick-and-mortar stores,” says Schmelter. It will be available in the coming weeks in-store in the family planning aisle, she says, as well as on online marketplaces and Opill.com.

How much will it cost?

A month’s supply of Opill has a recommended retail price of $19.99. It will be a little cheaper to buy in bulk, however, with a three-month supply costing $49.99. Opill.com will also sell a six-month supply for $89.99.

Although birth control pills are available to people with insurance without a copay due to the Affordable Care Act, not everyone wants their birth control pill to show up on their insurance, so they may choose to pay out of pocket.

Schmelter says Perrigo has also set up a patient assistance program for people who don’t have insurance and can’t afford Opill.

Who is this for?

This is for people who want to prevent pregnancy but perhaps aren’t able to visit their health care provider to get a prescription. They may be in between medical appointments, or they may be teens who otherwise aren’t able to access reproductive health care.

“It doesn’t require a doctor’s visit, which means it doesn’t require time off work or potentially a babysitter or finding a doctor,” Schmelter says. “You can walk into any local retailer and, in the family planning section, pick it up at your convenience.”

“When it comes from Opill.com, the packaging will be discreet,” Schmelter says. “It’s nobody’s business but your own.”

Copyright 2024 NPR. To see more, visit https://www.npr.org.

Ezra Croft has never filed an insurance claim, and his house in Raleigh, North Carolina isn’t close to a stormy coastline or a fire-prone forest.

So Croft was surprised when his annual homeowner’s insurance premium shot up to $1,600, or $700 dollars more than he was paying just a couple of years ago.

“I’m a middle income guy,” Croft says. “Don’t make a ton of extra money. At this point I’m teetering on the point of inaffordability.”

Similar complaints can be heard all over the country. On average, insurance companies sought to raise homeowners’ premiums by more than 11% last year, according to S&P Global Market Intelligence.

Auto insurance premiums are climbing even faster, far outpacing overall inflation.

Take Paul Morro. His auto insurance bill just jumped by $600 a year.

“Here’s the kicker,” Morro says. “My wife and I both work from home. So we have no commute to speak of.”

He’s bracing himself for the bill to insure his house, in Herndon, Va.

“It just feels like everything is rising at a scary rate,” Morro says.

Why insurance costs are surging

Insurance companies insist they’re just playing catch-up, after two years of big losses. For every dollar in home and auto premiums they collected last year, insurance companies paid an average of $1.10 in claims and expenses, according to the Insurance Information Institute.

“Nobody wants to have that higher-price bill,” says Sean Kevelighan, the institute’s CEO. But he added companies “need to price insurance according to the risk level that’s out there.”

Inflation is partly to blame for those big payouts. The cost of fixing or replacing damaged homes and cars has jumped sharply in recent years as a result of rising labor and material prices.

Even as those prices start to level off, though, insurers are having to contend with a mounting toll of natural disasters, and not just in the usual places like Florida and California.

Last year, there were around two dozen severe storms in the U.S. with billion-dollar price tags, spreading lightning, hail and damaging winds through many parts of the country.

“While a lot of these storms don’t make national headlines, they do tend to be very costly at the local level,” says Tim Zawacki, principal research analyst for insurance at S&P Global Market Intelligence. “And the breadth of where these storms are occurring is something that I think the industry is quite concerned about.”

As a result, insurance premiums are likely to keep climbing this year even as overall inflation cools.

Insurers have a lot of pricing power

While state regulators have some power to limit those price hikes, insurance companies tend to get their way. Regulators know that if they move too aggressively to limit premiums, insurance companies might stop offering coverage altogether.

“The insurance companies have become really aggressive in their bullying,” says Doug Heller, director of insurance for the Consumer Federation of America. “You’ve heard a lot about companies that are threatening to pull out of the market if they don’t get what they want. Generally speaking that bullying has worked.”

Last week, the Treasury Department hosted a roundtable with consumer and environmental groups to discuss the ways climate change is rattling insurance markets. The department also plans to host a meeting on the topic with insurance industry stakeholders.

Customers can sometimes save money by shopping around. Alicia Pitorri switched insurance carriers after the cost of her family’s auto policy jumped more than a thousand dollars.

“It was Liberty Mutual,” she says with a rueful laugh. “We’ve since switched to State Farm since the renewal went up so much.”

Pitorri, who lives in Nashville, says while she managed to shave a few hundred dollars off the bill, she’s still paying a lot more than she did two years ago.

“What can you do?” she asks. “You need insurance. You can’t have a vehicle or a house without them. So you have to pay for it. And you figure out where you can cut other things to make sure you can drive around.”

Going without insurance

Auto insurance is required in nearly all states. And lenders typically require homeowners who have a mortgage to carry insurance as well. Still, as premiums keep climbing, more people are scaling back their coverage or even going without.

Ezra Croft considered dropping his homeowners’ coverage, but ultimately decided to pay the higher premium.

“I’m fairly good at home repairs, but if something like a tree fell on my house or a tornado or a fire, I don’t know what I would do,” Croft says.

A survey by the Insurance Information Institute last year found 12% of homeowners had no insurance, up from 5% four years earlier. Going without coverage is risky, though, for both individuals and communities.

“Insurance is an important product, not only for economic stability but for community resilience,” says Heller. “We are very concerned that these escalating premiums are going to lead to escalating rates of uninsured drivers and homeowners, which makes us all quite vulnerable.”

Copyright 2024 NPR. To see more, visit https://www.npr.org.

The four-day workweek is proving to be the gift that keeps on giving.

Companies that have tried it are reporting happier workers, lower turnover and greater efficiency. Now, there’s evidence that those effects are long lasting.

The latest data come from a trial in the U.K. In 2022, 61 companies moved their employees to a four-day workweek with no reduction in pay.

They began it as a six-month experiment. But today, 54 of the companies still have the policy. Just over half have declared it permanent, according to researchers with the think tank Autonomy, who organized the trial along with the groups 4-Day Week Campaign and 4 Day Week Global.

Follow-up surveys help to explain the four-day workweek’s success.

Improvements in physical and mental health, work-life balance, and general life satisfaction, as well as reductions in burnout, have been maintained over the past year, says sociologist Juliet Schor of Boston College, who’s part of the research team. Workers report higher job satisfaction now than before the trial began.

“The results are really stable. It’s not a novelty effect,” she says. “People are feeling really on top of their work with this new model.”

Similarly positive results are emerging from other four-day workweek trials, including in the U.S., Schor says.

“Doesn’t happen by magic”

At a recent webinar, participating companies shared their experiences and tips for success.

“It absolutely doesn’t happen by magic,” says Nicci Russell, CEO of the London-based water conservancy non-profit Waterwise. “You can’t just drop a day and carry on as usual, because how stressful would that be?”

Russell says after some initial teething problems, they managed to find efficiencies that allow all 10 employees to take Fridays off. They keep all meetings to 30 minutes and make sure those meetings start on time. They block off focus time on their calendars — sometimes even declaring Monk Mode Mondays. They’re more mindful of the emails they send and of the time they spend going through their inboxes.

“I only do my emails now at certain times of the day. I’m not drawn into them all day, every day,” she says.

At the end of the pilot, the staff at Waterwise were unanimous in their desire to continue the four-day week. A majority said they wouldn’t consider a five-day-a-week job again unless presented with a significant pay raise.

“It’s brilliant for retention, which is super important in a teeny organization like ours,” says Russell.

No one-size-fits-all

One important finding, researchers say, is that there is no one-size-fits-all recipe when it comes to the four-day workweek.

At Merthyr Valleys Homes in South Wales, giving everyone Fridays off wouldn’t have worked, says Ruth Llewellyn, who led the pilot at the housing cooperative.

With 240 employees working in roles from customer service to home repairs and maintenance, they decided to keep their operations running from Monday through Friday.

“For us, the thought of dropping repair service for our tenants one day a week meant that we wouldn’t be providing the same service,” Llewellyn says.

Instead, employees work a variety of schedules depending on individual and team needs. Some have a set day off every week, while others are on a rolling schedule. Some employees work two half-days, and some still work five days a week but shorter hours, allowing them to drop off and pick up their children from school.

The teams found time savings in different places. Some of the trades staff found they could reduce travel time to and from the building supplier with better planning around which materials they needed. Customer-facing teams found they could address smaller issues quickly over the phone.

Employees are more motivated, employee performance has held consistent, and absences for illnesses have fallen, Llewellyn says.

Yet the company is not committing to the four-day workweek forever — at least, not yet. Hoping for still more data, it extended the pilot and will re-evaluate the results later this spring.

“We’re really hopeful at that point that we can make it permanent,” says Llewellyn.

Why companies fail

Of the 61 U.K. companies that joined the 2022 pilot, only a few have discontinued the four-day workweek.

At one small consultancy, although the staff reported improved morale and the company reported a boost in efficiency, there were problems managing client and stakeholder expectations, according to feedback collected after the pilot.

Researchers suggest that better external communications and more flexibility in adapting the policy to challenging conditions might have made a difference.

“There is a suggestion that the organisation did not give the policy enough of a chance, and indications of a change of heart on the issue from management,” the researchers wrote.

Copyright 2024 NPR. To see more, visit https://www.npr.org.

Debra Prichard was a retired factory worker who was careful with her money, including what she spent on medical care, said her daughter, Alicia Wieberg. “She was the kind of person who didn’t go to the doctor for anything.”

That ended last year, when the rural Tennessee resident suffered a devastating stroke and several aneurysms. She twice was rushed from her local hospital to Vanderbilt University Medical Center in Nashville, 79 miles away, where she was treated by brain specialists. She died Oct. 31 at age 70.

One of Prichard’s trips to the Nashville hospital was via helicopter ambulance. Wieberg said she had heard such flights could be pricey, but she didn’t realize how extraordinary the charge would be — or how her mother’s skimping on Medicare coverage could leave the family on the hook.

Then the bill came.

The patient: Debra Prichard, who had Medicare Part A insurance before she died.

Medical service: An air-ambulance flight to Vanderbilt University Medical Center.

Service provider: Med-Trans Corp., a medical transportation service that is part of Global Medical Response, an industry giant backed by private equity investors. The larger company operates in all 50 states and says it has a total of 498 helicopters and airplanes.

Total bill: $81,739.40, none of which was covered by insurance.

What gives: Sky-high bills from air ambulance providers have sparked complaints and federal action in recent years.

For patients with private insurance coverage, the 2020 No Surprises Act bars air-ambulance companies from billing people more than they would pay if the service were considered “in-network” with their health insurers. For patients with public coverage, such as Medicare or Medicaid, the government sets payment rates at much lower levels than the companies charge.

But Prichard had opted out of the portion of Medicare that covers ambulance services.

That meant when the bill arrived less than two weeks after her death, her estate was expected to pay the full air-ambulance fee of nearly $82,000. The main assets are 12 acres of land and her home in Decherd, Tenn., where she lived 48 years and raised two children. The bill for a single helicopter ride could eat up roughly a third of the estate’s value, said Wieberg, who is executor.

The family’s predicament stems from the complicated nature of Medicare coverage.

Prichard was enrolled only in Medicare Part A, which is free to most Americans 65 or older. That section of the federal insurance program covers inpatient care, and it paid most of her hospital bills, her daughter said.

But Prichard declined other Medicare coverage, including Part B, which handles such things as doctor visits, outpatient treatment, and ambulance rides. Her daughter suspects she skipped that coverage to avoid the premiums most recipients pay, which currently are about $175 a month.

Loren Adler, a health economist for the Brookings Institution who studies ambulance bills, estimated the maximum charge that Medicare would have allowed for Prichard’s flight would have been less than $10,000 if she’d signed up for Part B. The patient’s share of that would have been less than $2,000. Her estate might have owed nothing if she’d also purchased supplemental “Medigap” coverage, as many Medicare members do to cover things like co-insurance, he said.

Nicole Michel, a spokesperson for Global Medical Response, the ambulance provider, agreed with Adler’s estimate that Medicare would have limited the charge for the flight to less than $10,000. But she said the federal program’s payment rates don’t cover the cost of providing air ambulance services.

“Our patient advocacy team is actively engaged with Ms. Wieberg’s attorney to determine if there was any other applicable medical coverage on the date of service that we could bill to,” Michel wrote in an email to KFF Health News. “If not, we are fully committed to working with Ms. Wieberg, as we do with all our patients, to find an equitable solution.”

The resolution: In mid-February, Wieberg said the company had not offered to reduce the bill.

Wieberg said she and the attorney handling her mother’s estate both contacted the company, seeking a reduction in the bill. She said she also contacted Medicare officials, filled out a form on the No Surprises Act website, and filed a complaint with Tennessee regulators who oversee ambulance services. She said she was notified Feb. 12 that the company filed a legal claim against the estate for the entire amount.

Wieberg said other health care providers, including ground ambulance services and the Vanderbilt hospital, wound up waiving several thousand dollars in unpaid fees for services they provided to Prichard that are normally covered by Medicare Part B.

But as it stands, Prichard’s estate owes about $81,740 to the air-ambulance company.

The takeaway: People who are eligible for Medicare are encouraged to sign up for Part B, unless they have private health insurance through an employer or spouse.

“If someone with Medicare finds that they are having difficulty paying the Medicare Part B premiums, there are resources available to help compare Medicare coverage choices and learn about options to help pay for Medicare costs,” Meena Seshamani, director of the federal Center for Medicare, said in an email to KFF Health News.

She noted that every state offers free counseling to help people navigate Medicare.

In Tennessee, that counseling is offered by the State Health Insurance Assistance Program. Its director, Lori Galbreath, told KFF Health News she wishes more seniors would discuss their health coverage options with trained counselors like hers.

“Every Medicare recipient’s experience is different,” she said. “We can look at their different situations and give them an unbiased view of what their next best steps could be.”

Counselors advise that many people with modest incomes enroll in a Medicare Savings Program, which can cover their Part B premiums. In 2023, Tennessee residents could qualify for such assistance if they made less than $1,660 monthly as a single person or $2,239 as a married couple. Many people also could obtain help with other out-of-pocket expenses, such as copays for medical services.

Wieberg, who lives in Missouri, has been preparing the family home for sale.

She said the struggle over her mother’s air-ambulance bill makes her wonder why Medicare is split into pieces, with free coverage for inpatient care under Part A, but premiums for coverage of other crucial services under Part B.

“Anybody past the age of 70 is likely going to need both,” she said. “And so why make it a decision of what you can afford or not afford, or what you think you’re going to use or not use?”

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

Emmarie Huetteman of KFF Health News edited the digital story, and Taunya English of KFF Health News edited the audio story. NPR’s Will Stone edited the audio and digital story.

Copyright 2024 KFF Health News. To see more, visit KFF Health News.