This week we highlight the anniversary of the Americans with Disabilities Act, important new proposed rules aimed at combating discrimination and reducing health inequities, and reports highlighting how Medicaid and other federal policies can be leveraged to reduce health disparities. A condemnation by the United Nations for staggering Black maternal health outcomes and new studies highlighting access challenges for rural populations, administrative red tape for lower-income Americans, underrepresentation of Latinos in health professions, care barriers for trans Americans, and the effect of redlining on Black health outcomes underscore the urgency of efforts to address inequities in health.
Protect Our Care is dedicated to making high-quality, affordable and equitable health care a right, and not a privilege, for everyone in America. We advocate for policies that lower health care costs and strengthen coverage, which are critical to expanding access to quality health care and, ultimately, achieving better health outcomes, particularly for people of color, rural Americans, LGBTQI+ individuals, people with disabilities, and more. Our strategies are driven by a broader commitment to tackling systemic inequities that persist due to racism and discrimination and the reality that multi-sector policies are needed to address basic conditions that affect health and related outcomes, particularly for marginalized communities.
INITIATIVES
Spectrum News 1: Looking Ahead for Disability Care Anniversary of the Americans With Disabilities Act. “It’s been 33 years since the landmark Americans with Disabilities Act was signed into law, paving the way for people with disabilities to gain more access to work, schools, transportation and other aspects of public life. It has been a long journey toward accessibility, but there are still changes to come. The ADA has helped protect people with disabilities in many areas of public life, areas such as voting and parking.Advocates took a moment Wednesday to recognize the anniversary, while also highlighting areas in which it could improve. [New York’s] Department for People With Developmental Disabilities rolled out ‘I Am,’ a new initiative aimed at breaking down the stigma surrounding developmental disabilities. A new documentary is also streaming on the state Developmental Disabilities Planning Council’s website, highlighting the 50th anniversary of the expose on the deplorable conditions at the Willowbrook State School, a former institution on Staten Island that housed children with intellectual disabilities. Such initiatives keep the conversation alive, which advocates say is invaluable.” [Spectrum News 1, 7/26/23]
The Department of Health and Human Services: HHS Announces Rule to Advance Nondiscrimination in Health Programs for the LGBTQ+ Community. “This NPRM further builds on HHS’ efforts to ensure access to health and human services in furtherance of President Biden’s Executive Orders on Preventing and Combating Discrimination on the Basis of Gender Identity and Sexual Orientation and Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals. The proposed HHS Grants Rule, if finalized, would clarify and reaffirm the prohibition on discrimination on the basis of sexual orientation and gender identity in federal statutes administered by HHS, consistent with the Supreme Court’s decision in Bostock v. Clayton County, 140 S. Ct. 1731 (2020). The proposed rule would confirm non-discrimination protections in HHS programs, including Head Start, as well as services and grants that provide aid to refugees, assistance to people experiencing homelessness, substance abuse treatment and prevention, community mental health services, maternal and child health services, and community services.” [The Department of Health and Human Services, 7/11/23]
The Centers for Medicare and Medicaid Services: Physician Payment Rule is Addressing Inequities in Care. “Building on the agency’s commitment to health equity, and the Biden-Harris Administration’s Executive Order to support caregivers, CMS is proposing coding and payment for several new services to help underserved populations, including addressing unmet health related social needs that can potentially interfere with the diagnosis and treatment of medical problems. First, CMS is proposing to pay for certain caregiver training services in specified circumstances, so that practitioners are appropriately paid for engaging with caregivers to support people with Medicare in carrying out their treatment plans. CMS is also proposing separate coding and payment for community health integration services, which would include person-centered planning, health system coordination, promoting patient self-advocacy, and facilitating access to community-based resources to address unmet social needs that interfere with the practitioner’s diagnosis and treatment of the patient. These are the first Physician Fee Schedule services designed to include care involving community health workers, who link underserved communities with critical health care and social services in the community and expand equitable access to care, improving outcomes for the Medicare population.” [The Centers for Medicare and Medicaid Services, 7/13/23]
National Academies: HHS Holds Webinar on Committee’s Study Researching Racial, Ethnic, and Tribal Health Inequities. “The Department of Health and Human Services Office of Minority Health commissioned the National Academies to convene an interdisciplinary committee to conduct an analysis of federal policies that contribute to preventable and unfair differences in health status and outcomes experienced by all U.S. racial and ethnic minority populations. The resulting report, “Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity,” identifies how past and current federal policies operate in ways that create, maintain, and amplify racial, ethnic, and tribal health inequities; identifies key features of policies that have served to reduce inequities; and makes recommendations to not only further reduce and eliminate inequities but also achieve racial, ethnic, and tribal health equity.” [National Academies, 7/27/23]
Stat: New Study Shows How Medicaid Can Reduce Inequities in Health Care. “Medicaid is an essential source of maternal and postpartum care for low-income Americans, covering 42% of births in the U.S. People who give birth receive maternity care until at least two months after delivery, or longer depending on state or local policies. In states with no coverage for recently documented and undocumented immigrants, 20% of low-income postpartum immigrants didn’t receive any care, compared to 12% of low-income postpartum non-immigrants. But in states where access was granted to all immigrants, the situation reversed, and more low-income immigrants accessed postpartum care (89.5%) than non-immigrants (87.7%). The study also suggests that lack of coverage for immigrant parents is linked to worse maternal care coverage for non-immigrants, too. In ‘no coverage’ states, access to postpartum services was 4% lower even among non-immigrants compared to ‘full coverage’ states.” [Stat, 7/18/23]
The Hill: AHIP Adds Health Care Expert to Lead Health Equity Initiatives. “Dr. LaShawn McIver joined AHIP as chief health equity officer. Dr. McIver was previously the director of the Office of Minority Health at the Centers for Medicare & Medicaid Services (CMS). Before that, she was the senior vice president of government affairs at the American Diabetes Association, where her advocacy work focused on health disparities among people with diabetes and securing more funding for diabetes research and programs.” [The Hill, 7/26/23]
CHALLENGES
The Washington Post: UN Calls Out Black Maternal Mortality Crisis in the Americas. “Black women in the Americas bear a heavier burden of maternal mortality than their peers, but according to a report released Wednesday by the United Nations, the gap between who lives and who dies is especially wide in the world’s richest nation — the United States. Of the region’s 35 countries, only four publish comparable maternal mortality data by race, according to the report, which analyzed the maternal health of women and girls of African descent in the Americas: Brazil, Colombia, Suriname and the United States. And while the United States had the lowest overall maternal mortality rate among those four nations, the report said Black women and girls were three times more likely than their U.S. peers to die while giving birth or in the six weeks afterward. Between 2016 and 2020, maternal deaths increased 15 percent in Latin America and the Caribbean, and by 17 percent in North America, according to the report from the U.N. Population Fund, which is the United Nations’ sexual and reproductive health agency.” [The Washington Post, 7/12/23]
CNN: Black People in Redlined Neighborhoods Are At Higher Risk of Heart Failure. “Black adults living in zip codes historically impacted by redlining have an 8% higher risk of developing heart failure than Black adults in non-redlined areas, a study published Monday in the American Heart Association’s scientific journal Circulation says. Researchers analyzed data on more than 2.3 million residents who were enrolled in Medicare between 2014 and 2019 by linking it with residential ZIP codes across the US. The analysis included 801,452 participants who identified as Black adults and nearly 1.6 million participants who self-identified as non-Hispanic White adults. Unlike Black adults, the study found that White adults living in communities with a high proportion of redlining did not have a higher risk of heart failure.” [CNN, 7/17/23]
The New York Times: Health Insurers Deny Frequently Deny Doctor-Requested Medical Care for Poor Americans. “Private health insurance companies paid by Medicaid denied millions of requests for care for low-income Americans with little oversight from federal and state authorities, according to a new report by U.S. investigators published Wednesday. Doctors and hospitals have increasingly complained about what they consider to be endless paperwork and unjustified refusals of care by the insurers when they fail to authorize costly procedures or medicines. The companies that require prior authorization for certain types of medical services say these tools are aimed at curbing unnecessary or unproven treatments, but doctors claim it often interferes with making sure patients receive the services they need. The for-profit insurance companies, including Aetna, Elevance Health, Molina Healthcare and UnitedHealthcare, operated some Medicaid plans that denied medical care under requests for prior authorization of services by rates that were greater than 25 percent in 2019, the report found. About 2.7 million people were enrolled in these plans at the time. Another 8.4 million were enrolled in plans with above-average denial rates from 15 to 25 percent. Molina, based in Long Beach, Calif., operated seven plans with denial rates greater than 25 percent, according to the report. Its Illinois plan denied 41 percent of requests.” [The New York Times, 7/19/23]
Los Angeles Times: HHS Announces Civil Rights Investigation Into California Hospital in Order to Address Care Inequities for Black Mothers. “Cedars-Sinai Medical Center is facing a federal civil rights investigation over how the Los Angeles hospital treats Black women who give birth there, an official with the U.S. Department of Health and Human Services confirmed. The investigation comes after allegations of racism and discrimination emerged in the years after the death of Kira Dixon Johnson. The Times obtained a copy of a letter the federal agency sent to Charles Johnson in March indicating that it was aware of the allegations involving the hospital’s level of care for Black women. The letter noted that based on the allegations and the fact that Cedars-Sinai receives federal funding, the agency is reviewing whether the hospital is complying with federal civil rights laws. Cedars-Sinai helps nearly 7,000 women deliver their babies each year, according to the hospital’s website. The National Center for Health Statistics reported in March that 1,205 pregnant women died in the United States in 2021, a 40% increase over 2020, when 861 deaths occurred. The total was 754 in 2019. Pregnant Black women continued to have the highest risk of dying, according to the report. In 2021, the maternal mortality rate for Black women was 69.9 deaths per 100,000 live births, 2.6 times the rate for white women at 26.6 deaths. Among Hispanic women, the report found there were 28 deaths per 100,000 live births.” [Los Angeles Times, 7/11/23]
Axios: Rural Americans More Likely to Not Seek Needed Health Care Due to Costs. “The U.S. outranks other developed nations in the percentage of rural adults who skip medical care because they can’t afford it, per a new Commonwealth Fund analysis of 11 high-income countries. About 15%, or nearly 46 million people, live in outlying areas in the U.S., and rural Americans have poorer health outcomes than their urban counterparts, in part due to access issues. More than a third of rural Americans reported skipping needed care because of costs — more than twice the rate of rural residents in six of the other countries in the analysis. Telehealth, increased primary care access and recruitment of health workers to underserved areas are some strategies other countries have employed to even out the disparity, per the Commonwealth Fund.” [Axios, 7/25/23]
Mississippi Today: Half of Rural Hospitals in Mississippi At Risk of Closing. “The report from the Center for Healthcare Quality and Payment Reform shows that 34 of Mississippi’s 74 rural hospitals are struggling financially and at risk of closure. Twenty-five of those are at risk of closing immediately, or within the next couple of years. The new data puts Mississippi third in the country — behind New York and Alabama — for states with the highest percentage of rural hospitals at risk of immediate closure. Harold Miller, CEO of the Center for Healthcare Quality and Payment Reform, said Mississippians should be concerned about the new data. He attributed the hospitals’ worsening financial state to poor payments from private insurers. Miller’s organization advocates for hospital payment reform. Blue Cross insures the majority of Mississippians with private insurance. The company went head to head with the state’s largest public hospital, the University of Mississippi Medical Center, for months last year over its reimbursement rates. An analysis by Mississippi Today and The Hilltop Institute at the University of Maryland, Baltimore County showed that during the throes of the dispute, Blue Cross’ negotiated rates were largely lower than other major private insurance companies for several common procedures.” [Mississippi Today, 7/24/23]
George Washington University: Latinos Are Underrepresented in Health Professionals With Advanced Degrees. “The study revealed that Mexican Americans, despite being the largest Latino subpopulation in the United States, are greatly underrepresented in the health professions that require an advanced degree. One out of ten people in the United States are Mexican American yet in five of the eight professions requiring advanced education included in the study, Mexican Americans represent one-quarter or less of the professions. This study suggests they and other Latinos in the study face many barriers to occupations in the healthcare field that require an advanced degree such as doctor, nurse or pharmacist. Latino representation in the health workforce did show improvement during the time frame studied from 2016-2020: For example, Latino representation among recent graduates went from 6.7 to 13.5% for health professions requiring a bachelor’s degree. However, the researchers note that Latinos represented more than 21% of the population ages 20-35.” [George Washington University, 7/5/23]
Axios: Trans Patients Are Facing Barriers to Access Hormone Therapy Due to Drug Shortages. “The worst drug shortage in a decade is disrupting gender-affirming care, as scarce supplies of injectable estrogen prevent some transgender women from obtaining hormone therapy. Shortages of cancer drugs and other life-saving medications have already forced doctors to develop workarounds. A lack of access to estrogen products can affect trans patients in different ways: putting some through early onset menopause, reversing certain physical changes from their transition or causing them to experience anxiety and depression. Because injectable estrogen is seldom used outside of trans health care, “manufacturers have little incentive to produce this medicine,” which leads to shortages, according to the University of California, San Francisco Gender-Affirming Health Program. Pfizer — the sole supplier — said that the disruption has been caused by a change in its manufacturing process. The Food and Drug Administration does not have either form of injectable estrogen on its drug shortage database. Under federal law, manufacturers are required to notify to the FDA when there are changes in drug productions that could affect their availability. However, suppliers often don’t.” [Axios, 7/21/23]
