This week we highlight the upcoming Black Maternal Mortality Week of action, new Centers for Medicare and Medicaid (CMS) rules on Medicare Advantage focusing on improving health equity, the 75th anniversary of the World Health Organization as well as its heightened focus on reducing health disparities, and new private ventures aimed at addressing underserved rural communities in the South where Republican legislators often exacerbate inequities through their apathy towards state action. While progress is continuing to be made, there is also mounting evidence that the radical Republican agenda in state legislatures, the Courts, and within Big Pharma is undermining measures and policies which have saved countless lives and empirically reduced health disparities across the board.
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
The White House: A Proclamation on Black Maternal Mortality Week. “Studies show that Black women are often dismissed or ignored in hospitals and other health care settings, even as they suffer from severe injuries and pregnancy complications and ask for help. Systemic inequities are also to blame. When mothers do not have access to safe and stable housing before and after childbirth, they are at greater risk of falling ill. When women face barriers traveling to the hospital for prenatal and postpartum checkups, they are less likely to remain healthy. Air pollution, water pollution, and lead pipes can have dangerous consequences for pregnant women and newborns. And when families cannot afford nutritious foods, they face worse health outcomes. Vice President Kamala Harris has been a leader on the issue of maternal mortality for years and led the charge to improve maternal health outcomes, including by issuing a call to action to address disparities in maternal care. She continues to elevate the issue nationally, convening State legislators, medical professionals, and others so all mothers can access the care they need before, during, and after childbirth. This week, as we continue our work to make pregnancy and childbirth safe, dignified, and joyful for all, let us remember that health care should be a right and not a privilege. Let us give thanks to the extraordinary maternal health care workforce, which serves its patients and their families every day. And let us join in common cause to end the tragedy of maternal mortality once and for all.” [The White House, 4/10/23]
The Ford Foundation: Dom Kelly’s A New Disabled South is Working on Increasing Equity and Access in the Southern U.S. “New Disabled South is a coalition of disability justice activists, advocates and organizations working across the South. The South is home to one third of all disabled people in the United States. Because people with disabilities live at the intersection of all systems of inequality, they are impacted by the problems that plague the South—from high poverty levels to an incredibly harsh criminal justice system—all the more. Today, New Disabled South is working across 14 states to lift our people out of poverty, remove barriers that disabled people face when voting, end the criminalization of Black disabled people, and more. Of the millions of disabled people living in poverty, the majority of the population in the South are BIPOC. We know that 8 out of the 12 states that have yet to expand Medicaid are in the South, and that means that hundreds of thousands if not millions of disabled people are without access to affordable health care. Fifty percent of people killed by law enforcement in the U.S. are disabled, and more than half of disabled Black men have been arrested by the time they turn 28—double the risk in comparison to their white disabled counterparts.” [The Ford Foundation, 4/3/23]
The World Health Organization: WHO Celebrates 75th Anniversary and Calls for Increased Focus on Health Equity. “WHO is urging countries to take urgent action to protect, support and expand the health workforce as a strategic priority. Investments in education, skills and decent jobs for health need to be prioritized to meet the rapidly growing demand for health and avert a projected shortage of 10 million health workers by 2030; primarily in low- and middle-income countries. A global education programme on basic emergency care targeting 25% of nurses and midwives from 25 low- and middle-income countries by the end of 2025 was also recently announced by WHO. In the shadow of the COVID-19 pandemic, WHO’s roadmap to recovery includes an urgent paradigm shift towards promoting health and well-being and preventing disease by addressing its root causes and creating the conditions for health to thrive. WHO is urging countries to provide health by prioritizing primary health care as the foundation of universal health coverage.” [The World Health Organization, 4/3/23]
Modern Healthcare: CMS Announces Final Rule on Medicare Advantage. “The Centers for Medicare and Medicaid Services’ Medicare Advantage and Medicare Part D final rule for 2024 aims to further the agency’s efforts to strengthen federal oversight of health insurance companies. CMS published the regulation Wednesday, which includes major changes to the standards for quality metrics, prior authorizations, marketing and health equity. CMS received nearly 40,000 marketing misconduct complaints from beneficiaries in 2021, a 157% increase over the prior year, the agency previously reported. Based on this evidence of growing problems, the final rule imposes new restrictions on marketing by health insurers, brokers and others. CMS will replace the reward factor with a health equity index and reduce the weight of patient experience and complaints on quality scores. The health equity provisions and other aspects of the regulation are intended to reward health insurance companies for ensuring people from underserved communities receive quality care. Insurers must halve the length of time they take to respond to prior authorization requests and extend approvals through the full course of a patient’s treatments, and may no longer require preapproval for emergency behavioral healthcare. In addition to including a health equity metric in the Star Ratings program, the final rule requires Medicare Advantage insurers to provide access to healthcare in a “culturally competent manner” by including the languages providers speak in network directories, offering digital health education and addressing health disparities in quality improvement programs. The regulation also implements prescription drug pricing provisions from the Inflation Reduction Act of 2022.” [Modern Healthcare, 4/5/23]
CHALLENGES
The New Republic: The ACA Requires Insurers to Not Deny Coverage for Contraceptives, Insurers are Doing it Anyways. “The Affordable Care Act, or ACA, was signed into law 13 years ago, but some provisions of the landmark health care legislation regarding contraceptive care are still unenforced. Although the ACA requires that health plans cover contraceptive care without cost-sharing, several million patients still face hurdles to accessing certain products, with companies using outdated federal guidance to justify the lack of coverage. That’s according to a letter signed by 91 Democratic members of the House of Representatives that was sent to the Biden administration on Monday, including a two-pronged request for cracking down on health plan noncompliance. The letter, led by Democratic Women’s Caucus chair Lois Frankel and first obtained by The New Republic, asks for new guidance clarifying that insurers must cover all prescribed contraceptive products without therapeutic equivalents, as well as the out-of-pocket costs for certain over-the-counter products. Despite updated guidance and enforcement from the Departments of Health and Human Services, Treasury, and Labor—or the tri-agencies, as they are known—the letter says that ‘unlawful barriers’ remain to accessing contraceptive care… citing an October report by the House Committee on Oversight and Reform… That report found that at least 34 contraceptive products face coverage exclusions or cost-sharing; for 12 of those products, there is no therapeutic equivalent. The October report also found that an average of 40 percent of exception requests were denied by insurers and pharmacy benefit managers between 2015 and 2021. The letter argues that if insurers haven’t changed their practice over the past decade or so, they aren’t going to start now if they’re left to their own devices.” [The New Republic, 3/28/23]
The Washington Post: Syphilis Cases are Increasing in Infants Across the Country. “A decade ago, the United States stood on the brink of eliminating the scourge of babies born with syphilis. Now, cases are surging, a phenomenon that is underscoring deep inequities in the nation’s health-care system and reviving concerns about a disease easily controlled with routine antibiotics. The spike, driven in part by the nation’s drug and homelessness crisis, is especially apparent across the Sun Belt, according to public health experts and data from the Centers for Disease Control and Prevention. The rate of syphilis is five times higher for babies born to Black mothers than to White mothers, reflecting racial disparities in access to maternal health care. While the overall number of infected infants seems low — nearly 2,700 nationally in 2021, or 74 of every 100,000 live births — public health officials say no baby in developed nations should be born with syphilis because most cases are preventable with testing and penicillin treatment of the mother. The fact that cases have climbed, experts say, is an indictment of the U.S. health-care system. Oman, Cuba and Sri Lanka are among the countries that have virtually eliminated mother-to-child transmission of syphilis in recent years, according to the World Health Organization. After steadily declining since World War II, congenital syphilis roared back in the United States to about 4,000 cases a year in the early 1990s as syphilis surged in adults. The number of infected infants dwindled to several hundred a year in the 2000s, then started climbing again in 2013. To reverse the trends, public health authorities are striving to reach women at highest risk for passing syphilis to their babies — those who are homeless, exchange sex for money, or use drugs are more likely to be exposed to the disease and less likely to seek prenatal care.” [The Washington Post, 4/1/23]
Yale Daily News: Researchers Predict Rapid Increase in HIV Infections Due Directly to Braidwood Ruling. “In a recent study led by the Yale School of Public Health, researchers found that the Sept. 2022 Texas ruling in Braidwood Management v. Becerra could potentially result in more than 2,000 predictable cases of human immunodeficiency virus in the U.S. in the coming year. In the study, the researchers tried to estimate how many new HIV infections would result from the outcome of this court ruling, focusing on men who have sex with men… In addition, the researchers estimated that coverage would drop from 28 percent to 10 percent after the Braidwood Management v. Becerra decision… However, according to Paltiel, this number is almost certainly an underestimate.” [Yale Daily News, 3/31/23]
Axios: The COVID-19 Pandemic Has Increased Maternal Mortality Rates. “The U.S. maternal mortality rate increased during the COVID-19 pandemic, disproportionately impacting Black women, with far higher odds of severe complications among pregnant patients with COVID infection at delivery, a new analysis published in JAMA Network Open found. The JAMA analysis, led by researchers from the University of Southern California, Los Angeles, found the mortality risk of pregnant patients with COVID-19 at delivery between March 2020 and December 2020 was 14 times higher than those without the virus. Previous studies have found contributors to the high maternal mortality rate during the pandemic have included a lag in COVID-19 vaccination in pregnant people due to concerns over the potential effects of the vaccine that may persist despite studies showing they are safe. The CDC estimates that as of April 1, approximately 71% of pregnant people have completed the primary vaccination series (below the vaccination rate for those over the age of 18), and only about 23% of pregnant people have received an updated booster dose. The pandemic also exacerbated existing social determinants of health, and as a result disproportionately impacted women of color, who were often on the frontlines working ‘essential’ jobs and getting sick.” [Axios, 4/10/23]
The Washington Post: Two Pregnant Women Were Denied Care After Florida Banned Abortion, One Almost Died. “[Anya Cook] was about to deliver her baby alone in the bathroom of a hair salon. On this Thursday afternoon in mid-December, about five months before her due date, she knew the baby would not be born alive. Over the course of the day, according to medical records, Cook would lose roughly half the blood in her body. She had intended to deliver the fetus in a hospital, a doctor by her side. When her water broke the night before — at least six weeks ahead of when a fetus could survive on its own — she drove straight to the emergency room, where she said the doctor explained that she was experiencing pre-viability preterm prelabor rupture of the membranes (PPROM), which occurs in less than 1 percent of pregnancies. The condition can cause significant complications, including infection and hemorrhage, that can threaten the health or life of the mother, according to multiple studies. At the hospital in Coral Springs, Fla., Cook received antibiotics, records show. Then she was sent home to wait. Cook’s experience reflects a new reality playing out in hospitals in antiabortion states across the country — where because of newly enacted abortion bans, people with potentially life-threatening pregnancy complications are being denied care that was readily available before the Supreme Court overturned Roe v. Wade in June. When abortion was legal across the country, doctors in all states would typically offer to induce or perform a surgical procedure to end the pregnancy when faced with a pre-viability PPROM case. But in the 18 states where abortion is now banned before fetal viability, many hospitals have been turning away pre-viability PPROM patients as doctors and administrators fear the legal risk that could come with terminating even a pregnancy that could jeopardize the mother’s well-being, according to 12 physicians practicing in antiabortion states. The medical exceptions to protect the life of the mother that are included in abortion bans are often described in vague language that does not appear to cover pre-viability PPROM, doctors said. A 2022 study on the impact of Texas’s six-week abortion ban found that 57 percent of pre-viability PPROM patients in Texas who were not given the option to end their pregnancies experienced ‘a serious maternal morbidity,’ such as infection or hemorrhage, compared with 33 percent of PPROM patients who chose to terminate in states without abortion bans.” [The Washington Post, 4/10/23]