This week we highlight the inaugural Centers for Medicare and Medicaid Services (CMS) Health Equity Conference and statements affirming LGBTQI+ health equity. As well, LGBTQI+ advocacy groups, the Black Maternal Health Caucus, and the private sector are pushing forward critical initiatives to accelerate progress to reduce health disparities throughout the country. There are persistent challenges to be overcome, and we have highlighted in particular the growing health crisis in the Southern United States this week. From systemic bias in medicine to political polarization actively harming members of our most marginalized communities, the situation in the U.S. south is dire and must be addressed by local and state leaders.
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
National Law Review: CMS Holds First Annual National Health Equity Conference. “CMS hosted its inaugural Health Equity Conference on June 7 and 8. The theme of the conference was “Framing the Future of Equitable Health Care” and, as the name suggests, it was an opportunity for CMS leadership to share foundational information and discuss plans for the future. Leaders throughout CMS provided updates on health equity research, discussed promising practices and innovative solutions, and highlighted the value of collaboration across the agency and with the broader community. To that end, the conference also provided a platform for community partners to discuss multiple programs that incorporate equity-focused initiatives.” [National Law Review, 6/9/23]
Department of Health and Human Services: HHS Statements Reaffirm Support for Promoting Health Equity During and After Pride Month. “Every year, during Pride Month, we honor and celebrate the many ways our family, friends, colleagues, neighbors, and fellow Americans in the LGBTQI+ community contribute to the health and wellbeing of our great nation. Today and every day, the Department works to ensure that every American has access to health care – including gender-affirming care – regardless of their sexual orientation or gender identity. We stand with and support Americans who are targeted because of their gender identity and are committed to protecting them. We also stand with and support their parents, caretakers, and families. We will continue to fight on behalf of all Americans to ensure they have access to the care and support they need… Pride is a reminder that until everyone enjoys the full promise of equity, dignity, protection, and freedom, our work is not finished. I am proud to be part of our Administration-wide effort to protect LGBTQI+ Americans from discrimination in health care, including those who need vital behavioral health support.” [HHS, 6/1/23]
Los Angeles Blade: Gilead to Award $5 Million to the HRC’s HIV and Health Equity Programs. “The Human Rights Campaign was awarded a $5 million grant from drugmaker Gilead Sciences to expand the organization’s HIV and health equity programs, supporting efforts to end the HIV epidemic by 2030 while combating stigma in Black and Latino communities. Funds will be used over the next three years for the HRC Foundation’s HIV and Health Equity Program, its Historically Black Colleges & Universities Program, and its Transgender Justice Initiative, HRC said in a statement Wednesday announcing receipt of the award, which extends Gilead’s $3.2 million grant to the HRC Foundation in 2021. The organization said its HIV and Health Equity Program plans to develop a ‘benchmarking tool for institutions that provide HIV services, helping better evaluate the quality of care and measure racially and socially inclusive approaches’ while defining ‘best practices, policies, and procedures to optimize HIV service provision for BIPOC LGBTQ+ communities.’” [Los Angeles Blade, 5/31/23]
America Magazine: Momnibus Has a Chance to Significantly Reduce the Maternal Mortality Rate. “[T]he Catholic Health Association of the United States is strongly advocating for the passage of the Black Maternal Health Momnibus Act. C.H.A. has joined with more than 45 diverse organizations that represent health care providers, public health professionals, researchers, community-based organizations, nonprofits, health insurance providers, hospitals, maternal and infant health advocates, and other key stakeholders in calling on Congress to pass this legislation to address the maternal mortality crisis and eliminate maternal health inequities. Passing the Momnibus Act would begin to address a number of factors that are responsible for the maternal health crisis and its racial inequities, including issues of systemic racism and social risk factors like housing, transportation and environmental conditions. By advancing the Momnibus Act, Congress can make historic investments in high-quality, culturally appropriate maternity care and robust social support. The reintroduction of the Momnibus Act in May yielded a historic number of congressional co-sponsors, demonstrating the importance of this issue.” [America Magazine, 5/30/23]
Healthcare Finance: Groups Including the AMA Launch Movement to Promote Health Equity. “On Tuesday, the American Medical Association, the Institute for Healthcare Improvement (IHI) and Race Forward officially launched Rise to Health, a call to action for providers, payers, pharma and professional societies to make health equity a priority. Rise to Health will have enforcement teeth in the form of establishing a set of measures across numerous participants. Rise to Health: A National Coalition for Equity in Health Care has been in the works for about two years. Its ten founders include the AMA, American Hospital Association and AHIP. A unified strategy is the most effective way to create meaningful change, said AMA president Dr. Jack Resneck Jr. Prior efforts have been in siloes, said Mate, who has been working with coalition members around the founding principle that healthcare quality is inseparable from health equity. The coalition has seen dozens of providers, pharma companies and payers add equity to their strategic plans, Mate said. Specific actions defined by the coalition include: a commitment to acting for equity, getting grounded in history and the local context, identifying opportunities for improvement, making equity a strategic priority, taking on initiatives, and aligning, investing and advocating for thriving communities.” [Healthcare Finance, 5/31/23]
CHALLENGES
U.S. News: Southern States Refusing to Expand Medicaid Perpetuates Racism According to Data. “While 40 states have expanded Medicaid, 10 states have not – and most of those are in the South. This refusal to enact Medicaid expansion amounts to a refusal to ease the health care burden of some 3.5 million uninsured adults. People want health insurance, and polling shows 57% of U.S. adults believe the federal government should be tasked with providing health care for all Americans. Of the 10 states that have not expanded Medicaid, seven are in the South: Alabama, Georgia, Florida, Mississippi, South Carolina, Tennessee and Texas. Ironically, Southern states are some of the hardest hit by interrelated issues like poverty, poor health care access and health disparities. Southern states are also home to some of the largest Black populations in the U.S., highlighting how expanding Medicaid in the South is clearly an issue of racial justice. In fact, according to a March analysis from KFF, more than 6 in 10 nonelderly adults who fall into the national coverage gap – meaning they live in a state that has not adopted Medicaid expansion and are not eligible for coverage through the program or for subsidies through the Affordable Care Act’s marketplaces – are people of color. Nearly all nonelderly adults in this coverage gap live in the South. A similar case in point: If Mississippi expanded Medicaid, KFF data has shown Black and Hispanic people accounted for 55% of the uninsured adults who would be newly eligible for coverage, with whites accounting for 42%. This would be crucial for children and adults in the state, which is home to the nation’s highest rate of infant mortality, according to data from the Centers for Disease Control and Prevention.” [U.S. News, 6/7/23]
KFF Health News: There is a Stark Disparity Between Black and White Infant Mortality in the South. “By 2030, the federal government wants infant mortality to fall to 5 or fewer deaths per 1,000 live births. According to annual data compiled by the Centers for Disease Control and Prevention, 16 states have already met or surpassed that goal, including Nevada, New York, and California. But none of those states are in the South, where infant mortality is by far the highest in the country, with Mississippi’s rate of 8.12 deaths per 1,000 live births ranking worst. Even in those few Southern states where infant mortality rates are inching closer to the national average, the gap between death rates of Black and white babies is vast. In Florida and North Carolina, for example, the Black infant mortality rate is more than twice as high as it is for white babies. A new study published in JAMA found that over two decades Black people in the U.S. experienced more than 1.6 million excess deaths and 80 million years of life lost because of increased mortality risk relative to white Americans. The study also found that infants and older Black Americans bear the brunt of excess deaths and years lost. Some experts believe expanding Medicaid coverage to single, working adults who aren’t pregnant and don’t have children — something most Southern states have failed to do — would also help curtail infant deaths. A woman who is healthy when heading into pregnancy is more likely to give birth to a healthy baby because the health of the mother correlates to the health of the infant. Birth outcomes experts agreed that racism and poverty lie at the heart of this difficult problem, which disproportionately threatens Black infants and mothers in the rural South. Research shows that white doctors are often prejudiced against Black patients and minimize their concerns and pain. In South Carolina, the maternal mortality rate increased by nearly 10% from 2018 to 2019, according to the latest data, which found that the risk of pregnancy-related death for Black mothers was 67% higher than for white mothers. Upon review, the state health department determined 80% of those pregnancy-related deaths were preventable.” [KFF Health News, 5/22/23]
AP: Doctors Not Taking Black Women Seriously is a Major Component of Maternal Mortality Racial Disparities. “Black women have the highest maternal mortality rate in the United States — 69.9 per 100,000 live births for 2021, almost three times the rate for white women, according to the Centers for Disease Control and Prevention. Black babies are more likely to die, and also far more likely to be born prematurely, setting the stage for health issues that could follow them through their lives. To be Black anywhere in America is to experience higher rates of chronic ailments like asthma, diabetes, high blood pressure, Alzheimer’s and, most recently, COVID-19. Black Americans have less access to adequate medical care; their life expectancy is shorter. Black Americans’ health issues have long been ascribed to genetics or behavior, when in actuality, an array of circumstances linked to racism — among them, restrictions on where people could live and historical lack of access to care — play major roles. Discrimination and bias in hospital settings have been disastrous. Maternal sepsis is a leading cause of maternal mortality in America. Sepsis in its early stages can mirror common pregnancy symptoms, so it can be hard to diagnose. Due to a lack of training, some medical providers don’t know what to look for. But slow or missed diagnoses are also the result of bias, structural racism in medicine and inattentive care that leads to patients, particularly Black women, not being heard. For decades, frustrated birth advocates and medical professionals have tried to sound an alarm about the ways medicine has failed Black women. Historians trace that maltreatment to racist medical practices that Black people endured amid and after slavery. To fully understand maternal mortality and infant mortality crises for Black women and babies, the nation must first reckon with the dark history of how gynecology began, said Deirdre Cooper Owens, a historian and author.” [AP, 5/23/23]