This week we highlight new rules from the HHS supporting state actions to increase access to care for those leaving incarceration, an important tool to reduce disparities for this population who are disproportionately people of color. Multiple new reports from entities and organizations like the World Health Organization and the Robert Wood Johnson Foundation highlight both new data in health disparities as well as policy solutions refocusing health efforts towards community-based models that promote health equity. Finally, a groundbreaking new piece of research has shown that access to Black physicians is directly correlated to a marked increase in Black life expectancy within that community, whether or not people attend that physician’s practice. Other studies featured in this edition underscore the importance of policy implementation to maximize the likely equity impact.
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
World Health Organization: WHO Releases Largest Global Collection of Health Inequality Data. “The repository allows for tracking health inequalities across population groups and over time, by breaking down data according to group characteristics, ranging from education level to ethnicity. The data from the repository show that, in just a decade, the rich-poor gap in health service coverage among women, newborns and children in low- and middle-income countries has nearly halved. They also reveal that, in these countries, eliminating wealth-related inequality in under-five mortality could help save the lives of 1.8 million children. The Health Inequality Data Repository (HIDR) includes nearly 11 million data points and consists of 59 datasets from over 15 sources. The data include measurements of over 2000 indicators broken down by 22 dimensions of inequality, including demographic, socioeconomic and geographical factors. Though limited, the available disaggregated data reveal important inequality patterns. In high-income countries, hypertension is more common among men than women and obesity rates are similar among men and women. By contrast, in low-income countries, hypertension rates are similar among women and men, but obesity rates are higher among women than men. The repository also reveals inequalities in national COVID-19 responses. In 2021, in more than a third of the 90 countries with data, COVID-19 vaccination coverage among the most educated was at least 15 percentage points higher than among the least educated.” [WHO, 4/20/23]
Department of Health and Human Services: HHS Releases New Guidance to Support States Increasing Health Care for Those Leaving Incarceration. “The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is announcing a new opportunity for states to help increase care for individuals who are incarcerated in the period immediately prior to their release to help them succeed and thrive during reentry. The new Medicaid Reentry Section 1115 Demonstration Opportunity would allow state Medicaid programs to cover services that address various health concerns, including substance use disorders and other chronic health conditions. In January, California became the first state to cover certain health care services for individuals transitioning back to the community. The Medicaid Reentry Section 1115 Demonstration Opportunity will allow states to cover a package of pre-release services for up to 90 days prior to the individual’s expected release date that could not otherwise be covered by Medicaid due to a longstanding statutory exclusion that prohibits Medicaid payment for most services provided to most people in the care of a state or county carceral facility. According to the U.S. Department of Justice, from 2011 to 2012, approximately 37 percent of people in state/federal prisons and 44 percent of people who were incarcerated overall had a history of mental illness. The National Institute on Drug Abuse (NIDA) estimates that the rate of substance use disorders for people who are incarcerated may be as high as 65 percent. The NIDA report also says that, without treatment, individuals formerly incarcerated are at increased risk of overdose within the first few weeks of reentry.” [HHS, 4/17/23]
Stat: New Research Shows in Counties With More Black Doctors Correlate to an Increase in Black Life Expectancy. “The study, published Friday in JAMA Network Open, is the first to link a higher prevalence of Black doctors to longer life expectancy and lower mortality in Black populations. The new study found that Black residents in counties with more Black physicians — whether or not they actually see those doctors — had lower mortality from all causes, and showed that these counties had lower disparities in mortality rates between Black and white residents. The finding of longer life expectancy persisted even in counties with a single Black physician. Lisa Cooper, a primary care physician who directs the Johns Hopkins Center for Health Equity and has written widely on factors that may explain why Black patients fare better under the care of Black doctors, called the study ‘groundbreaking’ and ‘particularly timely given the declining life expectancy and increasing health disparities in the U.S. in recent years.’ The team found life expectancy increased by about one month for every 10% increase in Black primary care physicians. While extending life by a few months may not sound like much given that the life expectancy gap between Black and white Americans nationally is nearly six years, picking up such a signal on a population level is significant, the authors said. The study found that every 10% increase in Black primary care physicians was associated with a 1.2% lower disparity between Black and white individuals in all-cause mortality.” [Stat, 4/14/23]
Yahoo News: Decreasing Black Maternal Mortality Rates Means Supporting Community-Health Models. “The crisis of maternal mortality in the United States continues to escalate. After rising steadily over time, annual death rates skyrocketed by a shocking 40% in 2021 alone, according to the Centers for Disease Control and Prevention. What’s more, Black women are 2.6 times more likely to die of maternity-related causes than white women. Such outcomes transcend class—in the highest-income groups, twice as many Black women die within a year after childbirth. The same holds true for their babies. Our work has convinced us that conversations about maternal mortality tend to underplay one of the most powerful tools at our disposal: community-based models that respect nuances of culture and language. That said, there are evidence-based alternatives that actually work. Midwives, who are far more common outside the U.S., can provide a host of prenatal and delivery services while staying vigilant to the possible need for interventionist obstetrical care. Community health workers, doulas, and other providers skilled at integrating family and social supports with appropriate healthcare also belong in the prenatal to post-partum continuum. Often, they have local roots, come from backgrounds similar to the populations they tend to, and respect the need to provide continuous, family-centered support. To take fuller advantage of their background and skill set, we believe the federal government should finance efforts to increase the number of licensed midwives and other local providers. States should develop credentialing and scope-of-practice standards so that perinatal community-based providers can use the full breadth of their knowledge. Guided by a commitment to quality and equity, hospitals should make referrals to external resources and prioritize less acute services, even if that reduces their revenue. Employers and public and private insurers should also guarantee coverage for appropriate maternal care outside the hospital. None of this will adequately reduce the toll of maternal mortality unless it is accompanied by affordable insurance that covers community-based services, guarantees continuity of care, and addresses the chronic medical and social conditions that often cause the greatest harms.” [Yahoo News, 4/13/23]
Robert Wood Johnson Foundation: New Report on How to Achieve Healthy Births for All. “Far too frequently, a Black person’s pain or suffering is dismissed because of discrimination or implicit bias in our healthcare system. It cannot go on that way. For Black women and their infants to thrive, it’s crucial that doctors, nurses, and other medical professionals value and respect every birthing person’s experiences. Access to the best possible care is a fundamental right. Offering it can be an act of social justice. That means access to care at every stage of our lives. Women’s health during pregnancy is deeply connected to their health before and in between pregnancies. If you live in a community with limited access to medical care and are unable to see a doctor regularly, you are entering into pregnancy with increased risk. Women need comprehensive reproductive healthcare, from primary care through postpartum support, for healthy outcomes. We deserve to receive this care from providers who understand our needs. We deserve to enter pregnancy with anticipation, not trepidation. America is the most dangerous place to give birth in the developed world—and pregnancy-related deaths are on the rise. The toll is not equally distributed: Black women are three times more likely to die of pregnancy-related causes than White women. Birth justice-focused organizations are advancing policies and practices that address the impact of structural racism on maternal and infant health outcomes. Communities on the front lines of this crisis are advocating to increase the number of birth support people demonstrated to improve birth outcomes—and expand insurance coverage to include their care. These efforts are vital to reducing disparities. Lastly, our policymakers must invest in making birth equity a reality in our country. Medicaid expansion, on the rise in some states, is associated with reduced rates of maternal death, particularly for Black women. In order to address the Black maternal health crisis, however, we must not only expand and enhance Medicaid coverage, but also ensure that providers receive adequate payment. Without both expanded Medicaid and fair reimbursement, Black women will not be able to access the healthcare they need.” [Robert Wood Johnson Foundation, 3/23/23]
CHALLENGES
Axios: Communities of Color Saw Disproportionately Higher COVID Deaths in Young Adults. “Communities of color experienced significantly higher premature death rates than white people during the pandemic and accounted for 59% of the years of life lost during the health crisis, according to a KFF analysis released on Monday. Although individuals 75 and older had the highest risk of becoming seriously ill and dying from COVID-19, younger adults who had their lives cut short by the illness offer a window into racial disparities that the pandemic laid bare. Between March 2020 and the end of 2022, the U.S. experienced nearly 1.7 million excess deaths, defined as fatalities beyond what would have been expected in a typical year that can be due directly or indirectly to COVID-19. The increase in the premature death rate for Hispanic people (33%) was over twice that of white people (14%) from 2019 to 2022. White people experienced an average of 12.5 years of life lost from premature deaths while Hispanics experienced 19.9 years of life lost and American Indian-Alaska Natives had 22 years of life lost before age 75. AIAN people made up 3% of total years of life lost but just 1% of the population. Black people made up 26% of the total years of life lost but just 13% of the population, and Hispanic people accounted for 27% of years of life lost in contrast to 19% of the population. Some groups of color also have higher rates of underlying conditions that may have increased the risk of severe illness and death.” [Axios, 4/25/23]
New York Times: Black Pregnant Women Are More Likely to be Suspected and Tested for Drug Use. “Hospitals are more likely to give drug tests to Black women delivering babies than white women, regardless of the mother’s history of substance use, suggests a new study of a health system in Pennsylvania. And such excessive testing was unwarranted, the study found: Black women were less likely than white women to test positive for drugs. The authors of the new study urged hospitals to examine their drug testing practices in order to address racial biases. It’s not clear what led to greater drug testing of Black women at the Pennsylvania health system. All patients entering the labor and delivery department were screened verbally for substance use, with questions adapted from the National Institute on Drug Abuse’s quick verbal screening test. The policy called for running urine toxicology tests on patients with a positive result from the screening test, a history of substance use in the year before delivery, few prenatal visits or a poor birth outcome without a clear medical explanation. But substance use history couldn’t fully explain the results. And the researchers found no racial differences in the number of prenatal care visits or the rate of stillbirths.” [New York Times, 4/14/23]
Axios: Medicaid Redeterminations Disproportionately Leave Pacific Islanders Vulnerable. “Thousands of Pacific Islanders who went years without promised Medicaid coverage before Congress made amends during the pandemic could lose those benefits this spring in the first wave of eligibility redeterminations. States are culling their Medicaid rolls with the end of the COVID-19 emergency, removing guarantees of continuous coverage that reduced health inequities in ways obvious and not-so-obvious. Consider the 94,000 individuals from the Marshall Islands, Palau and the Federated States of Micronesia now living in the U.S. While non-citizens, they’re guaranteed Medicaid and CHIP benefits under a Reagan-era agreement that gave the U.S. exclusive use and control of sites in those islands for military activity. Congress erroneously stripped the group’s Medicaid benefits when drafting welfare reform legislation in 1996. That left communities exposed to the ravages of COVID-19 more than other groups before Congress restored the benefits in a year-end spending package in 2020. Now, some of those same individuals could be forced out of the safety net program as states redetermine eligibility requirements. They include the Marshallese from islands that were the site of Cold War U.S. nuclear tests that left residents suffering from cancers, birth defects and forced relocations. After 25 years without Medicaid benefits, some Pacific Islanders could fall through the cracks again unless states and health groups come up with workarounds, new processes and outreach.” [Axios, 4/21/23]