This week we highlight a White House proclamation, state actions, studies, conferences, and additional private and public sector efforts focused on reducing inequities in health. These are much-needed interventions in a system plagued by systemic barriers to care, which is only being further exacerbated by the ongoing Republican war on America’s health care.
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 Asian American, Native Hawaiian, and Pacific Islander Heritage Month. “This year I was proud to launch the first-ever National Strategy to Advance Equity, Justice, and Opportunity for Asian American, Native Hawaiian, and Pacific Islander Communities. This plan reflects my Administration’s commitment to improving the lives of AA and NHPIs — ensuring that the census collects accurate data so they are properly reflected when new policy is made; advancing safety, inclusion, and belonging for AA and NHPI communities; promoting language access and preservation; advancing AA and NHPI representation in the Federal workforce; and striving toward an equitable COVID-19 recovery.” [The White House, 4/28/23]
Metro Weekly: Maryland Governor Signs Trans Health Equity Act. “Maryland Gov. Wes Moore (D) has signed a law requiring Medicaid to cover the costs of medically necessary gender-affirming care for low-income transgender residents. The ‘Trans Health Equity Act’ removes prohibitions on what types of transition-related treatments can be covered by Medicaid, enabling lower-income transgender residents to obtain coverage for medically necessary care. Under the bill, any gender-affirming treatments that have been prescribed to a transgender patient in accordance with current clinical standards of care and have been deemed medically necessary must be covered by Medicaid. The bill stands in direct opposition to actions taken by Republican-led states, whose legislatures or governors have sought to ban gender-affirming treatments for minors, and who have sought to bar Medicaid dollars from being used for any transition-related treatments — even in the case of legal adults who have been recommended to receive such treatments by their primary health care provider.” [Metro Weekly, 5/5/23]
KCRA: Black Health Equity Advocacy Week Established in California. “The California Black Health Network is celebrating its 40th anniversary. The organization is dedicated to advancing health equity for Black and brown communities. In April, Assemblymember Akilah Weber introduced ACR-53, with the support of the California Legislative Black Caucus. According to a news release, the resolution established a statewide focus on the need to address the health disparities gap for Black Californians and declares May 1 to 5, 2023, and every first week of May thereafter, as Black Health Equity Advocacy Week in California. In 2021, CBHN launched the Campaign for Black Health Equity, an initiative that aims to decrease health disparities and improve the life expectancy of Black Californians, according to the news release. The resolution will help amplify CBHN’s campaign efforts across the state, it says.” [5/1/23]
UAMS News: Two-Day Conference Brings Together Organizations Working to Reduce Health Disparities in Arkansas. “The University of Arkansas for Medical Sciences (UAMS) Arkansas Center for Health Disparities (ARCHD) held a two-day conference in North Little Rock for its community partners and individuals from throughout the state. During the opening day of the conference several College of Public Health faculty, staff and students presented final results or updates to research projects funded by the center. Additionally, maternal and child health, violence intervention, chronic diseases and stress management received additional attention as topics of group discussion. ‘The attendees enjoyed learning about how UAMS is partnering with Arkansas’ communities to combat health disparities,’ said Crystal Jones, MS, ARCHD program manager. ‘The event provided an amazing opportunity for researchers to share their findings and collaborate with community leaders and colleagues on strategies to address the state’s health disparities.’” [UAMS News, 5/4/23]
National Institute of Health: Anti-Poverty Policies May Reduce Disparities in Brain Development and Mental Health Symptoms for Children. “States that provide stronger social safety nets have lower socioeconomic disparities in the brain development and mental health of children 9 to 11 years old, according to research supported by the National Institute on Drug Abuse (NIDA) at the National Institutes of Health. The disparity in brain structure between children from high- versus low-income households was more than a third lower in states with greater cash assistance than in those offering less, and the disparity in mental health symptoms was reduced by nearly a half. Emerging evidence has shown that children from families with lower income relative to children from families with higher income exhibit smaller hippocampal volume. The hippocampus plays a critical role in memory and emotional learning. As hypothesized, differences in hippocampal volume between children from high- and low-income families were greater in states with a higher cost of living. However, the availability and benefit value of monetary assistance programs in higher cost-of-living states reduced this disparity by 34%, and similarly, in states with Medicaid expansion, the disparity was reduced by 43%. Overall, more expensive cost-of-living states with anti-poverty programs in more expensive states had narrower gaps in income-associated differences in brain structure. Similar levels were observed in states with the lowest cost of living.” [National Institute of Health, 5/2/23]
The Bakersfield Californian: AAFA Announces New Health Equity Program Sites. “[O]n World Asthma Day, the Asthma and Allergy Foundation of America (AAFA) [announced] the second round of awardees to be supported through AAFA’s Health Equity Advancement and Leadership (HEAL) program. This initiative bolsters AAFA’s commitment to drastically reduce health disparities in communities with the heaviest asthma and allergy burden. AAFA’s HEAL program identifies and funds community-based health interventions tailored to at-risk populations most impacted by asthma and allergic diseases. Now in its second year, AAFA has selected two new programs in New York and Alabama to be funded through HEAL. The first program to be confirmed… will be implemented in New York City… will develop a unique asthma care intervention targeted toward the Hispanic population in the Bronx and surrounding areas. In high-poverty neighborhoods of the South Bronx, Hispanic communities comprise the largest racial and ethnic group that bears the highest burden of asthma-related morbidity. In addition to New York City, the new round of HEAL funding will support a new program in Alabama using a virtual model to complete asthma management home visits and provide asthma health education. The program will build a community health worker network to address the rural health disparity needs through collaborations with schools, local and state departments of health, and other state-based organizations and partners.” [The Bakersfield Californian, 5/2/23]
CHALLENGES
Axios: Immigrants Make Up a Disproportionate Number of Uninsured People in the United States. “Immigrant adults and children under the age of 65, including those who are undocumented, account for 8% of the U.S. population but make up nearly 32% of the uninsured population in the country, according to a new report from the Urban Institute and the Robert Wood Johnson Foundation. Despite tax credits being available for Marketplace coverage through 2024, the majority of immigrants who are uninsured still won’t be able to access coverage ‘solely because of their immigration status,’ the report says. Researchers estimate that after Medicaid redeterminations take place this year, 8.6 million of the 27 million people who will be uninsured will be noncitizens. California, New York, Colorado and Washington state have proposed or are expanding health coverage for nonresidents either through Medicaid parity programs or their Affordable Care Act Marketplaces. Despite these state options, just 16.5% of uninsured noncitizens are eligible for Medicaid or Marketplace coverage, the report found.” [Axios, 5/5/23]
Medical Economics: New Report Emphasizes Need to Reduce Racial Health Disparities. “In March, the Kaiser Family Foundation published an annual update to its Key Data on Health and Health Care by Race and Ethnicity. The analysis examines how people of color in the U.S. fare when compared to White people across a broad range of measures of health, health care and social determinants of health (SDOH). The update reveals that Black, Hispanic, and American Indian and Alaskan Native (AIAN) adults fared significantly worse than White adults across most of the more than 30 measures examined. Something that continues to cause grave concern is the mortality rate among both mothers and infants, particularly among minority patients. We know that Black infants were more than two times as likely to die as White infants, with 10.4 deaths per 1,000 births versus 4.4 deaths per 1,000 births. And the AIAN infants were nearly twice as likely to die as White infants with 7.7 deaths per 1,000 births. Black and AIAN women also had the highest rates of pregnancy-related mortality. Another finding… is that adults of color were more likely than White adults to report not having a usual doctor or provider and to have to choose to go without care because of the cost. Approximately one-third of Hispanic adults, (a) quarter of AIAN adults and nearly 1 in 5 of Asian and Black adults reported not having a personal health care provider, compared (with) 16% of White adults.” [Medical Economics, 4/27/23]
Stat: Study Shows One in Three Black Americans Live in a “Cardiology Desert.” “About 16.8 million Black Americans — roughly 1 in 3 — live in counties with little or no access to heart specialists, according to a report from GoodRx, a digital health company that provides drug discounts and also researches health trends. When zooming in on counties that have sizable Black populations, the analysts found that 72% of these counties are ‘cardiology deserts,’ most of them concentrated in southeastern states. The findings illustrate the barriers to accessing care for a population that already faces a disproportionate burden from cardiovascular disease. It’s the leading cause of death in the U.S., and Black Americans face a 30% higher risk of death from heart disease than white people. [A]reas where heart specialists are most difficult to reach are also where specialists may be most needed.” [Stat, 5/2/23]
RevCycle Intelligence: Preventable Heart Failure Admissions Driven by Inequities in Health Care Access Costing Medicare Over $60 Million Annually. “The South is considered the ‘Heart Failure Belt,’ with heart failure mortality being 69 percent higher than the national average at 31.0 per 100,000 in rates in Alabama, Arkansas, Mississippi, Oklahoma, Louisiana, and Georgia. What’s more, Black Americans have the highest incidence of heart failure among all racial and ethnic groups in the US, with the disparity being especially noticeable in the US South. Uneven access to primary care, failure to deliver guideline-based care, and lack of care coordination all contribute to excess hospital admissions, especially among Black patients. Some 16.8 million Black Americans live in areas with suboptimal specialty care access, including cardiology care deserts. Stopping closures and opening new pharmacies in underserved areas could help Black, Hispanic, and other racial and ethnic minorities get access to life-saving, self-management medications, researchers said. Additionally, European models in which some drugs are made available through non-pharmacy settings could also increase access for certain patient populations.” [RevCycle Intelligence, 5/3/23]
Axios: More Than One in Five Americans Skip Health Care Due to Barriers in Transportation. “While telehealth may have reduced transportation barriers for mental health, primary care and some other services, it’s not accessible to all and can’t substitute for in-person care for some medical needs, the Urban Institute researchers wrote. The findings point to gaps that could be filled by Medicaid coverage of nonemergency medical transportation, which varies by state, or expanded access to telehealth where public transit options are limited, they said. 21% of adults without access to a vehicle or public transit went without needed medical care last year. About 5% of nonelderly adults didn’t get needed care in the past year because of difficulty finding transportation, an experience more common among individuals from low-income families, people with disabilities and those on public health programs. Though 91% of adults said they had access to a vehicle, the figure was substantially lower Black adults (81%), those with low family incomes (78%) or a disability (83%) and for individuals with public health insurance (79%) or no coverage (83%). Research suggests as much as 40% of a person’s health can be attributed to socioeconomic factors like education, employment and the availability of transportation.” [Axios, 4/28/23]