This week we highlight two federal agencies and their programs to increase health equity by modernizing rules for blood donations and increasing incentives for health providers to ensure that needed care is accessible to all people as well as newly reintroduced, comprehensive federal legislation to address the Black maternal health crisis. Private sector initiatives are complementing federal and state efforts, with the most recent Asembia Summit explicitly addressing the need for gender equity in care and Black legacy civil rights organizations joining with Biden-Harris Administration officials and calling on health insurers and health associations to take meaningful action to prevent coverage losses and strengthen care quality and affordability. Local programs, the front lines of promoting health equity, often go without recognition, but a Chicago-based group is making a splash now that it is expanding beyond the Chicago area to provide free counseling and classes to cancer patients across the country. Among other research highlighting stark and persistent health disparities, a seminal study funded by the National Institutes of Health (NIH) calculated the staggering economic burden of health disparities for five racial and ethnic minority groups and additional research quantified lives lost and the societal price for failing to achieve health equity.
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
Fierce Healthcare: Momnibus Act Reintroduced to Congress as Lawmakers Call for Protection of Black Mothers. “Senator Cory Booker and Representatives Lauren Underwood and Alma Adams have reintroduced the bicameral Black Maternal Health Momnibus Act. The Momnibus is comprised of thirteen bills backed by the Black Maternal Health Caucus members. Bills within the act would combat rising maternal mortality rates directly through healthcare reform and indirectly through addressing social determinants of health. Data collected in 2021 showed that maternal mortality rates have reached a nearly 60 year high. If Congress were to pass the act, further funding for improving maternal healthcare for veterans and incarcerated mothers would be unlocked, programs to improve data collection on the crisis would be launched and education programs on maternal vaccinations would expand. Other parts of the bill would convene a task force to address the maternal health crisis. Said task force would direct the investment of funds into programs tackling social determinants of health. Environmental factors leading to poor maternal health outcomes would be addressed through extending eligibility for the special Supplemental Nutrition Program for Women, Infants and Children (WIC) to the postpartum and breastfeeding periods and triggering investment in digital tools to improve maternal health in underserved areas.” [Fierce Healthcare, 5/16/23]
Politico: FDA Relaxes Blood Donation Restrictions on Gay and Bisexual Men. “The FDA on Thursday finalized a long-awaited plan to loosen restrictions on blood donation by men who have sex with men. Currently, men who have sex with men must abstain from sex for three months before giving blood. The new policy still limits people who have certain risk factors — such as a history of non-prescription injection drug use, those who have exchanged sex for money or drugs, or those who previously tested HIV-positive from donating. The final guidelines are consistent with the draft policy issued in January, which proposed to ease restrictions on blood donation from certain men who have sex with men. The FDA says blood donation establishments “may now implement” the new policy, but it is unclear how long it will take for donation centers to revise questionnaires and procedures. The agency did not set a deadline for implementing the revised policy.” [Politico, 5/11/23]
Health Affairs: Looking Back One Year Out From CMS’s New Health Equity Initiative. “In the past year, three revised models and one new model have been announced, all of which have a prominent focus on addressing health equity. One revised model is the Medicare Advantage (MA) Value-Based Insurance Design Model, which builds upon the statutory authority permitting CMS to waive the uniformity requirements with respect to supplemental benefits provided to chronically ill enrollees. Participating plans can provide targeted supplemental benefits such as food, transportation, and housing assistance; reduced copayments; and rewards and incentives in connection with participation in activities that focus on promoting improved health, preventing injuries and illness, and promoting efficient use of health care resources. Beginning in July 2023, [CMS] will collect detailed information from participating plans about the supplemental benefits provided, so that we can assess their use and effectiveness in improving care and outcomes. The second revised model is the ACO Realizing Equity, Access, and Community Health (ACO REACH) Model, which is a revamped and renamed version of the former Global and Professional Direct Contracting Model. [T]he ACO REACH Model is testing a novel “health equity benchmark adjustment,” to remove the disincentive for providers serving disproportionate numbers of underserved beneficiaries to participate in the model. [CMS] also revised the Maryland Primary Care Program, a component of the third model, the Maryland Total Cost of Care Model. In January 2022, the Maryland Primary Care Program began to offer a “Health Equity Advancement Resource and Transformation (HEART)” payment to provide additional support to primary care participants and federally qualified health centers (FQHCs) furnishing enhanced care management services to socioeconomically disadvantaged and complex patients with high clinical risk in counties with high ADI relative to other counties in the state.” [Health Affairs, 5/11/23]
American Journal of Managed Care: Talking About Women’s Health is the First Step to Improving Health Equity. “Panelists at the 2023 Asembia Specialty Pharmacy Summit discussed the myriad of challenges that women face when they encounter the health care system and how these issues can be addressed to provide female patients more agency. Joanne Armstrong, MD, vice president and chief medical officer of women’s health and genomics at CVS/Aetna, began with championing digital tools, saying that although women are the dominant users of digital solutions but only 5% are targeted towards them. She also emphasized the role gender biases play in health disparities, especially for women of color, and why topics predominately experienced by women, such as menstruation, should not be considered taboo. Additionally, discussion around women’s health should extend beyond talking about menstruation and pregnancy to include all aspects of health, including mental health and conditions that predominately impact women, such as lupus and multiple sclerosis. Stephanie Sassman, portfolio leader of women’s health at Genentech, recommended that clinics and government agencies need to establish more partnerships to address major gaps in care for women and normalize discussions around women’s health equity.” [American Journal of Managed Care, 5/9/23]
NBC Chicago: Suburban Group is Beginning Expansion of Cancer Health Equity Initiatives. “Bringing cancer support programs to everyone, regardless of where they live or receive treatment, is Maigenete Mengesha’s mission. Through a partnership with the University of Illinois Cancer Center and the UI Health Mile Square Health Center, Wellness House is offering dozens of programs at the Mile Square location at 1220 S. Wood Street in Chicago. Two-time breast cancer survivor Jeanette Carter lives in Hyde Park and learned about the Wellness House support programs, that are offered completely free of charge, through her doctor, Deborah Manst. Manst urged Carter to try a Mediterranean diet, but Carter wasn’t sure what that meant. She began taking nutrition classes through Wellness House at Mile Square Health Center. In addition to nutrition and exercise classes, Wellness House also offers counseling. They now have a new designation that allows a Wellness House facilitator to expand online counseling sessions beyond the Chicago area, to cancer patients and their families in other states.” [NBC Chicago, 5/17/23]
Legal Defense Fund: Civil Rights Leaders Urge Action as the PHE Ends and Millions are at Risk of Jeopardized Care. “Yesterday, on the final day of the COVID-19 public health emergency designation, civil rights leaders convened at the White House for a joint meeting with the Office of Public Engagement, the Administrator for the Centers for Medicare and Medicaid Services (CMS), senior Biden administration officials, and representatives of health insurers and health associations to discuss concerns related to Medicaid unwinding, the end of the COVID-19 public health emergency, budget negotiations surrounding Medicaid work requirements, changes in Medicare Advantage Plans, and public awareness around cost-savings tied to the Inflation Reduction Act. Following the meeting, the civil rights leaders released a letter outlining key actions for insurers to consider, highlighting the urgent need for unified action. The leaders stated, ‘The lives of millions of vulnerable individuals, particularly Black people and other people of color, rely on the actions and commitments of health insurers and health associations. It is imperative that we work together, raise awareness, and take meaningful action to prevent individuals from being unjustly deprived of healthcare coverage and to ensure that families remain protected and healthcare remains affordable for everyone. We are urging insurers to commit to achieving health access, equity, and affordability for all.’” [Legal Defense Fund, 5/12/23]
CHALLENGES
National Institutes of Health: New Study Shows the Economic Burden of Health Disparities Remains High. “The study, funded by the National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health, revealed that in 2018, racial and ethnic health disparities cost the U.S. economy $451 billion, a 41% increase from the previous estimate of $320 billion in 2014. The study also finds that the total burden of education-related health disparities for persons with less than a college degree in 2018 reached $978 billion, about two times greater than the annual growth rate of the U.S. economy in 2018. This study is the first to estimate the total economic burden of health disparities for five racial and ethnic minority groups nationally and for all 50 states and the District of Columbia using a health equity approach. The health equity approach set aspirational health goals that all populations can strive for derived from the Healthy People 2030 goals. It establishes a single standard that can be applied to the nation and each state, and for all racial, ethnic, and education groups. It is also the first study to estimate the economic burden of health disparities by educational levels as a marker of socioeconomic status.” [National Institutes of Health, 5/16/23]
Washington Post: New Study Find Black Communities Faced Waves of Excess Deaths. “America’s Black communities experienced an excess 1.6 million deaths compared with the White population during the past two decades, a staggering loss that comes at a cost of hundreds of billions of dollars, according to two new studies that build on a generation of research into health disparities and inequity. In one study, researchers conclude that the gap in health outcomes translated into 80 million years of potential life lost — years of life that could have been preserved if the gap between Black and White mortality rates had been eliminated. The second report determined the price society pays for failing to achieve health equity and allowing Black people to die prematurely: $238 billion in 2018 alone. The reasons for the excess deaths and resulting economic toll are many, including mass incarceration, but the root is the same, according to the reports published Tuesday in the influential medical journal JAMA: the unequal nature of how American society is structured. That includes access to quality schools, jobs with a living wage, housing in safe neighborhoods, health insurance and medical care — all of which affect health and well-being. Expanding their analysis to a broader population, the researchers concluded that the failure to achieve health equity in 2018 cost the nation $1.03 trillion. That price tag includes the burden experienced by American adults older than 25 who do not have a college degree and by Native American, Asian, Black, Latino and Pacific Islander people.” [Washington Post, 5/16/23]
WAMC: Coalition of Public Health Experts Say Ending the PHE Will Lead to More Dangerous Outcomes for the Most Vulnerable. “Berkshire Health Systems, the county’s largest healthcare provider, is dropping many of its COVID-19 precautions in line with the state. Visitation policies have been expanded, pre-procedure testing will be discontinued, and testing centers in North Adams, Pittsfield, and Great Barrington will close at the end of the month. Even one of the most effective means of limiting the spread of the respiratory illness that has killed millions worldwide is being halted. But not all public health professionals think the concept of returning to normal is possible. A Massachusetts resident, Christine Mitchell, who received her doctorate from the Harvard T.H. Chan School of Public Health, signed on to an open letter from the Massachusetts Coalition for Health Equity calling on the commonwealth to maintain masking requirements for health care institutions. Given how disproportionately the pandemic impacted the most vulnerable at its height, Mitchell says this new chapter of public health policy underscores already deadly themes of ableism and discrimination against people with disabilities. ‘Only 29% of the Massachusetts population have gotten a COVID booster shot,’ said Dr. Lara Jirmanus. ‘And when you take a look at who’s gotten it, you actually find that there are huge inequities in terms of people of color, people according to levels of education. People with lower levels of education have also been less likely to get the vaccine, people with lower income. And that suggests to me that this is also an access issue. It’s about people who are unable to take the day off work to recover from the vaccine.’” [WAMC, 5/11/23]
The Post and Courier: Death Rate of Infants Born to Black Mothers in South Carolina Increased Over 40 Percent from 2017 to 2021. “Although the regional hospital in the city of Orangeburg delivers babies, the birth outcomes in the county are awful by any standard. In 2021, nearly 3 percent of all Black infants in Orangeburg County died before their 1st birthday. Nationally, the average is about 1 percent for Black infants and less than 0.5 percent for White infants. 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. A new study published in the Journal of the American Medical Association found that, over 20 years, 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 compared with White Americans. The study also found that infants and older Black Americans bear the brunt of excess deaths and years lost. [A] report published by the state Department of Health and Environmental Control in April shows the rate for non-Hispanic Black babies — who died at a rate nearly 2½ times that of non-Hispanic White infants in South Carolina in 2021 — is growing worse. The death rate among infants born to Black mothers in the state increased by nearly 40 percent from 2017 to 2021.” [The Post and Courier, 5/21/23]