April 2023

This April marks the 5th annual Medicaid Awareness Month. The Affordable Care Act’s (ACA) Medicaid expansion has been a critical part of working towards the goal of every American having access to affordable and quality health insurance, but Republicans in 10 states have not yet implemented expansion of the program, blocking millions from coverage and access to essential health care. Holdout states are located in the southern and midwest regions with significant rural populations. 60 million Americans reside in rural areas across the United States.

By The Numbers

• Millions Of Rural Americans Depend On Medicaid. Nearly 14 million Medicaid enrollees reside in rural areas.
• Medicaid Strengthens Health In Rural America. Overall, rural residents have worse health outcomes and tend to be older, poorer, and sicker than those in urban areas.
• Rural States Need Medicaid. Uninsurance rates in rural America are 2-3 percentage points higher than in urban areas. States that expanded Medicaid experienced a 7 point increase in insured rates after the passage of the Affordable Care Act.
• Rural Hospitals Rely On Medicaid. Since 2005, more than 150 rural hospitals have closed, including 20 closures in 2020 alone. Rural hospitals in Medicaid expansion states are 62 percent less likely to close. In 2023, over 600 rural hospitals are at risk of closing in the near future.
• Rural Hospitals Strengthen Local Economies. Hospitals employ ten percent of total county employment. Rural areas with hospital closures experience economic downturns with a 14 percent reduction in country employment. 673 rural hospitals are at risk of closing, and estimated that if those hospitals shut down, 99,000 health care jobs in rural communities would be lost.

How Medicaid Expansion Helps Rural Americans

Nearly 14 million Medicaid enrollees reside in rural areas. Health care for rural Americans is especially important due to higher prevalence of pre-existing conditions and barriers to accessing health care. The success of Medicaid expansion across the country demonstrates the need for the 10 holdout states to finally adopt expansion. Almost 20 percent of uninsured Americans live in rural areas and would benefit from the long awaited expansion. 

Medicaid Expansion Saves Lives. Medicaid expansion has been proven to increase access to care, improve financial security, and save lives. A study published in the Journal of Health Economics found that Medicaid expansion reduced mortality in people aged 20 to 64 by 3.6 percent. Mortality rates in rural areas are much higher than in urban areas due to a disparity in health care access and increased prevalence of fatal diseases, suicide, and overdoses. 

Medicaid Expansion Reduces Income Inequality And Medical Debt. Medicaid expansion reduces poverty and income inequality across the board by helping low income families access care without jeopardizing income that they may use for other basic living expenses. A 2019 Health Affairs study found that Medicare, Medicaid, and premium subsidies account for one-third of poverty reduction in households without a disability recipient. Medicaid has also been shown to reduce the prevalence of medical debt with nearly 80 percent of the counties with the highest medical debt being from states that haven’t yet expanded Medicaid. 

Medicaid Expansion Plays A Central Role In Fighting The Opioid Crisis. Rural America largely lacks the ability to treat substance use disorders with 65 percent of rural counties lacking the ability to prescribe buprenorphine, an effective drug used to treat opioid dependency. Starting in 2020, Medicaid began covering all medications, therapies, and counseling services that are approved by the Food and Drug Administration to treat opioid use disorders. Medicaid covers an estimated four in ten people with an opioid use disorder. Medicaid expansion in the remaining 10 states is a necessary foundation to help low-income, rural families dealing with higher rates of substance use disorders. 

Medicaid Expansion Is A Lifeline For Rural Hospitals

In states that haven’t expanded Medicaid, rural hospitals are drowning under financial pressure. Low occupancy rates, high levels of uncompensated care, competition with other hospitals, and struggling local economies create a financial burden that rural hospitals face all over the country. Since 2010, 138 rural hospitals have closed, including 20 closures in 2020 alone. One in four rural hospitals face closure without more federal funding in 2022. 

Medicaid Helps Rural Hospitals Stay Open. Rural hospitals in Medicaid expansion states are 62 percent less likely to close. The two most common types of supplemental Medicaid payments are disproportionate share hospital payments, that pay hospitals for uncompensated care for Medicaid and uninsured patients, and upper limit payments, which supplement the gap between fee-for-service Medicaid base payments and the amount that Medicare covers. Some states are also testing the use of global hospital budgets to increase care and improve health outcomes in rural hospitals.

Closure Of Specialized Care And Obstetrical Services. Some hospitals opt to close specific services or facilities that cause patients in rural areas to have to travel further for specialized care. On average, when a rural hospital closes patients have to travel over 20 miles further to access inpatient or emergency care. A 2021 study found that fewer than half of all rural counties in the United States had hospital-based obstetric care. When hospitals face financial hardship, obstetric services are among the first to be cut. Black and Native American women in rural areas are particularly at risk. Black and Native American women are two to three times more likely to die from pregnancy-related causes than white women.

Medicaid Expansion Boosts State Budgets. Medicaid expansion generates enough savings that it is well worth the initial cost, eventually helping boost states budgets. Expansion allows states to access federally matched funds for some people covered by traditional Medicaid. The American Rescue Plan (ARP) provides states with additional funding from the federal government. From 2022 to 2025, the states that haven’t yet expanded Medicaid would gain $90 billion in federal matching funds in addition to $17.6 billion in ARP bonus payments and $6.6 billion from higher state and local tax revenue.

Rural Hospitals Are Large Employers In Their Communities. For rural areas that often have high unemployment rates, hospitals contribute significantly to local economies by employing large numbers of people with relatively high-paying jobs.

Beyond just being a source of jobs, hospitals tend to pay higher wages than other rural industries. As the House of Representatives Minority Staff report on rural hospitals highlights, “The average pay of hospital employees in rural counties is 43 percent higher than the average pay of other workers in the same counties.” As Mark Holmes, the director of the Rural Health Research Program at the University of North Carolina, emphasizes, hospital closures in rural communities can be like losing a factory: “Losing an employer of 150 people with good jobs is like losing a manufacturing plant…Hospitals are usually the largest, or the second-largest, employer in a community. That’s something that’s easy to lose sight of because we think of this from a health standpoint. But the effects are wide-ranging when a hospital closes.”

Rural Hospitals Boost Local Economies. Besides hospitals providing higher paying jobs in the health care sector, rural hospitals also stimulate the local economies of other industries. Hospitals purchase goods or services from local private businesses which helps stabilize and reinforces the local economy. In turn, strong private sector employment allows for more tax dollars for public goods, such as education and safety services.

This April marks the 5th annual Medicaid Awareness Month. Medicaid is an essential pillar in providing coverage for communities of color. Generations of structural racism have resulted in people of color experiencing lower rates of health coverage, worse health outcomes, and staggering health inequities. As a result, Medicaid coverage remains a critical source of coverage, especially for Black, Latino, and Indigenous families in America who experience poverty at a higher rate than white Americans and remain less likely to have access to quality care – an important driver of health. These groups also face higher rates of chronic conditions that make access to affordable health coverage even more essential. And for people of color who live in rural areas, who are LGBTQI+, who have a disability, or who are low income, these intersectional dimensions of their identities compound the health disparities they experience.

Research confirms that Medicaid expansion saves lives and drastically reduces racial/ethnic health disparities. States that expanded their Medicaid programs saw a 51 percent reduction in the gap between uninsured white and Black adults after expansion, and a 45 percent reduction between white and Hispanic/Latino adults. Despite Medicaid expansion’s proven role in reducing racial/ethnic disparities in health care access and improving health outcomes, Republicans have spent years undermining the expansion of Medicaid, blocking millions from coverage. Currently, an estimated 2.1 million uninsured adults are locked out of coverage in the 10 holdout states refusing Medicaid expansion, with people of color comprising 62 percent of those who would gain coverage if these 10 states expanded Medicaid. 

By The Numbers

• 1 In 5 Medicaid Enrollees Are Black. As of 2022, Black Americans make up 13.6 percent of the U.S. population, but about 20 percent of Medicaid enrollees. 
• About 1 in 4 Native American And American Indian People Are Enrolled In Medicaid. According to the 2021 census, 4.3 million people identified as Native American and American Indian. Nearly 27 percent of this group is enrolled in Medicaid. 
• 30 Percent Of Medicaid Enrollees Are Hispanic/Latino. Hispanic/Latino people make up 18.9 percent of the U.S. population, but nearly 30 percent of Medicaid enrollees. 
• 15 Percent Of Asian Americans Are Enrolled In Medicaid. Roughly 6 percent of the American population identify as Asian American equating to about 21 million people.
• More Than 30 Percent Of Native Hawaiian And Other Pacific Islanders (NHOPI) Are Covered By Medicaid. That’s about 207,000 out of 690,000 NHOPI people.
• More Than 2.1 Million People Could Gain Coverage If Holdout States Accepted Expansion. If Republicans did the right thing and expanded Medicaid in the remaining holdout states, more than 2 million uninsured adults could gain coverage; people of color make up nearly 62 percent of this group, or roughly 1.3 million people. 

Research Confirms Medicaid Improves Coverage, Health, And Economic Equity

Reduced Racial/Ethnic Disparities In Coverage. Increasing Medicaid access is the single most important action available to expand coverage and address access to quality care as a driver of health. This together with additional actions to address other social and structural determinants of health can reduce racial/ethnic disparities in the American health care system. The majority of people in America who would gain coverage if the remaining 10 holdout states expanded Medicaid are people of color. The Affordable Care Act (ACA) led to historic reductions in racial/ethnic disparities in access to health care, but gaps in insurance coverage narrowed the most in states that adopted Medicaid expansion. States that expanded their Medicaid programs saw a 51 percent reduction in the gap between uninsured white and Black adults after expansion, and a 45 percent reduction between white and Hispanic/Latino adults. 

Medicaid Is Essential For Children Now And In The Future. Children of color disproportionately rely on Medicaid coverage, making robust Medicaid access a critical racial/ethnic justice issue for American children. Children of color make up nearly 52 percent of all American children, but nearly 75 percent of the children on Medicaid. This coverage not only provides health coverage in the immediate term, but also provides significant long-term benefits, such as being less likely to be hospitalized and more likely to graduate high school and college.

Medicaid Coverage Is Critical To Improving Maternal Health. The United States is only one of two nations that has reported an increase in maternal mortality since 2000, including increases over the past three years. According to the Centers for Disease Control and Prevention (CDC), more than 80 percent of these deaths are preventable. Women of color consistently experience higher rates of maternal mortality than white women, with the Center on Budget Policy and Priorities finding this to be the result of a combination of factors, including life-long toxic stress resulting from racism and the impacts of structural racism in the health care system. 30 states have expanded postpartum Medicaid coverage to a full year, covering more than 460,000 individuals. In the 10 states that have refused Medicaid expansion, eight had more than 40 percent of births covered by Medicaid. Medicaid covers 65 percent of all births to Black mothers and 65 percent of women of reproductive age living in the coverage gap are women of color. 

Reduced Racial/Ethnic Disparities In Rural Access To Care. 24 percent of rural Americans identify as a person of color. Rural Americans of color face a greater health disparity than their white counterparts due to barriers to health care access, reporting not having primary care providers, forgoing care due to cost, and having fair to poor health status. States that have expanded Medicaid have improved rural hospital financial performance and lower likelihood of hospital closures. Residents in states where Medicaid has been expanded are more likely to receive higher quality care, including for chronic health conditions, such as diabetes and hypertension that disproportionately impact communities of color. When Arkansas and Kentucky accepted Medicaid expansion, adults in those states became more likely to have a personal doctor, obtain care for ongoing conditions, and have a yearly medical check up.

LGBTQI+ People of Color Have Seen Reduced Health Disparities. Due to both systemic factors as well as complex familial dynamics, the LGBTQI+ community is much more at risk of poverty and uninsurance than cisgender heterosexual Americans. Because of this, Medicaid has become a lifeline for the LGBTQI+ community, especially people of color. Around 79 percent of Black LGBTQI+ Americans and 67 percent of Latino LGTBQI+ Americans with incomes below 400 percent of the Federal Poverty Line qualify for Medicaid. As well, Asian American and Pacific Islander (AAPI) LGBTQI+ Americans are over two times as likely to have Medicaid as their primary insurance compared to cisgender heterosexual AAPI individuals.

Medicaid Improves Financial Security For Families. The racial/ethnic wealth gap in America is staggering. According to data from the US Census Bureau, in 2020, the annual median household income for white Americans was nearly $20,000 higher than for Hispanic/Latino households and nearly $30,000 higher compared to Black households. As a result, policies to boost financial well-being undoubtedly help people of color. The bottom 10th percentile of earners In Medicaid expansion states saw a 22.4 percent boost in their income, compared to 11.4 percent in non-expansion states. Over the past decade, research has shown the gap in medical debt between Medicaid expansion and holdout states has grown approximately 30 percent. In 2020, Americans living in holdout states carried an average of $375 more in medical debt than their counterparts in expansion states.

Medicaid Reduces Poverty And Inequity. Poverty can produce negative long-term consequences for children and adults alike. Medicaid has long been considered one of the most effective anti-poverty programs in the nation, and its expansion has significantly improved health outcomes for people of color. In a nation where out-of-pocket health care spending forced more than 10 million Americans into poverty in 2016 alone, Medicaid serves as a lifeline not only for health care, but for economic stability. A January 2021 study from Health Affairs found that the ACA helped reduce income inequality across the board, but much more dramatically in Medicaid expansion states.

Medicaid Helps Those Dealing With Behavioral Health Conditions. States that have expanded Medicaid have added behavioral health benefits, including mental health and substance use disorder care, that particularly benefit beneficiaries of color who have disproportionately been affected by these conditions. Nearly 9 million Latinos, 6.8 million Black people, over 2 million AAPI, and 830,000 Native Americans and Alaskan Natives suffer from a mental health disorder. Medicaid is the single-largest payer for mental health services in America, serving 26 percent of all adults living with a serious mental health condition. It is also an important source of coverage for substance use disorder services.

Mifepristone Case Threatens Health and Safety of Millions of Patients and to Disrupt Entire Drug Approval Process  

Washington, DC — Today, Justice Samuel Alito issued an administrative stay of Judge Matthew Kacsmaryk’s ruling invalidating the FDA’s approval of mifepristone. This will allow the plaintiffs time to respond to the Justice Department’s request for a full stay of the ruling and for the court to make its decision on the stay request. Not only does the case threaten safe and legal abortion access, but it lays the groundwork for any judge to be able to overrule the evidence-based and scientific FDA medication approval process. The consequences of Judge Kacsmaryk’s ruling will be most detrimental for women of color, people living in rural areas, and poorer Americans who face the steepest barriers to accessing care. 

Watch Protect Our Care’s event with legal and public health experts discussing the dangers of Judge Kacsmaryk’s ruling here. In response, Protect Our Care Communications Director Anne Shoup issued the following statement: 

“This case is one of the single greatest threats to American health care today. Not only does it seek to undermine patients’ access to safe and legal abortions, but it threatens to throw the entire U.S. drug approval process into chaos. It opens the door to politically-motivated lawsuits seeking to remove or greatly restrict the availability of other safe and effective drugs. If the ruling stands, millions of patients will suffer, and the Supreme Court must issue a full stay of the district court’s decision.”

Watch the Event Here.

Washington, DC — Today, U.S. Representatives and Co-Chairs of the Medicaid Expansion Caucus joined Protect Our Care for a press conference discussing the urgency for the remaining 10 non-expansion states to follow North Carolina’s lead and finish the job to extend coverage to the estimated 1.9 million Americans in the coverage gap. During the call, the speakers discussed how expansion has never been more important as states face threats of major coverage losses due to the ongoing Medicaid unwinding.

“Every day we don’t expand Medicaid in Georgia is a day we lose out on millions in federal investments to our state but more importantly thousands of Georgians who lose out on life-saving, affordable health care,” said U.S. Representative Hank Johnson (D-GA-04). “It’s really tragic that some Georgians actually lose their lives because they don’t have access to the health care system. Our legislature needs to expand Medicaid in our state. It’ll help about 650,000 Georgians access the health care system.” 

“We have over 100,000 Tennesseans who are not getting Medicaid who could get it and Tennessee would receive $900 million over two years from the federal government,” said U.S. Representative Steve Cohen (D-TN-09). “This would not only be good for the health of Tennesseans but the health of poor Tennesseans who otherwise don’t get treated and for our rural hospitals, many of which have closed.”

“I’m really glad to see that we’re on a positive pathway towards expanding Medicaid in North Carolina. And now as a voice in Congress, I will continue to fight for all Americans that remain trapped by their states in the Medicaid coverage gap,” said U.S. Representative Don Davis (D-NC-01). “We must incentivize other non-expansion states to move forward and provide life-saving health care coverage to nearly 2 million Americans in need.”

“It is long past time that Republicans stop threatening cuts to Medicaid,” said Protect Our Care Executive Director Brad Woodhouse. “People desperately need health care. It shouldn’t be a partisan issue. It shouldn’t have been a partisan issue all these years. It’s simply just time to get it done.”

Washington, DC — Last night, the Fifth Circuit issued a partial stay of Judge Matthew Kacsmaryk’s ruling invalidating the FDA’s approval of mifepristone.The Justice Department announced today that it would ask the U.S. Supreme Court for a full stay of the ruling. While the court’s decision does not entirely bar access to mifepristone, it dramatically restricts access to the drug. This case lays the groundwork for any judge to be able to overrule the evidence-based and scientific FDA medication approval process. The consequences of this ruling will be most detrimental for women of color, people living in rural areas, and poorer Americans who face the steepest barriers to accessing care. Watch Protect Our Care’s event with legal and public health experts discussing the dangers of Judge Kacsmaryk’s ruling here. In response, Protect Our Care Communications Director Anne Shoup issued the following statement: 

“Despite issuing a partial stay, the 5th Circuit is still undermining patients’ access to safe and legal abortions and threatening to throw the entire U.S. drug approval process into chaos. It not only puts at risk the use of mifepristone, but it opens the door to politically-motivated lawsuits seeking to remove or greatly restrict the availability of other safe and effective drugs. If the ruling stands, millions of patients will suffer, and the Supreme Court should issue a full stay of the district court’s decision.”

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]

***MEDIA ADVISORY FOR WEDNESDAY, APRIL 12 AT 11:00 AM AZ TIME // 2PM ET***

Congress is Fighting to Finish the Job of the Inflation Reduction Act by Extending the Insulin Copay Cap to all Diabetics

Phoenix, AZ — On Wednesday, April 12 at 11:00 AM AZ TIME, Rep. Ruben Gallego (AZ-03) will join Protect Our Care Arizona to discuss the ongoing efforts to expand the Inflation Reduction Act’s insulin savings to every Arizonan. The event will showcase the Inflation Reduction Act’s insulin cap that benefits more than three million seniors nationwide, including 63,185 Arizonans. Lowering insulin costs is especially important for people of color, who disproportionately suffer from diabetes and are more likely to skip, ration, or completely forgo insulin as a result of outrageous costs. Read more about how the lifesaving policy is helping Arizonans here. 

Now, Congress is fighting to extend these savings to all Arizonans and people across the country. This would be a key step to ensuring access to the medicine an estimated 21 million patients need to thrive.

WHO:
U.S. Representative Ruben Gallego, (AZ-03)
Dora Vasquez, Executive Director, Arizona Alliance for Retired Americans
Mary Lynn Kasunic, President & CEO, Area Agency on Aging
Valle del Sol Community Health Center
Protect Our Care Arizona

WHAT: Press Conference

WHERE: Valle del Sol Community Health Center, 3807 N. 7th St., Phoenix, AZ 85014
Watch the livestream here.

WHEN: Wednesday, April 12 at 11:00 AM AZ TIME // 2PM ET

***MEDIA ADVISORY FOR THURSDAY, APRIL 13 AT 10 AM ET***

Washington, DC – On Thursday, April 13, 2023, at 10 AM ET, U.S. Representatives and Co-Chairs of the Medicaid Expansion Caucus will join Protect Our Care for a press conference to discuss the urgency for the remaining 10 non-expansion states to follow North Carolina’s lead and finish the job to extend coverage to the estimated 1.9 million Americans in the coverage gap. During the call, the speakers will discuss how expansion has never been more important as states face threats of major coverage losses due to the ongoing Medicaid unwinding. 

April marks the 5th annual Medicaid Awareness Month. A record 92 million Americans are covered by Medicaid, but extremists in Congress are seeking serious cuts to the program and proposing bureaucratic work reporting requirements. Meanwhile, protections put into place by Congress to keep people enrolled during the public health emergency expired on April 1. An estimated 15 million people may lose their coverage due to the unwinding, with those in non-expansion states being particularly vulnerable. 

PRESS CALL:

WHO:
U.S. Representative Steve Cohen (D-TN-09)
U.S. Representative Hank Johnson (D-GA-04)
U.S. Representative Don Davis (D-NC-01)
Brad Woodhouse, Protect Our Care

WHAT: Virtual Press Conference 

WHERE: Register for the Event Here.

WHEN: Thursday, April 13 at 10 AM ET

President Biden Continues to Fight to Protect Free Preventive Care for 150 Million Americans

Washington, DC — Today, the Department of Justice announced it was seeking a stay of the devastating ruling in Braidwood Management v. Becerra, which ends a major provision of the Affordable Care Act (ACA) that requires no-cost coverage of lifesaving preventive health care services. Braidwood is the latest effort by ACA opponents and their Republican allies to dismantle American health care. As it stands, Judge O’Connor’s ruling applies nationwide and ends the benefits covered under the U.S. Preventive Services Task Force, including lifesaving colorectal and other cancer screenings, anxiety and depression screenings for children and adults, heart disease screenings, and access to PrEP (pre-exposure prophylaxis), which can substantially reduce the chance of contracting HIV. Read more about the case here. 

In response, Protect Our Care Chair Leslie Dach issued the following statement: 

“Braidwood is a politically-driven effort to dismantle the ACA, brought by longtime foes of abortion rights, women’s health, LGBTQI+ rights, and affordable health care. Now, the same judge who ruled that the ACA should be overturned entirely is ending lifesaving protections under the health care law that 150 million Americans rely on. If Judge O’Connor’s ruling stands, more people will get sick, more people will die, and more people will have to choose between paying for health care and food or rent. The harm that will be caused by denying over 150 million people preventive health care is clear and irreparable. The court should act quickly to stay Judge O’Connor’s life-threatening decision.”

Watch the Event Here. 

Washington, DC – Today, Democratic Women’s Caucus Communications Task Force Co-Chairs Rep. Gwen Moore (D-WI-04) and Rep. Shontel Brown (D-OH-11) and President of the National Partnership for Women & Families Jocelyn Frye joined Protect Our Care for a press conference to discuss the ways Medicaid is a lifeline for women and children across the nation. 

During the call, speakers discussed how Republicans in Congress are seeking deep cuts to Medicaid and proposing bureaucratic work reporting requirements. GOP leaders in 10 states have still failed to expand Medicaid under the Affordable Care Act, blocking millions of families from affordable coverage. Meanwhile, protections put into place by Congress to keep people enrolled in Medicaid during the pandemic expired on April 1. It is predicted that approximately 15 million people may lose their coverage due to the unwinding with those in non-expansion states being particularly vulnerable. 

April marks the 5th annual Medicaid Awareness Month. A record 92 million Americans have enrolled in Medicaid. Adult women comprise an estimated 40 percent of those enrolled in Medicaid, and over half (54 percent) of children across the country are enrolled in Medicaid/CHIP. Read Protect Our Care’s fact sheet on how Medicaid helps women and children here. 

“I’m proud to serve as Chair of the Democratic Women’s Caucus and what we do is pretty simple: we fight with everything we’ve got for women and families. Women want their families and their kids to be healthy, plain and simple—and that means protecting Medicaid,” said Democratic Women’s Caucus Chair Lois Frankel (D-FL-22). “With Republicans in Congress seeking serious cuts to Medicaid that would be devastating for women, we’re fighting to protect and strengthen Medicaid for years to come. We’re fighting to make sure women can make their own health care decisions—without political interference. And the Democratic Women’s Caucus doesn’t back down.”

“As Republicans propose cruel and unnecessary work requirements for Medicaid, it’s so important that we stand up for this critical program and the millions of Americans it serves,” said U.S. Representative Gwen Moore (D-WI-04), Democratic Women’s Caucus Communications Task Force Co-Chair. “I am proud to join my colleagues and advocates in these efforts today and will continue championing Medicaid.”

“Medicaid is a crucial component to the health and welfare of women and children across the country,” said U.S. Representative Shontel Brown (D-OH-11), Democratic Women’s Caucus Communications Task Force Co-Chair. “Women of color consistently experience higher maternal mortality rates than white women primarily due to the intersection of multiple socio-economic factors, including generations of health inequities, and quite simply, institutional and structural racism. Expanding Medicaid and closing the coverage gap is a key element to improving maternal and reproductive health, especially for women of color.”

“As America’s crisis in maternal health worsens with each year, the importance of defending and expanding Medicaid is more urgent than ever,” said Jocelyn Frye, President of the National Partnership for Women & Families. “Medicaid is the largest source of reproductive health care in our country and strengthening its services is a key solution for addressing the maternal health crisis—which is especially severe among Black and Indigenous women.  With reproductive freedom currently under attack throughout our nation, the National Partnership is proud to mark Medicaid Awareness Month by calling on policymakers at every level to make Medicaid available to every household who needs it.”  

“When I was a college student at Lehigh University, I became ill in the winter of 2005. My illness dragged on and we didn’t really find a clear diagnosis for about eight to 10 years,” said Kristin Volchansky, patient storyteller from Pennsylvania. “The great thing about the Medicaid program is that it has protected my rights as a patient with an illness. I echo the concerns about work requirements. Work requirements are something that I know personally after attempting to try to work part time when I was improving a couple of years ago. With the wages that I would have earned, there would have been a severe reduction in my benefits, or I would have been completely removed from the program.” 

“Medicaid provides people from all backgrounds affordable, quality coverage, and it is absolutely vital for promoting maternal and child health,” said Protect Our Care Communications Director Anne Shoup. “We must continue to fight Republican attempts to undermine the program and work to expand Medicaid in the final 10 states to ensure women and their children can get the care they need and stay healthy.”