This week we highlight the 60th anniversary of the March on Washington and the announcement of the first round of high-cost drugs whose prices will come down as Medicare negotiates with the drug companies, as well as new maternal health and teen pregnancy prevention grants being provided with a focus on reduced health disparities and the shift in biotechnology investment towards accelerating health equity efforts across the country. Even so, from new National Academies of Science, Engineering, and Medicine report findings to climate change to insurer care-delay tactics to an increasing maternal health crisis, there is much work to be done to ensure that systematically marginalized groups benefit from the initiatives highlighted this week and other essential programs to improve health outcomes.
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
Washington Post (Opinion: Joe Biden): We Must Keep Marching Forward Towards Dr. King’s Dream. “Sixty years ago, the Rev. Martin Luther King Jr. and hundreds of thousands of fellow Americans marched on Washington for jobs and freedom. While we’ve never fully lived up to that promise as a nation, we have never fully walked away from it, either. Each day of the Biden-Harris administration, we continue the march forward. That includes a fundamental break with trickle-down economics that promised prosperity but failed America, especially Black Americans, over the past several decades. Vice President Harris and I came into office determined to change the economic direction of the country and grow the economy from the middle out and bottom up, not the top down. Black unemployment fell to a historic low this spring and remains near that level. More Black small businesses are starting up than we’ve seen in over 25 years. More Black families have health insurance. We cut Black child poverty in half in my first year in office. We’re taking the most significant action on climate ever, which is reducing pollution and creating jobs for Black Americans in the clean energy future. For generations, Black Americans haven’t always been fully included in our democracy or our economy, but by pure courage and heart, they have never given up pursuing the American Dream. On this day of remembrance, let us keep showing that racial equity isn’t just an aspiration. Let us reject the cramped view that America is a zero-sum game that holds that for one to succeed, another must fail. Let us remember America is big enough for everyone to do well and reach their God-given potential.” [Washington Post (Opinion: Joe Biden), 8/27/23]
Pittsburgh Post-Gazette: How Medicare’s Price Negotiation Will Affect People and Equity Efforts. “After months of speculation, the Centers for Medicare and Medicaid Services (known as CMS) has finally released the list of medicines that will be subject to the agency’s new price-negotiating powers. The list should give the public hope that — assuming legal challenges from drugmakers are defeated — the program could yield significant savings and more equitable healthcare access. Studies show that the more expensive drugs are, the less likely patients are to adhere to them. That’s been particularly true of several classes of drugs — diabetes and blood thinners — targeted by this list. Moreover, research also reveals significant racial disparities in the use of several of the medications on this first list, says Utibe Essien, a physician at the David Geffen School of Medicine at UCLA who studies health equity. He found that Black patients, including those on Medicare, were 25% less likely to take newer classes of blood thinners for a type of abnormal heartbeat called atrial fibrillation. Beyond improving equitable access, making these medicines more affordable could lead to healthcare savings, says Essien, by making patients healthier. Patients who take their blood thinners consistently can avoid worse health problems, like strokes or kidney disease.” [Pittsburgh Post-Gazette, 8/31/23]
Department of Health and Human Services: HHS Awards $23 Million to Support Teen Pregnancy Prevention Programs. “The U.S. Department of Health and Human Services (HHS), through the Office of Population Affairs (OPA), is announcing approximately $23 million in funding to foster innovation, provide new research, and expand the evidence to support and advance equity in the Teen Pregnancy Prevention (TPP) program. Through the TPP program, HHS seeks to advance equity in adolescent health by supporting projects that create, identify, and scale effective approaches in communities and populations with the greatest needs and facing significant disparities across the country to improve adolescent health and well-being. Collectively, these 18 new Tier 2 projects, along with the 53 new Tier 1 projects OPA announced in June 2023, demonstrate how OPA’s TPP Program is responsive to the needs of youth, their families, and communities. The TPP Tier 2 Rigorous Evaluation cooperative agreements will support 12 projects that will implement and rigorously evaluate a wide diversity of promising interventions. The new interventions include those for youth in foster care, youth in juvenile justice, rural youth, expectant and parenting teens, younger adolescents in middle school, as well as intervention geared for parents, and clinical providers. The projects will also evaluate interventions that use newer modalities including videos, video games, and virtual implementation. These awards are for five-year project periods beginning September 15, 2023.” [Department of Health and Human Services, 8/25/23]
Boston Globe: Governor Awards $1.5 Million in Grants to Promote Maternal Health Equity. “Attorney General Andrea Campbell Tuesday announced $1.5 million in grants to 11 organizations that provide maternal care in Massachusetts as part of her office’s efforts to combat rising maternal health inequities in the state. Campbell hosted the recipients of the Maternal Health Equity Grant for a roundtable discussion about how to reduce negative pregnancy and postpartum outcomes across the state, particularly for Black women, who continue to face the highest rates of pregnancy complications and deaths. First announced by Campbell’s office in April, the grant aims to reduce these racial and ethnic inequities by increasing access to prenatal care, behavioral health support, and breastfeeding support that meets the needs of the state’s diverse population. The Whittier Street Health Center, which serves a large population of low-income individuals and immigrants who receive services in languages other than English, will use the funding to hire bilingual staff and conduct community outreach initiatives to better serve those at highest risk of receiving poor maternal care. The grant also aims to increase access to care from doulas, non-medical professionals trained to offer emotional and informational support to families during and after pregnancy, and support a more robust and diverse workforce.” [Boston Globe, 8/15/23]
Health Affairs: Biotech Industries Are Transitioning Towards a Model of Funding Health Equity Programs. “The biotech story for the rest of 2023 will be neither entirely turmoil nor entirely growth. Instead, it will be a fundamental reset—an industry realignment born of the broader macroeconomic conditions and of the painful lessons learned from the global pandemic that brought us to this moment. As the realignment begins to take shape, one of its most prominent features is already becoming clear: Health equity will be a central focus in biotech. For instance, last year, UCLA Health launched an innovation accelerator to help scale up health equity-focused startups. Johnson & Johnson awarded seed funding to 14 entrepreneurs and organizations with the potential to advance health equity as part of its Health Equity Innovation Challenge. And an increasing number of health-focused private companies are hiring “Chief Health Equity Officers,” as commercial entities awake to longstanding shortfalls. The trend is also reflected in the regulatory landscape, as accrediting bodies and trade associations are increasingly prioritizing key health equity initiatives. Recently, the Institute for Healthcare Improvement and the American Medical Association launched a new National Coalition for Equity in Healthcare. There’s even been major governmental action, including the Biden administration’s 2021 formation of the Office of Climate Change and Health Equity.” [Health Affairs, 8/11/23]
WJTV: Mississippi Community Organization to Receive $6 Million Dollar Grant to Support Health Equity Efforts. “A national bio-tech company, Genentech, announced that a Mississippi based community organization is among 10 chosen to share a $6 million grant. Jackson-based Southern Echo will begin by reaching out to southern states interested in the conversation of health organizing. From there, they will build out a curriculum to better help address issues that can be presented to policy makers. Rachel Mayes, the executive director of Southern Echo, said health plays out in the lives of everyone on a daily basis. She said the grant from Genentech will allow Southern Echo to do what they have in the past. They support organizations in the south in civic engagement, community organizing, the importance of the census, redistricting and voting. This time, the focus is on health equity. Advancing health equity is the purpose behind Genentech’s Community Health Justice Fund, which supports nonprofits.” [WJTV, 8/3/23]
CHALLENGES
Stat: New Report Says Ending Health Disparities Will Require a Permanent Federal Regulatory Body. “In its many recommendations, the committee that wrote the report called for Congress to create a scorecard to assess how new federal legislation might affect health equity; urged all federal agencies to conduct an equity audit of current policies; asked the Centers for Disease Control and Prevention to create and facilitate the widespread use of measurements of social determinants of health, including racism; and urged the Office of Management and Budget to oversee efforts to improve the poor and sporadic collection of data about the nation’s racial and ethnic groups. The report’s authors stressed that improving health equity cannot be accomplished by the government’s health agencies alone. Education, income, transportation issues, and the quality of neighborhoods, the report noted, all play a role in harming or helping people’s health. While programs like Medicaid and the Children’s Health Insurance Program have proven to be the most effective policies to reduce health disparities, the report found policies that increase the federal minimum wage or close gaps in education spending have also promoted better health. The report details the nation’s many racial and ethnic disparities, including the fact that maternal mortality rates are two to three times higher in Black and Native American populations, and notes that in 2019, Black Americans lived more than four years less than white people and Native Americans lived more than five years less than those who are white. Because income is so closely tied to health and because past policies, such as redlining neighborhoods, have led to the massive loss of generational wealth for many Black Americans, the report urged the adoption of policies to boost income and housing security. These include providing more housing vouchers for low-income people; offering government-subsidized savings accounts for children; promoting fairer financial services that offer lower-cost credit for people with low incomes; and expanding social benefit programs to many who have been left out, including immigrants, people who have been incarcerated, and adults who do not have children.” [Stat, 7/27/23]
NPR: Heatwaves are Increasing Disparities in Health Across the Country. “Within the past five years, Dr. Sameed Khatana says, many of his patients in Philadelphia have realized how climate change hurts them, as they fared poorly with each wave of record heat. Record heat scorching the country is especially dangerous for the many, many people with common conditions like diabetes, obesity and heart disease. And within cities, many vulnerable communities face greater exposure to heat, fewer resources to address it or escape it, and higher rates of the diseases that make heat more dangerous for people. Heat stroke happens when the body’s core temperature rises so fast and high it rapidly becomes lethal. The heart pumps blood away from vital organs to dissipate heat. That can overload weakened hearts or lungs. Many of his patients also have obesity or diabetes, which can affect circulation and nerve function. That also affects the ability to adapt to heat. In addition, common medications his patients take for heart disease — beta blockers and diuretics — can make heat symptoms worse. Just as seen in other public health concerns like obesity or COVID-19, the elderly, communities of color, and people with lower socioeconomic status bear the highest risk. Those most in danger live in the Deep South and across the Midwest — where heat, older populations and rates of complicating disease run highest.” [NPR, 8/10/23]
Capitol News (Opinion): Insurer Tactics to Delay Care Makes Achieving Health Equity More Difficult. “Long plagued by racism and discrimination, communities of color lag on many healthcare measures. Eliminating disparities requires increasing access to care and improving outcomes. Unfortunately, some insurance companies are erecting extraordinary barriers that will actually delay necessary treatment for patients — and exacerbate inequities. UnitedHealthcare (UHC) just rolled out a nebulous new Advance Notification Program for all commercial plans that will require doctors to gather data at a granular level to order most gastrointestinal (GI) colonoscopy and endoscopy procedures for their patients — an arduous process that will be used to create a “Gold Card” prior authorization program in early 2024. Prior authorization, a process through which insurance companies can overrule doctors’ expertise and deny coverage for medically necessary care, will seriously disrupt patients’ ability to receive life-saving colonoscopies and endoscopies that can detect pre-cancers and cancers in the esophagus, stomach, small intestines, and colon. Unfortunately, any delay in treatment, by definition, prolongs patients’ pain and anxiety. And, even worse—since some forms of gastrointestinal cancers progress quite rapidly, it is not a stretch to say that these prior authorization requirements could cost lives. That is especially true for communities of color, which suffer higher burdens of colorectal cancer and which, due to a range of existing social determinants of health, also face significant access barriers to the procedures necessary to diagnose and monitor disease development. According to the American Cancer Society (ACS), colorectal cancer is the second-most common cause of cancer death in the country, with incidence and mortality rates highest among American Indian, Alaska Native, and non-Hispanic Black individuals. The racial disparities in incidence and mortality rates for colorectal cancer are largely driven by differences in risk factors and access to care, including screening and cancer treatment.” [Capitol Weekly (Opinion), 7/31/23]
U.S. News: One in Five Mothers Report Mistreatment in Maternity Care. “One-fifth of U.S. mothers say they have experienced mistreatment by their health care provider during their pregnancy and delivery care and 29% say they have faced discrimination, according to new research from the Centers for Disease Control and Prevention, with higher rates of such incidents reported among women of color. Approximately 20% of more than 2,400 women surveyed in a CDC Vital Signs report released Tuesday said they experienced some form of physical neglect or verbal abuse during their maternal care. The report’s findings were based on a survey conducted from April 24 through April 30 by public relations firm Porter Novelli. Higher rates of mistreatment were reported by mothers who identify with a racial and ethnic minority group, including 30% of Black women, 29% of Hispanic women and 27% of multiracial women during their pregnancy care, compared to 19% of white women and 15% of Asian mothers. Nearly 30% of women who were uninsured and 26% of those covered by Medicaid reported mistreatment during their maternity care compared to 16% of women with private insurance, according to the analysis. In addition, 29% of women surveyed said they experienced at least one form of discrimination during their pregnancy care, with 40% of Black women, 39% of multiracial women, and 37% of Hispanic women reporting such incidents, compared to 26% of white women and 23% of Asian women. The most common reasons for discrimination reported included issues concerning age, weight and income.” [U.S. News, 8/23/23]
PR Newswire: New Report Shows Maternity Care is Worsening for Millions of Americans. “March of Dimes today released Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity, a new collection of reports that shows more than 5.6 million women live in counties with no or limited access to maternity care services, forcing families to find new ways to get the care they need. The new research from March of Dimes shows that for millions of women in the United States, it is more difficult to access maternity care. One of the largest analyses on maternity care access, the report offers insight into the factors that impact pregnancies in all 50 states, Washington, D.C., and Puerto Rico. More than one third (36%) of U.S. counties are considered maternity care deserts, which are defined as counties without a hospital or birth center offering obstetric care and without any obstetric providers. The loss of obstetric units in hospitals was responsible for decreased maternity care access in 369 counties since the 2018 report, nearly 1-in-10 counties across the U.S. 70 additional counties have been classified as maternity care deserts due to a loss of obstetric providers and obstetric units in hospitals, since the initial report in 2018. More than 32 million reproductive-age women are vulnerable to poor health outcomes due to a lack of access to reproductive healthcare services, like family planning clinics and skilled birth attendants. States with the highest rates of maternity care deserts include North Dakota, South Dakota, Alaska, Oklahoma and Nebraska, states with more rural populations.” [March of Dimes Press Release, 8/1/23]
KFF Health News: Dangers and Deaths Around Black Pregnancy a Completely Preventable Health Crisis. “Black women are less likely than women from other racial groups to carry a pregnancy to term — and in Harris County, where Houston is located, when they do, their infants are about twice as likely to die before their 1st birthday as those from other racial groups. Black fetal and infant deaths are part of a continuum of systemic failures that contribute to disproportionately high Black maternal mortality rates. In fact, Harris County ranks third, behind only Chicago’s Cook County and Detroit’s Wayne County, in what are known as excess Black infant deaths, according to the federal Health Resources and Services Administration. Those three counties, which also are among the nation’s most populated counties, account for 7% of all Black births in the country and 9% of excess Black infant deaths, said Ashley Hirai, a senior scientist at HRSA. The counties have the largest number of Black births but also more deaths that would not occur if Black babies had the same chance of reaching their 1st birthdays as white infants. No known genetic reasons exist for Black infants to die at higher rates than white infants. Such deaths are often called “deaths of disparity” because they are likely attributable to systemic racial disparities. Regardless of economic status or educational attainment, the stress from experiencing persistent systemic racism leads to adverse health consequences for Black women and their babies, according to a study published in the journal Women’s Health Issues.” [KFF Health News, 8/24/23]
NPR: Abortion Bans Are Leading to an Influx of High-Risk Patients in Illinois Hospitals. “Since the Dobbs decision overturned Roe v. Wade on June 24, 2022, who can get an abortion and where has been complicated by medically ambiguous language in new state laws that ban or restrict abortion. Doctors in those states fear they could lose their medical licenses or wind up in jail. Amid these changes, physicians in abortion havens like Illinois are stepping up to fill the void and provide care to as many patients as they can. But getting each medically-complex patient connected to a doctor and a hospital has been logistically complicated. In response to the growing demand, Illinois Governor JB Pritzker recently launched a state program to help. The goal is to get patients who show up at clinics, yet need a higher level of abortion care, connected more quickly with Illinois hospitals. Providers will call a hotline to reach nurses who will handle the logistics. There is little concrete data on how many more patients are traveling to other states for abortions at hospitals. Hospitals are a “black box” for abortion-related data, according to Rachel Jones, a longtime researcher at the nonprofit Guttmacher Institute. Even before Roe fell, it was hard to get through the bureaucracy of hospitals to understand more comprehensively how abortion care was provided, Jones said. Guttmacher has tracked hospital-based abortions in the past, but doesn’t have updated figures since Dobbs. WeCount, widely considered a reliable tracker of shifts in abortion care over the past year, doesn’t break out hospital data separately. WeCount co-chair Ushma Upadhyay said the data would have gaps anyway. She said it’s been difficult to get providers in banned states to report what’s happening.” [NPR, 8/23/23]
Missouri Independent: One-Third of Rural Hospitals in Missouri At Risk of Closure. “A July report from the Center for Healthcare Quality and Payment Reform, a national policy group, found that 19 of Missouri’s 57 rural hospitals are at risk of shuttering because of ‘serious financial problems.’ Many of those hospitals at risk of closure could sustain themselves financially for six to seven years, according to the report. Eight rural hospitals, however, are in particularly dire straits, according to the report, and are at risk of ‘immediate closure’ — meaning they are at risk of closing in the next two to three years. That is up from only two rural hospitals at risk of immediate closure in the previous year’s report. The state’s 57 rural hospitals are providers located outside the 34 counties that make up Missouri’s metropolitan statistical areas. Ten rural hospitals in Missouri have closed since 2012. Those that remain open, but are faltering, often consider cutting services in an attempt to remain afloat — gradually chipping away at care as the prospect of closure looms. Cox Monett Hospital, in Southwest Missouri, announced earlier this year its plan to close its inpatient labor and delivery this summer, citing difficulty recruiting doctors. Some patients would need to travel upwards of 45 minutes from Monett to Springfield to access obstetric care, KY3 reported. In 2020, almost half of rural community hospitals nationally did not offer obstetric care, according to the American Hospital Association. Studies have found a higher risk of complications for those giving birth in rural areas. The last year of inflation and a tight labor market, along with the end of COVID federal grants, contributed to hospital losses increasing, Miller said. Many rural hospitals lost more money in 2022 than in pre-pandemic years, he said.” [Missouri Independent, 8/1/23]