This week we highlight President Biden’s budget, two new steps taken in health equity, and new research on health crises and the acute impact of these challenges on marginalized groups. Leading the charge in the battle to combat rural inequities, a new federal initiative will act as a lifeline to rural communities that are often left without adequate access to quality health care. A new bill in Minnesota seeks to expand access to testing methods that will likely lead to drastically reduced inequities in medical care to systematically marginalized communities throughout the state. New research reports show that health crises across the board, from infant mortality to obesity rates, are on the rise after the COVID-19 pandemic and disproportionately affecting already overlooked marginalized groups.
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 San Diego Voice and Viewpoint: President Biden’s Proposed Budget Will Advance Health Equity. “President Joe Biden unveiled a $6.8 trillion budget plan that includes aiding several social programs, raising taxes on the wealthy, and decreasing the country’s debt by $3 trillion over the next decade. The Budget includes $471 million to support implementation of the White House Blueprint for Addressing the Maternal Health Crisis to reduce maternal mortality and morbidity rates and address persistent disparities; expand maternal health initiatives in rural communities; implement implicit bias training for healthcare providers; create pregnancy medical home demonstration projects; and address the highest rates of perinatal health disparities, including by supporting the perinatal health workforce. In addition, the Budget requires all States to provide continuous Medicaid coverage for 12 months postpartum, eliminating gaps in health insurance at a critical time. The budget expands access to quality, affordable health care by investing $150 billion over 10 years to improve and expand Medicaid home and community-based services, such as personal care services. To bolster the health care workforce, the budget provides a total of $966 million in 2024 to expand the National Health Service Corps, which provides loan repayment and scholarships to healthcare professionals in exchange for practicing in underserved areas, and a total of $350 million to expand programs that train and support the nursing workforce. The administration said every child with a disability should have access to the high-quality early intervention, special education services, and personnel needed to thrive in school and graduate ready for college or a career. The budget invests $16.8 billion in Individuals with Disabilities Education Act (IDEA) grants to support special education and related services for more than seven million students with disabilities in grades Pre-K through 12, an increase of $2.1 billion above the 2023 enacted level.” [The San Diego Voice and Viewpoint, 3/13/23]
Kaiser Health News: Rural Hospitals Begin Signing Up for New Federal Lifeline. “Just off the historic U.S. Route 66 in eastern New Mexico, a 10-bed hospital has for decades provided emergency care for a steady flow of people injured in car crashes and ranching accidents. It’s the only hospital for the more than 4,500 people living on a swath of 3,000 square miles of high plains and lakes east of Albuquerque. But even with a tax levy to help support the medical outpost, the facility lost more than $1 million in the past six months, [Christine] Campos [administrator of Guadalupe County Hospital] said. Guadalupe is one of the nation’s first to start the process of converting into a Rural Emergency Hospital. The designation was created as part of the first new federal payment program launched by the Centers for Medicare & Medicaid Services for rural providers in 25 years. More than 140 rural hospitals have closed nationwide since 2010, and health policy watchers aren’t sure how many of the more than 1,700 rural facilities eligible for the new designation will apply. CMS officials said late last month that seven have already filed applications. Facilities that convert will get a 5% increase in Medicare payments as well as an average annual facility fee payment of about $3.2 million in exchange for giving up their expensive inpatient beds and focusing solely on emergency and outpatient care. Rural hospitals with no more than 50 beds that closed after the law passed on Dec. 27, 2020, are eligible to apply for the new payment model if they reopen.” [Kaiser Health News, 3/6/23]
MinnPost: Improved Medical Treatment and Health Equity Around the Corner With New Testing Method. “On a recent Friday, Emily Myatt of the American Cancer Society Cancer Action Network (ACS CAN) and [Aleta Steevens] delivered a newly drafted bill to remove barriers to biomarker testing in Minnesota to the Chief Clerk’s office in the State Capitol building, and it was introduced during the legislative session this week. Biomarker testing is the analysis of a patient’s tissue or blood sample for the presence of a molecular signature that can guide a physician’s treatment plan and assess risk for conditions such as cancer, arthritis, autoimmune diseases, and mental illness, among others. According to Dr. Douglas Yee, the director of the Masonic Cancer Center, testing for alterations in the BRCA gene changed the treatment outlook for breast cancer, in part by predicting which class of drugs may be most effective. The application of biomarker testing to determine who will respond to specific drugs and/or who will have adverse effects is essential to avoiding inappropriate or ineffective treatment. In the case of cancer, this can greatly impact a person’s quality and length of life. Currently, Minnesotans have unequal access to biomarker testing based on where they live (rural versus the metro area), insurance coverage, and socioeconomic status. People of color – particularly, the Black community – do not benefit from biomarker testing at the same rates as white people. This is particularly concerning, as rates of breast cancer mortality are highest in Black women, and Black men are at a higher risk of mortality from colon and prostate cancer than their white counterparts. No one should have to worry about out-of-pocket costs for this important test. Expanding biomarker testing access will improve justice and health equity. There are few, if any, drawbacks to this bill. The results of biomarker testing are confidential. Federal legislation, the Genetic Information Nondiscrimination Act (GINA), prohibits health insurers from discriminating against enrollees based on their genetic information. An actuarial analysis found that the increase in health insurance premiums to cover comprehensive biomarker testing would be just cents (between $.05 and $.51) per member per month.” [MinnPost, 3/13/23]
CHALLENGES
Washington Post: Rise in Infant Mortality Hitting Black Families the Hardest. “A new federal study highlights a striking racial disparity in infant deaths: Black babies experienced the highest rate of sudden unexpected deaths in 2020, dying at almost three times the rate of White infants. The findings were part of research released Monday by the Centers for Disease Control and Prevention, which also found a 15 percent increase in sudden infant deaths among babies of all races from 2019 to 2020, making SIDS the third leading cause of infant death in the United States after congenital abnormalities and the complications of premature birth. Before the pandemic, overall infant mortality — including diseases, accidents and injuries, and unexplained deaths — had been on a downward trend in the United States. Some of that drop can be attributed to the enormously successful campaign launched in the 1990s to encourage putting babies to sleep on their backs, as opposed to facedown when they may re-breathe the carbon dioxide they exhaled or suffocate in soft bedding. On average, about 3,400 U.S. babies die suddenly and unexpectedly each year, according to CDC data. In 2020, the SUID rate was highest among Black infants (at 214 deaths per 100,000 live births), followed by American Indian or Alaskan Native infants (at 205 deaths per 100,000 live births), and nearly three times the rate for White infants (75.6 deaths per 100,000 live births). Understanding the causes of those deaths, many of which are unobserved, is key to preventing them.” [Washington Post, 3/13/23]
The Root: Inequities in Black Maternal Health Remain Even After Increasing Wealth and Education Access. “One of the Biden Administration’s top healthcare officials is sounding the alarm about persistent maternal health disparities for Black women, which they say don’t wane even as income and education levels rise. Black women have long experienced higher rates of complications from pregnancy and childbirth, including miscarriage and stillbirth, than the population at large. Those disparities are known to be heavily concentrated among mothers with lower incomes, who are likely to be uninsured or live in communities with low concentrations of medical facilities. But many people assume that those challenges dissipate at least somewhat for Black women as they climb the income and education ladders and obtain college degrees and middle-to-upper income status. Unfortunately, those problems don’t decrease even as more money comes in… In a report issued last June, the Biden White House laid out what it deemed a ‘maternal health crisis facing the United States,’ in which overall maternal death rates are double in the United States than they are among other Western nations. As bad as that sounds, the numbers are startlingly worse for Black women, who suffer pregnancy-related deaths at a rate more than triple that of white women per 100,000 live births, according to the report, which also echoed Brooks-LaSure’s comments. Translation: Black women are dying at a high and unnecessary rate largely because doctors aren’t listening to them.” [The Root, 3/7/23]
Idaho Capital-Sun: On National Women’s Day, Groups Say U.S. Anti-Abortion Laws Violate Human Rights. “Ahead of International Women’s Day, hundreds of U.S. and global human rights groups, doctors and attorneys have asked the United Nations to intervene on behalf of the millions of women in the U.S. who have been left without access to legal abortion and vital forms of reproductive health care in the wake of last summer’s monumental U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization. The more than 50-page letter – dense with devastating anecdotes from news articles and studies and doctor interviews – argues that the effects of Dobbs and the resulting state and local anti-abortion policies have compromised Americans’ rights to life, health, privacy and liberty. The letter authors argue that the U.S. is violating various human rights treaties it has signed. They ask the U.N. officials to make an official visit to the U.S. to witness these harms, to convene a virtual stakeholder meeting with U.S. civil society, and to call for private companies to take action to protect reproductive rights. They also call on the U.N. to ask the U.S. to comply with its obligations under international law. They write that the U.N. Human Rights Committee has already established that denial of abortion in other countries can cause suffering and amount to torture. And they stress that in the U.S., racial minorities and marginalized groups disproportionately face health and legal harms because of the policies enacted after the Supreme Court overturned Roe v. Wade.” [Idaho Capital-Sun, 3/8/23]
NBC News: Systemic Barriers Persist for Black Diabetes Patients Even After Eli Lilly Price Cap. “The news last week that the drugmaker Eli Lilly will cap out-of-pocket costs for its insulin at $35 per month brought relief to some. But what remains are systemic problems with insurance coverage and misdiagnosis that continue to challenge many with diabetes. The price cap by Eli Lilly, the country’s largest manufacturer of insulin, will have an outsize effect on Black people, who are not only more prone to diabetes but are also more likely to struggle to pay for the drug. Without the caps, most people with diabetes who are uninsured or under-insurered can spend upward of $1,000 per month or more on insulin out-of-pocket. But beyond the cost of insulin, larger structural inequities contribute to poorer health outcomes for Black Americans as a whole, especially those with diabetes. [Otis Kirksey] said that Black people are more likely to live in food deserts and have fewer healthy food options, which means their chances of ‘developing diabetes are significantly higher.’ Black people may experience an overdiagnosis for prediabetes or Type 2 diabetes, according to a March 2021 report by the Centers for Disease Control and Prevention. Data from 2019 found that Black people were twice as likely than white people to die from diabetes and were 2.5 times more likely to be hospitalized with diabetes and experience long-term complications, according to the U.S. Department of Health and Human Services’ Office of Minority Health. Close to 1 in 5 adults in the U.S. with diabetes skipped, delayed or used less insulin to save money, a 2021 report by Annals of Internal Medicine found. It also said that insulin rationing was more common among Black Americans.” [NBC News, 3/8/23]
Washington Post: Diabetes and Obesity Rising in Young Americans. “Diabetes and obesity are rising among young adults in the United States, an alarming development that puts them at higher risk for heart disease, according to a study of 13,000 people between 20 and 44 years old. And Black and Hispanic people, particularly Mexican Americans, would bear the brunt. Deaths from heart attacks and other effects of cardiovascular illnesses had been declining in the United States because of medical advances in prevention and treatment. That progress stagnated during the past decade. Young Black adults face the greatest risk. Hypertension is twice as prevalent among them as it is in other racial and ethnic groups. Diabetes and obesity are also more common. The study’s authors pinpointed structural racial inequities in American society as a driver of the gaps. Hypertension is rising among Hispanic people, a trend not evident among other groups. They emphasized that it transcends lifestyle choices. When people struggle to pay the bills, they often turn to cheaper, unhealthier food. Fresh produce is harder to come by in areas with few grocery stores. Here are some ways the study’s authors proposed addressing the disparities: [e]xpanding large-scale efforts to screen and treat young Black adults for hypertension, [s]creening people for diabetes earlier in life because current guidelines often apply to people 35 and older [s]tarting a public health campaign addressing the rise in diabetes among Mexican American adults that is culturally competent and shaped by community leaders, [and c]reating more green spaces in communities that encourage exercise to counter sedentary lifestyles contributing to the rise in obesity.” [Washington Post, 3/5/23]
Afro: Black Women are Some of the Most Affected by Diabetes and Access to Treatment. “Over 30 million people in the United States have been diagnosed with both Type 1 and Type 2 diabetes—including nearly 13 percent of all non-Hispanic Black people. According to the Office of Minority Health at the Department of Health and Human Services, African Americans are 80 percent more likely to be diagnosed with diabetes and the majority of them are women. African Americans are more likely to develop Type 2 diabetes and unfortunately suffer fatalities from Type 2 diabetes at twice the rate of their White counterparts. Black people are overwhelmingly more likely to suffer from debilitating complications caused by diabetes such as amputations, blindness and kidney failure more than their white counterparts. Due to lack of health resources in predominately African American communities, black people receive poorer quality care and get care later when the disease has progressed. The risk for getting Type 2 diabetes increases with age with the highest incidence occurring between 65-75. This is precisely the point in life when income decreases. African-American women are especially affected. They are likely to be caregivers and spend their hard-earned money on ensuring family members are healthy making access to insulin a greater challenge. Instead of focusing on lowering drug costs for all Americans, some lawmakers continue to attack the Affordable Care Act and its health care protections for those that have pre-existing conditions. While they do this, as many as one in four people skips insulin doses or ration prescriptions because of the rising cost. Sadly, some of these people are dying as a result—and many black women are specifically at risk.” [Afro, 3/13/23]
US News: Primary Care Visits Are Shorter and More Prone to Error for Non-White Patients. “[A] new study that found Black and Hispanic patients — as well as patients with public health insurance like Medicaid or Medicare — tend to get the short end of the stick when it comes to the length of office visits. In some cases, shorter visits can potentially lead to dangerous consequences, investigators found, upping the risk for poor prescribing practices involving antibiotics, painkillers and/or sedatives. On one hand, Neprash and her team noted that the average primary care visit lasts about 18 minutes. On the other hand, they point to prior research suggesting that a primary care doctor would actually need 27 hours to fully convey all the critical information required to prevent chronic disease, while also addressing all of a patient’s specific issues. The huge gap between need and reality seems to please nobody, with surveys indicating that both patients and doctors wish they had less rushed experiences. But the team also found that a patient’s race/ethnicity and insurance status seemed to play a role, ‘with shorter visits observed among patients of color and patients with public insurance coverage, [such as] Medicaid and Medicare, rather than commercial insurance,’ she said. Younger patients also tended to have shorter visits. To explore how shorter visits might translate into worse care, Neprash and her colleagues focused on three subsets of patients: the roughly 223,000 visits that involved an upper respiratory tract infection diagnosis; the approximately 1.6 million visits that resulted in a pain-related diagnosis, and more than 2.75 million visits involving seniors. They found that more than half (nearly 56%) of visits involving an upper respiratory tract infection resulted in an inappropriate antibiotic prescription. They also found that 3.4% of pain-related visits resulted in the potentially lethal co-prescribing of both an opioid painkiller and a benzodiazepine sedative (such as Valium or Xanax). Taking both types of medications together ups the risk for an overdose, as both cause breathing suppression and sedation. Just over 1% of visits involving seniors involved the prescribing of medications that do not adhere to public health guidelines. And the chance that inappropriate prescribing of antibiotics, painkillers or sedatives might occur rose as the duration of the doctor visit got shorter, Neprash’s group noted.” [US News, 3/13/23]