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This Week in Health Equity

By March 29, 2023No Comments

This week we highlight recent anniversary commemorations – the 20th anniversary of the seminal Unequal Treatment report and 13th anniversary of the Affordable Care Act (ACA). Additionally, life changing legislation has been passed in multiple states which will reduce health disparities in kids and increase access to gender affirming care for LGBTQI+ individuals on Medicaid; and maternal health experts released a new roadmap to reverse the maternal health crisis. New research shows how the ACA has significantly reduced racial health disparities. Even with this progress there are continuing areas for growth, most significantly is diversifying the medical and broader health workforce, tackling the rising maternal mortality rates and protecting rural hospitals at risk of collapsing across the nation.

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.


New York Times: North Carolina Officially Expands Medicaid After Republicans Abandon Their Opposition to the Program. “North Carolina on Monday became the 40th state to expand Medicaid under the Affordable Care Act, the latest sign of how Republican opposition to the health measure has weakened more than a decade after President Barack Obama signed it into law. Gov. Roy Cooper, a Democrat, signed legislation expanding the state’s Medicaid program during a sunny afternoon ceremony on the lawn of the Executive Mansion, days after the Republican-controlled legislature gave final approval to the measure. He was surrounded by patients, advocates and some of the same Republican leaders who had previously blocked expansion in the state. The bill will expand Medicaid to adults who make up to 138 percent of the federal poverty level, or about $41,000 for a family of four. State officials say the expansion will cover an estimated 600,000 people. It will take effect when the state adopts a budget, likely by June, Mr. Cooper said in an interview before the signing ceremony. It has been nearly 11 years since the Supreme Court ruled that states did not have to expand Medicaid — the government health insurance program for low-income people — under the Affordable Care Act. Nearly half the states opted out. More recently, progressives have helped to expand Medicaid in seven states — all of them with either Republican-controlled or divided governments — by putting the question directly to voters; in November, South Dakota adopted Medicaid expansion via the ballot box. Monday’s bill signing leaves just 10 states — all with divided or Republican leadership, and most of them in the South — that have yet to expand Medicaid. Advocates say they now have their sights set on Alabama, where Gov. Kay Ivey, a Republican, can expand her state’s program with her own authority. Hospitals, especially struggling rural ones, are eager for the extra revenue that Medicaid reimbursement will bring. The federal government picks up 90 percent of the costs of reimbursement under the expansion, and in North Carolina, hospitals will pay the other 10 percent. The state has revamped its Medicaid program, moving it from a fee-for-service program to one that relies on managed care — a long-sought goal of Republicans.” [New York Times, 3/27/23]

CBS News: The Affordable Care Act Has Reduced Racial Disparities When it Comes to Health Access. “The Affordable Care Act, passed in 2010 under former President Barack Obama, has expanded health insurance coverage across the U.S. and significantly reduced racial and ethnic disparities in access to health care, according to a new report by the Commonwealth Fund. Data shows that prior to the 2013 implementation of the Medicaid expansion — a provision of the ACA that made more families eligible for Medicaid coverage — 40.2% of the Hispanic population, 24.4% of the Black population, and 14.5% of the White population were uninsured in America. However, by 2021, those numbers dropped significantly to 24.5%, 13.5%, and 8.2%, respectively. With more than 5 million people gaining coverage between 2020 and 2022 over the course of the pandemic, the overall uninsured rate in the U.S. dropped to just 8%, a historic low, according to the report. ‘The coverage gap between Black and White adults dropped from 9.9 to 5.3 percentage points, while the gap between Hispanic and White adults dropped from 25.7 to 16.3 points,’ according to the study. Additionally, the report found that adult uninsured rates for Black, Hispanic, and White people all improved during the first two years of the pandemic across all states — whether they had expanded their Medicare coverage or not —  and that Black and Hispanic adults experienced larger gains in insurance coverage than their White counterparts between from 2019 to 2021.” [CBS News, 3/19/23]

The Grio: Anniversary of Affordable Care Act Highlights Gains for Black Americans. “During a White House ceremony commemorating the anniversary on Thursday, President Joe Biden called the signing of ACA an ‘extraordinary achievement’ of Obama’s. When the law was signed in 2010, then-Vice President Biden infamously said to Obama on a hot mic that it was a ‘big f—ing deal.’ Referencing the viral moment, the president added, ‘I stand by the fact that it was a big deal.’ The landmark legislation has steadily reduced the number of uninsured Black Americans over the years. The Department of Health and Human Services said in a report last year that the uninsured rate among Black Americans has decreased 40% since the ACA was implemented. Chiquita Brooks-LaSure, the administrator of the Centers for Medicaid and Medicare Services in the Biden administration, told theGrio that the number of Black Americans enrolled in the ACA this year is about the same as last year, which experienced a record increase of 35%. Brian Smedley, a senior fellow and equity scholar at the Urban Institute, pointed out that the Affordable Care Act also includes civil rights provisions for patients of color who historically experienced inequitable care in America’s health care system. According to the Kaiser Family Foundation, the uninsured rate for Black people was 10.9% as of 2021 compared with 7.2% for white people. Though there is still a gap, it has decreased significantly since 2010. The Kaiser report shows that in 2010 — perhaps shortly before or after Obamacare became the law of the land  —  the percentage of Black Americans who were uninsured was 20% compared with 13% for their white counterparts.The uninsured rate for both groups has dropped dramatically during the Obamacare era. Though millions of Black Americans remain uninsured, Smedley said they are predominantly found in southern states that have refused to expand Medicaid. A 2012 Supreme Court ruling allowed expansion to be optional for states. Since then, many Republican-controlled states have opted out. To date, 10 states have not expanded Medicaid services.” [The Grio, 3/23/23]

Urban Institute: As 20th Anniversary of the Unequal Treatment Report Approaches, New Program to Elevate Health Inequities is Launched. “In 2003, the National Academies Press published a landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, that shocked many policymakers and the medical establishment with its finding that racial and ethnic disparities in the quality of care are “remarkably consistent,” even after controlling for access-related factors, such as income and insurance status. Despite the national attention this report received, the nation has made little progress toward eliminating health care inequities in the 20 years since the report was published. As the 20th anniversary of Unequal Treatment approaches, the Urban Institute is launching a new program of action to elevate health care inequities as a national priority and build momentum for key remedies and structural reforms. To kick-off the initiative, we invite you to join us for a full-day symposium designed to bring together policymakers, researchers, health care administrators and professionals, and other interested parties. The symposium will: make evidence of the causes and consequences of health care inequities more accessible to patients, health care consumers, health care industry leaders, and policymakers; identify the most promising research and policy strategies that have emerged in the 20 years since Unequal Treatment’s publication; allow interested parties to collaborate to develop tools and mechanisms to hold practitioners and policymakers accountable, particularly at the state level, where key opportunities exist to establish equity-focused strategies; and elevate the voices of patients from marginalized communities and a new generation of scholars of color whose perspectives must be centered in identifying research questions and solutions.” [Urban Institute, 3/23/23]

National Partnership for Women and Families: A Roadmap to Reversing the Maternal Mortality Crisis. “Our nation’s maternal mortality crisis and the staggering impact on Black and Brown communities are well documented. A new suite of resources, Raising the Bar for Maternal Health Equity and Excellence, authored by the National Partnership for Women & Families, working with a renowned advisory panel and the Alliance of Community Health Plans (ACHP), the Health Care Transformation Task Force (HCTTF) and the National Birth Equity Collaborative (NBEC), offers practical solutions designed for healthcare systems ranging from independent women’s health clinics to large hospital systems. These resources are grounded in a deep understanding that the healthcare sector plays many roles beyond that of provider – as an employer, a community partner, and a policy advocate, each of which shapes maternal health. Jocelyn Frye, president of the National Partnership for Women & Families, hailed the resource as a transformational tool that is urgently needed. Frye said, ‘We know that Black women are three to four times more likely to die from pregnancy-related causes, and we also know the causes are rooted in persistent and systemic biases. By breaking down the different roles and adapting the guidance for institutions of every size, we’re acknowledging not only the depth and complexity of the maternal health crisis but also the breadth of community engagement that will be required to address the crisis successfully.’ Raising the Bar for Maternal Health Equity and Excellence is the second phase of a multi-year Robert Wood Johnson Foundation project. Raising the Bar’s first phase produced a framework that crafted specific principles, roles and actions that healthcare organizations can use to begin or advance their health equity work. Richard Besser, President and CEO, Robert Wood Johnson Foundation (RWJF) said, ‘It is an honor to join the National Partnership for Women & Families in celebrating the application of the important health equity guidelines offered by Raising the Bar to maternal and newborn health. Too many barriers – particularly for Black women – get in the way of providing high quality care. I’m excited to see how Raising the Bar will help us eliminate barriers like bias and discrimination around reproductive healthcare.’ As part of the launch of the guidance report, the National Partnership will host an event that includes remarks from the Honorable Chiquita Brooks-LaSure, Administrator, Centers for Medicare & Medicaid Services, Her remarks will be followed by a panel discussion on innovative approaches to improving maternal health featuring Richard Besser, from RWJF, Betty Chu, MD, Henry Ford Health Systems; Carmen Green, MPH, National Birth Equity Collaborative, Elizabeth Howell, MD, the University of Pennsylvania Health System and Aditi Mallick, MD, Center for Medicaid and CHIP Services.” [National Partnerships for Women and Families, 3/22/23]

Star Tribune: Minnesota Governor Signs Free School Meals Into Law. “School meals will become free for every Minnesota public and charter school student. Gov. Tim Walz signed a bill Friday that makes the change, while surrounded by children who got a firsthand lesson in how legislation becomes law. Until now, Minnesota law required parents to apply for free meals through a federal reimbursement program based on their income. Starting this year, districts could also automatically add a student to the benefit rolls if their family qualified for Medicaid. But Walz and other backers of providing universal free meals said those forms created unnecessary barriers. Minnesota is the third state in the nation to require schools to offer all students free breakfast and lunch, regardless of their family income, behind California and Maine. In Colorado, a similar law allows schools to opt in to a state-funded free meals program. Advocacy group Hunger Solutions estimates that 1 in 6 Minnesota students experience food insecurity, about a quarter of them living in a household that doesn’t qualify for free meals. Sen. Heather Gustafson, DFL-Vadnais Heights, estimates that a family of four living in White Bear Lake would save about $1,900 per school year if their children ate two meals at school. She sponsored the bill in the Senate and called it a ‘lunchbox tax cut,’ at the signing ceremony.” [Star Tribune, 3/17/23]

WMAR Baltimore: Maryland Passes the Trans Health Equity Act Swiftly Through Both Houses. “The LGBTQ+ community is celebrating a huge milestone as law makers officially approved the Trans Health Equity Act, allowing transgender patients to more easily obtain gender-affirming care. The Trans Health Equity Act will expand gender-affirming care through Medicaid so more patients can get the proper treatment. The legislation aims to establish equity by ensuring low-income Marylanders seeking gender-affirming care will receive the same treatment as people with private insurance. Advocates with Baltimore Safe Haven say this allows people in the LGBTQIA+ community to have better access to resources and gain valuable support from medical professionals. Advocates say this bill will truly make a difference in the LGBTQ+ community. Both chambers passed their bill, and now the bills have to go through the opposite chambers before making their way to the Governor’s desk.” [WMAR Baltimore, 3/24/23]


California Health Report: Racism in Academia is Hindering Attempts to Reduce Inequities in Health Care. “Time and time again, scientific reports and surveys cite some version of the following findings: Black people have the worst health outcomes. Black patients have better health outcomes when they see Black doctors. Black patients prefer Black doctors. Black doctors tend to care for higher proportions of Black patients than their White counterparts. Yet 53 percent of Black people in the US say it’s hard to find a Black doctor, which is not surprising. While Black people account for roughly 13 percent of the US population, they make up only 4 percent of the physician workforce and 7.3 percent of medical students. These representational disparities haven’t changed appreciably in decades. We cannot achieve health equity for Black patients without expanding the Black physician workforce, and the nation’s medical institutions are not achieving that goal. When confronted with this problem, academic medicine leaders attribute the plateauing of the Black physician workforce to factors beyond its control — things like disparities in primary education and poverty. Medical institutions have yet to honestly examine and address how they perpetuate the problem of a White-dominated physician training system that unjustly excludes, punishes, and dismisses Black medical students, trainees, and attending physicians. White people must recognize that inclusion is not a zero-sum game, said Camara Jones, MD, MPH, PhD, a Black physician who served as the 2021-2022 UCSF Presidential Chair.” [California Health Report, 3/23/23]

Ms Magazine: Medical Racism Has a Large Role in the Spike of Maternal Mortality. “The coronavirus exacerbated the effects of medical racism already baked into the United States healthcare system, leading to a spike in Black maternal mortality rates between 2020 and 2021, new data from the Centers for Disease Control and Prevention reveals. The recent statistics, though bleak, come as no surprise to maternal health experts, who say the disparities have persisted for decades. In 2021, more than 360 Black women died of maternal health causes across the country, according to the CDC, up from just over 290 in 2020 and more than 240 the year prior. The spike amid the coronavirus pandemic is likely due to a combination of factors, ranging from infection by the virus itself to medical racism.  As women’s age increased, so did the maternal mortality rate. For Black women over 40, the rate was over 300 per 100,000 births, compared to 42 per 100,000 for those under 25.  Despite advancements in medicine and technology over the years, the racial gap in who is suffering the most severe consequences of childbirth is growing, and most Black maternal and child health experts point to systematic racism as the root cause. Inequities in access to quality healthcare before, during and after pregnancy, as well as provider bias during labor and delivery, contribute to the dismal outcomes. And, the “weathering” effect that exposure to discrimination has on Black people’s bodies over a lifetime, which can break down a mother’s body prematurely, is also linked to the high death rates. The spread of COVID-19 decreased the quality of maternal healthcare for everyone across the country, said Mahdi, so for those who already had issues accessing high quality care, the impact of that care being further reduced had a significant effect.” [Ms Magazine, 3/20/23]

NY Daily News: The U.S. Must Begin Tackling the Growing Maternal Mortality Crisis. “New CDC numbers reveal that 1,205 women died of pregnancy-related causes in 2021, compared with 861 in 2020 and 754 in 2019. That represented a one-year jump of 38% and a two-year jump of 64%, to the highest maternal mortality rate on record since 1965. America’s overall rate was and still is far higher than its peer countries, and remains high by international standards whether you’re white, Latina or Black. Our maternal mortality is 54% higher than Russia’s; nearly double Canada’s; more than double the U.K.’s, France’s and Italy’s, and five times Japan’s and Germany’s. Second, race-based disparities here are especially egregious, and stubborn. Black women are 2.6 and 2.5 times likelier to die of maternity-related causes than white or Hispanic women. Research suggests economic disadvantages, discrimination by health-care providers and chronic stress all add up to take their toll. And the problem is inextricable from the fact that, even after the passage of Obamacare, too many Black Americans lack affordable access to quality medical treatment. The Biden administration last year laid out a thoughtful blueprint to save mothers’ lives; passage of sweeping federal legislation, a dozen bills collectively nicknamed the Momnibus, would go further. Waste no time. American women are dying in numbers far too large. As long as they do, American values remain on life support.” [NY Daily News, 3/20/23]

Idaho Capital Sun: Only Hospital for 9,000 Residents in Idaho Ends Its Obstetrical Services. “Idaho’s Bonner General Health, the only hospital in Sandpoint, announced Friday afternoon that it will no longer provide obstetrical services to the city of more than 9,000 people, meaning patients will have to drive 46 miles for labor and delivery care moving forward. Sandpoint Women’s Health will not accept new obstetrics patients effective immediately and offered a referral list for patients to use for their care. The hospital said it would make every attempt to continue deliveries through May 19, but said it will depend on staffing. The release also said highly respected, talented physicians are leaving the state, and recruiting replacements will be ‘extraordinarily difficult.’ Idaho has one of the most restrictive abortion bans in the country, with affirmative defenses in court only for documented instances of rape, incest or to save the pregnant person’s life. Physicians are subject to felony charges and the revocation of their medical license for violating the statute, which the Idaho Supreme Court determined is constitutional in January. Dr. Amelia Huntsberger, an obstetrician-gynecologist at Bonner General Health, said in an email to States Newsroom that she will soon leave the hospital and the state because of the abortion laws as well as the Idaho Legislature’s decision not to continue the state’s maternal mortality review committee. Linda Larson, who has lived in Sandpoint for 36 years and delivered her first child at Bonner General Health, said the community relies on Bonner General Health for much of its health care services, including physical therapy and routine blood work.” [Idaho Capital Sun, 3/17/23]