Medicaid Pandemic Benefits Ending [Barrier: Access to Health Care, Cost of Care, Health Inequity]

An article in the Washington Post from March 29, 2023 entitled Millions poised to lose Medicaid as pandemic coverage protections end, discusses the fact that Medicaid protections will be ending in the United States. It states “At the end of this week, states will begin to sever an anticipated 15 million low-income Americans from Medicaid rolls that ballooned to record heights because of a pandemic-era promise that people with the health insurance could keep it — a federal promise that is going away.”

“The scale of the undertaking has no precedent. The number of Americans relying on Medicaid has soared by about one-third — to nearly 85 million as of late last year — since just before the coronavirus pandemic took hold in early 2020. Those who joined during that time did not need to pay attention to renewal notices from their states — which now could cost them their insurance.”

The article chronicles how this could impact a family in severely detrimental ways and how similar mothers might face similar challenges getting health care for themselves and their children. “As April 1 nears in the first states to thin their Medicaid rolls, advocates say many people at risk of losing their insurance are not aware of what is about to happen.”

At-Home Blood Pressure Monitor Cuffs that communicate with Physicians can improve health outcomes for pregnant women, especially Black Moms [Barriers: Inequity in Health Care, Access to Health Care]

An article from NPR on March 28, 2023 entitled The simple intervention that may keep Black moms healthier discusses how useful a blood pressure monitor that communicates with physicians from home can be for pregnant women. The article states “Blood pressure is just one way to measure a person’s health, but during pregnancy and soon after, it’s a critical metric. Unchecked, high blood pressure can contribute to serious complications for the pregnant woman and baby, and increase the risk of death.”

While all pregnant women can benefit, the article mentions that “Studies show that Black people are more than twice as likely as white people to experience severe pregnancy-related complications, and nearly three times as likely to have a pregnancy-related death.”

The article states:

“Many serious problems stem from high blood pressure, says Dr. Tina Yarrington, director of maternal-fetal medicine at BMC.

“It’s the root cause for many, many maternal health inequities,” she says. “People who are marginalized by structural racism, people who are Black, African American, Latina, Hispanic, suffer higher levels of hypertension and higher levels of complications when that hypertension strikes.”

This technology can have significant outcomes. “Each time a patient takes a reading at home, their blood pressure cuff sends the numbers straight to their electronic health record. The cuffs don’t need an internet connection; they use the signal of nearby cell towers.”

Armed with knowledge more quickly, physicians and pregnant mothers can take action faster to support the health of the mother and baby.

Shortage of Critical Care Physicians [Barrier: Medical Staff Shortage]

An article from Scientific American on March 26, 2023 entitled Fewer Doctors Are Choosing to Go into Emergency Medicine: Hundreds of unfilled residency spots in emergency medicine are telling us that critical care is in trouble discusses the situation in the United States that is resulting in a shortage of physicians choosing emergency medicine. The article mentions many possible causes, including nurse shortages, physician burnout, and lack of hospital beds.

Women in Health Care Leadership [Barrier: Inequity in Health Care, Shortage of Health Care Providers]

An article on NPR from March 24, 2023 entitled Women were already unequal in the world of global health. The pandemic made it worse discusses research by Women In Global Health that illuminates the need for more women in leadership roles in public health worldwide. The report looks at global data and country case studies from India, Nigeria, and Kenya. The article states “While 70% of the health care workforce around the world is made up of women, they hold only 25% of senior leadership roles, the report found – a phenomenon dubbed the “XX Factor.” The article goes on to describe the situation:

“And, the new report found, women already marginalized because of their gender often faced even further discrimination based on age, race, religion, sexual orientation and other factors – being more frequently relegated to the lowest-paying and riskiest jobs. And this, says the report, is a crisis because inequality in health care will only make global health worker shortages worse – especially in less well-off countries.”

The barriers illuminated in this report are deep and complex, but definitely reflect the larger concerns about a shortage of health care providers, in this case women.

Affordable Care Act Reduced Racial Disparities in Health Care Access [Barrier: Inequity in Health Care, Access to Care, Cost of Care]

An online article from March 19, 2023 on CBS News entitled The Affordable Care Act has significantly reduced racial disparities in health care access, report says discusses research that indicates the impact that the Affordable Care Act has had on health coverage. The report by the CommonWealth Fund Inequities in Health Insurance Coverage and Access for Black and Hispanic Adults: The Impact of Medicaid Expansion and the Pandemic states:

“Since its passage in 2010, the Affordable Care Act (ACA) has helped cut the U.S. uninsured
rate nearly in half while significantly reducing racial and ethnic disparities in both
insurance coverage and access to care — particularly in states that expanded their
Medicaid programs.”

Highlights from the research are:

  • “Insurance coverage rates improved for Black, Hispanic, and white
    adults between 2013 and 2021. 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.
  • Uninsured rates for adults in all three groups improved during the
    first two years of the COVID-19 pandemic, a finding that held true in
    states that had expanded Medicaid and those that had not. Black and
    Hispanic adults experienced larger gains in Medicaid and individualmarket coverage than white adults between 2019 and 2021.
  • Between 2013 and 2021, states that expanded Medicaid eligibility
    had higher rates of insurance coverage and health care access,
    with smaller disparities between racial/ethnic groups and larger
    improvements, than states that didn’t expand Medicaid.”

Telehealth & Public Health [Barriers: Access to Care, Location of Care, Physician Shortage

This article in Scientific American from April 1, 2023 entitled Telehealth Is Proving to be a Boon to Cancer and Diabetes Care: Virtual visits surged in the pandemic, and studies show they maintain high-quality medicine, discusses how Telehealth might be helpful in overcoming some of the barriers to public health. For certain situations that do not require physical examination or follow-up after your initial exam, telehealth can allow patients to have appointments when they cannot leave their home due to illness, caregiving responsibilities, far distance to the clinic, or their appointment only needs to be a conversation and not an exam.

Maternal Health Care in the US [Barriers: Cost of Care, Inequity in Health, Access to Care]

Another article highlights maternal health in the US. The article in BBC News entitled Why US mothers are more likely to die in childbirth, discusses the recent CDC research that found that

“In 2021, 33 women died out of every 100,000 live births in the US, up from 23.8 in 2020.

That rate was more than double for black women, who were nearly three times more likely to die than white women, according to the CDC.”

This article speculated on why black mothers are at a higher risk of dying in the UK. It states:

“Experts say the vast majority of the maternal deaths happen shortly after giving birth, when many women are forced to return to work and are unable to continue with post-partum care.

Black Americans in particular are often employed in low-income jobs that offer little-to-no health insurance coverage and minimal time off for maternity leave.

Many of those same jobs, like food service, were deemed essential during the pandemic and workers were unable to work from home. This increased black women’s chances of exposure to Covid-19 and, without adequate access to healthcare, contributed to higher rates of death.”

Pediatric Public Health Care in Short Supply [Barriers: Cost of Care, Physician Burnout, Physician Shortage, Location/Access]

This article entitled Pediatric hospital beds are in high demand for ailing children. Here’s why from March 16, 2023 on CNN discusses a very complicated situation that results in barriers to public health for children in the US. The article references issues such as 1) shortage of hospital beds, staff, nurses, 2) medicaid pays doctors who treat children less than those who treat adults, 3) mental health-related child illnesses require long stays, 4) shortage of beds for children require parents to travel to other facilities, and 5) facilities to care for children are closing in rural and certain areas. Here is a snippet from the article:

“The physical and mental burnout that occurred during the height of the Covid-19 pandemic has not gone away for overworked health care workers. Shortages of doctors and technicians are growing, experts say, but especially in skilled nursing. That, plus a shortage of people to train new nurses and the rising costs of hiring are leaving hospitals with unstaffed pediatric beds.

But a host of reasons building since well before the pandemic are also contributing. Children may be the future, but we aren’t investing in their health care in that way. With Medicaid reimbursing doctors at a lower rate for children, hospitals in tough situations sometimes put adults in those pediatric beds for financial reasons. And since 2019, children with mental health crises are increasingly staying in emergency departments for sometimes weeks to months, filling beds that children with other illnesses may need.”

Maternal Deaths Spiked In 2021—Particularly Among Black Women [Barriers: Inequity, Health Care Access]

Another article about the CDC National Center for Health Statistics’ recent study on maternal mortality, entitled Maternal Mortality Rates in the United States, 2021, was posted on March 16, 2023 in Forbes. This article is entitled Maternal Deaths Spiked In 2021—Particularly Among Black Women—As U.S. Maintains Deadly Reputation For Pregnancy And Childbirth, and further highlights the public health issues related to pregnancy and childbirth in the US. It discusses the following statistics:

“…the overall mortality rate for 2021 was 32.9 maternal deaths per 100,000 live births, the report said, up from 23.8 in 2020 and 20.1 in 2019.”

“Black women, who had a mortality rate of 69.9 deaths per 100,000 live births, disproportionately shouldered this burden, dying at 2.6 times the rate of white women.”

“Maternal mortality has steadily risen in the U.S. for decades, bucking a longstanding downturn that has been—and largely continues to be—observed in most other wealthy countries since the advent of better surgical techniques, discovery of antibiotics, rising living standards and general improvements to medicine. Many of these deaths are preventable. “

While the study did not detail the cause of the rise during the pandemic, it did state that “A Covid infection also increases the odds of giving birth prematurely, which is also riskier. Given the disproportionate impact Covid had on communities of color in the U.S.—coronavirus death rates were especially high among Black women—this could help explain some of the disparities in maternal deaths.”

U.S. Maternal Mortality Rate & Public Health [Barriers: Health Care Access, Inequity]

Today’s article from March 16, 2023 in The Washington Post, entitled U.S. maternal mortality climbs dramatically during pandemic, study finds, describes public health issues related to pregnancy and childbirth.

“The rate of Americans dying while giving birth — or in the weeks afterward — increased by more than one-third in 2021 compared with a year earlier, with the burden of death disproportionately borne by communities of color, according to a report released Thursday by U.S. health officials.” Health related to pregnancy and childbirth in a nation is “a top predictor of a nation’s health” because “maternal health is informed by an accumulation of life events that start long before pregnancy and that are centuries in the making. Experts and federal officials acknowledge that addressing maternal mortality means understanding the effects imposed on expectant mothers by racism, housing policy, policing, climate change, pollution — and the pandemic.” The article states “Researchers have found that the unrelenting stress caused by racism — and the cortisol it produces — wears the body down, aging it prematurely and is a factor in maternal mortality rates. “

Shortage of Black Doctors harms public health [Barrier: Physician Shortage, Access to Health Literacy, Inequity in Health Care]

In this CNN article from February 2023, entitled Only 5.7% of US doctors are Black, and experts warn the shortage harms public health, many barriers to public health are highlighted. The article highlights the work of Seun Adebagbo, a third-year medical student in Massachusetts, who was born in Nigeria and grew up in Boston. She states, “I know what to ask for on the patient side if I’m worried about something for myself. But then also, for my parents and my family. Because the way you have to move in the system as a Black person is very different, especially if you’re coming from a background where you don’t have family members that are doctors, you don’t know anyone in your periphery that went into medicine.”

The article discusses the many layers of barriers that patients encounter as they navigate the health care system. “There’s plenty of evidence, and other research has shown that the more the workforce in a health care setting really reflects the community it serves, the more open the patient population is to recommendations and instructions from their doctor,” said Dr. Mahshid Abir, an emergency physician and a senior physician policy researcher at the RAND Corp., a nonpartisan research institution.

Inequity & Racial Bias in Health Care [Barriers: Racial Bias, Inequity]

An article published on CaliforniaHealthline on March 9, 2023 entitled Black Patients Dress Up and Modify Speech to Reduce Bias, California Survey Shows, highlights inequity in health care. This article highlights personal stories about the experiences of those experiencing racial bias in health care. It starts with the following stories:

“A young mother in California’s Antelope Valley bathes her children and dresses them in neat clothes, making sure they look their very best — at medical appointments. “I brush their teeth before they see the dentist. Just little things like that to protect myself from being treated unfairly,” she told researchers.

A 72-year-old in Los Angeles, mindful that he is a Black man, tries to put providers at ease around him. “My actions will probably be looked at and applied to the whole race, especially if my actions are negative,” he said. “And especially if they are perceived as aggressive.”

The article points to research revealing the many types of activities that patients undergo in order to manage the racial bias they are faced with. “Many Black Californians report adjusting their appearance or behavior — even minimizing questions — all to reduce the chances of discrimination and bias in hospitals, clinics, and doctors’ offices. Of the strategies they describe taking, 32% pay special attention to how they dress; 35% modify their speech or behavior to put doctors at ease. And 41% of Black patients signal to providers that they are educated, knowledgeable, and prepared.”