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December 2020

HPIO analysis sheds light on COVID-19 impact on Ohioans

The Health Policy Institute of Ohio released new analysis this week illustrating the devastating impact of COVID-19 in Ohio.

HPIO analysis found that, over the past two weeks, deaths of people with COVID-19 in Ohio surpassed all cancer deaths during the same week in 2019 and are nearly as high as heart disease, the first and second leading causes of death in the state last year.

Since the first deaths of Ohioans with COVID-19 were reported in March, the number of people dying with the virus has been comparable to many of the leading causes of death in previous years, such as drug overdose deaths, motor vehicle crashes, stroke and diabetes, kidney disease and suicide. A spike in reported COVID-19 deaths beginning in early November, however, has made COVID-19 the second leading cause of death compared to 2019 data (see graphic below).


Additional HPIO analysis released this week found that more Black/African American Ohioans have died with COVID-19 this year than from most leading causes of death in 2019, including any specific type of cancer, stroke, diabetes and unintentional drug overdose deaths.

Between March 17 and Dec. 15, 1,065 Black/African American Ohioans died with COVID-19. In 2019, 790 died of a stroke or other cerebrovascular diseases and 639 died from trachea, bronchus and lung cancer, the type of cancer responsible for the most deaths. COVID-19 deaths currently rank fourth among leading causes of death compared to 2019 data, behind heart disease (3,355 deaths), all cancers combined (2,677 deaths) and unintentional injury (1,127, including drug overdose deaths, motor vehicle crashes and other accidents). See graphic below.


Overall infant mortality rate drops in Ohio, racial disparity increases, report finds

Black babies are dying before their first birthday in Ohio at an even greater rate — nearly three times that of white infants — even though the state's overall infant mortality rate was unchanged last year (Source: “Despite years of efforts to combat infant mortality in Ohio, racial disparity increases,” Columbus Dispatch, Dec. 17).

The data released on Thursday in a report by the Ohio Department of Health show that racial disparities are getting worse, despite years of efforts to close that gap and reduce infant mortality.

The report prompted Gov. Mike DeWine to announce the formation of a new task force charged with developing a plan to reduce infant mortality and eliminate the racial disparity by 2030.

While the state reported that the 929 babies who died before their first birthday in 2019 (down slightly from 938 a year earlier), the state's 6.9 infant mortality rate — the number of babies who die before their first birthday per 1,000 live births — was unchanged because fewer babies were born last year.

Among black babies, the infant mortality rate increased, though, to 14.3, up from 13.9 a year earlier, according to the report. That's nearly three times the 5.1 infant mortality rate for white babies.

1 in 5 U.S. adults report experiencing discrimination in healthcare system

A new national survey has found that one in five adults in the United States faces discrimination when accessing the healthcare system (Source: “Study: 1 in 5 U.S. adults subjected to race, gender bias in healthcare system,” United Press International, Dec. 15).

According to an analysis published Tuesday by JAMA Network Open, nearly two in five participants in a survey of more than 2,100 people reported they experienced racial and ethnic discrimination when seeking medical care, making it the most common form of bias, the data showed.

More than one in 10 participants reported being discriminated against based on their education or income level when they visited a doctor's office or went to the hospital. And roughly one in 10 reported experiencing bias based on their body weight, were discriminated against based on their gender or experienced age discrimination, according to the researchers.

"Discrimination is not uncommon in healthcare," study co-author Paige Nong, a doctoral candidate in sociology at the University of Michigan, told UPI. "We want our findings to show people who have experienced this kind of discrimination, which is often isolating and difficult to process, that that they are not alone."

New HPIO fact sheet highlights addiction policy changes, concerns related to children, youth, families

The Health Policy Institute of Ohio has released a new fact sheet on Ohio’s policy response to the addiction crisis and its implications for children, youth and families. The fact sheet, titled “On the Horizon: Changes and Concerns,” summarizes upcoming policy changes and initiatives that aim to address the issue, as well as looming concerns that could threaten progress.

The fact sheet includes excerpts from HPIO’s recently released “Ohio Addiction Policy Scorecard: Children, Youth and Families.” The scorecard is the fourth in a series of scorecards analyzing Ohio's policy response to the addiction crisis and outlining areas where the state could be more effective.

The fact sheet also includes a timeline of significant state-level child welfare policy changes in Ohio from 2016 to 2020.

Ohio expects first delivery of COVID-19 vaccines next week

Ohio officials are busy finalizing plans for the arrival of the first shipment of COVID-19 vaccines, which are expected on Dec. 15 (Source: “As early as Tuesday, the coronavirus vaccine arrives. Who's first in line, and what we know about who's next,” Cincinnati Enquirer, Dec. 10).

For at least the first three weeks of availability, the Ohio Department of Health has directed that the only people to be vaccinated are:

  • Hospital caregivers
  • Residents and staff at nursing homes
  • Residents and staff at assisted-living homes
  • Residents and staff pf psychiatric facilities
  • Residents and staff at Ohio veterans homes
  • Residents and staff of group homes or centers and EMS responders

It is not clear yet the order of vaccination after Phase 1A. States are waiting for the U.S. Centers for Disease Control and Prevention, which is developing the guidance, to recommend who is next. But the Ohio Department of Health has a draft plan that lists priorities. 

On Friday, the Ohio Department of Health reported 10,359 new COVID-19 infections and 128 more deaths.

The 128 deaths, the fourth-highest daily total, boosted December's virus death toll to 997, surpassing April to become the second-deadliest month of the pandemic. December deaths are on pace to well exceed the record 1,180 fatalities in May.

Studies confirm social, environmental factors driving COVID-19 racial disparities

Recent studies confirm that social and environmental factors, rather than underlying health conditions, are the reason for racial disparities in COVID-19 hospitalizations and deaths (Source: “Social Inequities Explain Racial Gaps in Pandemic, Studies Find,” New York Times, Dec. 9).

The new findings do not contradict an enormous body of research showing that Black and Hispanic Americans are more likely to be affected by the pandemic, compared with white people. The coronavirus is more prevalent in minority communities, and infections, illnesses and deaths have occurred in these groups in disproportionate numbers.

But the new studies do suggest that there is no innate vulnerability to the virus among Black and Hispanic Americans, experts said. Instead, these groups are more often exposed because of social and environmental factors.

A study of more than 11,000 New York patients in March and April found that, among many other vulnerabilities, Black and Hispanic communities and households tend to be more crowded; many people work jobs requiring frequent contact with others and rely on public transportation. Access to health care is poorer than among white Americans, and rates of underlying conditions are much higher. The study found that Black patients accounted for 76.9 percent of those hospitalized with Covid-19, although they made up just 31 percent of the health system’s population.

study of patients in Veterans Affairs hospitals found that underlying health conditions had no impact on fatality rates among Black and Hispanic Patients. In the study, nine of 1,000 white veterans had a positive coronavirus test, compared with 16.4 of 1,000 among Black patients. 

These disparities found in both studies are entirely explained by socioeconomic factors, researchers said.

SCOTUS agrees to hear case on Medicaid work requirements

The U.S. Supreme Court has agreed to hear a case on the Trump administration’s push for Medicaid work requirements, though the issue could be moot when President-elect Joe Biden takes office (Source: “Supreme Court to hear case on Trump's push for Medicaid work requirements,” The Hill, Dec. 5).

The Trump administration earlier this year had appealed lower court rulings that found the requirements adopted by New Hampshire and Arkansas to be unlawful. More than 18,000 people lost coverage in Arkansas due to work requirements before they were halted by a lower court.

Medicaid work requirements have been a priority for the Trump administration, though the incoming Biden administration is expected to eliminate the rules while pushing to expand access to Medicaid.

Latest HPIO addiction policy scorecard focuses on children, youth, families

The Health Policy Institute of Ohio has released the fourth in a series of scorecards analyzing Ohio's policy response to the addiction crisis and outlining areas where the state could be more effective.

The report, "Ohio Addiction Policy Scorecard: Children, Youth and Families," provides policymakers and other stakeholders with the information needed to take stock of Ohio's policy response to the crisis by reviewing state-level policy changes enacted in Ohio from 2013 to 2019. 

In conjunction with the release of the latest scorecard, HPIO has created a two-page fact sheet featuring excerpts from the report titled “Changes on the Horizon: Hopeful Trends.” A second fact sheet outlines three federal child welfare laws that were enacted or amended from 2016 to 2018.

DeWine discusses plan to begin distributing COVID-19 vaccines

Gov. DeWine announced Friday that Ohio will receive confirmed shipments of 299,475 doses of vaccine beginning around Dec. 15, with another 359,000 doses tentatively scheduled to arrive days later (Source: “DeWine outlines distribution of hundreds of thousands of doses of COVID-19 vaccines,” Columbus Dispatch, Dec. 4).

The priority groups for the first vaccinations are health care workers who tend to virus patients, emergency medical first responders and residents and staff of nursing homes and assisted-living facilities. Also in the first phase for vaccinations are those in state psychiatric hospitals and veterans homes and people with intellectual disabilities and mental illness, and the staff who care for them, in group homes, DeWine said.

DeWine conducted a news conference on Friday afternoon to provide more details on the state's plans to inoculate Ohioans against coronavirus, which now has infected 456,963 people and killed 6,882.

Friday’s high numbers extend a surge of spreading infections that saw monthly cases more than triple in November while the number of deaths also continues to accelerate. Daily hospitalizations totaled 392 on Friday to reduce the number of virus inpatients by 320 to 5,092, a level that still concerns health officials worried about ICU beds and staffing.

The seven-day average positive rate on virus tests increased to 15.5%.

States consider options for end to extra federal Medicaid payments


State officials are asking the federal government for more information to help them prepare for an eventual end to increased federal funding from the first COVID-19 relief law this year (Source: “States grapple with plans for end to coronavirus public health emergency,” Roll Call, Dec. 3). 

The health emergency is set to expire Jan. 20 but will almost certainly be extended by the next administration. The question is how states will transition to normal operations.

“The issue and the challenge is that CMS, I am sure, doesn’t want to send states a signal that the public health emergency is ending, given where we are. But on the other hand, states feel like they need some indications of what to do and when to do it,” said Allison Orris, counsel with Manatt Health and a former federal health policy official.

A CMS spokesperson pointed to existing guidance to states saying that the enhanced federal funding for Medicaid — a 6.2 percentage point increase being added to states' Federal Medical Assistance Percentage rates — will stop at the end of the quarter when the public health emergency ends. The spokesperson said it’s too early to speculate on potential status changes for the health emergency, and CMS remains in constant contact with states.