Access to care

Uninsured rate drops for all races in Ohio, with biggest reduction among Asian and Black Ohioans

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The percent of Ohioans who are uninsured dropped by almost half from 12.3% to 6.4% between 2011 and 2019 (see graphic above).

Every race saw a drop in the percent of uninsured, with the percentage of Asian and Black Ohioans dropping most dramatically compared to other groups. Despite these gains in access, however, Ohioans of color are still more likely to be uninsured than white Ohioans.

Much of the drop in Ohio’s uninsured population is attributable to the state’s 2014 decision to expand Medicaid eligibility as part of the Affordable Care Act. In HPIO’s 2021 Health Value Dashboard, Ohio ranked seventh out of the 50 states and the District of Columbia for access to care — the first time Ohio has ranked in the top quartile on any Health Value Dashboard domain.

While access is clearly a bright spot for the state, the Dashboard found that Ohio’s population health outcomes remain poor. Access to care is critical, particularly for Ohioans with serious health conditions. But the Dashboard and national research shows that health is shaped by many factors, including social, economic and physical environments.

This April, HPIO is creating a series of data graphics in recognition of National Minority Health Month


More than 4 in 10 teens had mental health challenges during pandemic, CDC study found

More than 4 in 10 U.S. high school students said they felt persistently sad or hopeless during the pandemic, according to government findings released Thursday (Source: “Pandemic took a toll on teen mental health, US study says,” Associated Press, March 31).
 
Several medical groups have warned that pandemic isolation from school closures and lack of social gatherings has taken a toll on young people’s mental health.
 
The Centers for Disease Control and Prevention study found that the pandemic did not affect teens equally. LGBT youth reported poorer mental health and more suicide attempts than others. About 75% said they suffered emotional abuse in the home and 20% reported physical abuse. By comparison, half of heterosexual students reported emotional abuse and 10% reported physical abuse, the CDC said.


Ohio Medicaid announces care management organizations for OhioRISE program

The Ohio Department of Medicaid announced this week the 20 organizations that would launch OhioRISE, a new Medicaid program for children with severe behavioral and mental problems (Source: “Parents have given up custody to get care for children with severe needs. Ohio Medicaid is closer to ending that,” Columbus Dispatch, Feb. 17).

OhioRISE, short for Resilience through Integrated Systems and Excellence, is scheduled to roll out in July with the goal of addressing situations where parents are at risk of giving up custody of their children to the state in order to get the required, unaffordable mental health and residential care needed by a child with severe behavioral and mental health problems. 

Aetna will be the health insurance company overseeing the program, which the department expects to cover up to 60,000 children by the end of the first year. The organizations, called care management entities, will be responsible for coordinating care for a child: Bringing together schools, behavioral health providers, juvenile services and other systems to provide help for complex needs. 

The $1 billion program is partly paid for by savings from other planned Medicaid reforms, such as centralized credentialing and billing systems. Around $19.5 million will be given to the entities to help them start up.


States brace for Medicaid redetermination following end of health emergency

The Biden administration and state officials are bracing for a great unwinding: Millions of people losing their Medicaid benefits when the pandemic health emergency ends (Source: “Why Millions on Medicaid Are at Risk of Losing Coverage in the Months Ahead,” Kaiser Health News, Feb. 14).

Before the public health crisis, states regularly reviewed whether people still qualified for the safety-net program, based on their income or perhaps their age or disability status. While those routines have been suspended for the past two years, enrollment climbed to record highs. As of July, 76.7 million people, or nearly 1 in 4 Americans, were enrolled, according to the Centers for Medicare and Medicaid Services.

When the public health emergency ends, state Medicaid officials face a huge job of reevaluating each person’s eligibility and connecting with people whose jobs, income and housing might have been upended in the pandemic. People could lose their coverage if they earn too much or don’t provide the information their state needs to verify their income or residency.

The Biden administration is giving states a year to go through the process, but officials say financial pressures will push them to go faster. Congress gave states billions of dollars to support the coverage requirement. But the money will dry up soon after the end of the public emergency — and much faster than officials can review the eligibility of millions of people, state Medicaid officials say.


Study: Many who attempted suicide can’t find mental health care

A new study has found that although suicide attempts in the United States have increased substantially over the last decade, the number of people who had recently attempted suicide and said they were not receiving mental health services has remained constant at about 40 percent (Source: “Survey of Americans Who Attempted Suicide Finds Many Aren’t Getting Care," New York Times, Jan. 19).

The study, published in JAMA Psychiatry on Wednesday, traces a rise in the incidence of suicide attempts, defined as “self-reported attempts to kill one’s self in the last 12 months,” from 2008 to 2019. During that period, the incidence rose to 564 in every 100,000 adults from 481.­ Among the major findings was that there was no significant change in the use of mental health services by people who had tried suicide, despite the passage of the Affordable Care Act in 2010 and receding stigma around mental health care.

The Affordable Care Act, which took effect fully in 2014, required all health plans to cover mental health and substance abuse services, and also sharply reduced the number of uninsured people in the U.S. Still, many respondents to the survey in the new report said the cost of mental health care was prohibitive; others said they were uncertain where to go for treatment or had no transportation.

Dr. Paul Nestadt, an assistant professor of psychology at Johns Hopkins who has researched the epidemiology of suicide but was not involved in the study, said the new data points, once again, to the scarcity of psychiatric beds or mental health professionals who take insurance, factors that have prevented medical science from bringing down the country’s suicide rates.

“The bottom line is, our treatments really work,” he said. “But people have to be able to access care. When they can’t, they’re left with less choices.”


Report: Lung cancer rates dropping because of better access, screening, treatment

A new report offers hope on the lung cancer front: Overall cancer rates are being driven down because patients are being diagnosed at an earlier stage in their disease and living longer due to better access to care, higher screening rates and improved treatments (Source: “Progress on Lung Cancer Drives Overall Decline in U.S. Cancer Deaths,” HealthDay News, Jan. 12).

Still, lung cancer remains the leading cause of cancer death in the country, according to the annual Cancer Statistics report conducted by the American Cancer Society and released Wednesday.

In 2018, 28% of lung cancers were detected at a localized stage, compared with 17% in 2004. Nearly one-third (31%) of lung patients now survive three years past diagnosis, compared to 21% a decade ago.

But lung cancer still causes 350 deaths a day -- more than breast, prostate and pancreatic cancers combined -- and is responsible for the most cancer deaths by far, according to the report.


Study: Racial disparities exist in every state in U.S.

Racial and ethnic health inequities are pervasive in every state in the U.S., according to a new analysis that found some of the widest disparities occur within states known for having high performing health care systems (Source: “States Have Large Racial Disparities in Health Care Equity, Study Finds,” U.S. News, Nov. 18).

A new report from the Commonwealth Fund assessed the performance of the health system in all 50 states and the District of Columbia on health care access, quality of care and health outcomes for racial and ethnic minority residents.

The report evaluated state health system performance for Black, white and American Indian/Alaskan Native residents, as well as for Asian American, Native Hawaiian, Pacific Islander and Latino populations.

Only six states had health systems that scored above the national average for all racial and ethnic groups studied – Oregon, Rhode Island,  Hawaii, Massachusetts, Connecticut and New York. Yet large disparities were also found in those states, where health system performance for white residents was scored the best of any group except in Massachusetts, where it was slightly higher among Asian American, Native Hawaiian and Pacific Islander residents.

The overall health of Black Ohioans ranked 22nd out of 38, Latino Ohioans ranked 16th out of 42, Asian Ohioans ranked 19th out of 23 and white Ohioans ranked 34th out of 51 states and D.C.


State Medical Board extends COVID-19 telemed rules through March 2022

The State Medical Board of Ohio on Wednesday delayed the scheduled expiration of COVID-19 emergency rules that allow for more liberal use of telemedicine, meaning Ohioans will be able to continue using telemedicine through March 2022 for doctor visits that involve prescribing drugs or renewing medical marijuana cards (Source: “Ohio COVID-19 telemed rules for medical pot, drug prescriptions extended through March 2022,” Columbus Dispatch, Nov. 10).

The extension comes as state lawmakers debate a bill that would make the COVID-19 emergency telemedicine rules permanent. 

In March 2020, as the COVID-19 pandemic took off, the medical board lifted a requirement that Ohioans must see a doctor in-person to prescribe a drug or renew medical marijuana cards. The in-person visit rule was set to expire Sept. 17 after Gov. Mike DeWine ended the COVID-19 emergency declaration. But health care organizations pushed to keep the flexibility since the virus was still circulating. The board delayed the expiration to the end of the year until Wednesday's move to extend it.


Advocates push state to use more federal dollars for school-based health clinics

Ohio child advocacy groups and doctors are pushing for more state funding to add additional school-based health clinics in the state (Source: “Child advocacy groups, doctors want to see more state funding for school-based health clinics,” News 5 Cleveland, Oct. 20).

The Children’s Defense Fund-Ohio and other child advocacy groups are asking the state to allocate $25 million from the American Rescue Plan Act for the next two years to help set up clinics for additional districts in the state.

Ohio received about $5 billion from the federal government as part of the American Rescue Plan Act. So far, about $3 billion has yet to be allocated. According to the Treasury Department, funds must be incurred by Dec. 31, 2024.


Study finds mortality improvements after rural hospitals merge

A new study published this week in JAMA Network Open found improved mortality rates across multiple common conditions when compared to equivalent facilities that remained independent (Source: “Rural hospitals saw mortality improvements after acquisition deals, study finds,” Fierce Healthcare, Sept. 21).

“The findings of this study regarding the positive outcomes associated with mergers in rural hospital quality challenge a common argument in prior research that hospital consolidation is likely to result in greater market power and higher prices but poorer quality,” researchers from the Agency for Healthcare Research and Quality and IBM Watson Health wrote in the journal.

The researchers noted that their findings differed from other studies that monitored quality changes following consolidation within urban markets, which found either no change or a decline following hospital acquisition.

The difference, they theorized, could be that rural hospital mergers more often allow these facilities “to improve quality of care through access to needed financial, clinical and technological resources, which is important to enhancing rural health and reducing urban-rural disparities in quality. This hypothesis needs to be assessed using data sources that capture data both on quality and hospital resources,” the researchers wrote.