Access to care

Wealthier counties in Ohio also have highest COVID vaccine rates

ounties in Ohio with the highest incomes also have the highest vaccination rates, according to analysis from the Columbus Dispatch (Source: “Wealthier Ohio counties more likely to have higher COVID vaccination rates,” Columbus Dispatch, April 19).

The Dispatch found a 27-percentage point difference in vaccination rates between Ohio's wealthiest and poorest counties. Delaware County, the wealthiest county in the state, is also the most vaccinated against COVID-19.

The connection does not come as a surprise to most experts who see it as a result of long-term disparities in health care.

In Ohio, vaccines were distributed to each county mostly based on population and a few risk factors. But the state didn't require Ohioans to get their shots in their counties of residence, meaning people with the time and the means could travel to get vaccinated.

People with more flexibility in their jobs tend to make more money and have good access to transportation, said HPIO President Amy Rohling McGee. That translates to more access to COVID-19 shots and health care services as a whole, she said.


Ohio ranks near bottom in latest HPIO Health Value Dashboard

Ohio ranks 47 in the nation in health value compared to other states and D.C. according to the latest edition of the Health Value Dashboard, which was released earlier this week by the Health Policy Institute of Ohio.

“Ohioans live less healthy lives and spend more on health care than people in most other states,” according to the Dashboard.

Ohio has consistently ranked near the bottom on health value in each of the four editions of the Dashboard. Ohio’s overall health value ranking was 47 in 2014, 46 in 2017 and 46 in 2019. 

The Dashboard found that Ohio’s healthcare spending is mostly on costly downstream care to treat health problems. This is largely because of a lack of attention and effective action in the following areas:

  • Children. Childhood adversity and trauma have long-term consequences
  • Equity. Ohioans with the worst outcomes face systemic disadvantages
  • Prevention. Sparse public health workforce leads to missed opportunities for prevention

The Dashboard is a tool to track Ohio’s progress toward health value — a composite measure of Ohio’s performance on population health and healthcare spending. In ranked profiles, the Dashboard examines Ohio’s rank and trend performance relative to other states across seven domains. In addition, through a series of equity profiles, the Dashboard highlights gaps in outcomes between groups for some of Ohio’s most systematically disadvantaged populations.

The Dashboard includes examples of nine evidence-informed policies that could be adopted by Ohio policymakers and private-sector partners to make Ohio a leader in health value.


State announces new Medicaid managed care contracts

The DeWine administration announced the winners of contracts to lead sweeping changes in the $20 billion Medicaid managed care system (Source: “Six companies will split $20B in managed-care work under biggest contract in Ohio history,” Columbus Dispatch, April 9).

In what was labeled as likely the largest pact in Ohio state government history, six companies are being hired to coordinate the federal-state health insurance for more than 3 million low-income or disabled Ohioans.

"What is really the revolutionary component here is that we have looked at all of the most cutting-edge practices, and we are pushing our system to the next generation," said Ohio Medicaid Director Maureen Corcoran.

"The entire country is watching us because there are some really important things we are doing differently."


Many pregnant women with low incomes lose insurance coverage after giving birth, study finds

While many pregnant women gain coverage through Medicaid, ensuring they have insurance after giving birth remains a significant challenge, according to a new study (Source: “Study: 1 in 3 women with prenatal Medicaid lack coverage before or after pregnancy,” Fierce Healthcare, April 7).

An Urban Institute study found that 26.8% of new mothers covered for prenatal care through Medicaid were uninsured prior to becoming pregnant. In addition, 21.9% became uninsured again within two to six months of their child's birth, the study found.

The study found higher rates of women without coverage in states that did not expand Medicaid and among Hispanic women. The researchers said that the difference in insurance rates between new Black and White mothers was smaller and that boosting coverage wouldn't necessarily tackle high rates of maternal mortality among Black women.


Report outlines state efforts to address racial disparities in maternal mortality

A new resource details efforts in states across the country to address racial disparities in maternal mortality (Source: “State Maternal Mortality Review Committee Membership and Recommendations,” National Academy for State Health Policy, Feb. 18).

The United States faces a growing maternal mortality crisis with a maternal death rate that is higher than other developed countries. Additionally, Black women are two-to-three times more likely to die from pregnancy-related causes than non-Hispanic white women.

To better understand the root causes of these deaths and develop recommendations to improve health outcomes, many states have formed maternal mortality review committees (MMRCs). The report includes charts and maps that describe each state’s MMRC membership and recommendations.


Mental health demands rise as states face tighter budgets

States across the U.S., facing COVID-19 related budget shortfalls, are also contending with increased demand for mental health services as a result of the pandemic (Source: “As Demand for Mental Health Care Spikes, Budget Ax Set to Strike,” Kaiser Health News, Feb. 5).

A Kaiser Family Foundation poll found that demand for mental health services rose from 1 in 3 people in March to more than half of people surveyed in July.

The full extent of the mental health crisis and the demand for behavioral health services may not be known until after the pandemic is over, mental health experts said. That could add costs that budget writers have not anticipated.

“It usually takes a while before people feel comfortable seeking care from a specialty behavioral health organization,” said Chuck Ingoglia, president and CEO of the nonprofit National Council for Behavioral Health in Washington, D.C. “We are not likely to see the results of that either in terms of people seeking care — or suicide rates going up — until we’re on the other side of the pandemic.”


Biden administration expected to rescind approval for state Medicaid work requirements

The Biden administration is planning today to wipe out one of the core health policies of the Trump era, taking actions that will immediately rescind permission for states to compel poor residents to work in exchange for receiving Medicaid benefits (Source: “Biden administration to move Friday to rescind Medicaid work requirements,” Washington Post, Feb. 11).

Federal health officials will withdraw their predecessors’ invitation to states to apply for approval to impose such work requirements. They also will notify 10 states granted permission, including Ohio, that it is about to be retracted, according to a draft plan obtained by The Washington Post and confirmed by two individuals familiar with the decision, who spoke on the condition of anonymity because they were not authorized to discuss the matter publicly.

The actions anticipated Friday, outlined in bullet points in the draft, will come two weeks after President Biden signed an executive order instructing officials to remove barriers to Medicaid coverage. Work requirements enabled under President Donald Trump were the one policy mentioned in Biden’s directive.


ACA, Medicaid expansion reduce income inequality, study finds

Coverage gains made and subsidies offered under the Affordable Care Act reduced income inequality by more than 10% in 2019, according to a new study (Source: “ACA's coverage gains decreased income inequality: study,” Fierce Healthcare, Jan. 7).

The study from the left-leaning think tank Urban Institute, backed by the Robert Wood Johnson Foundation and published in Health Affairs, found that for a typical person in the bottom 10th percentile of income, those who enrolled in a plan under the ACA saw their incomes increase by an average of 18.8%.

In states that expanded Medicaid, their incomes rose by an average of 22%, the study found. The study also found that coverage gains led to reductions in income inequality within and between age and racial groups.


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.


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.