Federal policy

Medicare eligibility drives down racial disparities, study finds

Access to Medicare may help address racial disparities in insurance coverage, access and self-reported outcomes, according to a new study (Source: “Medicare eligibility erases many healthcare disparities in US,” Healthcare Dive, July 26).

The research, published in JAMA Internal Medicine, tracked more than 2.4 million Americans and found that immediately after turning 65, and thus becoming eligible for Medicare, coverage for Black respondents increased from 86.3% to 95.8%. Among Hispanic respondents, coverage increased from 77.4% to 91.3%.

The JAMA study has validated the importance of Medicare in terms of leveling the playing field for Americans when it comes to healthcare access — a gap that has been exacerbated by the COVID-19 pandemic. Whereas there are significant gaps in access to healthcare and disparities among ethnic groups, reaching Medicare age wipes much of them out.

Disparities in insurance coverage were cut by 53% between Black people and white people, and 51% for Latino people versus white people. The proportion of Black and Latino people who self-reported their health as poor also dropped significantly after they became eligible for Medicare.


CDC extends national moratorium on evictions

The Centers for Disease Control and Prevention (CDC) has extended a moratorium on evictions until the end of July (Source: “CDC Extends Eviction Moratorium Through July,” National Public Radio, June 24).

The ban had been set to expire next week, raising concerns that there could be a flood of evictions with some 7 million tenants currently behind on their rent.

The Biden administration says the extension is for "one final month" and will allow time for it to take other steps to stabilize housing for those facing eviction and foreclosure. The White House says it is encouraging state and local courts to adopt anti-eviction diversion programs to help delinquent tenants stay housed and avoid legal action.

The federal government will also try to speed up distribution of tens of billions of dollars in emergency rental assistance that's available but has yet to be spent. In addition, a moratorium on foreclosures involving federally backed mortgages has been extended for "a final month," until July 31.


Drug use harm reduction programs get boost in federal funds

Following a surge of overdoses during the pandemic, Congress, for the first time, has appropriated funds specifically for programs that distribute clean syringes and other supplies meant to protect people who use them (Source: “Helping Drug Users Survive, Not Abstain: ‘Harm Reduction’ Gains Federal Support,” New York Times, June 27).

Such programs have long come under attack for enabling drug use, but President Biden has made expanding harm-reduction efforts one of his drug policy priorities — the first president to do so. The American Rescue Act includes $30 million specifically for evidence-based harm reduction services, the first time Congress has appropriated funds specifically for that purpose. The funding, while modest, is a victory for the programs, both symbolically and practically, as they often run on shoestring budgets.

Still, many elected officials and communities continue to resist equipping people with supplies for drug use, including the recent addition of test strips to check drugs for the presence of illicitly manufactured fentanyl, which shows up in most overdose deaths. Some also say that syringes from harm reduction programs end up littering neighborhoods or that the programs cause an increase in crime. Researchers dispute both claims.


CDC awards $34.5 million to Ohio to address COVID-related health disparities

The U.S. Centers for Disease Control and Prevention announced earlier this month that it has awarded the Ohio Department of Health and Columbus Public Health a total of nearly $34.5 million to address COVID-19-related health disparities (Source: “Ohio receives nearly $34.5 million from CDC to address COVID-19 related health disparities,” Cleveland Plain Dealer, June 10).

ODH will receive $31,011,053, which includes $7,169,724 earmarked for rural communities. Columbus Public Health receives $3,396,978.

The grants are part of a $2.25 billion federal spending to promote health equity by expanding services and capacity at the state and local level, the CDC said. This is the agency’s largest investment to date to improve health equity in the United States.

The funds also will be used to increase COVID-19 testing and contact tracing among high-risk and underserved populations, including racial and ethnic minority groups and people living in rural communities, in Ohio and across the country.


EEOC says employers can mandate vaccinations

U.S. companies can mandate that employees must be vaccinated against COVID-19, the Equal Employment Opportunity Commission announced last week (Source: “US companies can mandate vaccinations, federal agency says,” USA Today, May 29). 

In a May 28 statement, the agency said that federal EEO laws do not prevent employers from requiring that all employees physically entering a workplace be vaccinated as long as employers comply with the reasonable accommodation provisions of the Americans with Disabilities Act and other laws.

Employers may also offer incentives to employees to get vaccinated, "as long as the incentives are not coercive," the statement said.


Biden administration announces $7.4 billion in public health spending

The White House announced Thursday that it is investing $7.4 billion to hire more public health workers to deal with the coronavirus pandemic and future health crises (Source: “Biden announces $7.4 billion to hire more public health workers amid pandemic,” Washington Post, May 13).

The money will come from the $1.9 trillion coronavirus relief package, which Congress passed in March.

The Biden administration said $4.4 billion will go toward boosting states’ overstretched public health departments, allowing them to hire disease specialists to do contact tracing, case management, and support outbreak investigations and school nurses to help schools reopen. Some of the money will also go to expanding the Epidemic Intelligence Service at the Centers for Disease Control and Prevention — which plays a critical role in containing outbreaks.

The remaining $3 billion will be used to create a new grant program to train and modernize the country’s public health workforce. Applicants for those grants will be asked to prioritize recruiting staff from the communities they will serve, especially those from underrepresented backgrounds.

HPIO’s 2021 Health Value Dashboard, which was released last month, found that one reason Ohio ranks poorly on health value (47th out of the 50 states and D.C.) is that the state’s sparse public health workforce leads to missed opportunities for prevention. Data in the Dashboard shows that only three states spend less on public health than Ohio.


CDC director declares racism ‘a serious public health threat’

In a statement released earlier this month, the director of the Centers for Disease Control and Prevention declared racism a “serious public health threat” (Source: “CDC Director Declares Racism A 'Serious Public Health Threat',” National Public Radio, April 8).

In the statement, Dr. Rochelle Walensky said that, “Racism is a serious public health threat that directly affects the well-being of millions of Americans. As a result, it affects the health of our entire nation. Racism is not just the discrimination against one group based on the color of their skin or their race or ethnicity, but the structural barriers that impact racial and ethnic groups differently to influence where a person lives, where they work, where their children play, and where they worship and gather in community. These social determinants of health have life-long negative effects on the mental and physical health of individuals in communities of color."

The CDC also launched a new web portal, Racism and Health, that's designed to be a hub for public and scientific information and discourse on the subject.


Public health officials concerned about sustaining resources after pandemic passes

After the pandemic is over, public health officials across the U.S. fear that they will be back to scraping together money from a patchwork of sources to provide basic services to their communities — much like after 9/11, SARS and Ebola (Source: “Public Health Experts Worry About Boom-Bust Cycle of Support,” Kaiser Health News/Associated Press, April 19).

Funding for the federal Public Health Emergency Preparedness program, which pays for emergency capabilities for state and local health departments, dropped by about half between the 2003 and 2021 fiscal years, accounting for inflation, according to Trust for America’s Health, a public health research and advocacy organization.

Spending for state public health departments dropped by 16% per capita from 2010 to 2019, and spending for local health departments fell by 18%, Kaiser Health News and the Associated Press found in a July investigation. At least 38,000 public health jobs were lost at the state and local level between the 2008 recession and 2019. Today, many public health workers are hired on a temporary or part-time basis. Some are paid so poorly they qualify for public aid. Those factors reduce departments’ ability to retain people with expertise.

The recently released HPIO Health Value Dashboard found that one reason Ohio ranks poorly for health value compared to most other states and D.C. is that Ohio’s “sparse public health workforce leads to missed opportunities for prevention.”

The report also found that “Ohioans spend a lot on downstream medical care, but investment in public health infrastructure is limited and prevention policies could be stronger.”


Feds consider adding text option to new 988 suicide hotline

Recognizing that many Americans rely on texting, U.S. regulators are weighing whether to require that phone companies allow people to text the new 988 suicide hotline (Source: “Texting option weighed for upcoming ’988′ suicide hotline,” Associated Press, April 22).

The Federal Communications Commission (FCC) last summer voted to require a new “988” number for people to call to reach a suicide-prevention hotline. Phone companies have until July 2022 to implement it. Once it’s in place, people will be able to dial 988 to seek help, similar to how 911 is used for emergencies. Currently, the National Suicide Prevention Lifeline uses a 10-digit number, 800-273-TALK (8255), which routes calls to about 170 crisis centers across the country.

Crisis counselors began responding to texts sent to the Lifeline last August, the FCC said. On Thursday, the agency voted unanimously to start a process that would also require phone companies to let people text 988. The agency noted the importance of texting for young people and those who are deaf, hard of hearing or have speech disabilities.

“While a voice hotline has its benefits, traditional telephone calls are no longer native communications for many young people. Texting is where they turn first,” said FCC Acting Chairwoman Jessica Rosenworcel in a statement. “So it’s time to make the suicide prevention hotline text accessible with 988.”


Ban on menthol cigarettes, long marketed to Black Americans, gains momentum

Banning menthol cigarettes appears to be gaining political momentum at the federal, state and local levels (Source: “Menthol Cigarettes Kill Many Black People. A Ban May Finally Be Near.,” New York Times, March 22).

Black smokers smoke less but die of heart attacks, strokes and other causes linked to tobacco use at higher rates than white smokers do, according to the Centers for Disease Control and Prevention. And 85% of Black smokers use Newport, Kool and other menthol brands that are aggressively marketed to Black Americans and are easier to become addicted to and harder to quit than plain tobacco, according to the Food and Drug Administration (FDA).

There is also now growing momentum in Congress to enact a ban. In states and municipalities across the country, Black public health activists have been organizing support and getting new laws passed at the state and local level. Public opposition among white parents to all flavored e-cigarettes, including menthol, has brought new resources to the issue. And the FDA is under a court order to respond to a citizens’ petition to ban menthol by April 29.