Monthly Archive for April, 2012

Eliminating Disparities in Maternal Health

Published on April 26, 2012 in Kalahn Taylor-Clark. 0 Comments

Christine Monahan, Health Policy Advisor

Kalahn Taylor-Clark, Director of Health Policy

How does race and ethnicity intersect with other identities (including sex, gender identity, etc.) in ways that compound barriers to health care and lead to health disparities?

Every mother and every infant deserve high-quality maternity care.  Yet despite the fact that the United States has many of the best medical professionals and facilities in the world, our health care system is failing to meet the maternal health care needs of millions of women, and Black women are at particular risk.

The statistics are striking.  According to the Centers for Disease Control and Prevention (CDC), Black women are more than three times more likely than White women to die from pregnancy-related causes.  Infants born to non-Hispanic Black mothers are more likely to be born preterm and nearly twice as likely to have low birth weights as infants born to White mothers.  And the preliminary infant mortality rate in 2010 for Black infants was more than twice that of White infants.  Further, only 54 percent of Black babies have ever been fed breast milk, compared to 74 percent for White babies, 80 percent of Latino babies, and 81 percent of Asian American babies.  So what’s the cause behind such troubling disparities and what is being done to combat them?

First, the problem of infant mortality among Black women cannot be dismissed as a result of lower educational attainment.  College educated Black women also suffer an infant mortality rate that is more than double that of their White counterparts – 11.5 deaths per 1,000 births for Black mothers compared to 4.2 per 1,000 for White mothers. White women who dropped out of high school have a lower rate of infant mortality than college-educated Black women – 9.1 deaths per 1,000 births compared to 11.5, according to the National Center for Health Statistics.

Rather, health researchers suggest that a lifetime of stress related to navigating systems plagued by race and gender bias has the additive effect of wearing on the body.  That is, when the body is stressed it produces a hormone called cortisol, which can work to induce labor.  Beyond equalizing access to health care services, more must be done to combat these stressors for Black women.

Over the past eight years, The March of Dimes’ Prematurity Research Initiative has provided nearly $22 million to address these issues broadly, and in 2012 alone has provided grants totaling nearly $3 million for this work. Targeting funding through these types of initiatives could do a lot to address, head on, this troubling disparity.

Second, more than 22.4 percent of Black women – compared to 12.7 percent of White women – have no health coverage. Black women are also more likely to be without a usual source of care than White women.  Consequently many Black women don’t have access to the health care they need before, during, and after pregnancy.  Many are without:

1) Community resources and health care services that can help them stay healthy before pregnancy (for example, 7.5 percent of Black women compared to 3.3 percent of White Women have been diagnosed with diabetes – a condition associated in pregnant women with greater risk of pregnancy complications, birth defects, and spontaneous abortions or miscarriages);

2) Contraception to help them plan families and appropriately and safely space pregnancies (Black women face a significantly higher rate of unintended pregnancies);

3) Preconception and prenatal care to allow doctors to identify and treat any health issues early (Black women are more than twice  as likely as White women to receive prenatal care starting in the 3rd trimester or not receive prenatal care at all); and

4) Postpartum care to assist mothers with breastfeeding (as noted earlier, Black babies are less likely to be breastfed.  Research has shown that breastfeeding can reduce the rates of a range of chronic conditions, including obesity, type 2 diabetes, and asthma. Further, Black adults are likely to suffer from all of these conditions at higher rates than are Whites.  Thus, it is possible that encouraging breastfeeding may help to alleviate some of the disparities that Blacks disproportionately face later in life.

The Affordable Care Act (ACA) contains a number of important provisions that will help us tackle these barriers.  It makes significant investments in prevention (in both the health care and community settings) and expands affordable health coverage to millions of women.  The ACA also specifically aims to improve conditions for pregnant women and new parents by providing comprehensive maternity coverage and supports for low-income mothers, and improving the infrastructure for breastfeeding.  In addition, through the Strong Start Initiative, providers, states, and others have the opportunity to build public-private partnerships to reduce early elective deliveries, and to test innovative approaches to provide access to high-quality prenatal care.  Targeted efforts through these programs will be imperative to reducing disparities in access to needed care services.

The National Partnership for Women & Families is committed to making sure the ACA delivers on these important protections, by working closely with both federal and state officials as they implement the law and combating efforts by opponents in Congress to undermine it.

By Christine Monahan, Health Policy Advisor and Kalahn Taylor-Clark, Director of Health Policy, National Partnership for Women & Families

Medicare Matters to Older Women

Published on April 24, 2012 in Health Care and Kirsten Sloan. 1 Comment

Kirsten Sloan, Vice President

The Medicare Trustees announced this week that the program will remain solvent until 2024 – the same projection as last year.  While this finding is reassuring, it doesn’t mean we can afford to be complacent. Millions of American women – mothers, grandmothers, and aunts – rely on this program every day for affordable health care coverage.  In fact, more than half of the roughly 49 million Medicare beneficiaries are women.  And the numbers continue to grow as our nation ages.

 

For these women, Medicare provides access to essential preventive care, physician and hospital services, prescription drugs, and home health care.  Often this is care women could not otherwise afford; nursing home care alone can cost roughly $75,000 per year.

 

Medicare also offers guaranteed protection.  There is no gender rating – women pay the same Medicare premium as men; there is no exclusion for pre-existing conditions – an eligible woman diagnosed with breast cancer will not be turned away from the program; Medicare coverage is never rescinded – women can be confident that the coverage will be there when they need it; and there are no annual limits that restrict coverage when a woman needs it most.

 

Medicare’s promise of affordable coverage has become one of the most important pillars of retirement security.  Women age 65 and older have average incomes of only around $22,000 – an amount easily wiped out by one serious illness.  Without Medicare, millions of older women would be left to shoulder unmanageable health care costs, forego the critical health care services they need, or be forced to rely on their children for assistance.

 

There is no question that refinements that reduce health spending and make Medicare more sustainable for the long-term are necessary.  There are also improvements in the program – like a sorely needed cap on total out of pocket expenses – that need to be made.  But any refinements must be done thoughtfully and carefully.  Changes that simply push more costs onto Medicare beneficiaries or cut provider payments in ways that deter physicians from accepting Medicare patients are short-sighted.

 

The Trustees report indicates there is some time to make the right changes – changes that strengthen the program for current and future generations of women and protect Medicare’s promise of affordable, quality health care.  We owe it to these women to get it right.

Women’s Work: A Political Flashpoint and an Urgent Policy Imperative

Published on April 16, 2012 in Debra Ness and Workplace Fairness. 1 Comment

Debra Ness, President, National Partnership

Cross-posted from the Huffington Post.

Women’s work. Last week, when Hilary Rosen used words she quickly admitted were poorly chosen, we were all reminded that it remains a huge flashpoint in our society. But there are some truisms that will hold even after the media frenzy and politically-motivated discourse subside.

First, America’s moms aren’t at war with each other. For a good part of our lives, most women are in the workforce. At other times, many women are stay-at-home caregivers. Most of us assume both roles at various points in our lives — and for several decades, many of us fill both of these roles, breadwinners and caregivers, at the same time. We all need and deserve respect.

Second, in this tough economy, women’s work is about not just family economic security over the long term, but also basic family economic survival right now. In 2010, nearly 40 percent of women were the primary breadwinners for their families, bringing home as much or more than their husbands — or providing solely for their families as single parents, and just under one-quarter more were co-breadwinners who brought in at least 25 percent of their families’ income.

Our jobs matter, and our caregiving responsibilities matter. And much more important than the rhetorical war around Hilary Rosen and Ann Romney is the urgent need to finally adopt policies that address the needs of employed women and their families, now and in the future. That means expanding the Family and Medical Leave Act so it covers more workers, adopting paid family and medical leave, and ensuring that all workers can earn paid sick days. And it means finally, once and for all, ending the gender-based wage discrimination that punishes women and families these days.

How bad is it? America’s women are paid just 77 cents for every dollar paid to men, which results in $10,784 in lost income each year. For women of color, the gap is even worse. African American women are paid 62 cents and Latinas are paid just 54 cents for every dollar paid to men, which means they lose $19,575 and $23,873 in critical income each year, respectively. And these gaps exist regardless of industry, education or personal choices.

The wage gap in this country is diminishing so slowly that it will take more than four decades for it to close. Yet, if it were eliminated, a woman in the United States could afford 13 more months of rent, 2,751 more gallons of gas, seven more months of mortgage and utility payments or nearly three years’ worth of family health insurance premiums. The loss of these basic necessities is no small matter for America’s families.

To paint a clearer picture of what these lost wages look like for households throughout the country, the National Partnership has released a state-by-state analysis of the wage gap. Although some states are closer to closing the gap than others, in no state are women paid equally. And the disparities for women of color are significant and often appalling.

In Wyoming, Louisiana and Utah the gap between men’s and women’s wages is more than 30 cents for every dollar. They make up the bottom states in our ranking of state wage gaps for all women. An analysis of the state gaps for African American women and Latinas shows that Wyoming, Rhode Island and Alabama have the worst gaps — more than 50 cents. The fact that women of color in these states are being paid half, or even less than half, as much as their male counterparts is truly appalling.

This week, we recognize Equal Pay Day — the day that marks how far into 2012 women have to work to match the total wages paid to men in 2011. You read that correctly: it takes women four extra months of work to catch up in wages to their male counterparts — and it’s hurting the nation’s families and our economy terribly.

That’s why we need Congress to pass the Paycheck Fairness Act, which would help fight wage discrimination and establish stronger workplace protections for women in all states. It is critically important legislation that has been introduced in the current Congress. Its passage must be a priority for anyone who cares about women’s work and families’ well-being.

It’s time to move beyond posturing and political dust-ups to real policy changes that will help real families. We cannot afford to wait.

 

 

 

Older Women’s Stake in Health Reform

Published on April 3, 2012 in Debra Ness, Health Care and Reform. 4 Comments

 

Debra Ness, President, National Partnership

Cross-posted from the Huffington Post.

This week, all the talk in Washington has been about handicapping the outcome of the Supreme Court health reform cases, and identifying winners and losers. What did the justices mean with each question? Which way are the potential swing votes leaning? Will the Court reach consensus of any kind? What are the likely political/electoral consequences of the upcoming rulings?

There’s been painfully little attention to the impact of the rulings for patients, and one group has been just about totally ignored throughout this debate: older women. But as one of the most vulnerable segments of our population, older women have a tremendous amount at stake as the future of reform is decided.

Why, when most seniors are covered by Medicare? Because older women tend to have low incomes and poor health — and because nobody suffers more in our fragmented, incoherent health care system.

Let’s get specific. Older women are more likely than others to have chronic conditions and, consequently, they bear the brunt of shortcomings in our health care system — among them high cost, poor quality and uncoordinated services that often generate additional cost, burden and sometimes serious harm. Older women also are more vulnerable than men to high costs, due to the lower wages and savings that result from time spent out of the workforce to meet family caregiving responsibilities.

That means older women gain a lot from the Affordable Care Act, because the law does so much to improve both the affordability and quality of health care.

It is closing gaps in Medicare coverage. Annual wellness visits are now covered, as are some preventive benefits older women need, such as mammograms and bone density tests, without co-pays. This benefit includes time for health care providers to conduct comprehensive health risk assessments and create personalized prevention plans for their patients.

Older women will save millions of dollars as reform closes the current gap in Medicare prescription drug coverage known as the “donut hole.” Beneficiaries who fell in this gap have already received a $250 rebate. Beginning last year, they benefited from 50 percent off brand-name drugs in the “donut hole.” By 2020, the donut hole will be closed, and beneficiaries will only have to cover 25 percent of the cost of their drugs until they hit the catastrophic cap, after which they will only have to pay 5 percent.

Health reform also created the Center for Medicare and Medicaid Innovation, to test, evaluate and rapidly expand new care delivery models that improve quality and care coordination. It encourages the use of health information technology in these models to help improve coordination and communication among health care providers and patients. It puts more resources into making sure older women get the follow-up support they need when they transition from a hospital stay back to the community. It supports new medication management services that will help patients and caregivers understand their medications and avoid dangerous interactions and medical errors. It supports better primary care and a team-based approach that will help older women avoid unnecessary hospitalizations and link them to community services that can help them maintain their health and live better quality lives. And the reform law establishes Geriatric Education Centers to support training in geriatrics, chronic care management and long-term care issues for family caregivers, as well as for health professionals and direct care workers. Read even more about the benefits for older women in health reform here.

Health reform is the greatest advance for women’s health in a generation. Access to affordable, quality health care is central to the well-being of older women. It is a key determinant of their quality of life, their economic security and their ability to thrive, prosper and participate fully in our society. Losing reform would have grave consequences for women and families, and older women have a particular stake. Nobody wins when we lose sight of that.