The Health Divide: COVID boosters for uninsured at risk, and women of color report mistreatment in maternity care

Published on
August 28, 2023

Nation faces delays in program to ensure free COVID-19 shots this fall

The Biden administration is rushing to finalize a $1.1 billion bridge program to provide free COVID-19 vaccines for uninsured and underinsured people in time for the release of new boosters, report Adam Cancryn and David Lim at Politico

Since the public emergency ended in May, the government will no longer cover the costs of COVID-19 prevention, testing and treatment for everyone. Private and public insurance plans are, for the most part, expected to cover the vaccine costs, which would otherwise be up to $130 out of pocket.

But as many as 30 million people don’t have coverage. That includes millions of people who lost Medicaid after expansive COVID-19-era benefits expired. Many of these people remain eligible but fell off the rolls due to bureaucratic hurdles. 

The bridge program is supposed to make the shots free for anyone whose insurance doesn’t fully cover the costs. 

The free vaccines will be available immediately at federally qualified clinics and individual providers. But pharmacies are the most convenient place for many to get the shots, and the pharmacy contracts are yet to be in place.

Nearly nine out of 10 Americans live within five miles of a pharmacy, but other health facilities are often farther away, reports Roll Call.

If officials fail to get the pharmacy plan in place by late September, when the new shots are expected to be released, it could complicate the rollout. 

“You’re going to have people showing up at the pharmacy looking to get vaccinated … and being told we’re not yet prepared to give it to you,” Georges Benjamin, executive director of the American Public Health Association, told Politico recently. “Some of those people will come back and get vaccinated and some of those people will just get frustrated and not show up again.”

Lack of awareness about eligibility or vaccine availability were key reasons that people didn’t get a booster last fall, when the shots were still free to all.

Pfizer and Moderna also plan to offer assistance programs for people who can’t otherwise afford their vaccines, reports Julie Appleby at KFF Health News.

Women of color report widespread mistreatment in maternity care

More than one in four Black, Hispanic and multiracial women report being mistreated during maternity care, according to a new CDC report. For women of all races combined, the figure was one in five.

Women who lacked health insurance or were on public insurance also reported more mistreatment than those with private insurance.

“These data show that we must do better to support moms,” said Dr. Debra Houry, the CDC’s chief medical officer.

Women reported a variety of problems, such as receiving threats to withhold treatment, being forced to accept undesired treatment, or not getting responses to their requests for help.

Discrimination, often based on age, weight or income, was reported by 29% of women overall, but by more than 35% of women of color.

The results covered 2,402 mothers surveyed in April 2023.

The report comes amid a growing crisis in U.S. maternal mortality rates, which have risen from 17.4 deaths per 100,000 live births in 2018 to 32.9 deaths per 100,000 live births in 2021, notes Eduardo Cuevas at USA Today

Black women die during pregnancy, childbirth or soon after at 2.6 times the rate of white women, notes Mary Kekatos at ABC News

Systemic racism leads to health consequences, including death, for Black mothers as well as their infants, writes Sandy West at KFF Health News

“Medical providers often dismiss Black women’s questions and concerns,” writes West. The gap in mortality rates between Black and white newborns was halved for Black babies when Black physicians cared for them, she adds.

Maternal mortality rates for Hispanic women overtook those for white women in 2021.

Native Hawaiian, Pacific Islander, American Indian and Alaska Native populations also have higher maternal death rates than white women, writes Shannon Firth at MedPage Today.

Maternity care “deserts” — about 2 million women of childbearing age live 25 miles or more away from the nearest labor and delivery unit — also create disparities for women of color, reports Nada Hassanein at USA Today.

More than 80% of maternal deaths are preventable, according to the CDC.

While the new survey results don’t directly explain maternal deaths, “We know that racism and discrimination can lead to delays in treatment and sometimes tragic and preventable deaths,” Wanda Barfield, director of the CDC’s division of reproductive health care, said in a media release.

Training health care providers in unconscious bias and how to provide care that is “culturally appropriate” could be a first step to repair the situation, Barfield suggested. The CDC also recommends health care systems hire diverse workforces and communicate better with patients.

“There is no single solution” to the maternal mortality crisis, writes the Editorial Board of The Washington Post. “Still, it’s time for federal, state and local institutions to start thinking creatively.” 

Paying attention to health equity and learning from other nations with lower maternal mortality rates should be part of the solution, the editors wrote.

They also note that American women need better postpartum care. Most pregnancy-related deaths occur not during childbirth but in the days and months that follow, but many women don’t receive any care.

Women, people of color and elders face extra-long waits for stroke treatment

Speedy treatment is essential to preserve brain cells after a stroke, but according to a new JAMA study, many people wait too long to be transferred to a hospital that can care for them.

The delays were longer for people older than 80, women and Black and Hispanic individuals.

“Every additional second that passes without blood flow increases the chance that the brain suffers irreparable damage,” writes Bree Iskandar at STAT. “These minutes could have profound impacts on patient outcomes.”

Medical guidelines recommend that stroke patients who arrive in the emergency room but require transfer to a better-equipped facility depart within two hours. The average delay in the study was closer to three hours.

Patients who arrived at the first hospital by ambulance got transferred faster, probably because the emergency medical technicians notified the first emergency department that they were coming, so physicians were prepared. 

But ambulance transfer is not covered by some insurance policies, disadvantaging low-income people of color.

And millions of rural residents live in “ambulance deserts,” more than 25 minutes from the nearest ambulance station, Taylor Sisk reports at KFF Health News.

Iskandar adds that medical training for stroke diagnosis has focused on the presentation in white males, but others may have variations in symptoms that slow the diagnosis.

The problem is also compounded by the higher stroke risk faced by Black Americans.

“These delays put older, Black and Hispanic patients with stroke at risk of not receiving effective treatments,” Dr. Deborah Levine of the University of Michigan, who was not involved in the study, told STAT. “It is critical we understand and reduce these inequities.”

What we’re reading: 

  • “Menopause is different for women of color,” by Alisha Haridasani Gupta, The New York Times
  • “Tribal health workers aren’t paid like their peers. See why Nevada changed that,” by Jazmin Orozco Rodriguez, KFF Health News
  • “Eating disorders and their impact on Black women,” by Laura Onyeneho, Defender
  • “Rising temperatures could mean more mental illness,” by 2023 National Fellow Alexa Spencer, Word in Black
  • “More Americans grow old alone, and faltering minds bring risks,” by Sarah D. Collins, HealthDay
  • “Medical illustrations neglect people with dark skin. A Nigerian doctor-to-be is working to change that,” by Annalisa Merelli, STAT