The Health Divide: Inequities affect COVID booster effort, Medicaid enrollees, and women with cancer

COVID booster rollout could miss vulnerable groups

With case rates already ticking up this fall, people most at risk from the coronavirus and its complications — including people of color and the elderly — may not receive the latest boosters, some epidemiologists fear. 

“Urging people to get boosters has really only worked for Democrats, college graduates, and people making over $90,000 a year,” Yale epidemiologist Gregg Gonsalves told Amy Maxmen at KFF Health News. “Those are the same people who will get this booster, because it’s not like we’re doing anything differently to confront inequities in place.”

Those in group housing, such as prisons and nursing homes, remain at high risk of contracting COVID, and there are significant disparities, both in vaccine uptake and case rates, between racial and ethnic groups. In general, low-income and unhoused people are less likely to be vaccinated, in part because many lack a regular medical provider or transportation to  a clinic.

Black Americans are at increased risk for complications from COVID and have been “harder hit by the spike than the general population,” writes Margo Snipe at Capital B News. Among the reasons are lower rates of vaccination and Paxlovid use.

COVID rates are also rising among young children, who are under-vaccinated, and among seniors, reports CNN. Yet nursing homes have not even begun to vaccinate their elderly residents, report Jordan Rau and Tony Leys at KFF Health News.

Many facilities intend to wait until October or even November, the pair write, even as the infection rate has risen to nearly 10 per 1,000 residents in September.

“Older adults in those settings are certainly the most vulnerable and should have been prioritized,” said Chad Worz, chief executive of the American Society of Consultant Pharmacists. “The distribution of the new COVID-19 vaccine is not going well.”

With the COVID emergency over, the cost of the vaccine falls on individuals and their health plans, rather than the federal government, which previously paid for all the vaccines. “The transition from a single-payer program to a system where a variety of private and public insurers are covering the cost of vaccine doses was bound to make for a bumpy ride,” writes Helen Branswell at STAT.

Despite promises that the shots would be covered by insurance, many Americans encountered difficulties during the early rollout, report Fenit Nirappil and Lena H. Sun at The Washington Post.

Even people with Medicare and Medicaid, which are supposed to cover the immunizations, have on occasion been denied vaccination.

The CDC’s Bridge Access Program is supposed to help uninsured people get free vaccines, but users must hunt for a clinic that will vaccinate them.

Government shutdown averted, sparing impacts on health and social supports. Meanwhile, states have reinstated half a million people mistakenly kicked off Medicaid.

The nation narrowly averted a shutdown of the federal government Saturday night when President Joe Biden signed a continuing resolution on the budget that the U.S. House and the Senate had approved at the last minute. This stopgap measure will keep the government operation until mid-November. Without it, vulnerable groups, including disabled and elderly individuals and low-income people and families, could have faced difficulties with health care and insurance -- and they still might if a more permanent agreement is not reached before this temporary agreement expires.

If that happens, Medicare’s funding for coverage would be secure, as would Medicaid's, since it is funded into early 2024, but many employees that manage these programs would be furloughed.

That could create delays in benefit verification, Medicare card issue, and payments to health care providers, reports Sabrina Malhi at The Washington Post.

During the 1995-96 shutdown, thousands of Medicare applicants were turned away every day, albeit temporarily. And there are plenty of government health programs that rely on discretionary funding that requires Congress’s stamp of approval, reports Julie Rovner at KFF Health News. These include community health centers and HIV/AIDS initiatives.

A shutdown could also affect federal oversight and assistance as states continue to remove people from Medicaid rolls post-pandemic.

That unwinding process has been fraught, with more than 7 million Americans removed from Medicaid rolls thus far — many due to bureaucratic issues, like a renewal letter than never arrived.

The importance of federal oversight became clear with the announcement last week that computer errors in 29 states and the District of Columbia led about half a million people, including many children, to unfairly lose Medicaid. The computers were assessing households as a unit, rather than considering individual children or other family members who remained eligible.

After federal officials discovered the problem in August, they halted Medicaid terminations in several states and provided clearer instructions to fix the problem. Eligible individuals are now being reinstated, reports David A. Lieb at AP News.

As people lost their coverage, states have received a surge in appeals, reports the Post. In Arkansas, for example, appeals have risen sixfold, with more than 2,500 in July alone. And appeals are taking months to resolve.

Rural Americans are at higher risk of being disenrolled and may struggle to maintain health coverage, writes Jazmin Orozco Rodriguez at KFF Health News. That’s because they may have less internet access and live farther from eligibility offices or health care “navigator” organizations that could help them stay enrolled or find new insurance plans.

“Rural communities rely on Medicaid to form the backbone of their health care system,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. “If states bungle unwinding, this is going to impact rural communities, which are already struggling to keep enough providers around and keep their hospitals."

SoCal companies tailor Medicare plans for specific populations

Insurers are developing Medicare Advantage plans specific to Asian Americans, Latinos, and LGBTQ+ people, reports Stephanie Stephens of KFF Health News.

Medicare Advantage plans are federally funded, but administered by private companies. They are often less expensive than traditional Medicare, but limit patients to providers in their networks.

The new plans offer advantages such as health care providers who speak the patient’s language, as well as tailored coverage, such as traditional Eastern herbal supplements for Asian American enrollees or HIV prevention and management that LGBTQ+ patients might want, Stephens writes.

But Medicare Advantage plans have come under fire lately for denials of care.

“It’s strange to think about commodifying and profiting off people’s racial and ethnic identities,” said UCLA public health professor Naomi Zewde. “We should do so with care and proceed carefully, so as not to be exploitative.”

Women face higher health care costs in U.S., but get worse cancer care globally

Being a working woman in America means spending an average of 18% more money, out of pocket, on health care than male colleagues, according to a new analysis of employer health plans.

While insurance premiums are the same for both genders, working women spend $15.4 billion more of their own money on health care than working men each year, according to the report by Deloitte Consulting.

This was true even after the researchers excluded the costs of pregnancy and maternity care, reports Bertha Coombs at CNBC. The analysts found the “covert pink tax,” writes Erin Prater at Fortune Well, after examining medical spending for 16 million U.S. workers from 2017 through 2022.

Financial stressors can contribute to delayed care and health problems, said Dr. Kulleni Gebreyes of Deloitte.

Even though total health costs for women were only 10% higher than for men, more of those costs were passed on to women patients, such that women wound up paying 18% more out of pocket. This suggests the problem lies in the health plans themselves being structured in a way that exacerbates inequities.

Insurance covers a smaller proportion of the costs for services women use than the ones men need. The extra costs for women include annual gynecological exams that can trigger costly follow-up care, menopause treatment and breast imaging.

Deloitte calculated it would cost employers $11 per employee per month in premium support to close the gap.

Women worldwide also face inequities in cancer prevention and care, reports Angus Chen at STAT. 

A new report in Lancet outlines how women are more likely to go bankrupt from cancer than men. The researchers calculated that 2.3 million deaths could be avoided if women had optimal cancer prevention, detection and care. 

Many women feel unable to address signs of cancer or spend their time and money on their children instead, so the disease reaches a more advanced stage before many seek help, said study author Dr. Ophira Ginsburg of the National Cancer Institute Center for Global Health.

“On the whole, cancer is less preventable in women than in men,” Ginsburg said. “Patriarchy dominates every aspect of these issues.”

What we’re reading: 

•  “Disability groups win fight to be included in health equity research,” by Amanda Morris, The Washington Post
• “Treating rural America: The last doctor in town,” a STAT documentary by Hyacinth Empinado
• “California workers who cut countertops are dying of an incurable disease,” by Emily Alpert Reyes and Cindy Carcamo, Los Angeles Times
• “Black people are more likely to be physically restrained in emergency rooms, study finds,” by Anika Nayak, STAT
• “Parents are pushing to get insurance coverage for children’s hearing aids,” by Sara Sidner, CNN
• “To age in place,” by Meera Kymal, Palabra
• “In North Carolina, a radical experiment targets social determinants of health with fresh produce and safe housing,” by Wudan Yan, STAT
• “Prescriptions for popular diabetes and weight-loss drugs soared, but access is limited for some patients,” by Dierdre McPhillips, CNN