The Health Divide: The threat of Medicaid cuts, disparities in genetic testing, and rural health at risk

As Congressional Republicans ponder cuts in federal spending to pay for tax cuts, Medicaid has emerged as a possible target. While states administer Medicaid, they rely on the federal government to help shoulder the bulk of the costs of the insurance program for low-income and disabled Americans.  

That is especially true for those covered by the Medicaid expansion, with the federal government paying for 90% of the costs of enrollees, compared to half to three quarters of those in traditional Medicaid.

If the federal government does slash funding to states, the effects won’t be felt equally, explains Politico Pulse. States with the highest proportion of low-income and aging residents will be hit hardest — and many of those states are red. 

Communities of color disproportionately rely on Medicaid for health coverage. For instance, nearly 40% of African Americans under 64 rely on public coverage, compared to about 20% of whites.

KFF published a brief on the various possibilities, including a state-by-state look at how many people could be impacted if the federal government lowers its funding match for adults who qualified for coverage under the Medicaid expansion. 

But such cuts carry political risk. Writing for Politico Magazine, veteran health journalist Joanne Kenen explains why cutting Medicaid won’t be easy for Republicans, given the program’s growing popularity.

Diabetes reports highlight disparities 

While diabetes mortality rates have declined nationwide, disparities persist. A study published this month examined racial and ethnic disparities in diabetes mortality rates.

Among the key findings: In 2019, American Indian and Alaska Native populations experienced the highest diabetes mortality rates (35.6 deaths per 100,000), followed by Black (31.9 per 100,000), Latino (19.7 per 100,000), white (17.6 per 100,000), and Asian (12.6 per 100,000) populations.

“Diabetes mortality remains too high for many Americans,” the authors wrote in the journal Diabetes Care. “Interventions focusing on communities at highest risk are vital to resolving persistent health inequities.”

Increasing adult ADHD diagnoses reflect changing understanding

More adults are receiving an ADHD diagnosis, a trend that has seemingly accelerated in recent years, reports the Associated Press. While diagnoses have been rising for decades, that trend has accelerated in recent years — doctors have reported “skyrocketing” demand for evaluations. 

While the condition starts in childhood, about half of adults with ADHD were diagnosed after age 18, the article notes. ADHD has historically been seen as more common among boys, but that’s changing, explains a 2023 study looking at stimulant prescription rates. 

Increasingly, ADHD is “recognized as a potentially lifelong condition that might be underdiagnosed or undertreated in both girls and adults,” according to authors of that report. 

That’s creating an ongoing medical equity issue, Kathleen Nadeau explains in an ADDitude Magazine article.

Where pregnant people live affects their risk of death

The state where a pregnant person lives shapes their risk of dying from homicide, suicide, drug overdose, and deaths related to firearms. 

A paper published this month in JAMA Network Open highlights newly available state-level data for pregnancy-related mortality.

Among the key findings: From 2018 to 2022, there were 10,715 deaths of people who were pregnant or within the first year of giving birth, including 837 homicides, 579 suicides, 2,083 drug overdoses, and 851 deaths that involved firearms. 

The risk of death varied by geography, though. For example, Mississippi experienced the highest pregnancy-related homicide rate and firearm-associated mortality, while the figures for suicide were highest in Montana. Delaware experienced the highest pregnancy-related drug overdose rate.

Reporters localize Trump’s health equity impacts

Across the country, reporters are finding ways to localize the health equity impacts of Trump administration policies — including possible slashes to federal Medicaid funding. For example, writer Dr. Ebony D. Only investigates the impact of proposed policy shifts on “Chicago’s stark life expectancy gap” in a cover story for The Chicago Reporter. 

Across Chicago, there is a nearly 12-year life expectancy gap between Black and non-Black residents, a difference that’s even wider when adding in affluence. Potential changes to the health care system could hit already vulnerable communities particularly hard, the article explains. For example, changes in Medicaid funding could have a severe impact on the city’s community health centers, affecting crucial healthcare like colonoscopies and mammograms.

Experts point to perils facing patients

Rural hospitals and obstetrics wards have been shuttering at a rapid pace, leaving many residents with no options but to travel for care. If federal health funding is cut, the situation could be even more dire for these already underserved regions, according to two public health experts at Purdue University, writing in The Conversation.

That’s because rural populations have higher shares of Medicare and Medicaid beneficiaries, making them especially vulnerable to any changes in funding. But there are lesser known federally funded programs that are vital to keeping these struggling rural hospitals afloat, too. 

For example, Congress passed legislation in 2003 that increases Medicare payments per patient in many rural hospitals, while the rural emergency hospital model provides higher Medicare payments to help these facilities access key services, the authors explain. Federal funding on areas ranging from telehealth to affordable housing also have significant and lasting impacts on rural health disparities.

Study highlights disparities in genetic testing 

White children are almost twice as likely as Black children to receive genetic testing, an important diagnostic tool for conditions such as epilepsy. In addition, insurance coverage for such testing was denied at higher rates for Black children, according to findings published this month in the journal Neurology. 

Even so, pediatric neurologists requested genetic tests at similar rates regardless of patients’ race and ethnicity — an encouraging finding, said study author Dr. Jordan Janae Cole in a release on the findings.Insurance denials contributed to the lower testing rates but do not fully explain the disparity. Instead, “Other unmeasured barriers stemming from systemic racism likely affected genetic testing among Black patients,” the study noted. 

What we are reading:

• “How Trump’s medical research cuts would hit colleges and hospitals in every state,” by Emily Badger, Aatish Bhatia, Irineo Cabreros, Eli Murray, Francesca Paris, Margot Sanger-Katz and Ethan Singer, The New York Times
• “Montana looks to regulate prior authorization as patients, providers decry obstacles to care,” by Mike Dennison, KFF Health News
• “Redlining’s lingering public health legacy,” by Lara Salahi and Paul Gordon, Association of Health Care Journalists
• “Insurers failed to comply with mental health coverage law, Department of Labor report finds,” by Duaa Eldeib, Maya Miller, Annie Waldman and Max Blau, ProPublica