Health Equity blog

During the two years following the SCOTUS Dobbs decision that overturned Roe v. Wade, states with abortion bans are experiencing a waning interest from medical school graduates seeking residencies, particularly those applicants wishing to enter an OB/GYN or other residency program (e.g., family medicine) whose patients are most likely to be affected.

Earlier this month, CMS released its Resource of Health Equity-Related Data Definitions, Standards, & Stratification Practices, which serves as a technical resource for organizations and others to use to align with CMS when collecting, stratifying, and/or analyzing health equity-related data. The guidance can also serve to reconcile discrepancies in results caused by relying upon different data standards and definitions. In that regard, this publication includes suggested definitions, standards, and stratification practices for numerous sociodemographic elements.

Approximately ¼ of the U.S. population that was enrolled in Medicaid prior to the pandemic have since lost coverage. The federal ban under the Families First Coronavirus Response Act (FFCRA) placed on disenrolling Medicaid beneficiaries during the COVID-19 pandemic was lifted in March 2023, freeing states to reexamine whether current enrollees continue to satisfy eligibility requirements – resulting in disenrollment of more than 20 million people. Unable to afford or qualify for coverage elsewhere, many former Medicaid beneficiaries have now been added to the ranks of the uninsured. Not surprisingly, minorities and children – the latter of which comprise nearly ½ of Medicaid/CHIP enrollees – are disproportionately impacted by this policy shift. Some states ostensibly claim that loss of coverage in many instances is due to procedural issues, such as failure to submit required paperwork, including proof of residency.

EY’s second annual Health Equity Outlook Report reflects responses to a survey of 500 health equity executives from various facets of the health care industry. Based upon the results, 73% anticipate health equity to become a higher priority for their entities during the next year, with the majority anticipating increased investments. Nonetheless, the main challenges these leaders face in advancing health equity in their organizations are competing priorities, a lack of financial commitment, and absence of an articulated purpose for health equity.

On April 9, the Arizona Supreme Court, in its Planned Parenthood Arizona, Inc. v. Hayes decision, upheld a state law dating back to 1864, which makes it a felony to perform, or even help a woman obtain, an abortion at any time following conception. The one exception is if the procedure is to save the pregnant woman’s life. Despite the Court’s decision, Arizona Attorney General Kris Mayes has vowed that she will not enforce the abortion ban. Fervent reaction to the Arizona decision quickly made its way up to President Joe Biden, who decreed Arizona’s abortion law as “cruel” and an affront to women’s reproductive rights.

SCOTUS EMTALA Oral Arguments. This week, the Supreme Court will hear arguments in Idaho v. United States and Moyle v. United States, cases asking whether the Emergency Medical Treatment and Labor Act (EMTALA) preempts, under certain emergency circumstances, an Idaho law banning most abortions. The Idaho argument is April 24 at 10 am ET, with an expected ruling by the end of the Supreme Court’s term in June.  Read more about these cases here.

California’s Department of Health Care Services (DHCS), along with the California Health Care Foundation (CHCF), continue to make progress on their recently launched Health Equity Roadmap initiative to advance health equity among Medi-Cal enrollees and eliminate health disparities they currently face. This endeavor is an ongoing, phased process, which seeks to create a more equitable and person-centered health delivery system for California’s largest public health program. What is most promising about this latest policy-driven effort is that DHCS/CHCF are directly engaging Medi-Cal members from across the state to hear their concerns and better understand what they perceive is working with the current program and what needs fixing. In addition, DHCS/CHCF are working with payors, local governments, providers, community-based organizations, and other stakeholders to help pinpoint opportunities that will clearly lead to advancing health equity among the most underserved of Medi-Cal’s beneficiaries, especially BIPOC communities.

Massachusetts (MA) holds the enviable position of being the first state to have all its hospitals meet The Joint Commission’s (TJC’s) new health care equity accreditation standard. The standard requires hospitals to develop an action plan to improve healthcare equity and identify an individual to lead its related activities; analyze quality and safety data to identify disparities; assess patients’ health-related social needs; take action when the hospital does not meet the goals in its action plan; and inform groups, such as patients, staff, and health care partners, about progress to improve healthcare equity. The current plan is that each MA hospital will earn the advanced TJC Health Care Equity Certification by 2025.

New research claims that the Centers for Disease Control and Prevention (CDC) has overstated its reported figures of maternal death rates during the past 20 years. The primary alleged culprit is the CDC’s introduction in 2003 of a new “pregnancy checkbox” on death certificates, which did not require corroborating cause-of-death information. CDC has stated they disagree with the study’s findings and claim methods used in research are known to undercount the mortality rate. Regardless, this potential discrepancy in reported data does not undermine the fact that a maternal health crisis continues to exist in the United States.

A new report examining maternal health care in Louisiana following that state’s near total ban on abortions found that pregnant women are commonly being denied timely procedures–often in the face of life-threatening medical situations–primarily because physicians are acting cautiously to avoid even the appearance of performing an abortion.

Last month, as required by the Coronavirus Aid, Relief, and Economic Security Act (CARES) Act, the Office of Civil Rights (OCR) released its highly anticipated Final Rule modifying standards applicable to the confidentiality and release of substance use disorder (SUD) patient records (a/k/a “Part 2”) to more closely align with HIPAA’s privacy and related regulations. You can read our alert on the Final Rule here: Part 2 Update: HHS Final Rule Aligning Federal Protections for Substance Use Disorder Records with HIPAA.