The racial disparity between white and black cancer patients in accessing timely treatments has virtually disappeared in states where Medicaid expanded under the Affordable Care Act (ACA), according to a new study. Yale Cancer Center researchers analyzed more than 30,000 health records and found that, prior to Medicaid expansion, black adults with advanced or metastatic cancer were 4.8 percentage points less likely than white adults to begin treatments within 30 days of being diagnosed. But in states where Medicaid was expanded, in 2014 or later, the percentage of black patients getting timely treatment rose from 43.5 percent to 49.6 percent. There also was a small improvement in expansion states among white patients receiving timely treatment – from 48.3 percent to 50.3 percent – bringing the post-expansion difference between the two racial groups to less than one percentage point. “Our results suggest that Medicaid expansion led to improved health equity,” said study author Amy Davidoff, a senior research scientist at Yale School of Public Health and in Yale Cancer Center’s Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER).
It’s a summer afternoon and parents with their young children have gathered to hear what a nutritionist with Women, Infants and Children (WIC) has to offer. They watch with intrigue as Mary Paige demonstrates how to make yogurt dots from frozen Greek yogurt and French fries from roasted parsnips and carrots. After a 10-minute demo in the WIC office at Yale New Haven Hospital’s Primary Care Center, Stephany Uriostegui of West Haven is sold. She can’t wait to try the recipes at home for her 10-month-old son and 5- and 7-year-old daughters. “I always buy the [yogurt dots] from Walmart,” she said.
Iasiah Brown, 25, of New Haven, said he does not see a need for a primary care doctor for himself and his daughter, opting to visit clinics in the area instead of waiting up to two weeks for an appointment at a doctor’s office. Brown is among the 83 people who said they didn’t have a primary care doctor in response to a health-care usage survey by the Conn. Health I-Team and Southern Connecticut State University. The team surveyed 500 people and interviewed dozens statewide between January and March. About 83 percent of respondents said they had a primary care doctor, but the rate was lower for African American (78 percent) and Hispanic respondents (75 percent).
Once a week, every week, the health center at Stamford High School offers sophomore Roger Sanchez an oasis—someplace he can talk to a trusted adult about life’s pressures and problems, a place he feels free and unjudged. School work, sports commitments, family and social obligations: life as a teenager can be stressful, he says. If it weren’t for the health center, conveniently located where he spends most of his days, he would have a much harder time accessing counseling sessions that help him cope with anxiety. “The health center helps me out academically, emotionally and physically,” he said, and he recommends it to friends. “They get nervous, kind of, but I try my best to get them to come in.
A few years ago, patient navigators at Project Access-New Haven set out to see if they could change the course of health care treatment for some Medicaid patients who frequently used emergency rooms.
They contacted emergency departments at Yale New Haven Hospital and its Saint Raphael campus and enrolled 100 patients in their study in 2013. Those selected had visited emergency rooms four to 18 times in the past year for chest pain, abdominal pain or chronic migraines, among other ailments. The navigators at Project Access coordinated health care for the patients. They scheduled appointments with primary care physicians, provided reminders, accompanied patients to physician visits and followed up to ensure compliance with the prescribed treatment. The preliminary results were eye-opening: “We saw an average cost reduction of $153 per member per month,” said Dr. Roberta Capp, assistant professor, Department of Emergency Medicine at the University of Colorado Denver, and lead investigator of the study.
Connecticut has seen significant reductions in deaths from breast and colon cancer in the last three decades, but the state exceeds the national mortality rate for uterine cancer and three other cancers, as well as for mental health and substance use disorders. An analysis of data compiled by the Institute for Health Metrics and Evaluation at the University of Washington, published in JAMA, also shows wide disparities between Connecticut counties in death rates from certain cancers and other illnesses. Windham County had the highest mortality rates for seven of 10 cancers identified in the study as having the highest disease burden or responsiveness to screening and treatment, including pancreatic, uterine and lung cancer. Tolland County, meanwhile, had the lowest death rates for five cancers, including breast cancer, while Fairfield County was lowest for four. Similarly, deaths from chronic respiratory diseases in Windham County were nearly double the rate in Fairfield County – 63.13 per 100,000, compared to 34.15.
In 2015, the Rev. Nancy Butler, the charismatic founder of Glastonbury’s Riverfront Family Church who died earlier this month, was diagnosed with ALS, or Lou Gehrig’s disease. Neither the advanced degrees she and her husband, Gregory B. Butler, earned nor his experience as a corporate lawyer prepared them for the complexities of the health care system. “My wife gets sick and I don’t have a clue how to navigate,” Greg Butler said. “This stuff is enormously complicated. What does your insurance cover?
Blacks and Hispanics are less likely than whites to get flu vaccines, have a preventive health care visit, or receive follow-up care after being hospitalized for a mental health disorder, according to a first-of-its kind federal report that looks at health disparities among people on Medicare Advantage plans. “While these data do not tell us why differences exist, they show where we have problems and can help spur efforts to understand what can be done to reduce or eliminate these differences, ” said Dr. Cara James, director of the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health, which released the report. The report looks at 27 clinical care measures and eight patient experiences to gauge differences in treatment among whites, blacks, Hispanics, and Asians or Pacific Islanders. It has some bright spots: Blacks and Hispanics reported slightly better communication with doctors than whites did. Hispanics had higher rates than non-Hispanic whites of colorectal screenings, blood sugar testing for diabetes, and treatment for osteoporosis (among women) after a fracture.
Thousands of Connecticut residents are prediabetic but don’t know it and if they did, doctors say, early detection and lifestyle changes could prevent diabetes from developing in most people at risk. The state Department of Public Health reports that 83,000 adults in Connecticut have prediabetes, which occurs when a person’s blood sugar level is higher than normal but not high enough to be classified as Type 2 diabetes. Nearly 9 percent of adults in the state—about 257,000 people—have been diagnosed with Type 2 diabetes. Prediabetes has few early warning signs, but a blood test by a primary care doctor can detect at-risk patients. Once detected, changes in diet and exercise, sometimes with medication, can stave off the disease, doctors say.
Health insurance coverage might be more accessible and affordable in Connecticut if the state applied for certain Affordable Care Act and Medicaid waivers, according to advocates who say the options should be explored. Two waivers in particular—Affordable Care Act (ACA) Section 1332 and Medicaid Section 1115—would let the state disregard certain federal requirements, possibly lowering health care costs for some individuals, according to a policy brief commissioned by the Universal Health Care Foundation of Connecticut and the Connecticut Health Foundation. “What we need to do in Connecticut is really think about … how could we creatively, imaginatively, innovatively use waivers to expand coverage to quality care and really help improve health,” said Frances Padilla, president of Meriden-based Universal Health Care Foundation of Connecticut. “We haven’t had that conversation yet in Connecticut.”
The ACA waiver isn’t available until 2017 but the Medicaid waiver is already being used by dozens of other states to lower costs, she said. “It allows a state to get past some of the requirements of Medicaid and do some things that are innovative,” she said of the Medicaid waiver.