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).
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?
Hypertension rates among women in all eight Connecticut counties increased from 2001 to 2009, with disparities widening for African American women compared to whites and Hispanics, according to a C-HIT analysis of data from the Institute for Health Metrics and Evaluation at the University of Washington. In fact, nearly one out of every two African American women living in Connecticut suffers from hypertension, a life-threatening condition that can lead to heart attack, stroke and kidney disease, research shows. The rising trend in hypertension coincides with increasing adult obesity rates in Connecticut and the nation, as stepped up efforts focusing on wellness — from Michelle Obama’s national physical activity campaign “Let’s Move!” to serving healthier meals at local public schools — look to stem the tide in future generations. The state findings on hypertension mirror national statistics showing black women with the highest rates. In Connecticut, health experts pointed to a mix of genetic, socioeconomic, and cultural factors as contributing to hypertension among black women.
Cheila Serrano knows educating Hispanics who are uninsured and underinsured about the new options available at Access Health CT – the health insurance marketplace that opens for business today – presents a unique set of problems.
But with one in every four Hispanics lacking coverage, Serrano, a program director at Junta for Progressive Action in New Haven, is up for the challenge. Connecticut’s Hispanics represent the fastest-growing, youngest and poorest segment of the state’s population. Estimates of Connecticut’s uninsured vary. Approximately 344,000 people lack health insurance in Connecticut and 65 percent of the state’s uninsured are minorities, according to data being used by Access Health. Estimates released by the U.S. Census Bureau in September, however, put the uninsured at 284,000.