Closing Racial and Ethnic Disparity Gaps for Women
Posted by on July 19, 2013 - 11:57am

For all intents and purposes, the Affordable Care Act (ACA), the President’s signature piece of legislation, will provide more health care coverage to poor and underserved populations. Persistently disadvantaged communities have much further to go than those with insurance, and new means of accessing and paying for care will benefit them disproportionately. Nevertheless, with more than 20 percent of the nation’s Black population uninsured, more than 30 percent of Hispanics uninsured and a country still grappling with understanding and properly addressing disparities, just how far does the ACA take uninsured women in the US?

By mandating individual health insurance coverage and expanding the list of covered preventative services, ACA legislation should, theoretically, improve the quality of health care for women at a disproportionate risk of being uninsured and having low incomes. However, research has shown that having health insurance itself does not necessarily have a substantial impact if women cannot find a doctor to see them, do not have proper information about accessing resources, or are not treated in a culturally and environmentally competent manner.

Moreover, when the number of uninsured could be decreased by more than half, but being uninsured is not equitable across racial and ethnic groups in the US, what happens to our countries most vulnerable women and children?

It has been well documented that low-income women and those without employee-sponsored insurance (ESI) are more likely to be women of color. Kaiser and US Census estimates indicate that there are significant differences in insurance rates by race and ethnicity, with national averages approximating there are almost three times as many uninsured Hispanics as Whites. In Louisiana, for example, it is believed that more than 50% of the state’s Hispanics are uninsured, while only 18% of Whites are. In the same state, it is estimated that 30% of Blacks are uninsured, reiterating just how unbalanced our country remains and how terribly far we have to go to eliminate inequalities.

Even in Massachusetts, where health reform has been a success, the number of Blacks and Hispanics that remain uninsured is two and three times that of Whites, respectively.

Although the ACA takes us a step forward in giving many of the countries uninsured woman an insurance card, the US must address what to do about probable provider shortages that will result from a lack of primary care physicians and different utilization in care between races, ethnicities and gender. We must be prepared to understand both to cultural differences in demand and pent-up demand of the previously uninsured, as well as start to really face how to deal with persistent racial and ethnic inequality in this nation that shows itself in our health care system every day.

Midwives are Integral Part of Greater Access to Women's Health Care
Posted by on November 6, 2012 - 11:23am

While the country struggles to provide affordable, quality health care to all Americans, a primary focus has been on women and children. However, one group of care providers is rarely discussed by health policymakers despite their significant contributions to health care: Midwives.

Certified nurse-midwives (CNMs) and certified midwives (CMs) provide high quality primary and maternity care to women and families. CNMs are recognized under federal law as primary care providers for women. They provide family planning services, gynecology services, primary care, childbirth and postpartum care, care of children for the first 28 days of life, and treatment of male partners for sexually transmitted infections. Midwives also use their credentials to prescribe medication, admit, manage and discharge patients, and interpret laboratory and diagnostic tests. These skills allow midwives to offset many of the primary and maternal care functions of MDs, and do so with lower costs.

The Institute of Medicine published in its report The Future of Nursing that critical workforce shortages are being seen across all health care systems, especially in primary and maternity care. There is a vast amount of literature that suggests CNM and CM professionals provide a high-value, cost-effective, patient-centered form of care in exactly those arenas. As 2014 and greater implementation of the Affordable Care Act nears, access to midwives is ever increasing, with the Affordable Care Act granting midwives 100% reimbursement under Medicare Part B. Further, new nondiscrimination requirements have been employed to ensure that individual and group health insurance plans must cover these services for women.

Nevertheless, many stakeholders including clinicians and policymakers are unaware of or fail to discuss the significant role midwives will play in health reform. Nor are they adequately addressing how barriers to their practicing medicine continue to play out in the medical world. It’s about time we make sure all women’s preventative and maternal services are given full attention and made effective.