The Connection

A roundup of recent Fund publications, charts, multimedia, and other timely content.

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February 26, 2024

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Health Care Workers Often Witness Racism and Discrimination

A new report from the Commonwealth Fund and the African American Research Collaborative reveals widespread racism and discrimination across U.S. health care facilities. The findings come from a first-of-its-kind national survey of more than 3,000 health care workers. Some key findings: nearly half of health care workers have witnessed discrimination against patients in their facilities; 57 percent said patients are treated differently based on their race and ethnicity; and younger health care workers and workers of color were more likely than their older or white counterparts to acknowledge witnessing discrimination.

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People in Medicare Advantage Plans More Likely to Report Care Delays

Growing enrollment in private Medicare Advantage (MA) plans, now almost equal to that in traditional Medicare, raises questions about how coverage experiences compare for the two groups. According to a new Commonwealth Fund survey, two-thirds of all beneficiaries say their coverage fully meets their expectations. But while similar shares of people in MA and traditional Medicare said they had to wait more than a month to see a doctor, those in MA plans were more likely to report delays due to needed approval.

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FEATURED CHART

Protecting Consumers from Surprise Ambulance Bills

Federal law protects consumers from many of the most prevalent forms of surprise medical billing, but not from bills for ground ambulance services. While a government advisory committee has sent recommendations to Congress to remedy the omission, 14 states have already passed laws to protect consumers. On To the Point, Georgetown University’s Jack Hoadley and Nadia Stovicek say these state laws, while beneficial, are not comprehensive. With a roadmap from the advisory committee, Congress could move to fill in the gaps and shield patients from unexpected ambulance charges.

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Medicaid Could Do More to Provide Financial Protections

Medicaid has two primary goals: ensuring people with low income have access to quality care and protecting them from the financial stress of costly medical expenses. As Tulane University’s Brigham Walker and colleagues explain, Medicaid does a lot to improve the financial health of those it covers, but there’s a lot the program doesn’t cover. That’s why it’s important that policymakers clarify rules on noncovered but medically necessary drugs, broaden benefits to include dental and vision care, and step up monitoring of provider billing practices, the authors say.

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How States Help Immigrants Get Affordable Coverage

The U.S. uninsured rate reached a historic low in 2023, but millions of people still lack comprehensive health coverage — including a disproportionate number of immigrants. Georgetown University’s Justin Giovannelli and Rachel Schwab say that while undocumented immigrants have limited health insurance options, some states — Colorado, Minnesota, New York, and Washington — are taking steps to expand coverage. The authors point out, however, that a truly comprehensive solution will most likely require changes to federal law.

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Enhancing Health Care Access Post-Incarceration

With research showing a clear link between health status and recidivism, policymakers are currently expanding Medicaid’s role in covering health services for people leaving incarceration. As key health system access points, community health centers can play an important role in delivering effective care to this population, but they face a number of operational and policy barriers to scaling their work, say John Sawyer and colleagues in a new Commonwealth Fund brief. Addressing these challenges will be crucial to the success of new Medicaid reentry initiatives now underway.

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Finland Sees Housing and Health as Inextricably Linked

Over four decades, Finland reduced its homeless population from 20,000 people to less than 3,700 last year. In the United States, about 20 of every 10,000 Americans lacked stable housing in 2023. The health consequences of not addressing the crisis are clear: people who experience homelessness have higher rates of illness, and unhoused people are more likely to have behavioral health needs. In the latest International Insights, the Commonwealth Fund’s Munira Gunja looks at Finland’s approach to curbing homelessness and improving health, and what lessons the U.S. could learn from them.

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Reforms Could Expand Behavioral Health Care Access

This year, Medicare will increase coverage for behavioral health services that community health workers and peer support specialists provide. Commonwealth Fund senior fellow Nathaniel Counts explains how these reforms will expand the type of providers eligible for reimbursement while increasing resources for early intervention and crisis care. Counts says the reforms also acknowledge the importance of addressing Medicare beneficiaries’ social needs.

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Study: Unequal Access to In-Person Medicare Counseling

Medicare coverage choices are numerous and complex. Federally funded State Health Insurance Assistance Programs provide beneficiaries with counseling and education on their coverage options, but little is known about the population this service reaches. A new Commonwealth Fund–supported study in the American Journal of Managed Care shines a light on potential inequities with in-person access to plan choice information. Researchers Melissa M. Garrido and Allison Dorneo found Medicare counseling locations to be disproportionately located in higher-income communities — despite the greater need for assistance in socioeconomically disadvantaged areas.

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How Clinicians Can Tackle Climate Change

Health care, it turns out, has a large carbon footprint. But who in the sector is responsible for reducing the emissions and waste it produces? While the short answer is everyone, Maria Gaden of Denmark’s Center for Sustainable Hospitals says clinicians, as drivers of health care consumption, are uniquely positioned to take immediate action while waiting for new laws, regulations, and incentives to be put in place. She explains that some 80 percent of health care emissions come from the goods and services used when treating patients, from single-use medical equipment and medicines to gloves, gowns, and scrubs.

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State Public Health Practice After COVID-19

What went wrong during COVID-19, and what can be done to make authorities in the U.S. better equipped for the next pandemic? In their study of how shifts in the public health landscape during the pandemic affect ongoing public health practice, Fund grantee Michelle Mello and colleagues write in BMJ that recent state legal reforms have generally exacerbated, rather than improved, weaknesses in states’ ability to respond to future public health threats.

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Helping Older Americans Age in Place

Last week, public radio station WUFT in Gainesville, Florida, reported on how the Alzheimer’s Association has dispatched its “Brain Bus” to provide education and navigation supports in rural communities ([link removed] ) where hospital closures and shortages of neurologists make it difficult for people to access dementia treatment. Commonwealth Fund researchers recently explored additional strategies rural communities are using to increase access ([link removed] ) to health care services and supports to help older Americans age in place.

Affordable, quality health care. For everyone.

The Commonwealth Fund, 1 East 75th Street, New York, NY 10021

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