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The Commonwealth Fund Connection

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




February 7, 2022

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Undoing the Effects of Medical Racism, One Provider and One Patient at a Time
Health care inequities in the United States mirror a societal divide fueled by long-standing racial, social, and economic segregation. A new Commonwealth Fund video, “The Divide: Confronting Racism in American Health Care,” shows how one city is taking action to dismantle the effects of medical racism. In St. Louis, the Pipeline to Compassionate Care program is seeking to nurture primary care practitioners with a passion for community medicine, helping medical education institutions train future doctors in trauma-informed care, the social and structural determinants of health, and the principles of antiracism.

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WATCH THE VIDEO

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How Build Back Better Would Advance Racial Equity in Coverage
Although the Affordable Care Act (ACA) led to historic gains in insurance coverage, large racial and ethnic disparities persist in nearly every state. With the Build Back Better Act stalled in the U.S. Senate, additional progress toward equitable health care coverage is at risk. On To the Point, the Commonwealth Fund’s Jesse Baumgartner and Laurie Zephyrin, M.D., review three key policies that would advance coverage equity.

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A Federal Fallback Strategy for Closing the Medicaid Coverage Gap
In the 12 states that have yet to expand Medicaid eligibility under the ACA, many people are caught in the so-called Medicaid coverage gap — ineligible for Medicaid but earning too little to qualify for ACA marketplace subsidies. George Washington University’s Sara Rosenbaum explains how a provision of the Build Back Better Act would offer a temporary federal fallback solution.

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If Mississippi Expanded Medicaid, the Impact Would Be Huge
Mississippi is one of 12 states that has opted not to expand Medicaid, despite having the country’s fifth-highest uninsured rate. Manatt Health researchers Adam Striar, Patricia Boozang, and Cindy Mann report that if the state were to expand eligibility, about 230,000 Mississippi adults with low income would gain Medicaid coverage over six years. What’s more, the expense of providing services to these new enrollees would be offset by the federal government, allowing Mississippi to significantly improve its residents’ health and well-being at zero net cost.

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Bolstering the U.S. Public Health System in the Wake of COVID-19
For decades, the U.S. public health system has been chronically underfunded. While Congress passed several relief and recovery bills during the COVID-19 pandemic, it has not yet advanced a significant effort to bolster the public health infrastructure. Experts from the Wynne Health Group and the Commonwealth Fund outline policies included in the Build Back Better Act that would invest in the nation’s public health system.

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The Supreme Court Weighs In on COVID-19 Vaccine Mandates
On January 13, the Supreme Court allowed the Centers for Medicare and Medicaid Services’ COVID-19 vaccination requirement for 10.4 million health care workers to take effect, but it blocked the Occupational Health and Safety Administration’s sweeping vaccinate-or-test mandate aimed at large businesses. Health law expert Timothy Jost considers the issue underlying both cases: whether Congress had empowered the two agencies to enact mandates to stem the pandemic.

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Getting to Net Zero: One Health System Fights Climate Change
Climate change can have a devastating impact on our health. But the health care sector itself is responsible for 4.5 percent of all greenhouse gas emissions. What can health systems do to address climate change? In the United Kingdom, the National Health Service (NHS) has set some ambitious goals to reduce its carbon footprint. On the latest episode of The Dose podcast, Nick Watts, the NHS’s chief sustainability officer, talks about how the health service is meeting these goals, and whether its efforts could be replicated in countries like the United States.

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Community Health Workers Meet Patients' Medical and Social Needs
Community health workers (CHWs) have led vaccine drives, delivered food, and otherwise helped people through the pandemic — with much of their work supported by the CARES Act and the American Rescue Plan. Now a bipartisan group of senators has introduced the
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Building a Sustainable Workforce for Healthy Communities Act , intended to create longer-term funding streams to support CHWs. Commonwealth Fund researchers explain how
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New Mexico deploys CHWs to help people find better jobs, stable housing, and nutritious food and how
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CHWs in Vermont help patients manage their conditions and find social supports.

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Making the Business Case for Social Health Integration
There is now widespread support within primary health care for addressing the social factors that affect health, like screening patients for food security, stable housing, and employment and linking people to services and supports. But there hasn’t been much consideration given to how health care organizations can fund these services over the long term. In a new Commonwealth Fund brief, Therese Wetterman and Lea Tompsett, both formerly of Health Leads, explore how organizations can make the business case for sustainably scaling and spreading social health interventions.

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Is Medicare’s Mental Health Coverage Meeting the Needs of Older Adults?
Nearly all U.S. adults over age 65 have some mental health coverage through Medicare. But are those benefits enough to ensure they get needed treatment? A new study based on the Commonwealth Fund’s latest international health survey finds that, compared to older adults in 10 other high-income countries, U.S. Medicare beneficiaries are far more likely to report being diagnosed with a mental health condition — and to experience cost-related problems getting needed care. And among all populations surveyed, Hispanic/Latinx Medicare beneficiaries have the highest rates of diagnosed mental health conditions and emotional distress.

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Using Price Regulation to Advance Market Competition
Many people believe that robust competition in U.S. commercial health insurance markets must include provider price competition. Other developed countries, however, commonly implement price regulation to support competition. In a Commonwealth Fund–supported article in Health Affairs, Robert Berenson and Robert Murray challenge conventional wisdom by urging U.S. policymakers to consider regulations that limit out-of-network provider prices and establish flexible hospital budgets.

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