A central aim of governmental efforts to improve individual and community health status in the U.S. is to remove inequities. Many kinds of social determinants influence the extent to which all segments of the population benefit from having equal access to high quality health care services. One factor affecting the ability to obtain services has to do with one’s residential location. For example, a report issued in September 2022 from the American Hospital Association highlights the variety of causes that resulted in 136 rural hospital closures from 2010 to 2021, and a record 19 closures in 2020 alone. Many longstanding pressures are involved, such as low reimbursement, staffing shortages, low patient volume, and regulatory barriers, as well as the continued financial challenges associated with the COVID-19 pandemic. The report outlines several pathways for rural hospitals to achieve financial sustainability, including additional federal support, flexible models of care, decreased regulatory burden, partnership arrangements, and state Medicaid expansion. The AHA also continues to urge Congress to extend the Medicare-dependent Hospital and enhanced Low-volume Adjustment programs, which are set to expire this month. The programs provide vital support for geographically isolated rural hospitals with low patient volumes.
Apart from having accessibility to hospitals, other examples can be provided about unequal use of health care services. A data brief from the Office of the Inspector General at the Department of Health and Human Services (HHS) in September 2022 reveals that the COVID-19 pandemic created unprecedented challenges for how Medicare beneficiaries access health care. The Centers for Medicare & Medicaid Services (CMS) took a number of actions to expand access to telehealth for Medicare beneficiaries temporarily. More than 28 million, about two in five, Medicare beneficiaries used telehealth during the first year of the pandemic. CMS increased the types of services that beneficiaries could use via telehealth, from 118 to 264 service types. Beneficiaries in urban areas were more likely than those in rural areas to use telehealth. In total, 45% of beneficiaries in urban areas used telehealth during the first year of the pandemic. They accounted for more than 24 million of the 54 million Medicare beneficiaries living in urban areas. In contrast, just 33% percent of beneficiaries in rural areas used telehealth. They accounted for more than three million of the more than 11 million Medicare beneficiaries living in rural areas. Reasons for this disparity pertain to rural populations being less likely than residents in urban areas to have access to broadband connectivity. Rural health care providers also may face challenges providing telehealth to their patients because equipment and internet connectivity can be too expensive.
Poverty And Health Insurance Coverage
The U.S. Census Bureau announced on September 13, 2022 that real median household income in 2021 was not statistically different than 2020. The official poverty rate of 11.6% also was not statistically different between 2020 and 2021. The Supplemental Poverty Measure (SPM) rate in 2021 was 7.8%, a decrease of 1.4 percentage points from 2020. Meanwhile, the percentage of individuals with health insurance coverage for all or part of 2021 was 91.7% (compared to 91.4% in 2020.) An estimated 8.3% of the population, or 27.2 million, did not have health insurance at any point during 2021, according to findings from the 2022 Current Population Survey Annual Social and Economic Supplement (CPS ASEC). That amount compared with an estimated 8.6% of the population, or 28.3 million, who did not have health insurance at any point during 2020. In 2021, private health insurance coverage continued to be more prevalent than public coverage, at 66.0% and 35.7%, respectively. Some individuals may have more than one coverage type during the calendar year. Of the subtypes of health insurance, employer-based insurance was the most common, covering 54.3% of the population for some or all of the calendar year.
Constitutionality Of Affordable Care Act Continues To Foster Litigation
A federal judge in Texas agreed this month with plaintiffs that requiring insurers to cover the costs of medications for HIV pre-exposure prophylaxis (PrEP) infringed on their religious rights, effectively eliminating a central tenet of the Affordable Care Act (ACA). Under the ACA, most health plans are required to pay for a range of preventive services. The decision came in response to Braidwood Management v. Becerra (formerly Kelley v. Becerra). Plaintiffs argued that the ACA requirement for insurers to pay for certain preventive services was unconstitutional, because it encouraged behavior that clashed with their personal and religious beliefs, such as services related to reproductive and sexual health.