Health care in this nation is affected by a wide range of social forces, including demographic perturbations. An opinion item published on November 10, 2021 in The Milbank Quarterly discusses some implications of a recent sharp decline in birth rates in the United States. Based on provisional data provided by the National Vital Statistics System in May 2021, the U.S. birth rate dropped 4% in 2020 and already was at a record low before the COVID-19 pandemic. The 2020 birth rate was 55.8 live births for every 1,000 females ages 15-44, trending downward for the sixth consecutive year.
The total fertility rate (TFR), a population statistic that simulates the average number of children females in a birth cohort will have if they go through life with current age-specific birth rates, also is trending downward. The TFR in the United States plummeted from 2.12 in 2007 to a record low of 1.64 in 2020, which is far below the level of 2.1 needed for population stability. When the TFR drops below 2.1 (the break-even replacement level), a population will age dramatically in the absence of immigration. Will such an occurrence pose societal challenges?
A major concern is that the reduced rate contributes to labor shortages and also will increase the population “total dependency ratio,” i.e., the ratio of the number of individuals in age groups not typically in the labor market (0-14 and 65+ years) to the number in all other age groups, multiplied by 100. U.S. Census Bureau data show that the U.S. dependency ratio was 59 in 2010, 64 in 2019, and is projected to be 73 by 2050 primarily due to population aging from the 1946-1964 Baby Boom. Additional declines in birth rates without offsets from immigration will further increase the dependency ratio, which raises serious concerns about economic stability/growth and the ability of the working population to support the social, financial, and health care needs of the dependent population. Policy-makers are faced with the task of devising workable interventions to prevent any deterioration in the nation’s ability to address the population’s health care needs effectively.
Why Measurement Matters In Advancing Health Equity
A blog published on November 2, 2021 by The Commonwealth Fund refers to how the COVID-19 pandemic exposed long-standing racial and economic injustices embedded in the U.S. health care system. One result is a renewed commitment to improve health equity and address the drivers of health (DoH) that account for 80% of health outcomes and have a disproportionate impact on communities of color, including stable, affordable housing; healthy food; reliable income; and interpersonal safety, among other factors. Advancing health equity and addressing DoH will require changing both how and what is measured in health care. Measurement plays a fundamental role because it equips providers with data to identify and address unmet needs, and allows policymakers and payers to account for DoH in payment models.
Despite the well-documented impact of DoH on health outcomes and costs and their impact on people of color, there still are no approved, standardized measures in any Centers for Medicare and Medicaid Services’ (CMS) programs. Although a growing number of CMS Innovation Center models are incorporating DoH screening and navigation on social needs, they use different tools and approaches, which means that CMS cannot systematically compare or use the data. On the positive side, the recently released CMS Innovation Center Strategy Report will require participants in all new models to collect and report beneficiaries’ demographic data and social needs data, when appropriate.
HealthCare.gov Open Enrollment Begins
November 1, 2021 marked the start of the HealthCare.gov Open Enrollment Period. This year, the period has been extended to January 15 to ensure that enough time is available to obtain health insurance coverage. The number of Navigators to assist with the process of obtaining coverage has been quadrupled so that now there are 1,500 of them. As a result of the American Rescue Plan (ARP), coverage also is more affordable. Four out of five individuals can find a plan for $10 or less per month with this newly expanded financial assistance. Additionally, there are more coverage options this season than last, with the average consumer being able to choose between six and seven insurance companies with plan options.