{"id":112,"hero_image":"https:\/\/defendfairaccess.org\/wp-content\/uploads\/2019\/08\/home-graphic.png","page_title_en":"","page_title_es":"","page_title_fr":"","page_subheader_en":"Doing right does not need to come at a high cost.\r\n<br><br>\r\nTogether we can achieve health equity at a fair price for all.","page_subheader_es":"Hacer lo correcto no tiene que tener un alto costo.\r\n<br><br>\r\nJuntos podemos lograr la equidad en salud a un precio justo para todos.","page_subheader_fr":"Faire la bonne chose n\u2019a pas besoin de venir \u00e0 un co\u00fbt \u00e9lev\u00e9. <br><br>Ensemble, nous pouvons atteindre l\u2019\u00e9quit\u00e9 en sant\u00e9 \u00e0 un juste prix pour tous.","page_content_2_en":"We prioritize working with safety nets, rural hospitals, critical access hospitals and other groups who focus their work on those most vulnerable to cost and inequities. We think a lot about the costs associated with receiving necessary care and the obstacles that prevent each of us from getting\u2014and staying\u2014healthy. We are especially concerned with the most vulnerable among us, such as those with limited income and those without adequate health insurance. We work to achieve equitable health solutions that are a win-win-win for patients, payers and providers throughout North America.","page_content_2_es":"Pensamos mucho en los costos asociados con la recepci\u00f3n de la atenci\u00f3n necesaria y los obst\u00e1culos que nos impiden a cada uno de nosotros llegar y mantenernos saludables. Estamos especialmente preocupados por aquellos m\u00e1s vulnerables entre nosotros, como aquellos con ingresos limitados y aquellos sin seguro m\u00e9dico adecuado. Trabajamos para lograr soluciones de salud equitativas que sean beneficiosas para todos los pacientes, pagadores y proveedores en toda Am\u00e9rica del Norte.","page_content_2_fr":"Nous pensons beaucoup aux co\u00fbts associ\u00e9s \u00e0 la r\u00e9ception des soins n\u00e9cessaires et aux obstacles qui emp\u00eachent chacun de nous de devenir - et de rester - en bonne sant\u00e9. Nous sommes particuli\u00e8rement pr\u00e9occup\u00e9s par les plus vuln\u00e9rables d'entre nous, tels que ceux \u00e0 revenu limit\u00e9 et ceux qui n'ont pas d'assurance maladie ad\u00e9quate. Nous travaillons \u00e0 la mise au point de solutions de sant\u00e9 \u00e9quitables qui profitent aux patients, aux payeurs et aux fournisseurs partout en Am\u00e9rique du Nord.","page_content_en":"<p>Fair Play is a nonpartisan, nonprofit research, advocacy and pro bono consulting group that creates sustainable solutions for the global affordability and health equity issues facing us locally. We work with payers, providers and patients to address barriers to care caused by root causes of poor health\u2014particularly where poverty and health care intersect. We conduct original research on cost and affordability, identifying issues and promoting positive solutions that eliminate those hurdles to care. Finally, we advocate for positive policy to address the issues that keep too many of us from accessing affordable necessary care.<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_es":"<p>Fair Play es una organizaci\u00f3n no partidista, sin fines de lucro, que trabaja con los contribuyentes, los gobiernos, los grupos de expertos y los sistemas de salud para abordar las barreras a la atenci\u00f3n causadas por las causas fundamentales de la mala salud, particularmente donde se cruzan la pobreza y la atenci\u00f3n m\u00e9dica.<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_fr":"Fair Play est une organisation non partisane et sans but lucratif qui travaille avec les payeurs, les gouvernements, les groupes de r\u00e9flexion et les syst\u00e8mes de sant\u00e9 pour \u00e9liminer les obstacles aux soins caus\u00e9s par les causes profondes de la mauvaise sant\u00e9, en particulier lorsque la pauvret\u00e9 et les soins de sant\u00e9 se recoupent.\r\n<style>header nav a:last-child { display:none !important; }<\/style>","page_content_link_en":"Learn more here","page_content_link_es":"Aprende m\u00e1s aqu\u00ed","page_content_link_fr":" En savoir plus ici","page_content_url":"about","home_block1_title_en":"Click to learn more about who we are","home_block1_title_es":"Haga clic para obtener m\u00e1s informaci\u00f3n sobre qui\u00e9nes somos","home_block1_title_fr":"Cliquez pour en savoir plus sur qui nous sommes","home_block2_title_en":"Click to learn how we can help","home_block2_title_es":"Haga clic para aprender c\u00f3mo podemos ayudarlo","home_block2_title_fr":"Cliquez pour savoir comment nous pouvons aider","home_block3_title_en":"Click here to read our research and briefs and to hear our podcasts","home_block3_title_es":" Haga clic aqu\u00ed para leer nuestras investigaciones y res\u00famenes y para escuchar nuestros podcasts","home_block3_title_fr":" Cliquez ici pour lire nos recherches et nos m\u00e9moires et pour \u00e9couter nos podcasts","home_block_1_content_en":"Learn more about how Fair Play started, who runs it and how we work. ","home_block_1_content_es":"Conozca m\u00e1s acerca de c\u00f3mo comenz\u00f3 Fair Play, qui\u00e9nes lo dirigen y c\u00f3mo trabajamos. ","home_block_1_content_fr":"Apprenez-en plus sur les d\u00e9bute de Fair Play, qui la dirige et comment nous travaillons. ","home_block_2_content_en":"Fair Play provides sliding scale consulting services to safety nets, nonprofit hospitals and other groups that address issues of access.","home_block_2_content_es":"Fair Play brinda servicios de consultor\u00eda de escala m\u00f3vil a redes de seguridad, hospitales sin fines de lucro y grupos que trabajan en temas de acceso.","home_block_2_content_fr":"Fair Play fournit des services de consultation \u00e0 \u00e9chelle mobile aux filets de s\u00e9curit\u00e9, aux h\u00f4pitaux \u00e0 but non lucratif et aux groupes travaillant sur des questions d'acc\u00e8s.","home_block_3_content_en":"We firmly believe in backing up our beliefs and our work is evidence of that. ","home_block_3_content_es":"Creemos firmemente en respaldar nuestras creencias, y nuestro trabajo es evidencia de ello.","home_block_3_content_fr":"Nous croyons fermement au soutien de nos croyances et notre travail t\u00e9moigne de cela.","home_block1_link":"About","home_block2_link":"Services","home_block3_link":"ideas","seo_title_en":"Fair Play | Health and economic research, policy and consulting","seo_title_es":"Fair Play | Salud, investigaci\u00f3n econ\u00f3mica, pol\u00edtica y consultor\u00eda","seo_title_fr":"Fair Play | Sant\u00e9, recherche \u00e9conomique, politique et consultation","seo_description_en":"Fair Play is a nonpartisan not-for-profit research, policy and consultancy group that works to eliminate barriers to health care rooted in cost and affordability.","seo_description_es":"Fair Play es un grupo de investigaci\u00f3n, pol\u00edtica y consultor\u00eda no partidista sin fines de lucro que trabaja para eliminar las barreras a la atenci\u00f3n m\u00e9dica arraigadas en el costo y la asequibilidad.","seo_description_fr":null,"featured_ideas":[{"slug":"coronavirus-threatens-the-lives-of-rural-hospitals-already-stretched-to-breaking-point","ideas_cat":"Recommended","main_image":"https:\/\/defendfairaccess.org\/wp-content\/uploads\/2020\/04\/Rural-Hospital-1.jpg","page_title_en":"Coronavirus threatens the lives of rural hospitals already stretched to breaking point","page_title_es":"Coronavirus threatens the lives of rural hospitals already stretched to breaking point","page_title_fr":"Coronavirus threatens the lives of rural hospitals already stretched to breaking point","page_content_en":"<p>Rural hospitals may not be able to keep their doors open as the coronavirus pandemic saps their cash, their CEOs warn, just as communities most need them.<\/p>\n<p>As the coronavirus sweeps across the United States, all hospitals are facing cancellations of doctor visits and procedures by a terrified populace \u2014 profitable services that usually help fund hospitals. Meanwhile, the institutions also find themselves needing to pay higher prices for personal protective equipment such as face masks and other gear that\u2019s in short supply. Vice President Mike Pence called on hospitals nationwide Wednesday to <a href=\"https:\/\/time.com\/5805715\/mike-pence-hospitals-delay-elective-procedures\/\">delay elective surgeries<\/a> to free up capacity and resources for future coronavirus patients.<\/p>\n<p>The American Hospital Association responded Thursday by asking Congress for <a href=\"https:\/\/www.aha.org\/system\/files\/media\/file\/2020\/03\/aha-ama-ana-urge-congress-provide-funding-hospitals-health-systems-nurses-physicians-response-to-covid-19-3-18-2020.pdf\">$100 billion<\/a> for all hospitals to offset coronavirus costs, citing rural hospitals\u2019 inability to withstand huge losses for long.<\/p>\n<p>\u201cIf we\u2019re not able to address the short-term cash needs of rural hospitals, we\u2019re going to see hundreds of rural hospitals close before this crisis ends,\u201d warned Alan Morgan, the head of the <a href=\"https:\/\/www.ruralhealthweb.org\/\">National Rural Health Association<\/a>, which represents 21,000 health care providers and hospitals. \u201cThis is not hyperbole.\u201d<\/p>\n<p>Well before the COVID-19 threat, rural health care\u2019s profitability had collapsed nationwide due to a combination of narrowing Medicare reimbursements, a larger share of patients lacking high-paying private insurance and the hollowing out of rural America. Given such pressures, more than <a href=\"https:\/\/www.shepscenter.unc.edu\/programs-projects\/rural-health\/rural-hospital-closures\/\">120 rural<\/a> hospitals have been forced to close over the past decade.<\/p>\n<p>Those hospitals in small-town America that have survived rely heavily on moneymakers such as elective surgeries, physical therapy and lab tests to make their razor-thin margins work. But, according to the Chicago-based Chartis Center for Rural Health, almost half of them still <a href=\"https:\/\/www.ivantageindex.com\/wp-content\/uploads\/2020\/02\/CCRH_Vulnerability-Research_FiNAL-02.14.20.pdf\">operate in the red<\/a>.<\/p>\n<p>So the added financial hit from the coronavirus outbreak could be the final straw for many rural hospitals \u2014 exposing the complicated business dynamics at play within the United States\u2019 critical public health infrastructure.<\/p>\n<p>\u201cThis virus, and what it is causing for these hospitals, is the perfect storm that will close these hospitals at a time this country critically needs them,\u201d said <a href=\"https:\/\/www.millercountyhospital.com\/tag\/robin-rau\/\">Robin Rau<\/a>, CEO of Miller County Hospital in southwestern Georgia. \u201cThis is going to be the death blow to them.\u201d<\/p>\n<p>Two weeks ago, she started eliminating all medical services that were not urgent. She estimated that has cut off at least half of the hospital\u2019s revenue. Other CEOs warned similar cuts at their hospitals mean they won\u2019t make payroll in the coming weeks.<\/p>\n<p>The National Rural Health Association, along with many rural hospital executives, is lobbying for immediate cash assistance, no-interest loans, Medicare reimbursement adjustments and other suggestions to alleviate the pain. The association favors a bailout plan being from Sens. <a href=\"https:\/\/www.barrasso.senate.gov\/public\/\">John Barrasso<\/a> (R-Wyo.) and <a href=\"https:\/\/www.bennet.senate.gov\/public\/\">Michael Bennet<\/a> (D-Colo.), which in initial drafts called for the equivalent of a three-month advance based on hospitals\u2019 previous patient numbers, according to Bennet\u2019s office.<\/p>\n<p>\u201cRural hospitals have already been closing their doors at startling rates, and this crisis will only exacerbate that fact,\u201d Bennet said in a statement to KHN. \u201cThere is an incredible opportunity for rural hospitals to shoulder some of the burdens of caring for patients and helping to meet possible bed shortages.\u201d<\/p>\n<p>Still, many rural hospital CEOs worry any assistance may come too late.<\/p>\n<p>\u201cAnd yet I hear they\u2019re going to bail out the cruise lines? Really?\u201d Missouri\u2019s Scotland County Hospital CEO Dr. <a href=\"http:\/\/www.scotlandcountyhospital.com\/about_us\/administration.aspx\">Randy Tobler<\/a> said.<\/p>\n<p>As Tobler looks at his older, sicker, underinsured patient population, he said he is afraid the hospital, located on the state\u2019s northeastern rural border, might last only until May before running out of money for payroll.<\/p>\n<p>\u201cIn the truly safety-net areas, we\u2019re being called to high duty,\u201d he said. \u201cAnd we\u2019re running on fumes.\u201d<\/p>\n<p><a href=\"https:\/\/www.candlercountyhospital.com\/news\/news-detail\/news\/candler-county-hospital-authority-has-welcomed-a-new-ceo\/?tx_news_pi1%5Bcontroller%5D=News&amp;tx_news_pi1%5Baction%5D=detail&amp;cHash=1454f73a215f50b47591cd3195f8b9cc\">Michael Purvis<\/a>, CEO of Candler County Hospital in Metter, Georgia, said he\u2019s already fallen into a negative cash flow situation in the past week. The number of patients coming to his hospital, which is about 65 miles outside Savannah, for profitable outpatient procedures has dropped by half as people in droves have canceled their surgeries, MRIs and physical therapy.<\/p>\n<p>Purvis has implemented fever checks of people at the entrance. But he remains fearful that his billing staff could be forced to quarantine themselves if they fall ill \u2014 effectively shutting off the hospital\u2019s revenue.<\/p>\n<p>\u201cIf my billers and coders stay healthy, I can make it to April, maybe end of June,\u201d Purvis said.<\/p>\n<p>On top of the massive loss of revenue, Julie Jones, CEO at <a href=\"http:\/\/www.fairfaxmed.com\/\">Community Hospital-Fairfax<\/a> in northwestern Missouri, said she can only get specialty N95 respirator masks that offer critical protection for her front-line providers for about $5 each \u2014 more than 16 times the normal cost of 30 cents.<\/p>\n<p><a href=\"https:\/\/clinchmh.org\/2018\/10\/hometown-health-recognizes-clinch-memorial-hospital-ceo-angela-ammons-as-hospital-leader-of-the-year\/\">Angela Ammons<\/a>, CEO of Clinch Memorial Hospital in Homerville, Georgia, said she has warned staff that if hand sanitizer and disinfecting wipes continue to go missing, she\u2019ll watch the video footage and fire on the spot anyone caught stealing supplies. And she is so worried about running out of protective equipment, she\u2019s asking any of her \u201ccrafty\u201d staff with sewing machines to sew cotton masks.<\/p>\n<p>\u201cI would rather staff go in with a fabric mask than no mask at all,\u201d she said.<\/p>\n<p>To be sure, rural hospitals are not as equipped as larger hospital systems to handle the most serious coronavirus cases. Many are <a href=\"https:\/\/khn.org\/news\/as-coronavirus-spreads-widely-millions-of-older-americans-live-in-counties-with-no-icu-beds\/\">not outfitted with ICUs<\/a> or enough doctors and staff to handle multiple intensive care patients. That means they have to transfer those patients to larger hospitals.<\/p>\n<p>Still, rural experts argue that their bed and health care capacity can be leveraged to keep potential coronavirus cases out of the major hospitals. Plus, rural facilities could be places for initial triage or eventual recovery care.<\/p>\n<p>And if nothing changes, Rau worries, the country is about to lose this critical public health infrastructure.<\/p>\n<p>\u201cWe can talk all we want about the cost of health care in this country in this ridiculous health care system we have,\u201d she said. \u201cBut at a time like this, who for a minute would think about getting rid of rural hospitals?\u201d<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"http:\/\/www.kaiserhealthnews.org\/\">Kaiser Health News<\/a> (KHN) is a national health policy news service. It is an editorially independent program of the <a href=\"http:\/\/www.kff.org\/\">Henry J. Kaiser Family Foundation<\/a> which is not affiliated with Kaiser Permanente.<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_es":"<p>Translation coming soon<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_fr":"<p>Translation coming soon<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_subheader_en":"As the coronavirus sweeps across the United States, all hospitals are facing cancellations of doctor visits and procedures by a terrified populace \u2014 profitable services that usually help fund hospitals. Meanwhile, the institutions also find themselves needing to pay higher prices for personal protective equipment such as face masks and other gear that\u2019s in short supply.","page_subheader_es":"As the coronavirus sweeps across the United States, all hospitals are facing cancellations of doctor visits and procedures by a terrified populace \u2014 profitable services that usually help fund hospitals. Meanwhile, the institutions also find themselves needing to pay higher prices for personal protective equipment such as face masks and other gear that\u2019s in short supply.","page_subheader_fr":"As the coronavirus sweeps across the United States, all hospitals are facing cancellations of doctor visits and procedures by a terrified populace \u2014 profitable services that usually help fund hospitals. Meanwhile, the institutions also find themselves needing to pay higher prices for personal protective equipment such as face masks and other gear that\u2019s in short supply."},{"slug":"return-to-sender-a-single-undeliverable-letter-can-mean-losing-medicaid","ideas_cat":"Recommended","main_image":"https:\/\/defendfairaccess.org\/wp-content\/uploads\/2019\/11\/Mailbox-e1714446551630.jpg","page_title_en":"Return to sender: A single undeliverable letter can mean losing Medicaid","page_title_es":" Devolver al remitente: una sola carta que no se puede entregar puede significar perder Medicaid","page_title_fr":"Retour \u00e0 l'exp\u00e9diteur: une seule lettre non distribuable peut signifier la perte de Medicaid.","page_content_en":"<p>COLORADO SPRINGS, Colo. \u2014 Forty-two boxes of returned mail lined a wall of the El Paso County Department of Human Services office\u00a0on a recent fall morning. There used to be three times as many.<\/p>\n<p>Every week, the U.S. Postal Service brings anywhere from four to 15 trays to the office, each containing more than 250 letters that it could not deliver to county residents enrolled in Medicaid or other public assistance programs. This plays out the same way in counties across the state. Colorado estimates about 15% of the 12 million letters from public assistance programs to 1.3 million members statewide are returned \u2014 some 1.8 million pieces of undelivered mail each year.<\/p>\n<p>It falls on each county\u2019s staff, in between fielding calls, to contact the individuals to confirm their correct address and their eligibility for Medicaid, the <a href=\"https:\/\/www.benefits.gov\/benefit\/1621\">federal-state health insurance program<\/a> for people with low incomes.<\/p>\n<p>But last year, state officials decided that if caseworkers can\u2019t reach recipients, they can close those cases and cut off health benefits after a single piece of returned mail.<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n<p>Boxes of returned mail, originally sent to residents enrolled in Medicaid or other public assistance programs, line a wall of the El Paso County (Colo.) Department of Human Services office. Although Colorado has lowered the threshold to trigger an eligibility review from three pieces of returned mail to just one, El Paso County rarely closes cases based on a single piece of returned mail and opts not to act on addresses that are often used by those who are homeless.<\/p>\n<p>Medicaid, food stamps and other public benefit programs have avoided the march toward digital communication and continue to operate largely in a paper-based world. That essentially ties lifesaving benefits for some of the most vulnerable populations to the vagaries of the Postal Service.<\/p>\n<p>As returned mail piles up, Colorado and other states take increasingly drastic measures to work through the cumbersome backlog, lowering the bar for canceling benefits on the basis of returned mail alone. <a href=\"https:\/\/www.kcur.org\/post\/more-half-missourians-who-were-dropped-medicaid-didnt-answer-mail#stream\/0\">Missouri<\/a>, <a href=\"https:\/\/www.enidnews.com\/oklahoma\/oklahoma-health-care-authority-resuscitates-controversial-rule-to-check-medicaid\/article_ee8ad59e-78b3-11e9-bde2-7f24ed535baf.html\">Oklahoma<\/a> and <a href=\"https:\/\/mmcp.health.maryland.gov\/Documents\/MMAC\/2017\/November\/MMAC%20Medicaid%20Mail%20Returns%20Nov%2017.pdf\">Maryland<\/a> are among those that have struggled with the volume. And when Arkansas implemented Medicaid work requirements, <a href=\"https:\/\/arktimes.com\/news\/cover-stories\/2018\/08\/09\/scrubbed-from-the-system?oid=21285998\">nearly half of the people who lost <\/a>benefits had failed to respond to mailings or couldn\u2019t be contacted.<\/p>\n<blockquote><p>At best, tightening returned mail policies could save states some money, and those cut from the benefits yet still eligible for them would experience only a temporary gap in their care. But even short delays can exacerbate some patients\u2019 chronic health conditions or lead to expensive visits to the hospital.<\/p>\n<p>And at worst, the returned mail may be contributing to a major drop in Medicaid enrollment and increased numbers of uninsured. Those dropped from the rolls rarely realize it until they seek care.<\/p><\/blockquote>\n<p>\u201cThere\u2019s a lot of concern on this issue,\u201d said <a href=\"https:\/\/www.urban.org\/author\/ian-hill\">Ian Hill<\/a>, a health policy analyst at the Urban Institute, a think tank based in Washington, D.C. \u201cAre they getting purged from the records unfairly and too quickly?\u201d<\/p>\n<p><strong>Taking Action<\/strong><\/p>\n<p>States have been walking a tightrope. While trying to aid their poorest residents, they also are grappling with budget-busting Medicaid costs and pressure from the Trump administration to ensure everyone on public assistance programs qualifies for the benefits.<\/p>\n<p>Some states have sought \u201cprocedural denials because it kept their costs down,\u201d said <a href=\"https:\/\/www.manatt.com\/Story\/Cindy-Mann\">Cindy Mann<\/a>, who ran the Medicaid program under the Obama administration.<\/p>\n<p>\u201cBut we certainly don\u2019t want to cut somebody off while they\u2019re still eligible,\u201d said Mann, who is now a partner with the law firm Manatt, Phelps &amp; Phillips. \u201cIt\u2019s penny-wise and pound-foolish.\u201d<\/p>\n<p>Low-income families who depend on public benefits tend to move often, leading to frequent errors in the addresses on file. But if a person moves out of state, the state-administered Medicaid benefit cannot move with them.<\/p>\n<p>\u201cStates have always struggled with how to handle returned mail,\u201d said <a href=\"https:\/\/www.cbpp.org\/jennifer-wagner\">Jennifer Wagner<\/a>, a senior policy analyst with the Center on Budget and Policy Priorities, a left-leaning think tank in Washington, D.C. \u201cBut we have more recently heard of states pushing a policy to be very aggressive about canceling clients when the state receives returned mail, and that has led to significant disenrollment.\u201d<\/p>\n<p>In April 2018, Colorado <a href=\"https:\/\/www.colorado.gov\/pacific\/sites\/default\/files\/Agency%20Letter%20Returned%20Mail%203-2018%20updated%20final.pdf\">lowered its recommended threshold<\/a> for acting upon returned mail from three pieces of undeliverable mail to just one. From May 2017 to May 2019, enrollment in Medicaid and the Children\u2019s Health Insurance Program dropped 8.5% in the state \u2014 more than three times the national decline of 2.5%, according to the Medicaid and CHIP Payment and Access Commission, a congressional advisory panel.<\/p>\n<p>It\u2019s unclear how much of the drop was due to returned mail. The enrollment declines could also reflect some combination of a proposed federal rule to deny green cards to immigrants who use public benefits, cuts in federal funding for outreach to sign people up for health coverage or an improved economy.<\/p>\n<p>Colorado has not set up a way of tracking how many people are losing benefits because of returned mail or what happens to those who do.<\/p>\n<p>\u201cWe don\u2019t have one data point that we can track,\u201d said Marivel Klueckman, who oversees Medicaid eligibility functions for Colorado. \u201cThat is something we\u2019re building into the future.\u201d<\/p>\n<p>Of the more than 131,000 Colorado households that have public benefit mail returned each year, the state estimates about 1 in 4 cannot be reached, resulting in the possible closure of nearly 33,000 cases.<\/p>\n<p>People cut off from benefits may never learn why and may not seek to restore their benefits, which concerns <a href=\"https:\/\/cclponline.org\/staff\/bethany-pray\/\">Bethany Pray<\/a>, health care program director at the Colorado Center on Law and Policy, a Denver-based legal aid group.<\/p>\n<p>\u201cYou\u2019re going to lose people who are truly eligible and should never have been taken off and who face barriers to re-enrollment,\u201d Pray said.<\/p>\n<p>Of the more than 131,000 Colorado households that have public benefit mail returned each year, the state estimates about 1 in 4 cannot be reached, resulting in the possible closure of nearly 33,000 cases.<\/p>\n<p><strong>Mailing Woes<\/strong><\/p>\n<p>The <a href=\"https:\/\/coloradosun.com\/2019\/06\/18\/colorado-mountain-town-post-office-problems\/\">lack of dependability of <\/a><a href=\"https:\/\/coloradosun.com\/2019\/06\/18\/colorado-mountain-town-post-office-problems\/\">the <\/a><a href=\"https:\/\/coloradosun.com\/2019\/06\/18\/colorado-mountain-town-post-office-problems\/\">Postal Service<\/a>, particularly in rural areas of the state, adds to the concerns about relying on snail mail for important government correspondence.<\/p>\n<p>Officials from the ski resort town of Snowmass Village, for example, complained last spring that they didn\u2019t have any mail delivered for an entire week.<\/p>\n<p>\u201cWe have received over 6 feet of snow in the last two weeks and we still get more complaints about postal delivery than snow removal,\u201d town officials wrote in <a href=\"https:\/\/coskitowns.com\/wp-content\/uploads\/2019\/03\/PostOfficeMarch-2019.pdf\">a March survey<\/a> conducted by the Colorado Association of Ski Towns. \u201cPeople aren\u2019t getting bills, jury summons, medications, certified mail.\u201d<\/p>\n<p>In June, three members of Colorado\u2019s congressional delegation sent <a href=\"https:\/\/tipton.house.gov\/sites\/tipton.house.gov\/files\/Postmaster%20General%20Letter%20-%20FINAL%20%2806-26-2019%29.pdf\">a letter<\/a> to the postmaster general, pressing her to address a range of postal issues including lost or returned mail.<\/p>\n<p>There\u2019s no question that cutting off people after one piece of paper mail is returned saves the state money in sending letters and processing undeliverable mail \u2014 though other costs may add up later. Colorado public assistance programs mail more than a million letters each month, at a cost of nearly $6 million annually. That is a small share of what is spent on the actual assistance, given that Colorado\u2019s <a href=\"http:\/\/files.kff.org\/attachment\/fact-sheet-medicaid-state-CO\">Medicaid program alone cost<\/a><a href=\"http:\/\/files.kff.org\/attachment\/fact-sheet-medicaid-state-CO\">s<\/a><a href=\"http:\/\/files.kff.org\/attachment\/fact-sheet-medicaid-state-CO\"> $9 billion<\/a> a year.<\/p>\n<p>Cutting off assistance after one piece of returned mail also helps the state avoid making monthly payments to regional health organizations for case management and dental services for those who no longer qualify for benefits.<\/p>\n<p>However, Colorado Medicaid\u2019s Klueckman said the state is primarily concerned with making sure eligible residents get their notifications and remain enrolled. The state moved eligibility determinations and renewals online and now offers a mobile app so residents also can receive notifications electronically.<\/p>\n<p>Local Discretion<\/p>\n<p>Colorado plans to open <a href=\"https:\/\/www.colorado.gov\/pacific\/sites\/default\/files\/HCPF%2C%20FY20%2C%20R-6%20Local%20Administration%20Transformation.pdf\">a consolidated returned mail center<\/a> for the state as soon as July 2020. That could provide some economies of scale and consistency, but has the potential of increasing the number of people dropped, as local knowledge is replaced by automation.<\/p>\n<p>Counties currently receive guidance from the state on how to process returned mail, but they have leeway to set their own procedures. El Paso County, for example, rarely closes cases based on a single piece of returned mail and opts not to act on addresses that are often used by those who are homeless, such as a shelter or post office.<\/p>\n<p>\u201cThey\u2019re the least likely for us to be able to have a phone number to call them,\u201d said <a href=\"https:\/\/humanservices.elpasoco.com\/dhs-contact-us\/\">Karen Logan<\/a>, economic and administrative services director for the county.<\/p>\n<p>The county, Colorado\u2019s second-largest, used grant money this year to pay staff overtime to whittle down its backlog of returned mail. That has helped the county process more than 48,000 pieces of returned mail in the past year, with more than a third prompting database changes. But officials could not say how many of those resulted in people losing benefits.<\/p>\n<p>\u201cWe have some other things that are a little bit higher on the priority scale, so we don\u2019t close as many cases as we probably could,\u201d Logan said. \u201cBut I can tell you this: Closing a case and having a person have to reapply two months later takes significantly more work.\u201d<\/p>\n","page_content_es":"<p>COLORADO SPRINGS, Colo. \u2014 Forty-two boxes of returned mail lined a wall of the El Paso County Department of Human Services office\u00a0on a recent fall morning. There used to be three times as many.<\/p>\n<p>Every week, the U.S. Postal Service brings anywhere from four to 15 trays to the office, each containing more than 250 letters that it could not deliver to county residents enrolled in Medicaid or other public assistance programs. This plays out the same way in counties across the state. Colorado estimates about 15% of the 12 million letters from public assistance programs to 1.3 million members statewide are returned \u2014 some 1.8 million pieces of undelivered mail each year.<\/p>\n<p>It falls on each county\u2019s staff, in between fielding calls, to contact the individuals to confirm their correct address and their eligibility for Medicaid, the <a href=\"https:\/\/www.benefits.gov\/benefit\/1621\">federal-state health insurance program<\/a> for people with low incomes.<\/p>\n<p>But last year, state officials decided that if caseworkers can\u2019t reach recipients, they can close those cases and cut off health benefits after a single piece of returned mail.<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n<p>Boxes of returned mail, originally sent to residents enrolled in Medicaid or other public assistance programs, line a wall of the El Paso County (Colo.) Department of Human Services office. Although Colorado has lowered the threshold to trigger an eligibility review from three pieces of returned mail to just one, El Paso County rarely closes cases based on a single piece of returned mail and opts not to act on addresses that are often used by those who are homeless.<\/p>\n<p>Medicaid, food stamps and other public benefit programs have avoided the march toward digital communication and continue to operate largely in a paper-based world. That essentially ties lifesaving benefits for some of the most vulnerable populations to the vagaries of the Postal Service.<\/p>\n<p>As returned mail piles up, Colorado and other states take increasingly drastic measures to work through the cumbersome backlog, lowering the bar for canceling benefits on the basis of returned mail alone. <a href=\"https:\/\/www.kcur.org\/post\/more-half-missourians-who-were-dropped-medicaid-didnt-answer-mail#stream\/0\">Missouri<\/a>, <a href=\"https:\/\/www.enidnews.com\/oklahoma\/oklahoma-health-care-authority-resuscitates-controversial-rule-to-check-medicaid\/article_ee8ad59e-78b3-11e9-bde2-7f24ed535baf.html\">Oklahoma<\/a> and <a href=\"https:\/\/mmcp.health.maryland.gov\/Documents\/MMAC\/2017\/November\/MMAC%20Medicaid%20Mail%20Returns%20Nov%2017.pdf\">Maryland<\/a> are among those that have struggled with the volume. And when Arkansas implemented Medicaid work requirements, <a href=\"https:\/\/arktimes.com\/news\/cover-stories\/2018\/08\/09\/scrubbed-from-the-system?oid=21285998\">nearly half of the people who lost <\/a>benefits had failed to respond to mailings or couldn\u2019t be contacted.<\/p>\n<blockquote><p>At best, tightening returned mail policies could save states some money, and those cut from the benefits yet still eligible for them would experience only a temporary gap in their care. But even short delays can exacerbate some patients\u2019 chronic health conditions or lead to expensive visits to the hospital.<\/p>\n<p>And at worst, the returned mail may be contributing to a major drop in Medicaid enrollment and increased numbers of uninsured. Those dropped from the rolls rarely realize it until they seek care.<\/p><\/blockquote>\n<p>\u201cThere\u2019s a lot of concern on this issue,\u201d said <a href=\"https:\/\/www.urban.org\/author\/ian-hill\">Ian Hill<\/a>, a health policy analyst at the Urban Institute, a think tank based in Washington, D.C. \u201cAre they getting purged from the records unfairly and too quickly?\u201d<\/p>\n<p><strong>Taking Action<\/strong><\/p>\n<p>States have been walking a tightrope. While trying to aid their poorest residents, they also are grappling with budget-busting Medicaid costs and pressure from the Trump administration to ensure everyone on public assistance programs qualifies for the benefits.<\/p>\n<p>Some states have sought \u201cprocedural denials because it kept their costs down,\u201d said <a href=\"https:\/\/www.manatt.com\/Story\/Cindy-Mann\">Cindy Mann<\/a>, who ran the Medicaid program under the Obama administration.<\/p>\n<p>\u201cBut we certainly don\u2019t want to cut somebody off while they\u2019re still eligible,\u201d said Mann, who is now a partner with the law firm Manatt, Phelps &amp; Phillips. \u201cIt\u2019s penny-wise and pound-foolish.\u201d<\/p>\n<p>Low-income families who depend on public benefits tend to move often, leading to frequent errors in the addresses on file. But if a person moves out of state, the state-administered Medicaid benefit cannot move with them.<\/p>\n<p>\u201cStates have always struggled with how to handle returned mail,\u201d said <a href=\"https:\/\/www.cbpp.org\/jennifer-wagner\">Jennifer Wagner<\/a>, a senior policy analyst with the Center on Budget and Policy Priorities, a left-leaning think tank in Washington, D.C. \u201cBut we have more recently heard of states pushing a policy to be very aggressive about canceling clients when the state receives returned mail, and that has led to significant disenrollment.\u201d<\/p>\n<p>In April 2018, Colorado <a href=\"https:\/\/www.colorado.gov\/pacific\/sites\/default\/files\/Agency%20Letter%20Returned%20Mail%203-2018%20updated%20final.pdf\">lowered its recommended threshold<\/a> for acting upon returned mail from three pieces of undeliverable mail to just one. From May 2017 to May 2019, enrollment in Medicaid and the Children\u2019s Health Insurance Program dropped 8.5% in the state \u2014 more than three times the national decline of 2.5%, according to the Medicaid and CHIP Payment and Access Commission, a congressional advisory panel.<\/p>\n<p>It\u2019s unclear how much of the drop was due to returned mail. The enrollment declines could also reflect some combination of a proposed federal rule to deny green cards to immigrants who use public benefits, cuts in federal funding for outreach to sign people up for health coverage or an improved economy.<\/p>\n<p>Colorado has not set up a way of tracking how many people are losing benefits because of returned mail or what happens to those who do.<\/p>\n<p>\u201cWe don\u2019t have one data point that we can track,\u201d said Marivel Klueckman, who oversees Medicaid eligibility functions for Colorado. \u201cThat is something we\u2019re building into the future.\u201d<\/p>\n<p>Of the more than 131,000 Colorado households that have public benefit mail returned each year, the state estimates about 1 in 4 cannot be reached, resulting in the possible closure of nearly 33,000 cases.<\/p>\n<p>People cut off from benefits may never learn why and may not seek to restore their benefits, which concerns <a href=\"https:\/\/cclponline.org\/staff\/bethany-pray\/\">Bethany Pray<\/a>, health care program director at the Colorado Center on Law and Policy, a Denver-based legal aid group.<\/p>\n<p>\u201cYou\u2019re going to lose people who are truly eligible and should never have been taken off and who face barriers to re-enrollment,\u201d Pray said.<\/p>\n<p>Of the more than 131,000 Colorado households that have public benefit mail returned each year, the state estimates about 1 in 4 cannot be reached, resulting in the possible closure of nearly 33,000 cases.<\/p>\n<p><strong>Mailing Woes<\/strong><\/p>\n<p>The <a href=\"https:\/\/coloradosun.com\/2019\/06\/18\/colorado-mountain-town-post-office-problems\/\">lack of dependability of <\/a><a href=\"https:\/\/coloradosun.com\/2019\/06\/18\/colorado-mountain-town-post-office-problems\/\">the <\/a><a href=\"https:\/\/coloradosun.com\/2019\/06\/18\/colorado-mountain-town-post-office-problems\/\">Postal Service<\/a>, particularly in rural areas of the state, adds to the concerns about relying on snail mail for important government correspondence.<\/p>\n<p>Officials from the ski resort town of Snowmass Village, for example, complained last spring that they didn\u2019t have any mail delivered for an entire week.<\/p>\n<p>\u201cWe have received over 6 feet of snow in the last two weeks and we still get more complaints about postal delivery than snow removal,\u201d town officials wrote in <a href=\"https:\/\/coskitowns.com\/wp-content\/uploads\/2019\/03\/PostOfficeMarch-2019.pdf\">a March survey<\/a> conducted by the Colorado Association of Ski Towns. \u201cPeople aren\u2019t getting bills, jury summons, medications, certified mail.\u201d<\/p>\n<p>In June, three members of Colorado\u2019s congressional delegation sent <a href=\"https:\/\/tipton.house.gov\/sites\/tipton.house.gov\/files\/Postmaster%20General%20Letter%20-%20FINAL%20%2806-26-2019%29.pdf\">a letter<\/a> to the postmaster general, pressing her to address a range of postal issues including lost or returned mail.<\/p>\n<p>There\u2019s no question that cutting off people after one piece of paper mail is returned saves the state money in sending letters and processing undeliverable mail \u2014 though other costs may add up later. Colorado public assistance programs mail more than a million letters each month, at a cost of nearly $6 million annually. That is a small share of what is spent on the actual assistance, given that Colorado\u2019s <a href=\"http:\/\/files.kff.org\/attachment\/fact-sheet-medicaid-state-CO\">Medicaid program alone cost<\/a><a href=\"http:\/\/files.kff.org\/attachment\/fact-sheet-medicaid-state-CO\">s<\/a><a href=\"http:\/\/files.kff.org\/attachment\/fact-sheet-medicaid-state-CO\"> $9 billion<\/a> a year.<\/p>\n<p>Cutting off assistance after one piece of returned mail also helps the state avoid making monthly payments to regional health organizations for case management and dental services for those who no longer qualify for benefits.<\/p>\n<p>However, Colorado Medicaid\u2019s Klueckman said the state is primarily concerned with making sure eligible residents get their notifications and remain enrolled. The state moved eligibility determinations and renewals online and now offers a mobile app so residents also can receive notifications electronically.<\/p>\n<p>Local Discretion<\/p>\n<p>Colorado plans to open <a href=\"https:\/\/www.colorado.gov\/pacific\/sites\/default\/files\/HCPF%2C%20FY20%2C%20R-6%20Local%20Administration%20Transformation.pdf\">a consolidated returned mail center<\/a> for the state as soon as July 2020. That could provide some economies of scale and consistency, but has the potential of increasing the number of people dropped, as local knowledge is replaced by automation.<\/p>\n<p>Counties currently receive guidance from the state on how to process returned mail, but they have leeway to set their own procedures. El Paso County, for example, rarely closes cases based on a single piece of returned mail and opts not to act on addresses that are often used by those who are homeless, such as a shelter or post office.<\/p>\n<p>\u201cThey\u2019re the least likely for us to be able to have a phone number to call them,\u201d said <a href=\"https:\/\/humanservices.elpasoco.com\/dhs-contact-us\/\">Karen Logan<\/a>, economic and administrative services director for the county.<\/p>\n<p>The county, Colorado\u2019s second-largest, used grant money this year to pay staff overtime to whittle down its backlog of returned mail. That has helped the county process more than 48,000 pieces of returned mail in the past year, with more than a third prompting database changes. But officials could not say how many of those resulted in people losing benefits.<\/p>\n<p>\u201cWe have some other things that are a little bit higher on the priority scale, so we don\u2019t close as many cases as we probably could,\u201d Logan said. \u201cBut I can tell you this: Closing a case and having a person have to reapply two months later takes significantly more work.\u201d<\/p>\n","page_content_fr":"<p>COLORADO SPRINGS, Colo. \u2014 Forty-two boxes of returned mail lined a wall of the El Paso County Department of Human Services office\u00a0on a recent fall morning. There used to be three times as many.<\/p>\n<p>Every week, the U.S. Postal Service brings anywhere from four to 15 trays to the office, each containing more than 250 letters that it could not deliver to county residents enrolled in Medicaid or other public assistance programs. This plays out the same way in counties across the state. Colorado estimates about 15% of the 12 million letters from public assistance programs to 1.3 million members statewide are returned \u2014 some 1.8 million pieces of undelivered mail each year.<\/p>\n<p>It falls on each county\u2019s staff, in between fielding calls, to contact the individuals to confirm their correct address and their eligibility for Medicaid, the <a href=\"https:\/\/www.benefits.gov\/benefit\/1621\">federal-state health insurance program<\/a> for people with low incomes.<\/p>\n<p>But last year, state officials decided that if caseworkers can\u2019t reach recipients, they can close those cases and cut off health benefits after a single piece of returned mail.<\/p>\n<p>Boxes of returned mail, originally sent to residents enrolled in Medicaid or other public assistance programs, line a wall of the El Paso County (Colo.) Department of Human Services office. Although Colorado has lowered the threshold to trigger an eligibility review from three pieces of returned mail to just one, El Paso County rarely closes cases based on a single piece of returned mail and opts not to act on addresses that are often used by those who are homeless.<\/p>\n<p>Medicaid, food stamps and other public benefit programs have avoided the march toward digital communication and continue to operate largely in a paper-based world. That essentially ties lifesaving benefits for some of the most vulnerable populations to the vagaries of the Postal Service.<\/p>\n<p>As returned mail piles up, Colorado and other states take increasingly drastic measures to work through the cumbersome backlog, lowering the bar for canceling benefits on the basis of returned mail alone. <a href=\"https:\/\/www.kcur.org\/post\/more-half-missourians-who-were-dropped-medicaid-didnt-answer-mail#stream\/0\">Missouri<\/a>, <a href=\"https:\/\/www.enidnews.com\/oklahoma\/oklahoma-health-care-authority-resuscitates-controversial-rule-to-check-medicaid\/article_ee8ad59e-78b3-11e9-bde2-7f24ed535baf.html\">Oklahoma<\/a> and <a href=\"https:\/\/mmcp.health.maryland.gov\/Documents\/MMAC\/2017\/November\/MMAC%20Medicaid%20Mail%20Returns%20Nov%2017.pdf\">Maryland<\/a> are among those that have struggled with the volume. And when Arkansas implemented Medicaid work requirements, <a href=\"https:\/\/arktimes.com\/news\/cover-stories\/2018\/08\/09\/scrubbed-from-the-system?oid=21285998\">nearly half of the people who lost <\/a>benefits had failed to respond to mailings or couldn\u2019t be contacted.<\/p>\n<blockquote><p>At best, tightening returned mail policies could save states some money, and those cut from the benefits yet still eligible for them would experience only a temporary gap in their care. But even short delays can exacerbate some patients\u2019 chronic health conditions or lead to expensive visits to the hospital.<\/p>\n<p>And at worst, the returned mail may be contributing to a major drop in Medicaid enrollment and increased numbers of uninsured. Those dropped from the rolls rarely realize it until they seek care.<\/p><\/blockquote>\n<p>\u201cThere\u2019s a lot of concern on this issue,\u201d said <a href=\"https:\/\/www.urban.org\/author\/ian-hill\">Ian Hill<\/a>, a health policy analyst at the Urban Institute, a think tank based in Washington, D.C. \u201cAre they getting purged from the records unfairly and too quickly?\u201d<\/p>\n<p><strong>Taking Action<\/strong><\/p>\n<p>States have been walking a tightrope. While trying to aid their poorest residents, they also are grappling with budget-busting Medicaid costs and pressure from the Trump administration to ensure everyone on public assistance programs qualifies for the benefits.<\/p>\n<p>Some states have sought \u201cprocedural denials because it kept their costs down,\u201d said <a href=\"https:\/\/www.manatt.com\/Story\/Cindy-Mann\">Cindy Mann<\/a>, who ran the Medicaid program under the Obama administration.<\/p>\n<p>\u201cBut we certainly don\u2019t want to cut somebody off while they\u2019re still eligible,\u201d said Mann, who is now a partner with the law firm Manatt, Phelps &amp; Phillips. \u201cIt\u2019s penny-wise and pound-foolish.\u201d<\/p>\n<p>Low-income families who depend on public benefits tend to move often, leading to frequent errors in the addresses on file. But if a person moves out of state, the state-administered Medicaid benefit cannot move with them.<\/p>\n<p>\u201cStates have always struggled with how to handle returned mail,\u201d said <a href=\"https:\/\/www.cbpp.org\/jennifer-wagner\">Jennifer Wagner<\/a>, a senior policy analyst with the Center on Budget and Policy Priorities, a left-leaning think tank in Washington, D.C. \u201cBut we have more recently heard of states pushing a policy to be very aggressive about canceling clients when the state receives returned mail, and that has led to significant disenrollment.\u201d<\/p>\n<p>In April 2018, Colorado <a href=\"https:\/\/www.colorado.gov\/pacific\/sites\/default\/files\/Agency%20Letter%20Returned%20Mail%203-2018%20updated%20final.pdf\">lowered its recommended threshold<\/a> for acting upon returned mail from three pieces of undeliverable mail to just one. From May 2017 to May 2019, enrollment in Medicaid and the Children\u2019s Health Insurance Program dropped 8.5% in the state \u2014 more than three times the national decline of 2.5%, according to the Medicaid and CHIP Payment and Access Commission, a congressional advisory panel.<\/p>\n<p>It\u2019s unclear how much of the drop was due to returned mail. The enrollment declines could also reflect some combination of a proposed federal rule to deny green cards to immigrants who use public benefits, cuts in federal funding for outreach to sign people up for health coverage or an improved economy.<\/p>\n<p>Colorado has not set up a way of tracking how many people are losing benefits because of returned mail or what happens to those who do.<\/p>\n<p>\u201cWe don\u2019t have one data point that we can track,\u201d said Marivel Klueckman, who oversees Medicaid eligibility functions for Colorado. \u201cThat is something we\u2019re building into the future.\u201d<\/p>\n<p>Of the more than 131,000 Colorado households that have public benefit mail returned each year, the state estimates about 1 in 4 cannot be reached, resulting in the possible closure of nearly 33,000 cases.<\/p>\n<p>People cut off from benefits may never learn why and may not seek to restore their benefits, which concerns <a href=\"https:\/\/cclponline.org\/staff\/bethany-pray\/\">Bethany Pray<\/a>, health care program director at the Colorado Center on Law and Policy, a Denver-based legal aid group.<\/p>\n<p>\u201cYou\u2019re going to lose people who are truly eligible and should never have been taken off and who face barriers to re-enrollment,\u201d Pray said.<\/p>\n<p>Of the more than 131,000 Colorado households that have public benefit mail returned each year, the state estimates about 1 in 4 cannot be reached, resulting in the possible closure of nearly 33,000 cases.<\/p>\n<p><strong>Mailing Woes<\/strong><\/p>\n<p>The <a href=\"https:\/\/coloradosun.com\/2019\/06\/18\/colorado-mountain-town-post-office-problems\/\">lack of dependability of <\/a><a href=\"https:\/\/coloradosun.com\/2019\/06\/18\/colorado-mountain-town-post-office-problems\/\">the <\/a><a href=\"https:\/\/coloradosun.com\/2019\/06\/18\/colorado-mountain-town-post-office-problems\/\">Postal Service<\/a>, particularly in rural areas of the state, adds to the concerns about relying on snail mail for important government correspondence.<\/p>\n<p>Officials from the ski resort town of Snowmass Village, for example, complained last spring that they didn\u2019t have any mail delivered for an entire week.<\/p>\n<p>\u201cWe have received over 6 feet of snow in the last two weeks and we still get more complaints about postal delivery than snow removal,\u201d town officials wrote in <a href=\"https:\/\/coskitowns.com\/wp-content\/uploads\/2019\/03\/PostOfficeMarch-2019.pdf\">a March survey<\/a> conducted by the Colorado Association of Ski Towns. \u201cPeople aren\u2019t getting bills, jury summons, medications, certified mail.\u201d<\/p>\n<p>In June, three members of Colorado\u2019s congressional delegation sent <a href=\"https:\/\/tipton.house.gov\/sites\/tipton.house.gov\/files\/Postmaster%20General%20Letter%20-%20FINAL%20%2806-26-2019%29.pdf\">a letter<\/a> to the postmaster general, pressing her to address a range of postal issues including lost or returned mail.<\/p>\n<p>There\u2019s no question that cutting off people after one piece of paper mail is returned saves the state money in sending letters and processing undeliverable mail \u2014 though other costs may add up later. Colorado public assistance programs mail more than a million letters each month, at a cost of nearly $6 million annually. That is a small share of what is spent on the actual assistance, given that Colorado\u2019s <a href=\"http:\/\/files.kff.org\/attachment\/fact-sheet-medicaid-state-CO\">Medicaid program alone cost<\/a><a href=\"http:\/\/files.kff.org\/attachment\/fact-sheet-medicaid-state-CO\">s<\/a><a href=\"http:\/\/files.kff.org\/attachment\/fact-sheet-medicaid-state-CO\"> $9 billion<\/a> a year.<\/p>\n<p>Cutting off assistance after one piece of returned mail also helps the state avoid making monthly payments to regional health organizations for case management and dental services for those who no longer qualify for benefits.<\/p>\n<p>However, Colorado Medicaid\u2019s Klueckman said the state is primarily concerned with making sure eligible residents get their notifications and remain enrolled. The state moved eligibility determinations and renewals online and now offers a mobile app so residents also can receive notifications electronically.<\/p>\n<p>Local Discretion<\/p>\n<p>Colorado plans to open <a href=\"https:\/\/www.colorado.gov\/pacific\/sites\/default\/files\/HCPF%2C%20FY20%2C%20R-6%20Local%20Administration%20Transformation.pdf\">a consolidated returned mail center<\/a> for the state as soon as July 2020. That could provide some economies of scale and consistency, but has the potential of increasing the number of people dropped, as local knowledge is replaced by automation.<\/p>\n<p>Counties currently receive guidance from the state on how to process returned mail, but they have leeway to set their own procedures. El Paso County, for example, rarely closes cases based on a single piece of returned mail and opts not to act on addresses that are often used by those who are homeless, such as a shelter or post office.<\/p>\n<p>\u201cThey\u2019re the least likely for us to be able to have a phone number to call them,\u201d said <a href=\"https:\/\/humanservices.elpasoco.com\/dhs-contact-us\/\">Karen Logan<\/a>, economic and administrative services director for the county.<\/p>\n<p>The county, Colorado\u2019s second-largest, used grant money this year to pay staff overtime to whittle down its backlog of returned mail. That has helped the county process more than 48,000 pieces of returned mail in the past year, with more than a third prompting database changes. But officials could not say how many of those resulted in people losing benefits.<\/p>\n<p>\u201cWe have some other things that are a little bit higher on the priority scale, so we don\u2019t close as many cases as we probably could,\u201d Logan said. \u201cBut I can tell you this: Closing a case and having a person have to reapply two months later takes significantly more work.\u201d<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_subheader_en":"Low-income families who depend on public benefits tend to move often, leading to frequent errors in the addresses on file. But in the United States, if a person moves out of state, state-administered programs such Medicaid can't move with them. This article, republished from Kaiser Health News, examines the challenges inherent in certain policies that potentially pin lifesaving health services to a single piece of mail. ","page_subheader_es":"Las familias de bajos ingresos que dependen de los beneficios p\u00fablicos tienden a mudarse con frecuencia, lo que lleva a errores frecuentes en las direcciones en el archivo. Pero en los Estados Unidos, si una persona se muda fuera del estado, los programas administrados por el estado como Medicaid no pueden mudarse con ellos. Este art\u00edculo, publicado de Kaiser Health News, examina los desaf\u00edos inherentes a ciertas pol\u00edticas que potencialmente sujetan los servicios de salud que salvan vidas a un solo correo.","page_subheader_fr":"Les familles \u00e0 faible revenu qui d\u00e9pendent des avantages publics ont souvent tendance \u00e0 d\u00e9m\u00e9nager, ce qui entra\u00eene des erreurs fr\u00e9quentes dans les adresses au dossier. Mais aux \u00c9tats-Unis, si une personne quitte l\u2019\u00c9tat, des programmes g\u00e9r\u00e9s par l\u2019\u00c9tat, tels que Medicaid, ne peuvent pas \u00e9voluer avec eux. Cet article, republi\u00e9 de Kaiser Health News, examine les d\u00e9fis inh\u00e9rents \u00e0 certaines politiques qui permettent de lier des services de sant\u00e9 vitaux \u00e0 un seul courrier."},{"slug":"commentary-correctional-health-is-public-health","ideas_cat":"Recommended","main_image":"https:\/\/defendfairaccess.org\/wp-content\/uploads\/2020\/04\/camilo-jimenez-49h5yXieSSM-unsplash-e1714446646440.jpg","page_title_en":"Commentary: Correctional health is public health","page_title_es":"Comentario: la salud correccional es salud p\u00fablica","page_title_fr":"Commentaire: La sant\u00e9 correctionnelle est la sant\u00e9 publique","page_content_en":"<p style=\"font-size: 85%;\">Note: Please be advised that as things are changing quickly during this pandemic, the information available on the conditions inside will continue to grow exponentially. It is and has been increasingly difficult to keep up with the developments and information. Nevertheless, the message is clear: thousands of lives are at risk. This brief commentary on the great risk looming over our correctional facilities urges the need to act immediately and transparently to ensure the safety of one of our most vulnerable populations.<\/p>\n<p style=\"font-size: 85%;\">This story originally appeared in QC Voices, a collaborative publication featuring writers from Queens College in New York City. <a href=\"http:\/\/qcvoices.qwriting.qc.cuny.edu\/\">Check them out here<\/a>.<\/p>\n<p>&nbsp;<\/p>\n<p>As of April 07, Chicago&#8217;s <a href=\"https:\/\/www.nytimes.com\/2020\/04\/08\/us\/coronavirus-cook-county-jail-chicago.html?action=click&amp;module=RelatedLinks&amp;pgtype=Article\">\u00a0Cook County Facility has become the top hotspot for the virus in the U.S<\/a>. According to data\u00a0<a href=\"https:\/\/www.nytimes.com\/interactive\/2020\/us\/coronavirus-us-cases.html\">compiled by The New York Times<\/a>, the jail in Chicago is now the nation\u2019s largest-known source of coronavirus infections. Why is this a problem? More importantly, why should we care about what occurs inside these institutions? The short answer to these questions is this: correctional health\u00a0<em>is<\/em>\u00a0public health.<\/p>\n<p>What happens inside will\u00a0<em>inevitably<\/em>\u00a0influence what happens outside. Any outbreak within our jails and prisons can cascade into the community. Once COVID-19 spreads throughout a facility, the burden of caring for these sick individuals will necessarily shift to local community medical facilities. Large numbers of seriously ill incarcerated individuals would strain the already taxed hospitals, increasing the morbidity and mortality of all people in NY.<\/p>\n<h4><\/h4>\n<h4>Correctional Facilities Create Optimal Conditions for an Infectious Disease Outbreak<\/h4>\n<p>After spending seven years in New York\u2019s jails and prisons, I am all too aware that the inadequate healthcare and hygiene in correctional facilities create optimal conditions for an infectious disease outbreak. During my time at\u00a0<a href=\"https:\/\/doccs.ny.gov\/location\/bedford-hills-correctional-facility\">Bedford Hills<\/a>\u00a0and\u00a0<a href=\"https:\/\/doccs.ny.gov\/location\/taconic-correctional-facility\">Taconic<\/a>, waiting days or weeks to have my sick-call slip addressed by a doctor was nothing out of the ordinary. I would first have to see a nurse who would determine whether I needed to see a doctor another week from then. Access to cleaning supplies were limited, leaving us to rely on our peers to acquire larger quantities of stolen bleach. With these dynamics at play, should any be surprised to learn that many inmates are currently self-manufacturing sanitizer to clean phones with diluted soap and shampoo that may afford them little to no protection against the virus? Sanitizers remain inaccessible to most inmates due to its high alcohol content.\u00a0 To what extent can inmates stay healthy and keep their living quarters clean under such conditions during this pandemic if it is hard to do so under normal conditions?<\/p>\n<h4><\/h4>\n<h4>Spread of the novel coronavirus is now accelerating within our jails and prisons<\/h4>\n<p>This post follows the first reported death of an in inmate in NYC. \u00a0As of April 08, &#8220;<a href=\"https:\/\/www.newsweek.com\/rikers-island-covid-19-new-york-city-1496872\">more than 700 people have tested positive for coronavirus on Rikers Island, including over 440 staff.<\/a>&#8221; At least\u00a0<a href=\"https:\/\/www.nydailynews.com\/coronavirus\/ny-coronavirus-correction-officers-dead-20200407-7p7ipsyss5dw3jy6bjeb6xkhxe-story.html\">seven correction officers have died<\/a>\u00a0as well. Across NYS, at least two inmates, two parolees and a civilian have died.\u00a0\u00a0<u>A<\/u><a href=\"https:\/\/auburnpub.com\/news\/local\/govt-and-politics\/more-covid-19-cases-in-ny-prisons-groups-urge-cuomo-to-release-high-risk-inmates\/article_c616d0b8-71cd-56f3-b108-402c1abd282e.html\">t\u00a0least 55 inmates have contracted the virus<\/a>.<\/p>\n<p>Will these numbers finally force us to pick up pace in releasing more inmates? The spread of the novel coronavirus is now accelerating within our jails and prisons across the nation. In fact, as of April 07, <a href=\"https:\/\/legalaidnyc.org\/covid-19-infection-tracking-in-nyc-jails\/\">the infection rate inside Rikers Island<\/a> was reported to have been at 6.59 percent, considerably higher than the infection rate of New York City, 0.89 percent. As expected in confined spaces, rapid spread of the virus is much more pronounced for inside the jail than outside.<\/p>\n<p>The number of individuals testing positive for coronavirus has surged in the past two weeks but New York&#8217;s strategy for battling a potentially disastrous outbreak within our jails and prisons has lagged far behind. In fact, a\u00a0<a href=\"https:\/\/nypost.com\/2020\/04\/04\/nyc-must-give-coronavirus-gear-to-corrections-officers-judge\/\">New York judge has only very recently mandated all correction officers to receive nonsurgical masks and rapid COVID-19 tests before every shift<\/a>. This decision came on the heels of a lawsuit filed against the city by the Correction Officers&#8217; Benevolent Association. Considering that it is far less likely that an inmate would bring coronavirus into a facility than would the daily ingress and egress of staff, this delay to protect inmates is rather disturbing.<\/p>\n<p>Despite the vulnerability of this population, news coverage on jail and prison conditions remain minimal.<\/p>\n<p>In fact, one of the first lengthy dialogues on COVID-19 and NY&#8217;s inmates was entirely devoted to quelling public panic about a statewide shortage of sanitizer. On March 9th, Governor Cuomo readily announced that\u00a0<a href=\"https:\/\/abcnews.go.com\/Health\/prison-inmates-ny-produce-100k-gallons-hand-sanitizer\/story?id=69501815\">NYS inmates were mass producing sanitizer<\/a>\u00a0for the state as a response to this shortage. Needless to say, his attempt to comfort the public was devoid of any reassurances about our inmates&#8217; health. There was comparable silence on the details of the protective measures for inmates as we learned that\u00a0<a href=\"https:\/\/www.gq.com\/story\/rikers-island-mass-grave\">inmates at Rikers Island were being offered $6.00 an hour and PPE to dig mass graves on Hart Island<\/a>.<\/p>\n<h4><\/h4>\n<h4>Transparency breeds trust<\/h4>\n<p>Now, it should seem that at a time of panic, pressure, and uncertainty, receiving more transparency from our leaders would be common sense. We need to know more than just how our loved ones inside are being exploited to meet the needs of the pandemic. Visitation bans across all facilities within NY makes it more pressing necessary for the news to keep us updates and informed about preventive and mitigating measures being taken inside. The following are some of the questions that need addressing.<\/p>\n<ul>\n<li>How is social distancing being promoted in crowded housing units?<\/li>\n<li>What measures have been taken to strike a balance between protecting inmate health and rights?<\/li>\n<li>How many inmates are being tested?<\/li>\n<li>What will happen in the event that medical staff or correctional staff fall ill to the virus and have to quarantine?<\/li>\n<li>How will that shortage be addressed?<\/li>\n<li>How are the medical needs of those who were sick in long term care prior to the pandemic having their needs met?<\/li>\n<li>Are inmates being given access to sanitizer, soap, and bleach?<\/li>\n<li>How are inmates that have to regularly leave their facilities to receive medical care at hospitals or other facilities being accommodated medically?<\/li>\n<li>To contain the spread of the disease, infection prevention protocols must be meticulously followed. Even if people are being quarantined in these facilities, to what extent can the CDC\u2019s guidelines for detention facilities be observed when inmates have to line up for medication and share showers, \u00a0cooking and dining \u00a0spaces, toilets, and dorms?<\/li>\n<\/ul>\n<p>Naturally,\u00a0 questions about the public safety implications of a large scale release of inmates have also surfaced. Questions about whether those released will commit crimes are valid; however, they are not the most pressing at the moment.<\/p>\n<h4><\/h4>\n<h4>Should we let high-risk inmates die?<\/h4>\n<p>At Rikers Island, a woman named Elisa expresses her concerns, illuminating the life-or-death situation inmates are facing behind bars.\u00a0<a href=\"https:\/\/www.nydailynews.com\/coronavirus\/ny-coronavirus-rikers-prison-limbo-20200327-wmbuh6ooivceriiaengkjrkwqy-story.html\">According to\u00a0<em>The New York Daily News<\/em>, Elisa was required to strip the bed of an inmate who had tested positive for the novel coronavirus.\u00a0<\/a>\u00a0Elisa, who has AIDS, was required to do so without gloves or mask, despite her immunocompromised status. Furthermore, her lawyer&#8217;s request for her release\u00a0and a slew of other secure alternate release were denied by the Manhattan District Attorney\u2019s. Despite her low security risk and preexisting conditions, the Manhattan District Attorney&#8217;s office argued that it could not consent to her bail because she was already sentenced to state prison time. Like Elisa, scores of high-risk inmates are confronting the reality that they may die in prison.<\/p>\n<h2><\/h2>\n<h4>Social distancing nearly impossible in correctional facilities<\/h4>\n<p>At the same time. releasing only those at risk of complications from the novel coronavirus will only have a minor effect on spread of the illness in the close quarters of jails and prisons.\u00a0<em>All<\/em>\u00a0inmates remain vulnerable by virtue of their environment.<\/p>\n<p>In fact, even for those who are low risk for severe illness, there is substantial difficulty to adhere to the\u00a0<a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/community\/correction-detention\/guidance-correctional-detention.html\">Center for Disease Control&#8217;s recommendations to prevent the spread of the virus.\u00a0<\/a>While releasing more inmates certainly reduces the density within these environments and may consequently slow the spread of the virus, social distancing is nearly impossible within these facilities.<\/p>\n<p>The dynamics at Bedford Hills Correctional Facility at this very moment underscore this reality. In the spirit of quarantining and self-distancing,\u00a0 the facility has\u00a0 limited movement by canceling all programs and interactions between different housing units. Still, dozens of women are still gathered around each other on their housing units\u2019 phone, cooking, and recreational areas daily. Dormitory areas fare even worse where as many as 60 inmates sleep together in close quarters. For these women, only thin bed frames and partitions separate them from their bunkmates and neighbors. Rest assured, the idea of consistently maintaining a 6 feet distance is next to impossible in these spaces.<\/p>\n<p>To the previously posed question, &#8220;should we let inmates die?&#8221; I pose another: &#8220;what gives us the right to ask that question?&#8221;<\/p>\n<p><a href=\"https:\/\/www.law.cornell.edu\/constitution\/eighth_amendment\">The Eighth Amendment<\/a>\u00a0of the U.S. Constitution requires that \u201cinmates be furnished with . . . reasonable safety,\u201d and the Supreme Court has explicitly recognized that the risk of contracting \u201cserious contagious diseases\u201d may constitute such an \u201cunsafe, life-threatening condition\u201d that it threatens \u201creasonable safety.\u201d Thus, we have a constitutional failure looming over us if we continue to take a slow, business-as-usual approach to releasing inmates immediately.<\/p>\n<p>Regardless of what a person may have been accused or convicted of, no individuals deserve to be placed at higher risk of a life-threatening illness when reasonable preventive measures are available.<\/p>\n<p>&nbsp;<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_es":"<p>Translation coming soon.<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_fr":"<p>Translation coming soon.<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_subheader_en":"As of April 07, Chicago's  Cook County Facility has become the top hotspot for the virus in the U.S. According to data compiled by the New York Times, the jail in Chicago is now the nation\u2019s largest-known source of coronavirus infections. Why is this a problem? More importantly, why should we care about what occurs inside these institutions? The short answer to these questions is this: correctional health is public health. In a special for Fair Play, writer Najet Miah explores this topic. ","page_subheader_es":"A partir del 7 de abril, las instalaciones del condado de Cook en Chicago se han convertido en el principal punto de acceso para el virus en los EE. UU. Seg\u00fan los datos recopilados por el New York Times, la c\u00e1rcel en Chicago es ahora la fuente m\u00e1s grande conocida de infecciones por coronavirus del pa\u00eds. \u00bfPor qu\u00e9 es esto un problema? M\u00e1s importante a\u00fan, \u00bfpor qu\u00e9 deber\u00eda importarnos lo que ocurre dentro de estas instituciones? La respuesta breve a estas preguntas es la siguiente: la salud correccional es la salud p\u00fablica. En un especial para Fair Play, el escritor Najet Miah explora este tema.","page_subheader_fr":"Depuis le 7 avril, le Cook County Facility de Chicago est devenu le principal hotspot pour le virus aux \u00c9tats-Unis.Selon les donn\u00e9es compil\u00e9es par le New York Times, la prison de Chicago est d\u00e9sormais la plus grande source connue du pays d'infections \u00e0 coronavirus. Pourquoi c'est un probl\u00e8me? Plus important encore, pourquoi devrions-nous nous soucier de ce qui se passe \u00e0 l'int\u00e9rieur de ces institutions? La r\u00e9ponse courte \u00e0 ces questions est la suivante: la sant\u00e9 correctionnelle est la sant\u00e9 publique. Dans une \u00e9mission sp\u00e9ciale sur le Fair Play, l'\u00e9crivain Najet Miah explore ce sujet."},{"slug":"cancer-race-income","ideas_cat":"Analysis","main_image":"https:\/\/defendfairaccess.org\/wp-content\/uploads\/2019\/06\/cancer-portrait.jpg","page_title_en":"How cancer discriminates: The role of income and race in cancer rates","page_title_es":"C\u00f3mo discrimina el c\u00e1ncer: el papel del ingreso y la raza en las tasas de c\u00e1ncer","page_title_fr":"Comment le cancer diff\u00e9rencie: le r\u00f4le du revenu et de la race dans les taux de cancer","page_content_en":"<p>Cancer kills hundreds of thousands of people in the U.S. each year, disproportionately affecting minorities and the poor. The reasons for this are complicated but often come down to two key issues \u2013 socioeconomic factors and race.<\/p>\n<p>Cancer is the second largest cause of death in the U.S.,<a href=\"#_edn1\" name=\"_ednref1\">[i]<\/a> killing approximately 609,640 people in 2018 alone. That year, more than 1.7 million new cases were diagnosed.<a href=\"#_edn2\" name=\"_ednref2\">[ii]<\/a> \u00a0This is not simply a problem that affects a small segment of the population; it is one of the most significant causes of premature death in the country, and there are multiple disparities between demographics.<\/p>\n<p>We know that biological diseases \u2013 like cancer \u2013 can be rooted in social causes.<a href=\"#_edn3\" name=\"_ednref3\">[iii]<\/a> It\u2019s important to understand how different social contexts can increase or decrease one\u2019s risk of health problems. To better understand this issue, we often use socioeconomic status (SES) as a way to understand the broader issues that surround poverty. With SES, we go beyond just wealth and examine other measures such as educational level, housing, employment and the social structures that increase or decrease health.<a href=\"#_edn4\" name=\"_ednref4\">[iv]<\/a> It is important to note that the majority of cancers are caused by lifestyle risk factors which are not innate, as opposed to genetic causes.<a href=\"#_edn5\" name=\"_ednref5\">[v]<\/a> Because of this, we need to look at these risk factors and the social patterns behind them in order to understand that inequities are more than just random occurrences or unfixable genetic conditions.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Poverty and cancer<\/strong><\/p>\n<p>Poverty is directly related to increased incidence rates of cancer,<a href=\"#_edn6\" name=\"_ednref6\">[vi]<\/a> as those with lower levels of education and lower levels of income \u2013 both common measures of SES \u2013 \u00a0experience higher rates of cancer diagnoses.<a href=\"#_edn7\" name=\"_ednref7\">[vii]<\/a> They are also more likely to die from certain cancers \u2013 particularly lung cancer and colorectal cancer.<a href=\"#_edn8\" name=\"_ednref8\">[viii]<\/a> For survivors, income and socioeconomic status are significant predictors of quality of life after cancer.<a href=\"#_edn9\" name=\"_ednref9\">[ix]<\/a> Increased income allows patients to maintain a level of comfort that people with low SES might not be able to afford.<a href=\"#_edn10\" name=\"_ednref10\">[x]<\/a> This means that even if a low income patient survives cancer, their quality of life after will be worse than someone more well off.<\/p>\n<p>People who are diagnosed at earlier stages of cancer are more likely to survive, regardless of ethnicity or SES.<a href=\"#_edn11\" name=\"_ednref11\">[xi]<\/a> Unfortunately, it is often more difficult to detect cancer in certain populations. For example, African American women are less likely to receive a stage I cancer diagnosis compared to white women, reducing their chances of survival.<a href=\"#_edn12\" name=\"_ednref12\">[xii]<\/a> This is because of biological differences between ethnicities that make it more difficult to diagnose cancer at an earlier stage in African American women in comparison to white women.<a href=\"#_edn13\" name=\"_ednref13\">[xiii]<\/a> African American women are also more likely to have triple negative breast cancer, meaning that the three most common receptors that cause breast cancer (and the ones that are primarily tested for) are not present, making it harder to diagnose them at earlier stages.<a href=\"#_edn14\" name=\"_ednref14\">[xiv]<\/a> This partially explains why African American women are often diagnosed later than white women, which leads to poorer cancer outcomes.<\/p>\n<p>However, this is not the only reason for disparities.<a href=\"#_edn15\" name=\"_ednref15\">[xv]<\/a> A study conducted on patients with stage I breast cancer demonstrated no differences in outcome based on ethnicity, when SES was controlled for.<a href=\"#_edn16\" name=\"_ednref16\">[xvi]<\/a> This would imply that if caught early enough, patients across a range of ethnic groups would have more equal health outcomes. Therefore, genetics don\u2019t appear to be the only factor for the higher rates of cancer rates and deaths for minorities.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>Race and cancer<\/strong><\/p>\n<p>Lower-income patients are more likely to have worse cancer outcomes than higher-income patients and are anywhere between 20 percent and 80 percent more likely to die from the disease.<a href=\"#_edn17\" name=\"_ednref17\">[xvii]<\/a> Therefore, not only are low-income patients more likely to be diagnosed with cancer, but those who are diagnosed are more likely to die from it than higher-income patients. The same is true for ethnicity. For example, white women have an 80 percent chance of surviving cancer, while Hispanic and African American women have a 78 percent and 66 percent chance of surviving up to ten years after treatment, respectively.<a href=\"#_edn18\" name=\"_ednref18\">[xviii]<\/a> For breast cancer, being an African American woman was a predictor of increased chances of death, compared to white counterparts.<a href=\"#_edn19\" name=\"_ednref19\">[xix]<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Treatment inequities <\/strong><\/p>\n<p>The severity of disease has been found to be directly correlated to a lack of access to necessary health care.<a href=\"#_edn20\" name=\"_ednref20\">[xx]<\/a> Also known as the inverse care law, this means that those who require the most help receive the least.<\/p>\n<p>A study of a number of different cancer types found that higher-income populations had lower cancer mortality rates when compared to lower-income populations.<a href=\"#_edn21\" name=\"_ednref21\">[xxi]<\/a> This can be attributed in part to the fact that higher SES populations have greater access to screening services \u2013 which can detect smaller abnormalities \u2013 as well as greater access to necessary follow-ups to track care and develop treatment plans.<a href=\"#_edn22\" name=\"_ednref22\">[xxii]<\/a> Therefore, there are inequities not only in which populations get cancer, but also in how cancers are detected and treatment options that are available due to certain populations being able to afford better testing, services, etc.<\/p>\n<p>Additionally, African American women receive lower rates of care when it comes to breast cancer treatment, even when studies are adjusted for SES (in the form of equal insurance coverage).<a href=\"#_edn23\" name=\"_ednref23\">[xxiii]<\/a> African American women are also less likely to receive care and more likely to undergo more invasive treatments when they do receive care.<a href=\"#_edn24\" name=\"_ednref24\">[xxiv]<\/a> When it comes to prostate cancer, African American and white men access screening services equally, but Asian and Hispanic men have lower levels of access to these same services.<a href=\"#_edn25\" name=\"_ednref25\">[xxv]<\/a> This highlights that not all ethnic groups face the same barriers or lack of treatment equally.<\/p>\n<p>It is important to note that while studies have found that higher-income populations with cancer live longer than lower-income populations with cancer, this is not necessarily due to increased levels of health care.<a href=\"#_edn26\" name=\"_ednref26\">[xxvi]<\/a> One study found the relationship between mortality rates due to cancer and socioeconomic status isn\u2019t necessarily connected to health care utilization.<a href=\"#_edn27\" name=\"_ednref27\">[xxvii]<\/a> Level of access to cancer treatment might explain the discrepancies in health outcomes, but it doesn\u2019t explain how certain groups of people can experience higher rates of cancer in the first place.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Barriers to care<\/strong><\/p>\n<p>Based on the fact that lower-income and ethnic minority populations receive cancer treatments at lower levels than their higher-income counterparts, it seems that either: a) care for them does not exist, or b) there are barriers preventing them from accessing it.<\/p>\n<p>Individuals with private medical health insurance are usually more likely to be screened for cancer than those who do not have insurance.<a href=\"#_edn28\" name=\"_ednref28\">[xxviii]<\/a> This shows that those with higher SES have the means to access these services, while those who cannot afford insurance do not have the means. Medicaid was created as an attempt to bridge the gap for low-income Americans, but not all low-income residents in all states are able to access it equally due to differences in state eligibility laws. In some states, all poorer people are covered by Medicaid. In others, you have to first have a significant diagnosis (like cancer) to receive coverage. This creates a bit of a catch-22: you don\u2019t have coverage to receive the screening but that screening is necessary to receive coverage.<\/p>\n<p>Those that are enrolled in Medicaid are more likely to develop late-stage cancer, compared to those with alternative forms of health insurance.<a href=\"#_edn29\" name=\"_ednref29\">[xxix]<\/a> Men who were either uninsured or insured through Medicaid had more developed cancer at the time of screening and diagnosis, compared to men who had private health insurance.<a href=\"#_edn30\" name=\"_ednref30\">[xxx]<\/a> Medicaid coverage reduces some financial barriers to care such as early detection screenings, but it doesn\u2019t remove every barrier. And Medicaid is still marginally better than not having insurance \u2013 but given the differences in how states approach Medicaid (and considering 14 states did not expand eligibility since the passage of the Affordable Care Act), in certain states there are higher rates of those with no insurance as well as lower screening rates.<\/p>\n<p>Screening is critical to cancer survival, as lack of access to screening services has also been associated with increased mortality rates.<a href=\"#_edn31\" name=\"_ednref31\">[xxxi]<\/a> Ethnic minority groups have lower rates of access to screening services, in comparison to the majority white population.<a href=\"#_edn32\" name=\"_ednref32\">[xxxii]<\/a> For example, African American and Hispanic populations were less likely to be screened for colorectal cancer, compared to the white population.<a href=\"#_edn33\" name=\"_ednref33\">[xxxiii]<\/a> There are a number of reasons for this, including lower levels of private health insurance, cultural differences, and lack of trust in the healthcare system due to previous negative experiences.<a href=\"#_edn34\" name=\"_ednref34\">[xxxiv]<\/a><\/p>\n<p>Cancer treatment is time consuming and can be difficult to navigate due to the fact that it often involves multiple providers and appointments.<a href=\"#_edn35\" name=\"_ednref35\">[xxxv]<\/a> One of the barriers is language differences \u2013 Spanish-speaking Hispanics were 24 percent less likely to receive cancer screening services, compared to English-speaking Hispanics.<a href=\"#_edn36\" name=\"_ednref36\">[xxxvi]<\/a> But this barrier alone was not enough to account for the complete differences in ethnic demographics \u2013 rather, it exacerbates already-existing inequalities.<\/p>\n<p>We can clearly see the unequal trends in both rates of cancer and deaths caused by cancer \u2013 but what causes them? There are a number of different factors that should be considered, but it should also be noted that these social trends are complex and interwoven, and there is no single cause of these unequal health outcomes.<\/p>\n<p>To some extent, we can also blame the different mortality rates of cancer on genetic differences between ethnic groups \u2013 something that is innate and cannot be changed. White women are more likely to present with certain types of breast cancer, which are easier to treat and result in better outcomes than other more deadly types.<a href=\"#_edn37\" name=\"_ednref37\">[xxxvii]<\/a> This suggests there is a biological reason for different ethnic outcomes, including why African American women are more likely to die from breast cancer than white women. However, this alone does not explain the disparity between ethnic groups when it comes to incidence and mortality rates, and also does not work as an explanation for all cancers.<\/p>\n<p>There are also certain cancers that are directly related to lifestyle choices, including lung cancer \u2013 which is one of the most common and deadly forms of cancer in the U.S.<a href=\"#_edn38\" name=\"_ednref38\">[xxxviii]<\/a> Lung cancer is primarily caused by smoking, which makes it a choice as opposed to an unchangeable lifestyle factor.<a href=\"#_edn39\" name=\"_ednref39\">[xxxix]<\/a> Lower-income and minority populations are more likely to smoke and have higher rates of lung cancer when compared to white and higher-income populations.<a href=\"#_edn40\" name=\"_ednref40\">[xl]<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Global trends<\/strong><\/p>\n<p>This phenomenon of cancer inequities is not specific to the U.S., as there are a number of countries that display the same trends in health inequities based on ethnicity and socioeconomic status.\u00a0 Much of the Western world loosely follows the same cancer trends due to the fact that lifestyles are very similar, and cancer trends between socioeconomic groups are relatively similar.<a href=\"#_edn41\" name=\"_ednref41\">[xli]<\/a> Although cancer mortality and inequities are increasing in some developed countries, including South Korea,<a href=\"#_edn42\" name=\"_ednref42\">[xlii]<\/a> overall cancer mortality rates are decreasing in developed nations.<a href=\"#_edn43\" name=\"_ednref43\">[xliii]<\/a><\/p>\n<p>Developing countries show differing cancer mortality trends compared to the U.S. and other developed nations. Developing nations are slightly behind U.S. trends &#8211; they are only now starting to increase levels of smoking, consumption of unhealthy fatty foods, and decrease levels of physical activity \u2013 all of which increase cancer.<a href=\"#_edn44\" name=\"_ednref44\">[xliv]<\/a><\/p>\n<p>When looking at cancer from the perspective of race and\/or income, it becomes immediately clear that the problem is complex and multi-faceted, with no one explanation or solution for why different outcomes occur.<\/p>\n<p>In the U.S., it is important to understand that race and income are intrinsically linked. Minorities are more likely to have a lower socioeconomic status, in comparison to the white population. This can compound the risk of cancer and poor health outcomes for minorities, who might also be lower-income. It should still be noted that even after SES is considered, ethnic minorities have worse health outcomes than the ethnic majority in the U.S.<\/p>\n<p>It is also important to note that poverty and poor health are cyclical. Health affects income levels and income affects health. People with poor health are less likely to be able to work full time and retain a steady income. This reduced income then causes further health problems due to a lack of financial access to care. Additionally, having cancer as a child can physically impact an adult survivors\u2019 ability to earn money, even years after they have been declared cancer-free.<a href=\"#_edn45\" name=\"_ednref45\">[xlv]<\/a> Adult survivors of childhood cancers are more likely to receive disability payments because they aren\u2019t able work when compared to the rest of the general population.<a href=\"#_edn46\" name=\"_ednref46\">[xlvi]<\/a><\/p>\n<p>Cancer is a complex health condition that is both caused and worsened by income and race. To even the playing field, we need to first understand how the root causes impact the chance that a certain person will get cancer. The differences in death rates between different socioeconomic groups and races can be partially explained by the different levels of care that these demographics receive, but this does not necessarily fully explain why these differences in care exist in the first place. To some extent, private insurance (or lack thereof) dictates the level of care that patients can access, but this alone does not account for all differences in outcomes that we see. The relationship between ethnicity, poverty\/wealth and cancer is complicated, and we must examine these all together if we are ever able to truly address the issues of inequities in cancer deaths.<\/p>\n<p>&nbsp;<\/p>\n<p><em>References<\/em><\/p>\n<p><a href=\"#_ednref1\" name=\"_edn1\">[i]<\/a> Short, Pamela Farley, and Erin L. Mallonee. \u201cIncome Disparities in the Quality of Life of Cancer Survivors:\u201d Medical Care, vol. 44, no. 1, 2006, pp. 16\u201323.<\/p>\n<p><a href=\"#_ednref2\" name=\"_edn2\">[ii]<\/a> \u201cCancer statistics, National Cancer Institute.\u201d Cancer.gov.<\/p>\n<p><a href=\"#_ednref3\" name=\"_edn3\">[iii]<\/a> Oakes, J. Michael, and Peter H. Rossi. \u201cThe Measurement of SES in Health Research: Current Practice and Steps toward a New Approach.\u201d Social Science &amp; Medicine, vol. 56, no. 4, Feb. 2003, pp. 769\u201384.<\/p>\n<p><a href=\"#_ednref4\" name=\"_edn4\">[iv]<\/a> Ibid.<\/p>\n<p><a href=\"#_ednref5\" name=\"_edn5\">[v]<\/a> Jemal, Ahmedin, et al. \u201cGlobal Patterns of Cancer Incidence and Mortality Rates and Trends.\u201d Cancer Epidemiology and Prevention Biomarkers, vol. 19, no. 8, Aug. 2010, pp. 1893\u2013907.<\/p>\n<p><a href=\"#_ednref6\" name=\"_edn6\">[vi]<\/a> Aarts, Mieke J., et al. \u201cSocioeconomic Status and Changing Inequalities in Colorectal Cancer? A Review of the Associations with Risk, Treatment and Outcome.\u201d European Journal of Cancer, vol. 46, no. 15, Oct. 2010, pp. 2681\u201395.<\/p>\n<p><a href=\"#_ednref7\" name=\"_edn7\">[vii]<\/a> Clegg, Limin X., et al. \u201cImpact of Socioeconomic Status on Cancer Incidence and Stage at Diagnosis: Selected Findings from the Surveillance, Epidemiology, and End Results: National Longitudinal Mortality Study.\u201d Cancer Causes &amp; Control, vol. 20, no. 4, May 2009, pp. 417\u201335.<\/p>\n<p><a href=\"#_ednref8\" name=\"_edn8\">[viii]<\/a> Aarts, Mieke J., et al. \u201cSocioeconomic Status and Changing Inequalities in Colorectal Cancer? A Review of the Associations with Risk, Treatment and Outcome.\u201d European Journal of Cancer, vol. 46, no. 15, Oct. 2010, pp. 2681\u201395.<\/p>\n<p><a href=\"#_ednref9\" name=\"_edn9\">[ix]<\/a> Short, Pamela Farley, and Erin L. Mallonee. \u201cIncome Disparities in the Quality of Life of Cancer Survivors:\u201d Medical Care, vol. 44, no. 1, 2006, pp. 16\u201323.<\/p>\n<p><a href=\"#_ednref10\" name=\"_edn10\">[x]<\/a> Ibid.<\/p>\n<p><a href=\"#_ednref11\" name=\"_edn11\">[xi]<\/a> Iqbal, Javaid, et al. \u201cDifferences in Breast Cancer Stage at Diagnosis and Cancer-Specific Survival by Race and Ethnicity in the United: Breast Cancer Stage at Diagnosis and Survival.\u201d JAMA, vol. 313, no. 2, Jan. 2015, pp. 165\u201373.<\/p>\n<p><a href=\"#_ednref12\" name=\"_edn12\">[xii]<\/a> Ibid.<\/p>\n<p><a href=\"#_ednref13\" name=\"_edn13\">[xiii]<\/a> Ibid.<\/p>\n<p><a href=\"#_ednref14\" name=\"_edn14\">[xiv]<\/a> Ibid.<\/p>\n<p><a href=\"#_ednref15\" name=\"_edn15\">[xv]<\/a> Ibid.<\/p>\n<p><a href=\"#_ednref16\" name=\"_edn16\">[xvi]<\/a> Parise, Carol A., and Vincent Caggiano. \u201cThe Influence of Socioeconomic Status on Racial\/Ethnic Disparities among the ER\/PR\/HER2 Breast Cancer Subtypes.\u201d Journal of Cancer Epidemiology, 2015.<\/p>\n<p><a href=\"#_ednref17\" name=\"_edn17\">[xvii]<\/a> Subramanian, Sujha, and Amy Chen. \u201cTreatment Patterns and Survival Among Low-Income Medicaid Patients with Head and Neck Cancer.\u201d JAMA Otolaryngology\u2013Head &amp; Neck Surgery, vol. 139, no. 5, May 2013, p. 489.<\/p>\n<p><a href=\"#_ednref18\" name=\"_edn18\">[xviii]<\/a> Iqbal, Javaid, et al. \u201cDifferences in Breast Cancer Stage at Diagnosis and Cancer-Specific Survival by Race and Ethnicity in the United StatesBreast Cancer Stage at Diagnosis and SurvivalBreast Cancer Stage at Diagnosis and Survival.\u201d JAMA, vol. 313, no. 2, Jan. 2015, pp. 165\u201373.<\/p>\n<p><a href=\"#_ednref19\" name=\"_edn19\">[xix]<\/a> Ibid.<\/p>\n<p><a href=\"#_ednref20\" name=\"_edn20\">[xx]<\/a> Fedewa, Stacey A., et al. \u201cAssociation of Insurance and Race\/Ethnicity with Disease Severity among Men Diagnosed with Prostate Cancer, National Cancer Database 2004-2006.\u201d Cancer Epidemiology and Prevention Biomarkers, vol. 19, no. 10, Oct. 2010, pp. 2437\u201344.<\/p>\n<p><a href=\"#_ednref21\" name=\"_edn21\">[xxi]<\/a> Welch, H. Gilbert, and Elliott S. Fisher. \u201cIncome and Cancer Overdiagnosis \u2014 When Too Much Care Is Harmful.\u201d New England Journal of Medicine, vol. 376, no. 23, June 2017, pp. 2208\u201309.<\/p>\n<p><a href=\"#_ednref22\" name=\"_edn22\">[xxii]<\/a> Ibid.<\/p>\n<p><a href=\"#_ednref23\" name=\"_edn23\">[xxiii]<\/a> Freedman, Rachel A., et al. \u201cThe Association of Race\/Ethnicity, Insurance Status, and Socioeconomic Factors with Breast Cancer Care.\u201d Cancer, vol. 117, no. 1, Jan. 2011, pp. 180\u201389.<\/p>\n<p><a href=\"#_ednref24\" name=\"_edn24\">[xxiv]<\/a> Ibid.<\/p>\n<p><a href=\"#_ednref25\" name=\"_edn25\">[xxv]<\/a> Fedewa, Stacey A., et al. \u201cAssociation of Insurance and Race\/Ethnicity with Disease Severity among Men Diagnosed with Prostate Cancer, National Cancer Database 2004-2006.\u201d Cancer Epidemiology and Prevention Biomarkers, vol. 19, no. 10, Oct. 2010, pp. 2437\u201344.<\/p>\n<p><a href=\"#_ednref26\" name=\"_edn26\">[xxvi]<\/a> Welch, H. Gilbert, and Elliott S. Fisher. \u201cIncome and Cancer Overdiagnosis \u2014 When Too Much Care Is Harmful.\u201d New England Journal of Medicine, vol. 376, no. 23, June 2017, pp. 2208\u201309.<\/p>\n<p><a href=\"#_ednref27\" name=\"_edn27\">[xxvii]<\/a> Yim, Jun, et al. \u201cContribution of Income-Related Inequality and Healthcare Utilisation to Survival in Cancers of the Lung, Liver, Stomach and Colon.\u201d Journal of Epidemiology and Community Health, vol. 66, no. 1, 2012, pp. 37\u201340.<\/p>\n<p><a href=\"#_ednref28\" name=\"_edn28\">[xxviii]<\/a> Jinjuvadia, Raxitkumar, et al. \u201c1168 Impact of Health Insurance, Education and Income Status on Colorectal Cancer Screening in Minority Populations: 2001 \u2013 2010.\u201d Gastroenterology, vol. 142, no. 5, 2012, p. S-214.<\/p>\n<p><a href=\"#_ednref29\" name=\"_edn29\">[xxix]<\/a> Subramanian, Sujha, and Amy Chen. \u201cTreatment Patterns and Survival Among Low-Income Medicaid Patients With Head and Neck Cancer.\u201d JAMA Otolaryngology\u2013Head &amp; Neck Surgery, vol. 139, no. 5, May 2013, p. 489.<\/p>\n<p><a href=\"#_ednref30\" name=\"_edn30\">[xxx]<\/a> Fedewa, Stacey A., et al. \u201cAssociation of Insurance and Race\/Ethnicity with Disease Severity among Men Diagnosed with Prostate Cancer, National Cancer Database 2004-2006.\u201d Cancer Epidemiology and Prevention Biomarkers, vol. 19, no. 10, Oct. 2010, pp. 2437\u201344.<\/p>\n<p><a href=\"#_ednref31\" name=\"_edn31\">[xxxi]<\/a> Choi, Seul Ki, et al. \u201cMedicaid Coverage Expansion and Implications for Cancer Disparities.\u201d American Journal of Public Health, vol. 105, no. S5, Oct. 2015, pp. S706\u201312.<\/p>\n<p><a href=\"#_ednref32\" name=\"_edn32\">[xxxii]<\/a> Liss, David T., and David W. Baker. \u201cUnderstanding Current Racial\/Ethnic Disparities in Colorectal Cancer Screening in the United States: The Contribution of Socioeconomic Status and Access to Care.\u201d American Journal of Preventive Medicine, vol. 46, no. 3, Mar. 2014, pp. 228\u201336.<\/p>\n<p><a href=\"#_ednref33\" name=\"_edn33\">[xxxiii]<\/a> Ibid.<\/p>\n<p><a href=\"#_ednref34\" name=\"_edn34\">[xxxiv]<\/a> Fedewa, Stacey A., et al. \u201cAssociation of Insurance and Race\/Ethnicity with Disease Severity among Men Diagnosed with Prostate Cancer, National Cancer Database 2004-2006.\u201d Cancer Epidemiology and Prevention Biomarkers, vol. 19, no. 10, Oct. 2010, pp. 2437\u201344.<\/p>\n<p><a href=\"#_ednref35\" name=\"_edn35\">[xxxv]<\/a> Freedman, Rachel A., et al. \u201cThe Association of Race\/Ethnicity, Insurance Status, and Socioeconomic Factors with Breast Cancer Care.\u201d Cancer, vol. 117, no. 1, Jan. 2011, pp. 180\u201389.<\/p>\n<p><a href=\"#_ednref36\" name=\"_edn36\">[xxxvi]<\/a> Liss, David T., and David W. Baker. \u201cUnderstanding Current Racial\/Ethnic Disparities in Colorectal Cancer Screening in the United States: The Contribution of Socioeconomic Status and Access to Care.\u201d American Journal of Preventive Medicine, vol. 46, no. 3, Mar. 2014, pp. 228\u201336.<\/p>\n<p><a href=\"#_ednref37\" name=\"_edn37\">[xxxvii]<\/a> Parise, Carol A., and Vincent Caggiano. \u201cThe Influence of Socioeconomic Status on Racial\/Ethnic Disparities among the ER\/PR\/HER2 Breast Cancer Subtypes.\u201d Journal of Cancer Epidemiology, 2015.<\/p>\n<p><a href=\"#_ednref38\" name=\"_edn38\">[xxxviii]<\/a> Torre, Lindsey A., et al. \u201cGlobal Cancer Incidence and Mortality Rates and Trends\u2014An Update.\u201d Cancer Epidemiology and Prevention Biomarkers, vol. 25, no. 1, Jan. 2016, pp. 16\u201327.<\/p>\n<p><a href=\"#_ednref39\" name=\"_edn39\">[xxxix]<\/a> Clegg, Limin X., et al. \u201cImpact of Socioeconomic Status on Cancer Incidence and Stage at Diagnosis: Selected Findings from the Surveillance, Epidemiology, and End Results: National Longitudinal Mortality Study.\u201d Cancer Causes &amp; Control, vol. 20, no. 4, May 2009, pp. 417\u201335.<\/p>\n<p><a href=\"#_ednref40\" name=\"_edn40\">[xl]<\/a> Ibid.<\/p>\n<p><a href=\"#_ednref41\" name=\"_edn41\">[xli]<\/a> Wong, Martin C. S., et al. \u201cIncidence and Mortality of Lung Cancer: Global Trends and Association with Socioeconomic Status.\u201d Scientific Reports, vol. 7, no. 1, Oct. 2017, pp. 1\u20139.<\/p>\n<p><a href=\"#_ednref42\" name=\"_edn42\">[xlii]<\/a> Yim, Jun, et al. \u201cContribution of Income-Related Inequality and Healthcare Utilisation to Survival in Cancers of the Lung, Liver, Stomach and Colon.\u201d Journal of Epidemiology and Community Health, vol. 66, no. 1, 2012, pp. 37\u201340.<\/p>\n<p><a href=\"#_ednref43\" name=\"_edn43\">[xliii]<\/a> Wong, Martin C. S., et al. \u201cIncidence and Mortality of Lung Cancer: Global Trends and Association with Socioeconomic Status.\u201d Scientific Reports, vol. 7, no. 1, Oct. 2017, pp. 1\u20139.<\/p>\n<p><a href=\"#_ednref44\" name=\"_edn44\">[xliv]<\/a> Jemal, Ahmedin, et al. \u201cGlobal Patterns of Cancer Incidence and Mortality Rates and Trends.\u201d Cancer Epidemiology and Prevention Biomarkers, vol. 19, no. 8, Aug. 2010, pp. 1893\u2013907.<\/p>\n<p><a href=\"#_ednref45\" name=\"_edn45\">[xlv]<\/a> Kirchhoff, A. C., et al. \u201cSupplemental Security Income and Social Security Disability Insurance Coverage Among Long-Term Childhood Cancer Survivors.\u201d JNCI Journal of the National Cancer Institute, vol. 107, no. 6, Mar. 2015, pp. djv057\u2013djv057.<\/p>\n<p><a href=\"#_ednref46\" name=\"_edn46\">[xlvi]<\/a> Ibid.<\/p>\n<p>&nbsp;<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_es":"<p>El texto de este art\u00edculo a\u00fan no est\u00e1 disponible en espa\u00f1ol. \u00a1Por favor mant\u00e9ngase al tanto!<\/p>\n<p>&nbsp;<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_fr":"<p>Le texte de cet article n&#8217;est pas encore disponible en espagnol. S&#8217;il vous pla\u00eet restez \u00e0 l&#8217;\u00e9coute!<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_subheader_en":"Cancer is a top killer and it discriminates. In the U.S., poorer people and minorities are both more likely to get cancer, and are more likely to die from cancer. The reason is complicated but often comes down to two key issues \u2013 income and race. ","page_subheader_es":"El c\u00e1ncer es el principal asesino y discrimina. En los EE. UU., Las personas m\u00e1s pobres y las minor\u00edas tienen m\u00e1s probabilidades de contraer c\u00e1ncer y m\u00e1s probabilidades de morir de c\u00e1ncer. La raz\u00f3n es complicada, pero a menudo se reduce a dos cuestiones clave: factores socioecon\u00f3micos y raza.","page_subheader_fr":"Le cancer est l\u2019un des principaux meurtriers et il fait preuve de discrimination. Aux \u00c9tats-Unis, les personnes les plus pauvres et les minorit\u00e9s sont \u00e0 la fois plus susceptibles d\u2019\u00eatre atteintes du cancer et plus susceptibles de mourir du cancer. La raison en est compliqu\u00e9e mais se r\u00e9sume souvent \u00e0 deux probl\u00e8mes cl\u00e9s: les facteurs socio-\u00e9conomiques et la race."},{"slug":"how-poverty-can-kill-you","ideas_cat":"Fair Play Radio","main_image":"https:\/\/defendfairaccess.org\/wp-content\/uploads\/2019\/09\/poverty.jpg","page_title_en":"Poverty's death toll","page_title_es":"Tasa de muerte de la pobreza","page_title_fr":"Le bilan de la pauvret\u00e9","page_content_en":"<p>For its inaugural podcast, Fair Play founder Holly Lang talks the barriers low-income Americans face in the health system, first in a three-part series looking at poverty and health in North America.<\/p>\n<audio class=\"wp-audio-shortcode\" id=\"audio-112-1\" preload=\"none\" style=\"width: 100%;\" controls=\"controls\"><source type=\"audio\/mpeg\" src=\"https:\/\/fair-play-api.webworldnow.net\/wp-content\/uploads\/2019\/10\/Mix1.5.mp3?_=1\" \/><a href=\"https:\/\/fair-play-api.webworldnow.net\/wp-content\/uploads\/2019\/10\/Mix1.5.mp3\">https:\/\/fair-play-api.webworldnow.net\/wp-content\/uploads\/2019\/10\/Mix1.5.mp3<\/a><\/audio>\n<p>Transcript:<\/p>\n<p>Hi and welcome to Fair Play Radio.<\/p>\n<p>I\u2019m Holly Lang and I\u2019m the founder and managing director of Fair Play, a nonprofit health and economic research, policy and consulting group.<\/p>\n<p>At Fair Play, we think a lot about how costs and income impact a person\u2019s health.<\/p>\n<p>After all, if you struggle to afford necessary or preventable care, how can you stay healthy?<\/p>\n<p>This is an issue that faces all of North America \u2013 and the world. In our debut podcast, we\u2019re looking first at the United States, where the intersection of health and wealth often tend to be at odds.<\/p>\n<p>In what\u2019s considered one of the wealthiest countries in the world, 40 million Americans live in poverty.<\/p>\n<p>And if we talk about \u201cnear-poverty,\u201d or those that live pretty close to the edge, that number jumps to just at 100 million Americans.<\/p>\n<p>That\u2019s about 30 percent of the country, a significant number.<\/p>\n<p>That means nearly one in every three people live dangerously close to destitution, if they aren\u2019t already there.<\/p>\n<p>And that&#8217;s even with US guidelines for poverty, which are fairly low.<\/p>\n<p>As it stands, a family of four would have to have a total household income of less than about $26,000 a year to even be considered to be living in poverty.<\/p>\n<p>$26,000 for four people.<\/p>\n<p>When you consider the basics of life \u2013 rent, utilities, food, clothing \u2013 this is a pretty low threshold, even if you\u2019re in a community where the living is fairly cheap.<\/p>\n<p>And what if you get sick?<\/p>\n<p>Poorer people are more likely to get sick for a number of reasons, including certain socioeconomic factors that lead to substandard housing conditions, inadequate nutrition and poorer work environments.<\/p>\n<p>Poor people also tend to less access to health care.<\/p>\n<p>In theory, if you are poor, you\u2019d receive Medicaid, the public health insurance program for low-income Americans.<\/p>\n<p>But Medicaid varies from state to state and coverage isn\u2019t guaranteed, particularly in the south and parts of the Midwest.<\/p>\n<p>Many that are low-income are also either uninsured or underinsured, which severally limits your options.<\/p>\n<p>You may be able to access care through community-based services, like federally qualified health centers or a charitable clinic.<\/p>\n<p>But those have their limitations and aren\u2019t available in all communities, especially rural areas.<br \/>\nIf you need more intense care, like surgery or emergency services, you\u2019d likely be able qualify for a hospital\u2019s financial assistance policy, particularly if you have a not-for-profit hospital in your community.<\/p>\n<p>But there are barriers there too.<\/p>\n<p>Many hospitals require an in-person application, notarized forms and other documents that require travel.<\/p>\n<p>If you aren\u2019t in a metro area with public transportation, you\u2019ll need a car or a friend giving you a lift to get there, and you\u2019ll need a job that is fine with you missing daytime work, as you\u2019d likely need to adhere to someone else\u2019s office hours to pull everything together.<\/p>\n<p>And keep in mind \u2013 this mostly just applies to emergency and necessary inpatient care.<\/p>\n<p>Routine doctor visits, non-emergent care and preventative care is often a no-go unless you have insurance, be it private, like through an insurance company, or public, like Medicaid.<\/p>\n<p>In 36 states, Medicaid is available to most everyone living in poverty.<\/p>\n<p>But in the other 14 states, Medicaid eligibility doesn\u2019t adhere to a national standard and generally has a complicated set of eligibility standards that tend to exclude many residents.<\/p>\n<p>This often means that it\u2019s a combination of both a significant condition \u2013 like cancer \u2013 and extreme poverty that gets you covered.<\/p>\n<p>If you don\u2019t have insurance \u2013 like 27-and-a-half million Americans \u2013 you likely will struggle to pay not just for your care but for other critical things, like medication and necessary equipment, like blood pressure monitors and glucose monitors.<\/p>\n<p>And it\u2019s important to note that, in general, poorer people are sicker than their wealthier counterparts.<\/p>\n<p>Numerous studies have shown that those living at or near poverty are most likely to die from cancer, heart disease and diabetes.<\/p>\n<p>This is due to several factors that go beyond income, such as education, housing and simple geography, things commonly dubbed \u201csocial determinants of health.\u201d<\/p>\n<p>This means that factors outside your immediate physical self can play a huge role in your health, even including how long you live.<\/p>\n<p>In fact, life expectancy varies as much as 30 years between the richest and poorest U.S. counties.<\/p>\n<p>Sadly, this is getting worse.<\/p>\n<p>A 2016 study done by the research group the Brookings Institute, showed that the difference between rich and poor death rates has significantly grown over the last few decades.<\/p>\n<p>Right now, differences in income can account for more than a decade of life, according to another study by MIT.<\/p>\n<p>This means that the richer you are, the more likely you are to live longer.<\/p>\n<p>And the poorer you are, the more likely you are to die sooner.<\/p>\n<p>This is often from generally preventable diseases, like Type II diabetes or hypertension.<\/p>\n<p>This is significant.<\/p>\n<p>This proves that, in many ways, poverty is the deadliest health condition.<\/p>\n<p>But maybe none of this applies to you.<\/p>\n<p>You are, after all, listening to a podcast.<\/p>\n<p>This means a few things \u2013 you have access to a computer or a smart phone, you have access to<\/p>\n<p>the internet, you understand English well and you likely have at least a high school education.<\/p>\n<p>Already, you\u2019re in a better spot than many.<\/p>\n<p>So why should you care?<\/p>\n<p>Poverty impacts everyone, not just those unlucky enough to live in it.<\/p>\n<p>Think of your schools, your police and safety services, your community infrastructure, all of which are fueled by tax dollars.<\/p>\n<p>Think of what brings new business to a community, and what motivates people to move to a neighborhood.<\/p>\n<p>Think of how high school graduation rates lead to college, or jobs, and how a skilled workforce is much more likely to continue to invest in the community around them than someone barely able to scrape together money for their children to eat or are too sick to work regular hours.<\/p>\n<p>None of this includes vital safety net services often funded through state and federal tax mechanisms, like food stamps, utility assistance, school lunches and housing support.<\/p>\n<p>And keep in mind that if you\u2019re sick because you aren\u2019t able to get the care you need to get healthy, you\u2019re more likely to miss work.<\/p>\n<p>Often.<\/p>\n<p>And those who are at or below the poverty level work hourly wage jobs, meaning an hour missed is an hour you don\u2019t get paid.<\/p>\n<p>All this goes without diving into the ethical issues that surround health care, including debates of whether health care is a right or what role we all should play in the care for others.<\/p>\n<p>And there\u2019s another twist.<\/p>\n<p>According to a recent report issued by the U.S. Census, medical expenses were the number one reason more people fell into poverty.<\/p>\n<p>These expenses included costs of care, prescriptions drugs and insurance premiums.<\/p>\n<p>The Census reported that an additional 8 million people were pushed into poverty from their health care expenses.<\/p>\n<p>A staggering one-in-six Americans have past due health bills on their credit reports, totaling about $81 billion in 2016, according to a study published last year in policy journal Health Affairs.<\/p>\n<p>And that\u2019s just what we know.<\/p>\n<p>Health costs can be an invisible sort of debt at times, hidden in credit cards or short-term loans, including predatory payday loans.<\/p>\n<p>This means that while we have an idea of the impact of health costs, there\u2019s still a whole lot we do not know.<\/p>\n<p>And in the struggle to afford care, many people are being pushed into detrimental financial situations.<\/p>\n<p>It\u2019s important to note that while there are a few bad players, many of the issues are inherent in the U.S. health system overall, not just a particular hospital or provider.<\/p>\n<p>At the risk of being trite, the system itself is broken.<\/p>\n<p>So, what can we do?<\/p>\n<p>There is a lot of room to work on the social determinants of health we mentioned earlier.<\/p>\n<p>We could increase reimbursement for social support systems through Medicaid and Medicare, and push insurance companies to do the same.<\/p>\n<p>Think investments in safe housing and food access, two key areas for improvement in most US communities.<\/p>\n<p>Hospitals could partner with community-based groups to address these issues and would likely see a significant return on that investment in the mid- to long-term.<\/p>\n<p>After all, it\u2019s been proven time and again that it\u2019s cheaper to invest in local housing than it is to house a patient in a hospital bed.<\/p>\n<p>We could also improve how government looks addresses the issue.<\/p>\n<p>Certain payment models, such as capitation and value-based care, are meant to control costs and could be expanded to more areas of care.<\/p>\n<p>And price transparency would use basic market principles to lower prices. But that is in theory, as health care doesn\u2019t always adhere to textbook economic rules.<\/p>\n<p>Locally, hospitals could improve their processes.<\/p>\n<p>This should include ensuring that every low-income patient has access to financial assistance, including those who are underinsured.<\/p>\n<p>This could also include better discharge protocols for patients who are likely to be lower income.<\/p>\n<p>For example, what\u2019s the point of telling someone to regularly monitor their blood pressure if they can\u2019t even afford the equipment to do so?<\/p>\n<p>Or how feasible is it to ask a patient to follow up with their cardiologist if they don\u2019t have affordable access to a specialist?<\/p>\n<p>Hospitals could also undertake referral partnerships with community health centers, Federally Qualified Health Centers and charitable care clinics.<\/p>\n<p>This could allow those doctors to refer into the hospital patients who have needs that go beyond what they\u2019re able to do in that setting.<\/p>\n<p>This is a great first step in many communities to extending care to those who otherwise wouldn\u2019t get it.<\/p>\n<p>But we also have to think big picture with this.<\/p>\n<p>There are some broad transparency standards being currently put in place on both a state and national level around prices that show a glimmer of promise.<\/p>\n<p>This is a critical first step, as most of us have no idea what a hospital visit, procedure or doctor appointment will cost us until at least a month after we\u2019ve received care, giving us little recourse.<\/p>\n<p>But these prices aren\u2019t the \u201creal\u201d prices, meaning what\u2019s posted isn\u2019t generally what anyone pays.<\/p>\n<p>And if you have no money, knowing the price in advance likely isn\u2019t going to help much.<\/p>\n<p>State and federal governments could increase their investment in social programs, such as stronger housing initiatives and programs like the supplemental nutrition assistance program.<\/p>\n<p>More states could expand Medicaid, and that\u2019s likely the most immediate \u2018big picture\u2019 fix we could undertake at this point.<\/p>\n<p>While many lawmakers balk at the price, the political tide is beginning to turn as more state governments see it as one of their only options in harnessing the harm caused by uninsurance.<\/p>\n<p>But we\u2019re seeing a trend of expansion coupled with requirements that would still place that option out of reach of most.<\/p>\n<p>Think work requirements, for example.<\/p>\n<p>Work requirements generally require beneficiaries to participate in certain activities, such as employment, a formal job search, or job training programs.<\/p>\n<p>As of now, Indiana is the only state doing this, though five more states have approved work requirement waivers and seven more have requested approval.<\/p>\n<p>On face value, many don\u2019t see this as an issue.<\/p>\n<p>After all, according to the Kaiser Family Foundation, most Medicaid adults are already working.<\/p>\n<p>But those that aren\u2019t working report barriers to work, including a lack of adequate opportunities, particularly for those without a high school or college diploma.<\/p>\n<p>And what if you are already too sick to work?<\/p>\n<p>Even when working, adults with Medicaid face disproportionately high rates of financial and food insecurity, as they are still living in or near poverty.<\/p>\n<p>So those problems of poverty we talked about at the beginning?<\/p>\n<p>Still an issue.<\/p>\n<p>In short, there\u2019s no silver bullet here.<\/p>\n<p>Without a doubt, poverty is the deadliest condition of all, and it will take federal, state and local communities working in concert to truly begin to make necessary changes that need to happen.<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_es":"<p>El texto de este art\u00edculo a\u00fan no est\u00e1 disponible en espa\u00f1ol. \u00a1Por favor mant\u00e9ngase al tanto!<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_content_fr":"<p>Le texte de cet article n&#8217;est pas encore disponible en espagnol. S&#8217;il vous pla\u00eet restez \u00e0 l&#8217;\u00e9coute!<\/p>\n<style>header nav a:last-child { display:none !important; }<\/style>\n","page_subheader_en":"Throughout North America - and the world - poverty remains one of the most deadly health conditions. We look at how this issue impacts Americans, and what solutions might be there. ","page_subheader_es":"En toda Am\u00e9rica del Norte, y en todo el mundo, la pobreza sigue siendo una de las condiciones de salud m\u00e1s mortales. Vemos c\u00f3mo este problema impacta a los estadounidenses y qu\u00e9 soluciones podr\u00edan existir.","page_subheader_fr":"En Am\u00e9rique du Nord et dans le monde entier, la pauvret\u00e9 reste l\u2019un des probl\u00e8mes de sant\u00e9 les plus meurtriers. Nous examinons l\u2019impact de ce probl\u00e8me sur les Am\u00e9ricains et les solutions qui pourraient y \u00eatre trouv\u00e9es."}]}