Disparities in heart failure prevention increase costs

Black Americans are hospitalized for preventable heart failure at disproportionately high rates in the southern U.S., driving up health care costs, a new study finds.

Researchers from Tulane University examined hospital admission rates for preventable heart failure among Medicare recipients in six southern states. They found that more than 28,200 admissions, an excess of 48%, would have been avoided if Black patients had the same admission rates as white patients. Rates were also high for American Indian and Alaska Native older adults, with 51% excess hospitalizations compared to white seniors, and Hispanic patients, with 14% excess hospitalizations.

The disparities came at high cost to Medicare: For Black patients, the excess admissions added up to $61 million annually; for American Indian and Alaska Native patients, $1 million; and for Hispanics, $8 million. 

As heart failure has proven screening and treatment methods, the hospitalizations were preventable, according to the Health Affairs study. Black Americans have the highest rate of heart failure among all U.S. racial and ethnic groups, but are less likely to receive recommended treatment or prevention, previous research has found.

Medicaid enrollment expected to fall dramatically 

Up to 24 million Medicaid users could lose health coverage as protective measures put in place during the COVID-19 pandemic expire, a recent analysis predicts.

When the federal COVID-19 public health emergency declaration ends today, many of the programs created under it will unwind, including continuous Medicaid enrollment. The policy kept people from being dropped from the program even if they were no longer technically eligible to receive it. 

Without that protection, 8% to 28% of Medicaid users could be disenrolled by March 2024, a survey of state officials conducted by KFF and the Georgetown University Center for Children and Families found.

On the low end, 7.8 million users would lose coverage, including 2.2 million kids covered through the Children’s Health Insurance Program. On the high side, 24.4 million people would be disenrolled, including 7.2 million kids. The number of Medicaid and CHIP beneficiaries swelled by 23 million during the pandemic, reaching 95 million by March 2023.

Disenrollment rates will range between states, as some have put policies in place to keep coverage for eligible participants. Previous research from KFF found that about 65% of people who lose Medicaid or CHIP coverage are left without health insurance for at least some time.

EPA complaint: Poultry waste threatens vulnerable communities

North Carolina’s failure to protect minority communities from the health hazards of poultry farm waste is a civil rights violation, according to a recent complaint filed with the U.S. Environmental Protection Agency. 

Authored by the Environmental Justice Clinic at Vermont Law and Graduate School on behalf of Friends of the Earth and others, the complaint asserts that North Carolina’s Department of Environmental Quality has inadequately regulated facilities that handle dry litter from poultry farms. 

Made up of feces, urine and bedding material, the litter is commonly spread in fields, with runoff affecting waterways and dust impacting air quality. Nearby communities, which are primarily made up of Black, Hispanic and American Indian residents, are more heavily impacted by the pollution, the complaint said.

California inpatient facilities at risk from wildfires

Many of California’s inpatient health care facilities are located near areas that are at high risk for wildfires, posing potential risks for patients and staff, a recent study finds. 

Researchers compared the location of the state’s more than 3,000 inpatient health care facilities with fire threat zones determined by the California Department of Forestry and Fire Protection. Of the more than 214,000 available inpatient beds, half are in facilities that are less than a mile from a high-threat zone, and 95% are within 3.7 miles, said the study, published in the American Journal of Public Health. 

Facilities in northern California — home to some of the state’s largest fires in recent years — are disproportionately closer to zones classified as very high and extreme threats. 

Smoke exposure, road closures and infrastructure damage can occur with little warning, threatening patients and staff, the study authors noted. They recommended that facilities create plans for smoke mitigation, sheltering and evacuation, among other measures.

Agreement reached on Alabama sewage discrimination 

Residents of a central Alabama county who lack adequate wastewater systems will no longer be subject to discriminatory penalties from state agencies that have failed to address their problems.

On May 4, the U.S. departments of Justice and Health and Human Services announced a resolution agreement with the Alabama Department of Public Health and the Lowndes County Health Department. An 18-month civil rights investigation found the state health department was aware of sanitation problems affecting county residents but failed to take meaningful action to address them. 

County residents — 73% of whom are Black and a third of whom live in poverty — experience frequent sewage backups, drainage problems and regular exposure to raw waste. Prior to the agreement, residents were subject to fines, jail time and property loss if they could not maintain or repair their sewage systems. 

Besides suspending the penalties, the agreement specifies that the state health department examine sewage-related health risks in the county and create a plan for adequate sanitation systems. Health officials are also required to launch a public health awareness campaign on the dangers of raw sewage, provide educational materials to health care providers and regularly engage with community stakeholders.

The Watch is written by Michele Late, who has more than two decades of experience as a public-health journalist.