National rankings found North Dakota’s health care system does well in terms of overall performance, but access and affordability are problem areas, prompting more discussions about connecting more populations with quality care.
This past week, the North Dakota Voices Network hosted a forum on health equity issues.
Whitney Fear, a psychiatric-mental health nurse practitioner at Family HealthCare and member of the Oglala Lakota Nation, spoke about barriers facing Indigenous populations. She said Native Americans are underrepresented in the health care workforce. While it does not mean non-Indigenous staff cannot care for these patients, the gap still has an effect.
“There’s a pretty significant amount of research that pointed to that if somebody on your team caring for you or directly caring for you, if they look like you, they share your belief system, your traditions, whatever, that you’re more likely to experience positive health outcomes,” Fear explained.
She also feels there are broader assumptions Indigenous populations get ample support through the Indian Health Service. Fear argued the federal agency is woefully underfunded and fails to reach Natives living in urban settings.
The Commonwealth Fund scorecard ranked North Dakota 13th in the nation for health-system performance, and noted access and affordability fall below the U.S. average.
Shannon Bacon, health equity manager for the Community HealthCare Association of the Dakotas, noted while primary care in a clinical setting is important, it only accounts for about 20% of health outcomes. She said social and economic factors carry more weight in this area.
“And so, if we don’t kind of get to the root of what a patient’s basic needs are, we’re not going to be able to get very far in helping them with kind of basic chronic disease and health needs,” Bacon contended.
She added community health centers, which operate in underserved areas, are becoming more proactive in screening patients for social determinants of health.
Policy-wise, her group suggested the federal government boost access to pharmacies, and state leaders consider for funding for community health centers. In 2020, the facilities served more than 30,000 patients in North Dakota. Roughly 30% were of a racial or ethnic minority.
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Veterans advocacy groups say expanding access to advanced-practice nurse practitioners (APRNs) will help more vets access critical medical care.
Under current state law, APRNs must work under doctor supervision, have a collaborative practice agreement and meet once every six months with their supervising physician.
Rick Disney, strategic director of Concerned Veterans for America North Carolina, said lifting the rules would increase the numbers of APRNs practicing independently in rural regions, which would be a game changer for veterans living long travel distances from the state’s four VA medical centers.
“This would help those rural veterans with the nurse practitioners being able to help those veterans access care,” Disney asserted.
According to a report by the American Enterprise Institute, compared to medical doctors, nurse practitioners are more likely to practice in rural areas, where the need for primary care is greatest. And rural patients are five times more likely to live in a health care shortage area than those living in urban or suburban areas.
The American Medical Association and other physician groups maintain collaborative practice agreements are needed for patient safety.
Leigh Grant Mullen, a family nurse practitioner at Veterans Life Center in Durham, who volunteers at Veterans Life Center in Durham, said while she currently has a supervising physician who is passionate about providing medical care to under-resourced populations, she is uncertain what will happen when he retires.
“If I am not able to find a collaborating physician who will collaborate with me for no cost, it is possible that I will not be able to practice and serve these populations,” Grant Mullen explained.
Dr. Ann King, assistant professor at East Carolina University College of Nursing, said in rural and underserved communities, patients repeatedly show up at hospital emergency rooms for minor issues that could easily have been taken care of in an outpatient setting.
“Which then further builds the financial deficits of facilities and systems,” King pointed out. “Access to care is a huge barrier for many of our uninsured or underinsured residents in North Carolina.”
A report by Duke University economists found allowing APRNs to practice more independently would increase local tax revenue, create more jobs and save the state between $433 million and $4.3 billion.
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For the past two decades, New Mexico has had one of the highest rates of overdose deaths in the nation, increasingly linked to fentanyl. But until now, fentanyl testing strips were banned.
Illegal drugs such as cocaine are often contaminated with fentanyl and unknowingly purchased by users, which can be deadly.
Shelley Mann-Lev, board president of the New Mexico Public Health Association, said passage of a decriminalization bill by lawmakers this year could help reduce the overdose crisis.
“New Mexico, along with so many other states, has seen a huge increase in overdose deaths related to fentanyl, and fentanyl test strips have been illegal; they’ve been considered drug paraphernalia,” Mann-Lev explained.
The state was the first to decriminalize drug paraphernalia in 2019, but fentanyl test strips were not yet developed. Mann-Lev pointed out House Bill 52, approved by legislators and signed by the governor, decriminalizes the inexpensive test strips.
As in other states, fentanyl overdose is the leading cause of death in New Mexicans ages 18 to 35.
Mann-Lev said passage of the measure also allows the state’s Department of Health to distribute sterile supplies to reduce the spread of infectious disease and enables the department to act quickly to address other lethal additives in drugs.
“It allows the Department of Health not to have to wait to come a year or two years later to the Legislature,” Mann-Lev stressed. “It actually gives the Department the regulatory power to adapt harm reduction to determine what kind of testing devices and supplies are necessary.”
Nationwide, fentanyl overdose is the leading cause of death among Americans aged 18 to 45, ahead of suicide, COVID-19 and car accidents, according to data from the Centers for Disease Control and Prevention.
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A coalition of 70 health and community groups called Care4All California released its
2022 package of 16 bills and budget requests on Monday, aiming to make health care more affordable and accessible.
The most well-known is Assembly Bill 4, which would extend Medi-Cal to all income-eligible adults regardless of immigration status.
Anthony Wright, executive director of the nonprofit Health Access, said taken together, the package would give health care to an additional 700,000 people and benefit millions more.
“The package would represent the biggest expansion of coverage since the Affordable Care Act and would be the most far-reaching in terms of providing cost relief to millions of Californians,” Wright asserted.
Senate Bill 944 and Assembly Bill 1878 would eliminate deductibles on Silver plans on the Covered California exchange. Assembly Bill 1995 would eliminate premiums on Medi-Cal. And Senate Bill 644 would require the state to reach out to people who apply for unemployment assistance, to see if they need help finding health care coverage.
Sen. Scott Wiener, D-San Francisco, is sponsoring Senate Bill 858, which would raise the fines for insurance companies that unlawfully deny or delay medically necessary services.
“And so we’re increasing that $2,500-per-violation fine to $25,000 so that it actually means something,” Wiener explained.
Asm. Blanca Rubio, D-San Gabriel Valley, is sponsoring Assembly Bill 2402, which would extend continuous coverage to children on Medi-Cal for the first five years of life.
“Right now, we have about 90,000 children ages 0 to 5 in Medi-Cal that have had a gap in coverage,” Rubio pointed out.
Other bills in the package include Senate Bill 923, which requires health plans to list doctors providing gender-affirming care, and Assembly Bill 1130, which would create an office of health care affordability.
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