PORTLAND, Ore. – Al menos una de las facetas del desarrollo del cuidado de la salud en Oregon es un éxito rotundo: la gente que vive en el nivel federal de pobreza, o cerca de él, ahora puede inscribirse en el Oregon Health Plan (Plan de Salud de Oregon) sin tener que estar en una lista de decenas de miles de nombres, esperando una oportunidad que se definía por lotería.

El año nuevo trae cambios favorables para los miles de adultos del estado que no fueron asegurados suficientemente y que viven en un nivel cercano a la línea de pobreza, porque Oregon es uno de los 26 estados que expanden sus programas Medicaid bajo la Affordable Care Act (Ley de Cuidado Asequible). La cobertura Medicaid es conocida como el "Oregon Health Plan (Plan de Salud de Oregon)," y unos 300,000 residentes del estado pueden acceder a la cobertura que inicia en enero. La directora de Coordinated Care Organization (Organización de Cuidado Coordinado) en Partership and Development (Paternidad y Desarrollo) de CareOregon, Erin Fair Taylor, dice que se acabó la época de la selección tipo loterías.

"En esencia, cualquiera que sea elegible por sus ingresos para inscribirse en el programa tipo lotería, será elegible automáticamente para entrar al Oregon Health Plan. Ya no se necesita la lotería, lo que es bastante emocionante."

Agrega que la expansión del Oregon Health Plan no ha sido plagada con los mismos problemas propios de otras partes del desarrollo del plan de salud estatal. El Departamento de Servicios Humanos (DHS) preadmitió a muchos individuos y familias de bajos ingresos, y les informó acerca de la expansión. Más de 100,000 respondieron inscribiéndose.

Por supuesto, el reto de tener más gente con seguro de salud es la escasez potencial de profesionales de la salud. Taylor dice que CareOregon y sus asociados anticiparon este problema. En lugares como el Condado Jackson, donde uno de cada cuatro residentes es elegible para Medicaid, están trabajando para convencer a más médicos y dentistas de que acepten Medicaid. También están trabajando para que los que ya lo aceptan, atiendan a más pacientes.

"Sea ayudándoles a conseguir más proveedores o ayudándoles con algo de tecnología, en algunos casos incluso con nuevos espacios de oficina o edificios, este tipo de cosas. Así que tratamos de tener un enfoque creativo, reconocer que en esto no hay soluciones universales y que cada comunidad tiene sus necesidades específicas."

Taylor destaca que no hay fecha límite para inscribirse al Oregon Health Plan. Cualquiera cuyo ingreso sea igual o menor al 138 por ciento del nivel federal de pobreza, es elegible. Eso significa un ingreso aproximado de $32,000 al año para una familia de cuatro.


get more stories like this via email

September is Health Literacy Month, and a Denver-based group is working to help health professionals break a persistent pattern of discrimination linked to high disparities in maternal death rates.

Danyelle Gilbert, CU Nursing alumna and a member of the Colorado Council of Black Nurses, points to research showing that between 2016 and 2020, nearly all pregnancy-related deaths of Black women could have been prevented through timely interventions - at the patient, provider or system level.

"That report specifically found that discrimination played a role in over half of pregnancy-associated deaths. And approximately 90% of those pregnancy-related deaths were identified as preventable," she said.

Black women in Colorado are twice as likely to die - during their pregnancy, or within one year of giving birth - than the state's overall pregnant population. The leading cause of maternal death overall is self-harm and unintentional overdose. But for Black women, the number one cause of death is heart failure.

Gilbert added that common forms of discrimination facing Black women include simply being dismissed, or not being taken seriously, by health care providers. She says their pain and symptoms are routinely minimized, and there are delays in their care.

"They may face a lack of shared decision making, and poor communication from their health care provider. They just don't feel educated, they are not able to make informed decisions. And all of that is leading to negative health outcomes," she continued.

Gilbert recalls one Black woman experiencing contractions who was turned away to fill out paperwork, even though her information was already on file, and ended up giving birth in a hallway. She said health professionals can do better, in terms of showing patients they are valued.

"And when we value someone, we pour life into them. So when caring for a Black woman, see her. Empathize with her, connect with her. Feel her pain, her joys, her cries. Hear her, because she is both strong and fragile," she added.


get more stories like this via email

In North Carolina, the gap between Medicaid reimbursement rates and the actual cost of dental care has reached a crisis point, impacting both patients and providers.

Dr. Rafael Rivera, a member dentist with the North Carolina Dental Society and owner of Smile Starters, said the gap is impacting quality dental care around the state.

"It's about 30 cents on the dollar, about 30% of what we should be getting paid for the procedures. And that's not exact, but 30 to 35% somewhere in that range. It's actually a lot worse if you're an oral surgeon in the state treating the patient population," he said.

Those reimbursement rates haven't been updated since 2008. Rivera added that a lack of funding hinders dental practices from attracting and retaining skilled professionals. He said as a result, Medicaid patients often resort to emergency rooms for dental issues-an option that is both more expensive and less effective.

To address these challenges, Rivera suggested expanding the network of Community Dental Health Coordinators. He believes these coordinators could play a crucial role in bridging the gap between patients and dental providers, particularly for those who face language barriers or lack knowledge about available services. He also called for increased funding and safeguards that help dental offices keep up with inflation.

"Our legislator ideally will find a way to not only just put an increase in place, but more importantly have a mechanism that requires them to reevaluate it on a regular basis so that we don't have to go another 16 years before an increase is in place again," he said.

Rivera underscored that this issue extends beyond just dental care, pointing out that data show strong dental health is linked to better overall well-being. Since the expansion of Medicaid, the program has enrolled over 500,000 people.

September is Self-Care Awareness Month and the American Heart Association in Missouri is urging caregivers to take some much-needed time for themselves.

Missouri has around 600,000 family caregivers, many of whom provide unpaid care to loved ones with heart disease, cardiac events and other debilitating illnesses. The emotional and physical toll can be severe, with 21% of caregivers reporting their own health has declined.

Dr. Ravi Johar, chief medical officer for UnitedHealthcare and a board member of the American Heart Association of St. Louis, wants caregivers to understand proper self-care is not selfish.

"It's really important that after an acute event, whenever you've had a chance to kind of catch your breath, sit down and think about exactly what they need and exactly what you need and how much you can give," Johar recommended. "That's not being selfish. That's not, not taking care of them. That's doing the right thing for both of you."

According to the American Heart Association, it is important for caregivers to have someone they can confide in about their fears and doubts; a person who can offer reassurance and emotional support.

A 2023 AARP survey showed nearly 40% of family caregivers spend more than 20 hours a week assisting their loved ones from driving to appointments to providing direct care, many while also working and raising children. Johar stressed the importance of caregivers using time off from work wisely, which includes new mothers with babies in neonatal intensive care.

"The baby's getting the best care in the hospital and there's nothing you can do to help," Johar pointed out. "Go ahead and go back to work. Save that time, go in every evening. Spend all night or as much time as you want with the baby. But save your time off, because when this baby comes home, then you're really going to need to be there."

Doctors also emphasized the critical role of regular exercise, like brisk walks and the need for caregivers of all ages to maintain a heart-healthy diet. The habits help manage stress and boost energy levels.