RALEIGH, N.C. - Parents in North Carolina are among those feeling the effects of the state's decision to turn down federal dollars to expand Medicaid. A new report released this week by the Urban Institute examines the impact to the more than 300,000 North Carolinians who fall into the coverage gap; they don't qualify for publicly funded-health coverage, or an insurance policy through the Affordable Care Act. Genevieve Kenney, co-director in the Health Policy Center with the Urban Institute, says there's a growing disparity between parents in states that opted for the expansion, and those that did not.

"Parents in the states that have not expanded Medicaid have an uninsured rate that is close to 20 percent, where it's closer to 10 percent for the states that have expanded Medicaid," Kenney says.

The report says states that have accepted federal funding have seen nearly a 33-percent drop in the rate of parents without health insurance. North Carolina lawmakers turned down the funding because of concerns over costs to the state. The federal government is paying 100-percent of the cost until 2016 and will reduce its funding to 90-percent by 2020.

Adam Linker, policy analyst with the North Carolina Justice Center's Health Access Coalition, says knowing the expansion could have provided care for thousands of uninsured people is a bitter pill to swallow.

"The most frustrating thing is there's really no reason North Carolina is not expanding, other than ideological reasons," he says.

Seventeen percent of uninsured parents surveyed reported having fair or poor health, and slightly more said they had mental-health concerns. Linker says research indicates when parents have access to preventive coverage and care when they are ill, they're also able to care for their families.

"We know insured parents are able to be more present in their children's lives. They're able to take better care of their children, because they are not themselves sick," Linker says.

According to the research, nearly half of the uninsured parents studied lived in southern states and more than half were Latino.


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Nurses are on the forefront of patient outcomes, and experts say a workforce that better reflects the population it serves can help reduce healthcare disparities.

In Ohio, people of color are under-represented in the nursing workforce. The percentage of nursing school graduates who are Black or Hispanic is lower than the percentage of the general population.

Associate Provost for Social Mission and Academic Excellence at Chamberlain University Dr. Kenya Beard has studied the issue of improving diversity in the nursing profession.

"Diversity among health professionals is associated with improved access to care, and the two overarching issues is access and quality," said Beard. "So, greater patient choice and satisfaction when we have a diverse workforce; it's better patient-clinician communication."

Beard noted that diversity is multi-dimensional, and includes race, ethnicity, socio-economic factors and gender. For example, men represent only 12% of nurses.

Beard said improving diversity in the profession starts with a more inclusive learning environment. She explained that when students sees themselves represented among the faculty, they realize a nursing degree is something they can achieve as well.

Beard explained that unconscious attitudes among medical professionals can impact patient outcomes.

For example, because of their own life experience, a nurse might assume incorrectly that a patient has the resources to drive to a pharmacy and purchase a medication when they leave a hospital.

"When you bring people into a learning environment that have different experiences," said Beard, "not just based on race but based on socioeconomic factors as well, these different experiences create a rich, robust dialogue that helps everyone understand how these social determinants of health impact patient outcomes."

Beard added that with culturally responsive teaching, nursing educators strengthen students' ability to recognize and respond in an inclusive way to diverse perspectives.

"When these students graduate," said Beard, "they are better positioned to have a conversation with patients and their colleagues in a way that shows cultural humility and a greater degree of understanding the difficulties of navigating healthcare and achieving your best level of health."

Chamberlain University, which has locations in Columbus and Cleveland, has what's called a Social Determinants of Learning model.

Beard said it addresses disparities and expands opportunities by focusing on barriers to student success, including economic, housing, and transportation insecurity, and psychosocial health

Many New Yorkers will be shopping for new health insurance plans this month, when open enrollment begins. If you are among them, experts advise it is important to be aware of exactly what you are getting.

New Yorkers pay some of the highest health care premiums in the U.S., second only to Alaska.

According to a study by the Empire Center, insurance costs here average more than $8,500 a year, which is more than $1,000 higher than the national average. No matter the cost, every health plan has its limitations.

Dr. Rhonda Randall, chief medical officer for UnitedHealthcare employer and individual, noted it is up to you to ask about what the plans cover, including any mental-health options.

"In addition to in-person mental health care, you might have access to a very large virtual network of licensed mental health professionals, like therapists and psychiatrists," Randall pointed out. "Some insurers also offer digital tools for mental health, and advocacy services to help you navigate those needs."

She stressed adding dental, vision or hearing coverage is another consideration, as well as double-checking whether the plan covers prescriptions. In short, she recommended people do their homework, as enrollment dates are fast approaching.

There are some elements of a plan Randall acknowledged people do not typically consider, but should. For example, how would the plan handle a significant health event, or a chronic health condition? And she added the pandemic has also influenced the services many insurers provide.

"Plans that include virtual care services for both medical conditions as well as behavioral health conditions have become very popular," Randall observed. "We've seen the utilization of those increase. You're also looking for a plan that has not only virtual health options, but a connection to in-person care as well."

Above all, Randall emphasized having health coverage is the most important thing, including the kinds of care you and your family need.

COVID upended many routines, including Texas parents getting kids in for regularly scheduled childhood vaccines. Data from the Texas Department of State Health Services showed the childhood vaccination rate dropped during the pandemic.

Starting in June, the Hispanic Access Foundation partnered with the U.S. Department of Health and Human Services to bring COVID-19 vaccine clinics to Latino churches in three Texas communities.

Aurie Garcia, secretary of Hope of Life Church of God in Houston, said COVID is still top of mind for many people, but children need protection from a variety of potential illnesses.

"And it's very important to protect the children," Garcia stressed. "Because they go out, they go back to school, so it's very important for them to have the COVID vaccine and the other vaccines."

If you have not kept track of immunization records, they're available from state-run immunization information systems.

A study published in the journal Vaccine found from 2019 to 2020, immunization rates fell 47% among five-month-olds and 58 % among 16-month-olds.

Garcia noted some Hispanic people avoid doctors because they're worried materials won't be available in Spanish and a translator will not be on site. She added it is a way the Hispanic Access Foundation can help.

"We explain to them that we partner with the Health Department in Houston," Garcia remarked. "I am bilingual, I speak Spanish; that's my primary language, and Harris County Department, they also have some of their people that speak Spanish."

Health care providers say many families skipped doctor's visits during the pandemic to avoid exposure to the COVID virus. Other parents do not immunize children for religious reasons, and still others are worried about potential health problems associated with some vaccines, although the risks are reported to be extremely small.