LINCOLN, Neb. – States that expanded Medicaid under the Affordable Care Act saw uninsured rates for low-income adults drop more than three times more than states, including Nebraska, that opted not to expand coverage, according to a new report from Georgetown University.

Molly McCleery, deputy director of the Nebraska Appleseed Health Care Access Program, says 24 percent of Nebraska's rural residents do not have coverage, compared with 19 percent without coverage in urban areas.

"We've made gains as a state in insurance coverage in the last few years, but there are – as this report shows – a significant number of people who have been left out, and a lot of those people are living in our smaller towns and our smaller communities," she points out.

McCleery says expanded coverage strengthens health care systems for all residents by keeping hospital doors open in small towns where provider shortages are common.

She adds that not having to drive long distances for health care is especially important for pregnant women and people with chronic conditions.

Nebraska lawmakers have blocked proposals to expand Medicaid since 2013, citing concerns that the state could be on the hook for the cost if the Affordable Care Act implodes.

Study co-author Joan Alker, executive director of the Georgetown University Center for Children and Families, says strong health centers are critical for rural communities, not only because of the care they provide, but they're frequently the largest employers in small towns.

She adds that expanding coverage to more residents in rural areas already struggling with higher rates of unemployment and poverty makes economic sense.

"When there's a real option here on the table to take these Medicaid dollars,” she states, “really, it's a wiser use of taxpayer dollars to provide them with the primary preventive care that comes with having health insurance up front, so they don't get sicker and wind up in the emergency room."

Nebraskans will soon have an opportunity to vote on the issue. Signatures for Initiative 427 to expand Medicaid coverage were recently certified by Nebraska's secretary of state, and the measure has been cleared for the Nov. 6 ballot.


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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 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.

Self-measuring blood pressure sites are coming to the Northwest, starting with a community organization in Portland.

The American Heart Association and Providence Health Plan have launched a program to bring self-monitoring blood pressure equipment to 20 clinics and community organizations in Oregon and Washington. The first was introduced at the Portland Opportunities and Industrialization Center, a training center serving more than 3,000 students age 17-65.

Michael Hale, a health navigator at the center, said some people get "white coat syndrome" when they visit the doctor, causing inaccurate blood pressure numbers.

"The beauty of this program is to be able to have our staff use the blood pressure monitors at home or in their office when they're regulated, before they drink their coffee," Hale explained. "Then they'll be able to log it throughout the week and then use that information, take it to the doctor."

Hale pointed out people can then discuss with their doctors whether it's time for blood pressure medication or lifestyle changes, depending on the readings. The program will loan out blood pressure monitoring equipment to students, families and staff at the center.

Blood pressure is an important indicator of health. Left untreated, high blood pressure can lead to heart attack, stroke and other health issues.

Meredith Collett, executive director of the American Heart Association of Oregon and southwest Washington, said the program is designed to bring monitoring to people who may not have access.

"Our hope with our collaboration with Providence Health Plan is to remove those barriers to health care access by setting up these self-measured blood pressure cuffs with POIC for at-risk communities," Collett noted. "They can really track and understand their numbers."

The initiative to bring self-measuring blood pressure equipment to clinics and organizations in the Northwest is expected to expand to 20 over the next three years.

Nonprofits across Texas are coming together to address disparities in health care for the Latinx community. A report by the Commonwealth Fund shows some factors that lead to the differences in health care include high poverty rates, elevated levels of pollution and crime and a lack of green spaces.

Paulina Sosa, Latinx Voces founder, said many in the Latinx community lack access to vital resources that could improve their overall health.

"Lack of physical access to a clinic or a doctor, the lack of information on how to go about accessing those health care services, and of course, it could be related to the lack of linguistics, otherwise known as information in Spanish," she said.

She added health disparities that had been in existence for years were brought to light during the COVID-19 pandemic when Hispanics experienced some of the highest death rates.

Edgar Carmona, president of the nonprofit Alliance for Progress in Dallas, which works to reduce health-care disparities among vulnerable populations, said some in the Latinx community don't seek medical care because they don't trust caregivers from other races.

"We just don't see the medical community being able to represent the community that it serves. We, as a society, are perhaps not creating the opportunities needed, or the encouragement for our youth to go into this field," he continued.

Both Sosa and Carmona said collaborations can help improve health outcomes for the Latinx community. Sosa added that during and after the pandemic, community partners, small businesses and faith-based organizations worked together to improve the lives of those most vulnerable.

"How do we ensure that the momentum, around addressing these disparities - particularly for Latino and Spanish-speaking communities - how do we ensure that the momentum continues? That is one of the biggest questions we're trying to tackle. We really believe that partnership is at the center of that solution," Sosa said.


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