NASHVILLE, Tenn. -- The federal government has quietly changed a policy that could make it easier for some residents to sign up for health insurance. Previously, workers had only 60 days after losing their job-based health coverage to sign up for marketplace plans on healthcare.gov.

Cheryl Fish-Parcham, director of access initiatives at Families USA, said now, anyone who lost coverage this year can check to see if they qualify for special enrollment. She added the Trump administration hasn't given an explanation for the change, but it's most likely related to the pandemic.

"I think at this point we are, more than anything, just grateful that it has finally opened," Fish-Parcham said. "Because between February and May, 5.4 million Americans lost their job-based coverage and became uninsured."

Before the pandemic, some 3.5 million Tennesseans received health insurance from their employer or through a spouse or parent - the largest source of coverage in the state. According to the Kaiser Family Foundation, as much as one-third of those who have lost job-based insurance could remain uninsured.

Because Tennessee has not expanded Medicaid, Fish-Parcham added, only households with very low incomes are eligible for Medicaid. But, she recommended individuals visit healthcare.gov, where they can check to see if they meet the requirements for a marketplace plan, available to people with modest and higher incomes.

"People who have a disability or who have a child should still click on that, see if you qualify for Medicaid or CHIP," she said. "You might still qualify for enrollment in the marketplace. So certainly, seeing if you qualify for the special enrollment period is a good thing to check on."

Research has shown Medicaid expansion would bring health coverage to more than 250,000 Tennesseans, particularly in rural areas.

Fish-Parcham added the pandemic has put a spotlight on the nation's heavy reliance on employer-sponsored health insurance. She said Black and Hispanic households, who have been disproportionately affected by COVID-19 and who are the most likely to have lost income, are bearing the brunt of health care costs.

"Health insurance is important. It helps people afford their bills and get to the doctor," she said. "And we know that's important, both in COVID times and also for long-term problems."

Current lack of access to coverage also could increase household medical debt. A new report shows medical debt affects the credit history of more than one in five Tennesseans, the eighth-highest rate in the country. The report's authors say ballooning medical debt will likely hamper the state's economic recovery from COVID-19.



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Health disparities in Texas are not only making some people sick, but affecting the state's economy.

A new study shows Texas is losing $7 billion a year because it does not adequately address quality-of-life issues and the health care needs of its lower-income residents.

The research was sponsored by the Episcopal Health Foundation, Methodist Healthcare Ministries of South Texas, and St. David's Foundation.

Brian Sasser, chief communications officer for the Episcopal Health Foundation, said health care includes more than doctors' visits and medication.

"Everything from increasing access to affordable health insurance to investing in under-resourced neighborhoods to give them more options, whether that's exercise options or food options," Sasser outlined. "Look at policy changes that expand health insurance coverage for new moms."

The report breaks down the economic costs of preventable health differences for every Texas county. It found Bexar, Dallas, Harris, Tarrant and Travis counties are losing the most money annually because of health disparities.

The amount of the economic impact depends on the racial and ethnic makeup of the county and the size of its working-age population. Sasser added the report shows Black and Hispanic children are more likely to grow up in neighborhoods with high poverty levels, and higher rates of diabetes and obesity.

"What can we do to work to make sure that the rate of diabetes isn't dramatically different between white households and Black households?" Sasser asked. "That we can make sure the food insecurity isn't dramatically different between someone who makes over $100,000 and someone who makes less than $30,000?"

The Texas Legislature has passed laws to address some of the disparities, including House Bill 12. It extends Medicaid health coverage for 12 months for new mothers, and pays for maternal health services for community health workers and doulas.

There is light at the end of the tunnel for Tennesseans struggling with opioid addiction, as a bill has been passed to increase access to treatment for opioid use disorder at Community Health Centers.

More than 3,800 lives were lost to overdose in the state in 2021, according to the Tennessee Department of Health.

Emily Waitt, policy and advocacy manager for the Tennessee Primary Care Association, said the original bill limited the number of patients nurse practitioners and physician assistants could treat with buprenorphine. The update removes the limitations, allowing more Tennesseans to access medication assisted treatment in their communities.

"It allows NPs and PAs to prescribe to 100 patients at a time, versus 50," Waitt explained. "Basically doubling the number of patients that they can prescribe to."

Community Health Centers serve more than 423,000 patients across Tennessee, regardless of their insurance status or ability to pay. About 7.7% of Tennesseans do not have health insurance.

Libby Thurman, CEO of the Tennessee Primary Care Association, said bringing the treatment to rural health centers expands access to a crucial service for patients who otherwise could not afford it. She noted it is important because people in remote areas often face challenges finding specialists and treatment facilities.

"We really wanted to work on this issue, because we know our Community Health Centers are where patients go for care," Thurman emphasized. "We really believe in an integrated model. So we want to treat the whole person, including if they are struggling with an addiction issue or a substance abuse disorder issue."

Health Centers offer behavioral health care, including counseling, along with treatment. The clinics also focus on creating a supportive network to help patients with family resources, job assistance and community connections.

While Black Maternal Health Week is wrapping up, health disparities for pregnant Black women continues to be an issue.

From April 11-17 this year, the high death rate of Black mothers is in the spotlight. Black women are three times more likely to die from pregnancy-related causes than their white counterparts.

Dr. Patricia Egwuatu, a family practice physician at Kaiser Permanente in Seattle, said racism is at the root of the disparities, which create barriers to health care access. She pointed out lack of access can lead to problems during pregnancy that are preventable or treatable.

"They may exist prior to pregnancy and then it gets worse during pregnancy if it's not managed as part of that maternity care," Egwuatu emphasized. "There are more pregnant women that have chronic conditions such as hypertension, diabetes and heart disease that are amplified during pregnancy."

The White House released a proclamation recognizing Black Maternal Health Week. The Biden administration began recognizing the week in 2021.

Egwuatu noted there are some warning signs any pregnant woman should be aware of and check in with their physician if they develop.

"You might get some changes in your vision that is not your normal. So, like, fuzziness, you can't see as well, or an excruciating headache," Egwuatu outlined. "You could also develop new swelling in your lower extremities that's making it difficult to get around or even new shortness of breath."

Egwuatu stressed physicians also need to recognize the role of racism in medicine. She argued continuous medical education is important for learning how to confront biases, and it is important for doctors to understand how they can provide people with resources.

"Asking the questions about personal barriers," Egwuatu suggested. "Does a patient have issues with getting to work, child care, transportation? What's their education, what's their cultural background and language? And do they even have a cell phone so we can connect with them?"