A new report looking at access to primary-care doctors found nearly 2 million Missourians are medically disenfranchised.

The report from the National Association of Community Health Centers and the American Academy of Family Physicians looked at medically underserved and disenfranchised populations across the country. Study authors estimated more than 100 million Americans lack access to a primary-care doctor, nearly double what it was in 2014.

The report argued community health centers, a federally supported health center system with more than 1,400 organizations, can help close care gaps.

Dr. Shari Thompson, a primary-care physician at Katy Trail Community Health Center in Marshall, said when they see new patients, young or old, they take the opportunity to treat the whole person.

"We get people to come in because of their sore throat; because they can't send their child back to school without a note," Thompson outlined. "While they're in-clinic, we use that time to close care gaps. We make sure that they are scheduled for their well child. We make sure that they get their colon cancer screening and breast cancer screening."

She noted the center performs needed screenings and preventive care for every patient they see. Study authors pointed out only one in 10 of the medically disenfranchised population is uninsured, illustrating how insurance coverage does not help when the problem is provider shortages.

Statistics showed the number of public health center patients has grown by 6 million since 2015, a 24% increase.

Thompson acknowledged community health centers are able to serve the entire community because of federal support.

"Community health centers have really stepped up to the plate at being able to provide all services for everyone," Thompson explained. "Regardless of their ability to have insurance to pay, because we have a sliding scale, but all that is made available because we're a community health center, and we're supported by federal grants."

The lack of primary-care providers in so much of the U.S. is seen by the study's authors as a serious public health threat, creating greater risks in a pandemic or during flu season, leaving millions at risk of preventable chronic diseases. Thompson stressed access to primary care is essential to the health of our society.

"Primary care is critical to the health care of the community, of the nation," Thompson asserted. "Critical with a capital C. Societies without primary care should show a definite lack in their health outcomes on multiple levels."


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North Dakota officials are urging people receiving health coverage through a key public program to stay on top of their renewal if they are still eligible. It follows the end of pandemic rules for Medicaid. At the start of the COVID crisis, Congress paved the way for states to keep people continuously enrolled in Medicaid. But with the public health emergency over, states such as North Dakota are unwinding the provision.

Krista Fremming, interim medical services division director of the North Dakota Department of Health and Human Services explained when they recently sent out renewal notices, only one in three people returned them. She pointed out it is possible that some people found other options, but her team suspects many who still need help did not take the necessary steps to secure it.

"For the forms that were returned, about seven in ten people still qualified," she added. "So, that gives a good indication that many of the unreturned forms are for people who would still qualify. And we want to continue their coverage, if they do. "

She said more than 4,000 people were disenrolled last Wednesday. The state carried out a media campaign, as well as outreach with providers, in hopes of ensuring recipients knew the forms were mailed to them. Fremming said the state is exploring other ways to connect with members. Those who were disenrolled have 90 days to return the forms to receive back-dated Medicaid coverage if they still qualify.

Fremming added they are especially worried about households with children losing coverage.

"We know that getting vaccinations and having access to dental care and behavioral health services are so important to laying a strong foundation for children as they grow up," she continued.

North Dakota has an auto-renewal process to make it easier for staff to verify if an individual still qualifies for coverage. But Fremming said it is still new and limited, and added it does not include people who have self-employment income, or who are subject to asset tests. Meanwhile, renewal forms are mailed out around the 20th of each month and are due within 30 days.


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Nevada has received an overall score of 43 in the nation for the health and well-being of its seniors in the state. According to the United Health Foundation's 2023 Senior Report, the Silver State's older adults fare well when it comes to lower rates of obesity, drinking and inactivity. The state is facing challenges related to high suicide and high poverty rates, as well as low flu vaccination rates among older Nevadans.

Dr. Rhonda Randall, Chief medical officer for United Healthcare, said when it comes to suicide, they are noticing more prevalence in some groups over others.

"We see that it disproportionately affects white men, and older white men because they have a tendency to choose more lethal means with suicide attempts," she explained. "They're more successful, and that's what we see in the trend here. It has been persistent for quite some time."

Randall added the report consists of 52 different measures of senior health across five different categories, including socioeconomic factors, the physical environment where seniors live, the clinical care they receive, behaviors and other health outcomes.

Nevada saw a 15% drop from just over 30 aides per 1,000 adults ages 65 and above in 2018 to 26 per 1,000 adults in 2021. The state also saw an 8% increase in early deaths among older adults. Randall said opioid overdoses led to an increase in premature deaths, and added that reflects "the same troubling trend" prevalent in other populations in the United States; seniors are not untouched.

"Why I highlight that as a geriatrician is, I think, a lot of people don't think that seniors are as affected by substance-use disorders and opioid-use disorder - but they are," she said.

Randall added it is concerning that as a country, many of the gains made in recent years related to longevity and an increase in life expectancy have started to reverse. Her group is calling for greater connectivity and community engagement among seniors in Nevada and across the country.

Longer sentences handed out for major crimes in Michigan and other states over the past few decades mean a larger portion of people in state and federal prisons are older adults. However, research from the Gerontology Department at Wayne State University finds senior inmates with special health needs are not getting the care they need. The study finds that half of all people in prison have at least one chronic health condition, such as hypertension, diabetes, heart disease or arthritis.

Roscinda Sneed, an associate professor at Wayne State University, said without intervention these conditions will worsen as the prison population ages.

"What you'll see in most correctional systems is that they have programming focused on mental health, they have programming focused on substance abuse, but there really isn't a lot of deliberate attention to chronic disease," Sneed explained.

Sneed will use those funds to study the effectiveness of an existing program called the Chronic Disease Self-Management Program, which she explained is used primarily in community settings and has improved health care communications, reduced ER visits and hospitalizations, and decreased health-care spending.

The National Institutes of Health grant is $600,000 over five years, and Sneed said she is applying for an additional grant to scale up the program for widespread use in state prisons in Michigan and other states to maximize its effectiveness. She said she is particularly interested in how prisons adapt chronic disease management programs to reflect the unique constraints of incarceration.

"What we want to do is talk to them about their experiences in implementing this program such that we can develop a scalability plan, so a plan for how we would actually implement this program on a large scale." she continued. "And that's what we would test in a future study."

Sneed added incarceration is already expensive. In 2013, the Federal Bureau of Prisons spent $881 million dollars to care for older prisoners, an amount that continues to rise exponentially.

"I think prisons are under-resourced in general, and so they try and do the best that they can in terms of managing health-care issues, but there's always an opportunity to do better," she said.