Medical debt was cut nearly in half in states that expanded Medicaid

“The Affordable Care Act offered states a huge infusion of federal money to expand Medicaid eligibility to low-income adults, and about 30 states took that deal right away in 2014. Since then, new medical debt in those states has fallen 44 percent, a dramatically bigger drop than was seen in the states that refused to expand the program over the same period. Those states showed only a 10 percent decline.”

“nonmedical debt had fallen by similar amounts in expansion and non-expansion states over the time period they studied, 2009 to 2020, strengthening the case that Medicaid expansion was the difference with medical debt.”

“In states that expanded Medicaid, both the lowest- and highest-income groups saw their medical debt drop after expansion, but the amount of medical debt added annually decreased much more for the former (by $180, from $458 to $278) than the latter (by $35, from $95 to $60).
In non-expansion states, on the other hand, the lowest-income group averaged a $206 average increase in new medical debt, from $630 to $836. But the highest-income bracket still saw a small decline in new debt for medical care.”

“Those states are concentrated in the South. Eight of the 12 non-expansion states are in the region. Nearly one in four Southerners have some medical debt in collections listed on their credit report, compared to 10.8 percent of people in the Northeast and 12.7 percent in the West.”

Covid-19 isn’t the reason that US life expectancy is stagnating

“The stagnation in life expectancy isn’t due to some natural limit of human lifespans. In 2019, life expectancy was 84.4 in Japan, 83 in France, and 81 in the United Kingdom and Germany. The US, with its life expectancy of 78.8 years, was already lagging before the pandemic.”

“The relatively poor health of the US is rooted in “fundamental causes,” according to epidemiologists Bruce Link and Jo Phelan. These are the social conditions like economic inequality and racial segregation that worsen some illnesses and reduce access to health care. In the US, solutions could also include policies that replace jobs in towns and cities that have been hollowed out by globalization and deindustrialization. The dignity of meaningful work can improve health.
Of course, we should not ignore the gains that can be made within medicine. I don’t mean high-profile technological advances that will make headlines or boost the bottom line of new biotech startups. I mean routine and preventive care that can detect disease early, help get patients into treatment, and provide a trusted source of medical advice.

Rather than wringing our hands about the Covid-19 life-expectancy dip, the US should be passing laws and expanding programs that draw medical workers into primary and preventive care, not least by paying them more. This is especially true in rural areas with aging populations and a shortage of doctors. Training more Black doctors, especially in obstetrics and gynecology, may lead to dramatic improvements in the shamefully bad maternal health outcomes among Black women in the US.

By focusing on one historical measure of years lost to the pandemic, we run the risk of dwelling on what we can’t change and ignoring what we can improve. If you want the next generation to live longer and healthier lives, one of the best things you can do is push for economic and health care policies that reduce economic and racial inequality, and help ensure that every person has access to the kind of world-class, routine health care that saves lives. Let’s give the demographers of 2110 something to celebrate.”

Will the Taliban roll back two decades of public health progress in Afghanistan?

“relatively little attention has been paid to what the Taliban victory will mean for one of the nation’s biggest accomplishments: the sharp decline in child and maternal mortality over the past two decades.

A study in The Lancet Global Health found that between 2003 and 2015, child mortality in Afghanistan fell by 29 percent. While maternal mortality is difficult to estimate, one data set found that deaths in childbirth fell from 1,140 per 100,000 in 2005 to 638 per 100,000 in 2017, or nearly in half.

This progress was not necessarily all generated by the US-led occupation, with aid from international organizations and Afghan-led initiatives contributing heavily; and these estimates rely on household surveys that are difficult to conduct well, especially in poor, war-torn countries with large nomadic populations, meaning they are likely off to some degree.”

“The best-case scenario would be a continued emphasis on the health of women and children, expansion of the developing public health sector — including nutrition, water, sanitation, and housing — and attention to the emerging problem with chronic or noncommunicable diseases.

The health workforce needs continuing support. Things can go bad if restriction of women, both as a health focus and in the workforce, occurs and ideology starts getting in the way of health programming. The health of Afghanistan cannot move forward without continuing external support, and this is likely to be required for some years to come, regardless of who is the government. A plunge back into war and instability is the very worst case imaginable for the health of the country”