Health Equity & Access Weekly Roundup: January 11, 2025

24 Million Consumers Choose ACA Coverage, Enrollment Still Open

The 2025 Affordable Care Act (ACA) Marketplace Open Enrollment Period has reached a record milestone, with 23.6 million Americans selecting affordable health care plans, aided by expanded financial assistance through the Inflation Reduction Act (IRA). These subsidies have made quality coverage available for as little as $10 per month and boosted enrollment among low-income individuals by 115% since 2020. However, the temporary nature of these subsidies, set to expire after 2025, raises concerns about steep premium increases for millions of enrollees unless extended. While some Republican lawmakers have shown openness to continuing subsidies, the return of President-elect Donald Trump introduces uncertainty about future ACA policies. The Congressional Budget Office projects a $335 billion cost over the next decade for a permanent subsidy extension, highlighting both the program’s significance and its fiscal challenges.

New Research Links Gender, Racial Microaggressions to Higher Postpartum Blood Pressure

A new study highlights how racial and gender-based microaggressions during obstetrical care significantly impact maternal health, contributing to elevated postpartum blood pressure. Among 373 Black, Hispanic, and Asian women surveyed, 37.5% reported experiencing at least one microaggression, with those in areas of high structural racism showing the highest blood pressure levels. The findings align with broader CDC data revealing that 1 in 5 patients report mistreatment during maternity care, a rate rising to 30% among Black, Hispanic, and multiracial mothers. The study underscores the urgent need for interventions addressing racism and microaggressions in health care to improve outcomes, particularly as Black mothers face the nation’s highest maternal mortality rate of 51.2 per 100,000 live births.

Black Women in the US Remain Hesitant Regarding Vaccines

Findings published this week point to persistent COVID-19 vaccine hesitancy among Black women in the US, rooted in mistrust of health care and government, concerns over vaccine safety, and ineffective communication strategies. Interviews with 54 Black women aged 21 to 66 revealed skepticism about the vaccine’s rapid development, long-term effects, and inconsistent public health messaging, often seen as culturally insensitive or coercive. Participants expressed concerns about historical medical mistreatment and the lack of clear, respectful educational efforts about the vaccine. Researchers emphasized the need for transparent, culturally respectful outreach and improved communication by health care professionals to address these concerns and boost vaccine confidence and uptake.

Collaboration to Transition Members to Preferred Formulary Dipeptidyl-Peptidase-4 Inhibitor

A retrospective study evaluating a partnership between a drug plan and pharmacists to transition patients from branded DPP-4 inhibitors to generic alogliptin found that 44% of patients contacted by pharmacists successfully made the switch, compared with only 1 patient in the group notified by letter alone. Hemoglobin A1C levels remained stable, indicating no compromise in clinical outcomes. However, by the study's end, only 12 of the 67 patients who initially switched were still using alogliptin, with many reverting to branded products or switching to GLP-1 receptor agonists. Despite this, the intervention resulted in significant cost savings of $220,717 for the health plan, demonstrating the potential financial and clinical value of pharmacist involvement in medication transitions.

Medicaid Managed Care Network Adequacy Standards and Mental Health Care Access

A cross-sectional study evaluating the impact of quantitative network adequacy standards (NAS) on mental health care access among Medicaid enrollees found limited effectiveness of these standards. While NAS were marginally associated with increased use of any mental health services among all Medicaid enrollees (adjusted OR, 1.4; P = .055), there were no statistically significant associations between NAS and specific outcomes, such as inpatient or outpatient mental health care, prescriptions, or unmet care needs, particularly among those with mental health conditions. The findings suggest that current NAS requirements alone may not significantly improve mental health care access and highlight the need for enhanced enforcement strategies and additional interventions to address barriers to care.