Nation in Brief

Medicaid expansion helps pregnant women

Fewer women are dying from pregnancy-related complications in states that have expanded Medicaid, new research finds.

In the study, published in February in Women’s Health Issues, researchers examined data from the District of Columbia and 31 states that expanded Medicaid by 2017, and 19 states that did not expand the federal health insurance program. A Centers for Disease Control and Prevention database was used to examine records from CDC’s National Center for Health Statistics between 2006 and 2017.

Researchers found an association between Medicaid expansion and fewer maternal deaths based on women deaths during pregnancy and up to 42 days after delivery. In expansion states, there were 7.1 fewer maternal deaths out of 100,000 patients as compared to nonexpansion states. When deaths after 42 days were included, researchers found 6.65 per 100,000 fewer maternal deaths.

Minority women benefited most from Medicaid expansion, the study found. States that expanded Medicaid showed 16.27 fewer deaths among black women per 100,000 people relative to nonexpansion states, followed by Hispanic mothers, with expansion associated with 6 fewer deaths per 100,000. Maternal mortality among white women was only slightly better in Medicaid expansion states when compared to nonexpansion states.

The study suggests that “improving health insurance access is a potential step that can be taken to save mothers’ lives,” the researchers said.

Too many smokers miss recommended annual screenings for lung cancer, a study says.

Photo by FatCamera, iStockphoto

Heavy smokers miss cancer screenings

Most smokers at high risk for lung cancer from years of cigarette smoking fail to follow recommendations that they be screened annually, a new study finds.

In 2013, the U.S. Preventive Services Task Force recommended annual screening for lung cancer for people over age 55 who are heavy smokers or who had been heavy smokers and quit within the last 15 years.

Researchers in the study, published Feb. 28 in Morbidity and Mortality Weekly Report, examined Behavioral Risk Factor Surveillance System data collected in 2017 by 10 states. Among people who fit the task force’s screening criteria, only 12.7% took part in lung cancer screening exams that year.

The percentage of people who were screened varied by state. In Oklahoma, 9.7% of people who met recommendation criteria were screened, as were 16% in Florida.

“States can use the BRFSS lung cancer screening estimates to identify where increased screening is needed, to develop supplementary research projects to evaluate barriers to screening and to monitor the effectiveness of interventions,” the researchers said.

Uninsurance rates jump among kids

The number of U.S. children without health insurance increased by 400,000 between 2016 and 2018, largely due to rollbacks of federal government health programs, according to a report by the Georgetown University Center for Children and Families.

Four million children in the U.S. now have no health coverage, according to the October report. Researchers said that repeals of portions of the Affordable Care Act, funding cuts to Medicaid, funding delays to the Children’s Health Insurance Program, elimination of the individual mandate penalty and other actions accounted for the decrease.

The hardest hit are children who are white or Hispanic, age 6 or below, living in low-income households or a combination.

Policies and actions against immigrants by the Trump administration have also contributed to the decrease, the report said, as fears deter some families from enrolling in Medicaid or the Children’s Health Insurance Program, even if they are eligible.

Fifteen states showed significant increases in uninsured children. The most dramatic increases occurred in Tennessee, Georgia, Texas, Utah, West Virginia, Florida and Ohio.

“Recent policy changes and the failure to make children’s health a priority have undercut bipartisan initiatives and the Affordable Care Act, which had propelled our nation forward on children’s health coverage,” said Joan Alker, executive director of the Georgetown University Center for Children and Families and a report author, in a news release. “This serious erosion of child health coverage is due in large part to the Trump administration’s actions or inactions that have made health coverage harder to access and have deterred families from enrolling their eligible children in Medicaid and CHIP.”

To read the report, “The Number of Uninsured Children Is On the Rise,” visit https://ccf.georgetown.edu.

Hepatitis C screening supported for adults

Most U.S. adults should be screened for hepatitis C, according to a new recommendation from the U.S. Preventive Services Task Force.

Released in March, the recommendation applies to all adults ages 18 to 79, including those who are asymptomatic. Previous recommendations called for screening adults only between ages 55 and 75.

In the U.S., 4 million people have a past or current hepatitis C infection, the task force said. Injection drug users are most at risk.

Most adults need screening only once, the task force said. Additional screenings would be needed for people with a history of injection drug use, blood transfusions or other factors that place them at risk. Pregnant women should be screen during pregnancy.

For more information, visit www.uspreventiveservicestaskforce.org.

Opioid fatality cases may be undercounted

By examining contributing factors to drug fatalities in the U.S., officials can make more accurate estimates of opioid-related deaths, a study posted in Wiley Online Library in February finds.

Researchers examined records between 1999 and 2016 from the National Center for Health Statistics, Multiple Cause of Death, which showed 600,000 overdose deaths from drugs of all kinds.

Researchers closely examined death records that did not have a specific drug class recorded. They found that over 99,000 of those deaths in fact involved opioids, even through it was not noted in the records.

That means there were about one-quarter more opioid-related deaths than previously recognized in the U.S., according to the researchers. When added to the already-known deaths, there were opioid-related 440,000 deaths from 1999 and 2016, they found.

Private, public health care spending in US escalates to $3.1 trillion

Health care spending in the U.S. has risen sharply in recent years and now accounts for 18% of the U.S. economy, a study in March’s Journal of the American Medical Association finds.

Researchers gathered data from U.S. government health budgets, insurance claims, facility records, household surveys and other records from 1996 through 2016 to estimate cost expenditure for 154 health conditions. They focused on public insurance, such as Medicare and Medicaid, as well as private insurance. They also examined the demographics and health conditions of insured people.

From 1996 to 2016, total health care spending increased from $1.4 trillion to $3.1 trillion, the study found. Private insurance accounted for 48% of health care spending in 2016, public insurance accounted for 43% and out-of-pocket payments accounted for 9.4%. The annual spending growth rate was 2.6% for private insurance, 2.9% for public insurance and 1% for out-of-pocket payments.

“Understanding how much each payer spent on each health condition and how these amounts have changed over time can inform health care policy,” researchers said.

To learn more, visit www.jamanetwork.com.