Inflation boosts demand at food banks as pandemic anti-hunger measures fall away

Inflation boosts demand at food banks as pandemic anti-hunger measures fall away

(RNS) — At the Seven Loaves Food Pantry at St. Andrew’s United Methodist Church in Plano, Texas, volunteers have been serving 800 to 1,200 families a week since the COVID-19 pandemic began — about four times the weekly traffic in 2019.

At the ICNA Relief Food Pantry in Raytown, Missouri, just east of Kansas City, 100 new families have registered to receive the Muslim-led organization’s services in just the past month.

“We are busier than ever right now,” said Shannon Cameron, executive director of the Aurora Area Interfaith Food Pantry in Aurora, Illinois, where, after a slight dip around tax return season, between 30 and 60 new families are registering every week.

The inflation that has loomed over the economy and restricted many Americans’ purchasing power of late has doubly affected low-income people who already struggle to get by. A recent survey by the anti-hunger organization Feeding America has shown that increased demand has affected nearly 80% of U.S. food banks, as higher prices cause more families to seek assistance.

And while President Joe Biden recently signed the Keep Kids Fed Act, extending free meal programs for schoolchildren, many stopgaps funded during the pandemic have ended or are only available in some states.

“For the households that were already food insecure in 2020, nearly half of those reported using a food pantry,” said Jordan Teague, interim director for policy analysis and coalition building at Bread for the World. “Now, more people are facing the crisis. We’re all sort of feeling that pinch, and government programs are coming to an end.”

Since the 1980s, the U.S. Department of Agriculture has donated surplus commodities it buys to stabilize farm prices to the Charitable Food Assistance System, a network of food banks. For four years, the Trump administration bolstered the program to offset the cost of its tariff increases, raising the share of the USDA’s contributions to as much as 15% of some food banks’ supplies. Those resources, too, have now tailed off.

“We saw a real increase even before the pandemic hit in those USDA commodities and, obviously, during the pandemic, USDA made more commodities available as well,” said Celia Cole, CEO of Feeding Texas, a faith-based food security organization based in Austin. “Now, without them, we’re seeing a drop-off.”

Food banks are looking more than ever to make up the gaps with private monetary donations, and government financial assistance. “For every dollar donated to a food bank, we can stretch it to four meals,” said Cole. “We encourage people to be educated with their elected officials in support of hunger-fighting programs like SNAP and the Child Nutrition Programs.”

Historically high gas prices have added further strain on local food pantries, causing delays in the transport of food from farm to market, and from market to food banks.

“We own a fleet of semis,” said Mike Hoffman, inventory and logistics director at Midwest Food Bank, a Christian charity that supplies more than 2,000 churches, nonprofits and community centers across the country. “Fuel prices have taken a toll. We’ve gone through our entire year’s fuel budget in the first five months.”

The same supply chain problems, including a lack of available truck drivers, that have beset the economy apply to fighting hunger as well. Barbara Wojtklewicz, part of the leadership team that runs the food pantry at Christ Church in Plymouth, Massachusetts, said staff at the Greater Boston Food Bank, a regional network of 600 food distributors, have reported driver shortages recently.

“There is ample food to distribute,” Wojtklewicz told Religion News Service, “but they’ve had to limit … distribution to different food pantries.”

Maj. Deb Coolidge at the Salvation Army’s food distribution center in Plymouth has had trouble sourcing fresh food. “Less salad mix and cucumber — oranges and apples,” Coolidge said. “Those have not been on the list for the last couple of months.”

At ICNA Relief in Missouri, Ferdous Hossain, associate operations coordinator, has likewise found it increasingly difficult to provide fresh produce to the 300 families who rely on the pantry for food assistance each month. Local agencies, farms and food banks that ICNA collaborates with are also feeling the produce pinch.

 To live up to her center’s unofficial motto — “Fresh produce. Fresh fruit. Anything and everything that is fresh” — Hossain has been buying produce at the grocery store, a last resort because of higher prices.

Donors are also stepping up, thinking creatively to help fill the gaps. Wojtklewicz said that the Christ Church pantry in Plymouth received 100 gift cards to local grocery stores along with its shipment from the Greater Boston Food Bank.

As economists prepare Americans for a possible recession, Beth Zarate, president and CEO of Catholic Charities West Virginia, expressed “anxiety” about the rural residents in her state and their ability to stay ahead of increased gas prices and food costs. At 15.1%, West Virginia has the highest percentage of households facing hunger, according to a 2020 USDA study.

Zarate is counting on West Virginians to come to their neighbors’ aid. “West Virginia is unique because we come out at the bottom of every chart in terms of chronic health issues, hunger and poverty,” Zarate said. “But we also have people who are good to each other.”

“People are generous,” said Darra Slagle, director of Rose’s Bounty, a food pantry operating out of Stratford Street United Church in Boston, “and when they are made aware of the need, are able to help. I encourage people to give to their local food pantries. They could use money to get the things that they need.”

Hoffman at the Midwest Food Bank said prayer is another life raft for anti-hunger operations.

“We have a lot of prayer warriors,” he said. “The faith community is a huge part of what we do, (and) many churches pray for us. The Bible says, ‘The poor you’ll have with you always,’ so we know we have a job that needs to be done, and we’ll keep getting it done.”

UF Ministry in the Barbershop

UF Ministry in the Barbershop

The barbershop serves as a default counseling center and community center for many Black men. But for barbers who are believers, it becomes a place for ministry. Meet Clayton Taylor, a minister and barber who sees his barber chair as his pulpit. UrbanFaith Contributor Maina Mwaura sat down with Taylor to discuss what it is like to be a barber who shares God’s love from behind the chair.

Race Is Often Used as Medical Shorthand for How Bodies Work. Some Doctors Want to Change That.

Race Is Often Used as Medical Shorthand for How Bodies Work. Some Doctors Want to Change That.

Several months ago, a lab technologist at Barnes-Jewish Hospital mixed the blood components of two people: Alphonso Harried, who needed a kidney, and Pat Holterman-Hommes, who hoped to give him one.

The goal was to see whether Harried’s body would instantly see Holterman-Hommes’ organ as a major threat and attack it before surgeons could finish a transplant. To do that, the technologist mixed in fluorescent tags that would glow if Harried’s immune defense forces would latch onto the donor’s cells in preparation for an attack. If, after a few hours, the machine found lots of glowing, it meant the kidney transplant would be doomed. It stayed dark: They were a match.

“I was floored,” said Harried.

Both recipient and donor were a little surprised. Harried is Black. Holterman-Hommes is white.

Could a white person donate a kidney to a Black person? Would race get in the way of their plans? Both families admitted those kinds of questions were flitting around in their heads, even though they know, deep down, that “it’s more about your blood type — and all of our blood is red,” as Holterman-Hommes put it.

Scientists widely agree that race is a social construct, yet it is often conflated with biology, leaving the impression that a person’s race governs how the body functions.

“It’s not just laypeople — it’s in the medical field as well. People often conflate race with biology,” said Dr. Marva Moxey-Mims, chief of pediatric nephrology at Children’s National Hospital in Washington, D.C.

She’s not talking just about kidney medicine. Race has been used as a shorthand for how people’s bodies work for years across many fields — not out of malice but because it was based on what was considered the best science available at the time. The science was not immune to the racialized culture it sprung from, which is now being seen in a new light. For example, U.S. pediatricians recently ditched a calculation that assumed Black children were less likely to get a urinary tract infection after new research found the risk had to do with a child’s history of fevers and past infections — not race. And obstetricians removed race and ethnicity from a calculation meant to gauge a patient’s ability to have a vaginal birth after a previous cesarean section, once they determined it was based on flawed science. Still, researchers say those race-based guidelines are just a slice of those being used to assess patients, and are largely based on the assumption that how a person looks or identifies reflects their genetic makeup.

Race does have its place during a doctor’s visit, however. Medical providers who give patients culturally competent care — the act of acknowledging a patient’s heritage, beliefs, and values during treatment — often see improved patient outcomes. Culturally competent doctors understand that overt racism and microaggressions can not only cause mental distress but also that racial trauma can make a person physically sick. Race is a useful tool for identifying population-level disparities, but experts now say it is not very useful in making decisions about how to treat an individual patient.

Because using race as a medical shorthand is at best imprecise and at worst harmful, a conversation is unfolding nationally among lawmakers, scientists, and doctors who say one of the best things patients can do is ask if — and how — their race is factored into their care.

Doctors and researchers in kidney care have been active recently in reevaluating their use of race-based medical guidance.

“History is being written right now that this is not the right thing to do and that the path forward is to use race responsibly and not to do it in the way that we’ve been doing in the past,” says Dr. Nwamaka Eneanya, a nephrologist with Fresenius Medical Care, who in a previous position with the University of Pennsylvania traced in the journal Nature the history of how race — a social construct— became embedded in medicine.

The perception that there is such a thing as a “Black” or “white” kidney quietly followed patient and donor as Harried and Holterman-Hommes were on the path to the transplant — in their medical records and in the screening tests recommended.

Medical records described Harried as a “47-year-old Black or African American male” and Holterman-Hommes as a “58-year-old, married Caucasian female.” Harried does not recall ever providing his race or speaking with his physicians about the influence of race on his care, but for two years or more his classification as “Black or African American” was a factor in the equations doctors used to estimate how well his kidneys were working. As previous KHN reporting lays out, that practice — distinguishing between “Black” and “non-Black” bodies — was the norm. In fall 2021, a national committee determined race has no place in estimating kidney function, a small but significant step in revising how race is considered.

Dr. Lisa McElroy, a surgeon who performs kidney transplants at Duke University, said the constant consideration of race “is the rule, not the exception, in medicine.”

“Medicine or health care is a little bit like art. It reflects the culture,” she said. “Race is a part of our culture, and it shows up all through it — and health care is no different.”

McElroy no longer mentions race in her patients’ notes, because it “really has no bearing on the clinical care plan or biology of disease.”

Still, such assumptions extend throughout health care. Some primary care doctors, for example, continue to hew to an assumption that Black patients cannot handle certain kinds of blood pressure medications, even while researchers have concluded those assumptions don’t make sense, distract doctors from considering factors more important than race — like whether the patient has access to nutritious food and stable housing — and could prevent patients from achieving better health by limiting their options.

Studying population-level patterns is important for identifying where disparities exist, but that doesn’t mean people’s bodies innately function differently — just as population-level disparities in pay do not indicate one gender is fundamentally more capable of hard work.

“If you see group differences … they’re usually driven by what we do to groups,” said Dr. Keith Norris, not by innate differences in those groups. Still, medicine often continues to use race as a crude catchall, said Norris, a UCLA nephrologist, “as if every Black person in America experiences the same amount and the same quantity of structural racism, individualized racism, internalized racism, and gene polymorphisms.”

In Harried and Holterman-Hommes’ case, one striking example of race being used as shorthand for determining how people’s bodies work was an informational guide given to Holterman-Hommes that said African Americans with high blood pressure could not donate an organ, but Caucasians with high blood pressure might still qualify.

“I can’t believe they actually wrote that down,” said Dr. Vanessa Grubbs, a nephrologist at the University of California-San Francisco. That worries Grubbs because using race as a reason to exclude donors can create a situation in which Black transplant recipients have to work harder to find a living donor than others would.

“I do think that criteria such as these become barriers for transplantation,” said Dr. Rajnish Mehrotra, head of nephrology at the University of Washington. He said that type of hypertension distinction could exclude potential donors — like the 56% of Black adults with high blood pressure in the U.S. — when more of them are sorely needed.

The inclusion of race did not necessarily affect Harried’s ability to receive a kidney, nor Holterman-Hommes’ ability to give him one. But following their case offers a glimpse into the ways race and biology are often cemented together.

The St. Louis Case

Harried and Holterman-Hommes met 20 years ago when they worked together at a nonprofit that serves youth experiencing homelessness in St. Louis. Harried was the guy who pulled kids out of their ruts and into a creative mindset, from which they would write poems and songs and do artwork. Holterman-Hommes said he was “the calm in their storm.” Harried calls Holterman-Hommes “big stuff” because she is the nonprofit’s CEO who keeps the lights on and the donations coming in. “You never knew that she was the president of the company,” said Harried. “There wasn’t an air about her.”

Harried resigned in 2018 as his health declined. Then in 2021, Holterman-Hommes saw a KHN article about Harried and decided to see if she could help her former colleague. Although Holterman-Hommes’ mother was born with one kidney, she had lived a long and healthy life, so Holterman-Hommes figured she could spare one of her own.

As Holterman-Hommes explored becoming a donor candidate, initial tests showed high blood pressure readings, in addition to lower-than-ideal kidney function. But “I like to get an A on a test,” she said, so she redid both sets of tests, repeating the kidney function test after staying better hydrated and the blood pressure test after a big work deadline had passed. She moved on in the screening process after her results improved.

Grubbs wonders whether, if Holterman-Hommes had been Black, “they would have just dismissed her.” Grubbs shared an instance in which she suspects that’s exactly what happened to the wife of a patient of hers in California who needed a kidney transplant.

The wife, who is Black and was in her 50s at the time, wasn’t allowed to give the patient a kidney because of her hypertension.

“There are people in this country that will tell you that, ‘Oh, white people donate kidneys, Black people don’t donate kidneys, and that’s not true,’” said Mehrotra. “You hear that racist trope. But [there are] all of these barriers to kidney donation.”

Barnes-Jewish Hospital later said it had given Holterman-Hommes an outdated guide, “an unfortunate circumstance that is being corrected,” and provided a new one that does not say Black people with hypertension cannot donate. Instead, it says that people cannot donate if they have hypertension that was either diagnosed before age 40 or requires more than one medication to manage.

But “at some point, it was a policy,” said Harried, whose kidneys have been failing for several years. And it’s unclear how many years that “outdated” guidance shaped perceptions among those seeking care at Barnes-Jewish, which performs more living-donor kidney transplants per year than any other location in Missouri, according to the Scientific Registry of Transplant Recipients.

There is little transparency into how medical centers incorporate race into their decision-making and care. Guidelines from the United Network for Organ Sharing, the national organization in charge of the transplant system, leave the door open for hospitals to “exclude a donor with any condition that, in the hospital’s medical judgment, causes the donor to be unsuitable for organ donation.”

Tanjala Purnell, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health studying disparities in kidney transplantation, said she knows of several centers that used race-based criteria, though some have relaxed those rules, instead deciding case by case. “There’s not a standard set to say, ‘Well, no, you can absolutely not have different rules for different people,’” she said. “We don’t have those safeguards.” Dr. Tarek Alhamad, medical director of the kidney program at the Washington University and Barnes-Jewish Transplant Center, said race-based criteria for kidney donations aren’t created to exclude Black people — it was born of a desire to avoid harming them.

“African Americans are more likely to have end-stage renal disease, they are more likely to have end-stage renal disease related to hypertension. And they are more likely to have genetic factors that would lead to kidney dysfunction,” said Alhamad.

Compared with white and Hispanic donors, non-Hispanic Black donors are known to be at higher risk for developing kidney failure because of their donation, though it’s still very rare.

He said it feels unethical to take a kidney from someone who may really need it down the line. “This is our role as physicians not to do harm.”

The Science

Researchers are studying a possible way to clarify who is really at risk in donating a kidney, by identifying specific risk factors rather than pinning odds on the vague concept of race.

Specifically, a gene called APOL1 could influence a person’s likelihood of developing kidney disease. All humans have two copies of this gene, but there are different versions, or variants, of it. Having two risk variants increases the chance of kidney injury.

The risk variants are most prevalent in people with recent African ancestry, a group that crosses racial and ethnic boundaries. About 13% of African Americans have the double whammy of two risk variants, said Dr. Barry Freedman, chief of nephrology at the Wake Forest School of Medicine. Even then, he said, their fate isn’t sealed — most people in that group won’t get kidney failure. “We think they need a second hit, like HIV infection, or lupus, or covid-19.”

Freedman is leading a study that looks, in part, at how kidney donors with those risk variants fare in the long term.

“This is really important because the hope is that kidneys won’t be discarded or turned down as frequently,” said Moxey-Mims, who is also involved in the research.

Researchers who are focused on health equity say that while APOL1 testing could help separate race from genetics, it could be a double-edged sword. Purnell pointed out that if APOL1 is misused — for example, if a transplant center makes a blanket rule that no one with two risk variants can donate, rather than using it as a starting point for shared decision-making, or if doctors offer the test based only on a patient’s looks — it could merely add another criterion to the list by which certain people are excluded.

“We have to do our due diligence,” said Purnell, to ensure that any effort to be protective doesn’t end up “making the pool of available donors for certain groups smaller and smaller and smaller.” Purnell, McElroy, and others steeped in transplant inequities say that as long as race — which is a cultural concept defining how someone identifies, or how they are perceived — is used as a stand-in for someone’s ancestry or genetics, the line between protecting and excluding people will remain fuzzy.

“That’s the heart of the matter here,” said McElroy.

So where does race belong in kidney transplant medicine? Many of the physicians interviewed for this article — many of them people of color — said it primarily serves as a potential indicator of hurdles patients may face, rather than as a marker of how their bodies function.

For example, McElroy said she might spend more time with Black patients building trust with them and their families, or talking about how important living donations can be, similar to the ways she might spend more time with a Spanish-speaking patient making sure they know how to access a translator, or with an elderly patient emphasizing how important physical activity is.

“The purpose is not to ignore the social determinants of health — of which race is one,” she said. “It’s to try to help them overcome the race-specific or ethnicity-specific barriers to receiving excellent care.”

While all the science gets sorted out, Eneanya is trying to get the message out to patients: “Just ask the question: ‘Is my race being used in my clinical care?’ And if it is, first of all, what race is in the chart? Is it affecting my care? And what are my options?”

“Just keep your eyes open, ask questions,” said Harried.

In late April, a kidney from Holterman-Hommes’ body was successfully placed into Harried’s. Both are home now and say they are doing well.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Subscribe to KHN's free Morning Briefing.

Homecoming: An Interview with Thema Bryant

Homecoming: An Interview with Thema Bryant

Dr. Thema Bryant is a psychologist and minister who has become one of the most influential voices addressing mental health and spiritual health. UrbanFaith sat down to interview her about her new book Homecoming: Overcome Fear and Trauma to Reclaim Your Whole, Authentic Self. The interview is above, more information about the book is below.

In the aftermath of stress, disappointment, and trauma, people often fall into survival mode, even while a part of them longs for more. Juggling multiple demands and responsibilities keeps them busy, but not healed. As a survivor of sexual assault, racism, and evacuation from a civil war in Liberia, Dr. Thema Bryant knows intimately the work involved in healing. Having made the journey herself, in addition to guiding others as a clinical psychologist and ordained minister, Dr. Thema shows you how to reconnect with your authentic self and reclaim your time, your voice, your life.

Signs of disconnection from self can take many forms, including people-pleasing, depression, anxiety, and resentment. Healing starts with recognizing and expressing emotions in an honest way and reconnecting with the neglected parts of yourself, but it can’t be done in a vacuum. Dr. Thema gives you the tools to meaningfully connect with your larger community, even if you face racism and sexism, heartbreak, grief, and trauma. Rather than shrinking in the face of life’s difficulties, you will discover in Homecoming the therapeutic approaches and spiritual practices to live a more expansive life characterized by empowerment, healthier relationships, gratitude, and a deeper sense of purpose.

Students of color in special education are less likely to get the help they need – here are 3 ways teachers can do better

Students of color in special education are less likely to get the help they need – here are 3 ways teachers can do better

Conversations around race and disability often get left out of schools. FG Trade/E+ via Getty Images
Mildred Boveda, Penn State

When I was a special education teacher at Myrtle Grove Elementary School in Miami in 2010, my colleagues and I recommended that a Black girl receive special education services because she had difficulty reading. However, her mother disagreed. When I asked her why, she explained that she, too, was identified as having a learning disability when she was a student.

She was put in a small classroom away from her other classmates. She remembered reading books below her grade level and frequent conflicts between her classmates and teachers. Because of this, she believed she received a lower-quality education. She didn’t want her daughter to go through the same experience.

Ultimately, the mother and I co-designed an individualized education plan – known in the world of special education as an IEP – for her daughter where she would be pulled out of class for only an hour a day for intensive reading instruction.

When compared to white students with disabilities, students of color with disabilities are more likely to be placed in separate classrooms. This may lead to lower educational outcomes for students of color in special education, as students with disabilities perform better in math and reading when in general education classrooms.

A student of color with down syndrome uses a tablet in the classroom.
Students with disabilities perform better academically when placed in general education classes. Robin Bartholick via Tetra images/GettyImages

Researchers, such as University of Arizona education scholar Adai Tefera and CUNY-Hunter College sociologist of education Catherine Voulgarides, argue that systemic racism – as well as biased interpretations of the behavior of students of color – explains these discrepancies. For example, when compared to students with similar test scores, Black students with disabilities are less likely to be included in the general education classroom than their non-Black peers. To curb this, teachers can take steps toward being more inclusive of students of color with disabilities.

As a Black feminist researcher who focuses on the intersection of race and disability, here are three recommendations I believe can help teachers to better support students of color with disabilities.

1. Inform families of their rights

Federal law requires that schools provide parents and guardians with Procedural Safeguards Notices, a full explanation of all the rights a parent has when their child is referred to or receives special education services. These notices need to be put in writing and explained to families in “language that is easily understandable.”

However, research shows that in many states, Procedural Safeguards Notices are written in ways that are difficult to read. This can make it harder for families, especially immigrant families, to know their rights. Also, families of color report facing greater resistance when making requests for disability services than white families do.

When meeting with families, teachers can take the time to break down any confusing language written in the Procedural Safeguards Notice. This can assure that the families of students of color are fully aware of their options.

For example, families have the right to invite an external advocate to represent their interests during meetings with school representatives. These advocates can speak on behalf of the family and often help resolve disagreements between the schools and families.

Educators can tell families about organizations that serve children with disabilities and help them navigate school systems. The Color of Autism, The Arc and Easterseals are striving to address racial inequities in who has access to advocacy supports. These organizations create culturally responsive resources and connect families of color with scholarships to receive training on how to advocate for themselves.

2. Talk about race and disability

Despite the growing diversity within K-12 classrooms, conversations around race are often left out of special education. This leaves a lack of attention toward the issues that students of color face, like higher suspension rates and lower grades and test scores than their white peers in special education.

When teachers talk about race and disability with their colleagues, it can help reduce implicit biases they may have. Also, dialogue about race and disability can help to reduce negative school interactions with students of color with disabilities.

Arizona State University teacher educator Andrea Weinberg and I developed protocols that encourage educators to talk about race, disability, class and other social identities with each other. These include questions for teachers such as:

Do any of your students of color have an IEP?

Has a student with disabilities or their family shared anything about their cultural background that distinguishes them from their peers?

Are there patterns of students not responding to instruction?

The protocols also encourage educators to consider their own social identities and how those may shape how they interpret students’ behaviors and academic needs:

Who do you collaborate with to help you better understand and respond to students’ diverse needs?

In what ways are students and teachers benefiting from the diversity represented in the classroom?

Educators using these questions in the Southwest, for example, say they help a mostly white teacher workforce understand their role in disrupting inequities. One study participant said, “These things are not addressed, and they’re not talked about among faculty.”

3. Highlight people of color with disabilities in the classroom

Often, classroom content depicts disabled people – especially those of color – as people at the margins of society. For example, in “To Kill a Mockingbird,” Tom Robinson, a Black character with a physical disability, is killed after being falsely accused of a crime. Teachers can incorporate thoughtful examples of disabled people of color in their lesson plans to help students better understand their experiences.

When teaching about Harriet Tubman, educators can mention how she freed enslaved people while coping with the lifelong effects of a head injury. Tubman’s political activism provides a historical example of disabled people of color who helped improve society for all.

A man and a woman in a wheelchair pose together next to a painting.
Famous Mexican artist Frida Kahlo suffered from spinal and pelvic damage after a bus accident. Universidad Carlos III de Madrid/flickr

Art teachers can highlight Mexican artist Frida Kahlo and how she boldly addressed her physical disabilities in self-portraits. Disabled people’s experiences are frequently shown from the perspective of people without disabilities. In her art, Kahlo displayed herself with bandages and sitting in a wheelchair. Her portraits featured her own reactions to having disabilities.

Physical education teachers can discuss current events, such as recent news about Olympian Simone Biles’s attention-deficit/hyperactivity disorder and anxiety. Her openness has sparked international conversations about less noticeable disabilities.

Teaching students about the contributions that disabled people of color make to our society emphasizes that neither race nor disability should be equated with inferiority.The Conversation

Mildred Boveda, Associate Professor of Special Education, Penn State

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Biden Administration’s Rapid-Test Rollout Doesn’t Easily Reach Those Who Need It Most

Biden Administration’s Rapid-Test Rollout Doesn’t Easily Reach Those Who Need It Most

In the past week, the Biden administration launched two programs that aim to get rapid covid tests into the hands of every American. But the design of both efforts disadvantages people who already face the greatest barriers to testing.

From the limit placed on test orders to the languages available on websites, the programs stand to leave out many people who don’t speak English or don’t have internet access, as well as those who live in multifamily households. All these barriers are more common for non-white Americans, who have also been hit hardest by covid. The White House told KHN it will address these problems but did not give specifics.

It launched a federally run website on Jan. 18 where people can order free tests sent directly to their homes. But there is a four-test limit per household. Many homes could quickly exceed their allotments — more than a third of Hispanic Americans plus about a quarter of Asian and Black Americans live in households with at least five residents, according to an analysis of Census Bureau data by KFF. Only 17% of white Americans live in these larger groups.

“There are challenges that they have to work on for sure,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

Also, as of Jan. 15, the federal government requires private insurers to reimburse consumers who purchase rapid tests.

When the federal website — with orders fulfilled and shipped through the United States Postal Service — went live this week, the first wave of sign-ups exposed serious issues.

Some people who live in multifamily residences, such as condos, dorms, and houses sectioned off into apartments, reported on social media that if one resident had already ordered tests to their address, the website didn’t allow for a second person to place an order.

“They’re going to have to figure out how to resolve it when you have multiple families living in the same dwelling and each member of the family needs at least one test. I don’t know the answer to that yet,” Benjamin said.

USPS spokesperson David Partenheimer said that while this seems to be a problem for only a small share of orders, people who encounter the issue should file a service request or contact the help desk at 1-800-ASK-USPS.

A White House official said 20% of shipments will be directed every day to people who live in vulnerable ZIP codes, as determined by the Centers for Disease Control and Prevention’s social vulnerability index, which identifies communities most in need of resources.

Another potential obstacle: Currently, only those with access to the internet can order the free rapid tests directly to their homes. Although some people can access the website on smartphones, the online-only access could still exclude millions of Americans: 27% of Native American households and 20% of Black households don’t have an internet subscription, according to a KHN analysis of Census Bureau data.

The federal website is currently available only in English, Spanish, and Chinese.

According to the White House, a phone line is also being launched to ease these types of issues. An aide said it is expected to be up and running by Jan. 21. But details are pending about the hours it will operate and whether translators will be available for people who don’t speak English.

However, the website is reaching one group left behind in the initial vaccine rollout: blind and low-vision Americans who use screen-reading technology. Jared Smith, associate director of WebAIM, a nonprofit web accessibility organization, said the federal site “is very accessible. I see only a very few minor nitpicky things I might tweak.”

The Biden administration emphasized that people have options beyond the rapid-testing website. There are free federal testing locations, for instance, as well as testing capacity at homeless shelters and other congregate settings.

Many Americans with private health plans could get help with the cost of tests from the Biden administration reimbursement directive. In the days since its unveiling, insurers said they have moved quickly to implement the federal requirements. But the new systems have proved difficult to navigate.

Consumers can obtain rapid tests — up to eight a month are covered — at retail stores and pharmacies. If the store is part of their health plan’s rapid-test network, the test is free. If not, they can buy it and seek reimbursement.

The program does not cover the 61 million beneficiaries who get health care through Medicare, or the estimated 31 million people who are uninsured. Medicaid and the Children’s Health Insurance Program are required to cover at-home rapid tests, but rules for those programs vary by state.

And the steps involved are complicated.

First, consumers must figure out which retailers are partnering with their health plans and then pick up the tests at the pharmacy counter. As of Jan. 19, however, only a few insurance companies had set up that direct-purchase option — and nearly all the major participating pharmacies were sold out of eligible rapid tests.

Instead, Americans are left to track down and buy rapid tests on their own and then send receipts to their insurance providers.

Many of the country’s largest insurance companies provide paper forms that customers must print, fill out, and mail along with a receipt and copy of the box’s product code. Only a few, including UnitedHealthcare and Anthem, have online submission options. Highmark, one of the largest Blue Cross and Blue Shield affiliates, for instance, has 16-step instructions for its online submission process that involves printing out a PDF form, signing it, and scanning and uploading it to its portal.

Nearly 1 in 4 households don’t own a desktop or laptop computer, according to the Census Bureau. Half of U.S. households where no adults speak English don’t have computers.

A KHN reporter checked the websites of several top private insurers and didn’t find information from any of them on alternatives for customers who don’t have computers, don’t speak English, or are unable to access the forms due to disabilities.

UnitedHealthcare and CareFirst spokespeople said that members can call their customer service lines for help with translation or submitting receipts. Several other major insurance companies did not respond to questions.

Once people make it through the submission process, the waiting begins. A month or more after a claim is processed, most insurers send a check in the mail covering the costs.

And that leads to another wrinkle. Not everyone can easily deposit a check. About 1 in 7 Black and 1 in 8 Hispanic households don’t have checking or savings accounts, compared with 1 in 40 white households, according to a federal report. Disabled Americans are also especially likely to be “unbanked.” They would have to pay high fees at check-cashing shops to claim their money.

“It’s critically important that we are getting testing out, but there are limitations with this program,” said Dr. Utibe Essien, an assistant professor of medicine at the University of Pittsburgh School of Medicine. “These challenges around getting tests to individuals with language barriers or who are homeless are sadly the same drivers of disparities that we see with other health conditions.”

KHN Midwest correspondent Lauren Weber contributed to this report.

Subscribe to KHN's free Morning Briefing.