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

by | Jan 28, 2022 | Commentary, Headline News |

Hannah Recht and Victoria Knight

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.

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With Roots in Civil Rights, Community Health Centers Push for Equity in the Pandemic

by | Jul 16, 2021 | Black History, Headline News |

In the 1960s, health care across the Mississippi Delta was sparse and much of it was segregated. Some hospitals were dedicated to Black patients, but they often struggled to stay afloat. At the height of the civil rights movement, young Black doctors launched a movement of their own to address the care disparity.

“Mississippi was third-world and was so bad and so separated,” said Dr. Robert Smith. “The community health center movement was the conduit for physicians all over this country who believed that all people have a right to health care.”

In 1967, Smith helped start Delta Health Center, the country’s first rural community health center. They put the clinic in Mound Bayou, a small town in the heart of the Delta, in northwestern Mississippi. The center became a national model and is now one of nearly 1,400 such clinics across the country. These clinics, called federally qualified health centers, are a key resource in Mississippi, Louisiana and Alabama, where about 2 in 5 people live in rural areas. Throughout the U.S., about 1 in 5 people live in rural areas.

The covid-19 pandemic has only exacerbated the challenges facing rural health care, such as lack of broadband internet access and limited public transportation. For much of the vaccine rollout, those barriers have made it difficult for providers, like community health centers, to get shots into the arms of their patients.

“I just assumed that [the vaccine] would flow like water, but we really had to pry open the door to get access to it,” said Smith, who still practices family medicine in Mississippi.

Mound Bayou was founded by formerly enslaved people, many of whom became farmers.

The once-thriving downtown was home to some of the first Black-owned businesses in the state. Today the town is dotted with shuttered or rundown banks, hotels and gas stations.

Mitch Williams grew up on a Mound Bayou farm in the 1930s and ’40s and spent long days working the soil.

“If you would cut yourself, they wouldn’t put no sutures in, no stitches in it. You wrapped it up and kept going,” Williams said.

When Delta Health Center started operations in 1967, it was explicitly for all residents of all races — and free to those who needed financial help.

Williams, 85, was one of its first patients.

“They were seeing patients in the local churches. They had mobile units. I had never seen that kind of comprehensive care,” he said.

Residents really needed it. In the 1960s, many people in Mound Bayou and the surrounding area didn’t have clean drinking water or indoor plumbing.

At the time, the 12,000 Black residents of northern Bolivar County, which includes Mound Bayou, faced unemployment rates as high as 75% and lived on a median annual income of just $900 (around $7,500 in today’s dollars), according to a congressional report. The infant mortality rate was close to 60 for every 1,000 live births — four times the rate for affluent Americans.

Delta Health Center employees helped people insulate their homes. They built outhouses and provided food and sometimes even traveled to patients’ homes to offer care, if someone didn’t have transportation. Staffers believed these factors affected health outcomes, too.

Williams, who later worked for Delta Health, said he’s not sure where the community would be today if the center didn’t exist.

“It’s frightening to think of it,” he said.

Half a century later, the Delta Health Center continues to provide accessible and affordable care in and around Mound Bayou.

Black Southerners still face barriers to health. In April 2020, early in the pandemic, Black residents accounted for nearly half of covid deaths in Alabama and over 70% in Louisiana and Mississippi.

Public health data from last month shows that Black residents of those states have consistently been more likely to die of covid than residents of other races.

“We have a lot of chronic health conditions here, particularly concentrated in the Mississippi Delta, that lead to higher rates of complications and death with covid,” said Nadia Bethley, a clinical psychologist at the center. “It’s been tough.”

Delta Health Center has grown over the decades, from a few trailers in Mound Bayou to a chain of 18 clinics across five counties. It’s managed to vaccinate over 5,500 people against covid. The majority have been Black.

“We don’t have the National Guard, you know, lining up out here, running our site. It’s the people who work here,” Bethley said.

The Mississippi State Department of Health said it has prioritized health centers since the beginning of the rollout. But Delta Health CEO John Fairman said the center was receiving only a couple of hundred doses a week in January and February. The supply became more consistent around early March, center officials said.

“Many states would be much further ahead had they utilized community health centers from the very beginning,” Fairman said. Fairman said his center saw success with vaccinations because of its long-standing relationships with the local communities.

“Use the infrastructure that’s already in place, that has community trust,” said Fairman.

That was the entire point of the health center movement in the first place, said Smith. He said states that were slow to use health centers in the vaccine rollout made a mistake that has made it difficult to get a handle on covid in the most vulnerable communities.

Smith called the slow dispersal of vaccines to rural health centers “an example of systemic racism that continues.”

A spokesperson for Mississippi’s health department said it is “committed to providing vaccines to rural areas but, given the rurality of Mississippi, it is a real challenge.”

Alan Morgan, CEO of the National Rural Health Association, said the low dose allocation to rural health clinics and community health centers early on is “going to cost lives.”

“With hospitalizations and mortality much higher in rural communities, these states need to focus on the hot spots, which in many cases are these small towns,” Morgan said of the vaccine efforts in Mississippi, Louisiana and Alabama.

A report from KFF found that people of color made up the majority of people vaccinated at community health centers and that the centers seem to be vaccinating people at rates similar to or higher than their share of the population. (The KHN newsroom, which collaborated to produce this story, is an editorially independent program of KFF.)

The report added that “ramping up health centers’ involvement in vaccination efforts at the federal, state and local levels” could be a meaningful step in “advancing equity on a larger scale.”

Equal access to care in rural communities is necessary to reach the most vulnerable populations and is just as critical during this global health crisis as it was in the 1960s, according to Smith.

“When health care improves for Blacks, it will improve for all Americans,” Smith said.

This story is from a partnership that includes NPR, KHN and the three stations that make up the Gulf States Newsroom: Mississippi Public Broadcasting; WBHM in Birmingham, Alabama; and WWNO in New Orleans.

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Trying to Avoid Racist Health Care, Black Women Seek Out Black Obstetricians

Trying to Avoid Racist Health Care, Black Women Seek Out Black Obstetricians

by | Jun 11, 2021 | Commentary, Headline News |

In South Florida, when people want to find a Black physician, they often contact Adrienne Hibbert through her website, Black Doctors of South Florida.

“There are a lot of Black networks that are behind the scenes,” said Hibbert, who runs her own marketing firm. “I don’t want them to be behind the scenes, so I’m bringing it to the forefront.”

Hibbert said she got the idea for the website after she gave birth to her son 15 years ago.

Her obstetrician was white, and the suburban hospital outside Miami didn’t feel welcoming to Hibbert as a Black woman pregnant with her first child.

“They had no singular photos of a Black woman and her Black child,” Hibbert said. “I want someone who understands my background. I want someone who understands the foods that I eat. I want someone who understands my upbringing and things that my grandma used to tell me.”

In addition to shared culture and values, a Black physician can offer Black patients a sense of safety, validation and trust. Research has shown that racism, discrimination and unconscious bias continue to plague the U.S. health care system and can cause unequal treatment of racial and ethnic minorities.

Black patients have had their complaints and symptoms dismissed and their pain undertreated, and they are referred less frequently for specialty care. Older Black Americans can still remember when some areas of the country had segregated hospitals and clinics, not to mention profoundly unethical medical failures and abuses, such as the 40-year-long Tuskegee syphilis study.

But even today, Black patients say, too many clinicians can be dismissive, condescending or impatient — which does little to repair trust. Some Black patients would prefer to work with Black doctors for their care, if they could find any.

Hibbert is working on turning her website into a more comprehensive, searchable directory. She said the most sought-after specialist is the obstetrician-gynecologist: “Oh, my gosh, the No. 1 call that I get is [for] a Black OB-GYN.”

For Black women, the impact of systemic racism can show up starkly in childbirth. They are three times as likely to die after giving birth as white women in the United States.

Nelson Adams is a Black OB-GYN at Jackson North Medical Center in North Miami Beach, Florida. He said he understands some women’s preference for a Black OB-GYN but said that can’t be the only answer: “If every Black woman wanted to have a Black physician, it would be virtually impossible. The numbers are not there.”

And it’s also not simply a matter of recruiting more Black students to the fields of medicine and nursing, he said, though that would help. He wants systemic change, which means medical schools need to teach all students — no matter their race, culture or background — to treat patients with respect and dignity. In other words, as they themselves want to be treated.

“The golden rule says, ‘Do unto others as you would have them do unto you,’ so that the heart of a doctor needs to be that kind of heart where you are taking care of folks the way you would want to be treated or want your family treated,” he said.

George Floyd’s murder in Minneapolis in May 2020, and the subsequent wave of protests and activism, prompted corporations, universities, nonprofits and other American institutions to reassess their own history and policies regarding race. Medical schools were no exception. In September, the University of Miami Miller School of Medicine revamped its four-year curriculum to incorporate anti-racism training.

New training also became part of the curriculum at Florida Atlantic University’s Charles E. Schmidt College of Medicine in Boca Raton, where students are being taught to ask patients about their history and experiences in addition to their bodily health. The new questions might include: “Have you ever felt discriminated against?” or “Do you feel safe communicating your needs?”

“Different things that were questions that we maybe never historically asked, but we need to start asking,” said Dr. Sarah Wood, senior associate dean for medical education at Florida Atlantic.

The medical students start learning about racism in health care during their first year, and as they go, they also learn how to communicate with patients from various cultures and backgrounds, Wood added.

These changes come after decades of racist teaching in medical schools across the United States. Adams, the OB-GYN, completed his residency in Atlanta in the early 1980s. He recalls being taught that if a Black woman came to the doctor or hospital with pain in her pelvis, “the assumption was that it was likely to be a sexually transmitted disease, something we refer to as PID, pelvic inflammatory disease. The typical causes there are gonorrhea and/or chlamydia.”

This initial assumption was in line with a racist view about Black women’s sexual activity — a presumption that white women were spared. “If the same symptoms were presented by a Caucasian, a white young woman, the assumption would be not an STD, but endometriosis,” Adams said. Endometriosis is not sexually transmitted and is therefore less stigmatizing, less tied to the patient’s behavior.

That diagnostic rule of thumb is no longer taught, but doctors can still bring unconscious racial bias to their patient encounters, Adams said.

While they revamp their curricula, medical schools are also trying to increase diversity within their student ranks. Florida Atlantic’s Schmidt College of Medicine set up, in 2012, a partnership with Florida A&M University, the state’s historically Black university. Undergraduates who want to become doctors are mentored as they complete their pre-med studies, and those who hit certain benchmarks are admitted to Schmidt after they graduate.

Dr. Michelle Wilson took that route and graduated from Schmidt this spring. She’s headed to Phoebe Putney Memorial Hospital in Albany, Georgia, for a residency in family medicine. Wilson was drawn to that specialty because she can do primary care but also deliver babies. She wants to build a practice focused on the needs of Black families.

“We code-switch. Being able to be that comfortable with your patient, I think it’s important when building a long-term relationship with them,” Wilson said.

“Being able to relax and talk to my patient as if they are family — I think being able to do that really builds on the relationship, especially makes a patient want to come back another time and be like, ‘I really like that doctor.'”

She said she hopes her work will inspire the next generation of Black doctors.

“I didn’t have a Black doctor growing up,” Wilson said. “I’m kind of paving the way for other little Black girls that look like me, that want to be a doctor. I can let them know it’s possible.”

This story is part of a partnership that includes NPR, WLRN and KHN.

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.

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