Cost, access still barriers to medical care for Black Ohio women

Introduction

In the heart of Ohio, a stark reality continues to unfold: Black women face significant barriers to accessing quality medical care. Despite the strides made in healthcare reform, persistent disparities in cost and access remain entrenched, threatening the well-being of this vital demographic. A recent study has highlighted the need for increased Medicaid eligibility and legislative measures to address these issues. This article delves into the complexities of these barriers, their impact on health outcomes, and the potential solutions that could bridge the gap.

The State of Healthcare in Ohio

Ohio, like many states, grapples with the dual challenges of cost and access in its healthcare system. For Black women, these challenges are compounded by multiple factors, including socioeconomic status, systemic racism, and gender-based disparities.

Socioeconomic Indicators

Cleveland, Ohio, is a microcosm of these issues. The city's racial and ethnic populations face higher poverty rates compared to their Caucasian counterparts. In 2014, the overall poverty rate in Cleveland was 35.9%, with children being particularly vulnerable at 53.5% (Cleveland Office of Minority Health,). This high concentration of poverty is most evident on the city's east and near-west sides, where many Hispanic and African-American residents reside.

Health Disparities

Health disparities in Cleveland are alarming. African Americans and Hispanics are three times more likely to live in poverty than Whites (Health Improvement Partnership-Cuyahoga,). The lack of insurance or being under-insured is a significant risk factor for decreased access to high-quality care, delays in seeking care, and a low priority placed on preventive care (HealthPowerForMinorities,).

Specific Health Issues

Infant Mortality

Infant mortality rates in Cleveland are disturbing. African-American infants are 42% more likely to die before reaching their first birthday compared to Caucasian infants (Cuyahoga County Health Needs Assessment,). This pattern extends to low birth weight and very low birth weight births.

Obesity

Obesity rates among African-American children are significantly higher than those among Caucasian children. In Cuyahoga County, the obesity rate among adults was 24.7% in 2012—lower than the national and state averages. However, the obesity rate among African Americans was 37%, which is 18% higher than the rate among Caucasians (Cuyahoga County Health Needs Assessment,).

Cancer

African Americans in Ohio have much higher mortality rates for various cancers compared to White residents. For instance, the total cancer mortality rate per 100,000 people in Ohio was 201 for African Americans and 180 for Whites in 2015 (Ohio Annual Cancer Report,).

Barriers to Access

The barriers to healthcare access for Black Ohio women are multifaceted and deeply ingrained.

Cost as a Barrier

High Costs of Tests, Visits, and Medications The high costs of medical tests, doctor visits, and medications are significant deterrents to seeking healthcare. A recent survey found that 44.7% of respondents delayed or skipped care due to the high costs of tests, 37.8% due to visit costs, and 43.7% due to medication costs (Policy Matters Ohio,).

Medical Debt Many Black Ohio women experience stress due to medical debt. A majority of respondents reported experiencing stress due to high co-pays, increased out-of-pocket expenses, and high medication costs. This stress can exacerbate existing health conditions and deter individuals from seeking necessary care (Policy Matters Ohio,).

Lack of Insurance

Uninsured Rates Despite efforts to increase health insurance coverage, significant disparities persist. The uninsured rate among nonelderly Black Americans decreased from 20.9% in 2010 to 10.8% in 2022, thanks in part to the Affordable Care Act (ACA) (ASPE,). However, this progress is not uniform across all demographics, and many Black Ohio women still lack adequate coverage.

Limited Access to Providers Black women face additional barriers in accessing healthcare providers. They are more likely to delay seeking care or filling prescriptions because of cost. In 2022, almost half of Black adults reported being worried about medical bills, and 7% delayed filling prescriptions due to cost (ASPE,).

Systemic Barriers

Systemic Racism Systemic racism plays a significant role in perpetuating these disparities. Implicit and explicit bias among healthcare providers, inconvenient provider office hours, and limited providers who see patients with public insurance due to lower reimbursement rates all contribute to decreased access to care and worse health outcomes for Black Americans (ASPE,).

Transportation Barriers Transportation issues further exacerbate the problem. Many Black Ohio women lack access to reliable transportation, making it difficult for them to attend appointments or seek emergency care (ASPE,).

Legislative Measures to Address Disparities

In response to these persistent barriers, a recent study recommended increases in Medicaid eligibility and other legislative measures to help improve healthcare outcomes and access for Black women.

Medicaid Expansion

Proposed Budget Changes Proposed budget changes aimed at increasing pregnant women's eligibility for Medicaid would have significantly benefited Black women. This expansion would have provided more women with access to quality prenatal care, reducing maternal mortality rates and improving overall health outcomes (Policy Matters Ohio,,).

Legislative Rejection However, this proposal was rejected by the legislature, leaving many Black women without the necessary coverage. The rejection was particularly concerning given the high maternal mortality rates among Black women in Ohio, which stood at 29.5 deaths per 100,000 births in 2022, more than twice the rate for White women (Policy Matters Ohio,,).

Other Legislative Measures

Healthcare Access Improvements To address these disparities, lawmakers should consider implementing other legislative measures. These could include:

• Increased Funding for Community Health Workers

  • Employing more community health workers in strategic areas can help bridge the gap between healthcare providers and underserved communities.

• Data Collection and Reporting

  • Improving data collection and reporting mechanisms can provide a clearer picture of healthcare needs and disparities, allowing for more targeted interventions.

• Neighborhood-Based Initiatives

  • Developing neighborhood-based initiatives based on local data findings can help tailor healthcare services to meet the specific needs of each community.

Conclusion

The struggle for Black Ohio women to access quality healthcare is a deeply ingrained issue that requires comprehensive solutions. While recent studies have highlighted the need for increased Medicaid eligibility and other legislative measures, the rejection of such proposals underscores the complexity of addressing these disparities.

It is imperative that lawmakers, healthcare providers, and community leaders work together to address the systemic barriers that inhibit access to care. By doing so, we can begin to dismantle the persistent disparities that threaten the health and well-being of Black Ohio women.

References

• Cleveland Office of Minority Health. (PDF) Cleveland Office of Minority Health - Ohio.gov. Retrieved from https://dam.assets.ohio.gov/image/upload/mih.ohio.gov/partnerships/MGS%2016%20-%2002%20Cleveland%20Office%20of%20Minority%20Health%20LC%20.pdf
• Policy Matters Ohio. Black women can thrive in Ohio. Retrieved from https://www.policymattersohio.org/research-policy/sustainable-communities/health-health-equity/black-women-can-thrive-in-ohio
• ASPE. Health Insurance Coverage and Access to Care Among Black Americans. Retrieved from https://www.aspe.hhs.gov/sites/default/files/documents/4fc0ddbcee8d583d57e399dad6201536/aspe-coverage-access-black-americans-ib.pdf
• Policy Matters Ohio. Eliminating barriers to good health for Ohio's Black women. Retrieved from https://www.policymattersohio.org/research-policy/sustainable-communities/health-health-equity/eliminating-barriers-to-good-health-for-ohios-black-women