Each year approximately 700 women die in the United States as a result of pregnancy or related complications, and Black women are three- to five-times more likely to die in childbirth than White women. In honor of the fourth Black Maternal Health week, April 11-17, 2021, sponsored by the Black Mamas Matter Alliance, the National Academy for State Health Policy (NASHP), is showcasing recent state health policy resources to help improve Black maternal health.
- New Jersey Medicaid Implements New Policies to Improve Maternal Health, March 2021
- How New York Is Safeguarding Pregnant Women during the COVID-19 Pandemic, November 2020
- State Strategies to Address the Black Maternal Health Crisis, October 2020
- Eight States Join NASHP’s Maternal and Child Health Policy Innovation Program Policy Academy to Address Maternal Mortality, April 2021
- Four State Strategies to Employ Doulas to Improve Maternal Health and Birth Outcomes in Medicaid, July 2020
Interactive Maps and Charts
- State Maternal Mortality Review Committee Membership and Recommendations, February 2021
- State Medicaid Policies for Maternal Depression Screening During Well-Child Visits, April 2020
- View Each State’s Efforts to Extend Medicaid Coverage to Postpartum Women, March 2020
State Team-Based Care Strategies for Medicaid-Eligible Women, December 2019
Many states are transforming their health care delivery systems to improve health and control costs. Reducing health disparities — and addressing their social and economic causes — is at the heart of many of these efforts.
More than a year into the pandemic, COVID-19 is proving to be a complicated syndemic with political, economic, and social factors influencing who is most at risk of infection and death. With communities impacted by structural racism facing higher COVID-19 infection and mortality rates, state responses and recovery plans are focusing on equity.
- Employment and income;
- Food environment;
- Health and medical care;
- Outdoor environment; and
- Community safety.
The committee recommends sustaining investments in the expansion of supportive and affordable housing for domestic violence victims and incarcerated individuals re-entering their communities, as well as non-congregate housing for people experiencing homelessness.
The committee also recommends incentivizing employers who accommodate extended work-from-home requests from employees and working with pharmacies and other medical corporations to prevent treatment shortages in underserved areas.
The DC Council has also passed legislation to create the Council Office of Racial Equity (CORE). CORE recently released a report in March examining racial equity in the District’s vaccination rates and practices, and proposing best practices to ensure the District can ensure a racially equitable process moving forward. For example, to ensure equitable vaccine distribution, the District prioritizes doses for individuals living in high-need zip codes and has restricted registration on certain days to allow only those individuals to sign up on the vaccine portal or call the vaccine hotline. CORE is currently working on another report that focuses on a racially equitable economic recovery.
In Illinois, the Department of Public Health established a COVID-19 Health Equity Task Force to work across the department and with other relevant state and local entities to assess health concerns of minority communities and create and maintain culturally sensitive programs. The task force launched a COVID-19 text messaging system that includes a Spanish-speaking option. The department also supported the City of Chicago, in partnership with the city’s chief equity officer, to create the Racial Equity Rapid Response Team (RERRT) to address the disproportionate effects of the pandemic on communities of color. The city experienced a significant improvement in vaccine administration to communities of color by February 2021 as a result of RERRT’s oversight and involvement.
Georgia’s Department of Public Health created a COVID-19 Health Equity Council to ensure equity in COVID-19 vaccination education and distribution efforts in communities most affected by COVID-19. Members of the council represent community-based organizations, news stations, chambers of commerce, and universities. The council will work with Georgia’s 18 public health districts to address COVID-19 concerns.
State Actions to Address Equity Beyond the Pandemic
States are making financial and cross-agency leadership commitments to ensure equity is the focus of their work moving forward. Washington, DC, Illinois, Indiana, and Washington State have recently hired or are in the process of hiring cabinet-level positions to oversee inter-agency diversity, equity, and inclusion (DEI) initiatives. States are also implementing cross-sector equity plans and making significant investments in identified program and policy areas.
Washington’s state legislature passed HB 1783 in 2020 to create the Office of Equity. Lawmakers explained, “the legislature finds that a more inclusive Washington is possible if agencies identify and implement effective strategies to eliminate systemic inequities.” In February 2021, Gov. Jay Inslee named a director of the program to be in office by March 8. The office will be staffed by eight people and is tasked to develop and implement a five-year equity plan for the state. Staff will work with other state agencies to help create and implement DEI plans.
In his $365 million equity policy package, Gov. Inslee earmarked $2.5 million from the state’s general fund for the office. Other state equity priorities include:
- $10 million for the Washington COVID-19 Immigrant Relief Fund;
- Funding for the Office of Minority and Women’s Business Enterprises to launch the Washington State Toolkit for Equity in Public Spending to increase the number of minority and women contractors;
- Funding for the Department of Financial Institutions to address racial wealth inequities by working with financial institutions, federal, state, and local governments, and community partners;
- $79 million to support residential broadband connection for families and $6 million for a Digital Navigator Program that enables navigators to provide one-on-one support for students, English language learners, older adults, and individuals searching for work; and
- $8.4 million for students who experienced foster care or homelessness, including $3 million for pre-apprenticeship training.
In Florida, bills introduced in the House of Representatives and State Senate (HB 183 and SB 404) require each county health department to designate a minority health liaison. The liaison will collaborate with the state Office of Minority Health and Health Equity on implementation of programs, policies, and practices. Examples of these activities include:
- Data analysis for disparities in health status, health care quality, and access to care for racial and ethnic minority populations;
- Demonstration projects to increase health equity;
- Community health workers working to improve cultural competency and individual and community self-sufficiency;
- Analysis of a community’s risk for involvement in the adult and juvenile legal system and foster care system, or risk of homelessness. Available support programs and diversion programs addressing these areas will also be examined; and
- Developing and executing programming for individuals with limited English proficiency to help them better access health care services.
Racial equity impact assessments are another strategy to address equity beyond the pandemic. These assessments help determine the impact of a policy or budget item on racial and ethnic groups. Seven states (CO, CT, FL, IA, MD, NJ, and OR) require racial impact statements. The following states recently took action to establish racial impact assessments:
- Maine’s legislature passed LD 2, a bill that requires the inclusion of racial impact statements in the legislative process. The bill allows legislative committees to request state agencies to provide analysis of the impact of pending legislation on historically disadvantaged racial populations.
- The Virginia General Assembly passed HB 1990, a bill that allows the chairs of the House Committee for Courts of Justice and Senate Committee on the Judiciary to request racial and impact statements from the Joint Legislative Audit Review Commission. Committee chairs may not request more than three racial and ethnic impact statements during a single session.
- The Washington, DC Council passed L23-0181, the Racial Equity Achieves Results (REACH) Act. Among other activities to ensure racial equity in the District, the legislation creates a racial impact assessment requirement for council legislation. The District’s Council Office of Racial Equity (CORE) is charged with evaluating legislation prior to committee markup for its potential impact on racial equity.
States are taking important steps to immediately address the impact of COVID-19 on racial and ethnicity disparities and incorporating health equity approaches into their systems moving forward. In their 2021 state of the state addresses, 21 governors highlighted strategies to address racial and ethnic disparities. Several governors specifically discussed racism and racial injustices, citing how communities of color were disproportionately impacted by COVID-19 and articulating their commitment to improvement. The recent passage of the American Rescue Plan will provide significant financial support to states for their recovery efforts. States have the opportunity to center equity in their dispersal of funds and address the health, social, and economic impact of COVID-19.
To read more about state initiatives to address health equity, explore NASHP’s toolkit, Resources for States to Address Health Equity and Disparities.
Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.
More than 200 bills to lower drug prices have been filed across states during this session and nine states are proposing prescription drug affordability board (PDAB) legislation.
Nine states (AZ, CO, MN, NJ, NM, OR, RI, VA, and WI) are currently advancing PDAB bills in their legislatures. While a number of these bills are similar to Maryland’s approach that phases in upper payment limits by initially limiting them to public purchasers before potentially expanding them to include private purchasers, the majority of the currently proposed bills map more closely to NASHP’s original model legislation, which implements payment limits across all payers (public and private) in a state in a more expedited fashion.
The bills are generally similar in two approaches:
- They use similar price thresholds to identify a drug for investigation by their PDABs, and
- They apply the same factors when setting an upper payment limit for drugs found to be otherwise unaffordable – such as weighing the cost of administering the drug and delivering the drug to consumers.
Minnesota’s bill, however, includes unique language that empowers its PDAB to consider both the “the range of prices at which [a] drug is sold in the United States and the range at which pharmacies are reimbursed [for it] in Canada.” This language creates a bridge between the PDAB model and a newer approach in a recently released NASHP model law that creates payment rates for certain high-priced drugs based on Canadian pricing. This approach, reflected in NASHP’s Act to Reduce Prescription Drug Costs Using International Pricing, offers states a more streamlined approach than establishing a PDAB, which requires the complex task of determining the appropriate value of a drug in order to set an affordable payment rate. Five states (HI, ME, OK, ND, and RI) are currently considering international reference rate bills that use (or “reference”) Canadian prices to set more affordable rates.
As states consider PDABs and international reference rate approaches to achieve the goal of setting more affordable payment rates for drugs, there are several key factors to consider.
- While international reference rates look to Canada’s drug prices when establishing appropriate payment rates, PDABs keep the task of identifying affordable rates within a state.
- While PDABs may be conceptually preferable for this reason, the time and resources required to implement this approach may not make PDABs feasible for all states. For those states, using Canadian prices to set rates may be the most viable option.
Minnesota’s bill, however, points to a third option, a hybrid approach in which a PDAB would consider Canadian pricing as part of its process.
Explore this chart to compare the different state approaches and implementation timelines of the nine PDAB bills proposed as of March 9, 2021.