With this condensed primer, MedPage Today looks at the health policy records of Democratic presidential candidate Kamala Harris and Republican presidential candidate Donald Trump.

Abortion

Harris' Stance:

• Harris supported abortion rights throughout her Senate career; preserving those rights is expected to be a central part of her campaign.
• She is believed to be the first vice president ever to visit an abortion clinic -- a Planned Parenthood facility in Minnesota in March.
• Two months earlier, in Wisconsin, she kicked off her "Fight for Reproductive Freedoms" tour, highlighting the harms of extreme abortion bans.
• In July, Harris pledged that if Congress passed a law to preserve the right to abortion nationwide, she would sign it.
• Abortion-rights groups were quick to endorse Harris after Biden ended his campaign; anti-abortion groups seem alarmed by her unflinching commitment to the issue.

Trump's Stance:

• Trump has called himself "the most pro-life president" in American history.
• He appointed three of the six Supreme Court justices who helped overturn Roe v. Wade.
• Earlier this year, Trump expressed support for a 15-week ban; since then, however, he has stated that abortion is a states' rights issue.
• During the presidential debate in June, Trump falsely accused Democrats of supporting abortions "even after birth."
• The 2024 GOP Platform excludes a definitive call for a national abortion ban for the first time in 40 years, instead stating that the party opposes late-term abortions, and supports prenatal care and access to birth control and in vitro fertilization.
• The platform also supports the 14th Amendment, which protects the rights of "any person" to "due process"; some conservatives have interpreted the words "any person" to include the "unborn."

Why It Matters:

• According to polling by the Pew Research Center, 63% of adults in the U.S. support abortion in all or most cases. Furthermore, in at least seven different states where abortion has been on the ballot (including conservative states like Kansas, Montana, and Kentucky), voters have come down on the side of abortion rights.

• Healthcare Reform

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Thirty-two states are experiencing a summertime surge of COVID-19, with infections growing or likely growing based on emergency room visits, according to updated CDC estimates. [CDC and Axios}

Why it matters: Emergency visits for COVID have crept upward since the first half of May, coinciding with a busy travel season and more people congregating indoors to avoid extreme heat.

• Connecticut, Hawai'i and Nevada were the only states with rates declining or likely declining.
• Southern states — including Georgia, Kentucky and South Carolina — had some of the highest probabilities that the outbreak is spreading, the CDC estimated.
• Eight states had rates that were stable or could not be estimated.

Yes, but: Overall COVID case levels remain relatively low. The KP.3 and KP.2 strains, descendants of the highly contagious JN.1 variant and among the so-called FLiRT variants, account for almost 70% of all cases.

CDC advisers in June recommended that people 6 months of age and older receive updated COVID-19 vaccines when they become available this fall.

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Youth emergency room visits and hospitalizations for depression and anxiety have decreased for Illinoisans since the height of the COVID-19 pandemic, according to a report last week from researchers at Northwestern Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago. {Health News Illinois]

The study analyzed all emergency room visits and admissions from Illinois youth with a coded primary diagnosis of depression and anxiety from January 2016 to June 2023, with data collected from 232 hospitals across the state. [Health News Illinois]

Outpatient emergency room visits for depression and anxiety — where patients go home rather than be admitted to the hospital — declined the most sharply, with the rates falling to pre-2016 levels in the three-plus years since the start of the pandemic.

“We wanted to see if COVID exacerbated the problem or changed it in any way,” Joe Feinglass, a research professor of medicine at Northwestern and the study’s lead author, said in a statement. “And the answer was, somewhat to our surprise, that COVID actually reduced the number of emergency room visits, which was expected during the shutdown, but was sustained into 2023.”

Inpatient hospitalization rates remained constant across the study timeline, which Feinglass said indicates the youth mental health epidemic is ongoing. Along with increasing the number of psychiatric beds and therapists, more needs to be done to address early mental health interventions and the use of social media, he and his colleagues said.

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Provisional data from the National Center for Health Statistics (NCHS) on the top causes of deaths in the United States in 2023 shows COVID-19 dropped to the tenth leading cause of death. In 2022, it was the fourth leading cause of death, meaning deaths from COVID dropped by 68.9% in 1 year. [University of Minnesota -CIDRAP- Center for Infectious Disease Research & Policy} 

There were 76,446 deaths from COVID-19 in 2023, and 245,614 in 2022. In 2023, the leading causes of death in the United States were heart disease (680,909 deaths), cancer (613,331), and unintentional injury (222,518).

A provisional total of 3,090,582 deaths occurred in the United States last year, with the age-adjusted death rate per 100,000 population standing at 884.2 among males, and 632.8 among females. The overall death rate, 750.4 per 100,000, was 6.1% lower than in 2022 (798.8).

The overall death rate was highest among non-Hispanic Black or African American persons  (924.3), and lowest among non-Hispanic multiracial persons (352.1).

Deaths highest among those 85 and older

The number of deaths was highest during the week ending January 7 (68,965) and during the week ending December 30 (65,257). 

Similar to previous years, the lowest death rates were among people aged 5 to 14 years (14.7) and highest among persons aged 85 years and older (14,285.8).

For COVID, the death rate decreased from 2022 to 2023 for all age groups, but the age-adjusted COVID-19–associated death rate per 100,000 among males (22.1) was higher than that among females (15.4). COVID-19–associated death rates decreased from 2022 to 2023 for all racial and ethnic groups, the authors said. 

Provisional death estimates can give researchers and policymakers an early signal about shifts in mortality trends and provide actionable information sooner than do the final mortality data.

"Provisional death estimates can give researchers and policymakers an early signal about shifts in mortality trends and provide actionable information sooner than do the final mortality data. These data can guide public health policies and interventions that are intended to reduce mortality," the report concluded.  

See CDC List and more details here> 

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Cook County Health said Wednesday it plans to open a new medical center in Chicago’s Bronzeville neighborhood by early next year. [Health News Illinois]

The site will serve as an extension of the health system’s Provident Hospital and will offer family medicine, mental healthcare and rehabilitation services, such as physical, occupational and speech therapy.

The 26,000-square-foot facility will have 44 exam rooms and gym space for therapy services, said Cook County Board President Toni Preckwinkle. Once open, she said they expect the site to have 85,000 visits in its first year.

“The health center holds the promise, not only of addressing the immediate health needs of the community, but also fostering long-term improvements in health outcomes on Chicago's south side,” Preckwinkle said. “It will play a critical role in addressing the persistent, systemic barriers to health that we're all aware of. It will also support a healthier and more equitable future for Cook County.”

Officials said the center is part of a larger modernization of services at Provident Hospital. Dr. Erik Mikaitis, interim CEO of Cook County Health, said the new center will give the service lines “room to grow” and open up more clinical space within the hospital to expand care.

“While we're still strategically planning for what that (clinical space) will look like, we know that services will be based on community needs and further enhance access to care on the south side,” Mikaitis said.

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The suicide rate for U.S. children 8 to 12 years old has steadily climbed in the past decade and a half, with a disproportionate rise among girls, data released Tuesday by the National Institute of Mental Health shows. [The Washington Post]

The findings, published in the journal JAMA Network Open, highlight pervasive issues regarding mental health that affect U.S. children daily, the study authors said.

The authors of the study blame no single reason for the increase, but experts not involved in the study say the problem is multifaceted, citing technology, social media and guns as the main culprits.

Between 2001 and 2022, 2,241 children ages 8 to 12 — known as preteens — died by suicide. While suicide rates were decreasing until 2007, they increased by about 8 percent each year from 2008 to 2022.

From 2001 through 2007, 482 children ages 8 to 12 died by suicide at a rate of 3.34 per 1 million preteens. From 2008 to 2022, the number of suicides in that age group rose to 1,759, with a rate of 5.71 per 1 million.

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Illinois’ new Medicaid demonstration program that supports facilities that provide comprehensive, around-the-clock behavioral healthcare and substance abuse treatment is set to begin in October. [Health News Illinois]

Kristine Herman, chief of the behavioral health bureau at the Department of Healthcare and Family Services, told members of the Medicaid Advisory Committee that they are working on a “robust communication and technical assistance strategy” to ensure all participating clinics can begin offering the necessary services by Oct. 1.

The initial 19 mental health and substance use treatment providers in the demonstration program must provide care coordination, 24/7 access to crisis services and serve all patients, regardless of their ability to pay.

“These agencies will serve anyone who comes through their doors, regardless of the individual's insurance status, and they're going to ensure that these individuals have access to a very broad array of mental health, substance use, recovery and physical health screening services, as well as referrals and coordination with any other services that the individual may need,” Herman said.

Additionally, she said they will begin hosting weekly meetings that are open to all the participating clinics to answer any questions or address concerns. They will also hold meetings during the first demonstration year to ensure the process is going smoothly.

While the demonstration program will start with 19 providers, Herman said there will be opportunities for other organizations to join during its second year.

Illinois was one of 10 states added to the demonstration program earlier this year by the U.S. Department of Health and Human Services. Eight states are already part of the program.

The state is expecting a $150 million boost as part of the program, which is a mixture of state funding and an enhanced federal match.

In other business, Medicaid Administrator Kelly Cunningham said they are now “knee-deep” in the pre-implementation work for the 1115 waiver, which was approved last month by the Centers for Medicare and Medicaid Services.

The waiver aims to address social determinants of health and behavioral health through various programs, including those that will provide short-term post-transition housing, medically necessary home remediation, nutrition counseling, home-delivered and medically tailored meals, and nutrition prescriptions targeting health risks.

Cunningham said the federal agency will have to approve operational protocol and some of the other implementation work, but she thanked members for helping to craft the waiver’s provisions.

“It’s not going to be like flipping a switch and turning a service on,” she said. “That will come, but we are still in the planning and pre-implementation phase.”

Additionally, a town hall will be held later this month with more information on the waiver and how providers and other stakeholders can assist with the rollout.

Dana Kelly, HFS chief of staff, told committee members that the agency will start conducting meetings in the coming weeks to get feedback related to the managed care procurement process.

“It's really a time to make sure that we're getting kind of a full grasp of the overall experience of the Medicaid consumer in this process,” she said.

The current contracts with Medicaid managed care organizations in the HealthChoice Illinois program were extended for an additional year to give HFS’ new leadership time to settle in.

Kelly said they expect to open the procurement process next spring.

Contact IOMC if you are interested in learning more about the Behavioral Health workgroup. Send an email to info@iomc.org.

 

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Jonnae Thompson has felt for a long time that her dark brown skin and natural hair have made finding work in Hollywood especially hard. [ KFF Health News]

“It’s like this negative connotation,” said the 37-year-old actress, singer, and stand-up comedian, who said she is often asked to audition for villainous roles such as a bully, drug dealer, or pimp.

Her quest for more equitable representation on the big screen isn’t just professionally exhausting. Thompson says anxiety about her skin complexion has affected her health.

“It definitely had a negative impact on my self-esteem,” she said. She recalls being called “charcoal” in kindergarten. “It was big, like, your skin is dark and that’s a problem.”

The term colorism — a form of prejudice and discrimination in which lighter skin is favored over darker skin — was popularized by author Alice Walker in her 1983 book “In Search of Our Mothers’ Gardens: Womanist Prose.”

Clinicians from various ethnic groups have recently begun to draw a direct line between colorism and poor health. A 2023 KFF survey found that, among Black and Hispanic adults, those with self-described darker skin tones reported more experiences with discrimination in daily life compared with those who have lighter skin tones. People who feel they experience daily discrimination can be at higher risk for depression, loneliness, increased alcohol and drug use, and anxiety, data shows.

And colorism can also lead to physical health concerns. Hair straighteners and skin lighteners commonly used by women of color, sometimes to conform to racialized beauty standards, increase their exposure to toxic chemicals, research shows.

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The March of Dimes report, shares how ob-gyn facility closings adversely impacted maternal health care especially Chicago's south and west side communities. These closings resulted in maternity care deserts, decreased access care, impaired the quality of care, and more. Recently, the AMA and Sinai Health Institute stated they agreed with this impact. 

Policy and actions are needed to correct the problems created in part by the change in access and distribution of maternal care in the US including Chicago and the State of Illinois. 

Download the March of Dimes report here>

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Gov. JB Pritzker signed a new law Monday that advocates hope will close maternal health equity gaps by expanding coverage for services. [Health News Illinois]

The law tasks insurers with covering all pregnancy, postpartum and newborn care provided by perinatal doulas and licensed certified professional midwives. 

Coverage includes home births and home visits.

Home visits by lactation consultants would also be covered, as well as recommended products like breast pumps and feeding aids.

Insurance policies will have to cover up to $8,000 of home visits by a perinatal doula for each pregnancy and postpartum period.

Medicaid will also cover certified professional midwife services.

Pritzker said during a bill signing in Chicago that the law follows through on his promise earlier this spring to address disparities in maternal health, specifically among Black women.

“Black women are three times more likely than white women to die from medical complications during pregnancy and childbirth,” he said, citing a Department of Public Health report released last year. “That is appalling, it's unacceptable and we're not going to let that happen anymore in the state of Illinois.”

Sen. Lakesia Collins, a Democrat from Chicago who sponsored the legislation this spring, said the disparities can no longer be ignored.

“This law was not just about healthcare — it's about justice, equality and the right of every mother and child to have access to the safest and most effective care,” she said.

Stakeholders noted the law is part of a larger effort underway in Illinois to improve maternal health outcomes. 

The current state budget includes $15 million to support home visiting expansion, $4 million to support IDPH’s assessment of the state’s maternal mortality rate and the creation of an action plan to serve affected communities, $5 million to expand the Department of Human Services’ home visitor program, and $1 million to fund a pilot program at DHS to provide diapers.

It also includes capital grant funding to support birth centers trying to open in underserved areas as well as facilities that have seen an influx of patients in the two years since the Supreme Court’s Dobbs decision.

“There's more work to do, but this is an enormously important first and big step,” Pritzker said.

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