How the Trump Administration's Pandemic Health Care Response Failed Racial Health Equity: Case Studies of Structural Racism and a Call for Equity Mindfulness in Federal Health Policy Making.

CONTEXT: The racial health equity implications of the Trump administration's response to the COVID-19 pandemic. METHODS: We focus on four key health care policy decisions made by the administration in response to the public health emergency: rejecting a special Marketplace enrollment period, failing to use its full powers to enhance state Medicaid emergency options, refusing to suspend the public charge rule, and failing to target provider relief funds to providers serving the uninsured. FINDINGS: In each case, the administration's policy choices intensified, rather than mitigated, racial health inequality. Its choices had a disproportionate adverse impact on minority populations and patients who are more likely to depend on public programs, be poor, experience pandemic-related job loss, lack insurance, rely on health care safety net providers, and be exposed to public charge sanctions. CONCLUSIONS: Ending structural racism in health care and promoting racial health care equity demands an equity-mindful approach to the pursuit of policies that enhance-rather than undermine-health care accessibility and effectiveness and resources for the poorest communities and the providers that serve them.

Ensuring Equitable Access To COVID-19 Vaccines In The US: Current System Challenges And Opportunities.

There has been a worldwide effort to accelerate the development of safe and effective vaccines for severe acute respiratory syndrome coronavirus-2. When vaccines become licensed and available broadly to the public, the final hurdle is equitable distribution and access for all who are recommended for vaccination. Frameworks and existing systems for allocation, distribution, vaccination, and monitoring for safety and effectiveness are assets of the current immunization delivery system that should be leveraged to ensure the equitable distribution and broad uptake of licensed vaccines. The system should be strengthened to address gaps in access to immunization services and to modernize the public health infrastructure. We offer five recommendations as guideposts to ensure that policies and practices at the federal, state, local, and tribal levels support equity, transparency, accountability, availability, and access to coronavirus disease 2019 vaccines.

Children's Health Insurance Coverage: Progress, Problems, And Priorities For 2021 And Beyond.

Expansion of Medicaid and establishment of the Children's Health Insurance Program (CHIP) represent a significant success story in the national effort to guarantee health insurance for children. That success is reflected in the high rates of coverage and health care access achieved for children, including those in low-income families. But significant coverage gaps remain-gaps that have been increasing since 2016 and are likely to accelerate with the coronavirus disease 2019 (COVID-19) pandemic and the associated recession. Using National Health Interview Survey data, we found that the proportion of uninsured children was 5.5 percent in 2018. Children continue to face coverage interruptions, and Latino, adolescent, and noncitizen children continue to face elevated risks of being uninsured. Although we note the benefits of a universal, federally financed, single-payer approach to coverage, we also offer two possible reform pathways that can take place within the current multipayer system, aimed at ensuring coverage, access, continuity, and comprehensiveness to move the nation closer to the goal of providing the health care that children need to reach their full potential and to reduce racial and economic inequalities.