Heath Equity & Access Weekly Roundup: January 27, 2025

Executive Orders Suggest Swift Pivot in Managed Care and Health Policy

In his first actions as the 47th president, Donald Trump reversed several Biden-era health policies, including rescinding Affordable Care Act (ACA) enrollment expansions, withdrawing from the World Health Organization (WHO), and halting drug pricing initiatives. Trump's rollback of ACA provisions, which had significantly increased enrollment and improved health outcomes for low-income individuals, threatens coverage and financial benefits for vulnerable populations. His elimination of 3 Center for Medicare and Medicaid Innovation (CMMI) drug pricing models halts planned reforms targeting cost reductions for generics and innovative therapies. The WHO withdrawal drew backlash for undermining global health surveillance, while the dismantling of pandemic preparedness efforts and diversity, equity, and inclusion (DEI) initiatives raised alarm among experts advocating for health equity.

Unlocking Access: Exploring Mental Health Care Among Medicaid Managed Care Enrollees

In this episode of Managed Care Cast, Allison Ju-Chen Hu, PhD, a postdoctoral associate at Weill Cornell Medicine, discusses her study, "Medicaid Managed Care Network Adequacy Standards and Mental Health Care Access." The research explores how quantitative network adequacy standards—policies designed to ensure sufficient provider availability—impact mental health care access for adult Medicaid enrollees, particularly those with mental health conditions.

The 10 Americas: Persistent and Widening Life Expectancy Disparities in the US

A new study reveals a staggering 20.4-year gap in life expectancy across racial, ethnic, and geographic lines in the US by 2021, exacerbated by structural inequities and the COVID-19 pandemic. Expanding on the Eight Americas study, researchers identified 10 distinct "Americas" based on demographics and socioeconomic factors, showing widening disparities since 2000. American Indian and Alaska Native (AIAN) populations in the West faced steep declines, while gains for Black populations stalled, and Latino Americans experienced regional disparities. The pandemic deepened these inequities, particularly for socially and economically disadvantaged groups.

Esketamine Approved by FDA as First Monotherapy for Treatment-Resistent Depression

The FDA approved esketamine (Spravato) nasal spray as the first monotherapy for adults with major depressive disorder (MDD) who have not responded to at least 2 oral antidepressants following a priority review. Clinical trials showed rapid improvement in depressive symptoms within 24 hours and sustained benefits at 4 weeks, with 22.5% of patients achieving remission compared with 7.6% on placebo. The therapy demonstrated superior efficacy to quetiapine for TRD in 2023, increasing remission likelihood by 54%. Available in 77 countries and administered under a Risk Evaluation and Mitigation Strategy Program, esketamine offers a faster-acting alternative to traditional antidepressants, which often take weeks to work.

Going the Distance: The Impact of Travel Time on Emergency Surgical Outcomes, Health System Burden

The significant impact of prolonged travel time on emergency care outcomes was observed in new research, surpassing the influence of rurality alone. Analyzing data from over 190,000 patients in Florida and California, researchers found that longer travel times were associated with more severe disease presentation, higher surgical intervention rates, increased hospital admissions, longer stays, and greater costs. While rurality did not independently correlate with disease complexity, rural patients with extended travel times faced higher risks. The findings underscore the need for metrics and interventions to address travel barriers and ensure timely access to emergency care, particularly in underserved areas.