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Axios
10-03-2025
- Health
- Axios
COVID's legacy: Public health's diminished power
COVID-19 put public health officials on the front lines against a once-in-a-lifetime threat. It's left them with less power and resources to respond to future emergencies. Why it matters: Instead of strengthening America's public health infrastructure, the pandemic experience spawned hundreds of new laws in at least 24 states limiting public health orders or otherwise undercutting emergency responses. Republicans in Congress have also called for funding cuts to the Centers for Disease Control and Prevention, and the Trump administration and Health and Human Services Secretary Robert F. Kennedy are pivoting to chronic diseases, nutrition and nontraditional cures. What they're saying: Public health experts say it's all left the system weaker and less prepared for everyday threats — let alone the next big crisis. "Imagine if we just had a major fire ripping through our city, and our first instinct once we finally put the flames out is to basically get rid of all of our fire departments," said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health. "That is essentially what we're seeing happen here." The big picture: The weakening of public health is evident at every level, from small rural counties up to the highest ranks of the federal government, experts say. The postponement of a key CDC vaccine advisory meeting, as well as the cancellation of a Food and Drug Administration advisory meeting to select the next strain of flu vaccine have only heightened anxiety. "We are seeing a systematic erosion of even those capacities that existed at the start of the COVID-19 pandemic," Nuzzo said. Zoom in: A federal pullback in preparedness leaves states even more on the hook to respond to crises, according to an analysis published last week in JAMA Health Forum. But legislatures in mostly conservative states have been taking aim at public health powers for the past few years. State lawmakers introduced 1,500 bills between 2021 and 2022 targeting public health authority, with nearly 200 becoming law, most of them curbing officials' power. Dozens of states restricted vaccine mandates, the ability to order business closures and masking rules. Others went further, banning stay-at-home orders, limiting emergency declarations, and blocking local governments from enacting stricter health measures than their state. More than 60 of these laws stretch beyond the pandemic period, taking powers off the table for future crises, an analysis in the BMJ found. Picture this: In February, Louisiana's surgeon general canceled the promotion of all mass vaccination campaigns in the state. Montana barred employers from requiring vaccinations while Ohio law bans the state health department from issuing quarantines unless a person has been diagnosed with a disease. Such controls could hamper the response if a pathogen like H5N1 bird flu becomes transmissible among humans. "The idea that you that you would completely eliminate flexibility to use tools like that without knowing what you're up against is bananas," said author and Stanford Law School professor Michelle Mello. Between the lines: Public health officials say some of the more recent DOGE-directed cuts to federal health agencies feel retaliatory for what critics see as a heavy-handed pandemic response. The intense criticism of the COVID response has left a lingering public distrust in health and diminished their influence. "I think people got really angry at the federal government for what they felt was an invasion of their rights, and thus was born an even greater sort of medical freedom movement," said Paul Offit, a member of the FDA's vaccine advisory committee since 2018. The effect of cuts isn't just less preparedness for emergencies, but the ability to provide services for infectious and communicable diseases, and air and water quality. Public health departments around the U.S. largely rely on federal funds for their budgets, and many are alarmed at the cuts that have already occurred or been threatened. Some are trying to prepay bills because they aren't sure they'll be able to cut checks in a month, Nuzzo said. "I'm hearing about health departments wondering if even some of our bread and butter public health programs like studying the high burden diseases in our communities ... if those systems are going to be able to function," Nuzzo said. The bottom line: COVID demonstrated in many ways what can go right when there's a strong public health infrastructure backed by government. The prime example is the development, testing, evaluation and distribution of a vaccine in record time, said Richard Besser, CEO of the Robert Wood Johnson Foundation and former acting director of the CDC. "It was done without cutting any corners on safety, and resulted in saving millions of lives," Besser said. "The chances of us doing that again are zero."
Axios
03-03-2025
- Health
- Axios
High maternity costs hit Black and Hispanic patients hardest: study
Black and Hispanic people paid more in out-of-pocket costs for maternal care than Asian and white people with the same commercial insurance, a new study published in JAMA Health Forum found. Why it matters: Black mothers in the U.S. face a pregnancy-related death rate that is more than three times the rate for white mothers. About 80% of these deaths are preventable. The maternal mortality rate for Hispanic women is similar to that of white mothers but has surged in recent years. The cost burdens of maternity care may exacerbate those significant racial disparities, the researchers say. What they did: The study looked at pregnancy, delivery and postpartum care claims data from patients insured by Blue Cross Blue Shield of Massachusetts from 2018 through 2022. Among nearly 77,000 unique enrollees who gave birth, almost 79% were white, roughly 10% were Asian, about 8% were Hispanic and about 4% were Black. Blue Cross Blue Shield of Massachusetts undertook the research along with academics at the University of Maryland and Harvard to establish a baseline as they try to design solutions for more equitable care, co-author Mark Friedberg, senior vice president of performance measurement and improvement at Blue Cross, said in a news release. What they found: Black enrollees spent an average of $2,398 in total out-of-pocket spending for maternity care, between their deductible, copayments and coinsurance — or the amount an enrollee pays after they've hit their deductible. Hispanic enrollees paid $2,300, while Asian enrollees paid $2,202 and white enrollees $2,036, on average. Zoom in: Cost differences were especially pronounced for prenatal care, with Black enrollees paying 74% more than white people, the researchers found. Prenatal care is important to help avoid complications during birth. Levels of copayments were similar across all groups, and deductibles were slightly lower among Hispanic and white enrollees. But coinsurance payments differed significantly. Black enrollees paid an average of $772 for coinsurance and Hispanic enrollees paid an average of $779. Asian enrollees paid an average $669. White people paid an average of $511. The bottom line: Reducing coinsurance rates could make maternity care more accessible and, in turn, reduce maternal health disparities in the U.S., the researchers write.
