Poverty, pregnancy and prescription costs on agenda for Minnesota health leaders

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Trends in unintended pregnancies and health care for the elderly are topics Twin Cities community health leaders are closely following. Minnesota’s patchwork of government, and non and for-profit public health care providers must stay flexible if they hope to meet evolving needs in the communities, according to panelists taking part in an April 2 policy forum sponsored by Community Shares of Minnesota.

Take teen pregnancy. According to a just-released report from the Centers for Disease Control and Prevention, teen pregnancies are on the rise again in 26 states after a 15-year national decline. The National Center for Health Statistics said both the number of teens giving birth and the rate at which they are having births have increased. Unintended pregnancies have long-term repercussions for society.

Many staff at community health centers have come to view unplanned pregnancies, whether they occur in teens or young adults, as both a symptom and a cause that keep women trapped in poverty. Dr. Amy Gilbert, medical director of Family Tree Clinic in St. Paul, said “Women in poverty are less apt to feel they have a choice in pregnancy and parenthood.” They also start prenatal care later in their pregnancy, are less likely to breastfeed, are less likely to finish high school and more likely to go on welfare, and are in general more abused and depressed, than other women. One in four welfare families begin with an unwanted pregnancy, said Gilbert.

Minnesota: Land of disparities?

While the Twin Cities have among the nation’s lowest teen pregnancy and sexually transmitted disease (STD) rates among whites, it has one of the highest rates of minority teen pregnancies and incidence of STDs in the country, according to a 2005 Brookings Institution report, Mind the Gap: Disparities and Competitiveness in the Twin Cities. As the report makes clear, health care disparities cannot be separated from economic opportunity.

Suzanne Bring of Jewish Community Action said limited access to health care, better housing and educational opportunities in the African American communities can be traced back to race-biased bank lending patterns that kept people in segregated neighborhoods. That “segregation tax” continues and can be seen in the disparity in home values, family income, education attainment, and health insurance coverage between white and minority communities.

The assertion that some have been left behind to play catch up was driven home when one of the attendees noted that all of the panelists weighing in on health care disparities were white.

On the other end of the age spectrum, Lee Johnson, director of the Minnesota Senior Federation, said health disparities are growing among seniors, too. His organization sees people that “parcel out their meds and don’t go to the doctor as often” as those who have adequate health coverage.

The Federation partners with 300 clinics across the state in sponsoring a “Senior Partners Care” program for low to moderate income seniors. The program accepts Medicare, which pays 75 percent of health care costs, as full payment for its services. (Services covered must be approved for Medicare coverage and obtained from in-network providers.) Getting the word out is key to the program’s success. “We see a lot of isolated seniors….that don’t access the health system because they don’t know it’s there,” said Johnson. The Senior Federation makes a big push at the state fair each year where volunteers encourage seniors to learn about Senior Partners Care and other options.

Seniors have been finding other enterprising ways to save costs. The Minnesota Senior Federation was the first in the country to bus seniors to Canada so they could buy lower cost medications. Seniors today are “thinking outside the box,” said Johnson. “We’re seeing seniors gathering and doing some bartering.” One example he gave was a plumber and dentist trading services. Others gather in walking groups in downtown Minneapolis to walk and talk about their different skills that they might trade.

Public policy has to change, Johnson said. “A health system that’s not affordable is neither safe nor effective,” he said. The Minnesota Senior Federation supports a system of “Medicare for everybody,” also known as single payer health care. Family Tree’s Gilbert also believes a single payer plan “is the answer” because it would lower costs.

Bring of Jewish Community Action and Donna Zimmerman, vice president of government and community relations for HealthPartners, said their organizations were backing the “Cover All Kids” legislation being considered in the Minnesota legislature. “We think everyone should be required to have insurance,” said Zimmerman, but she doesn’t support the single player plans being discussed. “Don’t blow up the private coverage we have today,” she added.

Gail Kelly, clinic director at West Side Community Health Services’s La Clinica, said now that “there’s a minor revolution” taking place in terms of public demand for health care reform, people involved with community health efforts should adopt a unified voice to help it along.

Kathlyn Stone is an independent journalist in St. Paul. She maintains a health and science news site at fleshandstone.net.

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