As Congress again considers increased assistance for the global response to COVID-19, we look at how current funding is being channeled, particularly to countries and regions. Congress has enacted six emergency supplemental funding bills to address the COVID-19 pandemic as of June 23, 2022, which collectively provide approximately $19.03 billion for the global response, including for health and humanitarian efforts. Of this amount, $10.54 billion (55%) was either directly appropriated to or is managed by the U.S. Agency for International Development (USAID).¹  The remainder was appropriated to the State Department and the Centers for Disease Control and Prevention (CDC).²  To better understand how this funding has been used, we analyzed newly available data from USAID (current data disaggregated by country and region were not available for other agencies). This included overall USAID funding obligated³  as of March 31, 2022, as well as country and regional funding amounts obligated as of the same date. Data were aggregated from several documents to provide a more complete analysis of what is known.

Findings

• USAID reports that, as of March 31, 2022, of the $10.54 billion directly appropriated to or managed by the agency, it had obligated approximately $9.81 billion in COVID-19 emergency funding for programming and related efforts to respond to COVID-19 globally, with an additional $584 million approved or notified to Congress.⁴  Together, this represents all emergency funding directly appropriated to or managed by USAID to date.
• Included in the $9.81 billion in funding obligated by USAID for programming and related efforts are the following:
  • $4.14 billion⁵  (42%) for country and regional COVID-19 programming (as of March 31, 2022) to support a range of activities, including: delivery and distribution of vaccines; strengthening health care systems by expanding surveillance, supporting health workers and facilities, and providing essential health supplies; providing emergency food assistance; and improvement of sanitation and hygiene services;
  • $4.0 billion (41%) to support Gavi’s COVID-19 vaccine procurement and delivery activities through COVAX,⁶  and
  • $1.5 billion (15%) for COVID-19 vaccine procurement for distribution through COVAX. See Figure 1.
• Funding was obligated to 124 countries (additional countries may be reached through regional programming) See Table 1.
• The top ten countries, by funding amount, each received at least $89 million and together accounted for nearly half of funding (47% or $1.9 billion) obligated by USAID. Four countries received more than $200 million each: Ethiopia, Yemen, Syria, and India. See Figure 2.
• By region, the largest share of country and regional funding was directed to sub-Saharan Africa (44%), followed by Asia (20%), the Middle East and North Africa (19%), Latin America and the Caribbean (13%), and Europe and Eurasia (4%). See Figure 3.
• By bureau, the largest share of country and regional funding was directed through the Bureau for Humanitarian Assistance (59%), followed by the Bureau for Global Health (23%), regional bureaus (18%), and the Bureau for Development, Democracy, and Innovation (<1%),⁷  though this distribution varied widely by region. For example:
  • in sub-Saharan Africa, the Bureau for Humanitarian Assistance received most funding (68%), followed by the regional bureau (19%) and the Bureau for Global Health (13%);
  • in Asia, the Bureau for Global Health received most funding (61%), followed by the regional bureau (20%) and the Bureau for Humanitarian Assistance (19%); and
  • in Europe and Eurasia, the regional bureau received the largest share of funding (43%), followed by the Bureau for Global Health (39%). See Figure 4.

1. This includes certain funding provided through the ESF accounts, which are sometimes jointly managed by the State Department and USAID, and funding provided through the U.S. Department of Agriculture for the Title II program but managed by USAID. ↩︎
2. CDC has posted broad information on how it plans to spend $1.55 billion of the emergency funding; see CDC, “CDC’s COVID-19 Resources for Global Results,” fact sheet, April 2022, https://www.cdc.gov/budget/documents/covid-19/COVID-19-Global-Response-fact-sheet.pdf. As of June 22, 2022, CDC reports it has obligated approximately $900 million from FY20-FY22 and plans to obligate about $456 million more in FY22. KFF personal communication with CDC, June 24, 2022. ↩︎
3. An obligation is a legal commitment for payment, which may be dispersed immediately or sometime in the future. An agency incurs an obligation “when it places an order, signs a contract, awards a grant, purchases a service, or takes other actions that require the government to make payments to the public or from one government account to another.” See, GAO, A Glossary of Terms Used in the Federal Budget Process, 2005, https://www.gao.gov/assets/gao-05-734sp.pdf. ↩︎
4. Agencies must, in most cases, notify Congress of their intent to obligate funds. Additionally, there is other funding ($250 million provided to State to address the impact of COVID-19 on HIV efforts, $40 million in existing funding, and $99 million of prior year USAID funding from the Emergency Reserve Fund for Contagious Infectious Disease Outbreaks/ERF), some of which is managed by USAID, that is not yet identifiable and therefore not included in the funding totals. The obligated and notified totals also do not include funding provided to USAID for operating expenses, which USAID does not include in COVID-19 programming totals, per KFF personal communication with USAID, April and June 2022. Of the $143 million managed by USAID for operating expenses, it has obligated $93 million and notified $50 million. ↩︎
5. Some of this funding is Department of State and USDA COVID-19 emergency COVID-19 funding that has been provided to USAID for implementation, per USAID, COVID-19 Fact Sheets, March and April. 2022, https://www.usaid.gov/coronavirus/fact-sheets. Additionally, this funding includes $40 million in existing funding (reprogrammed Ebola funding) as well as $81.2 million of prior year funding through the Emergency Reserve Fund for Contagious Infectious Disease Outbreaks (ERF), per KFF personal communication with USAID, April and June 2022. In earlier fiscal years, Congress provided funding to the ERF at USAID to allow such funding to be made available to support future responses to any “emerging health threat that poses severe threats to human health.” See KFF, The U.S. Government and Global Health Security. ↩︎
6. See KFF, The U.S. Government & Gavi, the Vaccine Alliance. ↩︎
7. Total does not sum to 100% due to rounding. ↩︎

The House Committee on Appropriations released its FY 2023 State, Foreign Operations, and Related Programs (SFOPs) appropriations bill on June 21, 2022 and accompanying report on June 28, 2022. The SFOPs bill includes funding for U.S. global health programs at the State Department and the U.S. Agency for International Development (USAID). Funding for these programs, through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totaled nearly $11 billion, an increase of $1.1 billion (12%) above the FY 2022 enacted level and $400.5 million (4%) above President Biden’s FY 2023 request, which was released on March 28, 2022. The bill provides higher levels of funding for almost all program areas compared to both the FY 2022 enacted level and the FY 2023 request, with family planning and reproductive health (FP/RH) and global health security receiving the largest increases. The bill also removes the Helms amendment (see KFF fact sheet on major statutory requirements and policies pertaining to U.S. global FP/RH efforts here) and repeals the Mexico City Policy (see KFF explainer here). See the table below (downloadable version here) for additional detail on global health funding. See the KFF budget tracker for details on historical annual appropriations for global health programs.

In recent months, many states have enacted laws to either prohibit abortions or to expand and protect access to abortion in anticipation of the Supreme Court’s likely ruling to overturn Roe v. Wade in the Dobbs v Jackson Women’s Health case. There has been less clarity, however, about what abortion access will be like in the 17 states that do not have any explicit laws either upholding abortion rights or prohibiting abortion. If the Court rules to overturn Roe, then it is anticipated that while some states may not fully ban abortion, some will act to further restrict abortion access through new or expanded abortion restrictions to regulate abortion providers and the provision of abortion care.

Since the Roe v. Wade decision in 1973, states have not been permitted to ban abortions before viability. However, the High Court’s ruling in the Planned Parenthood v Casey case allowed states to regulate the abortions that were done before fetal viability, so long as the regulation did not create an “undue burden” for people seeking abortions. If the Supreme Court overrules Roe v. Wade, states will be permitted to restrict access to abortion before the point of viability and to regulate abortions without any federal constitutional standards. It is likely that some of the states that will not prohibit abortion will have so many restrictions that access to abortion will be extremely limited, essentially blocking most abortions without enacting an outright ban.

In the 17 states without explicit laws prohibiting or protecting abortions, we present a number of indicators to assess abortion access, including abortion restrictions, the number of clinics, and women of reproductive¹  age per clinic, as well as State Supreme Court rulings interpreting the right to abortion in that state.²  We included seven main categories of abortion restrictions: counseling requirements, waiting periods, ultrasound requirements, parental notification or consent requirements, gestational limits, prohibitions on insurance coverage of abortion³ , and regulations on facilities or clinicians providing abortion. Some states might have enacted other abortion restrictions or abortion-specific regulations that are not included in our review.

Five of these states (Alaska, Florida, Kansas, Minnesota, and Montana) have a prior State Supreme Court decision interpreting a right to abortion in the State constitution. There is current litigation challenging these Court decisions in Florida and Montana. In Kansas, there is a constitutional amendment on the November ballot to amend the Kansas Constitution to explicitly state that nothing in the state constitution creates a right to abortion or requires government funding for abortion and that the state legislature has the authority to pass laws regarding abortion.

In ten of these states, the legislatures have a history of enacting many laws that restrict abortion. Even if these states do not prohibit abortion outright, it is likely that many people seeking abortions in these states will not be able to access care. It is also important to consider that eleven of these states will have gubernatorial elections this year and the outcome of these elections will play a role in the future of abortion access in several of these states.

While it’s not possible to precisely predict the extent of abortion access in these states, the number of abortion restrictions, abortion coverage policy, and the partisan composition of the state legislature and governor’s office today can give us a good sense of what the future holds in many states. Future litigation resulting in state Supreme Court rulings and the outcomes of the 2022 and future elections will also be critical in determining the extent of abortion access in these states.

Alaska

The Alaska Supreme Court found that the state constitution protects the right to abortion.

Number of abortion restriction indicators: 1

Abortion-related health insurance coverage prohibitions: None

Number of abortion clinics in 2021: 5

Number of women of reproductive age per clinic: 32,300

Current partisan composition of state offices: Republican governor and legislature, and attorney general (AG). AG is appointed by the governor. Supreme Court justices are appointed in part by the governor.

Key 2022 state elections:

• Governor, with the Republican incumbent running
• Potential for the House to flip

Florida

The Florida Supreme Court found that the state constitution protects the right to abortion. Florida enacted a 15-week abortion ban that is scheduled to take effect July 1, 2022; it is being challenged by two lawsuits as being in violation of the state constitution.

Number of abortion restriction indicators: 7

Abortion-related health insurance coverage prohibitions:

• Health insurance exchange
• Medicaid

Number of abortion clinics in 2021: 55

Number of women of reproductive age per clinic: 82,892

Current partisan composition of state offices: Republican governor, legislature, and attorney general. Supreme Court justices are appointed by the governor.

Key 2022 state elections:

• Governor, with the Republican incumbent running
• Attorney general, with the Republican incumbent running

Georgia

Georgia has enacted a 6-week ban that has been temporarily blocked by a Court. If the U.S. Supreme Court allows states to ban abortion at any point during pregnancy, then Georgia could implement this law.

Number of abortion restriction indicators: 6 (one restriction temporarily blocked)

Abortion-related health insurance coverage prohibitions:

• Health insurance exchange
• Public employee plans
• Medicaid

Number of abortion clinics in 2021: 15

Number of women of reproductive age per clinic: 169,260

Current partisan composition of state offices: Republican governor, legislature, and attorney general. Supreme Court justices are elected on a non-partisan basis.

Key 2022 state elections:

• Governor, with the Republican incumbent running
• Attorney general, with the Republican incumbent running
• Three non-partisan Supreme Court seats

Indiana

Number of abortion restriction indicators: 7

Abortion-related health insurance coverage prohibitions: All market segments including Medicaid

Number of abortion clinics in 2021: 7

Number of women of reproductive age per clinic: 216,785

Current partisan composition of state offices: Republican governor, legislature, and attorney general (elected). Supreme Court justices are appointed in part by the governor.

Key 2022 state elections: None

Iowa

On June 17, 2022, the Iowa Supreme Court overturned the 2018 decision that found the state constitution protects the right to abortion. While the Court found there is no fundamental right to abortion found in the state constitution, the Court did not set a standard for how to evaluate abortion regulations but noted that they will turn to the U.S. Supreme Court decision on the Dobbs case for future insights in how they will interpret the state constitution regarding abortion.

Number of abortion restriction indicators: 5

Abortion-related health insurance coverage prohibitions:

• Medicaid

Number of abortion clinics in 2021: 7

Number of women of reproductive age per clinic: 97,458

Current partisan composition of state offices: Republican governor and legislature, and Democratic attorney general. Supreme Court justices are appointed in part by the governor.

Key 2022 state elections:

• Governor, with the Republican incumbent running
• Attorney general, with the Democratic incumbent running

Kansas

In 2019, the Kansas Supreme Court found that the Kansas Bill of Rights includes the right to abortion.

Number of abortion restriction indicators: 6

Abortion-related health insurance coverage prohibitions: All market segments including Medicaid

Number of abortion clinics in 2021: 4

Number of women of reproductive age per clinic: 160,156

Current partisan composition of state offices: Democratic governor and Republican legislature and attorney general. Supreme Court justices are appointed by the State Bar Association.

Key 2022 state elections:

• Governor, with the Democratic incumbent running
• Attorney general, with the Republican incumbent running
• Ballot initiative (during its August 2, 2022, primaries) that would amend the state constitution to state that nothing in the state constitution creates a right to abortion or requires government funding for abortion and that the state legislature has the authority to pass laws regarding abortion.

Michigan

The Governor and Planned Parenthood filed a lawsuit to block the implementation of Michigan’s pre-Roe abortion ban. The Michigan Court of Claims issued a preliminary injunction that bars the state government from enforcing the ban as the litigation continues. The current attorney general, a Democrat, will not appeal this decision. If the incumbent Democrat loses the 2022 election, the new attorney general could choose whether to defend the pre-Roe ban.

Number of abortion restriction indicators: 6

Abortion-related health insurance coverage prohibitions: All market segments including Medicaid

Number of abortion clinics in 2021: 28

Number of women of reproductive age per clinic: 78,165

Current partisan composition of state offices: Democratic governor and attorney general, and Republican legislature. Supreme Court justices are elected on a non-partisan basis.

Key 2022 state elections:

• Governor, with the Democratic incumbent running
• Attorney general, with the Democratic incumbent running
• Potential for the Senate and House to flip
• Two non-partisan Supreme Court seats with the potential to shift the majority of the Court from liberal to conservative
• Pending ballot initiative (July 11 deadline for inclusion) that would create a state constitutional right to reproductive freedom, including abortion, and that the state could only prohibit abortion after fetal viability except to protect the life, physical, or mental health of the pregnant person, as determined by a clinician.

Minnesota

Number of abortion restriction indicators: 3

Abortion-related health insurance coverage prohibitions: None

Number of abortion clinics in 2021: 9

Number of women of reproductive age per clinic: 138,226

Current partisan composition of state offices: Democratic governor and attorney general, and split legislature. Supreme Court justices are elected on a non-partisan basis.

Key 2022 state elections:

• Governor, with the Democratic incumbent running
• Attorney general, with the Democratic incumbent running
• Potential for the House to flip

Montana

In 1999, the Montana Supreme Court found that the state constitution protects the right to abortion. Montana’s Attorney General is challenging the state's constitutional protection.

Number of abortion restriction indicators: 3 (two are temporarily blocked)

Abortion-related health insurance coverage prohibitions:

• Health insurance exchange

Number of abortion clinics in 2021: 7

Number of women of reproductive age per clinic: 31,898

Current partisan composition of state offices: Republican governor, legislature, and attorney general (elected). Supreme Court justices are elected on a non-partisan basis.

Key 2022 state elections:

• Two non-partisan state Supreme Court seats, with the potential to shift the majority to potentially conservative

Nebraska

Number of abortion restriction indicators: 7

Abortion-related health insurance coverage prohibitions: All market segments including Medicaid

Number of abortion clinics in 2021: 3

Number of women of reproductive age per clinic: 142,036

Current partisan composition of state offices: Republican governor and attorney general. Legislators are elected on a nonpartisan basis. Supreme Court justices are appointed in part by the governor.

Key 2022 state elections:

• Governor, with the Republican incumbent not running
• Attorney general, with the Republican incumbent not running

New Hampshire

Number of abortion restriction indicators: 3

Abortion-related health insurance coverage prohibitions:

• Medicaid

Number of abortion clinics in 2021: 7

Number of women of reproductive age per clinic: 41,300

Current partisan composition of state offices: Republican governor, legislature, and attorney general (appointed by the governor). Supreme Court justices are appointed by the governor.

Key 2022 state elections:

• Governor, with the Republican incumbent running

New Mexico

Number of abortion restriction indicators: 0

Abortion-related health insurance coverage prohibitions: None

Number of abortion clinics in 2021: 6

Number of women of reproductive age per clinic: 76,010

Current partisan composition of state offices: Democratic governor, legislature, and attorney general. Supreme Court justices are elected on a partisan basis.

Key 2022 state elections:

• Governor, with the Democratic incumbent running
• Attorney general, with the Democrat incumbent not running

North Carolina

Number of abortion restriction indicators: 7

Abortion-related health insurance coverage prohibitions:

• Health insurance exchange
• Public employee plans
• Medicaid

Number of abortion clinics in 2021: 16

Number of women of reproductive age per clinic: 149,847

Current partisan composition of state offices: Democratic governor and attorney general (elected), and Republican legislature. Supreme Court justices are elected on a partisan basis.

Key 2022 state elections:

• Two partisan state Supreme Court seats with the potential to shift the majority of the Court from Democrat to Republican

Ohio

Ohio has enacted a 6-week ban that has been temporarily blocked by a Court. If the U.S. Supreme Court allows states to ban abortion at any point during pregnancy, then Ohio could implement this law.

Number of abortion restriction indicators: 7

Abortion-related health insurance coverage prohibitions:

• Health insurance exchange
• Public employee plans
• Medicaid

Number of abortion clinics in 2021: 9

Number of women of reproductive age per clinic: 285,661

Current partisan composition of state offices: Republican governor, attorney general, and legislature. Supreme Court justices are elected on a partisan basis.

Key 2022 state elections:

• Governor, with the Republican incumbent running
• Attorney general, with the Republican incumbent running
• Three partisan Supreme Court seats that could shift the majority from Republican to Democrat

Pennsylvania

Number of abortion restriction indicators: 6

Abortion-related health insurance coverage prohibitions:

• Health insurance exchange
• Public employee plans
• Medicaid

Number of abortion clinics in 2021: 16

Number of women of reproductive age per clinic: 173,246

Current partisan composition of state office: Democratic governor and attorney general (elected), and Republican legislature. Supreme Court justices are elected on a partisan basis.

Key 2022 state elections:

• Governor, with the Democratic incumbent not running

South Carolina

South Carolina has enacted a 6-week ban that has been temporarily blocked by a Court. If the U.S. Supreme Court allows states to ban abortion at any point during pregnancy, then South Carolina could implement this law.

Number of abortion restriction indicators: 7

Abortion-related health insurance coverage prohibitions:

• Health insurance exchange
• Public employee plans
• Medicaid

Number of abortion clinics 2021: 3

Number of women of reproductive age per clinic: 380,350

Current partisan composition of state offices: Republican governor, legislature, and attorney general. Supreme Court justices are elected by the legislature.

Key 2022 state elections:

• Governor, with the Republican incumbent running
• Attorney general, with the Republican incumbent running

Virginia

Number of abortion restriction indicators: 2

Abortion-related health insurance coverage prohibitions:

• Medicaid
• Public employee plans

Number of abortion clinics 2021: 17

Number of women of reproductive age per clinic: 114,086

Current partisan composition of state offices: Republican governor and attorney general (elected), and split legislature. Supreme Court justices are elected by the legislature.

Key 2022 state elections: None

1. Ages 15-49. ↩︎
2. SOURCES: KFF Analysis of State Laws; NARAL State Laws Archive, 2018; Center for Reproductive Rights, What if Roe Fell, 2021; Guttmacher Institute, State Bans on Abortions Throughout Pregnancy, May 2022; KFF, Interactive: How State Policies Shape Access to Abortion Coverage, August 2021; Guttmacher Institute, State Policies in Brief, Counseling and Waiting Periods for Abortion, Parental Involvement in Minors' Abortions, Targeted Regulation of Abortion Providers; ANSIRH: Trends in Abortion Care in the United States, 2017-2021, 2022 ↩︎
3. This may include restrictions on private health insurance and/or a state’s Medicaid program. State regulations for employer-sponsored health plans apply to fully-insured plans and do not apply to self-funded plans. Sixty-four percent of covered workers are enrolled in a self-funded plan. ↩︎

With uptake of COVID-19 vaccines and boosters leveling off and the U.S. currently in the midst of another Omicron wave, ensuring equitable and rapid distribution of COVID-19 treatments will be important for mitigating the uneven impacts of the pandemic. COVID-19 has disproportionately affected certain underserved and high-risk populations, including people of color and those who are socioeconomically disadvantaged. Because many of these groups remain at increased risk of exposure, given that they are less likely to work in jobs that can be done remotely and due to other structural factors, access to treatments (in addition to vaccines) is particularly important. The Biden Administration has identified increasing access to COVID-19 treatments as a priority, but there has been wide variation in access across states and local jurisdictions.

To date, data on who has received COVID-19 treatments remains very limited, hindering the ability to assess whether access to them has been equitable. To provide better insight into access to COVID-19 treatments, we analyzed data from the HHS Office of the Assistance Secretary for Preparedness and Response on public locations that have received shipments of federally-procured oral antiviral COVID-19 treatments. We examined availability treatments by county and certain county characteristics, including metro vs. non-metro status, poverty rate, and majority Black, Hispanic, or American Indian or Alaska Native (AIAN), the groups who have experienced the largest disparities in COVID-19 health outcomes. The analysis is limited to oral antiviral COVID-19 treatments that can be administered at home.

In sum, the findings show that:

• COVID-19 oral antiviral treatments are available through facilities across the country and nearly all people live in a county with availability regardless of whether they live in a metro or non-metro area, their income, or their race/ethnicity.
• However, the small number of counties with the highest poverty rates and those that are majority Black, Hispanic, and AIAN are less likely to have a facility with COVID-19 treatments available and have fewer facilities available compared to their counterpart counties. Findings are more mixed for treatment courses. Non-metro and majority Hispanic and AIAN counties also have fewer courses available than their counterpart counties, while high poverty and majority Black counties having slightly larger numbers of courses available.

In sum, while nearly all people live in a county with a facility with COVID-19 treatments available, disparities in access persist among the potentially highest risk and highest need counties. Non-metro counties and majority Hispanic and AIAN counties, which have fewer facilities and courses available have more limited access to treatments overall. High poverty and majority Black counties, which have fewer facilities but more courses available relative to their population size, may not have disparities in terms of number of treatments available, but may still have more limited access, as individuals could have to travel a farther distance to obtain them. Given that there have been no recent shortages in treatment courses, proximity to a facility may be a more relevant measure of access at this time.

While this analysis provides some insight into the availability of facilities and treatments, getting them also depends on having knowledge about treatments, access to medical advice, and the time and resources to obtain them. However, to date, no federal data is available on who is receiving treatments. Going forward, continued steps to ensure equity in access to COVID-19 treatments will be important, as will increasing data availability to understand who has received COVID-19 treatments.

Background

The Food and Drug Administration (FDA) has issued emergency use authorization for two home oral antiviral COVID-19 treatments. These treatments – Paxlovid and Lagevrio – are available for people who test positive for COVID-19 and are at high risk of developing serious illness. They must be taken within the first five days after COVID-19 symptoms appear and each require a prescription from a health care provider. Both have been shown to significantly reduce hospitalization and death from COVID-19. The federal government has purchased supplies of both treatments for distribution to sites throughout the country and to be provided for free to those who are eligible.

The Biden Administration launched a nationwide Test to Treat initiative in March 2022 to expand access to oral antiviral COVID-19 treatments. The Test-to-Treat initiative builds on prior distribution of oral antivirals, which began in December 2021, to states, Tribes, territories, and community health centers, which in turn distribute these treatments to health care providers, pharmacies, and other locations. The goal of this program is to enable people to get tested and, if they are positive and treatments are appropriate for them, receive a prescription from a health care provider and have their prescription filled all at one location. These Test-to-Treat sites are available at locations nationwide, including clinics, federally-funded health centers, long-term care facilities, and community-based sites. In May 2022, the Administration expanded the initiative to include new federally-supported Test-to-Treat locations that focus on reaching hard-hit and high-risk communities and helping to ensure equitable access to COVID-19 treatments. The Administration indicates that 40% of pharmacy sites with oral antivirals available are located in communities with the highest levels of social vulnerability.

Key Findings

Nearly all people (98%) live in a county with at least one facility that has COVID-19 oral antiviral treatments available. As of June 7, there were 2.6 million courses of oral antiviral treatments available in 37,100 facilities across the U.S. Nearly 8 in 10 (79%) of counties have a facility with COVID-19 oral antiviral treatments available, while one in five (21% or 665) counties do not. Even with these gaps in some counties, nearly all people in the U.S. (98%) live in a county with a facility available regardless of whether they live in metro or non-metro area, their income, or their race/ethnicity.

The average number of facilities and treatment courses available varies across counties. On average, there are 10.2 facilities and 668 treatment courses available per 100,000 people per county. However, the number of facilities per 100,000 ranges greatly, from 0 to 154 across counties. Similarly, the number of courses per 100,000 ranges from 0 to 22,644 across counties.

On average, access to COVID-19 oral antivirals is largely comparable between metro and non-metro counties, although non-metro counties are more likely to not have a facility with treatments available. Nationwide, there are 1,167 metro counties and 1,976 non-metro counties. The majority (86%) of the population lives in metro counties, while 14% lives in non-metro counties. Non-metro counties are more likely than metro counties to not have a facility with oral antiviral treatments available (28% vs. 9%), and people living in a non-metro county are less likely to have a facility with treatment available (92% vs. 100%). However, the average number of facilities per 100,000 people was similar for metro (10.7) and non-metro (9.9) counties, reflecting the lower population density in non-metro counties. Metro counties did have more courses available compared to non-metro counties (737 vs. 629 per 100,000 people).

Although nearly all people (98%) with incomes below poverty live in a county that has a facility with COVID-19 treatments available, high-poverty counties have fewer facilities available than areas with lower rates of poverty. While most counties have low or moderate poverty rates (defined as less than 10% and between 10% and 30%, respectively), a small number (87) counties have a high poverty rate of 30% or more. Four in ten (40%) high poverty counties did not have a facility with oral antiviral COVID-19 treatments available compared to 26% of low poverty counties and 19% of moderate poverty counties. Moreover, high poverty counties had fewer facilities compared to low and moderate poverty counties (7.7 vs. 10.4 and 10.2 per 100,000 people, respectively). However, high poverty counties have slightly more treatment courses available compared to low and moderate poverty counties (692 vs. 601 and 686 per 100,000 people, respectively).

Majority Black, Hispanic, and American Indian Alaska Native (AIAN) population counties have more limited access to facilities with oral antiviral COVID-19 treatments than non-majority Black, Hispanic, and AIAN counties. (There were no majority Asian counties, so similar analysis was not conducted for this group.)

• Overall, there are 96 counties where Black people make up 50% or more of the population. These counties are home to nearly 10% of the total Black population. While nearly all Black people (99%) live in a county that has a facility with COVID-19 treatments available, these majority Black counties have more limited access compared to non-majority Black counties. Roughly one in three (31%) majority Black counties did not have a facility with oral antiviral COVID-19 treatments available compared to 21% of counties where Black people make up less than half of the population. Moreover, there were 8.6 facilities per 100,000 people in majority Black counties compared to 10.3 facilities per 100,000 people in non-majority Black counties. However, majority Black counties had a somewhat larger number of courses available on average compared to non-majority Black counties (705 vs. 667 per 100,000 people).
• Hispanic people account for at least 50% of the population in 102 counties that are home to nearly 20% of the total Hispanic population. Nearly all Hispanic people (99%) live in a county with a facility with COVID-19 treatments available, but majority Hispanic counties have fewer facilities available than non-majority Hispanic counties. One-third (33%) of majority Hispanic population counties did not have a facility with COVID-19 treatments available compared to about one in five (21%) of non-majority Hispanic counties. On average, there were 7.3 facilities per 100,000 people in majority Hispanic counties compared to 10.3 facilities per 100,000 people in non-majority Hispanic counties. Majority Hispanic counties also had fewer courses available than non-majority Hispanic counties (503 vs. 674 per 100,000 people).
• In 28 counties, AIAN people make up 50% or more of the population, and these areas are home to 11% of the total AIAN population. Overall, just over nine in ten (91%) of AIAN people live in a county with a facility available. However, three-quarters (75%) of AIAN majority population counties did not have a facility with COVID-19 treatments available compared to roughly one-quarter (21%) of non-majority AIAN counties. Moreover, majority AIAN counties had a lower average number of facilities available than non-majority AIAN counties (4.2 vs. 10.3 per 100,000 people) and a lower average number of courses available (185 vs. 673 per 100,000 people).

Implications

The COVID-19 pandemic has disproportionately affected the health and financial security of people of color due to underlying disparities that place people of color at increased risk for exposure and illness, and ensuring equity in access to COVID-19 treatments (as well as vaccines) is important for mitigating disparities and preventing against further widening of disparities going forward.

This analysis shows that while treatments are available at facilities across the country and nearly all people live in a county with such a facility, regardless of their income, race/ethnicity, or whether they live in a metro or non-metro area, some disparities in access persist among the potentially highest risk and highest need counties. Non-metro counties and majority Hispanic and AIAN counties, which have fewer facilities and courses available have more limited access to treatments overall. High poverty and majority Black counties, which have fewer facilities but more courses available relative to their population size, may not have disparities in terms of number of treatments available, but may still have more limited access, as individuals could have to travel a farther distance to obtain them. Given that there have been no recent shortages in treatment courses, proximity to a facility may be a more relevant measure of access at this time.

While the counties facing disparities account for a small share of counties overall, they represent areas that have the highest shares of residents who have borne the heaviest burdens of the pandemic. These high burden counties represent a narrower set of counties than those that measure high on the overall social vulnerability index, an index developed by the federal government to identify communities that will most likely need support in response to hazardous events, which the Administration is using to guide equitable distribution. Our findings suggest that distribution based on the social vulnerability index alone may leave some areas with high concentrations of residents at increased risk facing gaps in access, and as such, additional equity lenses may be helpful for promoting access.

Importantly, while this analysis provides some insight into the availability of COVID-19 oral antiviral treatments, getting them also depends on having knowledge about treatments, access to medical advice, and the time and resources to obtain them. As such, even if there is broad geographic availability of treatments, there may still be disparities in who is able to obtain them. Going forward, continued steps to ensure equity in access to COVID-19 treatments will be important, as will increasing data available to understand who has received them.

Methods

For this data note, KFF researchers analyzed data at the county level and drawing from multiple sources:

Our main outcome of interest, facilities with oral antiviral COVID-19 treatments available, was collected from the U.S. Department of Health & Human Services (HHS) COVID-19 Public Therapeutic Locator Data as of June 7, 2022 The HHS data includes locations that have received an order of Evusheld, Paxlovid, Renal Paxlovid, Lagevrio (molnupiravir), or bebtelovimab in the last two months and/or have reported availability of these therapeutics within the last two weeks. The analysis is limited to locations in the 50 states and D.C. (excludes territories) that reported inventory in the past two weeks and have a current supply of oral antivirals (Paxlovid, Renal Paxlovid, or Lagevrio). Locations that did not report inventory within the prior two weeks and whose status was unknown were not included in the analysis. These locations may have treatments available but are not counted as an active location in this analysis.

Metro and non-metro classifications are based on the U.S. Department of Agriculture’s 2013 Rural-Urban Continuum Codes. Counties with codes 1 through 3 are classified as “metro” and 4 through 9 are classified as “non-metro.” The rural-urban continuum codes distinguish metropolitan counties by the population size of their metro area and nonmetropolitan counties by degree of urbanization and adjacency to a metro area. Data to categorize counties by racial composition of residents is based on the Census Bureau’s 2019 American Community Survey (ACS) 5-Year Estimates by county. Specifically, we calculate the share of the county population that is majority (50% or more) Hispanic, non-Hispanic American Indian Alaska Native, and non-Hispanic Black. Non-Hispanic Asian people were not included in this analysis, as no county had a majority non-Hispanic Asian population according to 2019 ACS data. Data to categorize counties by poverty level is also based on the Census Bureau’s 2019 American Community Survey 5-Year Estimates by county. We used the 30% threshold to define “high poverty” since research has shown that the negative effects of neighborhood poverty are most prominent when a neighborhood has between 20% and 40% poverty and 30% is commonly used in existing literature measuring high poverty neighborhoods.

Appendix

As the federal government prepares to launch the national three-digit number “988” for the mental health crisis hotline next month, a new KFF analysis shows that suicide death rates increased by 12 percent in the decade from 2010 to 2020 — with death rates rising fastest among people of color, younger individuals, and people who live in rural areas.

The number of suicide deaths peaked at 48,344 in 2018 and then decreased slightly in 2019 and 2020, although some research suggests that some suicides may be misclassified as drug overdose deaths. Between 2019 and 2020, drug overdose deaths increased by 31 percent.

Suicide deaths by firearms accounted for more than half of the 45,979 suicides in 2020, the most complete data available, according to the analysis. Looked at another way, suicide deaths accounted for more than half (54%) of all deaths involving a firearm in 2020.

Among people of color, the highest increase in suicide death rates was among Black people (43% increase), followed by American Indian or Alaska Natives (41%), and Hispanic people (27%). As of 2020, American Indian and Alaska Native people had the highest suicide death rate, at 23.9 per 100,000 people – substantially higher than the rate for White people (16.8 per 100,000 people). Suicide death rates for Black, Hispanic, and Asian and Pacific Islander people were all less than half the rate for White people.

Suicide death rates also increased significantly in rural areas, rising 23 percent over the decade — possibly due to acute shortages of mental health workers in these areas. Among adolescents age 12 to 17 the suicide death rate increased 62 percent, and among young adults ages 18 to 23 the increase was 33 percent.

Suicide death rates varied substantially by state in 2020, ranging from 5.5 per 100,000 population in Washington, D.C. to a high of 30.5 per 100,000 people in Wyoming.

Against that backdrop of need, the federally mandated crisis number “988” will be available to all landline and cell phone users beginning July 16. Callers who are suicidal or experiencing a mental health crisis will be routed to the National Suicide Prevention Lifeline and connected to a crisis counselor.

For the full analysis, as well as other KFF data and analyses related to mental health, visit kff.org.

On June 17, the Food and Drug Administration authorized emergency use of both Moderna and Pfizer’s COVID-19 vaccines for children between the ages of 6 months and 5 years and on June 18, the Director of the Centers for Disease Control and Prevention (CDC) recommended their use for this population, noting their safety as well as their effectiveness in preventing severe COVID-19 outcomes. This marks the first time COVID-19 vaccines are available to virtually all people in the United States. The CDC has already provided guidance to jurisdictions to help in their planning, including instructing them to pre-order doses in anticipation of a recommendation. Pre-orders began on June 3 and shipments as soon as the emergency use authorizations (EUA) were granted on June 17; vaccination can begin now that the CDC has provided its recommendation.

We previously explored policy considerations for vaccinating 5-11 year-olds, who became eligible in November of last year, and have continued to track vaccine progress and demand among this group, both of which may be instructive for this next phase. Among 5-11 year-olds, vaccination rose quickly after first recommended but then dropped just two weeks in; as of June 16, just 29.5% have been fully vaccinated compared to 75% of those ages 12 and above. While a similar pattern may be expected for younger children – our most recent COVID-19 Vaccine Monitor survey, fielded before vaccines were recommended for them, found that only 18% of parents said they would get their young child vaccinated right away – there are also unique issues to consider for younger children that may present additional barriers and issues for policymakers, public health practitioners, and parents and caregivers. This brief provides an overview of the characteristics of children under the age of 5 nationally and by state and discusses some of the particular issues to consider in rolling out vaccination to this age group.

What are Characteristics of Children Under Age 5?

There are approximately 19 million children under the age of 5 in the United States. They account for 6% of the U.S. population. The share of the population represented by young children varies by state, ranging from a low of 4.6% in Maine to a high of 7.7% in Utah.  Data about the size and composition of children under age 5 across the country come from the 2019 American Community Survey.  Due to data on age only being collected in years, we include all children under the age of 5, including children less than 6 months old who would not be eligible to receive the vaccine under this authorization.

Half of children under the age of 5 are children of color, including more than a quarter who are Hispanic (25.9%), 12.9% who are Black, and 4.5% who are Asian (Figure 1). Smaller shares are American Indian or Alaska Native or Native Hawaiian or Other Pacific Islander (<1 % each). The distribution varies across the country (Table 1). For example, in four states, a third or more of younger children are Black – Georgia (32.7%), Louisiana (34.1%), Mississippi (41.7%) and DC (43.7%). States in the West and South include higher shares of Hispanic children; at least half of younger children are Hispanic in New Mexico (62.4%), California (51.3%), and Texas (49.8%).

Four in ten children under the age of 5 live in a family with income below 200% of the Federal Poverty Level (FPL), including 18.1% below poverty and 21.9% between 100-200% FPL (Figure 1). An additional 29.8% live between 200-400% FPL and 30.2% are above 400% FPL. This income distribution varies significantly by state (Table 2). For example, the share living in a low-income family (below 200% FPL) ranges from 23.9% in New Hampshire to 56.3% in Arkansas. In four states, the share living below 200% FPL is greater than 50%; In 5 states, more than a quarter of younger children live below the poverty level.

Just over half of children under the age of 5 have private insurance coverage while 41.3% are covered by Medicaid/CHIP, and 4.5% are uninsured. This too, varies by state (Table 3). For example, the share of young children who are privately insured ranges from 35.7% in Mississippi to 72.8% in Utah, while the share covered by Medicaid/CHIP ranges from just 19% in Utah to 64% in New Mexico. The share of young children who are uninsured ranges from 1.3% in Massachusetts to 9.8% in Texas.

How will vaccine roll-out to children under 5 be similar or different to 5-11 year-olds?

Many of the issues that have affected vaccine roll-out to 5-11 year-olds will likely apply in the case of younger children as well, including access challenges in some places. As with 5-11 year-olds, access will likely vary across the country, depending on jurisdictional decisions and implementation plans, the number and location of pediatric vaccinators and sites, the adequacy of provider networks, and communication and outreach plans.  Unlike with adults, for example, where vaccines have been widely available at multiple locations to reach the close to 260 million who are eligible, the small population size of children has meant fewer locations with vaccines, an issue that has created access barriers in some rural areas. There are also other factors in play that will likely result in even fewer vaccination sites being available for those under age 5, as discussed below.

COVID-19 vaccination for children under age 5 will require yet another formulation and new doses and supplies to be shipped, and there are differences between the two newly authorized vaccines that may present new challenges for parents in their decision-making. One issue that arose during the roll-out of vaccination to 5-11 year-olds was that their vaccine dosage was lower than that for adults and required new vials to be shipped out to states and pharmacies. This delayed access in the beginning days of eligibility and has meant that vaccinators have had to specifically order and stock pediatric vaccines. For those under 5, there will again be different product configurations, compared to those for 5-11 year-olds, requiring new shipments to jurisdictions. This may once again hold up vaccination opportunities in the early days of authorization.

Moreover, unlike for those ages 5-11 where only one vaccine, Pfizer’s, was authorized for them last November (Moderna’s vaccine was only authorized for 5-11 year-olds on June 17), two vaccines have been authorized for those under 5 at the same time, each with a different number of doses, dosing schedules, and age ranges (see Table 4). Moderna’s vaccine requires two doses, with 28 days between them, while Pfizer’s requires three doses over a much longer time period. As a result, full protection will be reached several weeks sooner with Moderna compared to Pfizer. In addition, while both were found to be safe and effective, their trial results cannot be directly compared due to differences in  trial designs. At the same time, parents and vaccine providers are likely more familiar with Pfizer’s vaccine, which has been more widely available to all ages for months. Finally, there are slight differences in the age range authorized for each. These unique factors may present new challenges for parents in their decision-making. It may also be the case that vaccine providers stock only one of the vaccines.

Pharmacies and schools, while important components of the COVID-19 vaccination effort for older children, will be less likely to reach those under 5.  Many states limit the age at which pharmacists are allowed to vaccinate children. To address this issue in the context of COVID-19, the federal government amended the PREP Act under the COVID-19 public health emergency to allow pharmacists and pharmacist technicians to vaccinate children as young as 3 for routine immunizations as well as against COVID-19 (upon authorization). However, the Act has not been amended to allow for children under 3 (who account for almost 60% of all children under 5) to be vaccinated at a pharmacy, and according to data from the National Alliance of State Pharmacy Associations (NAPS) and American Pharmacists Association (Alpha), most states do not permit this. In addition, while schools have been important sites for providing access as well as information to help expand vaccination take-up among children as young as 5, and have been encouraged by the federal government to do so, most children under 5 are not yet enrolled in school, limiting this option for younger kids. Lastly, many of the larger vaccine clinics organized by jurisdictions, which were able to expand to new age groups when eligible, are no longer operating.

Pediatricians will likely be more important for vaccinating young children than even their slightly older counterparts. Pediatricians, who are already cited by parents as a highly trusted source of information about COVID-19 for children, will likely play an even more important role in vaccinating children under 5.  This is in part due to the more limited access to vaccinations at pharmacies and schools, but also because parents are even more accustomed to getting their routine immunizations for younger children at their doctor’s offices. CDC reports, for example, that in the 2020-21 flu season, 80% of children ages 6 months to 4 years old received their flu vaccine at a doctor’s office, while only 4% of children 2–4 years old and <1% of those under age 2 received their vaccine at a pharmacy. Still, pediatricians face unique challenges with pediatric COVID-19 vaccinations for children, relative to other vaccinations. In addition to cold storage requirements (Pfizer’s vaccine requires an ultra-low temperature for long-term storage), a COVID-19 pediatric vaccine vial, for either vaccine, contains 10 doses which must be used within 12 hours after opening. This means that pediatricians, or any other pediatric vaccinator, would need to be able to vaccinate 10 children within this time period or risk wasting doses.  Importantly, the CDC reports that as of early May 2022, more than two-thirds of Vaccines for Children (VFC) program providers were enrolled as COVID-19 vaccine providers, which could help to facilitate access, and encourages jurisdictions to enroll more VFC providers. But it also reports that while 73% of VFC providers intend to offer COVID-19 vaccines children under 5, only 52% intend to do so for children who are not regular patients.

Medicaid will be an especially important avenue for reaching younger children, as will community health centers. Among all children under age 5, over four in ten (41.3%) are covered by Medicaid, and almost three-quarters (74.1%) of children under age 5 with incomes below 200% of FPL are covered by Medicaid. We previously identified how state Medicaid programs and Medicaid managed care plans can facilitate access to vaccines for young, low-income children. In addition to these strategies to increase vaccine uptake, CMS released guidance requiring states to cover COVID-19 vaccine counseling visits for children under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. Community health centers also offer vaccine access points for families with young children. A national network of safety net primary care providers, they are a primary source of care for many low-income populations (91% have incomes below 200% FPL) and communities of color (62%), and they have already been mobilized to provide vaccinations to their clients through the federal Health Center COVID-19 Vaccine Program. Community health centers serve between 5 and 6 million children under the age of 12, including about 2 million under the age of 5.

As with 5-11 year-olds, parents and caregivers will determine how quickly and how many younger children get vaccinated. Our latest COVID Vaccine Monitor report found that about one in five (18%) of parents of children under 5 say they’ll get their child vaccinated against COVID-19 right away once a vaccine is authorized, 38% say they will wait and see, and almost 4 in 10 say they won’t get their younger child vaccinated at all or only will if required. If the experience of vaccinating 5-11 year-olds is a guide for what might happen with younger children, vaccination coverage will likely be quite slow.  While the share of parents of 5-11 year-olds who say they have or will get their child vaccinated has increased over time, more than 4 in 10 say they will not do so, or will only do so if required. Our analysis of vaccine coverage among 5-11 year-olds found that while vaccination rose sharply for the two-week period after eligibility, it then dropped steeply and daily rates of administration have remained low. As of June 16, just 29.5% of children ages 5-11 have been fully vaccinated, compared to 75% of those ages 12 and above.

Prioritizing equity is particularly important as vaccination efforts extend to the youngest group of children. Of the estimated 19 million children in the U.S. under age 5, half are children of color (compared to 40% of the U.S. population overall), including more than a quarter who are Hispanic (25.9%) and 12.9% who are Black. Over the course of the vaccination rollout, Black and Hispanic people have been less likely than their White counterparts to receive a vaccine, but these disparities have narrowed over time and been reversed for Hispanic people. Disparities in children’s take-up of the vaccine could reverse that trend. Another KFF COVID Vaccine Monitor report found Hispanic parents, Black parents, and parents with lower incomes were more likely to say they might have to miss work to get their child vaccinated, that they won’t have a trusted place to go, or that they’ll have difficulty traveling to a vaccination location compared to other parents. To mitigate similar disparities in vaccination rates among children, it will be important to address potential access barriers, ensure vaccinations are available through trusted sites, and address parent/caregiver concerns and questions through trusted individuals in the community. CDC guidance provided to jurisdictions asks them to take equity into consideration when selecting vaccine sites, particularly those initially selected in the early days of roll-out. Data on vaccination rates for children by race and ethnicity is important for being able to identify disparities and to direct resources to address them. However, the federal government is not currently reporting vaccinations among children by race and ethnicity, and only a handful of states report these data.

Implications

Many of the issues that presented challenges to vaccinating 5-11 year-olds will likely be at play in the effort to vaccinate younger children; however, there are additional factors to consider. These include the likelihood that there will be fewer places to get vaccinated for this age group, due to more limited opportunities at pharmacies and schools, and reduction in larger scale vaccination clinics formerly operated by jurisdictions across the country. Parents may be more likely to seek out pediatricians, who themselves may face new challenges to vaccinating younger children against COVID-19, or to encounter an offer for COVID-19 vaccination only when they bring their child to a routine check-up, a time period which may or may not correspond to a COVID-19 surge. In addition, there will be new communication challenges to reaching parents of children in this age group, given that two vaccines are being made available at the same time, each of which requires a different number of doses and time period to achieve full protection. Finally, particular attention to equity will be important given that large shares of children under 5 are children of color and live in low-income households.

On May 2, 2022, news media reported a leaked draft of the Supreme Court’s decision in Dobbs v, Jackson Women’s Health that would overturn Roe v. Wade and Planned Parenthood v. Casey and eliminate the federal standard regarding abortion access. The Supreme Court acknowledged the authenticity of the draft but stated “it does not represent a decision by the Court or the final position of any member on the issues in the case.” The final decision is expected sometime next month.

If the Supreme Court overturns Roe v. Wade, states will set their own abortion policies without any federal constitutional standards. Access to abortion care will be protected in 16 states and DC. Abortion will likely become illegal in 17 states that have laws that are intended to immediately ban abortion; four of these states have a law banning abortion on the books that predates Roe v. Wade and 14 states have expressed the intent to limit abortion to the maximum extent permitted by federal law.  While Michigan has a pre-Roe abortion ban on its books, a Michigan judge recently blocked this law while litigation challenging the law as violating the Michigan State Constitution proceeds. Two states, Oklahoma and Texas, currently have a pre-viability ban enforced by civil penalties in effect. Eight states have State Supreme Court decisions recognizing the right to abortion under the state constitution. If the Supreme Court overturns Roe, then some of these states and others without laws have expressed interest in passing state laws banning pre-viability abortions.

Source

KFF, Abortion at SCOTUS: Dobbs v. Jackson Women’s Health, Appendix 1: State Policies and Court Decisions Regarding the Legal Status of Abortion, May 2022.

Olympia Snowe Chair of the Board and Jim Canales Vice-Chair

Five New Trustees Have Been Elected

San Francisco – KFF announced today the election of former U.S. Senator Olympia Snowe as the new chair and Jim Canales as vice-chair for its board of trustees and the completion of a two-year recruitment and selection process that has concluded with the election of five new trustees.

Snowe, a KFF trustee since 2016, succeeds James Doyle, former Governor of Wisconsin, whose term as a trustee came to an end last year. Jim Canales, President and Trustee of the Barr Foundation in Boston, succeeds Snowe as vice-chair and has been a KFF trustee since 2018.

“I’m honored to have been elected by my distinguished colleagues as we help guide KFF during these challenging times. The pandemic has highlighted the problems with our health system and KFF’s trusted health policy information is needed more than ever,” Senator Snowe said.

In addition to recent board leadership changes, KFF has completed a two-year effort led by the chair of the board’s selection and governance committee, former U.S. Secretary of the Department of Health and Human Services and Kansas Governor Kathleen Sebelius, to elect five new members to the board: Frederick Cerise, MD, Marcella Nunez-Smith, MD, Soledad O’Brien, Frederick Terrell, and Reed Tuckson, MD.

Frederick Cerise and Reed Tuckson were elected to the board last year and began their terms in the fall of 2021.

Frederick Cerise is President and Chief Executive Officer of Parkland Health & Hospital System and previously served as Vice President for Health Affairs and Medical Education of the Louisiana State University System. From 2004 to 2007, Dr. Cerise was Secretary of the Louisiana Department of Health and Hospitals. He serves on the federal Medicaid and CHIP Payment and Access Commission and previously served on KFF’s Commission on Medicaid and the Uninsured.

Reed Tuckson is Managing Director of Tuckson Health Connections LLC. and is a Co-Founder of the Black Coalition Against COVID, a multi-stakeholder and interdisciplinary effort working to mitigate the COVID-19 pandemic in Washington, D.C. and nationally. He previously held numerous leadership positions in health care in the public and private sectors, including a long tenure as Executive Vice President and Chief of Medical Affairs for UnitedHealth Group. He was also Senior Vice President for Professional Standards of the AMA; Senior Vice President of the March of Dimes Birth Defects Foundation; President of the Charles R. Drew University of Medicine and Science; and Commissioner of Public Health for the District of Columbia.

Marcella Nunez-Smith, Soledad O’Brien, and Frederick Terrell were elected to the board of trustees this year. Mr. Terrell will begin his term in June and Dr. Nunez-Smith and Ms. O’Brien will start in September.

Frederick O. Terrell is a Senior Advisor with Centerbridge Partners, L.P. a multi-strategy investment management firm based in New York City. He is the former Executive Vice Chairman of Investment Banking and Capital Markets at Credit Suisse and Founder and CEO of Provender Capital Group, LLC which made investments in emerging companies of behalf of major institutional investors. Mr. Terrell has an extensive background in finance, investment management and corporate governance and currently serves on the boards of BNY Mellon, where he is Chairman of the Audit Committee, Paramount Global, Vroom Inc. and Mobility Capital Finance (MoCaFi). He is a member of the Investment Committee of the Rockefeller Foundation, the boards of the Partnership Fund for New York City, Planet Word Museum and is a member of the Economic Club of New York and the Council on Foreign Relations.

Marcella Nunez-Smith serves as the inaugural Associate Dean for Health Equity Research, and C.N.H Long Professor of Internal Medicine, Public Health and Management, and Founding Director of the Equity Research and Innovation Center at the Yale School of Medicine. The country saw Dr. Nunez-Smith regularly when she served as Senior Advisor to the White House COVID-19 Response Team and Chair of the Presidential COVID-19 Health Equity Task Force.

Soledad O’Brien is a documentarian, journalist, producer, speaker, author, and philanthropist who has produced and reported as wide range of critically acclaimed journalism. She is currently the CEO of Soledad O’Brien Productions, a multi-platform media production company, and anchors and produces the Hearst Television political magazine program “Matter of Fact with Soledad O’Brien.” She also reports regularly for HBO’s “Real Sports with Bryant Gumbel.” She has won numerous awards and authored two books.

“KFF’s ability to adapt and change as we continue to produce vital, relevant policy analysis, polling and journalism on health care issues is tied to the wealth of diverse experiences and the wisdom our board members bring to their duties as trustees. Our new board leadership and five new board members will add fresh perspectives and the judgment we need as we move the organization forward,” said KFF’s longtime CEO and President Drew Altman, PhD who founded the modern-day organization.

With the new additions, KFF’s board will have 13 members, including its CEO. The other board members currently serving are: President and CEO of the National Nursing League Beverly Malone PhD, RN, FAAN, Executive Editor of the Los Angeles Times Kevin Merida, former U.S. Secretary of Health and Human Services Kathleen Sebelius, former Chief Innovation Officer of GE Sue Siegel, and President of the ECMC Foundation Peter Taylor, MPP. Board members serve up to two five-year terms. Additional information about KFF’s board can be found at https://www.kff.org/board-of-trustees/.

June marks National Immigrant Heritage Month, which honors the contributions of immigrants to the U.S. As of 2020, there were close to 45 million immigrants residing in the U.S., accounting for 14% of the total U.S. population. Immigrants make up a significant part of the nation’s workforce and families yet face increased barriers to accessing health coverage and care. While citizens account for the majority of the nonelderly uninsured population, noncitizens are much more likely than citizens to be uninsured. Many lawfully present immigrants and citizen children in immigrant families who are eligible for coverage remain uninsured due to a range of barriers, including immigration-related fears. Research suggests that changes to immigration policy made by the Trump Administration contributed to growing fears among immigrant families about enrolling in Medicaid and CHIP even if they were eligible. The Biden Administration has since reversed some of these changes and implemented other policies to increase enrollment of eligible people in public coverage options, but sustained outreach efforts by trusted messengers will be key for reducing fears among the community.

The pandemic likely worsened the health and financial challenges faced by immigrants, as they have been at increased risk for exposure and financial difficulties and face greater barriers to accessing testing, treatment, and vaccines, in part, due to ongoing immigration-related fears. In addition, migrants have faced new barriers to enter the U.S., which have resulted in negative health impacts. Despite their role in the U.S., data are often missing to understand the diverse experiences of immigrants. Enhancing data to understand their experiences is of particular importance, given their growing population, the evolving landscape of immigration policies, the impact of the pandemic, and upticks in hate incidents among racialized groups.

Source

Health Coverage of Immigrants