Researchers from the University of California released a paper this month examining the disparate impacts of the COVID-19 pandemic on school students. The pandemic exacerbated longstanding educational inequities in student academic performance and mental health outcomes based on race, ethnicity, and socioeconomic status.

Data from students across the United States during the 2020-21 school year shows:

• Pre-existing achievement gaps in reading and math widened notability for students of color and those from high-poverty school districts.
• Absenteeism and grade retention increased at higher rates for Black and Hispanic students, who were more likely to attend schools negatively impacted by the transition to remote learning.
• School closures were more typical in underserved communities, and low-income families had limited access to traditional in-person instruction and high-quality remote learning experiences.
• The pandemic led to widespread increases in fear, anxiety, depression, loneliness, and behavioral issues for students of all ages, regardless of race, ethnicity, or socioeconomic status.
• School engagement rates were highest among students from households with higher incomes and parental education levels.

Black and Hispanic students were more likely than White students to feel very or extremely worried about the pandemic. They reported disproportionately high rates of COVID-related stress despite their caregivers being less likely than white caregivers to report concerns about their children’s mental health in the wake of school closures.

Maternal health ensures mothers and birthing parents are healthy and their children have the best start possible. Research shows healthy mothers are more likely to raise healthy babies. Unfortunately, the U.S. has the highest maternal mortality rate among developed countries, and racial disparities plague the health care system for Black and Brown women.

Our first-ever maternal health county fact sheets show each county’s overall perinatal vulnerability index (PVI). The PVI uses data across five domains: behavioral health, environmental context, health care availability, pregnancy and birth outcomes, and social stratification. The fact sheets also highlight data about prenatal care and the percentage of low birth weight births.

In 2020, there were over 130,000 total births across Pennsylvania. Yet, only 13 counties had moderate access to care, and six counties were considered maternity care deserts, based on the March of Dimes Maternity Care Deserts Report (2022).

Research shows low birth weight is a strong indicator of maternal health, and the rate increased nationally by 4% since 2014. When children are born with low birth weight, there is an increase in the risk for future health and developmental issues.

Racial disparities limit access to maternal health care and can impact the health of both mother and child:

• The rate of non-Hispanic Black women giving birth to children with low birth weight is 14.5% compared to 6.8% of White women and almost double the state rate of 8.3% across all races.
• When comparing counties, the rate of low birth weight among Black women ranged from 22.9% in Lebanon County to 7.5% in Bucks County.

Thriving PA aims for women and birth parents to have access to the health resources needed for a healthy pregnancy and delivery. Maternal health is necessary for raising healthy children, and more attention is needed to make maternal health care more accessible, especially for Black and Brown women who have a higher risk of poor birth outcomes and maternal mortality and morbidity.

  The Kaiser Family Foundation examines newly released provisional data from the Centers for Disease Control and Prevention showing a record high of 49,369 suicide deaths in 2022.  Rates were highest among American Indian and Alaska Native people, males, and people who live in rural areas.  Suicide by firearm is identified as the primary driver of the increase – up by 8 percent from 2020 and another 3 percent in 2022, while deaths from other suicide methods remained more stable.

  The Office for Evaluation at the U.S. Department of Health & Human Services analyzed data from the Centers for Medicare & Medicaid Services.  The report covers all U.S. hospitals enrolled in Medicare with data on hospital type, rural/urban location, organizational structure, and types of ownership – organizational and hospital chains, and individual owners.

2023 Metropolitan Statistical Areas (MSAs)

The Office of Management and Budget (OMB) released the Revised Delineations of Metropolitan Statistical Areas, Micropolitan Statistical Areas, and Combined Statistical Areas, and Guidance on Uses of the Delineations of These Areas.  Click here to view the bulletin.

The OMB Bulletin uses OMB’s 2020 Standards for Delineating Core Based Statistical Areas.  It is also the first delineation to use the 2020 Decennial Census, American Community Survey, and Census Population Estimates Program data.

2030 Census

Planning for the 2030 Census – the 25th in U.S. history – is underway. To develop the operational design, the U.S. Census Bureau will factor in past census experiences, your feedback, and new research. They will also consider evolving technologies and the changing world around us. The Census Bureau also released an updated timeline showing the lead-up to the 2030 Census. Click here to learn more.

New Report on Aging Veterans

A new report released by the U.S. Census Bureau shows U.S. veterans 65 years or older were less likely to be at risk of experiencing social isolation than other older adults. The report, Aging Veterans: America’s Veteran Population in Later Life, examines characteristics of the nation’s 8.1 million veterans ages 65 or older in 2021.

New from the RUPRI Center for Rural Health Policy Analysis

Distributional Analysis of Variation in Medicare Advantage Participation Within and Between Metropolitan, Micropolitan, and Noncore Counties
Dan Shane, PhD; Ufuoma Ejughemre, MD, MSc; Fred Ullrich, BA; Keith Mueller, PhD

This policy brief uses county-level information from 2017-2022 on population and MA plans to analyze relative MA participation rates by geographic classification. We use Urban Influence Codes to split counties into metropolitan, micropolitan, and noncore categories. Within each geographic classification, we order counties into quintiles by MA penetration rate (MA enrollees / Medicare-eligible enrollees) with the lowest 20% of county penetration rates comprising the first quintile. We find consistent growth in the median number of plans and median enrollment across all geographic classifications and all quintiles between 2017 and 2022, with slightly higher growth in micropolitan and noncore counties. We also find that growth rates were consistently higher in the lowest quintiles (lowest penetration rates) in each geographic classification. However, the absolute differences in median number of plans and median enrollment between these lowest-ranked counties and higher ranking counties in MA participation remained the same.

Key Findings

• From 2017 through 2022, growth (measured as percent increase) in the number of MA plans and MA enrollment rates was higher in noncore and micropolitan counties than in metropolitan counties, but metropolitan enrollment rates remained higher than nonmetropolitan enrollment rates. The median number of MA plans in metropolitan counties is higher than that in micropolitan counties which is higher than the median number of plans in noncore counties.
• Within each rural-urban classification, percent growth in MA penetration rates, plans, and enrollment has been highest in counties with the lowest participation rates in 2017.

Population size is closely tied to higher participation rates both within and across geographic classifications, with the important caveat that micropolitan and noncore counties with higher MA participation exceed rates that population only would suggest.

Click here to read the full report.

 Among key findings from the University of Minnesota Rural Health Research Center: rural residents are more likely than urban residents to have lived in their homes for more than 20 years (27 percent vs. 20 percent); more likely to have a disability (17 percent vs. 13 percent), and/or be in poor health (24 percent vs. 17 percent).

A coordinated early care and education system ensures infants, toddlers, and preschoolers succeed in school and allows parents to work while knowing their children are safe and learning in high-quality care. Yet, inequities exist, causing too few children to have access and a historic early learning workforce shortage, as shown in our first-ever State of Early Care and Education report.

Working with Pre-K for PA and Start Strong PA as part of Early Learning Pennsylvania (ELPA), a statewide coalition of advocates focused on supporting young Pennsylvanians from birth to age five, the report uses data and research to show that without new investments in the child care workforce, Pre-K Counts, or the Head Start Supplemental Assistance Program, early learning providers will continue to lose teachers and close classrooms.

The growth and development of young children in high-quality early care and education is the start of a continuum with benefits that last into adulthood. Providing every child—regardless of race, ethnicity, geography or income—access to high-quality early care and education programs ensures an equitable start to their academic careers.

A coordinated child care system serving infants and toddlers is vital to the economy, allowing parents to work while knowing their children are safe and learning in high-quality care.

According to the report, inadequate funding for the child care system has led to issues of supply and demand that impact a family’s ability to find affordable, high-quality child care, and child care providers’ ability to be compensated fairly to pay their teachers and maintain business expenses:

• Unlivable wages of less than $12.50/hour are causing a historic workforce shortage that is closing classrooms and driving up wait lists for working mothers and families.
• Child care providers can’t raise teacher wages because families are already struggling to afford the costs of care. On average, costs for infant child care comprise approximately 17.5% of the Pennsylvania median family income.
• Only 21% of eligible children under three are served by Child Care Works, leaving over 83,000 eligible infants and toddlers unserved.

The next step in the academic continuum for children is access to high-quality pre-k programs, but only 43% of eligible 3- and 4-year-olds participate in high-quality, publicly funded pre-k, leaving over 87,000 without access to a high-quality program.

The workforce is essential for delivering high-quality pre-k. Yet, while the level of quality expects and demands the appropriate knowledge and credentials of professionals, the compensation for pre-k teachers remains significantly lower than their colleagues in K-12 settings.

Unlike child care, publicly funded pre-k programs in Pennsylvania rely on annual state budget funding appropriations. High-quality pre-k has historically been a consensus issue, aligning political parties and enjoying a decade of growing investment. However, policymakers have flat-funded pre-k in the 2023-24 state budget, which is baffling.

The report shows inequitable access to early care and education opportunities for children in Pennsylvania:

• As of March, only 1 in 4 income-eligible infants, toddlers, and preschoolers who are Black, Indigenous, and children of color participated in Child Care Works, with only 40% enrolled in a high-quality child care program. Of the 12% of income-eligible non-Hispanic white infants, toddlers, and preschoolers participating in Child Care Works, 51% were enrolled in a high-quality child care program.
• Only 23% of all children served in Pre-K Counts and Head Start Supplemental Assistance Programs in Pennsylvania are Non-Hispanic Black, compared to 41% of children identifying as Non-Hispanic White.
• Researchers at Penn State University found white preschoolers accounted for the majority of program participants in Pre-K Counts, and white children were increasingly more likely to be enrolled in a high-quality pre-k program compared to Black children. Recommendations from the report specifically called for Pennsylvania to increase funding for pre-k access and to serve more Black children from urban and high-poverty communities.

And compared to the K-12 and post-secondary education systems, the sector is the most diverse yet the lowest paid.

• Racial disparities exist within the professional child care sector, with Black educators earning approximately 2% less than their white counterparts. Hispanic educators earn approximately 5% less than white educators, exacerbating the already low wages of the sector and deepening inequities and gaps in pay.
• There is a pay gap between pre-k and kindergarten teachers, but an even larger wage gap between Black and non-Black educators. A $1/hour wage gap exists between Black and non-Black teachers at the preschool level.

The evidence is clear that access to a high-quality early care and education system positively impacts the lives of Pennsylvania children. Unfortunately, the state is falling short for children, families and providers across the commonwealth. Comprehensive policy solutions and increased investments are needed to change the system’s trajectory. Working together, we can build Pennsylvania’s early care and education system as a leading model.

The Rural Health Value team is pleased to release a new Rural Innovation Profile: A Rural Accountable Care Organization’s Journey

For more than a decade, South East Rural Physicians Alliance Accountable Care Organization (SERPA‐ACO), a physician‐led ACO that includes 16 physician-owned clinics in Nebraska has been leveraging health care payment and delivery models to provide high quality, comprehensive, coordinated, and patient‐centered care at a lower cost.

Related resources on the Rural Health Value website:

• Demonstrating Your Value: A Guide to Potential Value-based Care Partnerships for Rural Health Care Organizations. This Rural Health Value resource assists rural health care leaders in demonstrating the value their organizations can bring to networks, affiliations, payers, systems, or accountable care organizations.
• Catalog of Value Based Initiatives for Rural Providers – One-page summaries describe rural-relevant, value-based programs currently or recently implemented by the Department of Health and Human Services (HHS), primarily by the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare & Medicaid Innovation (CMMI).
• Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations – A summary of the changes made to the Medicare Shared Savings Program taking effect January 2023 and 2024. This Rural Health Value analysis outlines how the changes would reduce barriers to participation for potential or reentering ACOs that operate in rural contexts.

For more information, contact Clint MacKinney, MD, MS, Co-Principal Investigator, at clint-mackinney@uiowa.edu