The Root Cause Coalition is dedicated to amplifying the voices of communities and driving impactful policy reforms. As a nonprofit committed to addressing the root causes of health disparities and poverty, we aim to educate our members on recent news and research that advocates for equitable healthcare access and influencing policy decisions that combat food insecurity and poverty. 

Read our April 22, 2024 news on social drivers and advocacy updates below:

Social Drivers in the News:

Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health
This article outlines two approaches for addressing social conditions that harm health—the multisector collaboration approach and the social democracy approach. After the 2022 White House Conference on Hunger, Nutrition and Health, there has been widespread agreement that social conditions such as food insecurity, nutrition policy and environmental factors harm health outcomes. Multisector collaboration between health insurers, health care systems and social service organizations is the current dominant approach to responding to harm caused by social determinants, but the author argues that these collaborations are difficult to build, and they seek only to mitigate harm caused by social conditions, not solve them. The second approach, social democracy, has greater potential to solve the root causes of health equity but requires political contestation.
 
The Pillars of Health Disparities Science—Race, Ethnicity, and Socioeconomic Status
This article outlines the many governmental departments devoted to minority health research and the two pillars of health disparities science—race and ethnicity and socioeconomic status (SES). Race and ethnicity reflect the social hierarchy of access to wealth, power and opportunities and shape the inequitable distribution of health outcomes within and across populations. SES considers individual, household or family-based social and economic position. Lower SES is linked with poorer health outcomes because it contributes to limited resources and opportunities to access health-promoting activities and insufficient access to nutritious and affordable food, greater exposure to environmental hazards and higher chronic psychosocial stressors. The article concludes that research is moving towards integrating intersectionality into health disparities science to deepen understanding of how a combination of social identities and SES is associated with many layers of health-related disadvantage.
 
Hospital use of common Z-codes for Medicare fee-for-service beneficiaries, 2017–2021
This study examines the rates of Z-code utilization to document health-related social needs (HRSNs) for Medicare fee-for-service recipients across five common social determinants of health (SDOH) domains among US hospitals between 2017 and 2021. In 2016 the Centers for Medicare and Medicaid Services recommended the use of Z-codes to capture HRSNs in Medicare fee-for-service recipients to mitigate the impact of SDOH on health outcomes. The study found that 56.9% of US hospitals recorded at least one Z-code in at least one patient per year, but rates of adoption of Z-codes apart from those referring to housing needs were low. This study highlights the needs for continued promotion of standardized SDOH capturing methods and greater utilization of data gathered.
 
Redlining the Reservation: The Brutal Cost of Financial Services Inaccessibility In Native Communities
This report seeks to fill the gaps in data on the public understanding of economic realities for Native Americans through a detailed analysis of census tracts that overlap tribal territories in Arizona and New Mexico. The study found that Native Americans do not have access to the country’s financial infrastructure and outlines four key takeaways: mortgage lending loan capital should flow through Native-led financial institutions that are attuned to the administrative issues, geography and culture of tribal lands; half of all home purchase loans on tribal lands are used to purchase manufactured mobile homes, which will decrease in value instead of fostering wealth-building; tribal lands received less than one cent for each dollar loaned to small businesses in Arizona and New Mexico and the average census tract on tribal land received just five small business loans compared to 82 such loans in an average non-tribal census tract; and tribal areas have higher quantified financial need than other rural areas. The report concludes with policy recommendations so Native American and Tribal residents can receive the same access to financial capital as their counterparts not living on tribal territories.

SDoH Advocacy Update:

CMS Approves New York’s New Section 1115 Demonstration Amendment
The Centers for Medicare & Medicaid Services (CMS) recently approved an amendment to New York’s Medicaid section 1115 demonstration that works to advance health equity and strengthen access to primary and behavioral health care across the state. With New York’s demonstration, CMS has approved several initiatives to address health-related social needs as well as support greater integration between primary care providers, community-based organizations and behavioral health specialists. The demonstration amendment also aims to support hospitals that serve the most vulnerable populations and those that have more adverse health risk factors and poorer health outcomes. It includes funding to support a Medicaid Hospital Global Budget Initiative for a subset of financially distressed safety net hospitals looking to transition payment to rewarding value rather than volume of care provided. The demonstration will also help with establishing sustainable base reimbursement rates for safety net hospitals and addressing significant health care workforce shortages in safety net settings. The workforce initiatives include a loan repayment program for clinicians who commit to working in community-based practices in underserved areas, and enhanced training for under- and unemployed individuals who assist doctors and nurses as part of broader health provider teams.
 
H.R.6892 – Medical Nutrition Equity Act of 2023
This bill was introduced by Representative James McGovern [D-MA] to address the disproportionate financial burden on families seeking treatment for digestive and inherited metabolic disorders. Currently, most insurance plans do not provide coverage for medically necessary food and other forms of medical nutrition even though they are often the safest and most effective treatments for these disorders. The bill would require private insurance and public health programs, including Medicare, Medicaid, Federal Employees Health Benefits (FEHB) and the Children's Health Insurance Program (CHIP) to provide coverage for medically necessary nutrition when it is needed to prevent severe disability and death. Since lack of access to medically necessary food and medical nutrition leads to higher risk of malnutrition, surgery and repeated hospitalizations, providing coverage will not only save lives but also reduce health care costs. The bill was referred to the Committees on Energy and Commerce, Ways and Means, Oversight and Accountability and Armed Services. 
 
S.3525 – Supporting All Students Act
This bill was introduced by Senator Bob Casey [D-PA] to address the youth mental health crisis in the US by increasing access to mental health services. The bill would establish a youth peer-to-peer support line, available via call, text and chat, that would be integrated into the 988-crisis hotline. Young people would be able to reach the line directly or via a 988 referral for issues including relationship or family problems, stress, depression, anxiety and bullying, and would be connected with a trained peer responder for support. This bill would also establish a grant program, run through the Department of Education, for schools to hire mental health coordinators who could provide information about school and community-based mental health resources and partner with licensed mental health professionals to identify and meet with students experiencing stress, social isolation, family instability, homelessness or other adverse childhood experiences. Mental health coordinators would also work with students to strengthen their social support network and establish relationships with community-based mental health providers to facilitate the transition from school to community-based care as needed. The bill was referred to the Committee on Health, Education, Labor, and Pensions.
 
H.R.6970 – DASH Act
This bill, introduced by Representative Val Hoyle [D-OR], would address the housing crisis by establishing a Housing Choice Voucher for individuals or families experiencing homelessness or at risk of homelessness with incomes under 50% of the area’s median income. Under the legislation, voucher recipients would have access to health care services including mental health, dental and vision, substance use disorder treatment and assistance in enrolling in Medicare or Medicaid, the Supplemental Nutrition Assistance Program or other economic assistance programs. Recipients would also have access to family self-sufficiency programs, credit or housing counseling, education services including credit recovery, and transportation to any of these services. The bill would also provide $10 billion in the Housing Trust Fund (HTF) for the next 10 years to states to acquire, develop or rehabilitate deeply affordable housing. Funding would also be given for a pilot program to invest in innovative, cost-effective and efficient building methods to reduce the cost of developing affordable housing. The bill would strengthen the Low-Income Housing Tax Credit (LIHTC) by preserving and protecting current LIHTC properties, dramatically expanding production, and extending housing to those at extremely low incomes. It would also establish a Renter's Tax Credit and Middle-Income Housing Tax Credit (MIHTC) and would invest in homeownership in underserved communities with new tax credits and down payment assistance, including a down payment tax credit for first-time homebuyers. The bill was referred to the Committees on Ways and Means and Financial Services.