Deb Gordon
Deborah D. Gordon has spent her career trying to level the playing field for healthcare consumers. She is co-founder of Umbra Health Advocacy, a marketplace for patient advocacy services, and co-director of the Alliance of Professional Health Advocates, the premiere membership organization for independent advocates. She is the author of "The Health Care Consumer's Manifesto: How to Get the Most for Your Money," based on consumer research she conducted as a senior fellow in the Harvard Kennedy School's Mossavar-Rahmani Center for Business and Government. Deb previously spent more than two decades in healthcare leadership roles, including chief marketing officer for a Massachusetts health plan and CEO of a health technology company. Deb is an Aspen Institute Health Innovators Fellow, an Eisenhower Fellow and a Boston Business Journal 40-under-40 honoree. Her contributions have appeared in JAMA Network Open, the Harvard Business Review blog, USA Today, RealClear Politics, The Hill and Managed Care Magazine. She earned a BA in bioethics from Brown University and an MBA with distinction from Harvard Business School.
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1. A new op-ed highlights HealthyWomen’s survey of midlife women
In March 2023, The Hill published an op-ed highlighting research HealthyWomen conducted with midlife women about their health and well-being. The report findings revealed that 4 out of 10 women surveyed said that their overall health was just “OK” or worse. Nearly as many said the same about their mental and sexual health. Most (62%) of the women surveyed reported facing some kind of barrier, including emotions such as shame, fear, distrust or tangible obstacles, such as cost or lack of insurance coverage. In the piece, HealthyWomen Senior Policy Advisor Martha Nolan argued that these findings call for a healthcare system that provides greater support for women and their health. Nolan recommended reframing women’s health as a broad journey through women’s life stages, rather than simply as reproductive care. She also encouraged the normalization of aging and specifically of menopause as well as increased funding for research into women’s midlife health.
2. Medicaid coverage gets better in North Carolina and Mississippi
In March, North Carolina became the latest state to expand Medicaid, the publicly funded health insurance program for people with low incomes. As many as 600,000 adults could now get health insurance as a result. Medicaid provides coverage for nearly 1 in 5 — or nearly 62 million — Americans. Forty-two percent of all births in the United States are covered by Medicaid. North Carolina joins the majority of states that have already expanded Medicaid.
In other Medicaid news, Mississippi passed a law to give postpartum women with low incomes a full year of Medicaid coverage.
3. The FDA updates mammography guidelines to alert women to breast density
The Food and Drug Administration has updated its rules for mammography to ensure women receive information about their breast density. Approximately half of women over age 40 have dense breasts, which can make it more difficult to detect cancerous tissues on a mammogram. The new requirements may lead to more follow-up screening, the costs of which could fall to patients.
In Missouri, the legislature passed a bill to make it easier for women to access mammography. Under the bill, patients would not be charged a copayment if they need a second mammogram to detect breast cancer. The bill will now go to the state Senate for consideration.
4. The FDA is considering allowing over-the-counter birth control
The FDA is considering new rules that would expand over-the-counter access to certain prescription medications, including birth control. The new rules would allow certain medications to be sold over the counter with an extra safety step, such as a survey to identify and exclude patients who may be at higher risk for negative side effects or harmful drug interactions. New rules could be finalized by October 2023. Outstanding questions will remain about whether insurers will cover over-the-counter contraception if the FDA approves this change. FDA advisors will meet on May 9 and 10 to evaluate making birth control pills available without a prescription.
5. New studies shed new light on hormonal treatments and breast cancer risks
A new study published in March 2023 found that, despite differences in the formulation of different hormonal birth control methods, increased risks of breast cancer are similar. Hormonal birth control can contain different hormones (estrogen and progestin or just progestin). Regardless of the formulation, though, researchers found that women who took any type of hormonal birth control were 20% to 30% more likely than other women to be diagnosed with breast cancer, which translates to approximately half a percent of increased risk. For women with higher underlying risk of breast cancer, the increase in absolute cancer risk from using hormonal birth control may be higher. These risks are consistent with research conducted in the 1990s.
Another study examined breast cancer risks among transgender men and found that when they transition, their breast cancer risks fall substantially and become comparable to breast cancer risks among cisgender men (men who are assigned male at birth). Scientists had previously hypothesized that breast removal in transgender men accounted for lower breast cancer risks, but the latest findings suggest that hormone replacement therapy is influential in lowering breast cancer risks. Researchers analyzed breast tissue from trans men and cisgender women and analyzed the effect of hormone therapy with the male hormone androgen. Androgen seems to suppress estrogen receptor positive breast cancer growth, according to the researchers.
6. Maternal health provider constraints worsen as birth outcomes remain concerning
A Mississippi hospital on the Gulf Coast announced it would stop offering labor and delivery service effective April 1 as a result of a shortage of obstetricians. This move follows another hospital closing its Gulf Coast obstetrics services last year. Mississippi has some of the worst birth outcomes in the country.
Nationwide, more than 2 million women of child-bearing age live in maternity care deserts, defined as areas without access to hospital-based obstetrics care or to a birthing center. According to recent reports, more than 20,000 pregnancies in the United States end with a stillbirth.
7. State legislatures move to limit access to gender-affirming care for transgender people
Several states have passed or are considering legislation that would limit access to gender-affirming care for transgender youth and/or adults. In Mississippi, the governor approved a bill that bans healthcare providers (HCPs) from providing gender-affirming care for minors; under the new law, HCPs can lose their professional licenses and be sued by former patients for providing gender-affirming care. The Arkansas governor recently signed a similar law that will allow former patients to sue HCPs who provided gender-affirming care for malpractice. The legislatures in Indiana, Georgia, and Kentucky are taking steps to enact similar laws. Other states, such as Oklahoma and South Carolina are considering laws that would limit insurance coverage for gender-affirming care.
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