Indiana ranks eighth in the country for stillbirth and infant mortality numbers, as many counties lack access to obstetric care.

One out of every 165 pregnancies in the state ends in stillbirth, and there are almost seven infant deaths per one thousand live births.

These rates are higher among Black women, so the Indiana Minority Health Coalition is working to reduce them.

The coalition offers the services of doulas - trained professionals who assist before, during and after a pregnancy with physical and emotional support and information.

Coalition Maternal Child Health Manager Lauren Lancaster said doulas are assigned to areas throughout Indiana - and more are needed.

"In our program," said Lancaster, "we have a doula program that covers St. Joseph, Elkhart, Laporte, Howard, Cass, and Miami counties."

According to the March of Dimes, Indiana saw 529 infant deaths in 2019 - the most recent reporting year. The causes include birth defects, preterm birth and low birth weight, maternal complications, and sudden infant death syndrome (SIDS).

The highest number of pregnancy complications are reported in Grant, Madison, Parke, Switzerland and Vanderburgh counties.

In 2020, the leaders of three of Indiana's largest healthcare systems - Community Health Network, Eskenazi Health, and Indiana University Health - acknowledged health care disparities and inequities in the state's minority communities, describing systemic racism a "public health crisis."

Lancaster said Black women should demand equal care for a safe and healthy delivery and baby.

"If you feel that your provider is not acting upon what you believe to be an issue within your pregnancy, go see another provider," said Lancaster. "Or if you have to, go to the emergency room - but make sure that you're being heard and that you're being listened to."

The coalition in partnership with Anthem Health created a multilingual app, "Count the Kicks," to assist those who are pregnant with tracking fetal movement - a key indicator of the baby's health, especially in the third trimester.

Lancaster said in an emergency, the app can verify with a healthcare provider that immediate care is needed.





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California's medical aid-in-dying law is back in court. Three patients with disabilities and two doctors are asking to intervene in a lawsuit challenging the law - and they want the judge to dismiss the suit.

In April, a coalition of disability rights groups and people with disabilities sued to stop the End of Life Option Act, claiming it is discriminatory and "coerces" people with disabilities into using medical aid in dying.

Jess Pezley is the senior staff attorney with Compassion & Choices, which supports the bill.

"It's not discriminatory to offer an additional end-of-life option," said Pezley. "And there's a lot of safeguards built in within the act to make sure that this law is not being used by people who do not want it. The only people who qualify for it are terminally ill with a prognosis of six months to live, and who have the capacity to make the decision."

California is one of ten states - plus Washington, D.C. - that allow doctors to prescribe medication that would allow mentally capable, terminally ill adults to peacefully end their suffering if they choose to take it.

Peter Sussman is a retired journalist and author from the Bay Area who said he lives with constant and disabling pain after a series of spinal surgeries. He said he supports medical aid in dying, and has joined the motion to intervene in the lawsuit.

"When my time comes and I am certified by doctors to be dying within six months, I do not want to die suffering needlessly," said Sussman. "The government shouldn't be able to tell me the manner of my own death."

The State of California, the defendant in the lawsuit, has also filed a motion to dismiss.

Earlier this year, the same judge dismissed a different challenge to the suit brought by the Christian Medical and Dental Association - after it reached a settlement with the state that said doctors who have a religious objection don't have to record a patient's request for medical aid in dying on their chart.

Open enrollment begins soon for employer-sponsored health insurance for coverage starting Jan 1.

Most people will have multiple options to choose from. Some are complex, so now is the time to do your research. According to the website USA Facts.org, about 7.5% of Indiana residents do not have health insurance. Experts say it is important to shop for plans, see exactly what they offer, and if a choice fits a family's needs and budget.

Dr. Rhonda Randall, chief medical officer of Employer and Individual for UnitedHealthcare, said understanding some of the basic insurance jargon is a good place to start.

"Things like deductibles, copays, coinsurance, premiums, etc.," Randall outlined. "Be familiar with what those terms are and what the costs associated with each one is for the plans that you're offered and the plans that you're considering."

Randall advised paying close attention to out-of-pocket costs and monitoring changes which can occur within a plan each year. She suggested the online health insurance glossary Just Plain Clear, which UnitedHealthcare has compiled. In 2021, more than one-third of Indiana's population was covered by public health insurance funded by governments at the federal, state or local level.

Nearly 17% of Indiana's population is 65 or older and eligible for Medicare. But it does not cover everything, so most people also buy a supplemental policy for added coverage, and a prescription drug plan. The Medicare annual enrollment period starts Oct. 15 and ends Dec. 7, when people can get new coverage or change what they've had.

Randall noted UnitedHealthcare has also compiled an online guide to help people navigate those plans.

"Medicare beneficiaries want to make sure they're understanding and learning the difference between original Medicare -- Medicare Parts 'A' and 'B' -- and Medicare Advantage, Medicare Part 'C' and 'D,' the prescription drugs," Randall explained.

Randall encouraged Hoosiers to consider insurance plans including coverage for telehealth -- virtual 24-hours-a day, 7-days-a-week mental and behavioral health services, or management of chronic conditions, such as migraines, plus physical therapy and wellness visits.

Health care advocates are urging Gov. Gavin Newsom to sign four bills aiming to lower medical bills, improve transparency, and make health care more accessible.

Assembly Bill 665 would allow minors over age 12 to use Medi-Cal benefits for treatment they consent to on their own, while still allowing providers to involve a parent or guardian when appropriate.

Angela M. Vázquez, policy director for The Children's Partnership, said teens may avoid getting help if they have to give intimate details to their parents.

"Surveys show that making parental opt-in mandatory reduces the likelihood that teens will seek timely treatment, especially among LGBTQ+, and youth of color," Vázquez reported.

The bill would also allow Medi-Cal to cover services even if the youth is not a danger to him or herself or the victim of child abuse or incest. Opponents say the bill interferes with parental rights.

A second bill would stop surprise bills from out-of-network ambulance companies, instead requiring patients to pay only the in-network cost-sharing amount.

Danielle Miele, a mom from Citrus Heights, said after her teenage son tried to take his own life, the hospital transferred him via ambulance to a treatment center several hours away, resulting in a huge bill.

"Within a month we received an ambulance bill of over $9,000," Miele recounted. "Adding insult to injury, literally. Why is this practice commonplace? Why is it even considered acceptable?"

Debt collectors have objected to a section of the bill dealing with wage garnishment.

A third bill would add physicians' groups of 50 or more to the list of organizations required to make public financial data they report to two state agencies.

Sonia Pellerin, a health care worker in Sacramento and a member of the Service Employees International Union-United Healthcare Workers, said it is a matter of transparency.

"With health care costs rising, we all deserve to know where our health care dollars are going and what's driving up the costs," Pellerin contended. "Many times our patients are struggling to afford their health care. Those patients have the right to know how these medical groups are spending their money."

Medical groups have called the bill an unnecessary layer of regulation. A fourth bill would extend Medi-Cal's Comprehensive Perinatal Services Program from 60 days to 12 months postpartum. The program helps arrange housing and food assistance, job training, and breastfeeding support. Opponents cite budget concerns.


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