A person’s freedom to live a healthy life shouldn’t depend on their race or gender. However, Ohio legislators have a history of making it harder for Black women in our state to access health care and improve health outcomes. One recent example: The legislature said no to a state budget proposal that would have increased pregnant women’s eligibility for Medicaid. Because Black women are more likely than others to work jobs that don’t offer health care, expanded Medicaid access would have especially helped Black women access care during pregnancy. Black women in Ohio are more likely than women in other racial groups to die while or shortly after giving birth, suffering 29.5 deaths per 100,000 births in 2022. The legislature was presented with an option that could reduce that disparity by saving Black women’s lives. They rejected it.[1]

These statistics are one sign of a shameful reality: As a state, Ohio fails Black women. But statistics and state-level decisions aren’t the only ways to tell this story. By talking to Black women about their experiences with Ohio’s health care system, we can learn how this big-picture structural failure impacts individuals, their families, and communities.

This report is based on a survey conducted by the Ohio Organizing Collaborative (OOC) from January 2024 to June 2024, involving 503 Black[2] women[3] from around Ohio. More than half of respondents (64.8%) were between the ages of 40 and 69, 18.6% were between 70 and 89 years old, and 14.1% were between 18 and 39 years old.[4]

Questions focused on access to medical services, perceived discrimination, barriers to care, and financial stress related to health care costs. The survey was distributed both electronically and on paper at church meetings and a meeting of The Women’s Health Initiative in Dayton, Ohio. We also integrate findings from local and national survey reports and broader policy analyses, policymakers, and health care providers to develop targeted strategies that address the unique challenges faced by Black women, ultimately advancing health equity across Ohio.

Ohio's diverse socio-economic landscape plays a significant role in shaping health care access and outcomes. In 2022, Black women represented 13% of all women ages 18 to 64,[5] while Black Ohioans broadly represented about 12.4% of the general population.[6] In Ohio, Black women are paid less at the median than any other race or gender group, despite Black women having consistently higher workforce participation rates than their counterparts in other demographic groups.[7] The result is a significant disparity in household income compared to the general population, especially for single mothers. For example, in 2022, the median household income of a white family in Ohio was $70,749, compared to a Black household median income of $42,072.[8] Nationwide, the median net worth for white households in the U.S. was $212,600 in 2022. For Black households it was only $31,250.[9]

Health outcomes depend in large part on access to affordable, timely, high-quality care.[10] Too many Black women in Ohio don’t have that access. For example, Black women are more likely than white women to be diagnosed with cancer at a late stage.[11] Late-stage cancer is much harder to treat and more aggressive than cancer that is detected early. As a result, Black women have a lower 5-year survival rate for cancer than white women.[12] A 2021 Emory University study revealed that the median number of days between each step of the breast cancer screening and diagnostic process was 60% higher for Black women than for white women, delaying their diagnoses, increasing the likelihood that they die from the disease.[13]

Respondents were asked to briefly describe their experience as a woman of color navigating the health care system in Ohio. Some respondents stated that they’d had “good” experiences or had “no problems navigating” the system. Others described navigating the system as “frustrating” and a “maze.” Some respondents noted that they felt the need to be their own health care advocate, one stating, “You have to be the ‘Captain’ of your health. Ask questions and (ask) for explanations. I know my body best.” Another respondent noted the ways in which medicine wasn’t designed to consider the needs of Black people, writing, “My care isn’t designed based on my genetic makeup, but rather compared to my Caucasian (white) counterparts.” Lastly, a group of respondents noted that finding a doctor who really cared about them and their family was an extremely important part of whether they had a positive experience. One respondent stated, “as a woman of color, I find it hard to navigate through the health care system, especially finding doctors who really care.”

More than two in five respondents (43.3%) either agreed or strongly agreed that they had no problem finding a medical provider that they or a family member felt comfortable with, while 40% of respondents disagreed or strongly disagreed. Qualitative responses illustrated the nuances of individual experiences. The following are two responses to a question about the respondent's health care experiences broadly from different ends of the spectrum:

“I have most trouble finding Black female doctors. I sometimes feel doctors do not listen or take me as seriously about pain levels and my preference for non-invasive procedures and non-use of synthetic medicines. They don't often explore those options.”

“Fortunately, I currently have decent insurance and now on Medicare with a supplement. I have attentive doctors who listens to me, answers my questions and encourage questions. I’ve learned to be my own health advocate.”

Despite 87.9% of respondents having an established primary care doctor, only 71.8% reported being able to secure appointments within two weeks when sick. The share of respondents who had health insurance (94.2%) was the same share of the general population (93.9%), and slightly higher than the share of Black Ohioans with health coverage (92.8%).[14]

Most respondents (49.9%) found the cost of health insurance affordable, while 10.5% were unsure, and 38% found the cost unaffordable. Among the reasons for this perception, respondents reported high co-pays, increased out-of-pocket expenses, and high medication costs. A majority (56.3%) reported experiencing stress due to medical debt. The survey findings illustrate how the high cost of health care — even with insurance — can contribute to this problem and is itself a barrier to better health for Black Ohioans, especially for Black women.

In particular, the survey found that the costs of tests (44.7%), visits (37.8%), and medications (43.7%) are the primary reasons people delay or skip health care services. These results are similar to the findings of other studies. For example, the 2022 Women’s Health Survey KFF Health survey found that many women ages 18-64 went without or delayed health care services in the past two years, most commonly for dental care (52%).[15] A separate KFF Health survey on the cost of care found that 23% of Black adults and 24% of women had not filled a prescription because of cost.[16]

The findings show that there are many avenues to improve Black women’s access to and quality of health care in Ohio. While the women surveyed were about as likely to be insured as the rest of the general population, the survey over-represented populations that qualified for Medicaid and Medicare, likely skewing the findings toward a higher-than-proportional coverage rate.

Figure 1

This suggests that continuing to increase Medicaid eligibility will help ensure that more people can access health insurance broadly and save lives. Medicaid expansion may also include broadening the types of providers available, so families can remain with a consistent primary care doctor and find a provider who fits their specific needs. Medicaid expansion, and passing legislation like Ohio House Bill 7, could also help to address specific areas of need, like maternal mortality rates for Black women.

Affordability was also a major concern for many respondents that can be addressed through policy changes, like implementing legislation to protect Ohio families from medical debt and improving the financial aid process for patients. Expanding language accessibility and translation serves would specifically benefit this population when finding a provider and understanding the cost of services, especially for first- or second-generation immigrant families. Further expanding need-based eligibility programs and broadening access to low-premium health care coverage would assist those who listed cost as a barrier to services. Last, but not least, declaring racism a public health crisis is a strong first step in bringing awareness and recognition to the issue. Color-blind health care does not benefit our health care systems, because it erases the unique needs of individual populations. Lawmakers should center Black women in their health care decision-making through a “Black women best” ideology, “or enacting deliberate strategies of inclusion to create a stronger economy so that our most marginalized can thrive.”[17]

Understanding these challenges is crucial for designing effective health care policies and interventions. Policy recommendations include addressing affordability issues, improving provider-patient relationships through cultural competence training, and strengthening patient advocacy resources to mitigate disparities and enhance health care equity.

• Expand Medicaid services to pregnant women with income up to 300% FPL and continuous coverage for children up to age 6. This proposal was included in the governor’s 2023 Executive Budget and should be included again.[18]
• Continue investing in programs such as the Office of Health Opportunity (OHO) under the Ohio Department of Health, built specifically to address the social determinants of health in specific communities.[19]
• Enact House Bill 7, the Strong Foundations Act,[20] a targeted piece of legislation to improve maternal mortality, specifically by expanding access to resources for pregnant and postpartum women.[21]
• Fund Black-led public health and birthing programs, such as Birthing Beautiful Communities.[22]
• Improve the financial aid process for patients, with accessible language and hospital pricing transparency standards.
• Pass comprehensive legislation to address medical debt based on the National Consumer Law Center’s model medical debt legislation[23] or the bill passed in Rhode Island.[24]
• Declare racism a public health crisis, as done by Franklin County in 2020[25] and the state House[26] and Senate.[27] This would explicitly and publicly shift the state’s frame for discussing health equity.

For Black women in Ohio, health care services are often inaccessible or unaffordable. They frequently face discrimination in the health care system and, too often, receive care that is not as timely, targeted, or effective as the care received by other Ohioans. Addressing these issues requires collaborative efforts from health care providers, policymakers, and community stakeholders. With targeted policies, Ohio can create a more inclusive and fair health care system, benefiting Black women and all Ohioans.

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