Since George Floyd’s tragic death, citizens have been doing the important work of reflecting on the systemic racism and implicit biases that permeate their industries. The healthcare industry is no stranger to these issues. To truly honor George Floyd and countless other black lives senselessly lost to the scourge of racism, it is imperative to educate ourselves on the inequities that exist so we can finally provide equal quality and access to healthcare to all Americans.
These inequities have been brought into even starker relief as the impact of COVID-19 has fallen more harshly on blacks. In Louisiana, for example, blacks represent about one-third of the population but make up 70% of COVID-19 deaths.
As argued by Rashawn Ray for the Brookings Institution, structural conditions that inform pre-existing conditions and health conditions are the main culprit for this “epidemic within the pandemic.” These structural conditions range from neighborhood to access to healthy food to employment type. For example, black workers are disproportionately represented in risky front-line jobs, such as public transit, grocery stores, warehouses and social services, according to the Economic Policy Institute.
These structural conditions have been created by a long legacy of discrimination and systemic racism, such as redlining. “Health problems in the Black community manifest not because Blacks do not take care of themselves but because healthcare resources are criminally inadequate in their neighborhoods,” Ray writes.
This long legacy, which has culminated in exclusive housing policies, unequal access to education and a lack of multigenerational wealth, is the same reason blacks have been disproportionately unemployed by the COVID-19 pandemic, according to CNBC. Even as the economic outlook improved slightly in May with white unemployment falling to 12.4% from 14.2%, black unemployment rose to 16.8% from 16.7%.
This means blacks are especially vulnerable to losing their job-based health insurance coverage, as millions exit the commercial insurance and head for COBRA, Medicaid or the marketplaces. Black workers are already 60% more likely to be uninsured than white workers, according to the Economic Policy Institute.
Because blacks tend to be poorer than other demographic groups on average, access to Medicaid and other public health programs is especially vital during COVID-19. Many states in the South, where blacks are disproportionately represented, have not expanded Medicaid for adults with incomes up to 138 percent of the federal poverty level. In these states, blacks are most likely to fall within a “coverage gap” meaning they earn too much to be eligible for Medicaid, especially if they just lost their job, but they do not earn enough to be eligible for subsidies in marketplace plans, according to the Century Foundation.
From legislators deciding on Medicaid expansion to C-suite executives at insurance companies to primary care providers, all stakeholders in the healthcare community must do everything in their power to ensure that the black community has equal access to coverage and high-quality care. We must all devote more time and resources to understanding the structural and institutional forces that lead to blacks being more likely to be uninsured, unemployed, and contract COVID-19. This includes ramping up the momentum on social determinants of health and implementing policies that promote coverage for minorities, such as expanding Medicaid.
Softheon believes racial justice works in conjunction with our mission to make healthcare more affordable, accessible and plentiful for all. That is why, last week, we donated to the American Civil Liberties Union (ACLU). We are committed to continue listening and learning about inequity in healthcare so that we can ensure everyone, regardless of race, gets access to the high-quality care they deserve.