Even before the COVID-19 pandemic ripped through the country, Black Americans had been plagued by lower wages and benefits, as well as higher levels of unemployment. This contributed to more underlying medical conditions than were experienced by their white counterparts.
That prior insecurity has magnified the current fallout from coronavirus, with a pair of studies released this week revealing that communities of color are more likely to be uninsured and to suffer negative health outcomes. Even worse, the situation is expected to deteriorate further by year’s end.
The first study was based on a series of national surveys fielded by Civis Analytics among more than 13,000 people over the course of the year. It revealed that the percentage of Black Americans who lost their health insurance coverage due to COVID-19 rose steadily, from 17% in February to 21% in June to 26% by September.
That compares to 11% of white Americans who were uninsured in February, creeping up to 12.5% in June and down to 12% in September. Overall, the percentage of uninsured Americans jumped from 12% in February to 14.7% in September.
“It’s very serious,” said Civis director, applied data science and healthcare analytics Crystal Son of the seemingly slight 2.7% increase, which actually resulted in an estimated 6.7 million more people losing health insurance, potentially reaching 10 million by year’s end. Civis estimates that more than 36 million Americans are now without coverage.
Consider the health consequences of those economic realities. “We have known for a long time that not being insured has effects on your health outcomes. People may delay or completely forego preventive care and treatments that they otherwise would need,” Son explained.
Not only was loss of insurance greater among the Black community, but the inability to recapture their insured status – either through a spouse or partner or purchasing a plan themselves – proved more prevalent among this group.
The Civis data arrived days after the U.S. Census released its own findings for the number of uninsured, but those tabulations lag by a year. In 2019, 9.2% of Americans, or 29.6 million people, didn’t have health insurance. That percentage was down from 15.5% in 2010, before many provisions of the Affordable Care Act took effect. The figures will most certainly rise when the 2020 census data become available.
The Civis findings are not altogether surprising, given the ongoing legacy of racism that continues to produce unequal outcomes, said Gil Bashe, managing partner, global health at Finn Partners. (The firm assisted Civis in rolling out the data, although Civis is not a Finn client.)
“These Civis survey data lay bare the far-reaching impacts of systemic racism in America – and the consequences of an insurance system tied to employment,” Bashe said in a statement.
Coronavirus’ impact on health, meanwhile, continues to cut along racial lines. According to a new analysis from Epic Health Research Network and the Kaiser Family Foundation, Black people were twice as likely as whites to test positive for COVID-19, three times as likely to be hospitalized and twice as likely to die from the novel coronavirus.
The study, which analyzed Epic electronic health record data for roughly 50 million patients from 53 health systems representing 399 hospitals across 21 states, adds nuance to earlier research showing the coronavirus infects and kills Blacks at an alarmingly higher rate.
According to the Epic-KFF analysis, racial disparities persist among patients who tested positive for COVID-19 even after controlling for variables like age, sex and comorbidities. The finding suggests that racism and discrimination, not biological differences, are at play in the minorities’ poorer COVID-19 health outcomes.
“This analysis points to delays in testing for people of color, who are sicker and more likely to be infected when they do get tested,” said Drew Altman, KFF president and CEO, in a statement. “The findings highlight the continued importance of addressing racial disparities in responding to COVID-19 as in healthcare more broadly.”
Protecting African Americans from this undue burden starts by understanding differences between race and racism in the national virus dialogue, said Vanderbilt University’s Dr. Arleen Marcia Tuchman, who specializes in the U.S. and European history of science and medicine, especially the racial overtones of disease.
“The part of the COVID conversation that concerns me is that it’s being partially explained by comorbidities and pre-existing conditions,” said Tuchman.
Her most recent book, Diabetes: History of Race and Disease, tracks how that malady was blamed on various populations – from Jews in the early 20th century to Native Americans, African Americans and Hispanics today – by pointing to racial characteristics. She sees echoes of those shifting beliefs in current dialogue around which populations are most likely to be infected with coronavirus.
“To explain racial disparities in COVID-19 by pointing to a rise in comorbidities is just blaming the disease on the population that is sick. That really troubles me,” Tuchman said.
At the same time, she added, throughout history there’s always been a minority group that said, “‘Stop clinging to biology and behavior and start looking at living conditions, including discrimation.’ But that voice has had a really hard time getting traction.”
To ensure the current moment doesn’t pass without real change, Tuchman urges Americans to confront the root causes of health disparities and systemic racism in an open way. “It’s almost become a refrain when we talk about racism – low health insurance rates, jobs requiring travel, living in multi-generational homes – a litany of reasons,” she continued. “But we’re not getting to the explicit policies this government put in place.” Those policies range from red-lining (denying mortgages to people of color) to incentivizing fast-food chains to go into inner cities to denying GI Bill rights to people of color after World War II.
Research also suggests that chronic exposure to racism and discrimination create physiological or hormonal responses that negatively affect health, Tuchman said. “Racism is not just this thing out there that you can shoot down. It has a direct impact on peoples’ bodies.”
We must also take care to document the problem. It wasn’t until August that the Department of Health and Human Services mandated that states track the virus by race, Son added. Prior to that, the Centers for Disease Control and Prevention had been silent on the issue of race.
“There is a serious under-documentation of racial and ethnic subgroups, of identity alongside the cases, which makes it problematic when you’re trying to figure out what the impact of COVID has been for many of these groups,” Son said. While Civis noticed similar coverage trends between the Latinx and Black communities, it stopped short of making assertions because of a smaller statistical sample.
Things could get worse on the insurance front before the year is out. “I don’t see any reason why it wouldn’t, unfortunately,” Son said. “Uninsured levels could continue to rise unless there’s really focused efforts by payers and the government to ensure that challenges to getting reinsured are removed for that community in particular.”
For pharma marketers, too, the Civis research has major implications. “Medical advances are only meaningful if people can access these therapies,” Bashe wrote in an email. “If they are not insured, it is not a matter of formulary coverage. It’s the challenge of access.
“We are going to see a return to the 1990s, when people accessed healthcare by way of the emergency room. Pharma companies will need to revisit their patient assistance programs and make sure that people know how to engage the system. These data suggest more woes to come.”