Respond to Coronavirus with Equitable Health Care Access

THE ISSUE: HEALTH COVERAGE

Too many people in the U.S. still have no health insurance or lack sufficient insurance. The Affordable Care Act helped close the insurance gap by expanding eligibility for Medicaid and offering more affordable, private-sector health plans through the Health Insurance Marketplace. Among non-elderly adult Americans, the Affordable Care Act reduced the uninsured from 46.5 million in 2010 to 26.7 million in 2016. However, the number of uninsured Americans began rising again in 2017, primarily because of efforts to reduce coverage for low-income Americans, increasing to 27.9 million in 2018. Insurance gains are being eroded, as the number of Medicaid recipients declined by more than 2 million people (3.1%) and enrollment in the Marketplace dropped by more than 900,000 from December 2016 to December 2018 (Kaiser Family Foundation, 2019). In addition, the loss of Medicaid coverage for America’s 2.3 million incarcerated persons, a disproportionate 40% of whom are Black, can lead to particularly disruptive gaps in care for chronic diseases and substance abuse.

WHY IT IS IMPORTANT

Those who don’t have insurance or have gaps in their coverage are more likely to be people of color, have low income, have at least one working member in their household, are unable to afford the high cost of insurance, forego needed care, and face high medical debt when they do seek care. For African Americans, who have higher uninsurance rates than whites, expanding coverage is critical to address persistent disparities in health outcomes and health care access. The ACA led to a significant reduction in the uninsured rate among non-elderly, African-American adults, from 18.9 percent in 2013 to 11.7 percent in 2016—despite resistance to Medicaid expansion in the South, where higher proportions of African Americans live (Center on Budget and Policy Priorities, 2017). In 2017 and 2018, Black people began to experience a reversal of this positive trend, as they saw an increase in uninsurance from 10.7 percent to 11.5 percent. African Americans and other people of color remain more likely to be uninsured than white people (Kaiser Family Foundation, 2020).

WHAT SHOULD POLICY MAKERS DO?

The national response to the coronavirus must be informed by and proactively address existing racial disparities in terms of health care coverage, access, services, and outcomes, as well as testing and treatment for the virus. Otherwise, new policy approaches risk exacerbating current inequalities and undermining efforts to block the spread of the virus. To avert catastrophe and reduce the harm of COVID- 19, the NAACP recommends the following:

Expand Health Care Coverage

  • The federal government needs to advance efforts to expand health care coverage to the uninsured and underinsured across all 50 states and the U.S. territories toward the goal of ensuring coverage for all.
  • It should safeguard against state government efforts to restrict Medicaid coverage any further, which would be deleterious to African American health.
  • These efforts should extend to the 2.3 million people incarcerated across the country, a disproportionate number of whom are Black. (Prison Policy Initiative, 2019) At a minimum, incarcerated persons should have their Medicaid eligibility automatically reinstated once they are released, along with any other federal benefits they were receiving prior to incarceration.

THE ISSUE: PREVENTION AND TREATMENT

African Americans live with a greater burden of disease than their white counterparts, and many of their chronic conditions place them at increased risk for complications from COVID-19. The inequalities within the U.S. health care system impact people of color disproportionately, and lead to unequal access to services and poorer health outcomes, especially for African Americans. African Americans are also more likely to experience traumatic stress from racism, poverty, homelessness, and exposure to violence and incarceration, which puts them at an increased risk for mental and behavioral health problems (Anxiety and Depression Association of America, American Psychological Association). Yet African Americans are less likely to seek mental health care because of the shame, stigma, and lack of access to culturally competent mental health services. The emotional and financial toll of the pandemic is likely to increase the need for mental health services immediately and over time.

Because of residential segregation, neighborhoods that are mostly Black and Brown tend to be medically underserved. Residents in these areas often rely on federally-qualified health centers (FQHCs) for care, emergency rooms, or outpatient care for preventive services. Many of their neighborhoods lack enough primary care and mental health providers to serve area residents adequately (The Century Foundation, 2019). FQHCs are embedded within the communities they serve and understand their patients’ challenges; they offer primary, preventive health care services to all residents, regardless of insurance status and ability to pay (National Association of Community Health Centers, 2016).

In addition, while testing and treatment for COVID-19 are expanding for groups deemed most at-risk, these efforts cannot ignore populations who reside in or depend on institutional and social support settings including homeless shelters, domestic violence shelters, prisons, and juvenile detention centers.

WHY IT IS IMPORTANT

FQHCs can serve as efficient medical homes offering African Americans high-quality, patient-centered care if they receive the proper resources, including appropriate staffing for primary and mental health care, commensurate Medicaid reimbursement rates, and adequate support for physical and technology infrastructure. These institutions are especially important to the health care system since they provide comprehensive health care services to underserved, vulnerable populations and help reduce the need for more costly care, including ER visits and hospitalizations; their presence also helps stimulate local economies (Commonwealth Fund, 2019).

WHAT SHOULD POLICY MAKERS DO?

To avert catastrophe and reduce the harm of COVID-19, the NAACP recommends the following:

Improve Access to and Quality of Care

  • Incentivize the use of federally qualified health centers nationwide to address the COVID-19 pandemic.
  • Ensure dedicated resources for coronavirus education, prevention, testing, sanitation, and treatment services in all institutional and social support settings.
  • Prioritize populations who reside in or depend on institutional and social support settings, including homeless shelters, domestic violence shelters, prisons, and juvenile detention centers.