With the passage of the one-year anniversary of the first COVID-19 death in Tennessee, we can reflect on the prevailing message about the pandemic at the time being ‘we are all in this together.’ But it did not take long before it became very evident, as the epidemiologist Camera Jones pointed out: “The virus can infect anyone, but the disease discriminates in how profoundly those people are affected.”
Early in the pandemic evidence emerged that COVID-19 was disproportionately impacting Black and Brown communities and reminded us very painfully about the intersectionality of race, privilege, socioeconomic status, and health. Black and Latino people were four to nine times more likely to be infected by the COVID-19 virus than White people. Along with the higher rates of infection and death associated with the virus, minority communities faced an economic pandemic because of racist structural policies and practices that created under-resourced neighborhoods where many minorities who earn lower wages (but are considered essential workers) live. For example, 43% of Black and Latino people work frontline jobs compared to 25% of White workers. Frontline workers are in the stressful situation of higher COVID-19 exposure because of their jobs, and their risk is even greater because many do not have health insurance through their jobs.
These workers were the first to lose their jobs, resulting in them losing health insurance (if they had it) for themselves and their children when service industries abruptly shut down. Many parents may not know that almost every child in households below 250% of the federal poverty level qualify for health insurance at no cost or low cost. For these families, their children do not receive consistent health care, and parents may also delay needed medical services. Early intervention and preventative health care are necessary for children to grow, learn, develop, and maximize their full potential socially and academically.
Having health insurance increases access to emergent and preventative care, while protecting against financial hardships. The out-of-pocket cost of seeking medical care causes ripple effects, such as making it harder to buy food, pay rent and utilities, and secure other necessities like medicines. This is applicable to minorities and low resource White people, all who have experienced the intersection of the COVID-19 pandemic and the lack of health insurance.
Before the pandemic, people of color were more likely to be uninsured. The uninsured rate for non elderly White adults is 10% but for non elderly Black adults it is 12.3% and for non elderly Hispanic adults it is 36.5%.
Ten percent of Tennessee’s total population was uninsured in 2020, above the national average. Tennessee ranked 37th among the 50 states for the percentage of the population that is uninsured. Additionally, 122,000 Tennesseans lost health coverage because they lost their jobs between February and May 2020, bringing the state’s total uninsured adult population to 751,000. Nationally, about one of every three COVID-19 deaths and 40% of COVID-19 infections are linked to health insurance gaps. A new report shows that in Tennessee alone, from Jan. 22, 2020 through Aug. 31, 2020 there were 70,996 COVID cases (48% of total cases) and 661 deaths (38% of total deaths) linked to health insurance gaps.
For many people in under-resourced communities, the stress caused by illness and death from the COVID-19 pandemic is compounded by the stress already experienced as they faced issues of violence, pollution, substandard housing, low wage employment, food insecurity, and preexisting health conditions. For these people, who are disproportionately people of color, getting back to ‘normal’ should not be the objective. Creating a better normal should be the goal.
The American Rescue Plan Act (ARPA) recently passed by Congress is a bold effort to help Americans recover from the COVID-19 pandemic and create a better normal by addressing the existing inequities that made some people more vulnerable to a public health crisis, particularly access to health care. ARPA includes an additional incentive for states to take Medicaid expansion. An analysis by the Kaiser Family Foundation shows Tennessee would gain $900 million over two years in addition to the $1.4 billion in federal funds the state would receive each year. This is a deal that our state can’t pass up, as there is no good reason to refuse billions of federal funding to improve the physical and mental health of all our citizens. Medicaid expansion will provide support for those who are suffering because they cannot access physical and/or mental health services due to lack of health insurance. Do these lives matter? How do we justify human suffering that could be eliminated if only the people with power would do the right thing to ensure that all people can receive high quality health care?
As Dr. Martin Luther King, Jr. stated at the Second National Convention of the Medical Community for Human Rights in Chicago on March 25, 1966:
“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death. I see no alternative to direct action and creative nonviolence to raise the conscience of the nation.”
The only humane and viable long-term solution to decrease the number of uninsured Tennesseans and address racial health disparities is to close the coverage gap by expanding Medicaid.
(Freida Outlaw, Ph.D., RN, APRN, FAAN Retired Assistant Commissioner, Tennessee Department of Mental Health and Substance Abuse Services.)