Photo: Cloe Poisson / CTMirror.org
As state officials consider reforms to curb and prevent police brutality, the protests that have flared up nationwide since the death of George Floyd and the inequities exposed by the COVID-19 pandemic have laid bare the need to also address structural racism in the public health system, advocates say.
“As we’ve been watching the protests that have erupted across our country in response to the killing of George Floyd and others, we know now that even in the midst of the pandemic, structural racism and the racism that shows up as people navigate social space are still alive and well,” said Wizdom Powell, director of the Health Disparities Institute at UConn Health. “We’ve long been arguing for a systems change around health care access and insurance.”
In Connecticut, black residents are 2 ½ times more likely to die from a coronavirus infection than whites. The death rate for Hispanics is 67 percent higher than for white residents. Those chasms have long been present in other areas of health, from asthma rates to insurance coverage disparities.
People of color here are also more likely to work in high-risk, “essential” jobs, such as those in nursing homes, grocery stores and retail. Many live in densely populated communities and have higher rates of pre-existing conditions like diabetes and asthma that are caused or worsened by systemic racism.
During the pandemic, residents in low income, predominantly minority neighborhoods have faced larger barriers to testing and other services. Until May, two-thirds of the state’s testing sites required a doctor’s note, and many people living in these communities have no insurance or primary care doctor to refer them.
Advocates who for years have been pushing for reform in the health system say lawmakers should consider changes when convening a special session this summer.
Proposals that have taken on fresh urgency include an expansion of Medicaid, known as HUSKY in Connecticut, better data collection that reflects more races and ethnicities, opening up Medicaid coverage to undocumented residents, and accountability measures to ensure equity proposals are being followed in state agencies, advocates said.
“We are demanding that our government is actively intentional about focusing on racial equity through policy change,” said Tekisha Dwan Everette, executive director of Health Equity Solutions. “That means first declaring that racism is a public health crisis that must be addressed and requires our attention.”
Data on the coronavirus’ impact on minority communities was at first incomplete and later adjusted to give a truer picture of how people of color have been affected in Connecticut. But better data collection extends beyond the pandemic.
Most of the race-related statistics gathered in the state – from Medicaid enrollment to the uninsured population – show health outcomes for Black, Hispanic, Asian and white residents. The broader categorization masks disparities that affect residents of certain races and ethnicities. For example, diseases that disproportionately impact Puerto Ricans or Mexicans may not register in data that covers Hispanics more broadly.
Advocates are urging the state to expand its reporting by requiring more specificity in race and ethnicity. They also have recommended gathering data based on the many languages spoken in Connecticut. Reform in this area could include financial incentives for departments or agencies to step up their efforts.
“We don’t do a good job in the state of reporting actively and fully on racial, ethnic, and language data,” Everette said. “So we can’t solve a problem – even though we know it exists – if we don’t have the tools to monitor our progress in that way.”
Medicaid expansion is another priority. Many people in Connecticut make too much money to qualify for Medicaid but not enough to purchase a plan on the state’s health exchange – a population that advocates say “falls through the cracks” when it comes to health coverage.
Last year, lawmakers restored some of the funding for Medicaid that was cut in 2016 after the legislature tightened income restrictions. In 2019, they pushed the qualifying threshold to 160 percent of the federal poverty level, up from 155 percent. That extended coverage to about 3,600 more people.
But advocates are now pressing for the threshold to reach 201 percent of the federal poverty level. Officials with the state’s Department of Social Services did not have an estimate of what that would cost the state, which faces a deficit this year of more than $600 million due to the COVID-19 pandemic.
“This crisis has made evident that access to care is critically important,” Patricia Baker, head of the Connecticut Health Foundation, which advocates for policies that address racial and ethnic health disparities.“The population that often gets neglected is those who are 133 percent to 200 percent [of the federal poverty level]. They are the most vulnerable, with the least means of even purchasing coverage on the exchange. So we believe any expansion of coverage and discussion should make that a top priority.”
The COVID-19 pandemic has also turned a spotlight back on an issue that failed to gain support last year: opening Medicaid coverage to the undocumented community.
During the 2019 legislative session, lawmakers considered a bill that would have allowed Connecticut’s roughly 18,000 undocumented children to receive state-funded health coverage.
Nonprofit groups had estimated the first-year cost to be about $4 million and the second-year expense to be $15 million as more children joined the program. But the bill fell into limbo after the state’s nonpartisan Office of Fiscal Analysis pegged the cost at $53 million per year for the first two years.
State officials have extended some relief to the undocumented community since the COVID-19 pandemic began – Gov. Ned Lamont ordered that those residents could get access to Medicaid for emergency medical conditions (including testing for coronavirus and certain provider visits). Lamont also promised $3.5 million in state and philanthropic dollars to help undocumented families ineligible for federal pandemic relief.
But advocates say the COVID-19 crisis has highlighted the need for more to be done – including again exploring the feasibility of opening Medicaid to Connecticut’s undocumented population.
“The fact that we’re in an international pandemic shows how health care needs to be a human right and why people need to have access to health care,” said Camila Bortoletto, who with her twin sister founded the immigrant rights group CT Students for a Dream. “We’re only as healthy as the least healthy among us.”
Finding ways to direct more funding to community health workers, who help bridge the gap between the health care system and underserved communities, is another priority.
The Rev. Robyn Anderson, a co-founder of the advocacy group Ministerial Health Fellowship, said those workers play a crucial role in reducing disparities. After the pandemic began, she and her colleagues put together an initiative to educate communities of color about the coronavirus, to hand out masks and other supplies, and to discuss health care options. Having more community health workers could help expand that effort, she said.
“We’re very concerned,” Anderson said. “We hope [legislators] will be able to really look at health equity through the lens of structural racism and make some policy changes.”
Once these reforms are in place, Everette said she hopes state departments will appoint someone to ensure they are followed. Having an “equity monitor” embedded in key offices, such as the governor’s office and health-related departments, would keep people accountable.
Several key lawmakers said they are considering equity reforms.
Sen. Kevin Kelly, a ranking Republican on the legislature’s Insurance and Real Estate Committee, has suggested putting together a task force to study health insurance and health care inequities. The group would complete its work by the end of the year and make recommendations in time for the 2021 regular session.
“It’s an issue that needs to be studied because you can’t ignore the numbers and you can’t ignore the facts,” he said.
But others said the changes shouldn’t wait.
“It is certainly clear that one of the things we have seen highlighted by the pandemic is, once again, the disparities caused by race and poverty,” said Senate President Pro Tem Martin Looney, a New Haven Democrat. “This now gives us a mandate to move on things that had been seen as certainly advisable, but now seem even more urgent.”
Rep. Sean Scanlon, a Guilford Democrat who is a co-chairman of the Insurance Committee, said lawmakers should immediately begin looking at Medicaid expansion and access for the undocumented community.
“Disparities don’t end with policing,” he said. “The coronavirus has exposed something that we’ve long known but rarely talk about – that the kind of health care you receive is dictated by the ZIP code you live in. I just don’t think that that can be acceptable to us anymore.”