Key Priorities for Black Health and the Biden Administration
By Elon Smith
2020 has been eventful to say the least. From the racial tensions and unrest due to the deaths of George Floyd and Breonna Taylor, to the untimely passing of Kobe Bryant and Chadwick Boseman, to a novel coronavirus pandemic, and even the wildfires in the West… the election of President-elect Joe Biden can feel almost unimportant in the grand scheme of things, especially to a Black American. I have heard many of my friends and family express feelings of uncertainty that the Joe Biden and Kamala Harris administration will actually lead to change for our communities.
Although it’s been a hard and divisive year, I believe now is the most urgent time for us to hold the President-elect’s feet to the fire. The stakes are at their highest. We will need to hold this next administration accountable to promises made during the campaign. There are a number of hot-button issues in the healthcare space, specifically, that I would urge everyone to be informed about and to continue to advocate for in the years to come.
The Affordable Care Act (ACA) or Obamacare
When I think of the top health related issues that Black people should be aware of, I immediately think of the future of the ACA. Without going into the details of everything that was set in motion back in 2010, the ACA is responsible for a handful of key outcomes: 1) increased access to insurance coverage; 2) Medicaid expansion; 3) creating a focus on preventative care; and, 4) supporting more innovative care delivery to decrease cost and increase quality care. With this piece of legislation in place, almost 20 million previously uninsured Americans received coverage.
For Black people specifically, the ACA brought uninsured rates down from 20% in 2010, to 11.5% in 2018, however, Black people are still 1.5 times more likely to be uninsured than white people. It is also important to note that 15% of the uninsured Black population falls into a coverage gap (which is the largest gap of any racial group), due to the fact that a majority of us live in states that did not implement Medicaid expansion (as of January 2020) – Alabama, The Carolinas, Georgia, Florida, Mississippi, and Texas to name a handful [1].
It is imperative that we seek to be insured.
Having health insurance is beneficial to take on the often unexpected financial burden of an expensive health care system. Being insured also creates a focus on preventative care (which is also free care with a plan from the Obamacare Marketplace!). This allows us to take the right steps to proactively stay healthy through vaccines and screenings instead of only seeking healthcare when we are already sick. This point is critical for the Black community. Why? Because black people are more likely to die at an early age, in comparison to whites, from all causes [2]. We are also more likely to be unemployed, smoke, be obese, and not have access to a doctor in comparison to white people, which all plays a role in our overall health. With various social determinants of health – the conditions in the environment we do life (live, work, play, learn, worship, etc.) that impact our health – working against us, having the option to schedule preventative visits could make all the difference.
The Biden administration supports the continuation and expansion of the ACA. Although he does not support “Medicare for All” or any kind of universal healthcare system, he does propose a new public health insurance option similar to Medicare. With this “public option” the uninsured who live in states that did not expand Medicaid would be enrolled, and those who would like to opt in (and do away with their private or employee-sponsored insurance) could purchase as well [4]. Expanding enrollment to the uninsured and providing the option to switch to potentially lower cost public options could provide more Black people the opportunity to become insured. He also details the creation of tax credits to combat the cost of care and regulations on prescription drug prices. These new policies and regulations could lead to more affordable care and drug costs for many Black Americans.
The COVID-19 Pandemic
The second area that everyone should really focus on is the response to the COVID-19 pandemic in the coming years. The inconsistency in approach from the leaders of this country has left the nation unsure of what to believe. There is, admittedly, a lot left to learn about COVID-19, but we must remember it is still a virus that has, to date, infected 12.4 million people and caused more than 250,000 preventable deaths [5] in the United States alone; and it has had a disproportionate impact in the Black community. This isn’t something that we should ignore.
As a Black American you have a 2.6 times higher chance of getting COVID-19, a 4.7 times higher chance to be hospitalized, and a 2.1 times higher chance of death in comparison to white Americans [6]. Why is this the case? Our social determinants of health are at play once again. For example, in 2018 the Bureau of Labor Statistics showed only 31% of Black people in Management or Professional jobs [7] in comparison to 41% of whites and 54% of Asians. This means that we are more likely to work in service industries, public transportation, healthcare facilities, or other jobs that were considered “essential” and without the flexibility to stay home during the pandemic, putting us at greater risk of exposure. As a community we are also, as mentioned previously, more likely to be uninsured which could impact our choice to seek care or our ability to access proper care when needed. Discrimination against, overlooking, or failing to listen to the needs of Black patients in any healthcare setting could also result in adverse outcomes. For these reasons, and many more that I have not mentioned, the Biden administration’s response should be top of mind for us, as it is critical to our health.
Joe Biden has laid out a Federal plan to help combat the pandemic and has already selected his board of advisors to implement that plan. He has proposed a seven-step plan which includes restoring the White House National Security Council Directorate for Global Health Security and Biodefense (eliminated by the Trump administration), increasing access to testing and Personal Protective Equipment (PPE), as well as the implementation of a COVID-19 Racial and Ethnic Disparities Task Force to “provide recommendations and oversight on disparities in the public health and economic response” [8]. It is imperative that we continue to be vocal about COVID-19 disparities and push for strategies that mitigate the impact of the social determinants of health on our COVID-19 morbidity and mortality. Improvements in the SDOH will lead to better COVID outcomes and improved overall health.
Reproductive Health
With the passing of Justice Ruth Bader Ginsburg and the appointment of a new Supreme Court Justice by the Trump administration, the impact of a conservative majority in the court has many Americans thinking about the future of reproductive health in this country. Abortion rights and access to contraception are topics that we should be knowledgeable about not only as Americans, but as a member of the Black community.
In a study conducted by the CDC in 2016, it was found that Black women accounted for 38% of all abortions, and had abortions at the highest rate (25.1 per 1,000 women) and ratio (401 abortions per 1,000 live births) than another or race [9]. Abortions happen when there is an unwanted pregnancy, and this is not something that is unique to the Black community. So, why do we have these rates? As mentioned in the previous two sections, we must again direct our attention towards the social determinants of health and socioeconomic status (SES). As of 2018, roughly 22% of Black women lived in poverty (in comparison to 9% of white women). Living in a lower SES is not only correlated to a number of unhealthy behaviors, but there is also a relationship between SES and access to healthcare/a doctor and affordable contraception. Numerous studies and data collected through the CDC’s National Survey of Family Growth [10] show a correlation between people of color and disparities in abortion.
Biden’s plans related to reproductive health detail steps to codify Roe v. Wade, therefore making it federal law and protecting a person’s right to safe abortions. He also plans to ensure all employer-sponsored coverage as well as his new “public option” coverage have no-cost contraception requirements. This would give more people the resources to prevent unwanted pregnancies.
Maternal Mortality
Lastly, maternal mortality is also an important topic for the Black community given that Black women are 2.5 times more likely to die during childbirth than white women. In a nation as advanced as ours, this simply should not be the case. During the Biden administration, we need to ensure this issue gets the focus and funding it deserves, so that we can identify the real story underlying the disparities and make the necessary changes toward reducing them.
The Trump administration has taken some steps to bring a spotlight to maternal mortality, such as the Preventing Maternal Deaths Act of 2018, which provides funding for states to do more analysis on what is causing these deaths [13]. Biden and Harris have called out maternal mortality and the racial disparities seen in this area, proposing a plan to create a nationwide strategy as well as a promise to direct the Secretary of Health and Human Services to make this topic a priority for the Department [14].
Over the next few years it is important that we do our best to stay informed of potential policies and legislation that could impact the livelihood, health, and safety of our community. If we have learned anything this year, it is that we can command attention, create a conversation, and drive forward change when we let our voices be heard. Let’s advocate for Black health in the same way.
Elon Smith is a Healthcare Consultant at Huron Consulting Group where she has gained expertise in healthcare financial analysis and performance improvement. In order to further advance her career in the healthcare industry, she is currently a second year MHA student at The George Washington University. Elon also has particular interest in addressing population health and racial disparities within healthcare.
Follow Elon Smith on IG: @elonnadeen
References:
Artiga, S., & Orega, K. (2020, March 05). Changes in Health Coverage by Race and Ethnicity since the ACA, 2010-2018. Retrieved from https://www.kff.org/racial-equity-and-health-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/
CDC. (2017, July 03). African American Health. Retrieved from https://www.cdc.gov/vitalsigns/aahealth/index.html
Gonzales, S. (2017, October 11). Trump Administration Slashing Funding for Marketplace Enrollment Assistance and Outreach. Retrieved from https://www.cbpp.org/blog/trump-administration-slashing-funding-for-marketplace-enrollment-assistance-and-outreach
Joe Biden for President: Official Campaign Website. (2020, October 11). Plan to Protect and Build on Obamacare: Joe Biden. Retrieved from https://joebiden.com/healthcare/
CDC. (2020, January 21). CDC COVID Data Tracker. Retrieved from https://covid.cdc.gov/covid-data-tracker/
CDC. (2020, August 18). COVID-19 Hospitalization and Death by Race/Ethnicity. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html
U.S. Bureau of Labor Statistics. (2019, October 01). Composition of the labor force. Retrieved from https://www.bls.gov/opub/reports/race-and-ethnicity/2018/home.htm
Joe Biden for President: Official Campaign Website. (2020, September 16). COVID Timeline. Retrieved from https://joebiden.com/covid19/
Jatlaoui, T. C., Eckhaus, L., Mandel, M. G., Nguyen, A., Oduyebo, T., Petersen, E., & Whiteman, M. K. (2019). Abortion Surveillance — United States, 2016. MMWR. Surveillance Summaries, 68(11), 1-41. doi:10.15585/mmwr.ss6811a1
CDC. (2020, September 10). NSFG - National Survey of Family Growth Homepage. Retrieved from https://www.cdc.gov/nchs/nsfg/
CNN Research. (2020, May 07). Roe v. Wade Fast Facts. Retrieved from https://www.cnn.com/2013/11/04/us/roe-v-wade-fast-facts/index.html
Hyde Amendment Codification Act, S.142, 113th Congress (2013). https://www.congress.gov/bill/113th-congress/senate-bill/142
Preventing Maternal Deaths Act of 2018, H.R. 1318, 115th Congress (2018). https://www.congress.gov/bill/115th-congress/house-bill/1318
Joe Biden for President: Official Campaign Website. (2020, September 22). The Biden Agenda for Women. Retrieved from https://joebiden.com/womens-agenda/
