People of color are more likely to be uninsured and face increased risks for chronic conditions

Caitlin Owens
·4 min read

While the COVID-19 pandemic has exposed serious disparities in access to health care, those differences were baked deep into the American health system long before the coronavirus came along.

Why it matters: These systemic disparities are partly why people of color are more likely to be uninsured and face increased risks for certain chronic conditions — and even have shorter life expectancies.

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By the numbers: In 2019 — before the pandemic hit — 11% of Americans under 65 were uninsured, per KFF. Diving a little deeper...

  • 8% of white Americans and 7% of Asians/Native Hawaiians and Pacific Islanders didn't have coverage, compared with 22% of American Indians/Alaskan Natives, 20% of Hispanics and 11% of Black Americans.

  • The Affordable Care Act helped reduce uninsured rates among people of color, but stark disparities with white people persist, per KFF, especially in states that didn't expand Medicaid.

  • Data is not yet available to determine COVID's exact impact, but "we do know the dislocation resulting from the pandemic has exacerbated economic inequities, so it has likely exacerbated health coverage inequities as well," KFF's Larry Levitt says.

There are also stark racial divides in where people get their coverage.

  • Nearly two-thirds of white Americans get their health insurance through their employer. The same is true of only 47% of Black Americans, 43% of Hispanics and 37% of American Indians/Alaskan Natives.

  • Medicaid, which is usually free, often covers more benefits than employer insurance but may have limited networks of doctors and hospitals.

  • 15% of nonelderly white Americans are covered by Medicaid, compared with 33% of Black Americans and 30% of Hispanics, per KFF.

But those figures can undersell the severity of the disparities in access to care, which is fundamentally an affordability issue.

  • More generous coverage is often more expensive. Millions of insured Americans have high out-of-pocket costs, such as deductibles or copays, that they can't afford.

  • In 2019, 11% of white adults reported having skipped seeing a doctor over the last year because of cost, whereas 16% of Black adults and 21% of Hispanic adults said the same.

Between the lines: America's health care system insurers, doctors, hospitals and drug companies — is a business aiming for profitability and happy shareholders. When certain areas don't yield a profit, services can disappear.

  • Pharmacies have closed less-profitable stores in poor neighborhoods, creating "pharmacy deserts" that make it harder to fill prescriptions.

  • Disparities in the quality of care are often found, too. Black patients tend to receive care at lower-performing hospitals than white patients, even when they live in the same hospital market, a study published last year in NBER found.

Data: Kaiser Family Foundation analysis of 2018 Behavioral Risk Factor Surveillance System; Chart: Will Chase/Axios

Poor health care contributes to racial and ethnic disparities in health outcomes, too.

  • People of color are generally more likely to report being in "fair or poor health" than white people, per KFF.

  • They also have higher rates of certain underlying health conditions — like HIV, diabetes and heart disease in Black people — some of which contributed to a higher risk of severe COVID-19.

The gap in life expectancies between white and Black Americans had generally been shrinking since the 1990s — but the pandemic may have stalled that progress.

  • In 2019, Hispanic Americans had a life expectancy of 81.8 years, white Americans of 78.8 years and Black Americans of 74.7 years, per the CDC.

  • The pandemic caused life expectancy to drop for all three groups, but more for Hispanic and Black Americans than white Americans.

  • The pandemic also highlighted the vulnerability of Native Americans, who had the highest death rates of all.

Join Axios' Mike Allen and Hope King on Tuesday at 12:30 p.m. ET for a Hard Truths event on systemic racism in health care, featuring White House senior adviser Andy Slavitt, White House senior policy adviser Cameron Webb and California Surgeon General Nadine Burke Harris.

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