Tip Sheets

Coronavirus pandemic highlights disparities in health insurance and health care

By Joseph Burns

News about Pfizer-BioNTech’s COVID-19 vaccine was so big in December that video crews recorded what would be an otherwise mundane scene as tractor-trailer trucks rolled out of Pfizer’s distribution center in Portage, Mich., starting on Dec. 13.

But for non-white Americans, this good news is only part of the story because Blacks, Latinos, Native Americans, and other people of color may be reluctant to get the vaccine, as Glenn Howatt reported for the Minneapolis Star Tribune. For an article on skepticism about the vaccine among people of color, Howatt quoted Ana Núñez, M.D., a medicine and vice dean professor for diversity, equity, and inclusion at the University of Minnesota Medical School. “Unfortunately, the communities of people who are most affected by the pandemic are also more likely to be the most hesitant about a vaccine,” she said.

Howatt’s article is just one example of how journalists localize the national story about the vaccine for COVID-19. Also, it’s an excellent example of why people of color are reluctant to get the vaccine. Such reluctance is born of widespread disparities in the health insurance and health care systems in the United States. Here’s another example of how journalist Lola Fadulu localized the vaccine hesitancy story for The Washington Post.

Hesitancy about the vaccine is just one of many signs that the U.S. health care system has failed to provide adequate health insurance coverage and how the health care system itself so often fails to provide quality care for people of color. The disparities in each of these areas are glaring, and the COVID-19 pandemic have made them worse.

To Howatt’s credit, his article was published on Dec. 11, the same day that the FDA issued the first emergency use authorization (EUA) for a vaccine to prevent COVID-19. He showed that this is a story that journalists can do in their communities because the pandemic has been especially harmful to people of color in the United States.

Non-white Americans are more likely to suffer financial hardship, extreme cases of disease or death than the white population, Peter Johnson wrote in a recent AIS Health article. “Experts say the devastation to communities of color is the product of systemic racism—particularly a lack of access to insurance coverage and quality care—and the pandemic’s economic consequences will make all of those problems worse.”

In October, USA Today provided an excellent example of producing local angles on this story in a six-part series on how racism contributes to high COVID-19 infection and death rates. In the series, “‘An unbelievable chain of oppression:’ America’s history of racism was a preexisting condition for COVID-19,” at least 10 journalists reported on how:

On the series launch page, the editors wrote, “Racist policies mean many Black, Latino, Asian and Indigenous Americans are poorer and sicker than white Americans. COVID-19 makes these inequalities deadly. USA Today’s editor-in-chief Nicole Carroll explained how the team of print journalists, photographers and videographers reported the series. Georgia Health News showed how it used the USA series to develop a strong local story, “Race and COVID: Stark disparities in rural Georgia.”

Lack of health insurance is part of the story. Data from the series show that since the coronavirus emerged in the counties where people of color make up most of those counties’ residents, they have consistently had the highest COVID-19 death rates. “Seven of the top 10 counties have populations where people of color make up the majority, the analysis found,” Carroll wrote. “More than 11% of residents in the top 20 counties — 4,883 people — don’t have health insurance, the data show.”

Data from other sources support USA Today’s findings. In this March report, “Changes in Health Coverage by Race and Ethnicity Since the ACA, 2010-2018,” researchers at KFF showed that while the number of uninsured Americans declined after the Affordable Care Act went into effect in 2014, by 2018, more people of color were likely to be uninsured than their white counterparts. KFF’s data would be a good source for local stories on how a lack of health insurance affects non-white Americans.

“Blacks remained 1.5 times more likely to be uninsured than whites from 2010 to 2018, and the Hispanic uninsured rate remained over 2.5 times higher than the rate for Whites,” the KFF’s researchers reported.

Christen Linke Young, a fellow with the USC-Brookings Schaeffer Initiative for Health Policy, cited this KFF report in a video she recorded for the Brookings Institution in February 2020. “In the United States, there are significant racial disparities in access to health coverage and in health outcomes,” she wrote. “People of color are far more likely to be uninsured in America, due in part to several states’ refusal to expand Medicaid.” She also noted that the infant and maternal mortality rates for Black babies and mothers are far higher than those of white babies and mothers. This topic is one we covered in an earlier tip sheet.

Lack of health insurance creates uncertainty about how the uninsured will pay for coronavirus testing and treatment, according to a report that West Health and Gallup published in July, “New Survey Finds Large Racial Divide in Americans’ Concern Over Ability to Pay for COVID-19 Treatment. These data would be a good source to support a strong local angle on how the pandemic spreads in such neighborhoods.

People of color were far more likely to worry about their ability to pay for care if they were diagnosed with COVID-19 than their white counterparts, the West Health and Gallup research showed. “By a margin of almost two to one (58% versus 32%), non-white adults reported that they were either concerned or extremely concerned about the potential cost of care compared with white adults,” they added.

Now that the FDA has approved the Pfizer-BioNTech vaccine and Moderna’s vaccine is on the cusp of approval, health care journalists can explore how racism in the health care system raises fears about the vaccine. In October, KFF and The Undefeated, which ESPN publishes, reported the results of a poll showing that Blacks have a low opinion of health care, a factor that set the stage for the spread of the pandemic. “A new nationwide poll found that 7 in 10 African Americans believe that people are treated unfairly based on race or ethnicity when they seek medical care,” the researchers explained. “It’s a feeling born of unequal history and intensified by the coronavirus pandemic, which is disproportionately ravaging Black lives both physically and economically.”

About the vaccine, the researchers said, “Just half of African Americans surveyed said they would be interested in taking a vaccine, even if it were determined to be safe and were provided at no cost. By comparison, 2 in 3 white people said they would definitely or probably get vaccinated, as did 6 in 10 Hispanics.”

The research shows that how the vaccine will be distributed would be another story to pursue. “The vast majority of African Americans who said they would not take a coronavirus vaccine did not think that it would be properly tested, distributed fairly or developed with the needs of Black people in mind,” they noted.

Even a cursory search online will yield multiple story ideas for journalists seeking to cover this story. Two more are worth mentioning.

One is particularly worrisome: In October, Casey Ross of Stat News reported that analytics software used to identify patients whose certain medical treatments have infused racial bias into decision-making about who should receive stepped-up care. A Stat investigation found that hospitals use multiple algorithms nationwide to reinforce deeply rooted inequities into the health system, walling off low-income Black and Hispanic patients from services that less sick white patients routinely receive.

The other is maternal mortality, which we have covered many times in the past few years.

For more on the topic of how an algorithm used that health systems use widely exhibits significant racial bias, see this article from Science magazine in 2019, “Dissecting racial bias in an algorithm used to manage the health of populations.”