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Racism is a Public Health Crisis Say CA Lawmakers

Posted On 12 Jun 2021
By Angela Hart
In Health, Policy & Government
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After the killing last year of George Floyd, a Black man, by a white Minneapolis police officer, Wisconsin Gov. Tony Evers declared racism a public health crisis. The governors of Michigan and Nevada quickly followed, as have legislative bodies in Minnesota, Virginia and Washington, D.C.

Yet California Gov. Gavin Newsom, who governs one of the most racially and ethnically diverse populations in the U.S., has not.

State Democratic lawmakers are not waiting for Newsom to make a declaration and are pressuring the first-term Democrat to dedicate $100 million per year from the state budget, beginning July 1, to fund new health equity programs and social justice experiments that might help break down systemic racism. Possibilities for the funding include transforming parking lots in low-income neighborhoods into green spaces and giving community clinics money to distribute fresh fruit and vegetables to their patients.

Lawmakers say covid’s disproportionate impact on California’s Black and Latino residents, who experienced higher rates of sickness and death, makes their request even more pressing.

“Covid uncovered the disparities of the segregated California of the past that still has an effect today, and that we can correct if we focus on equity,” said Assembly member Mike Gipson (D-Carson), who is spearheading the funding push. “We need to build a healthier society that works for everyone.”

Lawmakers are lobbying for the money in their negotiations with the governor over the 2021-22 state budget. The legislature must pass a budget bill by June 15 for the fiscal year beginning July 1. Once Newsom receives the bill, he has 12 days to sign it into law.

The $100 million proposal to address the health effects of racism is part of the Democratic-controlled legislature’s broader public health agenda that includes a request for $235 million annually to help rebuild gutted local public health departments, $15 million per year for transgender health care and $10 million to establish an independent “Office of Racial Equity,” which would attempt to identify and address racism in state spending and policies.

Health care advocacy groups say the investments are critical to address inequality in society and the health care system that has contributed not only to higher rates of covid within disadvantaged communities, but also chronic diseases like diabetes and heart disease.

“Those who got sick and lost jobs were mostly communities of color, so seeing no new investment from the governor to really tackle racial equity is unconscionable,” said Ronald Coleman, managing director of policy for the California Pan-Ethnic Health Network, which sent Newsom a letter last July asking him to declare racism a public health crisis.

Newsom hasn’t committed to supporting the funding but said he’d be “very mindful” in negotiations with lawmakers. One proposal Newsom and state lawmakers agree on is funding for a chief equity officer to address racial disparities within state government.

Newsom pointed to other budget proposals he has made, including $600 economic stimulus payments to households earning less than $75,000, rent and utility bill assistance, and an expansion of the state’s Medicaid program for low-income residents, called Medi-Cal, to unauthorized immigrants age 60 and older.

Dr. Georges Benjamin, executive director of the American Public Health Association, said George Floyd’s killing in May 2020 motivated state and local lawmakers to look at racism through the lens of public health — which could have helped save lives during the covid pandemic. “We’re at a tipping point,” Benjamin said. “It’s important to first acknowledge that racism is real, but then it requires you to do something about it. We’re now seeing other states beginning to put money and resources behind the words.”

Some cities and counties in California have declared racism a public health crisis, including Los Angeles and San Bernardino County. But those declarations would be more meaningful backed by an infusion of state resources, health care advocates say.

“We need to be willing to put dollars into innovative approaches to addressing racism in the same way we invest in stem cells, and we need to be willing to accept that some of the things we try will work and some won’t,” said Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network.

Should Newsom sign off on the funding, grants would be available to health clinics, Native American tribes and community-based organizations to develop programs aimed at combating racism and health disparities.

The Community Coalition in South Los Angeles, a nonprofit that originally set out decades ago to address the crack epidemic, expressed interest in applying.

“There are so many vacant lots in South Los Angeles that could be turned into mini-parks. That helps not only with physical health but mental health,” said Marsha Mitchell, the organization’s communications director. “We have very few grocery stores, and if you live in Compton or South Los Angeles, your life expectancy is almost seven years lower than if you lived in Santa Monica, Beverly Hills or Malibu.”

Directing more resources to address racism could backfire, in part because voters, including some Democrats, have displayed skepticism over some of the liberal and expensive policies sought by Democrats who control Sacramento, said Mike Madrid, a Sacramento-based Republican political consultant who has also worked for Democrats.

He pointed to Proposition 16, the November 2020 ballot initiative that would have repealed California’s 1996 law banning affirmative action, which was defeated 57% to 43%.

“Racism is very much a public health problem — just look at the chronic diseases and lower life expectancies of Black and brown people, and most people believe that racism is systemic in our governance,” Madrid said. “But voters are becoming more discerning about how racism is being used by politicians to advance an agenda.”

Focusing too heavily on racism could prompt a backlash, he said, “whereas if you focused on poverty and inequality, that would solve many of the racial problems.”

But state Sen. Richard Pan (D-Sacramento), who is leading the drive to establish an Office of Racial Equity, said funding and state leadership focused intensely on structural racism are essential to ending it. Should the office not be funded in the budget, Pan said he’d press forward with a bill.

The office would work with the state’s new chief equity officer to examine the California government, including state hiring practices, proposed legislation and budget spending decisions, for evidence of racism or inequality.

It’s a priority for the legislature’s Asian & Pacific Islander Legislative Caucus, given the rise in hate crimes perpetrated against people of Asian descent, Pan said.

“We need to invest more in prevention,” Pan said. “The state needs to step up and support communities of color.”

This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

COVID Slams Ethnic Minorities

Posted On 18 Feb 2021
By Meera Kymal
In Community, Health & Wellness
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As the COVID-19 vaccination program rolls out erratically across the US, research increasingly shows that health inequities underlying who gets infected will also affect who gets vaccinated.

In telling statistics reported by the CDC and KFF, people of color are more likely to be infected or hospitalized, and more likely to die from the coronavirus.

The numbers are stark.

Compared to whites, American Indians are 1.9 times more likely to be infected, African Americans nearly 3 times more likely to be hospitalized, and Latinx people 2.4 times more likely to die.

Asian Americans are the highest risk for hospitalization and death among any ethnic group. In San Francisco, it’s reported that Asian Americans consistently account for nearly half of COVID-19 deaths.

It’s impossible to ignore the disproportionate toll of the pandemic on racial and ethnic minorities. Even though all communities are at risk for COVID-19, the socioeconomic status of people of color, and their occupations in frontline, essential and infrastructure jobs puts them at greater risk of exposure to the coronavirus.

For minority communities, it means that where you live and where you work shapes how the virus impacts your health, while inadequate access to healthcare makes you more vulnerable to its consequences.

“The pandemic has exposed the “underlying health disparities, social determinants of health, systemic inequalities and discrimination contribute to the disproportionate impact the virus has had on all communities of color,” said Adam Carbullido of AAPCHO, at an EMS press briefing on February 12, about health inequities in the pandemic.

Health advocates predicted that an inequitable distribution of vaccines was inevitable, given the high rates at which Blacks, Latinos and other ethnic groups were being infected and dying in each wave of the pandemic.

This is borne out by data from the Kaiser Family Foundation (KFF) which is tracking vaccine distribution. For example, fewer black people are getting vaccines despite a higher rate of COVID 19 cases. In Delaware only 6% of Blacks were vaccinated though 24% were infected, and in Louisiana, only 13% of Blacks received vaccines though 34% were infected, while in Mississippi, 38% of Blacks were infected but only 17% got the vaccine.

However, the lack of disaggregated racial data at the state and national level is hobbling equitable distribution of the COVID-19 vaccine, noted Dr. Daniel Turner-Lloveras of the Latino Coalition Against COVID-19. Currently only 20 US states are reporting racial data.

Given that it’s primarily Black and Latino workers in essential jobs, it’s imperative to consider who’s at high risk when making decisions about reopening the economy, he added.

If we cannot quantify racial disparity in vaccine distribution, warned Lloveras, it will be difficult to develop interventions to ensure vaccines are given to those who need it most.

Health disparities between whites and people of color that are impacting vaccine distribution, are “gaps that have become chasms,” said Lloveras. The vaccine roll out “inherently prioritizes a population that is not reflective of the people who are disproportionately affected by the coronavirus”, added Virginia Hedrick, of the California Consortium for Urban Indian Health.

In American Indian country, inequitable vaccine distribution is merely a reflection of the historical trauma inflicted on indigenous communities that has negatively impacted their health and wellbeing over the long term, said Hedric resulting in the highest rates of diabetes, heart disease and substance use disorders. Its only because of advocacy that the Indian Health Service has a separate vaccine reserve allocated to urban and tribal Indian American communities.

Barriers to Better Health & Vaccines

Several other factors create barriers to better health and getting a vaccine among people of color.

Ethnic minorities tend to live in densely populated areas which makes social distancing difficult, and often in multi generation family homes which put elders at risk. They may use public transportation which could expose them the virus, and lack health insurance or healthcare access.

Farmworkers and the elderly face similar barriers in the form of digital literacy, language barriers and internet access, said Lloveras. With stay at home orders in place, telehealth depends on who has access to technology. He suggested providing Internet access hotspots and community classes on computer literacy to expand digital access for underserved minorities.

The lack of a robust public healthcare system requires that we provide the technology to help people see a doctor and register for vaccines.

In Asian communities, added Carbullido, patients of Asian descent report fear in getting help they need because of emotional trauma caused by racism and xenophobic attacks associated with the virus.

Yet, many ethnic minorities are reluctant to get their shot because they mistrust the government. Kaiser Family Foundation’s vaccine tracker data reports ‘fear of side effects” prevents people from obtaining the vaccine.

Lloveras proposed ‘a gigantic digital patient engagement project’ to address vaccine hesitancy to set the path to herd immunity and a semblance of normal life .

Missteps in California

Each state’s scramble to acquire and distribute vaccines signaled an unpreparedness for a public health crisis like the coronavirus, said Dr.David Carlyle, President and CEO of the Charles R. Drew University of Science and Medicine, calling California’s missteps in the pandemic a “failure of public policy.”

When MLK Community Hospital, a 130-bed facility at the epicenter of the pandemic in Los Angeles County tried to transfer its sickest patients to nearby tertiary hospitals for oxygenation, they were repeatedly refused because because their patients did not have health insurance. When the vaccine roll out flatlined mid-February, high volume vaccine centers (LA Forum, Dodgers Stadium) in LA county closed mid -February, because supplies of vaccine doses ran out. Commercial pharmacies placed vaccination sites in smaller, less diverse towns like Huntington Beach, Irvine and Newport Beach, while Los Angeles, a city of 8 million was allotted just one site.

“In my estimation we weren’t prepared for COVID 19.” Carlyle concluded.

A Robust Rescue Package

Given the lack of a robust public health system, panelists urged Congress to bolster the public health infrastructure with a bold COVID 19 rescue package for testing, treatment, vaccine distribution.

They called for increased investment in public health and community-based organizations (CBOs) that serve marginalized communities which have more chronic medical issues and higher risk factors for complications of COVID19. CBOs are vital in reaching communities of color and other hard hit communities, by providing culturally and linguistically appropriate services where government and private institutions have fallen short. Supporting CBOs could mitigate the health inequities of the COVID19 crisis, said Carbullido.

The pandemic overwhelmed most healthcare systems which were not prepared or adequately funded creating crises like the MLKCH that Carlyle called “a perfect example of the inhumanity of equities in healthcare.”

But “the pandemic has not created these inequities,” concluded Hedrick, “it’s simply highlighting them.”

More information is available at:
https://bit.ly/vaccines-race-data
https://ccuih.org/

Meera Kymal is the Contributing Editor at India Currents
Photo by Ivan Diaz on Unsplash

One-On-One With Trump’s Medicare And Medicaid Chief: Seema Verma

Seema Verma, administrator for the Centers for Medicare & Medicaid Services, sat down for a rare one-on-one interview with Kaiser Health News senior correspondent Sarah Varney.

They discussed her views on President Donald Trump’s plan for sustaining public health insurance programs, how the administration would respond if Obamacare is struck down by the courts in the future and her thoughts on how the latest “Medicare for All” proposals would affect innovation and access to care.

A portion of their conversation aired on PBS NewsHour on Dec. 23. A transcript follows, edited for length and clarity.

Sarah Varney: Thank you, Administrator Verma, for joining us. We really appreciate it. You spoke recently about this need to protect Medicaid as a lifeline, but also not to have people be entrapped, or trapped on, Medicaid and come to rely upon it too greatly. So, as I was mentioning, we were in Tennessee recently, and I know you can’t speak to specific cases —

Seema Verma: Mmm, hmm.

Varney: But, we did find a number of families who had been disenrolled, and then found it quite difficult to get back on. And I just wondered if there is a danger in taking this approach where there’s more frequent verification checks, a real focus on eligibility verification, that it could discourage some parents and kids who might be eligible for the program from signing up?

Verma: Well, our top priority is making sure that the beneficiaries in the Medicaid program have high-quality, accessible care, and we want to do everything that we can to improve the quality of their lives. In terms of the enrollment process, we also have an obligation to taxpayers to make sure that only the people that qualify for the programs are participating. And we also want to make sure that the programs are sustainable over the long term. I think there’s a balance between making sure it’s easy for people to apply, but we also have to make sure that we do the appropriate work to make sure that they qualify for the programs.

Varney: So, are you concerned, though, that there were a number of people, after the eligibility process kicked in again in 2017, after the ACA sort of put things on hold for a while, that there might have been families, though, that have been lost? That just don’t want to come back, or can’t come back? Or are hearing worries about the public charge rule, as well, and so are concerned about giving the government their information?

Verma: You know, our top priority is making sure that we focus on improving quality of care, high-quality care, accessible care, and making sure that we’re improving the quality of life for individuals. You know, when I think of the Medicaid program, and in every decision we make, I try to keep in mind the actual beneficiary. In my time spent on the Medicaid program, I’ve met a lot of Medicaid beneficiaries. I met a gentleman, Richard, who was in Indiana. He was a quadriplegic and literally requires 24-hour care. I met some parents of a child on the Medicaid program. This child had cerebral palsy and so severe that they require 24-hour care, and you can imagine the impact on the entire family. This is a child that will never be independent, will always require help. And so, when we’re creating our eligibility policies, we keep those individuals in mind. We don’t want to make it harder for them to apply for the program.

And so, we try to come up with policies that don’t put a lot of onerous requirements on the beneficiary, but we can have requirements for states that require them to do back-end processes, and back-end checks that don’t actually burden the actual recipient or their families, but that also ensure that we are putting the appropriate protections in place for taxpayers, so the program is sustainable over the long term. And we have only the people that qualify for the program participating.

Varney: We know that more health coverage leads to longer life expectancy; I think this has been well established. And I wonder if whether or not the administration should be emphasizing more finding those children who are not enrolled, who are eligible but not enrolled, and perhaps focusing on outreach, which we haven’t really heard your administration talk about?

Verma: Well, again. Our focus is on making sure, especially children, that they have access to high-quality health care. As a mom, I’ve got two kids, so I can personally attest to the fact that having health insurance is very important for children. Something very little, like an ear infection, can lead to deafness if it’s not, you know, treated appropriately. So having that access to high-quality health care is very, very important to their development. The Trump administration is very committed to the Children’s Health Insurance Program; the president signed legislation around that. Additionally, we have spent over $48 million on outreach efforts. We’re very focused on working with states, so that they can identify the best practices to make sure that those individuals, children that qualify, can enroll in the program, that they’re aware that this program exists.

Varney: Have you found that the reduction in the Navigator grants has made it more difficult to reach those families?

Verma: We, actually, we have not. If you look, the Navigator programs are really aimed at the Affordable Care Act programs and the exchange programs. So those are not aimed at children. Those are aimed at our adult population. And we have seen very minimal impact. What we have done is try to increase our digital communication, of, to help enrollment. And we’ve seen a very minimal impact on enrollment.

I think the issue around enrollment really comes back to affordability. Obamacare has had a direct impact on increasing premiums. Across the nation, we’ve seen premiums go up by 100%, 200%. [Editor’s note: PolitiFact rated this claim by the Trump administration “false.” ACA premiums were down by about 4 % in 2019 compared with 2018.] And so the issue around enrollment is that health insurance has become so unaffordable for families that that’s why they can’t afford their coverage.

Varney: So we did hear from a number of federally qualified health centers that although the Navigator grants really were focused on, you know, ideally they were focused on exchanges, people buying private health insurance, that, in fact, there were a lot of people who came in, who became eligible for Medicaid and discovered that they were eligible for Medicaid in that way. So I wonder if there is additional outreach that needs to be done to those families, not just virtually or online, but some other way to reach those families?

Verma: The real problem around making sure that people have access to affordable coverage is really addressing the high cost of health care. And that’s what the president is focused on. His health care agenda isn’t just about putting out more subsidies and having the government pay more and more and creating unaffordable programs. But it is about addressing the underlying cost drivers in health care. That’s why he’s focused on prescription drug pricing, he’s focused on transparency, price transparency, so that there’s more competition in the market. We’re also focused on getting rid of burdensome regulations that we know drive up the cost of care.

I think by addressing that, that is going to result in decreased premiums, which will result in more people having access to affordable coverage.

Varney: But all those things that you just mentioned — they don’t necessarily affect the Medicaid population directly. Now, they may affect them indirectly by increasing overall health care costs, but in terms of the Medicaid population, really reaching out, ensuring that every single child who’s eligible for Medicaid is enrolled?

Verma: So, our focus is also on addressing the economy. Under the president’s leadership, we have a booming economy. We have one of the lowest unemployment rates. We have more people that are earning more money, and we have fewer people living in poverty. There’s been a reduction in the number of people living in poverty by 1.4 million people. And so, we are seeing people coming out of the Medicaid program, and because the economy’s doing so well. The issue is, though, they can’t afford coverage. And so, even as we increase our outreach efforts, we spent over $48 million on outreach, the issue is around affordability. Obamacare has impacted the market in such a way that it’s become unaffordable for people that don’t have subsidies.

Varney: So, we’re at this moment in our country and our national conversation where we’re talking about how do we ensure that more and more people are insured? And I wonder what the administration is doing to move the needle, to stop the growth in the uninsured, particularly among children?

Verma: I think our focus has been about addressing affordability of health care. The underlying issue in people not being able to afford their health insurance is that it’s too expensive. And the solution is not trying to throw more government money around subsidies, because that’s just going to increase taxes for everybody. Our approach is to address the underlying issues. President Trump is addressing long-standing issues in health care that haven’t been addressed by any administration. The blueprint that he put out on drug pricing was very historic. The work that he’s done on price transparency. And the work that we’re trying to do around the regulatory burden, getting rid of all kinds of unnecessary regulations that are actually increasing the cost of health care for providers. We spend over $200 billion on administrative costs every year. So what we’re trying to do is address the cost of health care, but also make sure that we continue to have the high-quality, innovative health care system that Americans are used to.

Varney: So there are some people who are advocating for a Medicare for All type of solution to this, to say that much of those costs are because the marketplace, in a sense, doesn’t work in health care. And I wonder what you say to people who are proposing that? Who are saying, this is all just, that the market doesn’t work when it comes to health care?

Verma: So, when it comes to health care and it comes to the solutions around Medicare for All. … Medicare for All would strip Americans, 180 million Americans, of their private health insurance and put them on a government-run, bureaucratic program. If we look at the programs that we have today, our government-run programs, our Medicare program is not affordable. The Medicare Trustees have indicated in the next seven years they’re gonna run out of money, they’re gonna have trouble paying their bills. The Medicaid program is the No. 1, No. 2 budget item for many states. And you’re hearing states every day — look at the situation in New York, where they can’t afford their Medicaid programs. And so, our track record on government-run programs isn’t strong. And I think our focus is on trying to unleash competition to drive down costs, but keep the innovation in the system. Our concern is that a government-run or more government is going to thwart innovation.

As the head of the Medicare program, I see every day that government regulations kind of stand in the way, that there are delays in our beneficiaries being able to access treatments. That’s why the president put out the Medicare Executive Order, which was focused on making sure we can do better with this. But I think, you know, putting more people on a government program is actually going to threaten the sustainability of the programs that we have in place today.

Varney: And do you think through the measures that you’re talking about, that you could reduce costs — 15%, 20% — in the health care system of the United States?

Verma: I think our goal is to try to reduce cost, and to make it more unaffordable [sic]. And we’ve had great success with this under President Trump’s leadership. If we look at the Medicare Advantage Program, for example, under his leadership, premiums have gone down by over 23% since he came into office. In the Part D program, premiums are down by 13%, the lowest level in seven years. Going back to Medicare Advantage, that’s the lowest level in 13 years. So, I think the president’s policies are working, because we demonstrated that we can lower premiums.

Same thing on the individual exchanges. For the very first time, the individual market has been stabilized and premiums went down last year by a percent, this year by 4%, and they’re still too high, there’s a new class of uninsured being created by Obamacare, but President Trump’s policies have actually resulted in more Americans, more seniors having money back in their pockets.

Varney: Now we’re waiting for a ruling from the courts on the future of the Affordable Care Act. If it’s struck down, what is your plan to replace it?

Verma: Well, the president’s been very clear that he wants to make sure that individuals with preexisting conditions have protections. And we have prepared for a variety of scenarios, and we want to make sure that there’s no disruption in coverage. And we’ll work with Congress to make sure that Americans have access to high-quality, affordable coverage. That is not what they have today. People with preexisting conditions do not have those protections. Individuals that don’t get subsidies and can’t afford coverage really don’t have those protections. And so the president wants to make sure that we’re addressing those individuals, and that people with preexisting conditions have the appropriate protections that they don’t have today.

Varney: But how do you guarantee those protections, also reduce costs and not lead to widespread uninsurance rates going up?

Verma: I think our focus is not just on costs, but it’s also making sure that we preserve quality and innovation in the system. One of the initiatives that we’ve had is around trying to pay our providers differently. Right now, we’re paying in a system where we just pay for people to get things done. And we want to change that paradigm, where we’re holding providers accountable for providing quality care, improving the quality of life, preventing disease and keeping people healthy.

Varney: So, just my final question. There have been these reports of a rift, a growing rift between you and Department of Health and Human Services Secretary Alex Azar. And I wonder if people should be concerned about whether or not that’s going to get in the way of the very ambitious slate of initiatives that you and President Trump have planned?

Verma: Well, Secretary Azar and I are both committed and have a shared goal around delivering on the president’s agenda.

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