What is the status of disparities?
Prior to the COVID-19 pandemic, people of color and other underserved groups faced longstanding disparities in health. Major recognition of health disparities began nearly two decades ago with two Surgeon General’s reports published in the early 2000s that documented disparities in tobacco use and access to mental health care by race and ethnicity. Despite the recognition and documentation of disparities for decades and overall improvements in population health over time, many disparities have persisted, and, in some cases, widened.6 Recent data from before the COVID-19 pandemic showed that people of color fared worse compared to their White counterparts across a range of health measures, including infant mortality, pregnancy-related deaths, prevalence of chronic conditions, and overall physical and mental health status (Figure 2). As of 2018, life expectancy among Black people was four years lower than White people, with the lowest expectancy among Black men. Research also documents disparities across other factors. For example, low-income people report worse health status than higher income individuals,7 and lesbian, gay, bisexual, and transgender (LGBT) individuals experience certain health challenges at increased rates.
Figure 2: People of Color Fare Worse than their White Counterparts Across Many Measures of Health Status.
There also are longstanding disparities in health care. The Affordable Care Act health coverage expansions led to large gains in coverage across groups. Despite these gains, however, people of color and low-income individuals remain at increased risk of being uninsured (Figure 3), contributing to greater barriers to accessing health care. Further, starting in 2017, coverage gains stalled and began reversing, reflecting a range of actions by the Trump administration, including decreased funding for outreach and enrollment assistance, approval of state waivers to add new eligibility restrictions for Medicaid coverage, and immigration policy changes that increased fears among immigrant families about participating in Medicaid and CHIP. These coverage losses eroded some of the previous coverage gains under the ACA, particularly among Hispanic people, who already were at increased risk of being uninsured. Coverage losses have likely continued due to the COVID-19 pandemic as people have lost jobs and experienced declining income. Beyond disparities in coverage, people of color and lower income individuals also receive poorer quality of care. Recent KFF/The Undefeated survey data find that Black adults are more likely than White adults to report certain negative health care experiences, such as a provider not believing them and refusing them a test, treatment, or pain medication they thought they needed.
Figure 3: People of color face longstanding disparities in health coverage.