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Racial disparities occur across many health conditions, illnesses, and mortality rates. These differences have been brought into stark focus during the COVID-19 pandemic, as Black or African Americans are 2.6 times more likely to be infected and 2.1 times more likely to die from COVID-19 than their non-Latino, White counterparts.[1] But the disparate impact of the pandemic is only the latest evidence of racial health inequities.

Black Americans are 2.6X more likely to become infected by COVID-19 when compared to non-Latino, White counterparts

Black Americans are 2.1x more likely to die from COVID-19 when compared to non-Latino, White counterparts

African Americans have the highest mortality rate for all cancers compared with any other racial and ethnic group.[2] And, as of 2017, Blacks, Latinos, American Indians and Alaska Natives (AIANs), and Native Hawaiians and Other Pacific Islanders (NHOPIs) had higher infant mortality rates than Whites. These disparities were particularly significant for Blacks and AIANs, whose infant mortality rates were roughly two times higher than Whites.[3]

These disparities in health conditions and outcomes are exacerbated by inequities in access to care and care delivery as well as a lack of diversity in medical professions. People of color are more likely to be uninsured and to lack a regular source of care.[4] Additionally, evidence indicates that implicit bias in health care can influence the interactions between a provider and patient, the type of treatment a patient receives, whether a patient adheres to the medication they are prescribed, and, ultimately, their health outcomes.[5],[6]

Over half the non-elderly population of the United States is covered by employer-sponsored insurance.[7] This means that employers play an important role in ensuring that much of the nation has access to health care coverage and services that help reduce, not enlarge, racial disparities in health care.

In addition to being an important source of health insurance coverage, employers have opportunities to help address racial disparities in health conditions through the design and structure of their benefits and other employee services. For example, benefits can be structured to encourage relationships with primary care providers to help address the fact that people of color who have health coverage often lack a reliable source of care. As some of the nation’s largest employers, Business Roundtable companies can play an important role in identifying these opportunities and strategies to address them. Participating Business Roundtable companies will engage in a Health Equity Benefit Evaluation Initiative to identify employee health benefit practices that may reduce racial health disparities for employees.

Implicit bias in health care can adversely influence care and outcomes for people of color. When organizations prioritize diversity, equity and inclusivity and implement strategies to reduce implicit bias, they are taking important steps to ensure that people of color receive equitable, safe and appropriate care. Participating Business Roundtable companies will work with health plans and other health care partners to understand diversity, equity and inclusion (D,E &I) practices of the organizations that provide health care services to their employees and promote D,E & I practices to address implicit bias.

Especially during the COVID-19 public health emergency, expansion of telehealth services has provided crucial access to health care, particularly for communities of color that have traditionally lacked access to reliable sources of primary care. Medicare and Medicaid programs, as well as many companies, have provided additional coverage flexibilities during the pandemic to allow broader access to telehealth services. Business Roundtable supports efforts to expand telehealth coverage to employees of color and others during the pandemic and beyond. 

Business Roundtable will convene members to share insights and develop strategies in several areas:

  • Accurate and complete race and ethnicity data is needed to identify where racial disparities in key health conditions and health care utilization exist. This data provides health care organizations the opportunity to improve access and utilization of care for people of color, and to understand when interventions are successful in reducing disparities. Business Roundtable will work with members to develop strategies to help address barriers that inhibit the appropriate collection and use of race and ethnicity data to improve health outcomes.
  • Racial disparities in health outcomes are the product of more than just traditional health care provided in clinical settings. Social determinants of health (SDOH) are the economic and social factors, such as economic stability, education, safe housing and access to nutritious food, that significantly affect health. Black Americans are more likely to experience disadvantages in these factors.[8] Business Roundtable will convene members to discuss business’ role in addressing SDOH and develop a SDOH Roadmap that businesses can use to engage in community partnerships to address SDOH. This initiative will provide companies with actionable steps they can take to partner with local communities to address SDOH in the communities in which they do business.
  • Since people of color are more likely to be impacted by adverse SDOHs, some are also likely to experience immediate, non-medical or “social” needs, which impact their health and ability to participate fully in the economy. Companies can provide invaluable support to their employees by identifying and taking steps to meet these non-medical needs. Business Roundtable will convene member companies to develop strategies to identify and address aggregate, anonymized social needs for their employees.

Despite the coverage expansion under the Affordable Care Act (ACA), Black Americans remained 1.5 times more likely to be uninsured than Whites from 2010 to 2018. The Latino uninsured rate remained over 2.5 times higher than the rate for Whites.[9] According to the Kaiser Family Foundation, 58 percent of the 27.3 million uninsured in 2018 were eligible for subsidized insurance coverage through Medicaid, Children’s Health Insurance Program (CHIP) or the ACA exchanges.[10] Business Roundtable supports policies to increase health coverage in communities of color through outreach and education efforts and by exploring ways to enroll eligible individuals in coverage automatically. Business Roundtable also supports polices to expand reimbursement of telehealth services and ensure that states have the flexibility to offer a full year of Medicaid coverage to new moms. Business Roundtable will continue to identify policies that help communities of color access affordable health insurance that covers the health care services they need.

Black Americans are 1.5X more likely to be uninsured than White Americans from 2010 to 2018

A more diverse health care workforce can help reduce implicit bias in health care and improve culturally competent care. While diversity among health professionals has increased over past decades, these gains are not reflected across the spectrum of health care professions or in educational programs. A 2020 study found that diversity gains are concentrated in lower-paying or entry-level positions.[11] And a 2018-2019 report from the Association of Medical Colleges found that increases in Black or African American applicants, matriculants and graduates lagged other groups, and that medical school faculty and active physicians continue to be predominantly White.[12] Business Roundtable supports legislation designed to expand scholarship and loan repayment programs for minorities to address health care workforce shortages and bolster workforce diversity.

Increasingly, states and communities seek to address SDOH as part of strategies to improve health outcomes and decrease costs. Funding and technical support from the federal government will accelerate efforts to support the development and deployment of effective SDOH interventions. Business Roundtable supports legislation to establish grant programs that help states and communities determine, implement and measure the most effective SDOH interventions for their needs.

The U.S. Department of Health and Humans Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) increasingly recognize that SDOH impact health outcomes and health care costs. HHS has taken steps to integrate health-related social needs into several innovative payment models.[13] HHS should continue these efforts and expand the testing of payment models, which include reimbursement for social needs. Additionally, HHS should create opportunities for the private sector to partner with public programs and community organizations to financially support community SDOH efforts. Business Roundtable supports continuation and expansion of innovative payment models that allow SDOH to be addressed.

Sources:

[1] COVID-19 Hospitalization and Death by Race/Ethnicity. (2020, August 18).

[2] Maxwell, S. C. (n.d.). Health Disparities by Race and Ethnicity.

[3] Key Facts on Health and Health Care by Race and Ethnicity. (2019, November 13).

[4] Changes in Health Coverage by Race and Ethnicity Since the ACA, 2010-2018. (2020, March 05).

[5] Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., ... & Coyne-Beasley, T. (2015). Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. American journal of public health, 105(12), e60-e76.

[6] FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC medical ethics, 18(1), 19.

[7] Rachel Garfield, K. O. (2020, May 13). The Uninsured and the ACA: A Primer – Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act..

[8] Social Determinants of Health. (2020, August 19).

[9] Changes in Health Coverage by Race and Ethnicity Since the ACA, 2010-2018. (2020, March 05).

[10] Key Facts about the Uninsured Population (2019, December 13).

[11] Wilbur, K., Snyder, C., Essary, A. C., Reddy, S., Will, K. K., & Saxon, M. (2020). Developing Workforce Diversity in the Health Professions: A Social Justice Perspective. Health Professions Education

[12] Diversity in Medicine: Facts and Figures 2019 (2019, December).

[13] Azar, A. M. (2018). The root of the problem: America’s social determinants of health. Speech delivered at the Hatch Foundation for Civility and Solutions, Washington, DC, on November, 14.