April 22, 2020— The COVID-19 pandemic is the latest public health issue to highlight the persistent gaps among different groups of Americans in accessing needed care and attaining their best possible health outcomes. Amid another sobering reminder of these disparities, 340B hospitals continue to focus their missions on serving the underserved.
Early reports during the pandemic in the U.S. have shown patients who are members of racial and ethnic minorities are making up a disproportionate share of infections. Data released April 21 by the Centers for Disease Control and Prevention (CDC) showed that among the first roughly 600,000 cases of COVID infection in the U.S., 33.6% involved black or African American people even though they represent only 13% of the U.S. population.
This is only the latest indication of the disproportionate impact that many diseases and conditions have on certain population groups. Health care leaders and public policy makers have identified the goal of eliminating these disparities as a major priority in improving the health of the nation. Every 10 years, the government issues a major report setting goals for the decade ahead. In 2000, that report called for reducing disparities by 2010. In 2010, the report upgraded the mission to “eliminate” disparities by 2020. It is now a decade later, and clearly that goal has not been met.
Since 2002, the federal government has recognized April as National Minority Health Month, an observance designed “to raise awareness about health disparities that continue to affect racial and ethnic minority populations.” Public health experts note that raising awareness of minority health also means raising awareness of associated health disparities.
And the inequities do not stop there. Disparities exist across several characteristics that also include gender, sexual orientation, age, disability status, socioeconomic status, and geographic location. According to the CDC, they include “disparities in deaths and illness, use of health care, behavioral risk factors for disease, environmental hazards, and social determinants of health.”
Working to Close the Gap
Safety-net health providers that participate in the 340B drug pricing program will be part of any solution to this disparity problem. Many 340B covered entities – including hospitals, health centers and clinics – focus their core missions on reaching and serving marginalized communities.
For example, nearly 12% of the patients that 340B hospitals serve are African American, compared to just more than 7% at non-340B hospitals, according to our recent study. 340B hospitals also serve larger numbers of patients who are living with disabilities and who have very low incomes – another population that is made up disproportionately of people who are minorities. One in four patients served by 340B hospitals are eligible for both Medicare and Medicaid as a result of their income and disability status.
One important step toward health access parity was enactment of the Affordable Care Act of 2010. By extending health insurance to millions of Americans with low incomes, the ACA provided greater access to care for many minority patients. A 2019 report by the Commonwealth Fund found: “All racial and ethnic groups saw gains in health coverage between 2013 and 2016, but these gains were especially pronounced for minority groups and individuals with incomes below 139% of the federal poverty level.”
Still, there remain important caveats to some of the recent gains. Those improvements leveled off in 2017, and the economic turmoil caused by COVID-19 now is resulting in millions of Americans losing their employment and their health insurance. This could set back the clock on some of the recent progress our health system has made.
Like so much in the world today, the future for the campaign to reduce health care disparities remains frustratingly murky. But one thing our nation can count on is that safety-net health providers will remain undeterred in their commitment to see that all patients receive the care they need no matter their circumstances. This month and all months, we salute those who use their 340B savings in pursuit of that mission.