COVID-19, the Affordable Care Act and why America must tackle its health care disparities

One community at a time, the deadly coronavirus spread into every corner of the Chicago area last year, killing nearly 10,000 and sending thousands more to intensive care units at overwhelmed hospitals.

The harrowing story of COVID-19’s spread throughout Cook County, as told in a Sun-Times investigation by Kyra Senese and Eric Fan, drives home once again a powerful lesson about health care access:

America, much to its shame as the world’s richest nation, is a country beset by health care disparities that lead to enormous differences, based on race and income, in who lives, who dies and who can see a doctor when they get sick.

Those disparities, of course, were already clear to anyone who cared to look. They just became more glaring during a pandemic that swiftly killed the poor and vulnerable even as wealthier folks had the means to hunker down and avoid the virus.

Call it another powerful argument in favor of shoring up — permanently — the Affordable Care Act. The ACA was essential to addressing long-standing health care disparities when it became law in 2010.

Now, because of COVID-19, all of us can see why it must be shored up now. It’s simple: Every American, not just the wealthy or those with the good fortune to have employer-provided insurance, deserves access to decent health care.

The $1.9 trillion American Rescue Plan provides a stop-gap for shoring up the ACA. It provides financial incentives for more states to expand Medicaid and cover millions more of the neediest Americans. It also provides more generous subsidies for lower- and middle-income people who buy their insurance through the ACA marketplace. In some cases, middle-income folks who earn too much to qualify for Medicaid or existing subsidies are paying premiums of $1,000 a month or more — or going without insurance altogether.

But these additional subsidies are just for two years. Then what?

Congress has got to figure that out in the meantime.

A path of death

Long before the first Chicago area death was reported a year ago — on March 16, 2020 — COVID-19 was already creeping, largely undetected, through Cook County. Records from the Cook County Medical Examiner’s Office showed that hundreds, perhaps thousands, of people had been infected with the virus weeks earlier.

At that point, they were beginning to show up in hospitals. Eventually, COVID-19 spread widely enough to make Chicago and Cook County the third-worst coronavirus hot spot in the nation, exceeded only by New York City and Los Angeles areas.

Along the way:

Black and Brown people died more: During the first wave of the pandemic, Black residents made up 42.5% of Cook County deaths, white residents 36% and Latinos 15.4%. That stands in stark contrast to the county’s racial composition: whites, 42%; Blacks, 23.8%; Latinos, 25.6%. Since then, the death rate has become more reflective of the county’s population, but Black and Latino residents remain disproportionately more likely to die of COVID-19.

The uninsured and the undocumented have died more, including at home. “A much greater rate of African Americans and Latinos die in their home because they have a higher percentage of people who are uninsured or undocumented, people who don’t have cars to get them to the hospital,” Dr. Howard Ehrman, a former assistant commissioner of the Chicago Department of Public Health, told the Sun-Times. Latinos were far more likely than any other group to die at home. That’s especially true in immigrant-heavy Cicero, where more than one-third of COVID-19 victims died at home.

People in poor-quality nursing homes have died more.The staggering COVID-19 death toll in nursing homes has been a national disgrace. Residents of the worst nursing homes, clustered in poor neighborhoods and communities of color, were at the greatest risk. “The greatest number of deaths in any single place has been in nursing homes and other long-term care facilities,” Ehrman said.

Poorer people have died more. Low-income people are more likely to lack insurance, and Black and Latino victims were disproportionately from lower-income neighborhoods. But the income disparity held even among largely white communities, once the virus began to spread there in the summer and fall. Take the suburbs of Northbrook and Skokie, where the median income is half that of Winnetka and Wilmette — and where residents were five times more likely to die from COVID-19.

Poverty, of course, is strongly linked to certain health conditions, such as obesity and high blood pressure, that make people more vulnerable to the coronavirus.

All the more reason to make sure everyone has access to decent medical care and a regular doctor who can help them manage those conditions.

Vaccine equity, health care equity

Vaccines are now becoming more widely available, which will help us greatly in beating the virus. Yet the same disparities that made COVID-19 so deadly were evident in the early days of the vaccine rollout, when Black and Latino residents were far less likely to get vaccinated than whites. Those numbers now are improving.

America can do the same: Fix our health care system for good.

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The Sun-Times investigation was done with the Brown Institute for Media Innovation’s Documenting COVID-19 project.