Study highlights racial inequity in health care access, quality

NORTH CAROLINA STATE UNIVERSITY

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A recent study finds states that exhibit higher levels of systemic racism also have pronounced racial disparities regarding access to health care. In short, the more racist a state was, the better access white people had - and the worse access Black people had.

"This study highlights the extent to which health care inequities are intertwined with other social inequities, such as employment and education," says Vanessa Volpe, corresponding author of the study and an assistant professor of psychology at North Carolina State University. "This helps explain why health inequities are so intractable. Tackling health care inequities will require us to address broader social systems that significantly benefit white people - and that makes them difficult to change."

Previous research has examined how people's individual experiences with racism affect the quality of their health care. There is also research that examines relationships between structural racism and health outcomes. The recent study from Volpe and her collaborators looks at structural racism at the state level, people's individual experiences with racism, the extent to which those things affected the ability of Black people to access health care, and the quality of that health care. The researchers also examined the ability of white people to access health care and the quality of their health care.

For their study, the researchers drew on the Association of American Medical Colleges' Consumer Survey of Health Care Access for the years 2014 to 2019. The survey, of adults who needed care within the previous year, included measures of self-reported health care access, quality, and provider racial discrimination. The survey included 2,110 Black adults and 18,920 white adults. The researchers also used publicly available state-level data from the Census Bureau and the U.S. Department of Justice to create an index of state-level racial disparities that serve as a proxy for structural racism. The researchers used the index to determine racism scores for all 50 states and the District of Columbia.

The researchers found that the higher the level of racism in a given state, the less access Black people in that state had to health care. There was no statistically significant relationship between a state's racism index score and quality of health care. However, Black people who reported experiencing racism with their health care providers also reported lower quality of care.

Meanwhile, the higher the level of racism in a given state, the more access white people had to health care. In addition, the worse the state's racism score, the higher the quality of care white people reported receiving.

"These state-level inequities are symptoms of racism baked into laws, policies and practices that ensure there is not a level playing field," Volpe says. "It underscores the need to address inequities in a meaningful, structural way, not just assume that racism is solely an interpersonal phenomenon. And it's important to use data-driven approaches like the ones we used here, so laws or regulations can be developed by policymakers to more effectively even the playing field."

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The paper, "State- and Provider-Level Racism and HealthCare in the U.S.," is published in the American Journal of Preventive Medicine. The paper was co-authored by Sam Cacace, Perusi Benson and Noely Banos of NC State; and by Kristen Schorpp of Roanoke College.

How many households can afford healthcare in Connecticut?

Complete report

 • As of June 2021, approximately 18% (165,684) of households in Connecticut with working adults face costs that exceed the target for affordability. The percentage of households with access to health insurance costs below the affordability target varies by the source of coverage. 42% (60,906) of households purchasing insurance through Access Health CT face health care cost that exceed the target for affordability, while only 16% (104,788) of households with employer-sponsored insurance face healthcare costs that exceed the target for affordability. Households covered by HUSKY (Medicaid) are all presumed to have affordable healthcare. | This estimate includes new, temporary premium subsidies provided to consumers purchasing health insurance through Access Health CT, the state health insurance exchange established under the Affordable Care Act, under the new federal American Rescue Plan Act (ARPA) enacted in February. | We estimate the temporary ARPA subsidies will make health care costs affordable for over 35,000 additional Connecticut workingage households purchasing health insurance through the individual marketplace. Prior to passage of ARPA, 21% of households in Connecticut faced healthcare costs that exceeded the target for affordability. 

• The new state budget provides additional assistance to offer fully subsidized coverage to another 40,000 people in Connecticut. Beginning on July 1, 2021, the state will pay any remaining premiums and all cost sharing, other than what is already paid in premium assistance and through cost-sharing reductions for caregiver adults of children on HUSKY A, up to 175% FPL, who are not otherwise covered by Medicaid and who enroll in the benchmark silver plan via Access Health CT. Beginning July 1, 2022, the state will pay all remaining premiums and cost sharing (after federal assistance) and will also cover dental and non-emergency medical transportation for all adults under 175% FPL. When it takes effect on July 1 of this year, this new state assistance will further reduce the percentage of Connecticut households that face healthcare costs that exceed the target for affordability. 

The Protecting the Right to Organize (PRO) Act expands workers’ rights on the job

Examples of loopholes in current labor law and how the PRO Act closes them

Problem with current labor law	PRO Act solution
Under current law, employers can drag out the union election process—the process by which workers form a union at their workplace—through litigation at the National Labor Relations Board (NLRB). The NLRB is the principal government agency responsible for enforcing the rights of private-sector workers to organize and engage in collective bargaining with their employers—but current law is preventing them from doing their job, by giving too much power to employers, who are able to use delay tactics to postpone elections while they campaign against the union.	Under the PRO Act, workers and the NLRB set union election procedures. The employer is not involved.
Employers have free rein to make their employees attend “captive audience” meetings—where the employer delivers anti-union messages without giving the union an opportunity to respond.	The PRO Act prohibits employers from forcing workers to attend captive audience meetings.
Under the current system, workers can wait months and even years to be reinstated or receive back pay after being unlawfully discharged by their employer for joining together with their co-workers to improve their wages and working conditions. Workers’ rights to do so are protected under the National Labor Relations Act (NLRA)*—but that hasn’t stopped employers from retaliating, and the system isn’t set up to enforce workers’ rights in a timely manner.	The PRO Act requires the NLRB to go to court and get an injunction to immediately reinstate workers if the employer has illegally retaliated against workers for union activity.
Employers who violate workers’ rights under the NLRA face no civil penalties.	Under the PRO Act, employers who commit violations under the NLRA face civil penalties, and corporate officials can be held personally liable for violation of the the law.
Workers are prohibited from bringing civil lawsuits against their employer for violating their NLRA rights.	The PRO Act gives workers the right to file a civil action against their employer.
Employers are allowed to force workers to sign arbitration agreements—often buried in a stack of paperwork they sign on their first day of work—in which the workers waive their right to collective or class action litigation.	Collective and class action waivers are banned under the PRO Act.
Employers can misclassify workers as independent contractors—depriving those workers of the rights they would have as employees—without violating the NLRA.	The PRO Act makes employee misclassification a violation under the NLRA and requires employers to follow an “ABC” test for employee classification. An ABC test is a strict legal test for making sure employees are not misclassified as independent contractors.
Multiple employers are able to dictate workers’ terms of employment while evading collective bargaining with employees—a growing problem as employers outsource various functions to contractors and subcontractors. Under this system, each employer is likely to shift responsibility to the other employer(s).	The PRO Act codifies a strong joint-employer standard—meaning all firms that share control over a worker’s terms of employment are considered to be employers of that worker and are thus required to bargain with employees.
States may have “right-to-work” laws that undermine unions’ ability to collect “fair share fees” from workers whose interests they represent. Fair share fees cover the costs of bargaining, contract administration, and grievance processes that unions are required by law to undertake on behalf of all (union and nonunion) members of a collective bargaining unit. Without fair share fees, union power degrades quickly—which is exactly what anti-union employers want.	States must allow private employers and unions to enter into “fair share” agreements.
Employers can drag out the process of bargaining over a first collective bargaining agreement.	The PRO Act requires employers to follow a process for reaching a first agreement when workers organize, a process that uses mediation and then, if necessary, binding arbitration, to enable the parties to reach a first agreement in a timely manner.
Workers face limits on their fundamental right to strike.	The PRO Act prohibits employers from permanently replacing striking workers, bans the use of offensive lockouts, and removes prohibitions on secondary activity.

The Protecting the Right to Organize (PRO) Act

The Protecting the Right to Organize (PRO) Act would strengthen workers’ rights to form a union and negotiate with their employers for better wages and working conditions. Specifically, it would reform our nation’s labor law so that private-sector employers can’t perpetually stall union elections and contract negotiations and coerce and intimidate workers seeking to unionize. The PRO Act:

Gives workers more control

Under the PRO Act, workers and the National Labor Relations Board, not employers, control the timing of union elections and employers can’t force employees to attend anti-union meetings.

Imposes real penalties when employers break the law

Under the PRO Act, employers and corporate executives are penalized for illegally retaliating against workers trying to organize, and workers get monetary damages or other remedies if they are illegally fired or harmed; fired workers must also be reinstated while their cases are pending.

Creates a roadmap to a first contract

Under the PRO Act, employers and workers have a set process to follow to negotiate a first union contract, and if they can’t reach an agreement they go to binding arbitration.

Strengthens strikes

Under the PRO ACT, employers are prohibited from permanently replacing workers when they strike, and workers are no longer banned from engaging in so-called “secondary” activity, such as boycotts, seeking leverage in negotiations.

Cracks down on worker misclassification

Under the PRO Act, workers can’t be wrongly deprived of their organizing and bargaining rights by being misclassified as supervisors or independent contractors.

Connecticut the only state to see an increase in the child poverty rate: 2021 KIDS COUNT report

 Source: Connecticut Voices for Children

Highlights from the 2021 KIDS COUNT report

• An increase in child poverty: Between 2010 and 2019, there was an 8% increase in the percentage of children living in poverty in Connecticut, making Connecticut the only state to see an increase in the child poverty rate. National trends saw a 23% decrease in the percentage of children living in poverty. This increase in child poverty is especially concerning as it does not include the impacts of the pandemic.
• An increase in youth connection: Between 2010 and 2019, there was a 20% decrease in the percentage of teens not in school and not working in Connecticut. Prior to the pandemic, the state did well at keeping teens engaged through either school or work. During this time, Connecticut’s national ranking of teens not in school and not working rose from third to first (with the lowest percentage ranked first). 
• An increase in preschool attendance of children: Between 2009-11 and 2017-19, there was an 11% decrease in the percentage of children ages 3 and 4 not attending school. During this time, Connecticut’s national ranking of the percentage of young children not in school rose from second to first (with the lowest percentage ranked first).
• An increase in uninsured children: Between 2010 and 2019, there was a 25% decrease in the percentage of uninsured children nationally. While Connecticut's low rate of uninsured children has wavered between 3% and 5% between 2010 and 2019, there was a worrisome uptick between 2018 and 2019, when the number of children without health insurance in Connecticut increased by 32% from 20,372 to 26,901.

Click here for the full 2021 KIDS COUNT report.