The governor of Kentucky promised this week that all black residents of the state would have health insurance, an initiative he justified by the specific risks of Covid-19 for the minority, and the general movement against racism in the police and discrimination. The surprise announcement is a spectacular example of the new awareness and quest for new – and potentially unconstitutional – ideas by American public officials to finally resolve inequalities which, despite decades of public policy, persist in all areas.
“The inequalities in the health system have been exposed by this Covid-19 epidemic, the consequences of health inequalities are clear, it is death,” said Andy Beshear, a Democrat, on June 10, 2020. chief executive of this poor, rural, mountainous little state. “We should not have waited for this pandemic, or these demonstrations, to commit to ending it,” he added, before declaring something that is not unanimous in the country: “Health is a fundamental human right ”. Therefore, “we are going to launch an initiative to cover 100% of individuals in black and African-American communities,” said Andy Beshear.
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We are witnessing the culmination of years of inequality.
“It is a first, to my knowledge,” reacts to Agence France-Presse Lovoria Williams, professor at the University of Kentucky and specialist in health inequalities, “surprised for the good” by the announcement. In this state, 29% of black people live below the poverty line, a double proportion of whites. They are relatively more obese, more diabetic and more affected by cardiovascular diseases, all of which are known risk factors for Covid-19. While they make up only 8% of the population, they represent 16% of the dead of the pandemic in Kentucky, according to Lovoria Williams.
“We are witnessing the culmination of years of inequality, with the public murder of George Floyd, the murder by police in Kentucky of Breonna Taylor, and also the incident with the amateur ornithologist” in New York, summarizes- to explain the current context. Breonna Taylor, 26, was killed at night in her apartment by police who had the wrong target. In New York, a white woman reported a black man to the police, asking her to keep her dog on a leash. But, warns the researcher, “the governor will have to be very careful about the way he puts this policy in place, and justify by data the impact it will have on this specific population”.
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Being black in the United States has been shown to be a risk factor, whether dying from Covid-19 or from gunshots; life expectancy is three years shorter among black Americans than among white Americans. We know this, because here, what the Americans call “race” (five official categories: white, black or African American, Native American or native of Alaska, Asian, native of Hawaii or other Pacific islands) and ethnic origin (Hispanic or Latin, or not) are demographic components systematically taken into account in official studies and statistics.
But “I don’t know of any example where health coverage is determined by someone’s race, that would be pretty striking,” said Lawrence Gostin, director of the center for health law at Georgetown University. “I share the governor’s intentions, but if you start to allocate benefits on the basis of race, you are setting a dangerous precedent, because others might decide to give them to whites or to a certain religion,” says l at the Agence France-Presse. He doubts the constitutionality of the initiative.
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The health insurance reform adopted under Barack Obama reduced the proportion of black people without insurance in Kentucky from 20% to 6% – many have accessed Medicaid, public insurance for the poor, co-funded by the federal government. But it is unlikely that Medicaid will grant an exception based on skin color. To pay its promise, Kentucky will probably have to rely on private insurers and pay the bill.