April 20, 2020
The following article was published on www.henryclaycenter.org as Part I of a healthcare policy dialogue series entitled “COVID-19, Healthcare, and American Identity.” View the article here.
As states strive to keep pace with COVID-19, numerous Southern states have been hesitant to address the crisis. One particularly worrisome response has developed in Alabama. The virus has laid bare one significant issue within the state’s healthcare system that is decades in the making and threatens to undermine its COVID-19 response: disparities in healthcare access.
The virus is disproportionately afflicting and killing Black people. In Louisiana, Black people represent approximately 70% of COVID-19 fatalities despite comprising approximately 33% of the state’s population. In North Carolina and South Carolina, Black people are disproportionately contracting COVID-19 compared to white people. Alabama reports that Black people comprised 40% of COVID-19 fatalities while only constituting 26% of the state’s population. These trends do not bode well for much of the South, which is home to the majority of Black Americans. The statistics are not circumstantial; they are a direct result of systemic and institutionalized racism, a lack of adequate healthcare infrastructure, and a slow response on the part of most state leaders.
In addition, LGBTQ+ individuals face significant risks from COVID-19. LGBTQ+ individuals smoke tobacco more frequently, have higher rates of asthma, and are more likely to lack health insurance than their non-LGBTQ+ peers; all of these conditions can exacerbate COVID-19 complications. According to a 2017 survey, 8% of gay, lesbian, and bisexual people reported being denied health care services due to their real or perceived sexual orientation, and 29% of transgender individuals reported being denied services due to their real or perceived gender identity. 8% of LGBTQ+ people nationwide avoided or postponed seeking medical services due to fear of discrimination or past experience with discrimination. The South is home to the largest percentage of the nation’s LGBTQ+ population, claiming about 35% of LGBTQ+ Americans. Among LGBTQ+ people, health disparities only intensify at the intersection of race, sexual orientation, and gender identity.
Alabama will face acute issues in protecting vulnerable populations due to state leaders’ lackluster response. The state already faces a healthcare crisis that the current pandemic will only exacerbate. Since 2010, the Alabama Hospital Association (AHA) found that 17 privately-run hospitals have closed in the state, with only one reopening. Among those closures, 8 occurred in rural counties, including one that closed just last month. The AHA also reported that approximately 90% of rural hospitals in the state operate on a deficit, and health care researchers announced that up to 40% of the state’s rural hospitals are at significant risk of closing. Seven counties across the state do not have a hospital at all, and one, Coosa County, does not have a single physician. These conditions threaten to implode a desperately-needed healthcare system in the face of a rapidly developing global pandemic. Alabamians are at a heightened risk for severe COVID-19 complications due to high rates of diabetes, heart disease, and other cardiovascular conditions. These conditions are especially prevalent for rural and Black Alabamians. To make matters worse, one in ten Alabamians do not have health insurance, which can discourage those in need from accessing medical services. Little to no action has been taken by the state to remedy these problems or prepare state hospitals for COVID-19.
Alabama’s slow response to COVID-19 only increases the need to immediately address gaping healthcare disparities for its most vulnerable populations. First, Alabama must immediately invest in healthcare infrastructure and service expansion among rural and majority Black counties. One of the most substantial solutions to slowing, and possibly halting, hospital closures is to expand Medicaid. Alabama did not expand its Medicaid system under the Affordable Care Act, and it is feeling the effects. By expanding Medicaid, more Alabamians would have access to health care services, hospitals would receive much-needed funding to stay afloat, and the state would see a positive economic impact. Alabama would also be better prepared for future recurrences of COVID-19. Second, Alabama must enact non-discrimination protections to ensure LGBTQ+ people, especially LGBTQ+ people of color, have access to medical services. No one should be denied adequate medical services, but these services are especially urgent now. Lastly, state leaders must act swiftly to get ahead of the COVID-19 crisis before conditions worsen. Alabama implemented a stay-at-home order on April 4, long after other states took action. Most Southern leaders have been slow to act, which increases the likelihood of worsening conditions in these already vulnerable states. Additional tests, laboratory capacity, and hospital preparation must be procured to ease the disease’s impact.
COVID-19 is a challenge unlike any we have faced in modern history. It has laid bare healthcare disparities developed by decades of policy making in Alabama and beyond. State leaders must act now to address these issues; it is no longer a choice; it is a necessity.
Originally from Florence, Alabama, Levi Bevis is a 2019 graduate of the University of Mississippi, where he studied public policy and political science. He attended the 2018 Henry Clay College Student Congress, where he represented the State of Alabama. He most recently worked as an assistant paralegal at a corporate immigration law firm in Washington, D.C. In the future, he plans to attend law school to pursue a career in LGBTQ+ rights law or immigration law. He currently resides in Washington, D.C.
Levi C. Bevis 