The governor of Kentucky has promised this week that all the black inhabitants of the State have a health insurance, an initiative that was justified by the specific risks of the Covid-19 for the minority, and the general movement against racism in the police and discrimination. The surprise announcement is a dramatic example of the new consciousness and the quest for new ideas – and potentially unconstitutional – by public officials in the u.s. to finally solve inequalities that, in spite of decades of public policies, persist in all areas.
“The inequities of the health system have been laid bare by this epidemic of Covid-19, the consequences of inequalities in health are clear, it is death,” said, on June 10, 2020, Andy Beshear, a democrat, the chief executive of this small, poor State, rural, and mountainous. “We would not have had to wait this pandemic, or these events, to urge us to put an end to it “, he added, before declaring a thing that does not have unanimous support in the country : “health is a fundamental human right “. Therefore, “we will launch an initiative to cover 100 % of individuals in the black communities and african-american,” said Andy Beshear.
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We are witnessing the culmination of years of inequality.
“This is a first, to my knowledge,” responds to the Agence France-Presse Lovoria Williams, a professor at the university of Kentucky and a specialist in health inequality, “surprise well” by the announcement. In this State, 29 % of the black inhabitants live under the poverty line, a proportion that is double that of whites. They are relatively more obese, more diabetic and more affected by cardiovascular disease, many risk factors are proven to the Covid-19. While they constitute only 8 % of the population, they represent 16 % of the deaths from the pandemic in Kentucky, according to Lovoria Williams.
“We are witnessing the culmination of years of inequality, with the murder in public of George Floyd, murder by police officers in Kentucky of Breonna Taylor, and also the incident with the birder” in New York, she summarizes to explain the current context. Breonna Taylor, 26 years old, was killed overnight in his apartment by police officers who had the wrong target. In New York, a white woman denounced to the police a black man who asked him to keep his dog on a leash. But, warns the researcher, ” the governor will have to be very careful how he puts this policy in place, and justify them by data about the impact that this will have to this specific population “.
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“Dangerous precedent”
It is shown to be black in the United States is a factor of risk, either of dying of the Covid-19 or firearms ; the life expectancy is three years shorter for black Americans than among white Americans. We know, because here, what the Americans call “race” (the five official categories : white, black or african-american, native american or native Alaskan, asian, native Hawaiian, or other Pacific islands), and ethnicity (hispanic or latino, or not) are the demographic components systematically taken into account in the studies and the official statistics.
But “I know of no example where the health coverage is determined by the race of someone, it would be quite striking,” said Lawrence Gostin, director of the centre on health law at Georgetown university. “I share the intentions of the governor, but if we start to allocate social benefits on the basis of race, it opens a dangerous precedent, because others might decide to give them to White or a certain religion,” says the university to the Agency France-Presse. He doubted the constitutionality of the initiative.
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The reform of health insurance is adopted under the Barack Obama has reduced from 20% to 6 % the proportion of black inhabitants without insurance in Kentucky – many have access to Medicaid, the public insurance for the poor, jointly financed by the federal State. But it is unlikely that Medicaid will grant an exception on the basis of the color of the skin. To pay for his promise, the Kentucky would probably have to rely on private insurers, and pay the bill.
