Kentucky Gov. Andy Beshear is working to make good on his promise to expand health coverage to all Black residents amid the coronavirus pandemic, but the emergency measure comes with an expiration date.
Black Americans have been disproportionately impacted by the health crisis. In Kentucky, where Black people make up just over 8% of the population, they represent more than 16% of the state's coronavirus deaths.
Beshear, a first-term Democrat who won a narrow election in deep-red state, sought to address that disparity in June.
"We are going to begin an effort to cover 100 percent of our individuals in our Black and African-American communities," the governor said last month. "We're going to be putting dollars behind it."
Six weeks later, Beshear told Salon that the effort is underway.
"My commitment when I ran for office is to ensure that every Kentuckian had some form of health care coverage and what COVID-19 has laid bare is a systematic racism in our health care system that has led to African Americans of Kentucky dying at twice the rate they make up of the population," Beshear said in an interview.
"And so that, along with these calls for justice and equity around the country, really brought into focus the fact that what's what's being asked for is finally some priority in our African American communities. So while our goal is to sign everyone up for some form of health care coverage, we are starting with our Black communities."
Beshear told Salon that the state has identified about 20,000 Black residents who lack health care coverage.
"The easiest means to, at least initially, provide that coverage … is through the pandemic Medicaid program," he said. "That right now in COVID-19 is a one-page form, and that's the way to get people into the system."
The pandemic Medicaid program is a temporary measure intended to provide free health care to eligible applicants. The state plans to reach out to churches and community leaders to help with the sign-ups and has approved a budget for a direct marketing campaign to reach residents who lack coverage. The marketing will also target the state's Hispanic residents, who have also been disproportionately affected.
But after the emergency program expires, residents may once again be left without coverage.
Beshear said the state aims to "transition" residents into "whatever people qualify for, whether it's the [Obamacare] exchange where they can get private insurance," "expanded Medicaid," or "through some other means or manner."
"I believe that there is a health care product, whether it's public or private, that everyone qualifies for," he said.
The expanded Medicaid and private exchange options are already available, however. While Kentucky's Medicaid expansion has greatly helped to reduce the number of uninsured people, many who do not qualify also lack the resources to purchase a private plan.
Pressed on potential coverage gaps when the temporary pandemic program expires, Beshear argued that the state's Medicaid expansion and health exchange subsidies would provide affordable options for all Black residents.
"We believe that right now in Kentucky, because of how we expanded Medicaid, that there will be a product out there for everyone that is affordable," he said. "And if we find various gaps, we want to address them first for our African American population. But second for everyone."
It's unclear how those gaps would be addressed. Kentucky's policy could "draw legal challenges that allege discrimination against other populations that also lack health insurance," Politico noted.
It's also unclear how Beshear would be able to get funding for any sort of health care expansion from the Republican-dominated state legislature.
"At the moment, we are able to use COVID funding, CARES Act funding," he said.
Many in Kentucky say they want Beshear to go further.
The disparity facing Black residents is "clearly immoral" but expanding coverage to uninsured Black residents is only "the beginning" because the number of all uninsured residents in the state has swelled, said Kay Tillow, a longtime nursing union organizer who chairs the group Kentuckians for Single Payer Health Care, which called on Beshear to endorse a Medicare for All system.
In an interview, Tillow described Medicaid as offering a "lower tier" of care than private plans, and said many Medicaid recipients, particularly in rural areas, have trouble finding hospitals and specialists. That leaves many with only private insurance options amid an economic crisis.
"We don't think that the structure of our current health care system is going to make it possible for him to do this, when you have to buy the insurance," she said. "And when we have 931,000 people laid off in just the past few months, I mean, there's no way. ... We don't have a structure that is going to make it possible to do this. So we're challenging the governor to say, 'OK, let's follow through.' Help us to get a national health care plan that really makes it possible to make this a human right and to cover every single person."
Rep. Attica Scott, the only Black woman in the Kentucky state legislature, said Beshear's plan was just a "short-term Band-aid."
"I don't see it as an actual longterm solution," Scott said in an interview. "To me, this felt like a quick rush to say, 'I'm doing something for Black people.' … But it is definitely not a longterm systemic solution to this crisis that Black people are facing because the crisis is attacking us at every single level."
Scott argued that Beshear should have sought the advice of more Black lawmakers before rolling out the plan.
"I'm not sure what members of our Kentucky Legislative Black Caucus he spoke to before deciding that this was what was best for Black people," she said. "Had he spoken to some of us, I know that I would have said we also need to look at, for example, the implicit bias in health care, because Black women are three to four times more likely to die in childbirth than white women," she said. Scott introduced a bill to address that disparity in the most recent legislative session, she said. "And neither he nor his lieutenant governor, who just had a baby this year, ever mentioned that bill, [they] didn't support it."
Implicit bias in health care "not only impacts maternal health, but all of our health as Black people," she said.
"Many Black folks across the Commonwealth need the governor to have a more expansive understanding of what impacts our health and that it's not only health insurance, it is access to health care," she said. "It is dismantling a system that is steeped in racism [and] historical trauma. Implicit bias means that as soon as we walk through the door, we're judged based on our educational level, our socioeconomic status and our zip code."
Black people have been disproportionately impacted by the coronavirus, Scott said, because of the "economic and social factors that we find ourselves living under, and the inequities that we experience every day.
"If the governor really wants to address our health and our economic security as Black folks, then he's got to make sure that he is pushing the legislature to address issues like education and access to higher education and making higher education affordable," she said. "Making sure that we have jobs that are located in our neighborhoods, making sure that we're paying people living wages, all of those issues have to be addressed. It's not just one thing. It's not only access to health insurance, which many of us actually have. It's also looking at how institutional systemic racism impacts even the health care field, that makes us not even want to go get health care when we're ill or when we think something's wrong."
Beshear said the health care plan was one part of his ongoing focus on addressing racial disparities.
"One of my first acts was restoring voting rights to over 170,000 Kentuckians that are disproportionately African American that had lost those voting rights," he said. "We rescinded a Medicaid waiver that would have disproportionately affected our African American communities. We have taken increasing steps in being intentional about diversity within our own cabinet. Our top two appointed officials in Kentucky for the first time ever are both African-American individuals."
When the pandemic hit, "it laid bare what inequality in health care does," he said. The subsequent protests over the police killing of Breonna Taylor in Louisville and broader issues systemic racism "greatly" affected the administration's priority on addressing inequality, Beshear said.
"I think what it has done is create more urgency and, frankly, we should have had more urgency before. It shouldn't have taken COVID-19, it shouldn't have taken the protests and demonstrations," he said. "But what you hear is people being tired of either no change or change that doesn't occur fast enough. And when you see what's happened with COVID, you understand that change has to happen faster. It has to happen now. Martin Luther King Jr. had a quote about health care being one of the worst inequalities. We should have done a heck of a lot more since then."
Scott said there were many other problems facing Black residents, such as environmental concerns related to chemical companies based in black neighborhoods like the West End of Louisville, along with widespread economic inequities.
"Where I live, people can't get to the doctor because of lack of public transportation. We can have all the health care in the world, but I can't get to a dentist. I can't get to a primary care physician. I can't get to a gynecologist," she said. "We've got to address access to employment opportunities because, of course, when people struggle to make ends meet, whether it's paycheck to paycheck or no check to no check, that's going to impact both their physical and mental health. So those are all issues that the governor and his administration has to work with our Legislative Black Caucus to address, because we're the people who are deeply rooted in community. We live these issues every single day."
Another pressing matter facing Kentucky's Black residents is the looming eviction cliff, when thousands will face potential homelessness after state and federal eviction moratoriums expire.
"Admittedly we have a challenge," Beshear said. "We need people to have a home to be able to stay in, to be healthy and to defeat COVID-19. And the cost of someone being evicted can be great. It can be the difference of life and death."
But Beshear argued that the eviction policy will have to be reviewed because some people are taking advantage of the moratorium.
"We do have some instances where people who can and should be paying their rent are not paying their rent because of orders we've put out," he said. "So our goal moving forward is to find a way to make sure that those that need extra time because of COVID have it [and] are not evicted, but also making sure that there aren't some out there just gaming the system. It's not easy to find that perfect solution, but that's what we're looking for."
Scott questioned the governor's focus on those "gaming the system," arguing, "If folks say they need help having secure housing, we need to help people."
"I'm a renter so that's a tough statement for me to hear," she added, "because who makes the determination about someone's situation and what they can and cannot afford to pay? That's such a judgment call at a time when people are living in crisis… People are back home or at home more than ever, so they're using up more utilities, eating more food … So that expense has increased. So who's making this judgment call? I think that's a real tough sell for me. I believe we just need to take care of people."
Kentucky is facing a $1.1 billion budget shortfall, like many other cash-strapped states that saw tax revenue dry up amid statewide stay-at-home orders, which will greatly affect its future ability to address these crises.
"We desperately need … another round of CARES Act [funding] to specifically help with our state budget," Beshear said. The current shortfall "would result in the largest budget cuts in modern history" and cuts to "all of these programs that are so critical."
Sen. Mitch McConnell, R-Ky., the Senate majority leader, has pushed back against calls to provide aid to state and local governments, which he termed "blue state bailouts" even as his own state faces a dire budget crisis.
Beshear said he "pushed hard" for state aid in recent conversations with McConnell.
"Obviously he's not made any commitments. My hope is that he understands that this is a must, not a maybe," he said. "So while I am optimistic … I'm worried, because what happens when you've got to cut a billion dollars from a budget? Those that need us most suffer. And our biggest part of our budgets are education and health care."
Scott argued that McConnell's comments about the state aid show that he "could care less about those of us in Kentucky who are struggling to make it every day."
"People like Sen. McConnell and many of the folks who are making those kinds of misguided decisions live quite well, quite comfortably," she said, "while the rest of us struggle to make ends meet. So, quite frankly, I'm not interested in their misguided opinions on what it means to try to survive every single day, let alone thrive. If the senator cared at all about the people in Kentucky, then he would do everything in his power to make sure that housing and utilities and food and medicine and medical care are highly accessible to every single person living in the Commonwealth of Kentucky.
"I have been concerned about what that's going to mean for people like my daughter, who is a pharmacy tech, because those are often seen as the frontline workers who can go first" in the event of budget cuts, Scott said. "We already disgracefully underfund public education as it is. So I'm not sure what more you can take away from us with public education. But I see frontline workers ... being laid off first. That, to me, is something that the federal government, led by Sen. McConnell, needs to look at and say, 'How do we make sure that we prevent this from happening?' I'm not convinced that Sen. McConnell or his colleagues are doing everything in their power to protect the people in the United States."