Why Kentucky pledged health coverage for entire black population

The governor of Kentucky committed this week to ensuring that 100 percent of the US state's black population has health coverage, an initiative given new urgency by the coronavirus pandemic and protests against police brutality.

The surprise announcement is a telling example of the shift brought about by the Black Lives Matter movement and the quest for new ideas -- potentially unconstitutional -- by US officials aimed at addressing longstanding racial disparities.

"In our health care system, the inequalities have been laid bare, have been exposed by this COVID-19 epidemic, and the results of inequality in health care have been shown: it's death," said Andy Beshear, the Democratic chief executive of the rural, mountainous state, one of America's poorest.

"It shouldn't have taken this type of pandemic, or it shouldn't have taken these types of demonstrations, for us to commit to ending it," he added.

It is a statement that is far from universally supported in the US, he declared that "health care is a basic human right."

"My commitment today is we're going to begin an effort to cover 100 percent of our individuals in our black and African American communities," he concluded.

"That is a first to my knowledge," Lovoria Williams, a professor at the University of Kentucky who specializes in inequalities in health care told AFP, saying she was "pleasantly surprised" by the announcement.

Twenty-nine percent of the state's black citizens live below the poverty line, more than double the number of poor white people.

They have higher rates of obesity, diabetes and heart disease, all risk factors for serious forms of COVID-19.

Though they make up just eight percent of the state's 4.5 million people, they represent 16 percent of all coronavirus deaths, said Williams.

"I believe that what we're seeing is the culmination of years of inequality with the public killing of George Floyd, in the state of Kentucky the police killing of Breonna Taylor, coupled with the incident with the birdwatcher" in New York, she continued.

Taylor, a 26-year-old emergency medical technician, was killed by police officers who broke into her apartment, while searching for two people already in their custody, according to reports.

In New York, a white woman reported a black birdwatcher to police after he asked her to leash her dog.

But, cautioned the scholar, "the governor has to be very careful in how he frames this policy change."

Williams said it would be important for the state to provide data "regarding what difference this will make for this specific population."

- 'Dangerous precedent' -

Research has shown that being African American heightens risk to both COVID-19 and police violence. Black people are three times more likely to be killed by police than their white counterparts, according to Mapping Police Violence, a research project.

But Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University, says Beshear's announcement could pave the way for abuse.

"I can't think of a single instance where health coverage has been determined by somebody's race, and race alone," he said.

"I'm enormously sympathetic with the governor's intentions, but once you parse out social benefits purely on the basis of race, I think it does open up a dangerous precedent, because others might decide they would give it to whites or a certain religion."

He also doubted whether the move was constitutional.

Health care reforms enacted under former president Barack Obama reduced the proportion of black Kentuckians without insurance from 20 percent to six percent.

Many were able to get coverage under Medicaid, a government-sponsored insurance program for people on lower incomes, which is co-financed by the federal government.

But it is unlikely that Medicaid will expand its coverage on the basis of race. To fulfill its promise, Kentucky will probably have to rely on private insurance companies, and foot the bill itself.

© 2020 AFP