Higher rates of COVID-19 infection among essential and frontline workers put a spotlight on underinsured laborers. Essential workers—those who perform a range of jobs and services that are necessary for society to function well, including but not limited to occupations in health care, food service, and public transportation—are less likely to have insurance and are more likely to be underinsured than non-essential workers. However, a 2020 Brookings report found that Black essential workers are more likely to be uninsured than white essential workers. Similarly, an Urban Institute analysis found that Black workers are more likely to be essential and frontline workers (a sub-category of essential workers comprised of people who cannot work from home), and they are more likely to be underinsured. The Urban Institute study adds that the problem of not having adequate insurance is even more acute for American Indian or Alaska Native and Latino or Hispanic workers. In order to achieve equity for the lowest paid and most essential frontline workers of color, the American health insurance and health care systems need a radical restructuring.

The concentration of Black people in essential jobs did not develop through happenstance. Racism in labor markets is revealed in racial disparities in occupational concentration, employment rates, and pay. For instance, Black people in Minneapolis, as in much of the nation, are more likely to work in jobs considered essential—transit, factories, retail, health care facilities, and childcare—which increases their exposure to COVID-19. In the state of Minnesota, Black people make up 7% of the total population, and account for approximately 25% of all COVID-19 infections as of the summer of 2020, according to a University of Minneapolis study. There is a causal relationship between wealth and quality of life outcomes, including health. Wealth is the sum of all assets owned minus debt held—a person’s net worth. Occupational discrimination factors into how much wealth a family has and the resultant degree of protection a family has to withstand inevitable economic shocks.

Medical debt among Black workers adds insult to injury. An examination of debt as a function of wealth provides insights into structural racism—the policies and practices that produce racial disparities. Therefore, we introduce evidence that by reducing the amount of medical debt held by all households, we are disproportionately helping Black people. This will signal that we are mitigating structural racism and improving conditions so that Black workers and their families can thrive. This report examines medical debt and its racial distribution with a focus on how it’s accrued, including failures in the insurance market and malign medical billing practices. Following that discussion, we review a number of policy reforms to reduce health care cost-sharing that broadly would move the nation further toward universal health care.

Read the full article about medical debt by Andre M. Perry, Joia Crear-Perry, Carl Romer, and Nana Adjeiwaa-Manu at Brookings.