The Good News

In a press release entitled African American Death Rate Drops 25 Percent, dated May 2, 2017, the Centers for Disease Control (CDC) announced some very good news for the African- American community: the gap in the death rate between African- Americans and White Americans has narrowed significantly. According to their report:

The overall disparity in death rates between these two races (Black and white) for all causes of death in all age groups was 33 percent in 1999 but fell to 16 percent in 2015.1

While noting there is still a need for improvement in some areas—there continues to be a mortality gap between Blacks and Whites of 4 percent—the news was hailed as signaling an increase in the overall health of the Black community. According to Leandris Liburd, Phd., M.P.H., M.A., associate director for the CDC’s Office of Minority Health and Health Equity:

We have seen some remarkable improvements in death rates for the Black population in these past 17 years. Important gaps are narrowing due to improvements in the health of the Black population overall. However, we still have a long way to go,”1

This decline in death rates is significant and telling. A more than fifty percent decrease in the mortality gap since 1999 is amazing progress; however, the most pertinent information is not in what the report says, but what it leaves unsaid: How did African- Americans achieve these amazing health improvements? 

Here are some interesting facts. While there have been significant declines in the mortality rates of African Americans across the board—all age groups and categories—the greatest improvement has been driven by two different groups of people in the Black community. According to the CDC: (1) The racial death rate gap closed completely for deaths from heart disease and for all causes of death among those 65 years and older.1 And (2), there are reported improvements in other causes of death, such as a decrease of about 80 percent in HIV deaths among 18- to 49-year-olds from 1999-2015. Still, a wide disparity remains with Blacks seven to nine times more likely to die from HIV. The Kaiser Family Foundation (KFF) report, dated October 2016—HIV And Medicare—states “A number of challenges contribute to the epidemic among Blacks, including poverty, lack of access to health care, higher rates of some sexually transmitted infections, lack of awareness of HIV status, and stigma”1,2

Anachronistically, the elderly and those living with HIV, who should be amongst the sickest groups in the Black population, because they are older and chronically ill, are living longer and as a group overall than other African-Americans. What’s the secret?  Besides melanin, they have something else in common: both groups have access to the life-saving program Medicare.

In 2000, the Health Care Financing Administration (HCFA)—now known as the Centers For Medicaid and Medicare Services—stated in their publication Medicare 2000: 35 Years Of Improving Americans’ Health And Security that Medicare “saves lives,” and noted that Medicare’s intervention ended one of the most deadly and historically disgraceful practices of hospitals and medical centers denying access to care on the basis of race:

Prior to Medicare’s enactment, many U.S. hospitals discriminated against African Americans and other racial and ethnic minorities. Most minority Americans were denied access to these facilities and had to rely on separate and often inferior hospitals and clinics to receive care. By requiring hospitals accepting Medicare funding to be integrated for all patients, Medicare played a powerful, but often overlooked, role in expanding access to high-quality care for minority seniors, …In 1963, minorities 75 years and older averaged 4.8 visits to the doctor; by 1971 their visits grew to 7.3, comparable to Caucasian utilization rates (NCHS, 1964 and 1971).3

HCFA’s publication also stated that, overall, Medicare has helped increase life expectancy:

In 1960, a 65-year-old American woman could expect to live an additional 15.9 years to reach the age of 80.9 years. In that same year, a 65-year-old man could expect to live an additional 12.9 years to the age of 77.9. Today, the average life expectancy of an American woman over the age of 65 has grown nearly 20 percent to 84.2 years and the average 65-year-old man can live to the age of 80.9 . . . Medicare quickly expanded access to care for the elderly. Hospital discharges averaged 190 per 1,000 elderly in 1964 and 350 per 1,000 elderly by 1973; the proportion of elderly using physician services jumped from 68 to 76 percent between 1963 and 1970. Currently, more than 94 percent of elderly beneficiaries receive a health care service paid for by Medicare. Medicare has improved quality of life.3

The same can be said for another group of African-Americans: those persons aged 18-49 living with HIV, who were granted access to Medicare. For those under 65, their access is complicated by the need to qualify for Social Security Disability Insurance, which means they must be sick enough to qualify as permanently disabled. Before this happens, however, many receive medical assistance through the Ryan White AIDS Program, a federally funded program created in 1990, as well as other government funded programs, such as the Affordable Care Act, which also expands access to Medicare.  Medicare 2000 also stated:

In 1972, Medicare expanded to include Americans living with disabilities and those with end-stage renal disease. Today, more than five million people with disabilities are enrolled in Medicare… The original Medicare program only covered those Americans age 65 and older. Recognizing the significant health care needs, and the lack of access to private insurance of other groups of Americans, Congress expanded eligibility (in 1972) to include Americans with disabilities and those with end-stage renal disease.3

Falling Into The Gap

Most Americans have health insurance provided for them through the mechanism of employment.  What most do not realize is that this insurance is heavily subsidized by the federal government. By tying medical insurance to employment, those who are most likely to be insured are fully employed individuals and their families, in their prime working years, disadvantaging those who are not employed or are underemployed, for the purposes of obtaining health insurance coverage. The KFF, in a report dated October 2014 entitled Tax Subsidies for Private Health Insurance, states:

The federal and state tax systems provide significant financial benefits for people with private health insurance. The largest group of beneficiaries is people who enroll in coverage through their jobs. The value of these tax benefits is substantial. The largest tax subsidy for private health insurance—the exclusion from income and payroll taxes of employer and employee contributions for employer-sponsored insurance (ESI) – was estimated to cost approximately $250 billion in lost federal tax revenue in 2013. . . Another complicating factor is that the largest tax incentive for private insurance—the exclusion of the cost of ESI—is an indirect subsidy that is never actually reported to the individuals and families who benefit from it. Many people with employer coverage are probably not aware that the federal and state tax exclusions for private health insurance provides them with a subsidy worth several thousands of dollars a year.5,4

This method of providing socialized medicine creates a system of government-provided health care, which advantages a shrinking group of individuals who are employed full-time, while disadvantaging the under- and un-employed. According to a report by the KFF entitled Health Insurance For The Unemployed:

When individuals with employer-sponsored coverage become unemployed, they face the loss of both income and health insurance. Moreover, any of the employee’s dependents that are covered through the employer could also lose coverage. The long-term unemployed are particularly vulnerable to loss of coverage as they face extended periods of reduced or no income. In 2009, more than half (57 percent) of adults who were unemployed and looking for work were uninsured. Among those adults, 68 percent said they were uninsured because they lost their job or were unable to afford coverage (Figure 1). The uninsured are more likely than the insured to forgo needed medical care, which increases the risk of developing serious health conditions. If the uninsured later obtain employer-sponsored coverage, these pre-existing conditions may not be completely covered. Those without health coverage are also more likely than the insured to incur medical debt, which poses an additional challenge to the unemployed facing precarious financial situations.6

This brings us back to the beginning. While the CDC’s press release was good news overall, a group of Black people continue to fall into the death gap, characterized by age, according to the CDC:

Of concern, the study also found that Blacks in their 20s, 30s, and 40s are more likely to live with or die from conditions that typically occur at older ages in whites, including heart disease, stroke, and diabetes. Risk factors for some diseases, such as high blood pressure, may go unnoticed and untreated during these early years. Notably, the death rates for homicide among Blacks did not change over the 17 years of the study.1

In June 2016, the Atlantic magazine produced an article which addressed the issue of male unemployment in the Black community entitled The Missing Men. Therein, author Derek Thompson stated:

Something is rotten in the U.S. economy. Poor men without a college degree are disappearing from the labor force. The share of prime-age men (ages 25-54) who are neither working nor looking for work has doubled since the 1970s.

The U.S.’s labor participation rate for this group of men is lower than every country in the OECD except for Israel (an outlier, because of the high number of non-working Orthodox Jewish men) and Italy (an economic omnishambles). Today, one in six prime-age men in America are either unemployed or out of the workforce altogether—about 10 million men. Men or black men?

But behind all of these trends, there is a larger story: the decline of sectors dominated by male workers. In 1954, the highwater mark for male participation, the manufacturing and construction sectors accounted for nearly 40 percent of all jobs. Now, after the long decline of manufacturing and the end of the housing bubble, they account for just 13 percent. These are jobs that men without a college degree can count on, and they’re much rarer than they used to be.7

Labor participation rates include those who are either employed, or unemployed and actively seeking employment. While they do not accurately reflect the true numbers of the unemployed, they indicate where the community is, relative to others. According to the Bureau Of Labor Statistics publication BLS Reports, dated September 2016, entitled Labor Force Characteristics By Race And Ethnicity, 2015, the labor participation rates for African-Americans as a whole  is among the lowest in the United States:

Among the race and ethnicity groups, Native Hawaiians and Other Pacific Islanders and Hispanics had the highest labor force participation rates, at 66.6 percent and 65.9 percent, respectively. American Indians and Alaska Natives (60.6 percent) and Blacks (61.5 percent) had the lowest participation rates.8

For the purpose of measurement, prime working age is 25 to 54. When you see that the group falling into the death gap are those most likely to be un- or under-employed due to low labor participation rates, in a nation where quality healthcare is tied to employment or disability, it’s no wonder the death gap still exists for them.What Can Be Done

Clearly the advent of Medicare and other government-sponsored healthcare programs have had an enormous impact on positive health outcomes for the African-American community. To address the existing death gap, expanding Medicare to all sectors of our community who go unprotected makes sense and could save many lives.

With the current collapse of ACHA—President Trump’s health care proposal—more Americans are trying to extend the life-saving protections of Medicare to non-traditional populations. In town halls and demonstrations across the country, many are demanding Single Payer. The proposals are many and varied. One of the most talked about and oldest is House Bill H.R. 676, sponsored by Representative John Conyers: Improved and Expanded Medicare For All. For the first time, as of June 2017, this bill has the support of the majority of House Democrats—112 of 193 members.  On the Senate side, Senator Bernie Sanders is seeking the support and signatures of citizen co-sponsors for his version of the Medicare For All Bill. If you would like to become a citizen sponsor and make your mark upon this important piece of legislation or for more information please visit: 9,10

A special thank you to PK Wil for her contributions to this story.“African-American Death Rate Drops 25
Percent. “ CDC Newsroom. Centers For Disease Control. 2, May 2017. Web. 12, Aug. 2017.

“Medicare and HIV.” Kaiser Family
 Foundation. Kaiser Family Foundation. 14, Oct. 2016. Web. 11, Aug. 2017.

Adler, Gary. Et. All. “Medicare 2000: 35 Years
Of Improving Americans’ Health and Security.” Health Care Financing Administration.  Centers For Medicaid and Medicare Services. Jul. 2000. Web.11, Aug. 2017.

Rae, Matthew.  Et. Al. “Tax Subsidies For
Private Health Insurance.” Kaiser Family Foundation.  Kaiser Family Foundation. 27, Oct. 2014. Web. 11, Aug. 2017.

“Health Insurance Coverage Of The Total
Population. “ Kaiser Family Foundation. Kaiser Family Foundation. 20015. Web. 10, Aug. 2017.

Schwartz, Karen. Sonia Streeter. “Health
Coverage For The Unemployed. “ The Kaiser Commission On Medicaid And The Uninsured . Kaiser Family Foundation. Jun. 2011. Web. 10, Aug. 2017.

Thompson,  Derek. “The Missing Men.” The
Atlantic. The Atlantic. Monthly Group.  27, Jun. 2016. Web. 10, Aug. 2017.

“Labor Force Characteristics By Race And
Ethnicity,  2015. Report 1062. BLS Reports. U.S. Bureau Of Labor Statistics, Division Of Information And Marketing Services. Sep. 2016. Web.  9, Aug. 2017.

Burns, Alexander. Jennifer Medina. “The
Single Payer Party? Democrats Shift Left On Healthcare. “ The New York Times. The New York Times Company. 23, Jun. 2017. Web. 9, Aug. 2017.

Guadiano, Nicole. “Bernie Sanders seeks
‘citizen co-sponsors’  for single-payer health care bill.” USA Today. USA Today. 9, Aug. 2017. Web. 9, Aug. 2017.