Martha Graham / Shutterstock.com

Health Inequity Persists in New York City: Impact of COVID-19 on Low-Income New Yorkers’ Access to Health Care

Irene LewElisabeth Ryden Benjamin

In the Spring of 2020, New Yorkers suffered the brunt of the initial onslaught of the coronavirus pandemic in America. Since then, the city has managed to keep infection rates low for months as it moved through a phased reopening of the economy. But now, it is experiencing a second surge in positive COVID-19 cases and hospitalizations. The structural policies described in our June 2020 report that resulted in the pandemic’s well-documented disparate impact on communities of color remain unchanged. In one effort to address these disparities, Mayor de Blasio has vowed that one million New Yorkers would receive the coronavirus vaccine by the end of January. But only 5 percent of the city’s population has been vaccinated so far. Concerns remain about the equitable rollout of the vaccine to Black, Latina/o/x, and low-income New Yorkers who have been disproportionately impacted by the coronavirus, as well as to frontline essential workers. Data from our 2020 Unheard Third survey sheds further light on the inequitable public health impacts of the coronavirus, and how COVID-19-related job loss has impacted the ability of low-income New Yorkers to remain insured and access the affordable healthcare they need.

This post is the fourth in A Roadmap to an Inclusive Recovery: Assessing COVID-19’s Impact on Low-Income New Yorkers, a special series highlighting key findings from our 2020 Unheard Third survey on the inequitable impact of COVID-19 in New York City. As the only regular public opinion poll of low-income households in the United States, the Unheard Third is an annual survey that tracks the hardships of New York City's low-income residents and their views on what policies would help them get ahead.

 

Communities of color and outer-borough residents have shouldered the brunt of public health consequences related to the virus 

Data from the New York City Department of Health has shown that Black and Latinx New Yorkers are twice as likely as white New Yorkers to die from the coronavirus. CSS’s Unheard Third data confirms the disproportionate public health impact of COVID-19 on communities of color. More than a third (36 percent) of Latina/o/x and 31 percent of Black New Yorkers said that they or a family member had been infected with the coronavirus, compared to 20 percent of white residents.

Many New Yorkers of color live and work in conditions that put them at heightened risk for exposure to COVID-19. Half of Latina/o/x and 54 percent of Black workers we surveyed in 2020 said that they identified as essential workers, compared to 40 percent of white workers. Most essential workers don’t have the luxury of working remotely—a phenomena that further perpetuates health disparities. One study found that only 17 percent of Latina/o/x workers and 20 percent of Black workers have jobs that allow them to work remotely, while 30 percent of white workers can do so.[1]

Our analysis of the 2020 Unheard Third found that COVID-19 infection rates were highest in the Bronx: 32 percent of low-income Bronx residents said that they or a family member had been infected with the coronavirus, compared to just 19 percent of those living in Manhattan. New York City Department of Health data likewise shows that the some of the hardest-hit neighborhoods were low-income communities of color in the outer boroughs.

The relatively high COVID-19 infection rate in the Bronx can be attributed to a number of factors, including overcrowded housing, a large concentration of essential workers, and the highest rates of underlying chronic health conditions such as asthma and diabetes that put residents at greater risk for more severe cases of COVID-19. The Bronx is to home to the highest share of respondents who said that they were essential workers: 54 percent of employed Bronx residents we surveyed self-identified as essential workers, compared to only 37 percent of those in Manhattan. Furthermore, the Bronx recently ranked last among the state’s counties in terms of health outcomes. In June 2020, CSS issued a report that described the disparate impact of the COVID-19 pandemic and investigated the structural policy decisions that exacerbated these disparities. The report found that compared to Manhattan, there are far fewer hospital beds in low-income neighborhoods in the Bronx: in 2020, Manhattan had 6.4 hospital beds for every 1,000 residents, while the Bronx had only 2.7 hospital beds for every 1,000 residents.

 

Pandemic job loss has led to loss of health insurance, especially for Low-income Latina/o/x New Yorkers

The COVID-19 pandemic and resulting economic downturn have led to loss of health coverage among low-income New Yorkers. According to the 2020 Unheard Third, 22 percent of low-income New Yorkers who lost employment income in their household due to COVID-19 said that they or someone in their household lacked health insurance coverage since the start of the pandemic, double the share of those who did not experience wage or job loss (11 percent). While New York can boast of an expansive health care safety-net, many people are unaware of how to enroll in coverage or are fearful that enrolling in coverage might adversely affect their immigration status. Among low-income New Yorkers who experienced wage or job loss in their households, Latina/o/x New Yorkers were nearly twice as likely as white New Yorkers to report losing health coverage since the start of the pandemic—32 percent of low-income Latina/o/x New Yorkers said that they or a member of their household lacked health insurance, in contrast to 17 percent of low-income white residents.

 

Inequitable access to health coverage across the city, especially for the Bronx and Queens

Even before the pandemic hit, there was uneven access to employer-sponsored health insurance among working New Yorkers across the city. Census data shows that in 2019, among employed adults aged 18 and older, 45 percent of Bronx residents and 39 percent of Queens residents did not receive health coverage through their employer or union, compared to less than a quarter (24 percent) of Manhattan residents.[2] An earlier post describes how the recession triggered by the pandemic has impacted the city unequally, with low-income New Yorkers in the Bronx and Queens hit hardest by COVID-19-related wage and job loss. On top of this, a sizable share of residents in these two boroughs also lost their health coverage—in the Bronx, more than a third of low-income residents with income loss in their household said that they or a household member have lacked health coverage since the start the pandemic, double the share of low-income Manhattan residents.

However, the Affordable Care Act’s expansion of Medicaid and its offer of subsidized health plans has led to the enrollment of 425,000 New York City residents into coverage between February and November of 2020, providing an important cushion for those who became unemployed due to the pandemic and lost employer-sponsored health insurance coverage. According to the 2020 Unheard Third, more than half of low-income New Yorkers (52 percent) who lost their job permanently or temporarily said that they received Medicaid or were on the Essential Plan. And even before the pandemic, Census data showed that nearly half (47 percent) of low-income New Yorkers received health coverage through Medicaid in 2019.

 

Conclusion

As New York City and State accelerate their vaccination efforts, policymakers must ensure an equitable distribution of the vaccine that targets essential workers and residents of low-income neighborhoods and communities of color. In addition, recent data indicates that vaccine hesitancy is far more common among Black and Latina/o/x people. Governor Cuomo recently announced the launch of the New York Vaccine Equity Task Force, which will focus on addressing existing barriers to vaccination and increasing access to vaccines in Black and Latina/o/x communities, public housing and healthcare deserts. The state should also ensure that New Yorkers most impacted by COVID-19 have access to health insurance, especially undocumented immigrants. New York could partially fill in this coverage gap by enacting a bill in Albany that would offer the Essential Plan to income-eligible New Yorkers who have contracted COVID-19 regardless of immigration status. The state should also expand resources to community-based organizations for outreach and enrollment into the New York State of Health Marketplace and stabilize safety-net hospitals by better targeting Indigent Pool Care funding and insulating them from any possible Medicaid cuts. With pandemic-related job loss also leading to loss of health coverage for many New Yorkers, the state must also prioritize universal health coverage by passing the New York Health Act, which would create one public health program that covers all New York residents regardless of income or immigration status. 

 

[1] Economic Policy Institute, “Not Everybody Can Work From Home:  Blacks and Hispanic Workers Are Much Less Likely to Be Able to Telework,” March 19, 2020, https://www.epi.org/blog/black-and-hispanic-workers-are-much-less-likely-to-be-able-to-work-from-home/.

[2] CSS analysis of 1-year 2019 American Community Survey data from US Census Bureau (accessed via IPUMS)

 

Issues Covered

Access to Health Care, The Unheard Third