Letter to Christi Grimm, Principal Deputy Inspector General of U.S. Department of Health and Human Services - Cleaver and Fellow Homeland Security Committee Democrats Call on HHS Inspector General to Investigate Healthcare Disparities Intensified by COVID-19

Letter

Dear Principal Deputy Inspector General Grimm:

Annually, the U.S. Department of Health and Human Services' (HHS) Agency for Healthcare Research and Quality releases the National Healthcare Quality and Disparities Report. The report chronicles the progress and opportunities for enhancing the quality of healthcare and lowering healthcare disparities. Despite the thorough reporting and awareness within HHS and amongst Federal health officials of racial, ethnic, and socioeconomic healthcare disparities, these disparities continue to plague our country's healthcare system. Our country's response to the coronavirus (COVID-19) pandemic further exposes this problem.

COVID-19 continues to devastate communities across the country, and data from the Centers for Disease Control and Prevention (CDC), state health departments, and public reporting indicate the devastation has been particularly severe within minority and economically disadvantaged communities. On April 8, 2020, the CDC released an analysis of COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) data showing 59% of the COVID-NET catchment population are white residents, 18% are black, and 14% are Hispanic. Among those hospitalized within that same population, approximately 45% are white, 33% are black, and 8% are Hispanic,
suggesting, as the CDC states in the analysis, "black populations might be disproportionally affected by COVID-19." The CDC's findings are consistent with state data and public reporting.

Similarly, the Associated Press (AP) found, based on data through April 18, 2020, "that of the more than 21,500 victims whose demographic data was known and disclosed by officials, more than 6,350 were black, a rate of nearly 30%." The AP report went further to state, "African Americans account for 14.2% of the 241 million people who live in the areas covered by the analysis, which encompasses data from 24 states and the cities of Washington D.C., Houston, Memphis, Pittsburgh and Philadelphia." In Mississippi, a state with close to 3 million residents, 37.8% black, 59.1% white, the racial disparity is no less glaring. As of April 26, 2020, of Mississippians diagnosed with COVID-19, 52% are black, while 33.4% are white, and of Mississippians that have died from complications related to COVID-19, 60.7% were black and 38.9% were white. In New Jersey, a state with close to 9 million residents, 15.0% black,
20.6% Hispanic, 72.0% white, disparities are also present. As of April 26, 2020, of New Jerseyans diagnosed with COVID-19, 19.1% are black, 28.6% are Hispanic, and 35.6% are white, and of New Jerseyans that have died from complications related to COVID-19, 20.4% were black, 16.2% were Hispanic, and 53.2% were white.

In New York City, a city with nearly 18% of all COVID-19 cases in the United States, similar disparities exist. As of April 22, 2020, according to data from the New York City Department of Health and Mental Hygiene, the age adjusted rate of fatal lab confirmed COVID-19 cases per 100,000 by race/ethnicity group for African Americans is 127.1 per 100,000, for Hispanics, the rate is 114.0 per 100,000, compared to 63.5 per 100,000 for whites, and 51.6 per 100,000 for Asians. Additionally, early data from New York City provides an example of the economic disparity in the spread of the virus. A TIME analysis of COVID-19 ZIP code data, released by New York City officials, found that the "ZIP codes in the bottom 25% of average incomes represent 36% of all cases of the disease, while the wealthiest 25% account for under 10%."

While the Patient Protection and Affordable Care Act made crucial improvements to the healthcare
system by expanding coverage to millions of Americans, African Americans, Indigenous Americans, and Latinx Americans are still less likely to have health insurance. Further, minority communities are more likely to work in essential workforce positions and are less likely than employed people overall to work in professional and business service jobs, limiting telecommuting (i.e. social distancing) opportunities. Additionally, historical, environmental, socioeconomical, and political disadvantages limit access to quality health care, and place communities of color and economically disadvantaged populations at greater risk for pre-existing medical conditions that increase the likelihood of adverse outcomes for individuals with COVID-19.

Examining the work HHS undertook prior to the COVID-19 pandemic to eliminate racial, ethnic, and socioeconomic disparities must be a component of our country's emergency response to this public health emergency and planning in the event of future emergencies. Such an examination should include recommendations on how HHS, and its partners can improve health outcomes, eliminate disparities, and bolster our country's ability to respond in the event of future public health emergencies. Therefore, we respectfully request that HHS OIG examine HHS's efforts prior to the COVID-19 pandemic to eliminate racial, ethnic, and socioeconomic health disparities, and recommend ways in which HHS independently, and in collaboration with other agencies, can improve efforts to lessen the effects of health disparities in the event of future public health emergencies. Please include the following in your review:

a review of the work HHS undertook prior to the COVID-19 pandemic to eliminate disparities
and prepare for the effects of potential health pandemics on minority and economically
disadvantaged communities;

a review of the work HHS is currently undertaking to respond to racial, ethnic, and
socioeconomic disparities in COVID-19 cases and outcomes; and

recommendations for HHS and its partners to lessen the effects of health disparities and support
the recovery of communities disproportionately affected by COVID-19.

We thank you in advance for your attention to this matter.