Letter from our Chair - Dr. Jessica Schorr Saxe

In the last few weeks, we have seen protests, listened to activists, and watched elected officials and businesses proclaim their commitment to racial justice. 

Whether this movement is at last a success does not rely on the words we hear or read nor the one-time donations of thousands or even millions of dollars. It depends on whether Americans are willing to make deep, sustained changes.

I hope you will read the letter from Wendell Potter below about the response of the insurance industry, which very much relates to our main mission of advocating Medicare for All. Potter points out that, even as the industry pays lip service to promoting equality, its core activities actually lead in the opposite direction--including opposing Medicare for All, which would move us far along the path to healthcare equity.

We see both COVID-19 and racism as public health issues related to systemic discrimination. Darren Walker, the president of the Ford Foundation, who is African-American and grew up poor, writes in a New York Times column about the fundamental change we need to make in financial and social policies in order to improve social and economic mobility. This should be particularly compelling to those of us in Charlotte still smarting from the finding a few years ago that we had the lowest social mobility of any county in the country. The need for major changes is supported by "Extreme inequality was the preexisting condition", from ABC News, which shows that not only is inequality financially and socially devastating, but that it also contributed to the excess illness and deaths among minorities.

Healthcare injustice, racial injustice, violence against Black Americans are all deeply rooted, and it will take deep change to root them out. We must educate ourselves, be thoughtful and focused, be active, and vote. And we can make the post-pandemic America a better one than we left behind.

Jessica Schorr Saxe,
Chair, Health Care Justice--NC

In recent days, Anthem has touted its “commitment to a more just society.” UnitedHealth pledged its “support” for Minneapolis “in response to George Floyd Tragedy.” And the industry’s PR and lobbying group, America’s Health Insurance Plans, “urges Americans to come together for peace and positive change.”

As a former health insurance executive myself who oversaw corporate communications, I know firsthand that these carefully crafted declarations are designed to paper over a shameful truth: When it comes to racial equity, the health insurance industry is no friend.

In health care, “equality” is a catchphrase that suggests a focus on making sure everyone in society gets the coverage they need. But the larger reality is that health insurance companies are businesses, first and foremost. Their purpose is to make money, and their most important goal to reward shareholders. And they’re very good at it. If that means denying health coverage (and it often does), so be it. Even if that means Black communities, the most likely to be uninsured or under-insured, are disproportionately impacted by COVID-19.

According to a study by a team of epidemiologists and doctors, while African Americans represent 13.4% of the population, counties with higher Black populations represent over half of all COVID-19 cases and nearly two in three deaths from the virus.

What exactly are health insurance companies doing to address these kinds of disparities?

First, you may see these corporations announce donations from their foundations to social justice organizations this week while the news is focused on racial inequities. These sums sound large to the average person and garner wonderful headlines for the company. But remember, big for-profit health insurers take in revenues in the hundreds of billions of dollars a year. UnitedHealth alone reported revenues of $242 billion last year alone.

These donations are a tiny expense to the insurers but pay off big in terms of the positive public relations value they get. I would know, as a former vice president for corporate communications at Cigna.

You might excuse this kind of thing as standard P.R. practice, or say they may do some good, so let’s look at the substance of how these corporations conduct their businesses when it comes to racial equality, The reality is, UnitedHealth and most other big for-profit insurers quickly left the “marketplaces” created by the Affordable Care Act a decade ago that reduced racial disparities in health insurance. There was a simple reason for this. The marketplaces had rules that prohibited the sale of policies with skimpy benefits and high-profit margins the insurers had previously sold. Those companies ran for the exits because they couldn’t make money fast enough on ACA-compliant policies to satisfy their shareholders’ demand for a quick return on investment.

Keep in mind that the insurance industry funneled more than $100 million to the U.S. Chamber of Commerce in 2009 and 2010 to finance the Chamber’s campaign to keep the healthcare reform law from passing in the first place. When that effort failed, insurers shifted their focus to trying to shape the legislation in ways to protect profits, such as allowing them to continue selling policies with very high deductibles. In that they were successful: the big insurers have reported record profits since the ACA went into effect.

It’s instructive to note who makes these decisions at these companies. The executive suites of the big insurers are predominantly white and male, and enjoy exceptional wealth for the profits they deliver. According to the executive salary list of the largest private health insurer (UnitedHealth) the seven highest-paid executives at the company last year were all white, with top salaries reaching almost $19 million.

While health insurers issue their warm and fuzzy statements about racial justice, they are quietly funding a front group called Partnership for America’s Health Care Future, to defeat reforms (like Medicare for All or Joe Biden’s public option) that would greatly expand health options that reduce racial disparities in health care. One of the rhetorical tactics this group uses is to deride these plans to expand access to more Americans as “one-size-fits-all health care,” a dog-whistle to wealthier (White) Americans that a healthcare system providing all Americans with equal benefits, can’t possibly be high enough quality for them.

But to truly understand how health insurance corporations see the current crisis in America, one fact is more significant than all the rest combined. During a global pandemic killing thousands of African American people -- not to mention a police violence epidemic that sees 1 in 1,000 Black men killed at the hands of the police -- health insurance companies are reaping ever more-massive profits.

So while these private health insurance companies post gauzy tweets and happy press releases about supporting racial justice, it’s important to look at what they actually do in practice. With African Americans are suffering from extraordinary health risks, the health insurance industry could put their money where their mouth is and provide better coverage to more people, rather than continuously place profits over care.

That would be the real test of their newfound commitment to racial justice.

In solidarity,
Wendell Potter