Abstract

Context: The racial health equity implications of the Trump administration’s response to the COVID-19 pandemic.

Methods: We focus on four key health care policy decisions made by the administration in response to the public health emergency: rejecting a special Marketplace enrollment period; failing to use its full powers to enhance state Medicaid emergency options; refusing to suspend the public charge rule; and failing to target provider relief funds to providers serving the uninsured.

Findings: In each case, the administration’s policy choices intensified, rather than mitigated, structural racism and racial health inequality. Its choices had a disproportionate adverse impact on minority populations and patients who are more likely to depend on public programs, be poor, experience pandemic-related job loss, lack insurance, rely on health care safety net providers, and be exposed to public charge sanctions.

Conclusions: Ending structural racism in health care and promoting racial health care equity demands an equity-mindful approach to the pursuit of policies that enhance—rather than undermine—health care accessibility and effectiveness and resources for the poorest communities and the providers that serve them.

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