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August 12, 2020

Black US Residents’ Views on Health Policy—Implications for the 2020 Election

Author Affiliations
  • 1Program in Health Policy, Harvard University, Boston, Massachusetts
  • 2Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 3Harvard Opinion Research Program, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston Massachusetts
JAMA Health Forum. 2020;1(8):e200954. doi:10.1001/jamahealthforum.2020.0954

Black US residents only constitute 11% of all registered voters, yet their electoral clout has grown during the past few decades because of high voter turnout. In several states, Black residents make up more than half of the Democratic electorate, and they represent approximately 1 in 5 (19%) Democratic registered voters nationally.1,2 However, voter turnout varies based on enthusiasm for candidates and their positions on important issues. Thus, it is important that major candidates take strong stands on issues Black voters care about, because it will affect turnout in November. This article examines the 3 top health policy issues facing Black residents in the upcoming election: health care, the coronavirus disease (COVID-19) pandemic, and racial justice. A review of recent public opinion data shows that candidates interested in appealing to Black voters will need well-developed proposals on universal health insurance coverage, health and economic protections from the COVID-19 pandemic, and strong federal action on antiracist policing and policies.

Health Reform

Black US residents have consistently held health care as a high political priority, and most Black adults (81%) say health care issues are very important to their 2020 vote. This is understandable considering their experiences. Compared with White individuals, Black US residents have higher mortality and worse health,3 and they are more likely to be uninsured.4 When it comes to racial inequality, most Black US residents (59%) believe that Black patients are treated less fairly than White patients when seeking medical care.

On health care reform, Black individuals broadly believe it is the government’s responsibility to make sure that all residents have health insurance coverage (75%). Beyond support for universal coverage, most Black adults favor 3 policies that work toward that goal: improving the existing Patient Protection and Affordable Care Act (ACA) (88%), enacting Medicare for All (78%), and adopting a Medicare buy-in (73%). Fewer Black adults (37%) support replacing the ACA with a state-based option.

The COVID-19 Pandemic

Health issues facing the Black community in this election year are broader than insurance coverage. Black communities across the United States have been ravaged by the COVID-19 pandemic, and Black individuals are more likely than White individuals to report being adversely affected by COVID-19 when it comes to both health and economics.5 For example, Black individuals are significantly more likely to contract and die of COVID-19 than White individuals, regardless of income.6 Approximately one-quarter of Black adults (24%) say they have a family member or a close friend who has died of COVID-19. Black individuals are also more likely to be exposed to COVID-19 in their work environments and are disproportionately experiencing major financial challenges because of the pandemic.

A substantial share of Black adults are critical of their state governors on several aspects of the COVID-19 outbreak in the United States. This includes one-third or more who reported disapproval of their state’s policies to ensure enough face masks (41%) and enough testing (40%), to help small- and medium-sized businesses (39%) and individuals (38%) in their state financially hurt by the outbreak, to provide health insurance or financial assistance to those who need medical care (35%), and ensure enough protective clothing for health workers (33%). Candidates interested in securing Black voters’ support must address the virus’s disproportionate economic and health consequences on this community.

In health and medicine, only about one-third of Black individuals (35%) have a great deal of confidence that medical scientists will act in the best interests of the public, only about 4 in 10 (41%) believe the benefits outweigh the risks in allowing greater access to experimental COVID-19 treatments before clinical trials are completed, and only a slight majority (54%) say they would definitely or probably get a COVID-19 vaccine if it were available today. Given these results, leaders in health and medicine must work to restore trust from Black US residents as policy solutions are developed and implemented.

Racism in Policing

Although the health policy dialogue has recently heavily rested on insurance reform, systemic racism has put in motion many disparities that persist today. This has been a long-standing issue of public concern among Black communities. Racism is widely and pervasively experienced by Black US residents in most areas of their lives, carrying significant adverse health consequences.7 In light of recent high-profile police killings of Black individuals and subsequent protests during the 2020 election season, polling has shown that Black US residents perceive racism as the most important problem (45%) facing the nation today. Black voters almost universally say (95%) that discrimination against Black people in the United States is a serious problem today, and 74% personally worry about experiencing police brutality.

As the issue of antiracism moves to the top of the national policy agenda, there is a window of opportunity to reform policing and other areas that affect racial inequities. Currently, most Black individuals favor several policies to prevent police violence, including requiring on-duty officers to wear body cameras (90%), penalizing officers for racially biased policing (87%), and prosecuting officers who use excessive force (86%). Most Black individuals (61%) also favor gradually redirecting police funding to social workers, drug counselors, and mental health experts for responding to nonviolent emergencies. Public opinion on these issues should continue to be closely tracked as policy discussions evolve.

Implications for the 2020 Election

Black voters’ turnout in this election will be heavily affected by how much potential voters believe candidates strongly care about addressing problems with health care, COVID-19, and racial justice. For the 2020 election, polling consistently shows that Black voters have a deep interest in universal health insurance, health and economic protection from the COVID-19 pandemic, and strong federal action on antiracist policing and policies.

Candidates that value Black US residents’ votes need plans for addressing these issues, including moving beyond the legacy of the ACA and implementing policies that address long-standing concerns of Black US residents regarding racism. Black livelihoods and the health they need to pursue these livelihoods have now become a strong influence on the 2020 election.

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Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License.

Corresponding Author: Nia Johnson, JD, MBE, Program in Health Policy, Harvard University, 14 Story St, Cambridge, MA 02138 (niajohnson@g.harvard.edu).

Conflict of Interest Disclosures: None reported.

Additional Contributions: John M. Benson was involved in editing drafts of this manuscript.

References
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Pew Research Center—US Politics and Policy. The changing composition of the electorate and partisan coalitions. Published June 2, 2020. Accessed July 1, 2020. https://www.people-press.org/2020/06/02/the-changing-composition-of-the-electorate-and-partisan-coalitions/
2.
Pew Research Center—Religion and Public Life. Racial and ethnic composition among democrats and Democratic leaners by state. Published 2014. Accessed July 1, 2020. https://www.pewforum.org/religious-landscape-study/compare/racial-and-ethnic-composition/by/state/among/party-affiliation/democrat-lean-dem/
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Cunningham  TJ, Croft  JB, Liu  Y, Lu  H, Eke  PI, Giles  WH.  Vital signs: racial disparities in age-specific mortality among Blacks or African Americans—United States, 1999-2015.   MMWR Morb Mortal Wkly Rep. 2017;66(17):444-456. doi:10.15585/mmwr.mm6617e1PubMedGoogle ScholarCrossref
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Kaiser Family Foundation. Uninsured rates for the nonelderly by race/ethnicity. Published December 4, 2019. Accessed July 1, 2020. https://www.kff.org/uninsured/state-indicator/rate-by-raceethnicity/
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Millett  GA, Jones  AT, Benkeser  D,  et al.  Assessing Differential Impacts of COVID-19 on Black Communities.   Ann Epidemiol. 2020;47:37-44. doi:10.1016/j.annepidem.2020.05.003PubMedGoogle ScholarCrossref
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Sethi  R, Siddarth  D, Johnson  N,  et al. Who is dying and why? COVID-19 Rapid Response Impact Initiative. Published May 20, 2020. Accessed June 11, 2020. https://ethics.harvard.edu/files/center-for-ethics/files/19cwhoisdying.pdf
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