Coronavirus Victims Include Health Clinics in Minority Communities

Low-cost and free health clinics that serve large minority and low-income communities are being hit hard by the pandemic, with nearly 2,000 health-center sites closing temporarily and others worried about their financial futures, trends that risk widening racial disparities in health care.

Federally funded community health centers that serve many of these people have temporarily shut many sites, in some cases because they shifted to virtual visits or for a time ceased operations because of staffing shortages. Some centers have also had to scale back traditional, revenue-making primary care services during the pandemic. Additionally, clinics that offer free or charity-based care are seeing a surge in demand, and many are concerned about their financial futures as donations drop off.

Clinics face financial strain as high levels of joblessness leave many patients without job-provided health care. The resulting surge in demand for services at free clinics could result in some patients being turned away, health- clinic officials said.

These challenges, taken together, could further limit access to the health-care system for minority and ethnic groups, compounding the toll the pandemic is already taking on Black, Hispanic, Native American and Alaska Native populations.

The pandemic is also adding urgency to efforts by public-health leaders and lawmakers who want more funding and community outreach to address inequities to reduce the spread of the virus in vulnerable racial and ethnic populations.

"The fight for health equity should never be an afterthought when we devise policy," said Rep. Raul Ruiz (D., Calif.), a physician. "We need major reforms on access to care."

Dr. Ruiz has pushed to have public-service announcements about the coronavirus distributed in several languages, for example, and said reopening without safeguards will cause disproportionate harm to Black, Latino and Native American communities and workers.

Community health-center funding comes in part from federal subsidies established under the Affordable Care Act, with $4 billion for fiscal 2019. Federal stimulus legislation has provided more than $1 billion for the centers, and discussions have been under way for additional support.

Legislation also extended federal funding through the end of November. Some Republicans such as Rep. Elise Stefanik (R., N.Y.) pushed for more funding for community health centers to be included in the stimulus.

Hospitalization rates for coronavirus show the disproportionate impact of the pandemic on minorities. Among racial and ethnic groups, non-Hispanic American Indian or Alaska Native people had the highest hospitalization rate with 221.2 hospitalizations for the virus per 100,000 people, followed by Black people with 178.1 hospitalizations per 100,000 people, according to data released in June by the Centers for Disease Control and Prevention.

Hispanics had 160.7 hospitalizations per 100,000 people, while non-Hispanic white people had 40.1 hospitalizations per 100,000 people.

The data show lower-income people at higher risk of hospitalization for a variety of reasons. Minorities are more likely than whites to be employed in essential jobs and have less ability to telecommute or be paid time off when sick, according to data from the Economic Policy Institute. In general, they have higher levels of pre-existing conditions, such as diabetes and high blood pressure, putting them at greater risk of severe coronavirus infection, Dr. Anthony Fauci has said in recent interviews.

Minorities are more likely than whites to lack health insurance, according to the Department of Health and Human Services Office of Minority Health, and less likely to have a primary-care doctor, according to an analysis by the Kaiser Family Foundation of data provided by the Centers for Disease Control and Prevention.

The virus led to the closure of about 1,950 community health-center sites as of May 20. There are about 1,365 health-center grantees operating around 12,000 delivery sites, according to a report by the Kaiser Family Foundation, which provides research on health-care issues. Many sites remain closed, said Jennifer Tolbert, director of state health reform at the organization.

Federal stimulus has provided more than $1 billion to the centers, but the amount falls short of the more than $3 billion that centers have requested.

Among the roughly 28 million patients served by health centers, 91% are low income and 63% are racial or ethnic minorities, according to the report.

"They serve disproportionately people of color, they're located in medically underserved areas both urban and rural," Ms. Tolbert said, adding that many sites still remain closed. "There is just a lot less care that's being provided."

Illinois community health centers will lose as much as 70% of their revenue during the next three months—or nearly $140 million, according to a March analysis by the Illinois Primary Health Care Association, which represents 51 community health centers serving 1.4 million patients.

Also suffering in the midst of the pandemic are free and charitable clinics, another category of health centers that largely serve low-income minority populations and don't receive federal funds.

The National Association of Free and Charitable Clinics found that about 65% of its roughly 1,400 member clinics report increasing demand, said Nicole Lamoureux, the organization's president and chief executive officer. The organization is pressing the Trump administration for funding. She said the association had to cancel spring fundraising events because of the virus; so far the clinics have been excluded from federal stimulus packages.

"This is coming at a time of a pandemic and racial revolution," said Ms. Lamoureux. "It's time for our government to rethink the way we've always done funding. It's got to dramatically shift."

Some lawmakers are calling for the inclusion of free and charitable clinics in federal funding streams. Reps. Abigail Spanberger, a Democrat, and Republican Rob Wittman, both of Virginia, said they are concerned stimulus funding "so far has neglected to provide much-needed funding to free clinics, charitable clinics, and other providers that serve uninsured patients," according to a June 19 letter to Health and Human Services Secretary Alex Azar.

An HHS spokeswoman said the department is working to respond and is evaluating options for future disbursements from federal stimulus funding. She said the agency will share information on future distributions publicly, when available.

A testing center is operating with CVS at Good Samaritan Health Center, a charitable clinic in Atlanta, said Chief Operations Officer Breanna Lathrop. Care is free or on a sliding scale.

More than 45% of people tested positive at the center on a recent day in late June, which she described as alarming. That is up from about 15% a couple of weeks ago.

"We see such a huge demand," said Ms. Lathrop. She said the center is relying on grants. "The projections for this year look OK, but what does the economy do in 2021?" she asked. "It's hard to rally and put resources toward something for a year, a year and a half."