Experts: COVID-19 pandemic highlights NC’s existing health disparities, health care weaknesses

Many of North Carolina’s 49 rural hospitals are on the brink of going under.

Communities of color in the state have long had less access to good medical care, leading to much worse health outcomes.

And half the counties in the state have just one psychiatrist; a third have none.

These life-threatening problems were all present before COVID-19, experts told lawmakers Tuesday, but the current pandemic makes each of them even more dangerous.

This week members of the N.C. House Select Committee on COVID-19’s Health Care Work group will begin hammering out a draft pandemic recovery bill to be filed when the legislators return to session on April 28. At Tuesday’s meeting health care experts reminded them that long-time weaknesses in the state’s health care picture have made North Carolinians particularly vulnerable during the pandemic.

Federal guidelines classify 90 of the state’s 100 counties as Health Professional Shortage Areas, according to Dr. Sy Atezaz Saeed, chair of Psychiatry and Behavioral Medicine at East Carolina University’s Brody School of Medicine. In a presentation to lawmakers, Saeed said most North Carolinians live in a county with few if any mental health professionals. That’s a particular danger during a pandemic when isolation and anxiety are exacerbating peoples’ existing mental health problems and making life harder for those who haven’t previously reported problems with anxiety or depression.

Late last month an American Psychiatric Association survey found 36% of respondents said coronavirus is having a serious impact on their mental health, Saeed said.

“We need to be ready for a surge of mental health care needs during and after the pandemic,” Saeed said.

But most of North Carolina’s counties  — mostly in rural areas — are poorly prepared for that surge.

“Many psychiatrists tend to practice in larger metropolis areas,” Saeed said, leading to a nationwide shortage of mental health care outside of the largest cities.

Telehealth programs, such as the NC Statewide Telepsychiatry Program (NC STeP), are addressing that problem, Saeed said.But about a third of the people program have no health insurance. The programs need more support and funding to do their work under the extreme conditions of the pandemic and in its aftermath.

A lack of resources and overwhelming need from uninsured and underinsured people is nothing new for the state’s rural hospitals. They were already in dire straits before the pandemic, said Dr. Roxie Wells, president of Cape Fear Valley Hoke Hospital, in a presentation to lawmakers.

Already underfunded, rural hospitals will lose an estimated $145 million each month during the pandemic, Wells said, most of it because they are no longer performing routine surgical procedures, like hip replacements and tonsillectomies. Instead, hospitals are trying to preserve resources to deal with COVID-19 cases.

Minor and routine surgeries are the financial backbone of most hospitals, Wells said — especially in rural areas.

“I have great concern for the survival of our state’s rural hospitals and the people they serve,” Wells said.

Those hospitals are the biggest employer in many of their communities, Wells said. When they go under, the economic effect can be devastating. To avoid a series of such failures, the legislature needs to commit serious resources to those hospitals — both in funding and support to help them secure scarce personal protective equipment. Additional PPE could help them to more quickly resume some of the minor procedures.

“We enter this pandemic with 49 rural and independent hospitals in North Carolina,” Wells said. “We should exit it with that many. We can do so if we’re proactive, decisive and swift in our actions.”

One way to effectively address both rural and urban health disparities is to expand Medicaid, said Cornell Wright, executive director of the office of Minority Health and Health Disparities with the state Department of Health and Human Services.

In his presentation to lawmakers, Wright laid out the historic racial disparities, ranging from access to education and employment to good nutrition and exposure to violence that have led to communities of color having much worse overall health and less access to care.

One in five North Carolinians live in poverty, Wright said — with the highest rates among Latinx (25 percent) and Black (21 percent) people.

People of color are more at risk for a variety of underlying and chronic conditions that make COVID-19 more deadly, Wright said. While only 21 percent of North Carolinians are Black, they make up 38 percent of the state’s COVID-19 cases so far.

“The health disparities that we see during COVID-19 didn’t start with this pandemic,” Wright said. “They have historically existed in this country and our state. Access to health insurance is especially important for communities of color, who face persistent disparities and far greater rates of chronic conditions such as diabetes and heart disease. That’s one of the reasons expanding Medicaid is so important. Several studies and experiences from other states show Medicaid expansion brings meaningful changes for minority health and access to care.”

On Thursday the work group will meet again, this time to begin crafting the specifics of the bills that will be submitted when lawmakers return to Raleigh later this month. Their hope: to have very little debate after the bills are drafted so that they can move quickly to get them passed and on to Gov. Roy Cooper.