[Congressional Record Volume 168, Number 40 (Monday, March 7, 2022)]
[House]
[Pages H1317-H1321]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    RACIAL DISPARITIES IN HEALTHCARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 4, 2021, the gentlewoman from Texas (Ms. Jackson Lee) is 
recognized for 60 minutes as the designee of the majority leader.
  Ms. JACKSON LEE. Madam Speaker, it is my pleasure to co-anchor this 
Congressional Black Caucus Special Order and to be joined by my co-
anchor, the distinguished gentleman from New York, Congressman Torres. 
I thank him so very much for his presence here today.
  Let me acknowledge the chair of the Congressional Black Caucus as 
well and thank her for helping to organize this Special Order as well 
as to be able to discuss health equity and the Black family and the 
reasons why the CBC strongly urges and supports substantial investments 
for healthcare in the budget for fiscal year 2023. I also want to 
especially acknowledge my friend and colleague, the Honorable   Donald 
Payne, whose office initiative has always focused us on the enormity of 
health disparities in the African-American community.
  Let me start with a few comments to be made regarding the work of the 
Congressional Black Caucus. Let me acknowledge and express my 
appreciation to the President of the United States for hosting the 
members of the Congressional Black Caucus this afternoon who serve on 
the executive committee and for the concern and interest that the 
President has expressed on a number of issues that I think are 
important to where we are today in America.
  Let me borrow this picture from Congresswoman Kaptur, who heads the 
Congressional Ukrainian Caucus, and just remind everyone, because the 
Congressional Black Caucus has been at the forefront of persons fleeing 
persecution.

                              {time}  1945

  We have been a leader. Whether it is Haiti or whether it is places in 
Africa or the Caribbean or Europe, African Americans have been at the 
forefront.
  This happens to be the mass of people that are trying to escape 
Ukraine because of the bloody and immoral and purposeless and vicious 
and vile actions of Vladimir Putin.
  We stand here today as well, recognizing the humanitarian crisis and 
recognizing as well that we, as Americans, are going to be supporting 
any people who are fighting for democracy. As we fight for those 
people, we will also recognize that we will ensure that we are 
protecting democracy and the freedom of all people.
  With that in mind, we had a number of issues that we discussed, and I 
think it is important that healthcare was certainly a part of it. And 
the disparities, disparities dealing with African-American boys and 
African-American men and recognize that we need to focus on eliminating 
those stark disparities that would result in less of a future for these 
young boys, for their lives turning around even before they enter 
school, that there is an intervention to ensure that they become the 
best of what they can be. That is a crucial element of what we talked 
about as well.
  I am very grateful that we were also in discussions on H.R. 40, the 
Commission to Study and Develop Reparation Proposals for African 
Americans Act; and, of course, the very positive discussion that we 
had, breaking news is that progress will be made on the idea of healing 
and repairing and reparations, and we are certainly grateful for that 
discussion.
  I would also like to mention as I begin, in the immediacy of the news 
of the day, we are well aware of my constituent that is now being held 
in Russia, that is Brittney Griner, an Olympian, a double-honors WNBA 
player. Unfortunately, we don't have the proof of the allegations. We 
are disturbed, but we know that she has the possibility of being held 
for 10 years because of the alleged charges that they are making 
against her. We are grateful to have had the opportunity to bring this 
to the attention of the President of the United States, and we expect 
that hopefully this situation will be looked at as closely as possible 
and that help will be coming.
  I mention this because our Chairwoman has always said, Our Power, Our 
Message. We speak of a multitude of messages that we will have tonight, 
focused in particular on the issue of healthcare.
  As a member of the United States Congress and the Congressional Black 
Caucus, we can't start this without talking about the COVID-19 pandemic 
that has laid bare for the Nation to see the stark racial and ethnic 
inequalities exacerbated by the virus.
  In my home State of Texas as of the end of September 2020, there had 
been more than 760,000 cases of COVID-19 and 16,000 deaths. According 
to the Texas State Department of State healthcare services, 70 percent 
of the confirmed fatalities are people of color.
  In Texas, COVID-19 mortality rates are 30 percent higher for African 
Americans and 80 percent higher for Hispanics. One factor in the 
Hispanic and African-American populations being more likely to contract 
COVID-19 is employment in occupations associated with public contact 
that cannot be done remotely.
  We saw that in the early stages of COVID-19, when testing was not at 
its peak, that the numbers were so high in New York, New Orleans, 
Detroit, and, yes, in Houston, Texas, because African Americans, in 
particular, were in jobs that they had hands on, that they were 
encountering people, whether they were metro bus drivers or TSA workers 
in the Federal system, whether they were retailers in the grocery 
store, whether they were firefighters and first responders or police 
officers, we were finding out that they were being confronted by these 
particular issues.
  The idea of health disparities in the African-American community 
lends itself to the very reason why this Special Order is crucial. 
Health coverage as it relates to African Americans in 2017:
  10.6 percent of African Americans were uninsured compared with 5.9 
percent of non-Hispanic Whites;
  89.4 percent of African Americans had healthcare coverage in 2017 
compared with 93 percent of White Americans;

[[Page H1318]]

  44.1 percent of African Americans had government health insurance 
coverage in 2017; and
  12.1 percent of African Americans under the age of 65 reported having 
no health insurance coverage.
  Chronic health conditions are prevalent in our community. 13.8 
percent of African Americans reported having fair or poor health. We 
are prone to diabetes; cancer, particularly breast cancer, prostate 
cancer, lung cancer, brain cancer; and the leading causes of death 
among African Americans are heart disease, cancer, and accidents.
  There are 11 infant deaths per 1,000 births among Black Americans. 
This is almost twice the national average of 5.8. Of course, we have a 
serious problem with Black maternal mortality, which I am very glad the 
Congressional Black Caucus has taken on as an important issue.
  I know that there are also the different kinds of cancer that impact 
African-American males, and I know my colleagues will spend their time 
discussing that.
  I think the point that is most important is that we realize that all 
of the indicia indicating disparities in healthcare unfortunately fall 
on African Americans.
  One I forgot to mention is obesity. African-American women have the 
highest rates of obesity or being overweight compared to other groups 
in the United States, about four out of five African-American women are 
overweight or obese.
  As we have this discussion tonight, there are several things that I 
think we should be reminded of. Twelve States refused to take the 
expanded Medicaid when the Affordable Care Act was finalized and signed 
by the President of the United States. I was here; we were fighting. In 
fact, we had included expanded Medicaid as a response to the public 
option, that we were fighting for. I was in support of the public 
option, but we compromised, and lo and behold, if I may use that 
terminology, didn't it get taken out. Didn't we have States refusing to 
accept expanded Medicaid, and they are in the worst dire straits which 
includes the State that is a poster child for uninsured, and that is 
the State of Texas.

  But in this Build Back Better Act, we created, with the work of the 
Congressional Black Caucus, a Federal Medicaid process that we could 
opt into so that whatever State you lived in--the 12 horrific States 
that did not accept it who suffer every single day, not the States, not 
the State government, but the people suffer every day, the children 
suffer every day--we provided this in Build Back Better.
  I was so excited because we were pushing and working and sending 
letters saying you had to fix this issue of not having the expanded 
Medicaid. We were able to secure that, and here we are with Build Back 
Better stalled in the United States Senate, after we worked so hard to 
get a bill that has so many elements to it that deals with the 
disparities in healthcare.
  As I conclude, let me indicate that the idea of these disparities 
fall right into the umbrella of H.R. 40, the Commission to Study 
Slavery and Develop Reparation Proposals for African Americans Act, but 
the idea is to track slavery and its trajectory to 2021, why these 
stark disparities in healthcare and education and science and housing 
and the criminal justice system. But healthcare is life or death, and 
we can see it in a glaring panorama of any community you go into, of 
hospitals that you go into, hospice that you are in, that you see this 
disproportionate proportion of African Americans who either did not 
have access to healthcare in the early stages of their disease or 
either suffered from diseases that were, in fact, inherited from 
families down through the generations because of diet, living 
conditions, or lack thereof.
  We stand here today on the floor of the House to say it is imperative 
that we work together as Americans to find a way to provide an even 
playing field for all of our children, if it takes legislation that 
focuses specifically on diseases that we have, that falls on our 
shoulders.
  I am a breast cancer survivor, and I have introduced over the years 
triple-negative breast cancer legislation that I hope I will see in the 
next few months passing, for triple-negative breast cancer is more 
deadly in our African-American populations and Hispanic populations. I 
know the cancer clusters that are in the Fifth Ward, Texas, in my 
district, or Kashmere Gardens, because living in conditions where there 
are toxic chemicals that these people are breathing or they are eating 
them because they are in the soil that they plant their gardens in.
  Can you imagine, Madam Speaker? This is what we are confronting. That 
is why the Congressional Black Caucus rises on the floor today to be 
able to address these serious questions of health disparities, which I 
believe is at this time a crucial moment in history for us to speak 
about.
  Madam Speaker, as a senior member of the Committees on the Judiciary, 
on Homeland Security, and on the Budget, and the Congressional Black 
Caucus, I am pleased to co-anchor this Congressional Black Caucus 
Special Order with my colleague, the distinguished gentleman from New 
York, Congressman Ritchie Torres.
  I thank the Chair of the CBC, Congresswoman Beatty of Ohio, for 
organizing this Special Order to discuss the health equity and the 
Black Family and the reasons why the CBC strongly urges and supports 
substantial investments for healthcare in the budget for FY 2023.
  Before I do, however, let me note for the record that today is March 
7, the 57th anniversary of ``Bloody Sunday,'' when hundreds of heroic 
souls risked their lives in Selma, Alabama, for freedom and to secure 
the right to vote for all Americans.
  Those ``foot soldiers'' of Selma, who were led by our beloved 
colleague, the late Congressman John Lewis of Georgia, were brave and 
determined men and women, boys and girls, persons of all races and 
creeds, who loved their country so much that they were willing to risk 
their lives to make it better, and to bring it even closer to its 
founding ideals.
  The foot soldiers marched because they believed that all persons have 
dignity and the right to equal treatment under the law, and in the 
making of the laws, which is the fundamental essence of the right to 
vote.
  I am Congresswoman Sheila Jackson Lee of Texas, and I proudly hail 
from the great city of Houston, which has been on the front lines since 
the beginning of the COVID-19 pandemic and paid more than its share in 
death, heartbreak, and suffering, especially among communities and 
healthcare workers of color, but has also seen the best our nation has 
to give in the selfless and courageous service of black nurses who were 
among the very first to answer the call and have never left or 
retreated from the field of battle.
  The COVID-19 pandemic has laid bare for the nation to see the stark 
racial and ethnic inequalities exacerbated by the virus.
  In my home state of Texas, as of the end of September 2020, there 
have been more than 760,000 cases of COVID-19 and 16,000 deaths.
  According to the Texas Department of State Health Care Services, 70 
percent of the confirmed fatalities were people of color.
  In Texas, COVID-19 mortality rates are 30 percent higher for African 
Americans and 80 percent higher for Hispanics overall.
  The differences become much larger when accounting for age; for 
example, in the 25 to 44-year-old age group, African American mortality 
rates are more than four times higher than White rates, and the 
Hispanic rates are more than seven times higher.
  One factor in Hispanic and African American populations being more 
likely to contract COVID-19 is employment in occupations associated 
with public contact and that cannot be done remotely.
  The sad fact is that most workers in these occupations are less able 
to be absent from their job or to have paid time off.
  In Texas, people of color are more than 40 percent of cashiers, 
retail salespersons, child care workers, licensed practical nurses, 
more than 50 percent of bus drivers and transit workers, medical and 
nursing assistants, personal care aides, and home health aides, and 
more than 60 percent of building cleaners and housekeepers.
  In addition, Hispanic and African American populations in Texas are 
less likely to have health insurance and to have a regular health care 
provider, so less likely to seek or receive early care for symptoms, 
especially in the first months of the epidemic.
  And African American and Hispanic populations are also more likely to 
have an underlying health condition that makes them more vulnerable to 
the effects of COVID-19.
  To respond and mitigate the devastation wrought by COVID-19 on 
Americans, and especially marginal and vulnerable communities of color, 
I have introduced H.R. 330, the ``Delivering Covid-19 Vaccinations to 
All Regions and Vulnerable Communities Act'' or ``COVID-19 Delivery 
Act,'' which I invite all Members to join as sponsors.
  Under the COVID-19 Delivery Act, FEMA will be authorized and directed 
to lead the effort for vaccine delivery from the receipt from

[[Page H1319]]

manufacturing facilities to delivery to designated inoculation sites 
(hospital, clinic, doctors' offices, school, places of worship, 
community centers, parks, or neighborhood gathering locations.
  The legislation directs FEMA to develop and deploy a fully staffed 
and resourced 24-7 advanced real-time tracking system that allows FEMA 
to monitor shipments of vaccine units that can provide end-to-end 
transparency on the temperature, real-time location, origin, and 
destination data, anticipated time of arrival, and report on changes 
and update recipients on the progress of their delivery and report on 
changes that may impact expected delivery or the viability of the 
vaccine while in transit.
  I see the disparities in the lives of so many of my constituents who 
suffer disproportionately from medical conditions that make COVID-19 
deadly.
  They work low wage or no wage jobs to make ends meet, and they have 
no health insurance and rely on community health centers or public 
health services for routine care.
  I call them friends and neighbors because they are that to me.
  That is why I strongly support CBC's legislative agenda for the 117th 
Congress to address the many social justice and health equity issues 
that are related to how the COVID-19 pandemic has manifested and 
amplified healthcare racial disparities in our communities.
  Specifically, I support:
  1. Expanded access to testing for all essential workers.
  2. Setup a comprehensive vaccination campaign targeting communities 
of color and ensuring free vaccination for all.
  3. Expanded SNAP food benefits.
  4. Direct relief payments of $2,000 a month until the end of the 
pandemic.
  5. Continue rent and mortgage payment suspension.
  6. Cancellation of student loan debt as students of color have the 
highest debt loads.
  I support legislation that will ensure that all essential workers 
have access to free PPE for the duration of the pandemic.
  I also support legislation to raise the minimum wage to $15 dollars 
an hour and to develop and support legislation that promotes the 
ethnic, racial and gender diversification of the health care workforce 
aimed at increasing overall cultural competence.
  Most importantly, I support legislation like H.R. 40 that directly 
augments the underlying social determinants of health (e.g., 
socioeconomic factors, education, employment, housing) that 
historically have disproportionately impacted black and other 
communities of color that have made them more vulnerable to the COVID-
19 pandemic.
  Madam Speaker, the CBC strongly supports comprehensive efforts to 
reduce maternal and infant mortality and its devastating effects.
  Maternal and infant mortality disproportionately impacts the Black 
community in comparison to other communities and this is unacceptable.
  700 women die each year in the United States as a result of pregnancy 
or delivery complications.
  Black women are shown to have a disproportionate fatality rate during 
pregnancy or within 42 days after giving birth.
  In 2018, the national maternal mortality rate was 17.4 deaths per 
100,000 births in 2018, 37.1 black women died per 100,000 births.
  Black infants have 2.3 times the infant mortality rate as white 
infants.
  African American infants are 3.8 times as likely to die from 
complications related to low birthweight as compared to non-Hispanic 
white infants.
  Black infants are at three times greater risk of accidental death 
than are white babies, and at more than four times the risk of 
developing SIDS.
  For these reasons, I strongly support and am working for:
  1. President Biden's Budget that proposes $31.9 million for the 
Program for Treatment for Pregnant and Postpartum women;
  2. legislation that will increase the diversity of the perinatal 
health care workforce;
  3. investment in digital tools like telehealth to improve maternal 
health outcomes, especially in underserved areas; and
  4. Establishment of an Office of Sexual and Reproductive Health & 
Wellbeing in the White House to align federal policies and programs so 
they promote sexual and reproductive health and wellbeing through a 
human rights, reproductive justice, and racial equity lens.
  The CBC supports comprehensive efforts to endorse actions to address 
the health effects of systemic racism, such as H.R. 379, Improving 
Social Determinants of Health Act of 2021, which will authorize the CDC 
to set up a program to improve health outcomes and reduce health 
inequities by coordinating CDC social determinants of health (SDOH) 
activities and improve capacity of public health agencies and community 
organizations to address SDOHs.
  We also support the passage of legislation focused on ways to 
increase the diversity of the U.S. health care workforce (especially 
nurses, physicians, dentists, and mental health workers) to include 
enhanced tuition and student loan repayment programs for those from 
Black communities and other communities of color.
  CBC supports as well the passage of legislation to combat 
institutional racism in all governmental health related agencies and 
programs.
  I am also the lead sponsor of legislation, H.R. 40, which will 
establish a commission on restorative justice to investigate the 
ramifications of reparations that includes the acknowledgment of 
historic health related atrocities.
  I support comprehensive efforts to ensure action to improve urban 
green spaces, public health, environmental health justice and global 
warming and support clean air/water protections and initiatives that 
ensure healthy environments for all people because the most recent data 
reveal that people of color compared to their white counterparts are 
disproportionately affected by poor socio-ecosystems that affect their 
physical, mental and social well-being.
  Poor socio-ecosystem services translate to disparities in health 
risks so innovative and multifaceted strategies aimed at reversing the 
following issues are critical to improve the health and well-being of 
all Americans and specifically people of color.
  The CBC supports comprehensive efforts to reduce cancer inequities 
and its devastating effects.
  According to the American Cancer Society, Blacks have the highest 
mortality and poorest survival rate of any racial--ethnic group in the 
U.S.
  Experts are concerned that the COVID-19 pandemic will exacerbate 
disparities in cancer care among Blacks, Hispanics, and other people of 
color.
  Accordingly, I agree with NBNA's call for the 117th Congress to:
  1. Support (H.R. 8845), the Multi-Cancer Early Detection Screening 
Coverage Act which would ensure prompt access to FDA-approved multi-
cancer screening tests and fuel innovation in cancer screening.
  2. Support legislation that would provide ongoing research and 
education for minorities impacted by cancer.
  3. Support legislation that limits and reduces the cost of cancer 
medications and medical treatment for all populations with an emphasis 
on disproportionately impacted Black and other communities of color.
  4. Support legislation (H.R. 1570) to Remove Barriers to Colorectal 
Cancer Screening and to modify cost-sharing requirements for colorectal 
cancer screening tests, and drug manufacturer reporting requirements 
under Medicare medical services.
  5. Support legislation (H.R. 113) to provide for research and 
education with respect to triple negative breast cancer and for other 
purposes.
  More than 600,000 uninsured African Americans with incomes below the 
poverty line are among the 2.2 million adults who have no access to 
affordable health coverage simply because they live in one of 12 states 
that have refused to take up the Affordable Care Act's Medicaid 
expansion.
  Permanently closing the Medicaid coverage gap is essential to remedy 
this racial health inequity.
  It has been over a decade since the passage of the Affordable Care 
Act. Of the 12 remaining states that have stubbornly declined to expand 
coverage to adults with low incomes, eight are in the South: Alabama, 
Florida, Georgia, Mississippi, North Carolina, South Carolina, 
Tennessee, and Texas.
  Fully 60 percent of those in the coverage gap in 2019 were people of 
color, even though people of color represent just 41 percent of the 
adult population of the 12 states.
  Most live in Florida, Georgia, or Texas; more than 100,000 African 
Americans in each state fall into the coverage gap.
  In Alabama, Mississippi, North Carolina, and South Carolina, a 
majority of those without a pathway to coverage are African American.
  In Texas, more than half of those in the coverage gap--422,000 
people--are Latinos.
  Who are the people in the coverage gap?
  They are parents, often with young children.
  They are working people.
  Many are essential workers who have kept our nation going during the 
pandemic by working in grocery stores and health care jobs.
  Yet they have no health coverage and no way to get it.
  By permanently closing the Medicaid coverage gap, Congress can 
improve the financial security of African Americans and Latinos as well 
as their health.
  Medicaid expansion is a powerful tool against financial hardship and 
bankruptcy because it prevents catastrophic out-of-pocket medical 
costs.
  Providing this safeguard is particularly critical for African 
Americans, given the substantial racial wealth gap.
  Closing the Medicaid gap will also help address the Black maternal 
health crisis.

[[Page H1320]]

  States that expanded Medicaid have seen improved access to 
preconception and prenatal services that make pregnancy and birth safer 
for parents and babies.
  Medicaid expansion is associated with reduced rates of maternal 
death, particularly for Black women.
  Yet 235,000 Black women of reproductive age with incomes below the 
poverty line remained uninsured in 2019 without any pathway to 
affordable health coverage.
  Almost all of them live in the Southern states that have refused to 
expand Medicaid.
  Consider these stark and persistent racial disparities in health 
coverage, chronic health conditions, mental health, and mortality 
between black and white Americans.
  An African American or Black person is any individual with total or 
partial ancestry from any of the Black racial groups of Africa.
  In 2017, 10.6 percent of African Americans were uninsured compared 
with 5.9 percent of non-Hispanic whites.
  89.4 percent of African Americans had health care coverage in 2017 
compared with 93.7 percent of white Americans.
  44.1 percent of African Americans had government health insurance 
coverage in 2017.
  12.1 percent of Africans Americans under the age of 65 reported 
having no health insurance coverage.
  13.8 percent of African Americans reported having fair or poor health 
compared with 8.3 percent of non-Hispanic whites.
  Eighty percent of African American women are overweight or obese 
compared to 64.8 percent of non-Hispanic white women.
  In 2017, 12.6 percent of African American children had asthma 
compared with 7.7 percent of non-Hispanic white children. Forty-two 
percent of African American adults over age 20 suffer from hypertension 
compared with 28.7 percent of non-Hispanic white adults.
  In 2018, 8.7 percent of African American adults received mental 
health services compared with 18.6 percent of non-Hispanic white 
adults.
  6.2 percent of African American adults received prescription 
medication for mental health services compared with 15.3 percent of 
non-Hispanic white adults.
  In 2018, 3.8 percent of African American adults reported serious 
psychological distress.
  These disparities are not a result of individual or group behavior 
but decades of systematic inequality in American economic, housing, and 
health care systems.
  Alleviating health disparities will require a deliberate and 
sustained effort to address social determinants of health, such as 
poverty, segregation, environmental degradation, and racial 
discrimination.
  Madam Speaker, in 2019, I introduced a Jackson Lee Amendment to the 
National Defense Authorization Act, which was adopted to address the 
issue of Maternity Mortality.
  I am pleased to report that the National Defense Authorization Act 
for Fiscal Year 2020 did include the adoption of a maternity mortality 
amendment that I offered.
  This Jackson Lee Amendment directs the Secretary of Defense to 
produce a report on maternity mortality rates among members of the 
Armed Forces and their dependents, which will include the Coast Guard 
to draw attention to the incident maternal mortality.
  Between 1990 and 2015 it is reported that maternal mortality rates 
around the world fell by 30 percent, while at the same time in the US, 
the ratio went up nearly 60 percent.
  A 2012, Pentagon report states that mothers delivering at military 
hospitals are more likely to hemorrhage after childbirth than mothers 
at civilian hospitals.
  More than 50,000 babies are born at military hospitals each year, and 
they are twice as likely to be injured during delivery as newborns 
nationwide.
  In the United States, black women are 2 to 6 times more likely to die 
from complications of pregnancy than white women, depending on where 
they live.
  Dating back from 1979 to 1992 maternity mortality was analyzed, the 
overall pregnancy-related mortality ratio was 25.1 deaths per 100,000 
for black women, 10.3 for Hispanic women, and 6.0 for non-Hispanic 
white women.
  These numbers did not improve between 1987 and 1996.
  During 2011-2015, the pregnancy-related mortality ratios were--
  42.8 deaths per 100,000 live births for black non-Hispanic women;
  32.5 deaths per 100,000 live births for American Indian/Alaskan 
Native non-Hispanic women;
  14.2 deaths per 100,000 live births for Asian/Pacific Islander non-
Hispanic women;
  13.0 deaths per 100,000 live births for white non-Hispanic women; and
  11.4 deaths per 100,000 live births for Hispanic women.
  Black women in the United States experience unacceptably poor 
maternal health outcomes, including disproportionately high rates of 
death related to pregnancy or childbirth.
  African American women have the highest rates of obesity or being 
overweight compared to other groups in the United States.
  About 4 out of 5 African American women are overweight or obese.
  Obesity in the African American community has been a growing concern 
in recent decades and can be attributed to a multitude of societal 
elements.
  Contributing factors include but are not limited to inequities in 
stable and affordable housing, risks of living in food deserts, income, 
and access to quality education.
  Each one of these factors has the potential to directly or indirectly 
influence an individual's chance to live a longer and healthier life.
  In addition, if one combines those circumstances with disparities in 
access to affordable and healthy food or safe places to be physically 
active, the picture of obesity in the African American community begins 
to take shape.
  Among African American adults, nearly 48 percent are clinically obese 
(including 37.1 percent of men and 56.6 percent of women, compared to 
32.6 percent of whites (including 32.4 percent of men and 32.8 percent 
of women).
  The Centers for Disease Control and Prevention found that among 
148,494 U.S. adults with COVID-19, a nonlinear relationship was found 
between body mass index (BMI) and COVID-19 severity, with lowest risks 
at BMIs near the threshold between healthy weight and overweight in 
most instances, then increasing with higher BMI.
  Overweight and obesity were risk factors for invasive mechanical 
ventilation.
  Obesity was a risk factor for hospitalization and death, particularly 
among adults aged <65 years.
  Using data from the Premier Healthcare Database Special COVID-19 
Release the CDC assessed the association between body mass index (BMI) 
and risk for severe COVID-19 outcomes as defined by hospitalization, 
stays in intensive care units and the use of invasive mechanical 
ventilation, and death.
  Among 148,494 adults who received a COVID-19 diagnosis during an 
emergency department (ED) or inpatient visit at 238 U.S. hospitals 
during March-December 2020, 28.3 percent had overweight and 50.8 
percent had obesity.
  Overweight and obesity were risk factors for invasive mechanical 
ventilation, and obesity was a risk factor for hospitalization and 
death, particularly among adults aged <65 years.
  Risks for hospitalization, ICU admission, and death were lowest among 
patients with BMIs of 24.2 kg/m2, 25.9 kg/m2, and 23.7 kg/m2, 
respectively, and then increased sharply with higher BMIs.
  Risk for invasive mechanical ventilation increased over the full 
range of BMIs, from 15 kg/m2 to 60 kg/m.
  Madam Speaker, I include in the Record three publications relating to 
racial health disparities.

                            [From USA Today]

 Family Ravaged by Coronavirus Begged for Tests, Hospital Care but was 
                           Repeatedly Denied

                       (By Kristen Jordan Shamus)

       Detroit--The man who raised Keith Gambrell, who loved him 
     like a son and married his mother, died in a blue recliner of 
     novel coronavirus in his Michigan home.
       Gary Fowler, 56, went to the emergency rooms of three metro 
     Detroit hospitals in the weeks leading up to his death, 
     begging for a coronavirus test, begging for help because he 
     was having difficulty breathing, but he was repeatedly turned 
     away, Gambrell said.
       ``My dad passed at home, and no one tried to help him,'' 
     Gambrell, 33, said through tears. ``He asked for help, and 
     they sent him away. They turned him away.''
       In the hours before his death, breathing was so difficult, 
     Fowler slept sitting up in the bedroom chair, while his wife, 
     Cheryl, dozed in the bed by his side. When she woke, her 
     husband of nearly 24 years was gone.
       Before he took his last breaths, Fowler scrawled on a piece 
     of paper, ``Heart beat irregular . . . oxygen level low.''
       ``My little brother called me, screaming, `Daddy won't wake 
     up!' '' Gambrell said.
       By the time Gambrell got across town to their house on the 
     morning of April 7, police and emergency medical workers had 
     arrived.
       His dad was still in the recliner. A bluish tinge had 
     settled on his lips and fingers.
       ``I went up and talked to him,'' Gambrell said, his voice 
     breaking. ``I told him I love him and that I'll see him again 
     one day and that I'm sorry we couldn't even have a funeral 
     for him.
       ``I just felt so bad because he was begging for his life, 
     and medical professionals did nothing for him.''
       The virus has brought renewed attention to health 
     disparities for people of color.
       ``About 33 percent of the cases of COVID-19 in this entire 
     state of Michigan are in African Americans, and about 40 
     percent . . . of the deaths,'' Dr. Joneigh Khaldun, the chief 
     medical executive for the Michigan Department of Health and 
     Human Services, said during a Facebook Live interview 
     Thursday with Detroit's Civil Rights, Inclusion and Equal 
     Opportunity Department. ``And that's incredibly concerning. 
     We know that African

[[Page H1321]]

     Americans are only about 14 percent of the entire 
     population.''
       Gambrell lives in Detroit's 48235 ZIP code, a coronavirus 
     hot zone with the highest infection rate per capita--162 
     cases per 10,000 residents--and the highest number of 
     confirmed cases of the virus at 724, according to data 
     released Friday by the city.
       Denise Fair, Detroit's chief public health officer, said 
     coronavirus testing remains a barrier for many in the 
     community, as does access to care.
       ``It's estimated that there are upwards of 10 people with 
     undetected infections for every confirmed case, and in some 
     communities, the estimates are even higher,'' she said.
       Dozens of factors feed the health disparities for people of 
     color, said Khaldun, who formerly worked as the director and 
     health officer for the Detroit Department of Health.
                                  ____


                   [From the American Cancer Society]

               Cancer Disparities in the Black Community

       African Americans have a higher cancer burden and face 
     greater obstacles to cancer prevention, detection, treatment, 
     and survival. In fact, Black people have the highest death 
     rate and shortest survival of any racial/ethnic group for 
     most cancers in the U.S. Research has shown that:
       African Americans experience more illness, worse outcomes, 
     and premature death compared to whites.
       African Americans have the highest death rate and shortest 
     survival of any racial/ethnic group for most cancers. African 
     American men also have the highest cancer incidence.
       Cancer death rates in black men is twice as high as in 
     Asians and Pacific Islanders, who have the lowest rates.
       Prostate cancer death rates in black men are more than 
     double those of every other racial/ethnic group.
       Black women are 40 percent more likely to die of breast 
     cancer than white women and are twice as likely to die if 
     they are over 50.
       About a third of Africa American women reported 
     experiencing racial discrimination at a health provider 
     visit.
       Living in segregated communities and areas highly populated 
     with African Americans has been associated with increased 
     chances of getting diagnosed with cancer after it has spread, 
     along with having higher death rates and lower rates of 
     survival from breast and lung cancers.
                                  ____


                Health Disparities in the United States


                  African Americans or Black Americans

       An African American or Black person is any individual with 
     total or partial ancestry from any of the Black racial groups 
     of Africa.


                            Health coverage

       In 2017, 10.6 percent of African Americans were uninsured 
     compared with 5.9 percent of non-Hispanic whites.
       89.4 percent of African Americans had health care coverage 
     in 2017 compared with 93.7 percent of white Americans.
       44.1 percent of African Americans had government health 
     insurance coverage in 2017.
       12.1 percent of Africans Americans under the age of 65 
     reported having no health insurance coverage.


                       Chronic health conditions

       13.8 percent of African Americans reported having fair or 
     poor health compared with 8.3 percent of non-Hispanic whites.
       Eighty percent of African American women are overweight or 
     obese compared to 64.8 percent of non-Hispanic white women.
       In 2017, 12.6 percent of African American children had 
     asthma compared with 7.7 percent of non-Hispanic white 
     children. Fortytwo percent of African American adults over 
     age 20 suffer from hypertension compared with 28.7 percent of 
     non-Hispanic white adults.


                             Mental health

       In 2018, 8.7 percent of African American adults received 
     mental health services compared with 18.6 percent of non-
     Hispanic white adults.
       6.2 percent of African American adults received 
     prescription medication for mental health services compared 
     with 15.3 percent of non-Hispanic white adults.
       In 2018, 3.8 percent of African American adults reported 
     serious psychological distress.


                        Leading causes of death

       The leading causes of death among African Americans are 
     heart disease, cancer. and accidents.
       African Americans have the highest mortality rate for all 
     cancers combined compared with any other racial and ethnic 
     group.
       There are 11 infant deaths per 1,000 live births among 
     Black Americans. This is almost twice the national average of 
     5.8 infant deaths per 1,000 live births.
       11.4 per 100,000 African American men and 2.8 per 100,000 
     of African American women die by suicide.

  Ms. JACKSON LEE. Madam Speaker, I would like to express my 
appreciation, and I yield back the balance of my time.

                          ____________________