A new paper from the Community Service Society of New York describes how policy decisions made by state leaders over the past 30 years concentrated health care resources in whiter, wealthier communities. Those choices contributed to the incredibly disproportionate impact COVID-19 has had on people of color, including a death rate that is quadruple for African-Americans compared to white people outside of New York City and double within New York City.

As the state backed away from planning and rate-setting for hospitals, hospital beds becamse concentrated in whiter areas regardless of community need. In Queens, where there were 22 cases of COVID-19 for every 1,000 people, there are only 1.5 beds per 1,000 people. In the Bronx, whcih suffered the highest rate of COVID-19 infections in the State, there are only2.7 hospital beds for every 1,000 residents.

One reason is that unlike every other state, New York distributes federal disproportionate share funding to all of its hospitals – not just those that serve the most Medicaid or uninsured patients. The safety-net hospitals that serve the most uninsured or Medicaid-covered New Yorkers – and also more people of color than average – share this funding with well-resourced hospitals that do not serve as true safety-nets. The authors find that New York’s top safety-net providers would have recieved over $13 billion more over the past 20 years.

Federal relief efforts haven’t changed this dynamic. Queens County providers only got an average of $1,500 for every positive COVID-19 case from CARES Act funding. Schuyler County providers recieved $426,000 for every case. Queens has had nearly 5,000 deaths from COVID-19. Schuyler County has only had 11 cases total, none fatal.

The paper include many recommendations for righting this resource imbalance. One of these is to start distributing disproportionate share funding to true safety-nets. Other recommendations include expanding public health programs to achieve universal coverage and to protect people who cannot afford care from collection actions for medical debt. The paper also calls for the state to step up and conduct health planning again so that resources are distributed according to community needs and not community wealth.