As fears rise about coronavirus (COVID-19) in the United States, state policy choices create a context that either limits or enables harm and disruption from its potential spread.
In Kentucky, risk is worsened by the lack of policies creating access to paid sick days for many Kentucky workers — especially those in low-wage jobs — and cutbacks in funding for local health departments. The state’s relative success in getting people health coverage is a bright spot, though the recent erosion in coverage heightens concerns.
Kentucky lacks paid sick day policy, and legislature blocked efforts at the local level
The Centers for Disease Control and Prevention (CDC) has issued instructions to “stay home when you are sick” to prevent spread of coronavirus. However, many workers lack that option, especially in states like Kentucky.
Nationally, 73% of private sector workers have access to paid sick days at work. But access is very unequal: Whereas 93% of the workers with the highest 10% of incomes have paid sick leave, only 30% of the lowest-paid 10% of workers do. As the Economic Policy Institute notes, this lack of access at the bottom ends up creating risk for everyone because “low-wage workers are more likely to be found in occupations where they have contact with the public — think early care and education workers, home health aides, restaurant workers and food processors.”
Access to paid sick days is more limited in the East South Central region made up of Kentucky, Tennessee, Alabama and Mississippi than any other region in the country. Only 62% of private sector workers in our region have paid sick days compared to 91% in the Pacific region of California, Oregon and Washington, as shown below.
Kentucky’s low rate of access to paid sick days is the result of policy choices, not just employer decisions. With no federal law requiring paid sick days, 12 states and 23 localities across the country have enacted such policies. Not only is Kentucky missing from that list of states, the General Assembly passed legislation in 2017 (HB 3) that prevents local governments from enacting their own paid sick day requirements.
Public health infrastructure is weakened by funding cuts, pension funding demands
Local health departments are critical frontline actors in preventing the spread of coronavirus. In states like California, they are playing a key role in testing, tracking and isolating those determined to be infected. But the Los Angeles Times reports that health departments are “straining to respond.” The chief medical officer of the Association of State and Territorial Health Officials told the New York Times that “all hands on deck are being pulled into this,” and “if it really blows up, at some point, it could overwhelm state and local health departments.”
In Kentucky, health departments already face serious capacity gaps due to over a decade of state budget cuts and rising requirements for pension contributions. Whereas Kentucky had 3,449 local health department employees in 2012, it had just 2,269 in 2019. As the state underfunded its pension contributions to the Kentucky Employees Retirement System (KERS) non-hazardous system, costs began rising for health departments and all other agencies in that system. Health departments must now contribute 49% of employees’ pay to the pension system, with the cost scheduled to spike to 93% this year without action by the General Assembly.
The lack of resources for local Kentucky health departments became clear during the recent outbreak of Hepatitis A, a disease spread primarily among people who are homeless or have a substance use disorder. Despite being just 1.4% of the U. S. population, Kentucky has had 16% of the nation’s Hepatitis A cases and 19% of the deaths. Kentucky’s former head of infectious diseases said the state didn’t allocate enough money to tackle the disease’s spread aggressively, and state officials cited “limited funding” in pursuing its more modest response.
Health coverage gains help Kentucky prepare, but recent erosion is unhelpful
The CDC is telling Americans concerned they may have been exposed to coronavirus to “contact their healthcare provider.” Yet many people still lack access to health insurance needed to pay a provider, especially in the 14 states that have not expanded Medicaid.
Kentucky’s gains in health coverage are a bright spot in its preparedness landscape. Thanks mostly to Medicaid expansion, Kentucky’s rate of uninsured individuals fell from 14.3% in 2013 to just 5.6% in 2018, the most recent year for which data is available. The billions of federal dollars flowing into Kentucky from Medicaid expansion have enabled the hiring of more nurses and other health care professionals at clinics and hospitals.
But a lack of universal coverage and concerning recent steps backward create risk. Kentucky’s 5.6% rate of uninsured people is an increase from its low of 5.1% achieved in 2016. The uninsured rate for children under the age of 6 rose from 2.7% in 2016 to 4.0% in 2018.
A state and federal “unwelcome mat” for public programs is the likely cause of these recent coverage losses. That includes stricter paperwork requirements, cuts in funding for outreach and enrollment assistance, the “public charge” rule and its chilling effect on enrollment for eligible immigrant families, and confusion over federal efforts to repeal the Affordable Care Act and the state barriers to Medicaid sought by the prior Kentucky administration through an 1115 waiver (recently withdrawn by Governor Beshear).
Kentucky needs short and long-term attention to protecting public health
In the short term, Kentucky must work closely with the CDC and other federal authorities to marshal the resources necessary to prevent the spread of coronavirus and limit its harm. In the longer term, the state must recognize that rules and investments are needed to protect Kentuckians from all kinds of public health harms. A lack of policies allowing workers to stay home when they are sick and to ensure every Kentuckian has health coverage, and a lack of investment in frontline health departments, put all Kentuckians at a greater risk from threats.