Whereas: Black and Native Americans have higher death rates than white people across a variety of illnesses.[1] Black and Latina women also face higher preconception and maternal health risks than other groups, even those in higher income brackets.[2] One study found “a potential economic gain of $135 billion per year if racial disparities in health are eliminated, including $93 billion in excess medical care costs and $42 billion in untapped productivity.”[3] UHG, as the largest health insurance provider in the United States, both by market share[4] and revenue[5], has an outsized role to play in eliminating these inequities.
To that end, the United Health Foundation, an affiliate of UHG, has announced a 10-year, $100 million commitment to advance health equity[6], among other initiatives, but UHG has not conducted an outside assessment of its current and potential racial equity impacts.
Although algorithms increase efficiencies, they should be vetted to prevent algorithmic bias. Optum, a UHG subsidiary, used an algorithm that reportedly referred equally sick Black people to care less frequently than white people.[7] We believe an analysis of these algorithms and proxy factors is necessary, along with disclosure of the results. Opaque data collection practices by health insurance companies raise the possibility of discrimination and pose reputational and financial risk.[8] New York’s Financial Services and Health departments launched an investigation of Optum after the results of the study were published.[9]
The company’s acquisition of Change Healthcare also raises racial justice concerns. The American Antitrust Institute told the Department of Justice that the deal is "likely to harm competition and consumers."[10] Decreasing market competition can lead to fewer options for consumers, which can disproportionally impact people of color. In fact, Color of Change states that “monopolies put economic justice at risk.”[11] Additionally, Change Healthcare had to fire an executive for racist behavior over the summer,[12] suggesting that the internal culture of the acquisition should be examined.
Finally, UHG’s 2021 EEO-1 report shows just 3.9 percent Hispanic and 3.9 percent Black executives compared to 83.4 percent white executives. UHG’s strategy to address the lacking diversity remains unclear to shareholders without public targets.
We urge the company to conduct a racial equity audit to examine its total impact and help dismantle systemic injustices.
[1] https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61, https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/
[2] https://www.nytimes.com/2020/08/06/nyregion/childbirth-Covid-Black-mothers.html .
[3] https://altarum.org/RacialEquity2018
[4] https://content.naic.org/sites/default/files/publication-msr-hb-accident-health.pdf
[5] https://www.beckersasc.com/asc-coding-billing-and-collections/5-largest-health-insurance-companies-by-revenue.html
[6] https://philanthropynewsdigest.org/news/united-health-foundation-commits-100-million-for-health-equity
[7] https://www.nature.com/articles/d41586-019-03228-6
[8] https://www.propublica.org/article/health-insurers-are-vacuuming-up-details-about-you-and-it-could-raise-your-rates , https://www.nejm.org/doi/10.1056/NEJMms2004740
[9] https://www.fiercehealthcare.com/payer/new-york-to-probe-algorithm-used-by-optum-for-racial-bias
[10] https://www.fiercehealthcare.com/payer/american-antitrust-institute-expresses-concern-about-proposed-8b-optum-change-healthcare-deal
[11] https://act.colorofchange.org/sign/2021-antitrust?source=coc_main_website
[12] https://biz.crast.net/we-value-diversity-company-fires-white-woman-who-harassed-black-man-and-his-children-outside-her-home/