Rising uninsurance is taking this pandemic from bad to worse

Published on
June 24, 2020

In the three months since the surge in COVID-19 cases in the U.S., over 45 million people have filed new unemployment claims. Since most Americans have health insurance through job-based coverage, this surge in unemployment could result in as many as 35 million Americans losing their health insurance.

Even before the first case of COVID-19, 28 million Americans lived without health insurance. This was the unsteady foundation on which we stood as we entered the deadliest pandemic in recent U.S. history. While a universal coverage or single-payer system would insulate Americans against the scourge of uninsurance we are seeing now, such a system is not feasible to implement rapidly in the current political climate. But by growing some of our existing programs, we can provide health care coverage for some of the poorest and most vulnerable Americans relatively quickly. The loss of a job should not translate to the loss of access to health care or debilitating medical bills.

With the rising uninsurance rates in this country, we are likely to see worse health outcomes and higher costs for many Americans. While the government is covering the cost of COVID-19 testing for the uninsured, they are not paying for the cost of treatment. Out-of-pocket costs for a hospital stay for an uninsured patient with COVID-19 is at least tens of thousands of dollars more than for an insured patient. People without insurance often delay seeking health care for fear of prohibitive costs. In the case of coronavirus, postponing care can lead to respiratory failure and death.

People without insurance are less likely to see a doctor or take medications for chronic conditions such as diabetes or high blood pressure. The uninsured are also less likely to receive preventive care such as cancer screening or vaccines. As more people lose their insurance during this pandemic, fewer Americans will be able to afford their medications or visit their doctors, likely resulting in more preventable diseases and deaths unrelated to COVID-19 in the near future. And that could further strain our health care system during this pandemic.

Worse still, as diabetes goes untreated, cancers go undetected, and children don’t receive critical vaccines, we may continue to observe the consequences of this rising tide of uninsurance years from now.

Uninsured working Americans are also more likely to be essential workers such as truck drivers, cashiers and cooks. These workers, who are taking extraordinary risks for their communities during this unprecedented time, are more likely to be exposed to COVID-19 through their jobs, yet don’t have the reassurance of access to health care or a financial safety net if they get sick.

Leading up to the pandemic, the Trump administration took steps that limited access to Medicaid, the state-federal insurance program for low-income individuals. These actions have included “public charge” rules that discouraged enrollment of immigrants in public health insurance and other assistance programs, allowing states to impose higher Medicaid premiums, and encouraging states to restrict eligibility for Medicaid through unnecessarily arduous standards such as work requirements, health risk assessments and time limits on coverage.

The Families First Coronavirus Response Act (FFCRA) was passed in March in an attempt to provide emergency funding relief for those affected by COVID-19. While the legislation prevents states from imposing further restrictions on Medicaid eligibility or raising premiums, it does not reverse the changes some states made to Medicaid in the past year.

The law has not deterred several states from further limiting access to public insurance – Wisconsin increased Medicaid premiums as recently as February (with a six-month lockout from Medicaid if members did not pay their premiums). States can no longer disenroll individuals who enrolled in Medicaid after the FFCRA’s implementation, but this change comes too little too late for Americans who already lost coverage.

Although many families in states that expanded Medicaid coverage under the ACA would be considered eligible for Medicaid after a job loss, in most of the 14 states that declined Medicaid expansion, loss of a job or even loss of substantial income for the family does not guarantee that a family will be eligible for Medicaid. In fact, in many of these states, families living below the poverty level would still not qualify for the public insurance program.  

Additionally, the Trump administration has refused to reopen the ACA’s health insurance exchanges to the 28 million Americans who were uninsured before the pandemic. While job loss qualifies individuals to sign up for new coverage, those who were previously uninsured are not eligible to sign up. A few states have created special enrollment periods to allow these individuals to sign up for a plan, but this option is not available to the majority of uninsured Americans.

If it wasn’t already clear, this pandemic — and its disproportionate impact on low-income and minority communities — has shown us why Americans must have equitable and affordable access to health care.

There are a number of steps states could quickly take here, such as reopening their health insurance exchanges, as some have done already. In the midst of a pandemic, health insurance marketplaces should give everyone another opportunity to purchase insurance coverage. States should also consider suspending burdensome Medicaid eligibility requirements. Instead, we should be simplifying the enrollment process for stressed and struggling Americans – for example, applications for unemployment benefits or food stamps should automatically trigger a Medicaid application.

Lastly, states could mandate that private health insurance companies maintain coverage for individuals who can no longer pay their premiums during this pandemic. This includes coverage for people who have lost their job or experienced other financial strains related to COVID-19. While many states have placed moratoriums on evictions or prevented utility companies from discontinuing water, electricity and gas, only a few states are requiring insurers to maintain health care coverage for Americans. These states would provide a grace period or “premium pause” for enrollees. Enrollees will still have to pay their premiums down the road but would not lose their existing coverage at this critical time.

Until Americans have affordable alternatives to job-based coverage, these state-level policies could provide lifelines for the newly unemployed. However, before the next crisis, our country needs a more robust health insurance system. The challenges of caring for an increasing number of individuals who have lost their health coverage during this pandemic make a strong argument for universal health care coverage, an idea that had gained substantial momentum before the pandemic hit. The loss of coverage many American have suffered since should only make it a more vital issue in our upcoming election. 

Lucas Lebovitz and Sonali Saluja contributed to this article.