In New York City, the pandemic’s national epicenter, the number of deaths from COVID-19 is finally flat. But the medical consequences of the pandemic could be far-reaching, as new research from the Kaiser Family Foundation reinforced on Wednesday. Catastrophic job losses will cost about 27 million people their employer-provided health insurance nationwide, Kaiser researchers concluded, and they won’t all qualify for Medicaid or for the Affordable Care Act’s subsidized insurance marketplaces. Some 5.7 million will likely have to bear the full cost of insurance on their own in the middle of a public-health disaster.
The fact that people have to sign up for ACA coverage is another obstacle to coverage, researchers added. “Even before the coronavirus crisis, there were millions of people eligible for Medicaid or marketplace subsidies who were uninsured,” they wrote. “Eligible people may not know about coverage options and may not seek coverage; others may apply for coverage but face challenges in navigating the application and enrollment process. Still others may find marketplace coverage, in particular, unaffordable even with subsidies.”
One of the most common rebuttals to Medicare for All is that it eliminates choice from the health-care system. If Americans prefer the plan their employer provides them over a hypothetical public alternative, why shouldn’t they get to keep the care they want? But as the pandemic clarifies, choice means little in the context of health care. A person’s ability to keep an insurance plan they like already depended on the choices their employer makes — or, in the case of COVID-19, on massive forces outside an employer’s control. So while Americans may like their employer-provided coverage when they have it, contra Obama, they can’t always keep it. That vulnerability simply becomes more pronounced during times of national economic distress.
Factor in the likelihood that many job losses could become permanent and a second health-care crisis looks imminent. Not only are many Americans without health insurance at a time when medical care is a paramount need, they may also find themselves in a long-term predicament that damages their health over time. Previous Kaiser research found that the uninsured are more likely to delay care because they can’t afford it and are thus more likely to get diagnosed with conditions like cancer or diabetes at advanced stages of disease. Even when the uninsured are eventually able to enroll in programs like Medicaid or Medicare, the physical consequences of health inequity may persist. In 2007, a study supported by the Commonwealth Fund found that older adults who gain access to Medicare after being uninsured tend to have higher health costs and are more likely to need hospitalization. Medicaid expansion and ACA subsidies have since patched some holes in the American health-care system, but so many remain that they are difficult to avoid.
A person who does not have insurance is on their own and must stumble clear of traps left behind by other forces. The task could be impossible in earlier, healthier times. Now it’s even deadlier than usual, and help looks a long way off.