Rising to the moment COVID demands: How to insure all Americans in pandemic times

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The COVID-19 pandemic has led to unprecedented upheaval of the U.S. health care system. For decades the United States has stood out among peer nations as the only country with no universal health care system. And now we are learning just how problematic it is to tie insurance to employment — an unintended consequence of employer workarounds of World War II wage freezes. Nearly 29 million Americans lacked insurance before the start of the pandemic. An additional 13.5 million individuals are projected to lose their employer-sponsored insurance by June 30th, 2020. As soon-to-be physicians, we have witnessed firsthand the devastating effects that lack of insurance can have on health.

Congress is now faced with two bills to address the growing ranks of the uninsured. The first, The Worker Health Coverage Protection Act, only addresses newly unemployed Americans who previously got insurance through their jobs. The second, the Health Care Emergency Guarantee Act, is much more comprehensive and calls for Medicare, the government program that traditionally covers adults 65 and older, to step in to cover medical costs during the COVID-19 pandemic.

The Worker Health Coverage Protection Act (WHCPA) expands coverage for the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA is a program designed to allow people to stay on their employer-sponsored insurance in the event they lose their job. However, for many individuals, COBRA is prohibitively expensive; consumers must foot both their usual monthly health insurance premium and the amount their employer traditionally covers. According to a recent survey, the average family enrolled in employer-sponsored insurance pays roughly only 30 percent of their annual premium ($6,015 of the full $20,576). The average monthly COBRA premium would amount to $1,714, eroding a household’s entire federal stimulus check (up to $1,200 per adult, up to $500 per child) by month two.

WHCPA would alleviate the financial burden imposed by the loss of an employer’s health insurance subsidy, covering all premiums for 15 months. It would also cover the full cost of premiums for furloughed workers who are still responsible for these costs despite receiving lower or no wages. Notably, copayments would not be covered.

The second piece of legislation, the Health Care Emergency Guarantee Act, has a much wider scope. Unlike WHCPA, HCEGA addresses both uninsured and insured patients. All uninsured Americans would receive coverage through Medicare to cover the cost of medically necessary health care. Insured Americans, on the other hand, would receive coverage of copayments and deductibles but not premiums. The legislation has additional provisions to reduce Americans’ health care spending: (i) limit surprise billing for all patients, (ii) for the previously uninsured population, reduce prescription drug costs by setting drug reimbursement rates at typically lower Veteran Affairs rates, and (iii) waive enrollment penalties for Medicare-eligible seniors who did not enroll in the program at age 65.

The bill would assist 270 million non-elderly Americans, approximately 20 times more Americans than WHCPA. Assistance would last until a coronavirus vaccine is approved by the FDA.

As medical students, we know many patients who have suffered unnecessarily because they were uninsured or underinsured. We have seen patients avoid seeking medical care and ration medications due to fear of the sky-high costs. With new studies emerging almost daily telling us that those with uncontrolled diabetes, high blood pressure, and other underlying conditions are at much greater risk of contracting and dying from COVID-19, we cannot afford to let health needs go unaddressed during this pandemic.

While The Worker Health Coverage Protection Act is a step in the right direction, it offers support for only a subset of Americans — those lucky enough to already have insurance through a job. Many employees of shuttered businesses, including restaurants or convenience stores, have fewer than 20 employees and typically do not offer employer-sponsored insurance. Undocumented individuals are also notably left out of this legislation. There is a strong moral and economic argument for changing this, as undocumented immigrants subsidize both public and private insurance for native-born Americans. Moreover, undocumented workers form the foundation of many essential industries, particularly America’s food supply chain.

HCEGA is more expansive, offering financial support to all Americans with health care needs. It’s an ambitious bill aiming to meet the scale of the moment. A looming recession, projected to be far worse than the Global Financial Crisis in 2008-2009, means that many of the jobs lost to COVID-19 are unlikely to return soon. Despite the Affordable Care Act’s expansion of coverage in the years since the Global Financial Crisis, the majority of Americans declaring bankruptcy cited medical bills as a cause. A study conducted in 2008 found that nearly 70 percent of individuals declaring medical bankruptcy had insurance at the time of filing. Additionally, it would be a boon for the 35 percent of Americans who report skipping needed care because they could not afford their copayment.

To prevent further COVID-19 cases and even deaths, we need more comprehensive health coverage that immediately enables all people living in the U.S. to manage chronic conditions, access medications, and, if necessary, be treated for COVID-19.

Isabel Ostrer and Chris Cai are medical students.

Image credit: Shutterstock.com

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