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Millions of Americans Face the Nightmare of Getting COVID-19 While Underinsured

Adults with underlying health problems are at increased risk of getting seriously ill or dying if they contract the coronavirus. These are also often the very same people who are least likely to have insurance.

Medical workers take in patients at a special coronavirus intake area at Maimonides Medical Center in Brooklyn. Spencer Platt / Getty

The Centers for Disease Control and Prevention identify two categories of people who are at increased risk for developing severe, life-threatening illness if they contract COVID-19: older adults and people with underlying medical conditions.

As the pandemic continues to sweep through the US population, aided by an inadequate government response best characterized as “giving up,” millions of people who fall into these categories remain in harm’s way. But while their health and even their lives are on the line, older adults have at least one thing going for them: everyone over the age of sixty-five has medical insurance through Medicare. At least this population’s medical worries aren’t compounded by the prospect of sky-high bills due to lack of insurance.

The same can’t be said for non-elderly people with underlying health problems. Because the United States lacks universal public health coverage, large swaths of the population are either uninsured or underinsured. And according to a study published in the Journal of General Internal Medicine, that includes 17 percent of people who fall into the increased-risk category.

All things considered, the study’s authors estimate that 18.2 million Americans are at increased risk of getting very sick if they’re infected and are inadequately insured.

The researchers, led by Harvard pulmonary specialist Adam Gaffney, also sought to understand who was most likely to be at increased risk and underinsured. They found a strong overlap between populations most endangered by the contraction of COVID-19 (e.g. non-elderly adults who have asthma, heart disease, severe obesity, and diabetes) and populations that lack adequate health insurance (e.g. low-income people, racial minorities, rural residents, and people who live in states that have rejected Medicaid expansion).

In other words, in many cases the same people who are likely to develop serious illness from contracting COVID-19 are the ones least likely to have good insurance, compounding the danger they face during this pandemic.

Income is a clear determining factor in who falls into both the at-risk and underinsured categories. The study found that people who make less than $15,000 a year are twice as likely to be at increased risk than those making over $50,000 a year, and three times as likely to be uninsured or underinsured. The study also found that racial minorities, with the exception of Asian Americans, were more likely than white people to be both at increased risk and to be uninsured or underinsured.

A number of factors help explain this overlap in the groups needing adequate medical coverage the most during this pandemic and those who are least likely to have it, but one reason is obvious: uninsured and underinsured people are less likely to receive preventative care and are therefore more likely to develop serious health problems over the course of their lives. Thus they are both more susceptible to life-threatening illness and least able or willing to seek medical treatment for that illness.

A major concern cited by the study’s authors is the “risk of delay in seeking care because of cost concerns and of financial toxicity if hospitalized.” Delay in seeking treatment has major implications: not only is the infected person more likely to grow sicker and possibly die if they don’t seek care immediately, but outside of an institutional setting they may fail to quarantine themselves and might spread the virus to others. If they go to the hospital, they will stand a better chance at recovery and they will be separated from the general population, abating the spread of the virus.

The researchers suggest that their estimate of 18.2 million high-risk, underinsured people is probably low. And indeed in mid-May, after the study was published, the Kaiser Family Foundation found that nearly 6 million of the 27 million people who’d lost their employer-provided health insurance in the course of shutdown-related layoffs were not eligible for subsidized health insurance. It’s impossible to know exactly how many people have just lost their health coverage and been unable to replace it, but the number is likely in the millions. And of those, many will be at increased risk for severe illness if they contract COVID-19.

If We Had Medicare for All

The study’s authors are all members and leaders of Physicians for a National Health Program, a group of doctors who advocate for a single-payer health insurance model in the United States. And no wonder: if we had Medicare for All, the number of people who fall into both vulnerable categories would be zero, because one of the categories would be completely eliminated.

Under Medicare for All, everyone would have health coverage, and all health care would be free at the point of service, financed by progressive taxes like our other public goods. People would be healthier in general, too, as those who rarely see a doctor now would be able to receive regular and preventative care throughout their lives.

The primary roadblock to true universal health care is the power of vested interests, chiefly the private insurance industry, to influence and manipulate the democratic process in order to protect the economic interests of major stakeholders. Private insurance is a multitrillion-dollar industry, and its key players have put a lot of effort into conscripting politicians to help them popularize anti-single-payer talking points, scaring the public with talk of high taxes and lost private insurance — never mind the astronomical personal cost of the status quo.

The private insurance industry and the majority of the Democratic Party presidential primary field teamed up to help sink Bernie Sanders’s 2020 presidential campaign, and with it the dream of rapid progress toward single-payer health care. But while the possibility of a Sanders presidency has evaporated, his flagship policy now has majority support across the country. The pandemic has simply clarified the issue: the only rational path forward is Medicare for All.