By Adam W. Gaffney MD, MPH, Laura Hawks MD, David H. Bor MD, Steffie Woolhandler MD, MPH, David U. Himmelstein MD & Danny McCormick MD
Journal of General Internal Medicine, June 10, 2020
We analyzed a nationally representative survey to identify individuals at elevated risk for severe COVID-19 and, among these, those at high risk of financial toxicity from care at the start of the epidemic.
Discussion
At the start of the outbreak, 18 million adults at increased risk of severe COVID-19 were inadequately insured and hence at risk of delay in seeking care because of cost concerns and of financial toxicity if hospitalized. Traditionally disadvantaged groups—racial minorities, low-income persons, and rural residents—were more likely to be at risk of severe COVID-19 (consistent with the experience of previous viral respiratory epidemics) and of financial harm. Those living in states that failed to expand Medicaid or issue a stay-at-home order were also at greater risk of severe disease and inadequate coverage.
Gaps in insurance coverage, and states’ decisions to reject Medicaid expansion and defer prevention measures, may hence exacerbate the damage wrought by the COVID-19 epidemic, as well as health disparities. Rising unemployment after the onset of the epidemic in the USA will likely translate into health coverage losses that could further widen these gaps; our estimates of uninsurance and underinsurance are likely underestimates. These findings provide support for steps taken to address inadequacies in coverage for the diagnosis and treatment of COVID-19 and for the consideration of additional policies that could expand coverage during the economic downturn.
‘Lethal Inequality’: New Study Shows Millions at High Risk of Covid-19 in US Lack Adequate Health Insurance
By Jake Johnson
Common Dreams, June 10, 2020
Dr. Adam Gaffney, a critical care physician and lead author of the study, said the coronavirus pandemic “is laying bare the lethal inequality of American society and American healthcare.”
“Our ICU has been flooded with poor and minority patients; having Covid-19 is scary enough without worrying that you’ll be bankrupted by medical bills,” said Gaffney, who works at the Cambridge Health Alliance and Harvard Medical School and serves as president Physicians for a National Health Program (PNHP).
“These promises of new protections for patients with Covid-19 are full of holes,” said Dr. Danny McCormick, a primary care physician and senior author of the study. “Covid-19 threatens the health of people everywhere, but only in the U.S. will it also ruin patients financially. When people avoid testing and care because they fear the costs, it fuels the epidemic’s spread.”
Dr. Steffie Woolhandler, distinguished professor of Public Health at CUNY’s Hunter College and another of the study’s authors, said the new research bolsters the case for both an emergency expansion of Medicare to the uninsured—as proposed by Sen. Bernie Sanders (I-Vt.) Rep. Pramila Jayapal (D-Wash.)—and an eventual transition to Medicare for All.
“It’s not just Covid care that’s unaffordable,” said Woolhandler, co-founder of PNHP. “Patients with heart disease, asthma, and diabetes need protection too. Medicare for All is the long-term answer.”
Comment:
By Don McCanne, M.D.
As Steffie Woolhandler states, “Medicare for All is the long-term answer.”
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