“How much will this cost me?” This is the last thing that a patient with COVID-19 should have to think about, but this is a major concern for the at least 27 million Americans facing the pandemic without health insurance. These individuals include construction workers, drivers, and cashiers, many of whom must continue to work because they are financially strapped or because they are essential personnel. As a physician on the frontlines of the coronavirus response, I worry that uninsured individuals who contract coronavirus will not present to medical care or even continue working, due to financial concerns. In one uninsured patient’s experience, her total bill for coronavirus testing and treatment at a Boston-area hospital was $34,927.43.
Last month, Congress approved the Families First Coronavirus Response Act, which will fund free coronavirus testing for everyone, including the uninsured. While optically appealing, in the grand scheme of medical care indicated for COVID-19, this provision is a band-aid over a bullet hole. Patients are still responsible for the cost of hospitalization and treatment, which can be astronomical. If the hospitalization includes intubation and several days in the intensive care unit, the bill can be hundreds of thousands of dollars. States like California and New York have opened enrollment in the state insurance exchanges created through the Affordable Care Act. The federal administration, which runs/oversees the remaining 38 state exchanges, recently rejected a special enrollment period for the rest of these markets. For the millions of uninsured Americans who do not qualify for health care under Medicaid, this leaves them with few options. Health care experts agree that making health care as cheap and as accessible as possible is key to controlling the pandemic, yet the current administration has chosen to reject this option.
In addition to not opening a special enrollment period through the federal exchange, the administration is also attempting to repeal the Affordable Care Act. In early March, during the initial rumblings of the pandemic, a group of Republican attorneys general led by Texas, were granted a Supreme Court hearing of their case to invalidate the ACA. The Supreme Court is scheduled to hear this case in the fall, likely around election season. Given that experts predict that COVID-19 may reappear in the fall, repealing the ACA at that time without having a replacement would leave 21 million Americans without health insurance. When asked if he would consider rescinding the lawsuit in the setting of coronavirus, Trump reiterated at a press conference that he still wanted to get rid of the ACA, without specifying how he would replace it.
Worst-case scenarios estimate that 50 percent of Americans could contract coronavirus. However, it is readily apparent that not everyone will be affected equally. Construction workers, drivers, cashiers, and other frontline workers are most at risk for becoming sick, and for losing insurance or not having it to begin with. The decision to not expand health care coverage right now will relegate Americans already hurting from a struggling economy, to financial ruin if they were to be hospitalized. These hospital bills are not something that a $1,200 stimulus check can cover. While the ACA has its imperfections, we cannot ignore the fact that it provided health insurance to 21 million people and could provide health insurance to millions more. It is crucial that the federal government open the insurance exchange so that uninsured individuals and workers who recently lost their employer-provided coverage can sign up for health insurance. It is also equally critical that they don’t take this coverage away in the fall, given the projected seasonality of COVID-19. There has never been a more pressing time to expand health care coverage in America: we need health insurance, and we need it now.
Jingyi Liu is an internal medicine resident.
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