One afternoon in clinic, I opened a patient’s chart for a telehealth visit. Within days of the COVID pandemic, all clinic visits had transitioned to telehealth. The young woman had sent a picture through the electronic medical record of a rash on her leg. Upon calling her, the woman explained that the rash started a month ago, wasn’t painful, and she couldn’t recall anything that caused it. On further investigation of the rash, the woman admitted. “It’s not my rash; it’s my sister’s. She lost her job with the pandemic and doesn’t have health insurance anymore.”
Inspired by the woman’s advocacy for her sister, I asked if I could speak to her sister. When the true patient got on the phone, I explained my concern for a vascular or autoimmune condition and encouraged her to make an appointment to be seen in clinic. “But how much will it cost?” she asked with concern. My heart sunk. Even though the woman’s health condition was a non-life threatening rash and not an acute cardiac condition, she was legitimately debating if whether or not her life was “worth it,” something people often ask themselves when faced by financial hardship, causing them to deprioritize their health. This internal struggle predates the COVID pandemic and will be further exacerbated by it.
Unfortunately, in the United States, access to health care is based on employment. During the COVID pandemic, nearly 40 million individuals have filed for unemployment so far. It’s not surprising that with the staggering amount of job loss, the uninsurance rate will multiply exponentially. The Kaiser Family Foundation found that nearly 27 million people will become uninsured due to job loss, which is higher than it was before the passage of the Affordable Care Act (ACA). The number of uninsured individuals is expected to be worse in states that did not expand Medicaid. Luckily, I was able to persuade the woman to be seen in the clinic so that she could have the rash evaluated by a provider and enroll in MassHealth, Massachusetts Medicaid program, on-site.
It is well known that the COVID pandemic disproportionately affects people with chronic medical conditions and vulnerable populations, including people of color and low socioeconomic status. Unsurprisingly, these are the same people who are more likely to hold “essential,” low-wage jobs with little to no coverage at all or employer-based plans with exorbitant premiums and copays that discourage them from seeking treatment. In a study published by the American Journal of Public Health, almost half of black and Latina female health care workers earned less than $15 per hour, and more than 10 percent lacked health insurance.
Similar to the need for a national unified response to overcome the COVID pandemic, we need a national health insurance program, like Medicare for all, to overcome the uninsured pandemic. We need health insurance that is not tied to employment or economic status and eliminates distressing financial barriers that force people to not seek medical care. Health care should be a public good endowed by society, similar to safety, transportation, and libraries. It should be a human right, guaranteed to all and not reserved for the few who can afford it.
Mallika Sabharwal is a family medicine physician.
Image credit: Shutterstock.com
