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Unemployment imperils health coverage

By: Leah Curtin, RN, ScD(h), FAAN

A fix is long overdue and needed now.

So many bad things are happening, it’s hard to keep up with them all. In many states, COVID-19 hospitalizations are rising rapidly. Over 6 million cases have been reported in the United States, and 180,000 people have died. In addition, over 50 million people have lost their jobs—and many have lost the accompanying health insurance. The nonpartisan Kaiser Family Foundation estimates that 27 million Americans have lost coverage in the pandemic; that study took into account family members of the insured. Another analysis, published by the Urban Institute and the Robert Wood Johnson Foundation, projected that by the end of 2020, 10.1 million people will no longer have employer-sponsored health insurance or coverage that was tied to a job they lost because of the pandemic.

Also, those losing coverage could face staggering costs if they are struck by COVID-19, which has sent the seriously ill to hospital intensive care units for weeks, and sometimes months.

Four of every five people who have lost employer-provided health insurance during the pandemic are eligible for free coverage via expanded Medicaid programs or government-subsidized private insurance through the Obama-era health law, according to the Kaiser Family Foundation. However, Democrats want to expand the law, and President Trump has asked the Supreme Court to overturn it. Regardless of partisan wars, experts say that insuring the recently unemployed is a difficult challenge. Many people can’t afford premiums for coverage through either the Affordable Care Act (ACA) or the Consolidated Omnibus Budget Reconciliation Act (COBRA). Others may or may not be eligible for Medicaid—or they might not know they’re eligible. Rather than expand access to subsidized insurance under the ACA, President Trump has promised to directly reimburse hospitals for the care of patients with COVID-19 who have lost their insurance. To date, little to no evidence exists that this has begun.

We in healthcare have known for 30 years that the way we fund our healthcare system (actually, it’s a non-system that works together only when necessity forces it to) is crazy. In fact, even the ACA is inadequate and overly expensive. The Families USA study is a state-by-state examination of the effects of the pandemic on laid-off adults younger than 65, the age at which Americans become eligible for Medicare. It found that nearly half (46%) of the coverage losses from the pandemic occurred in five states: California, Florida, New York, North Carolina, and Texas. In Texas alone, the number of uninsured jumped from about 4.3 million to nearly 4.9 million; three out of every 10 Texans are uninsured. In the 37 states that expanded Medicaid under the ACA, 23% of laid-off workers became uninsured; the percentage was nearly double that (43%) in the 13 states that did not expand Medicaid, which include Texas, Florida, and North Carolina. Five states have experienced increases that exceed 40% in the number of uninsured adults. In Massachusetts, the number nearly doubled—rising by 93%—a figure attributed to a large number of people losing employer-based coverage. Across the country more than one in seven adults (16%) are now uninsured.

Whether the fix is long-term (Medicare for All) or short-term (Congress reimburses costs for patients with COVID-19 [the President doesn’t have the authority to do it]), something has to be done. In short, whether you’re pro-Trump or pro-Joe Biden, it should be pretty clear that our hospitals will go broke if someone doesn’t pay them.

leah curtin registered nurse faan



– Leah Curtin, RN, ScD(h), FAAN, Executive Editor, Professional Outreach, American Nurse Journal


Dorn S. The COVID-19 pandemic and resulting economic crash have caused the greatest health insurance losses in American history. Families USA. July 13, 2020. familiesusa.org/resources/the-covid-19-pandemic-and-resulting-economic-crash-have-caused-the-greatest-health-insurance-losses-in-american-history/

Kaiser Family Foundation. Eligibility for ACA health coverage following job loss. May 13, 2020. kff.org/coronavirus-covid-19/issue-brief/eligibility-for-aca-health-coverage-following-job-loss

Kaiser Family Foundation. Explaining health care reform: Questions about health insurance subsidies. January 16, 2020. kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health

Kaiser Family Foundation. Status of state Medicaid expansion decisions: Interactive map. August 17, 2020. kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

Robert Wood Johnson Foundation. Changes in health insurance coverage due to the COVID-19 recession. Preliminary estimates using microsimulation. July 13, 2020. rwjf.org/en/library/research/2020/07/changes-in-health-insurance-coverage-due-to-the-covid-19-recession–preliminary-estimates-using-microsimulation.html?cid=xem_other_unpd_ini:quickstrike_dte:20200713_des:coverage%20changes;%20covid

Stolberg SG. G.O.P faces risk from push to repeal health law during pandemic. The New York Times. July 1, 2020. nytimes.com/2020/06/22/us/politics/republicans-health-care-coronavirus.html

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