How will COVID-19 pandemic impact America’s health care system?

Since the start of the pandemic, health care insurers have had to account for more people than they ever anticipated, and the process has been far from smooth

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More than 50% of Americans get health insurance through their own or a family member’s job, so chances are you, or someone you know, has had to kiss their health insurance goodbye at some point in the past 18 months.

Despite stubbornly high unemployment rates, Americans are remarkably adept at making due with or without health insurance. Access to care comes and goes — in any given month, millions of American workers gain or lose employer-sponsored health insurance due to churn in the labor market, as some people gain jobs while others lose theirs. It’s not uncommon for working class Americans to lose coverage for a brief period of time as they make the transition from one job to the next or accept entry level positions with low pay and no health care benefits in hopes of leveraging their experience into future opportunities. 

This ebb and flow of coverage is why many Americans take losing their health care coverage surprisingly well, but historic job loss during the pandemic has created an unprecedented amount of turbulence in the job market, leading some to wonder if this natural equilibrium has been disrupted forever. 

(Photo: Getty Images)

Since the start of the pandemic, insurers have had to account for more people than they ever anticipated, and the process has been far from smooth. Some have endured the perils of accessing care for the first time, frustratingly trying to figure out what is and isn’t covered; while others have had to frantically make doctor appointments and buy prescription drugs before they lose coverage altogether. Even those with a more relaxed, ‘I only need health insurance just in case something happens’ attitude, have come to realize that it is a privilege to have the type of broad coverage plan that provides you with access to the best hospitals and a means to pay for it. 

Why employee-based health insurance doesn’t work

As is always the case in the U.S. the privilege of high quality health care is reserved for a select few, leaving millions to fend for themselves. The once unfathomable thought of surviving a health crisis without health insurance has become a reality to the ire of public health advocates who have spent decades clamoring for universal health care to avoid this fate. 

The entire U.S. health care system is based on class — a better job, high social standing, or more money likely equals better care and a longer lifespan. A large majority of middle class U.S. households rely on employer-sponsored insurance to pay for health care so any economic shock that destroys jobs also destroys access to health coverage. The near-total shutdown of the U.S. economy amid the COVID-19 pandemic was one of those shocks that cut millions of Americans off from health care. Data collected from the Economic Policy Institute shows that in March and April 2020, historically large layoffs led to over 11 million workers losing their health insurance coverage. During that same time period new hiring led to under 5 million workers gaining employee sponsored coverage. The net loss of 6 million health-sponsored jobs represented the biggest job-losing period since the Great Recession; and while there has been a large bounce back in job growth, the overall level of employment remains historically depressed relative to pre-COVID benchmarks.

Assessing how things are going has proved challenging. Just how well we’re doing now compared to the beginning of the pandemic is anyone’s guess. For one, the moving parts that characterize the U.S. health care system make for a confusing and inefficient model. Employers and health insurance companies rarely talk to one another, electronic medical recording systems are hard to understand, and knowing who pays for what is nothing short of a nightmare for most consumers. Even more, tracking real-time changes in coverage and the uninsured rate is nearly impossible given the dynamic state of the pandemic and a lag by months or years in large national surveys.

Stemming the tide

Policymakers have made all COVID testing, vaccination, and treatment free of charge and a handful of states have required or created agreements with insurers to waive COVID-19 out-of-pocket treatment costs for their fully-insured plan enrollees. Congress has also passed legislation barring insurers, pharmacies, doctors, and hospitals from applying any cost sharing, such as a copayment or deductible. 

Louisiana Leads U.S. In New COVID-19 Cases As Hospitalizations Soar
Medical assistant Terry Nguyen administers a COVID-19 vaccination dose to Caldrick Williams at a quiet vaccination site August 19, 2021 in New Orleans, Louisiana. (Photo by Mario Tama/Getty Images)

While these measures have propelled the nation’s economic recovery, the altruism of the government and health insurance companies has come into question. For starters, the vast majority of people enrolled in fully-insured private health plans would have had their out-of-pocket costs waived if they were hospitalized with COVID-19 anyway; and the mandate to cover all COVID-related expenses only applies to those with Obamacare or government-issued health insurance which means that many Americans who are are grandfathered into older insurance plans that don’t cover vaccinations and other preventative services may be hit with surprise medical bills.

Your options if you’ve lost your health insurance

If you have children, a preexisting health condition, or family members who depend on your insurance for coverage, finding the right insurance plan can be a challenge. Fortunately, there are a number of options out there for you. If you are married or have a domestic partner with job-based coverage that allows for family coverage, losing your job is a qualifying event that would allow you to get on your partner’s health insurance plan. Similarly, being under the age of 26 qualifies you to receive health insurance under your parents’ plan thanks to Medicaid expansion under the Affordable Care Act. 

If your spouse or domestic partner does not have job-based coverage that allows for family coverage, you may qualify for Medicaid. Medicaid provides comprehensive health coverage at little to no cost for those who meet certain income requirements. Other options like the Consolidated Omnibus Budget Reconciliation Act, or COBRA gives workers and their families who lose their health benefits the right to choose to continue their group health benefits provided by their group health plan for a limited period of time, but this is often an expensive option. Signing up for a health insurance plan via the ACA marketplace may be cost saving and a more permanent fix, but it may not provide all the coverage you need. Also, Obamacare and COBRA require that you sign up during a pre-specified open enrollment period, unlike Medicaid which allows enrollment year round. 

This screen grab from the website shows the main web page for the HealthCare.gov. HealthCare.gov’s market for subsidized health plans reopens Monday, Feb. 15, 2021, for a special three-month sign-up window, as the Democratic-led Congress weighs legislation that could cut premiums by double digits for many. (Centers for Medicare and Medicaid Services via AP, File)

Taking hold of health means less reliance on the U.S. health care system

The uncertainty of having health insurance one day and not having it the next — during any time but especially crisis — puts families’ health and financial security at risk. The situation will become more dire as cost-saving COVID-related treatment waivers begin to be phased out by insurers, underscoring the importance of providing U.S. families with a public option for health insurance coverage.

We did not need a global pandemic to come to the conclusion that we can all benefit from universal health care, but catastrophe breeds opportunity. Expanding broad-based coverage is the quickest and most effective way to raise our collective baseline of health. Not having to worry about accruing huge medical bills encourages everyone, but especially high-risk individuals like the uninsured and under-insured, to seek care early, staving off stress-related diseases like hypertension and heart disease. 

If you feel like you’ve been left out in the cold during the pandemic you are not alone. The shock of abruptly losing health insurance has been compounded by the stress of finding new coverage for thousands of families. But in spite of our glaring need for more equitable access to health care, expanded coverage, while ideal, is not the solution in and of itself. 

Health starts in the home. Eating right, maintaining a healthy weight, staying active, and never smoking keep you out of the hospital altogether. Continued promotion of low-cost, high yield primary preventative strategies like hand washing, social distancing, and getting vaccinated are immeasurably important to keeping you and our most vulnerable populations healthy. It’s going to take time to fix this very broken system, but if you take control of your health now it will limit your dependence on it; and that may be the best solution of all.

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