Kevin Stang, a care coordinator at Cape Fear Clinic in Wilmington, NC, examines a patient. Health centers and free clinics across the U.S. may experience and influx of patients as they seek care outside of employer-provided health plans. (Photo by Donnie Hedden for Direct Relief)
Having health insurance comes with clear advantages.
Insured people are less likely to die and more likely to seek care, explained Stan Dorn, the director of the National Center for Coverage Innovation at Families USA, a health care advocacy nonprofit.
“We know that there are really serious consequences in terms of higher hospitalization rates if you’re uninsured, and even higher death rates if you’re uninsured,” Dorn explained.
And right now, Dorn is concerned.
According to a report that Families USA released on July 13, 5.4 million American workers – and, presumably, many of their family members – have lost insurance between February and May of this year, thanks to pandemic-related job loss.
That number, according to the report, is 39% higher than the largest annual increase ever recorded – in a matter of three short months. (The highest previous annual increase occurred during the Great Recession, when 3.9 million adults of working age became uninsured over the course of one year.)
“The bottom line”
What does this mean for the millions of affected adults – both those who lost employer-sponsored health insurance and their family members?
“The bottom line is really clear: It is bad for you not to have health insurance,” Dorn said.
He explained that uninsured people are four times more likely to delay getting care, which can be disastrous for long-term health conditions like cancer and diabetes.
During Covid-19, there’s an added risk: that people with Covid-19 symptoms will postpone or avoid seeking care, increasing the risk to themselves and those around them, Dorn added.
In addition, people who lose insurance may stop adhering to treatment regimens, or trying to stretch medications and other resources, said Caitlin Donovan, senior director for the National Patient Advocate Foundation, an advocacy organization focusing on the insurance and financial side of health care.
Essentially, she said, losing insurance means that medications become instantly unaffordable at precisely the moment when people don’t have an income.
“They either stop adhering entirely because they don’t want to put their families in dire financial straits…or they start modifying, so you see people cutting their pills,” she said.
“Cancer doesn’t go on vacation because of Covid,” Dorn said. “There’s an…avalanche we’re going to see of untreated health conditions.”
He pointed out that untreated health conditions have both financial and practical ramifications for families. For example, “even if the children in the household retain health insurance through Medicaid, if Mom doesn’t have health insurance and she doesn’t get treatment for depression, that puts the child at risk,” he said.
According to Benjamin Ukert, a professor of health policy and management at Texas A&M University, financial well-being also increases when a person has health insurance. Credit scores are higher; it’s less likely that the person will declare bankruptcy.
By some estimates, more than half of bankruptcies include medical debt.
For many families, Dorn said, the loss of insurance will require them to make a choice “between seeking medical care and putting food on the table.”
“A totally new game”
But when it comes to the current spate of insurance losses, Ukert made clear there are a lot of unknowns.
For starters, a lot of the available research tends to focus on public insurance like Medicaid, rather than on the employer-sponsored variety. “Some of the effects [of insurance]…are stronger, of course, for the low-income populations,” he said. “Stronger [health care] access effects tend to be stronger on the Medicaid side.”
Those lucky enough to have employer-sponsored health insurance are more likely to have good health care access.
In addition, Ukert said, more is known about gaining insurance than losing it: “The [Affordable Care Act] created a national experiment where people could compare what happened to people who didn’t have access before, or who had very limited access” and who found themselves newly eligible for public or individual-market insurance plans.
When thinking about what will happen to the millions of newly uninsured Americans, Ukert said, “the only comparable scenario that we have is the Great Recession, where, also, a lot of people lost health insurance.”
But there’s a vital difference: the Great Recession took place before the Affordable Care Act was passed in 2010.
Now, “it’s a totally new game,” Ukert said.
“Assume you will interact with the health care system”
For those who lose their jobs, Medicaid – the nationwide public-insurance program designed for those with limited income and resources – is often the first stop.
“If you lose your insurance, you should go to the Medicaid program and apply for coverage right away,” Dorn said. “A lot of people are eligible who don’t think they’re eligible.”
Donovan concurred, but explained that, particularly in states that elected not to expand Medicaid after the 2012 Supreme Court decision, “it’s very hard, if not impossible, for an able-bodied adult who has any income at all…to qualify in some states.”
Even aside from qualifying, Donovan said, the process of proving eligibility and dealing with paperwork is often labyrinthine and difficult, and people don’t know where to turn for outside help. (There are a number of groups, from advocacy organizations to free clinics, that can help uninsured individuals find an insurance plan.)
Some employees are eligible for COBRA, a health insurance program that will allow them to continue to receive the benefits they received as an employee – provided they pay the entire premium themselves. “For many people, that will be cost-prohibitive,” Donovan said.
And then, finally, there’s the individual marketplace, which, through the Affordable Care Act, allows people to select an insurance plan. Thanks to tax credits, the premiums will be subsidized for some.
But oftentimes, Donovan said, it’s the cost of premiums – not deductibles or copays – that drives people’s decisions about a health insurance plan. “Often they’re picking a bad plan, because they’re choosing the lowest monthly premium,” she said.
Instead, she said, people should “assume you will interact with the health care system this year, especially considering there’s a pandemic going on,” and act accordingly, taking deductibles, copays, and in-network coverage into account.
“Surveying the rubble”
Not everyone will be able to get new insurance. For one thing, some– such as undocumented workers – won’t be eligible. And some, Dorn said, will be distressed, overwhelmed, and even traumatized by a job loss. “Many people in those situations do not have the bandwidth needed to learn about America’s complicated health system,” he said.
In addition, health insurance isn’t always the first priority, said Nicole Lamoureux, president and CEO of the National Association for Free and Charitable Clinics. “A person who has lost their job is worried about their expenses…is mostly looking for how they’re going to get unemployment in that case,” she said.
Many of those will end up at a safety-net health center or clinic, and safety net providers across the country are already seeing a surge of patients seeking care, Lamoureux said: “Now we’re starting to see people call and say, ‘I don’t have my medicine and I don’t have a doctor and I don’t have health insurance. Do I go to you or do I go to the emergency room?’”
When it comes to clinics, “I think as they’re preparing for what we see as a tsunami,” she said.
Donovan said that her organization is also expecting to see a surge of patients in need of help with finances or insurance.
For the time being, she said, people are hesitant to seek care because of Covid, which seems to translate into less need for financial intervention. But as chronic conditions go untreated and other health issues crop up, that’s likely to change.
“What we’re expecting to see is a surge in September and October, when people are kind of surveying the rubble and realizing they need help, and looking for it,” she said.