Episode 25 | #COVIDConvo Ep. 11
#COVIDConvo Ep. 11: Impact of Loss of Healthcare for Underemployed During COVID Pandemic
Alex and Dr. Wendy Tong, MD MHA, talk about the recent events with the COVID-19 pandemic happening all over the world and discuss topics like healthcare, eldercare and keeping your loved ones safe.
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TOPIC:The impact of prolonged unemployment and underemployment on access to healthcare and how we as a a nation “recover” from COVID.
Alex: In many of our prior episodes we’ve mentioned the shortage of healthcare workers and the problems of access to healthcare in the US. Today, we are going to dive deeper into how unemployment due to the COVID pandemic has further driven the challenges many Americans face in getting healthcare. The unemployment rate in June was 11% and if you include the underemployed who generally don’t get employment healthcare benefits, the number of Americans is 18%. Prior to COVID, almost half of all Americans received healthcare coverage through their employer. How are the 17.75 million people who are left unemployed getting healthcare especially when they need coverage more than ever? And what is the impact on us as a nation?
Alex: first, who are the people who are affected most by the COVID related job lay offs?
Wendy: The areas that have been hit the hardest to COVID related job lay offs are in the non-essential businesses and especially in retail, food and beverage services, hospitality who usually use predominantly low wage workers who don’t have health care insurance to begin with. But we have to look at the cost of taking care of an uninsured patient compared to taking care of an insured patient. A typical hospitalization for an uninsured patient costs approximately $10,000 whereas the same hospitalization for someone with health insurance costs approximately $6,000 due to discounts offered to the health plan. If the patient cannot pay their hospital bills, then it’s written off as bad debt by the hospital and it ultimately is paid for by all of us in government subsidies and taxes from everyone else.
Alex: does the ACA (Affordable Care Act) help these workers?
Wendy: only those who lost employer based insurance.
Alex: For the people who lost their health care coverage because it was provided by their employers? Isn’t there COBRA (Consolidated Omnibus Budget Reconciliation Act) that provides coverage after losing employment related health benefits?
Wendy: The intent of COBRA to provide continuity of care is good however in reality, COBRA is expensive and therefore it’s for many not a viable option. Joking aside, it costs an individual $7200 and for families it can cost over $20K. Sometimes, people are able to negotiate extensions of their health benefits as part of their severance package but in this day and age of uncertainty and employers being cautious of spending, it’s much less likely such negotiations are going to be successful.
Alex: How about Medicaid and CHIP (Children’s Health Insurance Plan) as options?
Wendy: These are the safety nets for the low income and poor offered at the federal level and implemented at the state level. Eligibility is determined at the state level. Many low wage workers will qualify for Medicaid but for many of those who are newly unemployed, their savings and assets may be too high to qualify. Regardless, the processing time for Medicaid applications take at least 45 days and has been known to occasionally take years.
Alex: In March, congress passed the Families First Act that provides free COVID testing. Is this helpful?
Wendy: It is helpful but it does not cover treatment. Only testing. The CDC has authority to pay for COVID testing regardless of whether someone has insurance or not.
Alex: What are people doing when they get sick and don’t have insurance?
Wendy: People are waiting till they get very sick till they seek care. What this means is that people are delaying treatment which means they are at a more advanced stage of illness or have developed complications. It’s much more expensive to treat disease when it’s advanced or complicated. For example, a hospital stay in the ICU (Intensive Care Unit) costs about $20K compared to regular hospital stay that costs $10K. Mortality is higher and complications are more likely to have long term effects than if the patient sought care earlier. Also, while people are not in the hospital, they are exposing more people in their communities.
Alex: Dr Wendy, what are your recommendations for someone who has lost their health insurance?
Wendy: My mantra during this pandemic has been to practice social distancing, even self quarantining, wear a facial covering at all times in public. An ounce of prevention is worth a pound of cure. But specifically for those who are in need of health care and don’t have insurance, please do not let the lack of insurance affect the decision to get tested if there is a suspected exposure or infection. If you choose to purchase a health plan from the marketplace, the average plan in $460 and it’s a worthwhile expense if you can afford it. If not, then try to negotiate medical bills and use Telehealth options as much as possible because they will be cheaper than in-person clinic appointments. if you need immediate medical attention, go to the emergency room where you cannot be turned away. The Emergency Medical Treatment and Active Labor Act (EMTALA) requires that anyone regardless of insurance coverage has the right to an evaluation in the emergency room.