More than 18 million people who were most at risk of experiencing severe outcomes from COVID-19 at the start of the outbreak had the least access to healthcare because they were either uninsured or underinsured, according to a new study.
Researchers found some of the most vulnerable populations—including African Americans, Native Americans, lower-income individuals, those residing in rural areas and in states that have not expanded Medicaid—were both more likely to be at high risk of severe COVID-19 illness and lack adequate healthcare coverage to get care if they did get sick, according the study, published Wednesday in the Journal of General Internal Medicine.
African Americans were 42% and Native Americans 90% more likely to be at risk for severe COVID-19 compared to whites. High-risk persons from those racial groups were 51% and 53% more likely to have inadequate healthcare coverage compared to whites at high risk. Hispanics at high medical risk were more than twice as likely as whites to have inadequate coverage.
Researchers say the findings point to a critical need for policymakers to provide more robust support for testing and treating COVID-19 as rising unemployment causes more people to lose their insurance and states seek to re-open businesses, increasing the risk for more cases.
"In a way lower-income people and racial minorities are in double jeopardy because of the way our healthcare system is financed," said lead study author Dr. Adam Gaffney, a pulmonary specialist at the Cambridge Health Alliance in Boston. "
Gaffney said being uninsured or underinsured meant it was more likely those who got sick would delay seeking treatment because of cost concerns. Results of a Gallup survey released last December found a quarter of those polled reported they or a family member had postponed treatment for a serious medical condition over the past year because of the cost. That percentage increased from 19% in 2018.
Since the start of the outbreak lawmakers have taken a number of actions to provide funding to help cover the costs related to getting tested and treated for COVID-19. Such measures have provided hospitals with nearly $300 billion in relief aid to reimburse providers for expenses and lost revenues incurred during the pandemic.
Passage of the Families First Coronavirus Response Act in March mandated that insurers cover costs related to COVID-19 testing with no out-of-pockets expenses to consumers. The cost of treatment for COVID-19 has no such cost-sharing protections.
Most healthcare insurers have offered to waive copays and deductibles for the treatment of COVID-19. But a report released last month by the patient advocacy organization Public Citizen found at least 15 of the 23 fee waivers being offered are set to expire by July 1.
That report found only two of the 25 largest insurers offering fee waivers offer to cover costs for both in-network and out-of-network care. Up to 60% of people in private insurance plans may not be eligible for fee waivers at all since they exclude those in self-insured plans unless an employer underwrites for those plans to opt-in for that coverage.
Gaffney said more support was needed to address the rising level of need. An estimated 36 million people have lost their jobs since the beginning of the outbreak with as many as 25 million expected to lose their employer-based health insurance as a result.
"The protection is inadequate," Gaffney said. "I think we need to take further steps as this epidemic continues to ensure full coverage not just for COVID testing but for COVID treatment as well."