New twists with job-related health coverage for unemployed and vulnerable

covidclosedstore-300x200Wall Street investors may be seeing their portfolios flush again. But the Covid-19 pandemic has left tens of millions of Americans jobless. And if the once-flourishing health care business has not snapped back into rosy condition as it so often has in difficult times, the battle of the last decade over health insurance will haunt patients and employers throughout the coronavirus infection.

The New York Times reported that record-setting, sudden unemployment has exposed the perils to workers of their reliance on health insurance they get via their jobs:

“While hospitals and doctors across the country say many patients are still shunning their services out of fear of contagion — especially with new [Covid-19] cases spiking — Americans who lost their jobs or have a significant drop in income during the pandemic are now citing costs as the overriding reason they do not seek the health care they need. ‘We are seeing the financial pressure hit,’ said Dr. Bijoy Telivala, a cancer specialist in Jacksonville, Fla. ‘This is a real worry,’ he added, explaining that people are weighing putting food on the table against their need for care. ‘You don’t want a 5-year-old going hungry.

“Among those delaying care, he said, was a patient with metastatic cancer who was laid off while undergoing chemotherapy. He plans to stop treatments while he sorts out what to do when his health insurance coverage ends in a month. The twin risks in this crisis — potential infection and the cost of medical care — have become daunting realities for the millions of workers who were furloughed, laid off or caught in the economic downturn. It echoes the scenarios that played out after the 2008 recession, when millions of Americans were unemployed and unable to afford even routine visits to the doctor for themselves or their children.”

The 2020 jobless catastrophe differs from ’08 in an important way — the existence of the Affordable Care Act, aka Obamacare. It gives those who were laid off new options beyond the pricey extension of insurance under the Consolidated Omnibus Budget Reconciliation Act. With COBRA, the jobless can keep their employer-provided health insurance — if they pay an administrative fee, their share, and their employer’s cost of a plan. Few folks realize how costly health insurance can be without the employer contribution, which can be 80% of the cost.

The newly jobless, under the ACA, may seek and find coverage on public exchanges, including with federal assistance for their insurance costs, depending on their income. They may find insurance too costly still, however.

Because Obamacare also expanded Medicaid in three-quarters of the states, those who have hit the program’s lower-income benefits may find they now qualify in joblessness for the health coverage for the poor. This option won’t work for the unemployed in the 14 states that failed to expand Medicaid under the ACA.

Too many workers also have misread their economic situations, thinking their coronavirus-related layoffs would be short and they would be summoned back to their previous jobs before they needed to jump into COBRA, Medicaid, or ACA coverage, the New York Times reported.

“The inability to afford care is ‘going to be a bigger and bigger issue moving forward,’ said Chas Roades, the co-founder of Gist Healthcare, which advises hospitals and doctors. Hospital executives say their patient volumes will remain at about 20% lower than before the pandemic. ‘It’s going to be a jerky start back,’ said Dr. Gary LeRoy, a physician in Dayton, Ohio, who is the president of the American Academy of Family Physicians. While some of his patients have returned, others are staying away … the consequences of these delays can be troubling. In a recent analysis of the sharp decline in emergency room visits during the pandemic, officials from the Centers for Disease Control and Prevention said there were worrisome signs that people who had heart attacks waited until their conditions worsened before going to the hospital. Without income, many people feel they have no choice.”

The newspaper quoted many different patients, discussing their quandaries in affording and delaying treatments and prescription drugs due to lost health coverage and hefty worries about costs.

Stat, the science and medical news site, reported that doctors worry grows by the day about the major damage that postponed care will cause, notably with cancer cases:

“Ned Sharpless is worried. The director of the National Cancer Institute believes the Covid-19 pandemic is posing a danger to cancer patients across a wide spectrum of care and research. People — and their health care providers — are postponing screening measures like mammograms and colonoscopies. Fewer cancers are being diagnosed, and treatment regimens are being stretched out into less frequent encounters. Clinical trials have seen patient enrollment plummet. An NCI model looking just at breast cancer and colorectal cancer predicts there will be 10,000 excess deaths in the U.S. over the next 10 years because of pandemic-related delays in diagnosing and treating these tumors. That’s about a 1% increase over the number of expected deaths during that time span, with most of the rise coming in the next two years. And that assumes cancer care depressed by the coronavirus rebounds after six months.

“‘We think that [mortality] estimate we provided is very conservative and likely to grow if we continue to postpone screening treatment and other cancer care,’ Sharpless told Stat. ‘We’re very worried about the consequences of … delaying therapy on our patients.’”

Other health experts have different concerns on how health insurance worries affect patients and their behaviors, the New York Times reported in yet another story. Sarah Kliff, a seasoned medical writer, reported in the newspaper’s data- and evidence-based “Upshot” column that sick and vulnerable workers may be among the first to report back to work if they have retained their jobs during public health shut-downs. That’s because they know their health coverage depends on their work.

Kliff talked to a breast cancer patient who recently underwent chemotherapy and has big doubts still about how her weakened immune system will protect her from Covid-19 risks at the job to which she raced back. She told Kliff:

“‘I just got over chemo. Now is not the time for me to lose my insurance.’ So, despite her reservations, she returned to work. She wears a mask and makes sure customers sit a good distance away at an L-shaped desk. ‘It’s a scary thing to go back and know you have low immunity,’ she said in mid-May, after two days back at her job. ‘But when it all boils down to it, I don’t think Covid-19 is going away any time soon. I don’t think you can hide from it. You’ve got to trust God and go back.’”

Her experience, the New York Times reported, “illustrates how America’s employment-based health insurance system could become another liability in the country’s fight to contain coronavirus. It could push workers at highest risk of serious illness from coronavirus back to work the fastest. Those people need coverage to treat the pre-existing conditions that make them vulnerable in the first place.

“About one-quarter of American workers — 37.7 million people in total — are estimated to be at high risk of serious illness from coronavirus, according to a Kaiser Family Foundation study … Some are at increased risk because of age, and some have health problems like diabetes or asthma that the Centers for Disease Control and Prevention has identified as risk factors. ‘It is one of the many ways the U.S. health care system has made us so much more vulnerable to the effects of the pandemic than other countries,’ said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation and a co-author of the new study. ‘In other countries, you don’t hear about people losing health insurance when they lose their jobs.’”

In my practice, I see not only the harms that patients suffer while seeking medical care, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing cost, uncertainty, and complexity of therapies and prescription drugs, too many of which turn out to be dangerous drugs.

The Covid-19 pandemic has driven home for Americans how we all are way too vulnerable to sudden, major, and costly sickness or injury that not only can debilitate but bankrupt us. The U.S. health care system — on which this nation spends $3.7 trillion annually, while seeing some of the worst outcomes among western industrialized nations — needs many fixes, not the least of which is ensuring health insurance coverage for as many of us as is possible. Health care is a right, not a privilege. Health coverage is not the A-Z in making medical services more accessible and affordable for Americans.

But the coronavirus has underscored how so many health matters are shared concerns. If we all act with reciprocal altruism — getting more of us covered with insurance, and, with the virus, wearing face coverings, washing our hands, maintaining distance, and more — we collectively can prevent or ease the crushing calamities for individuals, whether financial or due to illness or injury.

By pooling knowledge, expertise, and capacities, doctors and medical scientists well may find a vaccine to reduce the coronavirus’ scourge. This global effort already is showing progress in treating the infection with drugs (remdesivir and the common steroid dexamethasone).

Politicians — like President Trump — who keep storming off on their own, however, aren’t benefiting us all. While health care workers and others keep crying out for significantly more Covid-19 testing, tracing, and medical supplies, especially personal protective equipment, hospitals and public health officials say the U.S. now has stockpiled tens of millions of anti-malarial pills with little use. The president and his minions promoted these drugs, with no evidence for their effectiveness. Studies, instead, have shown they can harm patients, while offering little help to them with the coronavirus.

Trump and his men, of course, have simply turned away from the disease that has infected more than 2 million and killed at least 120,000. Republicans, meantime, if asked, are happy to explain that, yes, they still want to kill the ACA and have no substitute, so what if millions of Americans, in the midst of a pandemic, lack health insurance?

We’ve got a lot to remember and to fix with our politics and our health care. The 2020 elections may not come soon enough for too many voters to have their say.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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