With the rise of COVID-19 cases in the United States, issues related to access to testing and treatment for the uninsured have taken on greater prominence. Efforts to limit the spread of coronavirus in the United States depend on people who may have been exposed to the virus or who are ill getting tested and seeking medical treatment. however, people without insurance are likely to face significant barriers to getting tested for covid-19 and any care they may need should they contract the virus.
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in 2018, there were nearly 28 million non-elderly people in the united states who lacked health insurance. states that have not expanded medicaid under the aca generally have higher rates of uninsured than the states that did. adults, low-income people, and people of color are at higher risk of being uninsured. Most of the uninsured lack coverage due to high cost or because of a recent change in their situation that led to a loss of coverage, such as losing a job. Although most people without insurance have a full-time worker (72%) or a part-time worker (11%) in their family, many people do not have access to coverage through a job, and some people, particularly poor adults in states that had no coverage. expand medicaid, continue to be ineligible for financial assistance for coverage.
many uninsured adults have jobs that may increase their risk of exposure to covid-19. most uninsured adults are working. Due to the jobs they hold, uninsured workers may be at higher risk of exposure to the disease. among the top ten occupations reported by the uninsured, many are service-oriented, such as drivers, cashiers, restaurant servers and cooks, and retail sales that cannot be done through telecommuting and put the uninsured in regular contact with the public (figure 1). Additionally, data analysis finds that nearly six million adults who are at increased risk of serious illness if infected with coronavirus are uninsured.
Uninsured workers who must take time off work because they or their family members are sick could face significant financial consequences. ee. uu. It does not have a federal law guaranteeing paid sick leave, and currently only 11 states and DC require paid sick leave. the burden of a lack of paid sick leave falls more heavily on low-paid, uninsured workers. in 2018, just over a quarter (26%) of uninsured workers said they had paid sick leave. Facing the risk of not being paid or possibly losing their position if they don’t show up for work, uninsured workers who don’t receive sick leave may be reluctant to take time off, which could put their health at risk and undermine efforts to control the spread of the coronavirus.
Congress enacted legislation that would require certain employers to provide paid sick leave during this public health crisis; however, this new policy will not reach all uninsured workers. Under the emergency paid sick leave provisions in the Families First Coronavirus Response Act, workers at all public agencies, as well As in some private companies with between 50 and 500 employees, they must receive compensation of at least a part of their regular salary for 14 days if they take time off to attend to their health needs or those of their relatives or to take care of children. children due to school closures. If workers need more than 14 days off to care for children due to school closures, they can get up to 2/3 of their typical compensation for up to three months, but this policy does not extend to all workers and excludes employees in companies with more than 500 employees. These new leave policies take effect two weeks after the legislation is enacted and benefits are not retroactive, meaning uninsured workers who already took leave due to the coronavirus would not be compensated for that time.
barriers to covid-19 testing and treatment
The uninsured will likely face unique barriers to accessing covid-19 testing and treatment services. More than half of the uninsured do not have a regular place to go when need medical care, and one in five uninsured adults in 2018 did not receive necessary medical care due to cost (Figure 2). Studies repeatedly show that the uninsured are less likely than those with insurance to receive services for major health conditions and chronic illnesses. Without a regular source of care, uninsured people may not know where to go to get tested if they think they have been exposed to the virus and may forgo testing or care for fear of having to pay out of pocket for the test. Test. Hospitals are required by the Emergency Medical Treatment and Labor Act to evaluate and stabilize patients with emergent conditions, however, they are not required to provide care at no cost to patients who cannot pay, and are not required to provide treatment for non-emergent conditions. As a result, people without insurance are less likely to visit the emergency department than people with insurance, and the high costs of ed care may deter people without coverage from seeking care in that setting.
Uninsured people who contract covid-19 and need medical attention will likely receive large medical bills, even if they have low incomes and cannot pay. When uninsured people need medical care, the costs can be prohibitive. Uninsured people pay the full cost of care, often at higher rates than those with insurance whose coverage can negotiate rates lower than those charged by a hospital. Although some uninsured people may obtain care from community health centers and other safety net providers, these providers have limited resources and capacity, and not all of the uninsured have geographic access to a safety net provider. because the usa lacks a comprehensive hospital charity care policy, uninsured individuals using hospital care will be billed for services. uninsured people who meet certain criteria may qualify for a hospital’s charity care program to reduce hospital bills; however, not all hospitals are required to offer charity care programs, and among those that do, eligibility criteria can vary widely. Fear of high and unaffordable medical bills can deter uninsured people from getting the care they need. In the context of a public health emergency, decisions to forgo care due to cost can have devastating consequences.
options to reduce barriers to covid-19 testing and treatment
Federal legislation enacted in response to the coronavirus crisis guarantees free testing for people without health insurance. The Families First Coronavirus Response Act, signed into law on March 18, 2020, includes a provision that gives states the option to expand Medicaid coverage to uninsured people in their state to provide coverage for COVID-19 diagnosis and testing with 100% federal funding. Although the coverage is limited to testing services, it will ensure that more people without insurance can access free testing, as the legislation also requires state Medicaid programs to cover COVID-19 diagnosis and testing without cost-sharing. The legislation also allocates $1 billion to the national disaster medical system to reimburse providers for costs associated with diagnosing and testing the uninsured. however, the legislation does not address coverage of covid-19 treatment costs for people who do not have insurance.
While federal legislation will lower barriers to testing for COVID-19, additional steps will be required to lower barriers to accessing treatment for uninsured people who get sick. expand options of comprehensive coverage for the uninsured would facilitate access to covid-19 treatment for those who need it. Decisions by states that have not yet adopted expanding Medicaid to do so would provide eligibility for coverage to the 2.3 million uninsured non-elderly adults in the coverage gap. In addition to adopting Medicaid expansion, the federal government could provide flexibility to states to use the Section 1115 and/or Section 1135 Medicaid waiver authorization to cover individuals who would not otherwise be eligible for coverage. during the public health crisis and potentially beyond. these exemptions have been used in previous emergencies to expand coverage. Additionally, states that operate their own health insurance marketplaces could provide a special enrollment period (September) in response to the coronavirus outbreak to allow the uninsured to enroll in coverage. Washington, Massachusetts and Maryland recently announced coronavirus-related separations for uninsured residents. The federal government could also establish a national special enrollment period that would apply to all states, allowing many more uninsured people to sign up for coverage.
Instead of expanding coverage, providing funds to providers to expand covid-19 services to the uninsured or to reimburse them for uncompensated costs they incur could also make it easier to access needed care. Supplemental appropriations legislation to fund the coronavirus response included $100 million for community health centers to support increased access to testing and primary care services in medically underserved areas. however, this funding does not address hospital costs for treating infected people. Congress could allocate additional funds to cover hospital costs related to treating uninsured people who contract the disease and need hospital care. Programs such as the National Disaster Medical System (NDMS) or Hospital Disproportionate Share (DSH) program could be used to reimburse hospitals for uncompensated costs; however, additional funding would be needed to cover covid-19 related treatment costs. Democratic presidential candidate joe biden has proposed using the ndms by expanding its authority to reimburse providers for the costs of testing, treatment, and vaccines associated with covid-19 for the uninsured and by fully funding those costs.