The losses inflicted by SARS-Cov-2, the novel coronavirus that causes COVID-19, have been staggering. In the U.S., over 555,000 have fallen ill, more than 22,000 have perished, and even our most optimistic models suggest we should steel ourselves for a grim course through at least the end of summer.
In Colorado, prior to Gov. Jared Polis’ implementation of mandatory social distancing measures, we were hurtling toward an unmitigated scenario in which upwards of 33,200 Coloradans could have died from COVID-19.
We gravitate toward these epidemiological numbers as health professionals, yet they do not tell the whole story. Our public health emergency is also an economic emergency.
Accompanying bleak epidemiologic models are bleak economic ones, which estimate that up to 40 million may lose their jobs across the country in the coming weeks.
A record number of Americans have filed for unemployment, including more than 127,000 in Colorado. Since the American health insurance system is largely employer-based, more than 31,000 of the laid-off workers in our state also lost their health insurance.
This creates an additional – and wholly unnecessary – source of economic and health insecurity. In unprecedented times, these Coloradans now must grapple with difficult questions, which lay bare the flaws of our private, employer-based health insurance system.
Where will they turn to manage their chronic medical conditions during this pandemic? Who will foot the bill if they get sick? How will they insure themselves and their families?
Some newly unemployed Coloradans will be lucky enough to join the health care plan of a spouse or family member; others, absent their former income, will be unlucky enough to qualify for Medicaid.
In a crisis – particularly one mediated by the novel coronavirus – Americans need health insurance to protect themselves and their families should they fall ill and need medical care.
Unfortunately, the very pandemic these individuals seek security from has wounded the economy, costing them both their jobs and their health insurance. Now, those who wish to restore some sense of security must regain that health insurance, but doing so is prohibitively expensive without their main source of income. For them, COVID-19 begets a catch-22.
Here are a few numbers that illustrate this impossible bargain. Coloradans seeking recourse through COBRA will be required to pay approximately 80% of the premium that their employer paid previously, effectively increasing their annual contribution to their health insurance five-fold.
The ACA avenue is also costly: the average Coloradan could purchase an Anthem Bronze plan with a $3,872 annual premium, an individual deductible of $8,150 and a family deductible of $16,300.
Some of these costs might be mitigated by unemployment benefits, the $600 a week provided by the federal government’s stimulus package, and a one-time $1,200 stimulus check, but not everyone will be able to access these funds promptly enough due to slow processing at state benefits offices, and many will still find themselves unable to afford coverage.
These Coloradans may be forced to gamble with high-deductible catastrophic care plans (which leave individuals overpaying and underinsured), or otherwise forgo health insurance altogether.
Of course, the risk of being uninsured during a pandemic is also untenable. According to recent modeling by experts in Colorado, even in a situation with effective social distancing, over 100,000 Coloradans could require hospital care for illness related to the novel coronavirus.
Most will walk out of the hospital, although an uninsured survivor might have little reason to celebrate: a hospitalization for COVID-19 has been estimated to cost between $22,000 and $74,000.
This pandemic did not create the issues described, but it continues to magnify them, underscoring the urgent need to uncouple health coverage from employment. Health insurance ought to provide a sense of security – all the more so during a time of new unemployment, or a global pandemic. Employer-based health care fails to do so.
In the short term, people will continue to lose their jobs, their health insurance, and with them, their financial and health security. This is unacceptable in a country whose health expenditures far outstrip those of all others.
Until we as a society recognize the imperative to overhaul our health care system and provide security for our citizens, we need to step up our efforts to protect victims of our current system today.
Some possible short-term remedies include small business loans that incentivize keeping workers on the payroll and insurance, legislation that provides subsidies for COBRA premiums, additional stimulus bills that benefit American workers and their families, or, as some elected officials in Washington have advocated, free COVID-19 care for all.
Such policies may attenuate the damage done to Americans who have already suffered greatly from this pandemic and the economic damage it has wrought.
In the long term, however, no solution short of government-ensured, universal health insurance (such as single payer, Medicare-for-All) will prevent this dilemma in the future. Until we uncouple employment and health insurance coverage, our citizens will remain vulnerable in times of crisis.
In times of pandemic and times of normalcy, we all want our friends, families, and patients to have protection from the unpredictable costs of illness.
As a society our policies should reflect the commitment of the doctors and nurses at the frontlines of the COVID-19 pandemic, who daily fight to protect the health of everyone.
Jordan Rook is a general surgery resident. Alec Feuerbach and Jake Fox are fourth-year medical students about to start residency in emergency medicine and internal medicine, respectively. All three authors are Colorado Springs natives.