Those at increased risk of severe COVID-19 uninsured or underinsured, study finds

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Even before soaring unemployment caused millions of Americans to lose their health insurance, 18.2 million individuals at increased risk of severe novel coronavirus (COVID-19) were either uninsured or underinsured, according to a new study by researchers at Harvard Medical School and City University of New York’s Hunter College published today in the Journal of General Internal Medicine.

Researchers determined who was at risk of severe COVID-19 based on age and medical risk factors such as diabetes. They found that African Americans, Native Americans, lower-income individuals of all races and ethnicities, and those residing in rural areas or in states that had not expanded Medicaid were doubly disadvantaged, they were both more likely to be at high risk of severe COVID-19 and to lack adequate coverage. 

According to the study, compared to non-Hispanic whites, African Americans were 42 percent and Native Americans 90 percent more likely to be at risk for severe COVID-19, and high-risk persons from those racial groups were 51 percent and 53 percent more likely to have inadequate coverage compared to high-risk whites. Persons in states that failed to expand Medicaid were 6 percent more likely to be high risk, and 52 percent more likely to have inadequate coverage compared to those in states that accepted the Affordable Care Act’s Medicaid expansion. Hispanics at high medical risk were more than twice as likely as non-Hispanic whites to have inadequate coverage.

"The pandemic is laying bare the lethal inequality of American society and American health care," said Adam Gaffney, MD, MPH, lead author and a pulmonary and critical care physician at the Cambridge Health Alliance and Harvard Medical School in a statement. "Our [intensive care unit] has been flooded with poor and minority patients. Having COVID-19 is scary enough without worrying that you'll be bankrupted by medical bills.”

Despite recent federal actions to help fund COVID-19 care, and some insurers' promises to upgrade coverage for the disease, many American still lack protection from COVID-19's costs, the researchers said. The Families First Coronavirus Response Act mandated full coverage for COVID-19 testing, but not for treatment, and the Coronavirus Aid, Relief, and Economic Security (CARES) Act provided some funding for hospitals treating uninsured patients, but the protection is far from adequate.

While some private insurers have promised to waive copays and deductibles for treatment as well as testing, this promise doesn't apply to out-of-network care, or to the majority of privately-insured workers whose employers are self-insured. Moreover, most of these waivers will expire by July 1. A Gallup poll found that many remain fearful of treatment costs, with 14 percent of Americans saying they would avoid care because of costs even if they develop symptoms of COVID-19.

"These promises of new protections for patients with COVID-19 are full of holes," said Danny McCormick, MD, senior author and a primary care physician and associate professor at Harvard Medical School. "COVID-19 threatens the health of people everywhere, but only in the U.S. will it also ruin patients financially. When people avoid testing and care because they fear the costs, it fuels the epidemic's spread.”

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