Life after COVID – desperate times, desperate measures

Things that are keeping me awake at night (besides the normal problems associated with being a 61 year old guy)

The number of people without health insurance will increase – a lot, driven by:

• 10 million have lost their jobs – as of last week – and those lucky enough to have good health insurance will be hard-pressed to pay health insurance premiums much less deductibles and copays.  This from the Economic Policy Institute, “EPHI” is Employer provided health insurance”; link to interactive site is here
  
• Many service workers don’t have employer-sponsored health insurance; some might qualify for Medicaid after a layoff unless they stay working part time or have other income. For those who live in the 17 states that haven’t expanded Medicaid, it’s even harder to qualify.
• The Trump Administration is refusing to open the Federal Insurance Exchange to allow people without health insurance to sign up – but pretty much every state-run exchange has already done this.
• The Trump Administration is still trying to overturn the ACA, which would kill Medicaid expansion, eliminate the requirement that insurers cover young adults (between 18 and 26) on their parents’ insurance plans, and allow insurers to discriminate and upcharge people with pre-existing medical conditions.
• more on this issue here.

Note – in yesterday’s press conference, President Trump did make some vague comments about possibly using Medicare and/or Medicaid to pay for COVID treatment. Here’s the quote:

“I’m not committing,” said Trump. “I have to get approval. I’ve got a thing called Congress. It’s something to look at and we have been looking. “

This would require a massive change to Medicare and/or Medicaid laws, followed by an equally massive change in lots of regulations, followed by…who knows what.  Reality is, there are way better ways to address this.

Back to the growth in the uninsured and implications for COVID:

• some/many will not get tested for COVID as they can’t afford treatment and are terrified of debt.  Some of these folks will continue to work because they have to, which increases the likelihood they’ll spread the disease.
• hospitals and other healthcare providers – which are already struggling financially because they aren’t doing profitable surgeries for privately insured patients – are going to be delivering a lot of care to people who can’t pay for it.

Net – fewer people with decent health insurance will mean more people will get infected, and the healthcare delivery system is going to have serious financial problems.

A modest proposal.

Here’s a fix.  The federal government makes COVID testing and treatment a federal benefit for all residents (yes undocumented people too) and reimburses providers at Medicare rates.

This would:

a) alleviate the huge financial pressure on hospitals, EMS, and all healthcare providers;

b) increase the number of people tested; and

c) get us back on track sooner than if we do nothing.