COVID-19: Exposing the Intrinsic Flaws of Our Healthcare System

Design by Annie Liu

After two months of the US’s delayed response to COVID-19, our country took widespread measures to quarantine starting in March. Non-essential businesses closed down, companies adopted remote structures, and people were strongly encouraged to stay inside in hopes of minimizing the spread of the virus, watching from home as this pandemic swept the world. Amongst many other upsets with our society, jobs became a huge concern as companies were forced to reallocate their resources and determine how employees would be able to work from home. For those who worked in a setting where virtual hours were simply not an option, such as in the dining and retail industries, this became an even bigger problem. As a result, unemployment numbers skyrocketed from 3.8% in February to 13% in May, an increase of roughly 14 million people. Even this is a conservative estimate, due to inaccuracies from COVID-19-related complications. This also does not count those who dropped out of the labor force during this time period, which would account for about 4 million people. Including these statistics, the unemployment rate is closer to 25%.

Amongst many other upsets with our society, jobs became a huge concern as companies were forced to reallocate their resources and determine how employees would be able to work from home.

Unfortunately, those of lower socioeconomic status, or SES, are impacted harder than those of higher SES. As of 2018, 67.3% of people were under private health insurance typically provided by their employer, while only 34.4% were under public health insurance (Berchick et al). Of Americans earning in the top 25% of incomes, nearly 6 out of 10 had the ability to work from home, compared to only 3 out of 10 earning in the lowest 25%. In addition to losing much-needed income, another major concern for employees is health insurance. This includes coverage of the minimum ten essentials marketplace health insurance is required to cover under the Affordable Care Act, or ACA: ambulatory patient services; emergency services; hospitalization; pregnancy, maternity, and newborn care; mental health and substance use disorder services; some prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services; and pediatric services.

Undoubtedly, there are still plenty of problems with health insurance and healthcare expenses that still must be addressed. The system only covers relatively inexpensive and regular costs, which typically excludes surprise medical bills and the bulk of treatment costs for serious medical conditions. Prescription costs have always been an issue, as pharmaceutical companies have consistently found various ways to synthesize new drugs and subsequently charge more. Americans may even have to fight their insurance company for coverage of various hospital, test, or drug bills. As of 2018, 34% of adults on health insurance already found it difficult to pay deductibles, 28% the cost of health insurance, and 24% copays for doctor visits and prescriptions.

So what about the coronavirus? What additional financial impact has it brought to America’s already flawed healthcare system? In addition to losing income and health insurance, cases in the US continue to grow, outpacing every other country. COVID-19 testing and hospitalization costs are no small feat, and due to the immense privatization of health insurance, coverage varies between providers. Fortunately, all comprehensive health insurance plans must cover all general COVID-19 testing costs. Antibody testing costs are also covered, but the reliability of these tests is still questionable. Several companies are waiving in-network copayments and deductibles. Some are also waiving out-of-network costs, which is beneficial for those living in more isolated areas where an in-network healthcare facility may not be readily accessible. But for the uninsured, these costs will be a challenge to cover. Most of them will be charged by the hospital with prices that have no discounts and are usually significantly higher than private insurance reimbursement. Speaking conservatively, costs for uninsured healthcare relief across the country are estimated to range anywhere from $13.9 to $41.8 billion, which would occupy a significant portion of the $175 billion fund Congress set up for COVID relief. More of this money will likely be given to states without Medicaid expansion, throwing into uncertainty the ability to cover other important COVID-related costs, such as medical supplies and healthcare facilities.

Given the ever-growing numbers of unemployed persons in the United States with COVID-19 cases still on the rise, the continual pursuit by the Trump administration of ACA repeal, a bill passed during the Obama administration designed to increase the affordability and accessibility of healthcare, has been widely criticized. If the case is ruled in their favor and the ACA is repealed, this will result in the loss of insurance for 23 million Americans, as well as many provisions the ACA provided, such as the guarantee of essential benefits, various consumer protections, and holding insurers accountable for spending premium money on patient healthcare. Of course, the ACA has its own issues that remain to be addressed. Businesses are still able to find ways around transparency regarding their employees’ insurance plans, and some businesses have cut employees’ working hours in order to prevent covering insurance. As insurance plans have become more comprehensive, so have the costs of premiums, which continually rise, This inevitably makes payment more difficult, especially for those of lower socioeconomic status. And there is a lack of public outreach regarding health insurance. Enrollment day is often a mess. There are no solid education programs established to help people navigate the undoubtedly complicated world of health insurance, leading to poor decisions, the inability to pay, or other problems people simply cannot predict because they do not know enough about how health insurance works, because they are health illiterate. However, completely repealing an act that still provides a significant amount of benefit to those across America and starting from scratch, something the Trump administration is still actively trying to accomplish, would leave millions more uninsured and thus unable to pay the high costs of healthcare. The ACA is especially important during this COVID-19 pandemic for many low-income families, when more people than ever are in need of healthcare and thus insurance coverage. Instead of completely tearing away the shelter the ACA currently provides for many people from the worst financial burdens of healthcare, the federal government should aim for the overarching goal of universal healthcare and take steady measures towards it.

Instead of completely tearing away the shelter the ACA currently provides for many people from the worst financial burdens of healthcare, the federal government should aim for the overarching goal of universal healthcare and take steady measures towards it.

As for those whose healthcare accessibility is directly under attack due to a lack of insurance, some measures have been taken in attempts to alleviate their financial burden. The Coronavirus Aid, Relief, and Economic Security Act, or CARES Act, instilled in April, allocated $175 billion for COVID-19 relief. Of that $175 billion, $10 billion has been allocated to hospitals with over 100 COVID patients, $12 billion for hospitals with less than 100 COVID patients, $10 billion for safety net hospitals, $15 billion for Medicaid providers, $50 billion for Medicare providers, $10 billion for rural communities, $4.9 billion for Skilled Nursing Facilities (SNF), and $500 M for Indian Health Services (IHS), with $62.6 billion unallocated. However, should funding run out, those uninsured may have to cover the medical bills themselves or possibly be delayed in their access to care. Additionally, not all hospitals are participating; some smaller hospitals are still unaware of the program, which entails the costs falling again on uninsured persons. Furthermore, to be eligible for reimbursement, a patient’s primary diagnosis must be COVID-19, meaning patients with COVID-19 but currently being treated for another health issue are illegible. Transparency is another issue; providers are not required to participate, and patients cannot easily learn whether or not a certain provider is participating in the program.

A partial and temporary solution to this problem is to increase enrollment in Medicaid, as patients under Medicaid receive CARES funding and don’t have to worry about whether or not a private provider is participating in the reimbursement program. With unemployment rates rivaling those of the Great Depression Era, states are experiencing elevated rates of Medicaid enrollment and thus costs. Some states have taken measures to facilitate the Medicaid enrollment process, such as adding the ability to enroll online or over the phone, shortening waiting times for application processing, and allocating more resources towards increasing the efficiency in determining eligibility. Of course, still more can be done to further streamline the enrollment process: more hospitals should establish presumptive eligibility programs that instantly enroll patients in Medicaid temporarily until full eligibility is processed; presumptive eligibility facilities should be expanded beyond hospitals to providers such as schools, community-based providers, and state agencies; federally facilitated marketplace enrollment determinations should be adopted which would decrease wait times for documents to be processed; and documentation requirements should be minimized for eligibility by implementing the use of more electronic data systems.

For employees and their families who have lost their jobs in the time of the pandemic or no longer qualify for health insurance from their employer, they are able to apply for temporary COBRA coverage, during which they can stay on their previous workplace insurance, typically for up to 18 months. Some modifications have been made to COBRA in light of the pandemic. The typical election period of 60 days in which employees must choose whether or not to stay on COBRA does not begin until the end of the Outbreak Period, which is defined by 60 days after the end of the declared COVID-19 national emergency; premium payment and grace periods also do not start until the end of the Outbreak Period. Essentially, employees adversely affected by COVID-19 in terms of health insurance have a greater time period to continue on their current workplace health insurance, which may provide additional time needed for soon-to-be uninsured workers to transition to another program such as Medicaid.

As COVID-19 continues to strangle our nation, the various intrinsic flaws embedded in our current health system repeatedly come to light

As COVID-19 continues to strangle our nation, the various intrinsic flaws embedded in our current health system repeatedly come to light. Costs of care remain a massive problem entangled deep in the US’s health industry. This huge influx of uninsured persons amplifies the persistent struggle for people of lower socioeconomic status, who for various reasons are unqualified for adequate health insurance. They face staggering medical bills from hospitals, emergency visits, prescriptions, and various other healthcare-related costs. Enrollment for Medicaid is a long and oftentimes confusing process, with no defined program dedicated to increasing healthcare literacy for those who have trouble navigating the nuances of the healthcare industry on their own. A handful of states still have yet to pass Medicaid expansion, which would significantly increase those eligible for Medicaid. And the Trump administration, aside from continually delaying or altogether striking various aspects of the ACA, is currently pursuing complete repeal of the act, which would cause millions more to lose health insurance in the middle of a health crisis. These problems will most certainly take an overwhelming amount of time to solve, if even possible, but until then, as individuals, our efforts should be directed towards properly quarantining and otherwise observing the necessary measures to minimize the spread of COVID-19, to both ensure our own health and to help those less fortunate who are impacted much harder than the average individual by this pandemic.

Edited by Rohan Ravirala

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