COVID-19 and the US health care system

I mentioned in my introduction a sense of collective good and pride in Canada. This is real when we talk about COVID-19, at least in one powerful sense: nobody in Canada has to worry about paying their test, medical bills and hospitalization if they become sick with the virus. That is not the case south of the border.

Before the COVID-19 pandemic, 27.5 million Americans had no health insurance, but now, many more are at risk of losing their current coverage plans as businesses lay off workers because of COVID-19 physical distancing. States, advocacy organizations and health care professionals are taking steps to ensure that the uninsured can still get testing and treatment, but that hasn’t dissipated the confusion. If there are people who are not getting the screening, testing and treatment because of fear of a bill, that not only endangers themselves but also spreads the virus. In addition to U.S. citizens who lack health insurance coverage, there are also millions of undocumented immigrants who are not eligible. Another 2 million people who live in the 14 states that did not expand Medicaid under the Affordable Care Act also fall into a coverage gap. They are not eligible for Medicaid, but are also ineligible for federal subsidies that make health insurance affordable through the national exchange. In the words of an expert, “A crisis like this, where everyone is at risk and everyone can be affected, highlights the gaps in our health care system in a way that we don’t often see.”

The cost of a test for an uninsured patient could be close to $500 at a doctor’s office, while one at a hospital would likely be at least $1,000. The cost of care if one were to test positive, varies depending on a person’s insurance and its various cost-sharing components. Most insurance plans have deductibles that could be around $1,500 to $2,000. Many plans also have coinsurance charges of roughly 15% to 20%. Individuals who don’t require hospitalization will likely incur relatively small out-of-pocket costs, but patients who do require hospitalization could expect a hefty bill. This could be between $75,000 and $100,000 for 10 days, including hospital stay, drugs and treatments. While insurance – for those who have it – would cover some of that, it almost certainly wouldn’t cover the full price tag.

An independent journalist without health insurance says: “I haven’t gone to the doctor since 2013… Like 27.5 million other Americans, I don’t have health insurance. It’s not for a lack of trying – I make too much to qualify for Medicaid, but not enough to buy a private health insurance plan on the Affordable Care Act exchanges. Since I can’t afford to see a doctor, my healthcare strategy as a 32-year-old uninsured American has been simply to sleep eight hours, eat vegetables, and get daily exercise… When you multiply my situation by 27.5 million, you end up with a country full of people who won’t see a doctor unless they’re extremely sick. And when you combine a for-profit healthcare system – in which only those wealthy enough to get care actually receive it – with a global pandemic, the only outcome will be unmitigated disaster.”