(CNN)The coronavirus outbreak is now burning primarily through states with the highest share of uninsured residents, complicating the local response and amplifying the political debate over the future of the Affordable Care Act.
2018 vs. 2020
How they’re campaigning
Challenges for non-expansion states
- The states with the largest share of uninsured also tend to be among those where the highest share of the population suffers from underlying health problems, such as heart disease, diabetes and obesity, that put them at elevated risk of serious health consequences if they contract coronavirus, according to a recent Kaiser analysis. And, according to an Urban Institute analysis for me of 2018 census data, African Americans and Hispanics — two groups suffering disproportionately in the outbreak — are far more likely than Whites to be uninsured in those same states. In Texas, for instance, Blacks are about 50% more likely than Whites to lack health insurance, and Hispanics are almost three times as likely. In Florida, Blacks are about 40%, and Hispanics about 75%, more likely than Whites to be uninsured.
- People without health insurance tend to put off seeking care until it is absolutely unavoidable, experts note. That could make them more reluctant to pursue testing for coronavirus at the first indication of symptoms — extending the time they are circulating the disease in the community. Many of the uninsured “won’t go get care because they assume they’re not going to get it,” says Vivian Ho, a health care economist at Rice University and the Baylor College School of Medicine in Texas. “I have no doubt that’s a good portion of why the disease is spreading here.”
- More uninsured receiving coronavirus care increases the financial strain on hospitals, already reeling from the severe decline in revenue for other services as potential patients avoid seeking medical care during the outbreak. The federal government has allocated a substantial $175 billion to support medical providers during the crisis, with about half of that earmarked for hospitals; but as the number of coronavirus patients without health insurance mounts, “that’s going to increase the financial stress,” says Rick Pollack, president and CEO of the American Hospital Association. “At the rate we’re going, none of this relief is going to make anybody whole.” The administration has promised to reimburse providers for treating the uninsured out of the relief money. On Friday, the Department of Health and Human Services said that it’s paid $340 million so far to hospitals that have submitted claims for treating the uninsured. HHS said it’s less than it had expected but that hospitals can continue to submit claims.
- These financial strains could increase the risk that more hospitals will close, especially in states where the decision not to expand Medicaid has already placed smaller and rural hospitals at risk. “The public health crisis, combined with the economic crisis, has put many health care providers, especially in states that have not expanded Medicaid, at greater financial risk,” says Levitt, of the Kaiser Family Foundation.
- With studies suggesting that lingering health problems afflict a significant portion of coronavirus victims who survive the disease, experts worry that many of the uninsured lack the regular source of care required for follow-up treatment.
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