Cost of COVID-19 makes closing the coverage gap more important than ever

By Richard Rosen, MD and Peg O’Connell, JD
 
A recent analysis from the Kaiser Family Foundation estimates that the average cost of COVID-19 treatment for someone with employer insurance—and without complications—would be about $9,763. Someone whose treatment has complications may see bills about double that: $20,292. For a person that is uninsured, the cost of surviving this disease could lead to financial ruin.  In North Carolina the most likely people who find themselves uninsured are the working poor, those who don’t qualify for Medicaid and make too little to get a subsidy on the federal health insurance exchange.  These are the exact same people who have been laid off, furloughed or shut down during this COVID-19 stay at home emergency—restaurant workers, retail workers and small business owners.
 
So how does COVID – 19 change the need to close North Carolina’s insurance coverage gap?
 
Before COVID – 19 there were compelling reasons for NC to join 37 other states and close our coverage gap and expand Medicaid.  400,000 people would gain health insurance.  In states that expanded Medicaid, many measures, including greater access to care, improved control of chronic conditions like diabetes and hypertension, and reduced infant mortality have been reported, compared to states that didn’t expand.  Insurance premiums average 11% less in states that have expanded Medicaid, as there is less cost shifting when there are fewer uninsured.  George Washington University, in a study sponsored by Cone Health Foundation and Kate B. Reynolds Charitable Trust showed improved health outcomes and creation of 37,000 jobs over the next 3 years if NC expanded Medicaid.
 
The COVID – 19 pandemic is adding stress to both health and economic aspects of life in North Carolina.   We are seeing huge increases of new unemployment claims and a daily uptick in positive test results.  Regulations, such as the shutting down of elective procedures and surgeries will deprive hospitals of a dependable source of income.  The edict that tests for COVID 19 are free for patients translates to greater unreimbursed expense for providers.  Donning protective equipment takes time, and if there are many patients in isolation, more caregiver hours will be necessary.  Overcoming supply shortages in protective personnel equipment and ventilators will be costly.  Stress from families cooped up at home is manifested by increase calls to law enforcement for domestic violence, and Medicaid Expansion would provide needed mental health care.  Many North Carolina hospitals, particularly in rural areas, were in a precarious financial way before COVID – 19, and the pandemic increases their vulnerability.
 
There is speculation that the federal share of expanding Medicaid, currently 90%, might climb to 100% for the next 3 years.  Whether the state share is 0 or 10%, it is now imperative that North Carolina stop sending our tax dollars to Washington, from whence it gets distributed to 37 other states.  COVID - 19 makes the important step of closing the health insurance coverage gap a health and economic emergency.
 
 
Richard Rosen has lived in Greensboro, NC since 1966, practicing in internal medicine in private practice for more than 30 years, followed by several years on part time faculty teaching interns and residents at Cone Hospital as a Clinical Professor of Medicine at University of North Carolina.  He has been active in organizations to reduce damage from tobacco and to close the coverage gap in insurance coverage. 
 
Peg O’Connell is a frequent panelist on NC Spin and a long-time public health advocate.