The coronavirus pandemic is causing widespread unemployment throughout the world, and many in the US are losing more than their job and income. They are also losing their health insurance at a time when coverage is critical. In the last few weeks, the US has seen unprecedented spikes in joblessness with more than 20 million people applying for unemployment insurance. According to an analysis done by the Economic Policy Institute (EPI), more than 9 million people across the country will also lose their source of health coverage, and at one of the worst times.
A recent EPI post indicated that 337,000 Wisconsinites filed for unemployment from March 21 through April 11, and about 162,000 of them will also lose their employer-sponsored health insurance. If those people made up one city, it would be the third largest city in the state, a city larger than Green Bay. These people are cancer patients, farmers managing their diabetes, construction workers with mental health challenges, as well as comparatively healthy people. All of them are at risk of contracting COVID-19. This is unacceptable in the richest country in the world.
In the United States, health insurance is very often tied to employment. Employers are responsible for negotiating premiums, benefits, deductibles, and copays. As a result, there are vast differences in how much people pay for health insurance, which doctors they can see, and what steps they have to take to receive care. This creates an uneven system and leaves many with inadequate or no health coverage. In the US, about 58 percent of the non-elderly population (under 65) get their health insurance through their employers. This rate is even higher in Wisconsin; about 2 out of 3 of non-elderly Wisconsinites have employer-sponsored health insurance, which is the second-highest reliance on employer coverage in the nation. Tying health insurance to employment makes us particularly vulnerable, especially during public health crises that create wide-spread unemployment.
This patchwork system perpetuates and accentuates deep inequities in who has access to health insurance and affordable health care. Because of long-term, systemic employment and economic discrimination, Black and Brown people have higher rates of unemployment and under-employment than white people and are more likely to have lower paying jobs that do not offer health coverage. For these and other reasons, people of color are far more likely to be uninsured, despite significant gains in coverage through the Affordable Care Act.
Further, there are also deep class and race divides in who has a job that can be done from home, meaning that the burden of job loss in this pandemic is likely to fall inequitably on Black and Brown people and others working lower-wage jobs.
Many people work in jobs that do not provide health insurance. Jobs in sectors such as retail, food service, agriculture, and construction are less likely to offer employer-sponsored coverage. One out of three non-elderly Wisconsinites (under 65) do not get health insurance through their employer. There is an often-confusing hodgepodge of options for people without job-based coverage. Most of these people are covered through government-sponsored insurance like Medicaid (BadgerCare), which covers approximately 1 in 5 state residents. In addition, approximately 6 percent of the non-elderly population have what’s called “non-group coverage,” primarily through the Affordable Care Act Marketplace, and 7% have no health insurance at all.
Just because someone has a job does not mean they have access to an affordable employer sponsored health plan; many workers do not have access to any health insurance through their jobs. Because of this system, the education system, ongoing employment discrimination and other inequities, these uninsured workers are more likely to be Black and Brown people. Even though the ACA has allowed many previously uninsured people to access health insurance, we still have these problems.
The United States should acknowledge and eliminate these vulnerabilities by making fundamental changes to reshape our health insurance landscape so it’s more equitable. We should make sure that everyone, regardless of employment, immigration, race, economic, or marital status has access to affordable, comprehensive health coverage. We must recognize that we are all only as well as those who are most vulnerable. A change of this magnitude will not be easy, and it will not be quick, but it is necessary.
More immediately, Wisconsin should do what it can now to mitigate coverage loss by filling some of the many holes in our patchwork system.
- The state legislature should allow Wisconsin to join the 37 other states and fully expand Medicaid under the Affordable Care Act, which would add an affordable coverage option that would help thousands of people across the state and save millions in state funds.
- Wisconsin should change Medicaid rules so that all people regardless of whether they have children have access to emergency medical services through BadgerCare (often called Emergency Services) and clarify that emergency services covers diagnostic, testing, treatment, and vaccines for coronavirus. Emergency Services is one of the only supports that are available to people regardless of their immigration status, but Wisconsin law only provides this to parents and children.
- Wisconsin elected officials should also call for the Trump administration to issue a nationwide special enrollment period for the ACA Marketplace and increase support for enrollment and outreach efforts.
- The state should pursue an option authorized by Congress in response to the COVID-19 pandemic that allows Medicaid to cover testing for anyone who is uninsured.
What you can do now, if you lost your health coverage?
There are some options for people in Wisconsin who have lost their health insurance coverage, and we have put together a fact sheet to help people understand their options. These options can potentially enable many people to get covered, but they are just bandaging, and do not address the fundamental weaknesses in our system.
Redesigning our health care system with the goal of universal, comprehensive coverage for all people regardless of employment status will make our communities large and small healthier and safer. Making sure that everyone has access to affordable health care – including testing and treatment for infectious diseases – would protect all of us by mitigating the spread of viruses like COVID-19, thus reducing the toll on an already taxed health system.
William Parke-Sutherland
