Health insurance again at risk in US

23 million people could lose coverage during pandemic

During a pandemic that has infected more than 2.6 million people and killed more than 126,000 in the U.S., the administration asked the Supreme Court—again—to review the constitutionality of the Affordable Care Act, known as Obamacare.

At 4:30 a.m. last Friday, I turned off the alarm, as I do every morning, and checked Apple News to see what had happened overnight. During a pandemic that has infected more than 2.6 million people and killed more than 126,000 in the U.S., the administration had asked the Supreme Court—again—to review the constitutionality of the Affordable Care Act, known as Obamacare. This is during an ongoing pandemic that already has cost millions of Americans their jobs and self-paid and employer-sponsored insurance.

The brief, submitted by officials in Texas and 17 other states, argues that when the individual mandate was declared unconstitutional, the entire program was invalidated. Texas is one of the worst states in numbers of daily cases of COVID-19.

I believe very strongly that health, like water, is a human right. But even for people who reject that principle, it is bad business and poor economic strategy to deny people health insurance, especially right now. Years of research show that, compared to people with health insurance, people without insurance tend to delay or forgo preventive office visits, delay seeking medical care for conditions that are treatable but potentially fatal when treatment is deferred, and opt not to fill prescriptions for lifesaving medications and/or stretch out doses because they cannot afford refills. This contributes to a cycle of poverty in which vulnerable populations – particularly Blacks and other people of color – become poorer and sicker. Many people without insurance end up in emergency rooms, where their care costs taxpayers more than if they had insurance and could seek care in their communities, with continuity of caregivers and health records.

Accessible, affordable health care during a pandemic

The news about the latest attempt to kill Obamacare prompted me to search for information comparing the response to the pandemic in countries with universal health care and other variants to countries without such insurance. Many media have included stories about Americans who did not seek care because they were worried about paying the bills. Even with Obamacare for millions, but still not everyone, deductibles and co-insurance can be significant barriers. The Commonwealth Fund concluded,

Responding effectively to COVID-19 requires that patients are able to access and afford health care services. About 30 million people are uninsured in the U.S., while another 44 million are underinsured because of high deductibles and out-of-pocket costs. A new poll by NBC News and the Commonwealth Fund found that more than two-thirds of U.S. adults say that their potential out-of-pocket costs would figure prominently in their decision to get care if they had coronavirus symptoms.

Consequently, U.S. patients are more likely to forgo medical treatments than those in other countries tracked by the Fund.

Galvani and colleagues argued that the pandemic has exacerbated all the fault lines in the U.S. healthcare system; e.g.,  dependence on employer-sponsored insurance when millions of jobs have been lost, and high deductibles and co-insurance and costs for ICU stays that will bankrupt many patients. Moreover, the pandemic has sharpened health inequities among Black people and other people of color, who have been harder hit by COVID-19. The authors concluded that universal health care is the path to dealing with medical control of this pandemic and future ones. In general, countries with universal health insurance have fared better in the pandemic, but that likely is partly due to their also having centralized planning and implementation, the lack of which has hampered U.S. efforts substantially (see the Council on Foreign Relations backgrounder, “Comparing Six Health-Care Systems in a Pandemic”).
Barbara