This research and analysis is part of our Discourse series. Discourse is a collaboration between The Appeal, The Justice Collaborative Institute, and Data For Progress. Its mission is to provide expert commentary and rigorous, pragmatic research especially for public officials, reporters, advocates, and scholars. The Appeal and The Justice Collaborative Institute are editorially independent projects of The Justice Collaborative.
Danni Askini was between jobs, and among the tens of millions of Americans without health insurance, when in February she experienced chest pain, shortness of breath, and a migraine. Askini has lymphoma, and her doctor thought the symptoms could be side effects from a new medication, according to TIME. Her doctor instructed Askini to visit an Emergency Room, and after several visits over the course of a week, she ended up testing positive for COVID-19. Her total bill for testing and treatment: $34,927.43. And because of the orders to stay home, Askini’s new job, and the health insurance it would bring, are on hold. She remains on the hook for the entire bill.
Even people who have insurance are often denied affordable care.
Andrew Cencini, a computer science professor at Bennington College in Vermont, earns about $54,000 per year and has health insurance through the college, according to The New York Times. In early March, he had a fever and trouble breathing, and, after a flu test came back negative, doctors sent him to an emergency room for newly-available coronavirus testing. Cencini tested negative, but he owed nearly $2,000 out of pocket. His test was apparently free — free testing is now provided for under federal law — but he was billed separately for his ER visit and for seeing a doctor, showing how each discrete step in care can be another line item on a medical bill, and how copays, deductibles, and “out-of-network” service fees can create enormous, unexpected costs.
“I was under the assumption that all that would be covered,” Cencini said. “I could have chosen not to do all this, and put countless others at risk… But I was trying to do the right thing.”
These two examples demonstrate why inadequate coverage and employer-based insurance are antithetical to the mitigation of epidemics. To reduce transmission, slow the epidemic, and start the path toward economic recovery, we must provide testing and comprehensive care to anyone who needs it.
Gaps in care are cracks in our national defense against the pandemic. They elevate the risk to everyone and prolong the crisis. And COVID-19 has put the cracks in America’s healthcare system under a microscope. Instead of a system designed to promote the public health, we see a system that imposes unpredictable costs while excluding millions of people, including many of the essential workers on whom we depend to meet our basic needs — the cashiers, drivers, delivery people, and cooks who ensure that, even during a pandemic, we have access to food and medicine and cleaning supplies. Although these workers face life-threatening risks to keep society functioning, the government has thus far shirked the financial responsibility of their treatment should they contract COVID-19.
While most politicians do not support government-funded healthcare, their constituents do. A new national poll of over 1,700 likely voters from The Justice Collaborative Institute and Data for Progress shows that, regardless of party affiliation, the majority of American voters believe that the federal government should take responsibility for covering our healthcare. Nearly 70 percent of voters, including 58 percent of Republicans, support “a crisis care plan that ma[kes] the federal government responsible for paying all health care costs for as long as the United States remains under a state of emergency.”
The public realizes that government-funded healthcare during this outbreak will not only save lives, it will help to reopen the economy and fairly compensate those who have lost insurance as a result of government-ordered shutdowns. Even people who generally oppose a single-payer healthcare system support aggressive government intervention to beat back COVID-19 and ensure that people are made whole for whatever losses they’ve suffered during this crisis. “You can look at it as socialized medicine,” Florida Rep. Ted Yoho, who has vocally opposed the Affordable Care Act, told HuffPost. “But in the face of an outbreak, a pandemic, what [are] your options?”
The new polling coincides with a new bill, the Health Care Emergency Guarantee Act, that Senator Bernie Sanders and Representative Pramila Jayapal introduced on April 10. The emergency legislation would empower Medicare to cover all healthcare costs for the uninsured and all out-of-pocket expenses for those with insurance, including prescription drug costs, for the duration of the coronavirus crisis. It would remain in effect until a vaccine for COVID-19 is available.
“During this unprecedented crisis, no one in America should delay seeking medical care because of the cost,” Sanders said in a statement. “If this pandemic has taught us anything, it is that we are only as safe as the least-insured among us.”
Other proposed legislation would continue to chip away at our system’s shortcomings. A proposal to fund health insurance under COBRA, for example, would provide some relief to people who lose employer-sponsored coverage, but still leave them subject to the deductibles, co-pays, and out-of-networks costs that can put affordable care out of reach. It also would do nothing to help the tens of millions of people without employer-based plans and the small-business workers to whom COBRA does not apply. This crisis demands more. The government must cover the costs of all care, for everyone, and our polling shows that is precisely what voters demand.
COVID-19 is, in many ways, a test of our national healthcare system, a test that we are failing. Without significant — and popular — government intervention to cover the costs of care, we will continue to feel the public health and economic ramifications long after most other high-income countries have controlled their COVID-19 outbreaks. This may be the moment in history when America ceases to be the most affluent, powerful country in the world, and the downfall will be of our own making.
On 4/26/2020, Data for Progress conducted a survey of 1702 likely voters nationally using web panel respondents. The sample was weighted to be representative of likely voters by age, gender, education, urbanicity, race, and voting history. The survey was conducted in English. The margin of error is ± 2.1 percent.
Alison P. Galvani is the Burnett and Stender Families Professor of Epidemiology, Director of the Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health.