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With our country’s broken health care system and high levels of uninsurance, it should come as no surprise that the United States has quickly become the world leader in the number of COVID-19 cases.
Despite being well-resourced and a leader in health research, we continue to fail to be able to provide adequate testing to our population, a key measure in containing the outbreak. The U.S. also ranks very low among similar nations on key indicators like number of hospital beds per capita; Washington State ranks lower than most states in the country on this same measure.
Nearly one out of every ten Americans lacks access to health insurance and one in five Americans is “underinsured,” paying more than 10 percent of their income to cover their health costs. And now, with unemployment rates projected to reach 30 percent in the coming months, people are losing their job-based health coverage in droves – right in the middle of a global pandemic.
With our nation staring down the barrel of a public health crisis and ensuing economic recession, Congress acted quickly in March to pass three federal relief packages aimed at supporting individuals, businesses, and our ailing public health and health care systems. On March 27, Congress passed the Coronavirus Aid, Relief and Economic Security (CARES) Act, the third and most substantial relief package so far, which provides $2.2 trillion in crucial benefits. Among the supports provided are tax rebates for eligible individuals, a massive expansion of unemployment insurance benefits, aid for small businesses and large industries, and emergency funds to prop up our overwhelmed and unprepared health systems.
Health care provisions of the CARES Act include bolstering hospital capacity by $100 billion, rebuilding the Strategic National Stockpile of medical supplies ($16 billion), supporting vaccine development ($11 billion), and funding state and local public health departments ($1.5 billion).
The CARES Act, which provides $2.95 billion in aid directly to Washington State, builds on two relief packages passed by Congress earlier in March. Health care provisions in the first bill provided immediate funding for federal, state, and local public health response work, vaccine research and development, and subsidies for telehealth services. The second bill, the Families First Coronavirus Response Act, made free COVID-19 testing available to all, including the uninsured, and increased the federal match to states for Medicaid payments by 6.2 percent to help backfill a dangerous funds shortage.
Where the Relief Packages Fall Short
Large groups of immigrants, including undocumented people and DACA recipients, are left out of important benefits, even while many people in these communities risk their lives on the front lines of our health care and food delivery systems. Undocumented people are 11 times more likely to be uninsured in Washington State than U.S. citizens, making them an especially vulnerable population during the COVID outbreak. Beyond the moral imperative to provide health coverage to everyone, failing to cover any portion of our society puts everyone at risk.
While the increase in the federal Medicaid match to 6.2 percent will help states respond to the massive increase in Medicaid enrollment and usage, it falls far short of what economists say states need to cover enormous budget gaps. According to the Center on Budget and Policy Priorities, the federal Medicaid match is the single most important way to funnel relief to states in a crisis and should be increased to at least 10 percent.
Free COVID-19 testing is good, as long as you can find one, but a test is nearly meaningless if you need treatment you can’t afford. Some states, like Washington, have required insurance carriers to waive cost-sharing for tests, but patients are still responsible for co-pays and deductibles for treatment, leaving patients to face exorbitant medical bills, like a man in New York last month who got hit with a $2,000 bill from his insurance company after visiting the ER for a COVID test.
Congress is already working on a fourth aid package, and will likely focus more on stimulating the economy, rather than emergency relief, as the three previous bills have done.
Future aid packages will need to do much more to respond effectively to the outbreak and expand health care coverage, including:
- Covering testing and treatment for all uninsured people, including undocumented people
- Expanding Medicaid eligibility beyond current income limits
- Encouraging non-expansion states to expand Medicaid
- Providing a special enrollment period for people to sign up for coverage on the state and federal marketplaces (an allowance Trump just announced he will not permit at the federal level, but that Washington’s Health Benefit Exchange is now allowing until May 8 in the event of a change in income or the loss of a job or employer-based health insurance)
- Broadening the Families First Coronavirus Response Act to include COVID treatment, in addition to the testing already provided
- Ensuring that Medicaid fully covers COVID-19 treatment, and
- Increasing the federal match for Medicaid to at least 10 percent.
Here in Washington, where the U.S. outbreak first hit, state officials have implemented crucial public health measures like sheltering-in-place, are seeking permission through the federal government to expand testing and treatment for all Washington residents, and are preparing emergency medical facilities like converting the CenturyLink Field Event Center into a field hospital.
Though the Washington State Legislature provided an initial $200 million for the outbreak response in March, much more will be needed to address the continuing crisis, making a special session of the legislature likely.
Government officials are now acting at every level to respond to the current situation and prepare for the devastation yet to come – but more needs to be done to ensure our nation can emerge strong and healthy on the other side of this crisis.
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