Blog IV- Universal Health Coverage and COVID-19 in the United States

According to Galvani et al. (2022), here in the U.S. “…the COVID-19 pandemic has underscored the public health, economic, and moral repercussions of widespread dependence on employer-sponsored insurance.” The majority of U.S. adults under age 65 access health insurance through their employer. From December 2019 to April 2020, there was a 14.5 million decrease in employer-sponsored health insurance enrollments, largely driven by the millions of Americans who became unemployed during this time. On the flip side, Medicaid enrollments increased by almost 10 million between March and December 2020, in no small part due to the Families First Coronavirus Response Act (FFCRA) which allowed state Medicaid programs to keep individuals continuously enrolled throughout the pandemic. Soon we may be seeing another drop in insurance coverage, though, as this provision ended on March 31st, 2023. It is expected that millions of people will lose coverage or experience a lapse in coverage, but the full impacts are yet to be seen. 

The uniquely American dependence on employer-sponsored health insurance no doubt contributed to the COVID-19 outcomes we experienced as a country. Workers may fear losing their job and therefore health insurance, so they decide to go into work even if they are sick and contribute to transmission. If a person did lose their job and insurance, fear of high costs and delayal of care results in increased case fatality rates. It was found that essential workers in Pennsylvania were 55% more likely to contract COVID in the early stages of the pandemic compared to Pennsylvanians who were able to work from home. Family members and roommates of these workers were 17% and 38% more likely to test positive, respectively. In this study, “essential workers” were more likely to live in communities of predominantly Black or Latino residents and individuals below the poverty line. Thinking back to early 2020, one of the memories that stands out most is society’s collective glorification of essential workers. While this rhetoric of heroism was being propagated, the material conditions that these individuals were working under, and the policies that allowed these conditions, displayed blatant disregard for the health and safety of Americans who literally kept our communities running. Our drained workforce, and more importantly the families who have an empty seat at the dinner table, signify the lasting effects of the U.S.’s COVID-19 response. 

While we can’t go back in time and fix all of the many problems associated with our COVID-19 response, we can use policy changes to become more resilient in preparation for future health emergencies. UHC is one piece of this puzzle. One study estimated that 26.4% of lives lost due to COVID-19 in 2020 could have been saved if the U.S. had UHC. This amounts to 131,438 COVID-related deaths in 2020 alone. UHC would have provided greater access to critical healthcare services and programs. Access to primary care and management of chronic conditions are two of the main mechanisms through which UHC could have been lifesaving in 2020. Hypertension increases the risk of COVID-19 mortality by 188%. Similar risk increases exist with other comorbidities such as diabetes and obesity. Adults who are uninsured are less likely to be diagnosed and receive treatment for chronic conditions, making them more vulnerable to severe COVID-19 infection. Access to primary care also contributes to the prevention of COVID-19 prevention, as it is associated with increased vaccine uptake. This relationship may account for vaccine uptake disparities between Black and Hispanic Americans and White Americans.

COVID-19 may have jeopardized the great strides made towards UHC in the 21st century, hopefully this collective trauma illuminated the need for change and sparked renewed energy across the world. COVID-19 showed both leaders and ordinary people the importance of health, and the impacts of its absence. It puts on full display how a threat to health can impact all corners of society: physical health, mental health, the economy, school systems, availability of goods and services, and the list goes on. We are still feeling these impacts years later. As for myself [Martha Smee], I value my health now more than ever. As a future public health professional and healthcare provider, I will continue to advocate until those in power value my health and the health of all peoples as much as they should. 

Martha Smee MPH (c) MMS (c) 

Martha Smee is a current student in Arcadia University’s Dual Master of Public Health/Master of Medical Science in Physician Assistant Program. As an MPH student, her capstone research explored the relationship between state Medicaid policy and mental health outcomes. She completed an internship at the Free Library of Philadelphia’s Culinary Literacy Center where she assisted with curriculum development and program facilitation to promote literacy through food, cooking, and community-building. Her public health interests include health policy, access to mental health services, and environmental health. After graduating, she plans to continue practicing evidence-based public health as a primary care provider in the Philadelphia area.

Dr. Heather F. McClintock PhD MSPH MSW

Dr. McClintock is an IH Section Member and Associate Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life Study and Integrating Management for Depression and Type 2 Diabetes Mellitus Study.