The potential financial burden resulting from medical care or hospitalization may deter many Americans, particularly those who are uninsured or underinsured, from seeking care. That could lead to catastrophic outcomes for themselves, their families and their communities. On March 18, 2020, the US House and Senate passed a stimulus package that only addresses the cost associated with diagnostic testing and associated medical visits, but not treatment for COVID-19.
“Americans who can’t pay for COVID-19 treatment without fear of huge medical bills may choose to avoid medical care entirely,” said Komala Ramachandra, senior business and human rights researcher at Human Rights Watch. “That will not just hurt people who have the illness, but most likely cause it to spread further.”
The US Centers for Disease Control and Prevention (CDC) project that between 2.4 and 21 million people in the US who contract COVID-19 will need hospitalization, with a significant number of those patients requiring intensive care. Experts estimate that the cost of COVID-19 hospitalization could be over $20,000 per person. For Americans with private insurance, that could translate to $1,300 or more in out-of-pocket costs in the form of deductibles and coinsurance payments.
Uninsured Americans could be billed directly for hospitalization at rates even higher than those with insurance. Low-income Americans face a double burden. They tend to have higher rates of pre-existing chronic health conditions that make them more vulnerable to serious cases of COVID-19 and the associated medical costs.
While older Americans are insured under Medicare, 28 million non-elderly Americans are uninsured. That number has grown for the first time in a decade as the current administration has tried to undo the Affordable Healthcare Act. People of color and children have been particularly affected by the falling numbers with insurance coverage. In addition, nearly one out of every three people in the US is underinsured, meaning they have insurance but it carries high deductibles, co-pays, and other out-of-pocket expenses. People with these high-cost plans are often low-wage workers, making it even more difficult for them to afford health care.
The growing number of people in the US without adequate coverage has meant that more and more families are struggling to pay their medical bills. A recent study found that more than 137 million Americans are facing financial hardship because of their medical bills, and that medical issues contribute to two-thirds of bankruptcies.
The high cost of care could lead people to avoid testing and treatment entirely, potentially exposing more people to the virus. A third of families already say they chose not to seek medical care generally in the last year because of cost. Compounding this is that many people also do not receive paid sick leave. If people cannot access affordable health care and they don’t have sick leave, they may continue to spread the virus as they have no option but to continue working, with nearly six out of every ten Americans living paycheck to paycheck.
Initiatives at the federal and state level are targeting free testing for COVID-19, but have not yet extended to the cost of treatment. Some states have mandated and some private insurance providers have pledged to waive co-pays and costs for testing but have not made similar commitments for treatment.
The US government has an obligation under international human rights law to ensure that this serious public health crisis does not also become a human rights crisis because people do not have adequate medical care, Human Rights Watch said. The US government has several options to ensure that the cost of treatment does not become a barrier to care.
In their next legislation to address the crisis, Congress could appropriate funds to ensure that treatment costs are covered for anyone unable to afford them and to reduce or eliminate out-of-pocket costs for those with insurance. The director of the CDC can also authorize payment for care and treatment, including costs associated with quarantine and isolation. Both Democratic presidential candidates have proposed mobilizing federal funding to ensure that treatment and care costs are covered for all Americans, whether insured or not.
State governments can also take steps to increase coverage, including by adopting Medicaid expansion, which would reach an additional two million people currently in a coverage gap, and eliminating or drastically reducing their out-of-pocket costs. The federal and state governments can also open special enrollment periods in health insurance marketplaces that would allow uninsured individuals to enroll.
For the roughly 2.2 million people who are currently detained in US prisons and jails, access to adequate health care is critical. A number of states have taken steps to eliminate co-pays for incarcerated populations in response to COVID-19. Local, state, and federal governments need to take steps and secure funding to ensure all incarcerated individuals have access to COVID-19 testing, preventative care, and treatment at no cost.
“For Americans struggling to make ends meet, getting treatment for the coronavirus could be a choice between getting healthy or going broke,” Ramachandra said. “That’s a choice that no one should have to make and the impact on the US could be tragic.”