As U.S. COVID-19 deaths start to spike, at least 11 of the 13 states with their own health insurance exchanges have reopened enrollment, so as to allow residents to access affordable health care. “We’re not going to be able to control the virus unless we get everyone covered and able to get tested and access the treatment they need,” Anthony Wright, executive director of the advocacy group Health Access California, told me this week.
California’s been ahead of the curve here, reopening up its exchange early in the pandemic, as well as over the past year, making an effort to bring more undocumented residents under its health care umbrella. As of the fall of 2019, the most recent period for which data is available, roughly 93 percent of Californians had some form of health coverage. That means that, as COVID-19 spreads on the West Coast, California at least has the health coverage infrastructure in place to get most of its population tested and treated if need be, without the treatment bankrupting the patients — though because of the sheer size of its population, roughly 3 million remain without reliable access to health care.
Most states, however, do not run their own insurance exchanges, let alone provide publicly funded health care to their undocumented residents. When economic conditions crater suddenly and there’s a rush of people looking for affordable insurance in these states, they are, instead, reliant on the federal exchange, set up as a central part of the Affordable Care Act (ACA), and thus, long in the crosshairs of the Trump administration, which supports a lawsuit seeking to get the entire ACA declared unconstitutional.
Bucking the advice of public health experts, earlier this week the Trump administration rejected calls by state governors and public health experts to reopen enrollment for the Affordable Care Act so that people losing jobs because of the economic crisis, or people who had not signed up for insurance in the fall, could access health care.
As a result of this inaction, millions of Americans who urgently need quick access to health insurance will find themselves between a rock and a hard place over the coming weeks. Because of government stay-in-place orders, many uninsured people are out of work, and because they are out of work during a period in which the insurance exchange isn’t operational, they will have to either pay the full cost of their previously employer-provided private insurance via COBRA, look elsewhere for full-cost private insurance, or hope that they don’t get sick. If they are poor enough, in some states they will qualify for Medicaid; but in many other states, notably those with Republican governors and legislative majorities, if they are able-bodied adults of working age, and they do not have children, they will find it extremely difficult to access Medicaid coverage.
The cascading series of health and economic crises triggered by the COVID-19 crisis is laying bare just how dysfunctional American health care is. It is showing, to anyone who cares to look, the vulnerability of this system — in which roughly half of the population receives health care via employer-provided insurance — to sudden economic shocks.
This would have been true even with a federal administration that was focused exclusively on how to best preserve human life during a pandemic, and how to best cushion health care systems at the local and state levels as the number of people falling ill and needing to be hospitalized soars.
But as the crisis has intensified, it’s become clearer by the day that the Trump administration isn’t focused on this to the exclusion of all else. Instead, it is distracted by petty fights, personal grievances and one-upmanship. In fact, on a daily basis, Trump, who uses his pandemic briefings as substitutes for his no-longer-possible campaign rallies, picks gratuitous fights with Democratic governors.
He has called Michigan Gov. Gretchen Whitmer “Half Whitmer;” has labeled Washington Gov. Jay Inslee a “snake” whom Vice President Mike Pence’s coronavirus response team should avoid talking to; and has demanded that governors show him how much they appreciate the work he is doing or, the implicit threat goes, he’ll withhold assistance. Indeed, Whitmer has alleged that medical suppliers are telling her that the feds have ordered them to divert medical supplies away from her state, despite the fact it is now a virus hotspot.
As the New York region’s caseload escalated last week, Trump mused aloud about quarantining the tri-state area. Yet he neglected to actually talk with the governors of New York, New Jersey and Connecticut about how such a scheme might work.
After New York Gov. Andrew Cuomo and hospital staff alike lambasted the White House for not better coordinating the manufacture and distribution of vital medical equipment, from face masks and gloves on up to ventilators, Trump implied that hospital staff in New York were stealing needed supplies. The shortage, he averred, had nothing to do with federal ineptitude and everything to do with front-line personnel being corrupt. Such an allegation is not only offensive, it’s also deeply counter-productive. After all, EMTs, nurses and doctors are working long hours in increasingly dangerous conditions to save lives and protect communities. When the president turns on them in the way that he did, he undermines morale just at the moment when that morale is most desperately needed.
Throughout his time in office, Trump has grabbed headlines by trash-talking his political opponents and rivals, be they Republicans such as John McCain, or Democrats like Elijah Cummings. He’s doing the same thing now, while the public health catastrophe grows and the death toll mounts. It’s unconscionable stuff, and yet, faced with a public health calamity at least partly of his own making and an economic implosion that threatens to unleash another Great Depression, it’s all that this empty suit of a president seems to know how to do.