One consequence of COVID-19 is that you no longer hear Democratic politicians talking much about how American workers love their job-based health coverage, or how working people should be free to choose their insurance options and “if you like your insurance, you can keep it.”
Since mid-March, more than 30 million people have applied for unemployment insurance. According to the AFL-CIO, at least 12 million of them lost their health coverage along with their jobs. They join some 30 million others who were uninsured even before the pandemic hit.
Leaving people to rely on their own resources to pay medical bills in the middle of a pandemic is a recipe for disaster, especially when they’ve also been left without income. For some time now, millions of Americans have been foregoing needed medical care because they had no way to pay for it. The pandemic has drastically increased their numbers, and the public health consequences are enormous. Untreated medical conditions leave people more vulnerable to infection, undermining efforts to control the spread of the virus. For those who do become infected and require hospitalization, the cost of care can run to the tens of thousands of dollars.
If they haven’t already qualified for Medicaid (and it can take a while), two options remain open to those without coverage. For most of us, both are prohibitively expensive.
In states like California that don’t require waiting until November, you can buy coverage on the Obamacare insurance exchange. That, of course, assumes there will be something left over after paying for rent, groceries, and other expenses that persist even when no money is coming in. Federal premium subsidies may be available, but they are no help with out-of-pocket costs, which can be substantial. In November, it should be noted, premiums are expected to rise as much as 40 percent, according to the director of California’s insurance exchange.
The other option is COBRA. This long-established but little-used federal program allows laid-off workers to extend their coverage temporarily — provided they pick up the tab for their employers’ share of the premiums as well as their own. Few people can afford that either.
What should Congress do? One proposal, the Worker Health Coverage Protection Act (HR 6514), actually originated with America’s Health Insurance Plans (AHIP), the lobbying arm of the insurance industry. It would simply have the federal government pick up the tab for COBRA premiums, allowing workers to continue their old coverage while providing an infusion of federal tax dollars to private insurers who have lost a lot of paying customers in recent weeks.
The AFL-CIO has embraced HR 6514 as part of a comprehensive program for worker relief during the pandemic. Given how desperate the situation has become for many laid-off union members, the support is understandable. It has been particularly strong from UNITE HERE, whose members in the hospitality and food-service industry are among those hardest hit by the crisis. The strategy is purely defensive: it would enable 12 million workers to keep what they have, and it has the added advantage of joining forces with one of the most formidable business lobbies in Washington.
Two alternative bills, both sponsored by Rep. Pramila Jayapal, involve putting uninsured people into Medicare rather than COBRA. The less ambitious of the two is the Medicare Crisis Program Act, co-authored with Rep. Joe Kennedy III. It would qualify anyone who has filed for unemployment since the crisis began in mid-March. The more comprehensive bill, coauthored with Bernie Sanders, is the Health Care Emergency Guarantee Act; it would cover anyone who was without health insurance when the crisis began.
These bills have an obvious advantage: it costs far less to give people health care through Medicare than to pay premiums to private insurers. A new study by the Political Economy Research Institute estimates that it would cost taxpayers nearly $70 billion to make three months’ worth of premium payments for 12 million workers under COBRA. The Medicare Crisis Program Act would cover an additional 7 million who have lost their jobs but do not qualify for COBRA. It would actually cost $22 billion less. The potential savings would increase as the jobless rate grows.
The Health Care Emergency Guarantee Act would cost more, because it casts a much wider net: its purpose is not simply to help the unemployed, but also to ensure that no one is deprived of access to medical care during the pandemic for financial reasons. But it achieves economies of its own as well. For one thing, prescription drug prices paid by Medicare would be comparable to those paid by the Veterans Health Administration (VHA). The VHA is allowed to use its massive purchasing power to negotiate lower drug prices. Currently, Medicare is not. For those who retain coverage with private insurers, it freezes premiums at their current level for the duration of the pandemic.
From a policy point of view, this should be a no-brainer. HR 6514 would provide badly needed relief to a significant number of workers, but it only begins to address the full dimensions of the COVID-19 crisis. Most private plans have gaps in coverage that can pose real problems under normal conditions; if you’re without income and living through a pandemic that threatens everyone and has already infected well over a million people, they can be deadly. Exorbitant bills for out-of-network treatment present a particularly serious problem, since hospitals overburdened by a flood of COVID-19 cases may be obliged to refer patients to providers their insurance company will refuse to pay.
The Medicare Crisis Program Act pays for all COVID-19 related cases in full; for other treatment, any co-pays and deductibles are capped at 5 percent of your monthly income. The Health Care Emergency Guarantee Act eliminates them altogether.
The political calculus is more complicated; it always is. Every union performs a perpetual balancing act between protecting its own members and advocating for the well-being of all working people. To reject a limited solution out of hand is to risk coming away with nothing. But when all of us are menaced by a deadly contagion, the maxim that an injury to one is an injury to all acquires special force. Someone who has access to care can easily be infected by someone who doesn’t, and if an infection is serious enough to require hospitalization, your chances of survival won’t improve because you “like the insurance you have.”
Another time-honored maxim of the labor movement bears mentioning here, too: go to the bargaining table with your maximum set of demands, and don’t make concessions unless you’re assured of getting something in return. All legislation involves some horse trading; that’s the nature of the beast. But there is no good reason why organized labor should not put up the strongest possible fight for the Health Care Emergency Guarantee Act.