An estimated 12% of Michiganders are without health insurance while 12% of Detroiters with coronavirus die. What options are available for the uninsured?
MICHIGAN — As many as 2,000 casino workers in Detroit will lose their health insurance Saturday as a result of the long-term closure of the gambling industry during the pandemic. They join millions of Americans who have lost their employer-sponsored health insurance at the height of a global health crisis.
And some of them are especially vulnerable.
Michigan’s economy was badly hit by the fallout from the novel coronavirus pandemic, and that included a significant reduction in the number of people in the state with health coverage.
An estimated 12% of Michigan adults below the Medicare eligibility age are currently uninsured, reports Families USA. Nationwide, millions of Americans lost their jobs, and with it their employer-sponsored health insurance plans.
“These record-breaking increases in the number of uninsured have taken place during the country’s worst public-health crisis in more than a century and the sharpest and deepest economic downturn since World War II,” Families USA said in a statement.
Families USA pointed out that despite this there has been no action on the federal level to address the sharp rise in uninsured Americans, even as Congress debates another bill aimed at coronavirus relief.
And this has Michiganders avoiding the hospital, resulting in an uptick of out-of-hospital deaths as high as 62%, according to the Michigan Department of Health and Human Services. But without insurance, it can be daunting to call 911.
“What that tells us is that people are not seeking care for important medical issues,” Samantha Iovan, a health and human services senior analyst at U-M’s Center for Health and Research Transformation, told the Lansing State Journal. “It’s scary to think about people not seeking care for things like stroke and heart attack, but that’s a real possibility when people don’t have health insurance.”
Who Are Michigan’s Uninsured Families?
Two months before the coronavirus arrived in Michigan, Garrett Levis tested positive for HIV. Entering a global health crisis after discovering he was immunocompromised was a terrifying experience.
Lewis, from Westland, also lost his job as a server when restaurants first closed down. When his restaurant reopened, Lewis couldn’t go back to work.
“My doctor told me that I cannot work until my T cells are normal because COVID will kill me,” he told The ̕Gander.
T cells are the type of blood cell that combats pathogens, and are the type of cell that HIV destroys. Without them, even ordinary illnesses can become fatal. And already almost one in ten Michiganders who contract the coronavirus die, according to calculations by The ’Gander using state coronavirus data.
Unable to return to work and needing to reapply for unemployment, the growing pile of $40 medical bills are rapidly becoming more than Lewis can manage.
“The hardest part is not being able to pay medical bills,” he said “They are small bills, but because I have had to have so many visits in such a small amount of time, the $40 bills have been adding up.”
But keeping people like him insured has not exactly been a top priority for lawmakers or the Trump administration during the pandemic.
“Helping people keep their insurance through a public health crisis surprisingly has not gotten much attention,” Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, told The New York Times earlier this month.
Nancy Zack, administrator for the Wyandotte Clinic for the Working Uninsured, said that the introduction of the health insurance reforms of the early 2010s provided some of the clinic’s patients with the ability to get health insurance at a price they could pay, but worries the pandemic will set back a lot of that progress. And the pandemic isn’t the only factor making it harder to get covered.
Weakening Healthcare During a Pandemic
President Donald Trump has not softened his stance toward those major healthcare reforms, still targeting them in the midst of the global health emergency.
And those reforms have helped everyday Michiganders.
Census data estimates that about 5.4% Michigan residents lacked health insurance in 2018. That compares to 12.4%, or 1.2 million, in 2010 before the major healthcare legislation, the Affordable Care Act (ACA), passed. That legislation cut Michigan’s rate of uninsured adults by more than half.
Part of that is due to Michigan expanding Medicaid eligibility in 2014 as part of the reforms introduced in that legislative package. Almost 750,000 Michiganders were covered by the expansion to Medicaid as of June, which reflected a large spike in enrollees attributed to the coronavirus pandemic. In total, Medicaid covers more than 2 million Michiganders.
In 2013, while the ACA was still in its infancy, Michigan had nearly 300,000 full-time workers without any insurance. That reform package reduced that number by nearly half as well. And families, particularly in Black and Latino communities, making less than $50,000 a year were the group among which coverage expanded the most.
But when Michiganders lost employer-sponsored health care in addition to those who still remained uninsured, there was another economic problem presented by the pandemic, as The ’Gander explained. Those reforms were threatened by Trump proposals.
“Around 30 million Americans are already uninsured to begin with. Trump is cutting even more, without a plan to replace the [Affordable Care Act],” Michigan ER doctor Rob Davidson wrote for the Washington Post. “His reckless effort to eliminate the ACA now could also take away health care or raise costs for 130 million Americans with preexisting conditions, and the consequences for people during this pandemic will be far-reaching and dire.”
There are other insurance programs at risk as well. The Trump Administration recently backed pushing work requirements for Medicaid during a period of record-setting unemployment, according to the Post. Those work requirements would prove onerous and burdensome to applicants and prevent them from getting needed healthcare, argued a federal judge last year.
Work requirements are a series of limitations placed on social safety net programs like food assistance or Medicaid to prevent out-of-work Americans from accessing those programs. But the process proving a recipient is employed is so confusing and onerous, it keeps even eligible people off the support services they need.
Research from the New England Journal of Medicine found that 95% of the people disenrolled in Arkansas’ Medicaid program over unmet work requirements were, actually, working and meeting those requirements.
“And now, as you know, it’s getting worse as people are getting laid off again or picking up little part time jobs to help supplement their income,” Zack told The ’Gander. “I really think we’re headed back to some dire times again with people needing medical care. It’s not looking good right now for a lot of our patients.”
What To Do If You’re Suddenly Uninsured
Visiting Zack’s clinic in Wyandotte is a free option specifically for the underserved population of working uninsured, but Zack said the Wyandotte Clinic is booked solid weeks in advance. While some things like telehealth appointments and critical non-emergencies can be addressed by her small staff, in most cases she lacks the resources to schedule an appointment quickly.
That leaves uninsured Michiganders with a few options: Medicaid, COBRA, becoming a spouse’s dependent, or seeking a plan on the healthcare.gov exchange.
Which of those options is best depends heavily on what income a family has. The Consolidated Omnibus Budget Reconciliation Act or COBRA — a provision that allowed laid off workers the ability to continue purchasing group rate coverage for a limited time—for instance, is an expensive policy. Medicaid, on the other hand, is only eligible to those making under $16,000 for a single person or $33,000 for a family of four.
“We are fortunate we have expanded Medicaid coverage in our state,“ Iovan said. “More people will be eligible with job losses.”