by Alexandra Cady Reid

As the U.S. enters its twelfth month in the pandemic, COVID-19’s impact on our physical and mental health continues to expand. In addition to all the ways we have adapted our work, social, and personal lives to manage the virus, we have also been altering our behaviors in ways that can have long-term, adverse effects. In particular, we have been changing the way we access and interact with the healthcare system.

Some of these changes have been positive (and necessary). For example, the number of patients using telehealth has increased significantly, with the Center for Disease Control reporting a 154 percent increase in telehealth visits at the end of March 2020 compared with the same period in 2019. Telehealth has become a necessary alternative as providing in-person care has been restricted by many providers for safety reasons, reducing COVID exposure possibilities for both patients and providers. This shift has been viewed favorably by some patients as improving convenience and access to healthcare.

Of course, this is not the case for all patients. To begin with, millions of people have lost their health insurance. The Economic Policy Institute projects that 12 million people – including 6.2 million workers and their family members – “have been cut off from employer-sponsored insurance coverage due to job losses” during the pandemic. Losing health insurance has immediate negative impacts. The Kaiser Family Foundation reports that “Lack of health coverage, even for short periods of time, results in decreased access to care.” More specifically, The Commonwealth Fund found that people who experienced gaps in their health coverage were less likely to have a regular doctor and receive preventative care tests such as blood pressure and cholesterol checks, compared to people with continuous health coverage.

As a result, uninsured individuals experience many barriers to accessing and interacting with the healthcare system, making it more difficult – and in some cases impossible – to effectively manage their health. To pose a hypothetical: due to COVID-19, a patient named John has recently lost his job and his health insurance, so he does not see a doctor for a routine annual appointment. However, John unknowingly has high cholesterol. Since he does not see a doctor, he is not diagnosed, and does not know that he needs to start making lifestyle changes or taking medication to lower his cholesterol. If left untreated, high cholesterol can increase the risk of heart disease and heart attacks. Ultimately, COVID-19 has increased the number of uninsured persons, leading to an increase in the number of people finding it difficult to access healthcare and manage their health – leaving them vulnerable to preventable adverse health outcomes up to and including death.

Even for individuals who have been fortunate enough to maintain healthcare coverage throughout the pandemic, COVID-19 has pushed many to put preventative care on the back burner. The American Medical Association found that childhood vaccinations decreased by roughly 60 percent, mammograms and pap smears declined nearly 80 percent, and colonoscopies were down almost 90 percent in mid-April 2020 compared with 2019. As the American Academy of Family Physicians puts it, “Patients are deferring routine office visits for chronic disease management and preventive services out of concern for their safety during COVID-19.” As it would turn out, even if our patient John were to have found new insurance and scheduled an annual appointment – a preventive visit – he might have chosen to attend his appointment virtually to reduce potential exposure to COVID-19 or his doctor may have encouraged or required that he attend virtually. And so, he still might not have received a blood test and had his high cholesterol diagnosed.

As Blaine Dinkin, an Administrative Fellow at Allegheny Health Network and Heinz College Alumna, noted, “COVID-19 is forcing us to redefine and reanalyze what access to healthcare means. It is becoming clear that access goes beyond the ability to see a doctor or get a vaccine; it’s about resources.” In her role, Dinkin works with nursing home administrators and patients in the Pittsburgh area. To them, and many other frontline and essential workers, access to healthcare is also about access to personal protective equipment (PPE). In our patient John’s case, access to healthcare is also about access to blood tests.

To pose another hypothetical: Jane loses her job and her employer-sponsored insurance due to COVID-19 – at the same time, she finds out she is pregnant. As she scrambles and struggles to find new insurance, she delays her first prenatal visit. After she successfully enrolls, she finds out that she lives in one of the 1095 counties in the U.S. classified as a maternity care desert – “a county without a hospital or birth center offering obstetric care and without any obstetric providers.” The closest provider is over an hour away, and the first appointment is required to be in-person. On top of the stress of finding a new job, navigating her new health insurance, and figuring out how to get to her doctor, Jane has to worry about the fact that she is at a higher risk for experiencing more severe symptoms from COVID-19 compared to non-pregnant people. 

For Jane, and many other women across the nation, COVID-19 has exacerbated gender inequities in regards to economic opportunities and access to healthcare. Women have been disproportionately impacted by the pandemic: according to the Center for American Progress (CAP), “Four times as many women as men dropped out of the labor force in September.” On top of that, women account for 53 percent of the loss of jobs with employer-sponsored insurance.[13] Women are being pushed out of the workforce and out of jobs with health insurance at higher rates than men. 

COVID-19 is affecting the way we access and interact with the healthcare system. While some patients have certainly benefited from the expanded virtual options, many others have chosen – or been forced – to minimize their engagement with the system and deprioritize preventative care. Expectedly, these changes make it harder for individuals to manage their health.

In sum, our nation’s healthcare system is failing many Americans. It is clear that any proposed solution to effectively address a system so plagued by problems would need to be massive, comprehensive, and multi-pronged. A key part of any reform effort should be disentangling health insurance from employment. This overdue policy change has received renewed attention during this pandemic, as this structure has caused many citizens who lost their jobs due to COVID-19 to also lose health coverage during a public health crisis. Not only is this traumatic for the people who have lost their jobs and coverage, but it is also bad for society as a whole since those without insurance are less likely to receive medical care, making it harder to contain the virus. COVID-19 has further highlighted our nation’s desperate need to implement universal health coverage in order to ensure that people will be empowered to manage their health, regardless of employment status, pre-existing conditions, or whether we are in a deadly pandemic.

Beyond improving the provision of health insurance, fixing our broken healthcare system relies on establishing a broad definition of “access” as it relates to managing our health. COVID-19 has laid bare existing gaps in access and created new ones, as exemplified by the difficulty in finding and attending a medical appointment and the inability to obtain PPE, respectively. While we cannot expect medical professionals to anticipate all of our healthcare needs, we can and should expect our government and healthcare sector to be flexible enough to respond to our needs and to prioritize our health and safety. 

About the author:
Alexandra Cady Reid is a first-year student in the Master of Science in Public Policy and Management – DC program at Heinz College, where she is studying how to improve gender equity with a focus on healthcare.

Correspondence:
amcady@andrew.cmu.edu

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