The 'Doubly Disadvantaged': At Risk for Severe COVID-19 and Lack Adequate Health Insurance

Adam Gaffney, M.D.

Almost 20 million Americans at risk of severe COVID-19 cause of health conditions were either uninsured or underinsured, according to a new study published today in the Journal of General Internal Medicine. Although most of those at high medical and financial risk were white, racial minorities were over-represented, according to a press release about the study.

The research team of investigators from Harvard Medical School and Hunter College in New York City determined who was at risk of severe COVID-19 based on age and risk factors such as diabetes, according to the press release. They also looked at insurance status and found that African Americans, Native Americans, lower-income individuals of all races/ethnicities, and those residing in rural areas or in states that had not expanded Medicaid were “doubly disadvantaged,” the press release said, because they were of high risk of severe COVID-19 and lack adequate health insurance coverage. The researchers said 18.2 million Americans are in that category.

They found that blacks were 42% and Native Americans 90% more likely to be at risk for severe COVID-19 than non-Hispanic whites, and high-risk persons from those racial groups were 51% and 53% more likely to have inadequate coverage compared to high-risk whites. Persons in states that failed to expand Medicaid were 6% more likely to be high risk, and 52% more likely to have inadequate coverage compared with states that expanded Medicaid. Hispanics at high medical risk were more than twice as likely as non-Hispanic whites to have inadequate coverage.

"The pandemic is laying bare the lethal inequality of American society and American health care," said lead author Adam Gaffney, M.D., a pulmonary and critical care physician at the Cambridge Health Alliance and Harvard Medical School, in the press release. "Our ICU has been flooded with poor and minority patients; having COVID-19 is scary enough without worrying that you'll be bankrupted by medical bills.”

Gaffney is president of Physicians for a National Health Program, a group that advocates for a single-payer healthcare system.

While some private insurers have promised to waive copays and deductibles for treatment as well as testing, this promise doesn't apply to out-of-network care or to the majority of privately insured workers whose employers are self-insured, said the press release, which also noted that most of these waivers will expire by July 1.