Knowing that we’re only at the beginning of a long road, we’re compiling two key lists — things we should know and things we can do. Through both, we hope to find inroads to lessening the financial burdens on patients, payers and providers, while ensuring that everyone has the care they need to recover.<\/p>\n
We already know that, in many ways, poverty is the worst health condition of all. But what happens when you combine poverty with a pandemic? For too many already, this means the difference between life and death. With nearly 22 million having filed for unemployment already in the U.S. since this pandemic started — a number that will surely continue to grow — these are issues we must address now.<\/p>\n
With this in mind, we’ve compiled two lists we hope can help — things we need to know and things we can do to help.\u00a0 These lists are meant as a starting point for the change necessary to move forward.<\/p>\n","page_content_es":"
We already know that, in many ways, poverty is the worst health condition of all. But what happens when you combine poverty with a pandemic? For too many already, this means the difference between life and death. For example, in mid-April, black people in predominantly low-income communities made up more than 70 percent of all COVID-related deaths in Chicago, despite only accounting for one-third of the city’s population,<\/a> a scenario playing out in Detroit, New Orleans and other cities. In the South particularly, poverty and race often go hand-in-hand, and the populations that suffer most are those least likely to have access to the services and care they need. Many are still working hourly jobs, not having the luxury of working from home<\/a>. This places poorer people at even further risk of contracting COVID-19, often without the resources to be immediately tested and treated.<\/p>\n","page_content_fr":" We already know that, in many ways, poverty is the worst health condition of all. But what happens when you combine poverty with a pandemic? For too many already, this means the difference between life and death. For example, in mid-April, black people in predominantly low-income communities made up more than 70 percent of all COVID-related deaths in Chicago, despite only accounting for one-third of the city’s population, a scenario playing out in Detroit, New Orleans and other cities. In the South particularly, poverty and race often go hand-in-hand, and the populations that suffer most are those least likely to have access to the services and care they need. Many are still working hourly jobs, not having the luxury of working from home. This places poorer people at even further risk of contracting COVID-19, often without the resources to be immediately tested and treated.<\/p>\n","page_subheader_en":" As COVID-19<\/a> continues to reshape our communities, we already see the detrimental impact on our lower-income, rural and minority neighbors. This is something that will only continue, with the physical and fiscal impact of the virus lasting far into the future.<\/p>\n","page_subheader_es":" As COVID-19<\/a> continues to reshape our communities, we already see the detrimental impact on our lower-income, rural and minority neighbors. This is something that will only continue, with the physical and fiscal impact of the virus lasting far into the future.<\/p>\n","page_subheader_fr":" As COVID-19<\/a> continues to reshape our communities, we already see the detrimental impact on our lower-income, rural and minority neighbors. This is something that will only continue, with the physical and fiscal impact of the virus lasting far into the future.<\/p>\n","pricing_title_en":"","pricing_title_es":null,"pricing_title_fr":"","pricing_content_en":"","pricing_content_es":"","pricing_content_fr":"","tangle_title_en":null,"tangle_title_es":null,"tangle_title_fr":null,"tangle_link_title_en":null,"tangle_link_title_es":null,"tangle_link_title_fr":null,"seo_title_en":"","seo_title_es":"","seo_title_fr":"","seo_description_en":"","seo_description_es":"","seo_description_fr":null,"tangle_url":null,"covid_notes_list":[{"slug":"things-we-could-do-to-help","hero_image":null,"header_en":"Things we could do to help","header_es":"Things we could do to help","header_fr":"Things we could do to help","teaser_en":"The issues COVID-19 bring will take years, if not decades, to solve. But there are things we can do to help reduce the impact on us all, and especially those already facing inequities and hardship.","teaser_es":"The issues COVID-19 bring will take years, if not decades, to solve. But there are things we can do to help reduce the impact on us all, and especially those already facing inequities and hardship.","teaser_fr":"The issues COVID-19 bring will take years, if not decades, to solve. But there are things we can do to help reduce the impact on us all, and especially those already facing inequities and hardship.","cta_en":"Read some ideas that may help lessen the impact of COVID-19 on low-income, rural and minority populations. ","cta_es":"Read some ideas that may help lessen the impact of COVID-19 on low-income, rural and minority populations. ","cta_fr":"Read some ideas that may help lessen the impact of COVID-19 on low-income, rural and minority populations. ","description_en":"Understanding there is no silver bullet, we are outlining immediate, intermediate and long-term ideas that could reduce the devastating impact that will inevitably hit those already facing inequities and hardship. The coronavirus exploits vulnerabilities associated with inequality and health disparities and highlights key shortfalls in our health systems. This is our time to finally effectively address those issues. Also note that most of the below relate primarily to the U.S. We\u2019ll continue to update with ideas for those in other parts of North America. We've broken these up into three areas:\r\n\r\nImmediate<\/a>\r\nIntermediate<\/a>\r\nLong-term<\/a>\r\n The CARES Act prevented the poverty rate from rising to 16.3 percent and instead the poverty rate remained at 12.7 percent.<\/p>\r\n - \u201cThe CARES Act Could Reduce Poverty to Pre-Crisis Levels if Access is Adequate<\/a>,\u201d Center on Poverty & Social Policy at Columbia University, 21 June 2020.<\/p>\r\n \r\n Within the black and Hispanic population, the CARES Act prevented a 7 percent and 5 percent increase in poverty rates, respectively.<\/p>\r\n - Jason DeParle, \u201cVast Federal Aid Has Capped Rise in Poverty, Studies Find<\/a>,\u201d New York Times, 21 June 2020.<\/p>\r\n \r\n In the private sector, about four million workers have had their pay cut and six million workers have been forced to work part time, even though they prefer full time work.<\/p>\r\n - Heather Long, \u201cPay Cuts are Becoming a Defining Feature of the Coronavirus Recession<\/a>,\u201d The Washington Post, 01 July 2020.<\/p>\r\n \r\n \"If quarterly unemployment hits 30 percent \u2014 as the president of one Federal Reserve Bank predicts<\/a> \u2014 15.4 percent of Americans will fall into poverty for the year, the Columbia researchers found, even in the unlikely event the economy instantly recovers. That level of poverty would exceed the peak of the Great Recession and add nearly 10 million people to the ranks of the poor.\"<\/p>\r\n - Jason DeParle, \"A Gloomy Prediction on How Much Poverty Could Rise<\/a>,\" New York Times, 16 April 2020<\/p>\r\n \r\n During the fourth quarter of 2020, the number of uninsured people could be 34 million.<\/p>\r\n - \u201cCovid-19 Impact on Medicaid, Marketplace, and the Uninsured,\u201d Health Management Associates, May 2020.<\/p>\r\n \r\n By early May, more than 16 million workers have lost employer sponsored health insurance.<\/p>\r\n - \u201cVirus Threat Grows in U.S. Where Millions Lost Health Coverage,\u201d Bloomberg, 30 June 2020.<\/p>\r\n \r\n Between 01 March and 02 May, a total 26.8 million people, including workers and their dependents, became uninsured due to loss of employer-sponsored health coverage. Of that, 5.7 million people are ineligible for subsidized ACA coverage.<\/p>\r\n - \u201cAs Unemployment Skyrockets, KFF Estimates More than 20 Million People Losing Job-Based Health Coverage Will Become Eligible for ACA Coverage through Medicaid or Marketplace Tax Credits,\u201d Kaiser Family Foundation, 13 May 2020.<\/p>\r\n \r\n In the worst-case scenario, the unemployment rate could rise to 20 percent, which means that about 25 million people will lose their employer-sponsored health insurance.<\/p>\r\n - \u201cHow the Covid-19 Recession Could Affect Health Insurance Coverage<\/a>,\u201d Robert Wood Johnson Foundation, May 2020.<\/p>\r\n \r\n \"Uninsured numbers could increase to 40 million, with bigger impacts in non-[Medicaid] expansion states.\"<\/p>\r\n - Health Management Associates, \"COVID-19 Impact on Medicaid, Marketplace, and the Uninsured, by State,<\/a>\" April 2020.<\/p>\r\n \r\n As part of the CARES Act, Congress has allocated $175 billion to reimburse hospitals and providers for treating uninsured individuals with COVID-19.<\/p>\r\n - Karyn Schwartz, \u201cLimitations of the Program for Uninsured COVID-19 Patients Raise Concerns,\u201d Kaiser Family Foundation, 16 June 2020.<\/p>\r\n \r\n Although the CARES Act should cover treatment costs for uninsured people, funding may run out. This is problematic because for uninsured individuals or those using an out-of-network provider, hospitalizations for COVID-19 could cost $40,000 to $70,000.<\/p>\r\n - Megan Leonhardt, \u201cUninsured Americans Could Be Facing Nearly $75,000 in Medical Bills if Hospitalized for Coronavirus,\u201d CNBC, 01 April 2020.<\/p>\r\n \r\n \u201cSince the government does not regulate health care costs, laboratory providers can charge $100 to $2,315 for each COVID-19 test. Since certain insurance plans may not cover the entire cost, this means that the provider can bill the remaining balance directly to the patient. Expensive testing costs could further result in higher premiums.\u201d<\/p>\r\n - Sarah Kliff, \u201cMost Coronavirus Tests Cost About $100. Why Did One Cost $2,315,\u201d The New York Times, 16 June 2020.<\/p>\r\n \r\n \u201cRemdesivir is the only known drug to quicken the recovery time for COVID-19. For patients with government-sponsored insurance, the cost for Remdesivir will be $390 per vial or $2,340 per treatment course. For patients with private insurance, the cost will be slightly higher, at $520 per vial or 3,120 per treatment course.\u201d<\/p>\r\n - Gina Kolata, \u201cRemdesivir, the First Coronavirus Drug, Gets a Price Tag,\u201d 29 June 2020.<\/p>\r\n \r\n One common complication of COVID-19 is pneumonia, which occurs when there is an infection in the lungs. In 2018, the cost for pneumonia hospitalizations was about $10,000 to $20,000. Employer-sponsored insurance covered a portion of that, but the average out-of-pocket cost was $1,300.<\/p>\r\n - \u201cWhat Is the Cost Of COVID-19 Treatment,\u201d NPR, 29 March 2020.<\/p>\r\n \r\n Hospitals have reported a 20 percent and 35 percent volume reduction for inpatient and outpatient services, respectively. Due to the decrease in patient volume and the otherwise high costs for COVID-19 treatments, hospitals have reported financial losses. From March to June, hospitals have lost about $200 billion.<\/p>\r\n - \u201cHospitals and Health Systems Continue to Face Unprecedented Financial Challenges Due to COVID-19,\u201d American Hospital Association, June 2020.<\/p>\r\n \r\n \"We estimate total payments to hospitals for treating uninsured patients under the Trump administration policy would range from $13.9 billion to $41.8 billion. At the top end of the range, payments on behalf of the uninsured would consume more than 40% of the $100 billion fund Congress created to help hospitals and others respond to the COVID-19 epidemic.\"<\/p>\r\n - \"Estimated Cost of Treating the Uninsured Hospitalized with COVID-19<\/a>,\" Kaiser Family Foundation, 07 April 2020.<\/p>\r\n \r\n \"... For those with insurance who are using in-network providers, out-of-pocket costs will be a portion of $21,936 to $38,755, depending on the cost-sharing provisions of their health plan.\"<\/p>\r\n \"The Projected Economic Impact of the COVID-19 Pandemic on the US Healthcare System,\"<\/a> Fair Health, 25 March 2020.<\/p>\r\n \r\n From February to May, the number of unemployed individuals increased from 6.2 million to 20.5 million. During the same time period, the unemployment rate increased from 3.8 percent to 13.0 percent.<\/p>\r\n - Rakesh Kochhar, \u201cUnemployment rose higher in three months of COVID-19 than it did in two years of the Great Recession,\u201d Pew Research Center, 11 June 2020.<\/p>\r\n \r\n In June, the unemployment rate fell to 11.1 percent and there were 4.8 million jobs added to the economy. Compared to the February unemployment numbers, there were still 15 million fewer jobs. Due to the second wave of infections, it is likely that businesses could close again, causing unemployment to increase.<\/p>\r\n - Ben Casselman, \u201cAfter June Job Gains, Still a \u2018Deep Hole,\u2019 and New Worries,\u201d The New York Times, 02 July 2020.<\/p>\r\n \r\n From February to April, black adults were 4 percent more likely to be unemployed than their white counterparts.<\/p>\r\n - Elise Gould, \u201cBlack Workers Face Two of the Most Lethal Preexisting Conditions for Coronavirus\u2014Racism and Economic Inequality,\u201d Economic Policy Institute, 01 June 2020.<\/p>\r\n \r\n \"The financial impact of the coronavirus is hitting Americans hard: 33 percent of voters have already lost their job, been furloughed, placed on temporary leave, or had hours reduced, with 41 percent of those who\u2019ve lost a job already reporting having trouble covering basic costs. Black voters are feeling the worst of the financial crisis with almost half (45 percent) reporting they\u2019ve lost jobs, hours, or been put on leave.\"<\/p>\r\n - \"The Staggering Economic Impact of the Coronavirus Pandemic,\" Data for Progress, 09 April 2020. Download the PDF report here. <\/a><\/p>\r\n \r\n \"If initial jobless claims don\u2019t begin leveling off, a 30% unemployment rate<\/a> moves from 'the realm of possibility\u201d to \u201cthe most likely forecast,' said Sahm, a former Federal Reserve economist.\"<\/p>\r\n - Reade Pickert, \"Worst-Case Fears of 20%-Plus U.S. Jobless Rate Are Now Realistic<\/a>,\" Bloomberg, 14 April 2020.<\/p>\r\n \r\n In May, 24.7 million adults reported a late or deferred housing payment for mortgage or rent. For mortgaged households, this included one in eight adults and for rental households, this included one in six adults.<\/p>\r\n - \u201cAdults in Households with Children Report Higher Rate of Late Housing Payments and Food Shortages Amid COVID-19,\u201d United States Census Bureau, 30 June 2020.<\/p>\r\n \r\n In June, half of adults with an income of less than $25,000 had little to no confidence in their ability to pay the next month\u2019s rent or mortgage on time.<\/p>\r\n - Brian Mendez-Smith, \u201cCensus Bureau\u2019s New Household Pulse Survey Shows Who Is Hardest Hit During COVID-19 Pandemic,\u201d United States Census Bureau, 19 June 2020.<\/p>","description_es":"<\/a>","description_fr":""}]}<\/h2>\r\n
Immediate<\/h2>\r\n
Support links to primary care for low-income and minority patients.<\/h3>\r\nStatistically, vulnerable populations are least likely to have access to a general practitioner and this is especially true for people living in the South or in states with minimal access to health programs like Medicaid. We should:\r\n
\r\n \t
Smartly target prevention, testing and treatment for high-risk populations.<\/h3>\r\nIn partnership with local and state public health and social services, we need to focus efforts on those who need it most. This includes testing in health care facilities as well as low-income communities with high rates of hourly essential workers (such as industrial areas and near distribution centers) and areas with high concentrations of older adults (such as known retirement communities), linking these people to the necessary social services they may need. This could include services such as Meals on Wheels or SNAP, or utility assistance through LIHEAP<\/a>. We should:\r\n
\r\n \t
Widely advertise and support available mental health services.<\/h3>\r\nThere is the inevitable mental toll of the pandemic, and particularly so for those that still must interact with others through work and those who had an existing issue, including those addressing addiction. A pandemic not only compounds already existing issues; it can create new anxieties for those who have not previously accessed mental health care. This is especially true for those on the front lines who may be uninsured or underinsured and do not have a mental health provider, and who are now dealing with a pandemic, food insecurity and fear. We can:\r\n
\r\n \t
Ensure uninterrupted supply of medicine.<\/h3>\r\nThis includes support to seniors and others managing prescriptions they now may not be able to afford.\u00a0 Pharmacists are often on the front lines in prescribing to people and may even act as a bridge to care. This could be especially disrupted during this pandemic. We should:\r\n
\r\n \t
Ensure social services aren\u2019t disrupted.<\/h3>\r\nFood banks and other critical community resources are already pushed to the limit, and we\u2019re just at the beginning. Lost jobs mean more demand for social services.\u00a0Kids out of school mean that families have to provide more meals to more children.\u00a0We need to ensure that critical social services \u2014 such as food stamps and utility assistance \u2014 aren\u2019t interrupted. This is particularly important in the South, where the pandemic is expected to hit just as the summer heat waves begin to roll in. We should:\r\n
\r\n \t
Ensure that the United States Postal Service remains in business.<\/h3>\r\nThe USPS should receive Congressional relief through emergency funds, and a task force should be formed to identify and address the USPS's longterm sustainability. Without a doubt, low-income and rural communities will suffer the most without postal service. Storefronts for suppliers such as FedEx and UPS are generally in suburban and urban communities only, and their costs far eclipse that of the postal service. Added social distancing measures make accessing these suppliers even harder. Additionally, poorer and\u00a0rural populations are also less likely to have internet to access correspondence and online systems of care<\/a>.\u00a0Also, keep in mind that many services, including Medicaid in many states, require mailed correspondence to complete registration.<\/a>\r\n\r\nThe ramifications go beyond health issues. Many residents throughout the country rely on mail to cast their vote, and particularly for absentee voting or those in small communities.<\/a> We need this option now more than ever, as we aren\u2019t sure when it will truly be safe to be in groups in public, the most common set-up for voting now. Finally, keep in mind that the USPS employs many veterans \u2013 about three times their share of the national workforce. It\u2019s critical we protect these employees that already face many unique difficulties in the labor market<\/a>.\r\n
Utilize the federal prepaid debit card program to provide relief funds to those without bank accounts.<\/h3>\r\nAs advocated by the Urban Institute, the U.S. Treasury should use its\u00a0federal prepaid debit card program<\/a> to get payments safely to these groups, just as it does for Social Security beneficiaries. The IRS has put in place two primary mechanisms to disperse funds: direct deposit and paper checks, and both can be problematic. And keep in mind \u2013 should the postal service close, the paper checks are not worth the pulp on which they\u2019re written.\r\n
<\/h2>\r\n \r\n
\r\nIntermediate<\/h2>\r\n
Reduce paperwork and other burdens for hospital-based financial assistance.<\/h3>\r\nMany hospital financial assistance policies require patients to provide an extensive list of documentation to prove their poverty and job status, including paperwork from state and local departments that are currently closed during the pandemic. Additionally, many hospitals require in-person consultations to qualify for financial assistance. Finally, many hospitals look at a prior year\u2019s income tax to determine eligibility. That information is likely irrelevant for many, considering nearly 22 million U.S. residents have already filed for unemployment in the last month alone, a figure that\u2019s continuing to sharply rise. \u00a0Keeping federal rules around nonprofit hospital-financial assistance in mind, hospitals should:\r\n
\r\n \t
\r\n \t
Support continued expansion of telehealth services.<\/h3>\r\nSince mid-March, the federal administration expanded Medicare telehealth coverage, which enabled access to many physician services for enrollees from their home. Among gains were limitations on site, including those that excluded many rural communities. Additionally, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), two types of organizations that traditionally serve low-income populations, are now eligible providers. We should:\r\n
\r\n \t
Provide federal subsidies for COBRA coverage.<\/h3>\r\nThis could be particularly important for those who lose their jobs in the middle of the pandemic and cannot afford the usually very high costs to partake in COBRA. We should revive the COBRA subsidy implemented in 2009 under the American Recovery and Reinvestment Act.\r\n
<\/h2>\r\n
\r\nLong-term<\/h2>\r\n
Make the \u201cnew normal\u201d better than the \u201cold normal.\u201d<\/strong><\/h3>\r\nThe issues of health inequities are long-standing, and minorities, low-income populations and those living in rural communities have faced significant barriers to care for decades. What is happening with the pandemic is heartbreaking and, in many ways, amplifies issues that have plagued our communities for too long. Never before have these issues been at the forefront as they are now. Although we may now be experiencing a \"perverse safety net,\" we must ensure that people have access to care and services that they need even without a pandemic. This would not only lessen the burden on individuals, but collectively we would be much more equipped to deal with national hardships. We have enacted many emergency measures to help. We should build upon these, folding in other measures that specifically address the needs of vulnerable populations, knowing that these are the populations that need our help the most now and in the future.\r\n
Expand Medicaid.<\/h3>\r\nCOVID-19 is highlighting a core failing of our health systems in all states, but none as much as those who have so far declined Medicaid funding. Medicaid expansion, which has a 90 percent federal matching rate, offers states the ability to care for tens of thousands of residents. But many have declined, and particularly those in the South, where high rates of chronic conditions and poverty are creating a perfect storm for accelerated infection rates. In the long term, expect even higher rates of uninsured populations in these states, as the economy stumbles to recovery. These people will have limited access to care, relying on already-stressed safety net systems for even the most basic of care.\r\n
Provide sustainable state funding for\u00a0public health departments, community health centers, and charitable clinics.<\/h3>\r\nWe are in the middle of a hard lesson on what it means to continuously defund public and community health for a number of years. Human capital helps drive pandemic response, and cuts to hard-working staff and committed health workers made us ill-equipped to ramp up boots-on-the-ground ways to prevent spread of this virus. States can provide funds earmarked specifically for these groups, utilizing mechanisms such as state associations to distribute funds. This is particularly important in states that have not expanded Medicaid. Please read additional recommendations in our recent editorial for Georgia Health News<\/a>.","description_es":"Translation coming soon.","description_fr":"Translation coming soon."},{"slug":"data-and-statistics","hero_image":null,"header_en":"Things we need to know","header_es":"Things we need to know","header_fr":"Things we need to know","teaser_en":"At the core of sustainable action lies data. Though there is so much we don't know, there are some things we've learned and analysts can predict, all information that can help ready us for the new normal.","teaser_es":"At the core of sustainable action lies data. Numbers can read like sentences, providing direction as to where we should go next. With COVID-19, there is still so much we don't know, but there are some things we are already learning and some things analysts are able to estimate, including projections on potential spikes in uninsured and unemployment rates. ","teaser_fr":"At the core of sustainable action lies data. Numbers can read like sentences, providing direction as to where we should go next. With COVID-19, there is still so much we don't know, but there are some things we are already learning and some things analysts are able to estimate, including projections on potential spikes in uninsured and unemployment rates. ","cta_en":"Read data and estimated impacts for low-income and other vulnerable populations here.","cta_es":"Read the latest data and statistics here.","cta_fr":"Read the latest data and statistics here.","description_en":"Now several months, some data and estimates on the impact of COVID-19 are beginning to emerge. Numbers can read like sentences, providing direction as to where we should go next. The below is a list of some projections and actuals we feel are relevant to the discussion. Note this is an active list; we'll continue to update the information below, adding and subtracting from the below as new data and projections emerge.\r\n\r\n \r\n
Rising poverty levels<\/h3>\r\n
Increased volume of uninsured<\/h3>\r\n
Cost of care<\/h3>\r\n
Unemployment<\/h3>\r\n
Housing<\/h3>\r\n