Senior Researcher
Thurgood Marshall Institute
America’s ability to limit the death and economic destruction caused by COVID-19 depends on dramatically ramping up testing for the coronavirus – a reality that the President and United States Congress acknowledge with the passage and signing of the most recent coronavirus relief bill that includes $25 billion to expand testing. We must be able to identify who has the disease and then isolate them, if they are not seriously ill, or treat them, if they are.
Testing and treatment are already challenging for people who have health insurance, but present much bigger challenges for those without health insurance — disproportionately low-income people and people of color. This is a particular concern as recent reports show a disproportionately high death rate from COVID-19 in the Black community.
It is definitely not the case that anyone who wants a coronavirus test can obtain one. USA Today reports, “Only three states – New York, Louisiana and Washington – have matched or exceeded the testing rate of South Korea, whose testing procedures experts hold out as a model for the world.” While the U.S. testing rate has been increasing, coronavirus testing is still not widely accessible.
The nearly 30 million Americans who lack health insurance are both more likely to need a coronavirus test and less likely to receive it. Large numbers of the uninsured work in jobs that require frequent contact with the public, which makes them more likely to be exposed to the virus. Uninsured Americans are disproportionately Black and Latinx — communities that may also be at higher risk of dying from COVID-19 because of underlying health problems and socioeconomic disadvantages.
People who lack health insurance are less likely to obtain a coronavirus test for at least three reasons:
(1) because a referral from a provider is typically required for testing and the uninsured are unlikely to have a regular health care provider;
(2) because they may be worried about not being able to pay for the cost of the test (in situations where they can obtain the test for free, they may not be aware of this fact) and the cost of the visit with a physician; and
(3) because they may be worried about not being able to pay for the cost of medical care if they are sick with the disease, so they may be inclined just to tough it out.
The COVID-19 recession has created an additional crisis for our healthcare system. In the last three weeks, America has added nearly 26 million people to the unemployed. Because the country mainly relies on employers to provide individuals with health insurance, a sizeable portion of the newly unemployed will join the ranks of the uninsured. Our current testing and treatment systems are inadequate for many of the people most at-risk of contracting COVID-19
We need a much greater testing capacity. To achieve this, the federal government should use all tools available, including the Defense Production Act, to increase the availability of coronavirus tests. The tests need to be free for everyone, including the uninsured.
Obtaining a coronavirus test should be like obtaining a flu shot. A doctor’s order should not be necessary. We need to develop the system that Donald Trump promised, but we have not yet achieved: anyone who wants a test should be able to get a test.
As testing capacity increases, our testing priorities should include communities with a large percentage of people at high risk of dying from COVID-19 if they become infected. Currently, the data suggests that Black and Latinx communities are at high risk. We now know that people can be infected and asymptomatic. Therefore, it is important that there be extensive testing in Black and Latinx communities to catch infections before they spread widely and before they reach the most vulnerable individuals. As Dr. Mark McClellan of the Duke University Center for Health Policy argues, we need a “robust sentinel surveillance system that routinely monitors for infection among samples of the population to enable early identification of small outbreaks, particularly in vulnerable populations.” Communities of color appear to be vulnerable populations.
Imagine an uninsured, low-wage worker who lives in a crowded family apartment. He gets a coronavirus test and finds out that he is infected with the virus. Now what? Should he go to his crowded apartment and risk infecting the rest of his family?
We must have ways of isolating infected individuals who are not sick. Currently, there are many empty hotels. The federal government can house infected individuals who can’t effectively isolate at home in hotels. This containment would slow the progress of the disease.
What if this man is not merely infected, but develops a severe case of COVID-19? He is uninsured and does not want to accumulate $75,000 in medical debt, much more than he makes in a year. He delays seeking treatment for as long as he can — and infects many people — before he ends up in an emergency room.
Congress could put everyone without health insurance who has a coronavirus infection into a Medicaid or Medicare-like system instantaneously. Before the next pandemic, we could join other countries and implement a universal health insurance system. There are many different ideas from across the globe for how to achieve this type of system.
The greatest coronavirus testing system in the world is useless unless we make sure that the infected can be isolated and the sick can be treated. Currently, in the United States, we don’t.
