For Those With Chronic Conditions, Being Uninsured During the Pandemic Is Deadly

A perfect storm has formed, and it poses a threat of historic proportions to 133 million Americans living with diabetes and other related chronic conditions like heart disease, cancer and pulmonary disorders. 

On Thursday, we learned that another 4.4 million Americans filed in the previous week for unemployment, bringing the immediate jobless toll from the coronavirus to more than 26 million people. Many of them — like 60 percent of all American adults — have a chronic medical condition, making them uniquely susceptible to the worst of the virus’ outcomes. 

For those who cannot afford to keep purchasing the health care that had previously been covered by their employers, losing their jobs will likely mean losing their health insurance. This combination of unemployment, lack of insurance and chronic illness creates a hyper-vulnerability that will cause the death of tens of thousands more Americans during this pandemic if we don’t act quickly to protect them.

We have known for some time that COVID-19 poses a greater risk of complications for people with underlying medical conditions. Troubling new data from Louisiana’s Department of Health illustrates how severe that risk is: The state reported last week that 95 percent of residents who died from COVID-19 had underlying medical conditions. 

The data also highlight which conditions are most correlated with fatal COVID-19 cases — 41 percent had diabetes, 23 percent had a heart condition and 18 percent had lung disease. This pattern is not unique to Louisiana: Texas reports show that over a quarter of Dallas County’s coronavirus patients have diabetes.

Experts predict this pandemic will cause at least 60,000 U.S. casualties. If Louisiana’s and Texas’ data foretell national outcomes, 57,000 of those deaths will be Americans with serious underlying medical conditions. That is more than 30 times the number of lives lost in Hurricane Katrina and over eight times the number of Americans killed in the Iraq and Afghanistan wars combined. This, we are told, is likely the best-case scenario.

As the head of the American Diabetes Association, I hear daily from our community that those who have lost their jobs are terrified. They fear that not only will they be unable to afford basic medical necessities such as insulin, but they will be helpless to seek treatment for this new virus that could claim their life. More than offering them hope, we urgently need to achieve continuity of coverage for all Americans, especially those with chronic conditions.

Continuity of coverage is an issue of basic health rights and also a strong strategy to slow the spread of this pandemic. It’s well-documented that the uninsured are slower to seek medical treatment and end up sicker than they otherwise would be. 

People with pre-existing conditions who delay treatment for COVID-19 likely will become sicker, and faster. And given the highly contagious nature of the threat, delaying treatment puts their families, friends and neighbors at heightened risk, too. With unemployment predicted to surge to 20 percent near-term, the most pressing issue now facing our nation’s leaders is getting and keeping people insured, even if they lose their jobs.

There are attainable solutions at policymakers’ fingertips. If the White House will not do it, legislators can mandate “special enrollment periods” to let more people into federal exchanges. They can automatically (if temporarily) enroll newly unemployed people with chronic conditions into Medicaid. 

Congress could also require employers to cover short-term insurance premium costs for laid-off workers and reimburse them with offsetting tax credits. Even though they can “pay to stay,” most employees do not keep their plans after losing their jobs because they cannot afford them. If premiums are covered for workers laid off during the outbreak, thousands more people could get the life-saving medical attention they need, changing the course of this national emergency.

Congress has made some monumental progress in response to this crisis, including the recently passed $2.2 trillion CARES Act. But we in the public health community know more intervention is necessary, and we know where it’s needed. 

Americans struggling with diabetes, heart disease, cancer and other chronic conditions need help most acutely, and those among them who lose their jobs are in the greatest danger. The question isn’t whether Washington should help them — it’s whether policymakers will take bold action before it’s too late. 


Tracey D. Brown, who lives with type 2 diabetes, is chief executive officer of the American Diabetes Association, the nation’s largest voluntary health organization and a global authority on diabetes.

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A previous version of this op-ed incorrectly stated that newly unemployed people with chronic conditions should be automatically and temporarily enrolled in Medicare.

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