Our Nation Was Utterly Unprepared for This

Greg Sargent discusses some of the same overlapping trends I wrote about yesterday. For example, yesterday I said that you look at the map of where people have been doing the least sheltering in place, it looks remarkably like the map of where Medicaid hasn’t been expanded.

Sargent writes,

What’s coming is a kind of perfect storm, according to experts I spoke with: Soaring unemployment risks pushing huge numbers of people into the ranks of the uninsured. Many of those people will probably seek Medicaid coverage, further straining state budgets.

Add into that combustible mix a coming wave of coronavirus cases, and you have what health economist Austin Frakt described to me as a “looming catastrophe.”

This may be felt with great intensity in the south. That’s because in that region, there is a developing situation that could prove very distressing in coming weeks. On one hand, there hasn’t been enough social distancing in these places. On the other, many of those states have not opted into the Medicaid expansion, which could make the health care crisis far more acute.

A great many people right now are losing their jobs and thereby their health insurance. Most probably qualify for COBRA, but the bite with COBRA is that it is grossly expensive, and if you don’t have other income coming in you may not be able to afford it. However, I understand that people who have recently lost jobs have a grace period with which to purchase insurance in the ACA marketplaces, possibly qualifying for subsidies.

But if you didn’t have insurance to begin with, the national ACA marketplace is closed to you. And Trump won’t open it. “Numerous Democratic-leaning states that run their own insurance markets have already reopened enrollment in recent weeks as the coronavirus threat grew,” it says in Politico. The Trump administration oversees enrollment for about two-thirds of states.

(According to this page, the states that completely run their own insurance markets are Washington, Idaho, Nevada, California, Colorado, Minnesota, Vermont, Massachusetts, New York, Connecticut, Rhode Island, Maryland, and the District of Columbia. A few states — Oregon, New Mexico, Maine, Pennsylvania, Virginia, and New Jersey — may be transitioning to a state-based platform. Arkansas and Kentucky have state-based marketplaces on the federal platform which I suspect would stop them from opening the enrollment period now. Everyone else is completely at the mercy of Trump.)

Anyway, put together the soaring unemployment numbers, the huge percentage of the population without health insurance, and the strain on the medical care system, and you’ve got a catastrophe that won’t go away when the pandemic ends. It will be with us for quite a while. And it’s going to hit the south and big chunks of the midwest (see maps above) especially hard.

Back to Greg Sargent:

“What it means is a lot more hardship, health problems and death,” Frakt, the health economist, told me. Frakt noted that the virus is now likely to spread in those regions, which will dovetail in a terrible way with the failure to expand Medicaid.

“People who have lost their jobs and have nowhere else to turn,” if they can’t get on Medicaid, “they’ll have great difficulty affording the care they’ll need,” Frakt said.

Or, as Larry Levitt of the Kaiser Family Foundation bluntly put it, “poor people in states that haven’t expanded Medicaid” will have “no help.” And those ranks will swell. …

…Ominously, in some of these states, cases are mounting. As of now, Florida has over 9,000 confirmed cases; Georgia has nearly 5,500; Texas has nearly 5,000; Tennessee has nearly 3,000; and North Carolina has nearly 2,000.

And then there is the economic hit the nation is taking. Paul Krugman discusses it here, basically saying that it doesn’t necessarily have to be a long-range economic disaster except that the Trump Administration is in charge. So it probably will be.

Other Stuff to Read

Michelle Goldberg, Putting Jared Kushner In Charge Is Utter Madness

Paul Waldman, Trump’s ignorant son-in-law is running the coronavirus response. That’s unacceptable.

Paul Waldman, How this crisis could help us get to health-care reform

Charles Pierce, Robert Kraft Did a Good Thing. Now What Happens to Other States Without an NFL Team?

DALLAS, TX – SEPTEMBER 14: Republican presidential candidate Donald Trump speaks during a campaign rally at the American Airlines Center on September 14, 2015 in Dallas, Texas. More than 20,000 tickets have been distributed for the event. (Photo by Tom Pennington/Getty Images)