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Every day, another 20,000 Americans between 20 and 60 years of age could be classified as living with a “preexisting condition” because of COVID-19, researchers from the Commonwealth Fund report.
Overall, the pandemic could cause almost 3.5 million Americans to be added to this category, a fact that has important implications approximately 1 month before the US Supreme Court is expected to weigh in on the constitutionality of the Affordable Care Act (ACA), the investigators note.
“Polls show that most Americans are worried that preexisting conditions could lead to loss of insurance coverage. People are surprised and even more worried when they realize that the pandemic is adding to this problem,” lead author Eric Schneider, MD, PhD, told Medscape Medical News.
The study was posted online in a blog post on October 8 by the Commonwealth Fund.
Schneider, senior vice president for policy and research at the Commonwealth Fund, and research associate Arnav Shah based their calculations on approximately 7.5 million cases of COVID-19 reported in the United States as of October 7, 2020. The figures include an estimated 45,000 new cases reported daily.
Using data from the Centers for Disease Control and Prevention and Johns Hopkins University, they found that 32% of 1,502,309 people with laboratory-confirmed or probable COVID-19 already had an underlying condition. This proportion varied by age.
Table. COVID-19 and Underlying Conditions
|Age in years||Proportion of confirmed or probable COVID-19 cases|
|20 – 29||23%|
|30 – 39||28%|
|40 – 49||36%|
|50 – 59||44%|
|Source: CDC Case Surveillance Task Force data.|
If almost one third already have an underlying condition, this means that for the remaining 68%, insurers might consider COVID-19 their first preexisting condition.
More Than 3 Million Could Be Affected
“We estimated that just over 3.4 million nonelderly adults had COVID-19 as a new pre-existing condition,” the authors write.
“If the Supreme Court overturns the preexisting condition provision of the ACA, private insurers will be able to deny insurance coverage to adults under age 65 who are unable to get insurance through an employer or large group,” Schneider said. “Testing positive for COVID-19 could be treated as a preexisting condition.”
Furthermore, he added, “Because the long-term health effects of COVID-19 are unknown, these adults could be uninsurable until they reach age 65 and qualify for Medicare.”
There could also be economic consequences, Schneider said. “If COVID-19 causes long-term health problems the way hepatitis C or HIV do, these costs could be high for patients, providers, and government programs.”
Removing preexisting condition protections could also act as a disincentive. “Healthy people might avoid COVID-19 testing altogether. And that is exactly the opposite of what must happen if we are ever to get this pandemic under control,” the researchers note.
“A Frightening Picture”
“These findings highlight the importance of preexisting protection,” Nathalie Huguet, PhD, who was not affiliated with the study, told Medscape Medical News.
The results “provide a frightening picture of what the future could be if such protection would be dismissed, with millions of Americans of all ages unable to obtain or afford health insurance,” said Huguet, research assistant professor of family medicine at Oregon Health and Sciences University School of Medicine in Portland, Oregon, and lead author of a study that compared the prevalence of preexisting conditions among community health center patients before and after passage of the ACA.
Considering COVID-19 a preexisting condition might not affect all communities the same, she said. “Even more distressing is that COVID infection is more common in people suffering from health disparities, for example, race and ethnic minorities and low-income patients. As such, the burden of naming COVID as a preexisting condition will likely exacerbate health disparities.”
Even if COVID-19 is not classified as a preexisting condition in the future, some of its long-term adverse health effects ― such as neurologic complications or cardiovascular damage ― could be, Huguet said.
Schneider and Huguet report no relevant financial relationships.
Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and neurology. Follow Damian on Twitter: @MedReporter.