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Understanding the intersection of COVID-19 and SDoH.

Over the past 20 months, I’ve reviewed countless nooks and crannies of COVID’s intersection with the social determinants of health (SDoH). One issue not addressed is the societal shift in insurance, from private and commercial plans to public options.

The U.S. Census Bureau has provided current demographical statistics on this topic, which should constitute information of interest to every healthcare organization.

The Bureau’s latest report, Health Insurance Coverage in the United States: 2020, looks at the breakdown across all coverage sectors:

  • Private coverage:
    • Employment-based: provided by employer or union;
    • Direct-purchase: purchased directly from an insurance company, or federal or state marketplace (e.g., healthcare.gov); or
    • TRICARE (formerly CHAMPUS).  
  • Public Coverage:
  • Medicare;
  • Medicaid and the Childrens Health Insurance Plan (CHIP); and
  • CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), and care provided by the Department of Veterans Affairs (VA) and the military.
     

Those without these coverage options are considered uninsured, along with persons only having coverage through the Indian Health Service, since this coverage is not considered comprehensive.

The report lowdown provides interesting considerations:

  • A total of 8.6 percent of Americans, 28 million, did not have health insurance at any point during the year.
  • A total of 91.4 percent had some type of health insurance for all or part of 2020.
  • A total of 66.5 percent of the population had private insurance, versus 34.8 percent with public.
  • Employment-based insurance was the most common type of insurance, at 54.4 percent.
  • The public coverage options included Medicare at 18.4 percent, then Medicaid at 17.8 percent, and direct-purchase coverage at 10.5 percent of the population.
  • TRICARE was at 2.8 percent, and CHAMPVA was at slightly under 1 percent of the population.
  • The overall rate of public health insurance rose to 34.8 percent.
  • The number of uninsured children under the age of 19 rose to 9.3 percent; this is a disparity with data released by CMS state records, which showed a 15.6-percent increase in the number of Medicaid and CHIP enrollees from February 2020-March 2021: over 10 million people.

Report reviewers were quick to note how the data reflected the pandemic’s impact: more people started relying on public insurance options, there were dramatic increases in families relying on CHIP, and there was a troubling rise to almost 10 percent of children now living below the poverty level (a story I reported on last week). The formal report is available through the U.S. Census Bureau website, with associated links in my story this week for RACmonitor. Data on Medicaid expansion and non-expansion states is also provided, a topic of ongoing scrutiny.

At the end of the day, close to 12 percent of the population lacked health insurance, the composition of that group being Hispanic (24.9 percent), Black (14.3 percent), and whites and Asians (7.7 percent). Hospitals provided $41.6 billion in uncompensated care in 2019, with the number expected to skyrocket for 2020! We’ve got miles to go before we sleep in addressing this challenge.

This week’s Monitor Mondays survey explored the impact of these trends on our listeners’ organizations; it asked what the applicable shift most noticed. Review this week’s, and other recent survey results, at Monitor Monday Survey Results.

Programming Note: Listen to Ellen Fink-Samnick’s live reporting on the social determinants of health, Mondays, on Monitor Mondays, 10 Eastern.

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