Uninsured and unvaccinated: Worries of surprise bills may be holding some back from COVID shot - The News Leader
Uninsured Americans do not have a family doctor. Their family doctor is the nearest emergency department. After they leave the hospital, the medical bills start arriving in the mail.
One trip to the ER could leave a person in debt for years. A hospital stay might even cost someone their house.
Any chance of climbing out of debt is obliterated when hospitals send past-due bills to collection agencies who then report to credit bureaus. The uninsured person can't qualify for a loan to help pay off their medical bills now that their credit is destroyed. Sometimes, they can't even qualify for a lease on a place to live. Filing bankruptcy may be the only way out of debt, but the damage is already done.
The government promises that COVID-19 vaccines are free for everyone living in the United States.
"Frankly, people who lack health insurance have reason to be skeptical of that promise," said Colin Planalp, senior research fellow for the State Health Access Data Assistance Center at the University of Minnesota.
"It is entirely reasonable to expect that while they're promised that their COVID vaccine will be free that they will end up getting a surprise bill later."
This level of distrust felt by many Americans was identified by SHADAC, an organization that helps to inform state governmental agencies on public health policies.
The group focused on predicting COVID-19 vaccination rates by looking at adult flu vaccination patterns using the CDC's Behavioral Risk Factor Surveillance System Data to determine challenges among key population subgroups and disparities. Most adults don't regularly get vaccines, except when it comes to yearly flu shots. This allowed SHADAC to get a proxy for challenges in COVID vaccination among adults.
"One issue that has not gotten the attention it should, especially if you're talking about a region like the Southeast, is the relationship between vaccination status and health insurance," said Planalp.
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28 million people are uninsured
Twenty-eight million Americans, a total of 8.6% of the population, didn't have health insurance in 2020, according to the Census Bureau's 2020 report.
"The biggest statistically significant difference we see in vaccination rates is between the uninsured and the insured," said Planalp. "People without insurance have a vaccination rate that is less than half of those people with health insurance."
States, particularly in the southeast and those without Medicaid expansion, would see lower COVID vaccination rates and higher COVID-19 infection rates.
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With media reports about mistaken COVID vaccine bills people should have never received, people without insurance have plenty of reason to be suspicious of those promises, said Planalp. "Because they don't always bear out. Because for many of these people, their experiences have shown that the U.S. healthcare system doesn't serve people without health insurance very well."
Individuals left behind by a healthcare system that kicked them to the curb, or more precisely, in the gap.
Now, tell them they have to enter their health insurance information (that they don't have) for administrative costs (that they aren't going to be charged for), you further compound vaccine hesitancy.
Mix in the psychologically demeaning process of filling out a registration form that asks them to take a picture of a health insurance card they don't have. Hard-working Americans who live in states where they don't make enough money to qualify for Affordable Health Care but make too much money to qualify for Medicaid.
They glance over at a pile of medical bills on their kitchen table. Many of them unexpected.
While minor details, such as vaccine administrative costs and entering health insurance information, may seem benign to a person who enjoys the privilege of health insurance in America, it's another example of the government saying one thing and then doing another.
To date, 39 states (including D.C.) have adopted Medicaid expansion and 12 states have not adopted the expansion, according to the Kaiser Family Foundation. In Virginia, the General Assembly approved Medicaid expansion, effective Jan. 1, 2019.
Coverage under Medicaid expansion became effective Jan. 1, 2014 except for the following 14 states:
- Michigan (Apr. 1, 2014)
- New Hampshire (Aug. 15, 2014)
- Pennsylvania (Jan. 1, 2015)
- Indiana (Feb. 1, 2015)
- Alaska (Sept. 1, 2015)
- Montana (Jan. 1, 2016)
- Louisiana (July 1, 2016)
- Virginia (Jan. 1, 2019)
- Maine (Jan. 10, 2019; coverage retroactive to July 2, 2018)
- Idaho (Jan. 1, 2020)
- Utah (Jan. 1, 2020)
- Nebraska (Oct. 1, 2020)
- Oklahoma (July 1, 2021)
- Missouri (Oct. 1, 2021; coverage retroactive to July 1, 2021)
(Data: Kaiser Family Foundation)
Early in the pandemic, efforts were focused on decreasing un-insurance rates when people were losing jobs at an exponential rate, but when it looked like COVID vaccines would become available in late 2020 to some people and most of the population in early 2021, SHADAC knew there were certain pockets of people in the country who are underserved by the U.S. healthcare system and public health system.
Now, Planalp said, it's about finding the best ways to reach out to them.
Monique Calello (she/her) is The News Leader's health reporter. Story ideas? I want to hear them. Please email me at [email protected] Follow me on Twitter @moniquecalello.
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