This is apparent in a variety of ways. Perhaps the most obvious area of vulnerability is the American healthcare system. Some of this fragility is evident in the devastating capacity problems that threaten the system’s ability to care for all the people in the country who will get sick; shortages of reliable Covid-19 tests, ventilators, protective equipment, and intensive care beds are hampering the response to the crisis. The Institute for Health Metrics and Evaluation at the University of Washington estimates that at the pandemic’s peak, the United States will have a shortage of nearly 90,000 hospital beds and almost 20,000 intensive care beds. As reports from the pandemic’s front line are beginning to show, these shortages are putting the lives of both patients and health care workers at risk.
Ten years after the passage of the Affordable Care Act (ACA), moreover, many Americans remain without health insurance. Despite dramatic increases in health insurance coverage since the ACA’s passage, nearly 28 million Americans (about 8.5% of the US population) are uninsured. Given the dramatic increase in joblessness, this number is certain to grow in the coming weeks and months, especially because the Trump administration has declined to open a special enrollment period for people to sign up for health insurance under the ACA. As a recent Kaiser Family Foundation report details, moreover, many uninsured Americans work in jobs that put them at high risk for Covid-19 exposure in industries such as food service, retail, transportation, and health care.
The health insurance gap heightens the risk for the uninsured. The major pandemic legislation passed by Congress and signed by President Trump last week provides for widespread free Covid-19 testing. But free testing is not the same as access to testing. Uninsured Americans are four times more likely than others to have no regular doctor, and three times more likely to postpone seeking medical care because they are afraid of the cost. Without regular access to care, these patients may be more likely to forego testing altogether and thus miss out on needed care.