The novel coronavirus has exposed and exacerbated existing weaknesses that have long been the focus of the Commonwealth Fund’s Scorecard on State Health System Performance . First, because most Americans get their health insurance through an employer, recent job losses have widened coverage gaps that existed prior to the crisis. The Urban Institute projects that 10 million people will lose their employer coverage by year’s end, leaving 3.5 million uninsured. 1 The loss of job-based coverage has also brought into sharp relief the impact of states’ decisions not to expand Medicaid eligibility for low-income residents; 12 states have yet to expand their programs as allowed under the Affordable Care Act (ACA). 2
Second, Black, Latino, and other communities of color, already more likely to be uninsured, have been disproportionally burdened by COVID-19 and the related economic fallout. Systemic racial and ethnic inequities in health care access and quality have contributed to higher hospitalization and mortality rates from COVID-19 among Black, Latino, American Indian, and Alaska Native individuals, among others.
Third, the pandemic has exposed the vulnerability of health providers reliant on the fee-for-service payment system. Many are facing steep revenue losses and the threat of closure as social-distancing restrictions, fear, and a nose-diving economy have driven down both the supply and demand for routine and elective care. 3
Finally, the country faces many unanswered questions on the extent to which COVID-19 and the ongoing economic fallout will contribute to suicides, deaths from alcohol and substance use, and further erosion of Americans’ life expectancy.