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As the coronavirus pandemic began to hit the United States, health systems were advised to delay non-essential health procedures in an attempt to stretch our already severely limited resources to cover the expected surge in coronavirus cases. And, as the number of COVID-19 cases has mounted across the country, fear of contracting the virus has kept people from going to the hospital if they experience a health emergency, or traveling to see their doctor for their own routine care, or their children’s pediatric checkups or routine immunizations.
While this guidance is necessary and the fear is understandable, it’s also clear that not everyone can safely delay “non-essential” care. For instance, those with chronic conditions often rely on routine medical care to manage these conditions and keep them from spiraling into an acute medical crisis. Approximately 6 in 10 U.S. adults have at least one chronic condition, such as asthma, diabetes, kidney disease, cardiovascular disease, hypertension, substance use disorder and/or pulmonary disease. People of color experience disproportionate rates of chronic disease due to factors like structural racism, income inequality and high rates of being un- or under-insured. In the era of COVID-19, people with chronic conditions find themselves both at higher risk of a severe course of illness should they contract the virus, and with more barriers to accessing maintenance care they need for their underlying conditions.
Fewer Support Services
Some of the delayed medical services include many essential services that individuals with chronic conditions rely on such as routine or preventative screenings, physical therapy and behavioral health care. Home visits from personal care attendants or community health workers may have also been cancelled or severely reduced.
Medication and Supply Shortages
People with chronic conditions may also have trouble filling their prescriptions and securing medical supplies. As COVID-19 cases have filled hospitals, demand for certain medications has skyrocketed along with the demand for personal protective equipment (PPE). Among the medications with increased demand is albuterol, typically used to treat asthma, and hydroxycloroquine, a critical medication for individuals with lupus that is now in short supply. Indeed, there have been reports of people with lupus having difficulties getting their prescriptions refilled. Other shortages include rubbing alcohol, which is often used by people with diabetes to clean their skin before injecting insulin, and other cleaning supplies which are vital for individuals who are immunocompromised.
Barriers to Telehealth
While telehealth has helped many people reach a provider during this time of crisis, reliable broadband is not universally accessible. The Pew Research Center estimates that 10 percent of U.S. adults do not use the internet. Low-income and rural communities have particularly poor access to broadband services. The lack of reliable internet access only compounds the existing disparate impact on rural areas which have both a higher incidence of chronic disease and lower access to in-person and virtual support services. Telehealth may also not be accessible for people with disabilities, either because the telehealth platform or website is inaccessible, but also because coverage for telehealth services, including telephone only appointments, is still not universal. Telemedicine also requires a private place to have a confidential conversation with your provider, something many people don’t have.
Policy Interventions
The COVID-19 pandemic has exposed critical flaws in our health system for people with chronic illness and disease. There are policy changes we can put in place now to help ease the burden individuals with chronic conditions are facing. First and foremost, the federal government should invest in Medicaid to increase its share of funding for the program, known as FMAP (federal medical assistance percentage), in a way that helps all states absorb new demand, including those that have not yet expanded Medicaid. In addition, we recommend the following changes:
- Guarantee patient access to telehealth through all health plans and at all levels of care. All insurance plans should cover telehealth services at parity with in-person care.
- Create equitable access and payment for telehealth services. Audio-only should be fully reimbursed at the same rate as a video telehealth visit to ensure that poor internet connectivity or lack of video conferencing ability do not hinder access to care.
- Expand access to paid leave and eliminate exemptions. Paid leave should be available to individuals who must attend to their own medical conditions and those who have been advised to self-quarantine due to exposure or high-risk status.
- Direct additional funding to under-resourced communities to support the health and financial security of essential workers. This includes home health workers, community health workers, peer support workers and others who provide front line care.
- Address critical social determinants of health, for example by expanding and enhancing SNAP benefits and suspending SNAP administrative rules that would terminate benefits.
The House HEROES bill released on May 12 is a step in the right direction, addressing some, but not all, of these recommendations.
While the initial wave of COVID-19 infections is appearing to gradually subside in some parts of the United States, we still have the highest number of cases in the world and we cannot lose our vigilance or cease federal support. A second wave is on the horizon – one that will coincide with seasonal flu in the fall. As the months of the calendar tick off, attending to chronic medical needs may shift from being “non-essential” to urgent, and no longer able to be put on hold. Now is the time to put planning for the care of people with chronic conditions front and center.