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Tuesday, August 16, 2022

What are the implications of prolonged COVID for employment and health coverage?

Long COVID has been described as our “next national health disaster” and the “pandemic after pandemic”, but we know little about how many people are affected, how long it will last for those affected, and how it could change the landscape of employment and health coverage. This policy brief reviews what we know and outlines key questions to consider regarding employment and coverage outcomes. We continue to follow research on who is most at risk for prolonged COVID and whether there are interventions that can reduce its incidence, duration, or severity. The numbers are already grim and infections continue to rise. The newest subvariant—BA.5—Ready Infections vaccinated and people with previous immunity. Vaccines and prior immunity protect against serious illness and death, but it is unclear whether they protect against prolonged COVID. A study of va health system found that the risks of prolonged COVID increased with each subsequent reinfection.

Prolonged COVID involves a range of potentially disabling symptoms and may affect 10 to 33 million working-age adults in the United States (Figure 1). Long-term COVID is not a single condition, but rather “a wide range of new, recurring, or ongoing health problems that people experience after first becoming infected with the virus that causes COVID-19,” according to to the CDC. Patients report a wide range of physical and mental health conditions, including malaise, fatigue, respiratory problems, cardiovascular abnormalities, migraines, and mental health problems. There is no standard presentation or treatment for prolonged COVID. It is a new phenomenon and the ICD-10 The code to identify medical claims was only available in October 2021. It is also unknown how long people with prolonged COVID will stay sick, although one study reported that 29 percent of long-COVID patients had self-reported symptoms for more than a year. The prevalence of long-term COVID is similarly uncertain, with studies finding that the percentage of working-age adults with COVID who develop long-term COVID could be 10 percent, 20 percenteither 33 percent. If we conservatively assume 100 million Working-age adults have been infected, meaning between 10 million and 33 million may have long-lasting COVID.

Preliminary evidence suggests there may be significant implications for employment: Surveys show that among adults with prolonged COVID who worked before infection, more than half are out of work or working fewer hours (Figure 2). Many conditions associated with prolonged COVID, such as malaise, fatigue, or an inability to focus, limit people’s ability to work, even if they have jobs that allow remote work and other accommodations. Two surveys of people with prolonged COVID who had worked before infection showed that between 22% other 27% of those workers were out of work after having prolonged COVID. By comparison, among all working-age adults in 2019, only 7% they were jobless. Given the large number of working-age adults with prolonged COVID, the employment implications can be profound and are likely to affect more people over time. A study estimates that the long COVID already represents 15 percent of job vacancies.

It is too early to have complete data or a clear picture of job outcomes, but there are reports that claims associated with the long COVID are increasing for disability insurance. workers compensationand group health insurance. Those higher claims could increase costs for insurers and eventually, employers. It is unclear how long-term these challenges will be and whether health insurance spending will increase due to the long duration of COVID. It’s also unclear how the job fallout will be distributed across industries, but some industries are likely to be disproportionately affected, particularly those with higher rates of initial infection, such as health care.

There may be significant changes in health coverage associated with the long duration of COVID. More than 60% of working-age adults have health insurance coverage through an employer. Therefore, changes in employment would have significant effects on people’s sources of health insurance. People who are no longer able to work could eventually lose their existing coverage and would also experience a loss of income. Some may recently qualify for help paying for private health insurance through the ACA marketplaces. Others may recently qualify for Medicaid, though eligibility is more limited in the dozen states that haven’t expanded the program. under the ACA. Those with high medical expenses may qualify for Medicaid through medically needy programs

An important question for the future is whether federal disability programs will count the long COVID as a disability. The Office for Civil Rights of the US Department of Health and Human Services determined that for a long time can be a disability under the Americans with Disabilities Act if an individual evaluation determines that it substantially limits one or more major life activities. Despite the recognition that prolonged COVID can be a disability, to qualify for the federal programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), applicants must be unable to work and have health conditions lasting at least a year or more. result in death. At this time, it is not clear how many people with COVID will qualify for disability benefits under this definition. If people with prolonged COVID qualify for federal disability programs, more people will have publicly funded health insurance through Medicare and Medicaid. People who are eligible for SSDI become eligible for Medicare after a 2-year waiting period and people who are eligible for SSI are generally eligible for Health insurance. If people with prolonged COVID are unable to work, federal disability programs could play a key role in helping those patients access the health care they need to get back on their feet.

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