What are the implications of a long 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 the number of people affected, how long it will last for those affected and how it might change the situation. employment and health coverage landscapes. This policy watch reviews what we know and outlines key issues to monitor regarding employment and coverage outcomes. We continue to track research to find out who is most at risk for long COVID and if there are interventions that can reduce its incidence, duration, or severity. The numbers are already impressive and infections continue to rise. The new sub-variant – BA.5 – easily infects vaccinated and already immunized people. Vaccines and prior immunity protect against severe illness and death, but it is unclear whether they protect against long COVIDs. A VA Health System study found that the risks of long COVID increased with each subsequent reinfection.
Long COVID involves a range of potentially disabling symptoms and can affect 10 to 33 million working-age adults in the United States (Figure 1). Long COVID is not a single condition but rather “a wide range of new, recurring, or persistent health problems that people experience after they are first infected with the virus that causes COVID-19,” according to the CDC. . Patients report a wide range of physical and mental health issues, including malaise, fatigue, difficulty breathing, cardiovascular abnormalities, migraines, and mental health disorders. There is no standard presentation or treatment for long COVID. This is a new phenomenon and the ICD-10 code for identifying medical claims only became available in October 2021. It is also unclear how long people with long-term COVID will remain ill , although one study reported that 29% of patients with long-lasting COVID were self-reported. symptoms for over a year. The prevalence of long COVID is also uncertain, with studies finding that the percentage of working-age adults with COVID who develop long COVID could be 10%, 20%, or 33%. If we conservatively assume that 100 million working-age adults have been infected, that implies that 10 to 33 million could have long COVID.
Preliminary data suggests there could be important implications for jobs: Surveys show that among adults with long-term COVID who were working before infection, more than half are unemployed or working less than hours (Figure 2). Many conditions associated with long COVID, such as malaise, fatigue, or the inability to concentrate, limit people’s ability to work, even if they have jobs that allow remote work and other accommodations. Two surveys of people with long COVID who had worked before infection showed that between 22% and 27% of these workers were out of work after contracting long COVID. By comparison, of all working-age adults in 2019, only 7% were unemployed. Given the large number of working-age adults with long COVID, the employment implications can be profound and are likely to affect more people over time. A study estimates that the long COVID already accounts for 15% of unfilled jobs.
It’s too early to have complete data or a clear picture of employment outcomes, but reports indicate that claims associated with the long COVID are increasing for disability insurance, workers’ compensation and group health insurance. These higher claims could increase costs for insurers and, possibly, employers. It is unclear how long these challenges will last and whether health insurance spending will increase due to the long duration of COVID. It’s also unclear how the employment consequences will be distributed across industries, but some industries are likely to be disproportionately affected, particularly those with higher initial infection rates, such as health care.
There may be significant changes in health coverage associated with the long COVID. More than 60% of adults of working age are covered by health insurance with an employer. Changes in employment would therefore have significant effects on people’s sources of health insurance. People who are no longer able to work could eventually lose their current coverage and also suffer a loss of income. Some may newly qualify for help paying for private health insurance through ACA Marketplaces. Others could newly 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 might qualify for Medicaid through medically needy programs.
An important question for the future is whether federal disability programs will long count COVID as a disability. The Office of Civil Rights within the US Department of Health and Human Services has determined that long COVID may be a disability under the Americans with Disabilities Act if an individual assessment determines that it significantly limits one or more major life activities. Despite the recognition that long COVID can be a disability, to be eligible for federal programs, Social Security Disability Insurance (SSDI), and Supplemental Security Income (SSI), applicants must be unable to work and have health problems that last at least a year or lead to death. At this point, it’s unclear how many people with long-term COVID will qualify for disability benefits under this definition. If people with long COVID qualify for federal disability programs, more people will have state-funded health insurance through Medicare and Medicaid. Persons eligible for SSDI become eligible for Medicare after a 2-year waiting period and persons eligible for SSI are generally eligible for Medicaid. If people with long-term COVID cannot work, federal disability programs could play a key role in helping these patients access the health care they need to recover.