Editor's Note: For the latest updates on the 2020 coronavirus outbreak, see our news coverage.
March 10, 2020 -- The lack of universal health care and sick time benefits may make Americans more vulnerable to the new coronavirus than they should be, a growing chorus of experts warns.
Without paid sick leave, people may drag themselves to work when ill. And people without insurance may be discouraged from getting tested for the virus, and perhaps eventually, from treatment, if they worry about the costs.
“We live in a free-market economy, fairly unfettered by regulation. This is the time when we face the consequences of that,” says Ellen Ruppel Shell, a journalist and author of the 2018 book The Job: Work and Its Future in a Time of Radical Change.
About 73% of Americans have paid sick time through work, according to the Economic Policy Institute (EPI), a nonpartisan Washington, D.C., think tank. Those who don’t -- more than one-quarter of the workforce -- won’t be able to follow the CDC’s advice to stay home if they’re not feeling well -- unless they want to go without pay, says EPI senior economist Elise Gould.
And even many people who are entitled to sick leave won’t have enough to stay home through a 2-week illness, or the extra days required to care for a sick family member, she says.
Many workers have to be on the job for at least a year to accrue sick days, says Gould, who is now analyzing how many workers have access to adequate sick leave to cope with a COVID-19 infection. At Starbucks, for instance, baristas were offered sick leave for the first time in 2018, and anyone working more than 23 hours a week is entitled to 5 days of sick leave over the course of a year.
But someone with no more than 5 days of sick leave probably isn’t going to stay home if they wake up feeling slightly under the weather -- they’re more likely going to wait until they’re extremely ill, Gould says.
Parents will have an extra challenge if schools are canceled and kids are at home, Gould says. Passing them off to a grandparent for care isn’t a good idea when dealing with a virus that has proven particularly dangerous for people over 60.
Other countries have a different attitude toward sickness and work. In Germany, for instance, employees are entitled to their full pay for up to 6 weeks of sick leave, with the government subsidizing 80% and the employer making up the rest. In Hong Kong, workers get 2 days of sick leave for every month they work in their first year of employment, and 4 days per month after the first year. In one map compiled by the WORLD Policy Analysis Center, a think tank affiliated with the University of California, Los Angeles, the U.S. is one of only a handful of countries -- including India, Liberia, Somalia, Sri Lanka and both Koreas -- that doesn’t provide sick leave from the first day of an illness.
President Donald Trump said Monday that he planned to discuss a way to make sure “hourly wage earners [are] getting help so that they can be in a position where they’re not going to ever miss a paycheck.”
Vice President Mike Pence said that the president’s order is to develop economic policies that “will make it very, very clear that we’re going to stand by those hardworking Americans.”
Details of the administration’s plan were not yet settled.
Furthering the situation, it’s not clear how sick someone has to be to pass on the virus. Some people who are symptom-free have infected others. And although children generally haven’t been getting sick, they may be a source of infection. Maria Van Kerkhove, PhD, head of the World Health Organization’s emerging diseases and zoonoses unit, said at a news conference last week that although people without symptoms can spread the disease, she doesn’t think they’re a major cause of the global outbreak.
Those who are most likely to be financially required to keep working through illness -- people who work in restaurants, nursing homes, and airports, for example -- are also particularly likely to come into contact with many others, Gould notes, making them even more likely to potentially pass on the virus.
A lack of insurance is also a problem in a situation like this, both to individual workers and our society as a whole, Gould and others say.
One Florida man, feeling ill after a recent trip to China, decided to get tested for the new coronavirus -- and was billed $3,270 after finding out he didn’t have it, The New York Timesreported recently.
“Holy moly!” Gould said when she heard that figure. People simply won’t get tested if it’s so expensive, she says. And if they don’t know they’re positive, they’ll be less likely to self-isolate and more likely to pass on the virus.
The cost of coronavirus testing will be covered by Medicaid and Medicare, Pence announced last week. That edict also applies to private insurance companies that are certified under the Affordable Care Act.
But it does not apply to most major private insurance companies. Most of them, however, are also promising to provide at least some coverage for COVID-19 tests. America’s Health Insurance Plans (AHIP), a national trade group, says insurance companies will offer the same coverage for COVID-19 testing as they do for other tests, which require out-of-pocket costs for patients.
AHIP’s board is committed to “working with others to minimize out-of-pocket costs,” including private and public organizations, says Kristine Grow, AHIP’s senior vice president of communications.
That could help the roughly 8.5% of Americans who, according to the U.S. Census Bureau, have no insurance. But many more have copays or other fees that make them hesitant to use the health care system.
“We simply can't have people making decisions about testing with worries about the financial toxicity of health care,” Harlan Krumholz, MD, a cardiologist and health care researcher at Yale University and Yale New Haven Hospital, wrote on Twitter. “This crisis exposes the fragility of our current system and how so many people are vulnerable because they simply can’t afford to be sick,” he wrote in a follow-up email.
Many Americans can’t handle an extra bill, particularly not one of that size, says Janet Kim, a spokesperson for Caring Across Generations, a national advocacy group for seniors and their caregivers. A 2018 survey by the Federal Reserve found that 40% of Americans don’t have enough savings to cover a surprise $400 bill.
If society valued caregivers more, Kim says, they would be paid adequately, and receive health insurance. When they’re sick, they can’t take care of the rest of us, she says. “Really, we’re all interconnected and interdependent. We’d all be healthier and better off if we collectively invested in each other’s well-being.”
Leigh Turner, PhD, an associate professor at the University of Minnesota Center for Bioethics, School of Public Health, and College of Pharmacy, agrees.
The American system has “been criticized for a long time for being a harsh, punitive, unforgiving system where [sick] people are pushed back into the workforce,” he says. “This is when that can potentially become not just an issue for individuals dealing with difficult times, but it can become a real collective public health threat.”
‘This Is a Wake-Up Call’
Kim and Gould say there may be a silver lining to this outbreak: That it will force Americans to reconsider how the employment system is structured and to provide more support to people at the lowest end of the pay scale.
“I think this is a wake-up call to reevaluate and re-prioritize what we want our lives to look like and what we want to invest in and value,” Kim says.
Concern about the new coronavirus, Gould says, should encourage the government to remove these roadblocks to protection, by promising to pay for testing and care, and by guaranteeing people their paychecks even if they are sick with the virus.
“The threat to public health is so great. If you had the will, you could totally change this,” she says. “It’s not some sort of disaster that we’re going [to have] to watch happen. Let’s do everything we can do to be prepared.”
Sara Rosenbaum, JD, a legal expert and health policy professor at George Washington University, argues in a column for the Commonwealth Fund’s health policy blog that the federal government can cover vast numbers of Americans. It’s called Medicaid.Copy
Medicaid is the health insurance policy for millions of low-income and disabled Americans. Each state determines how “low” of an income a person has to have to qualify for Medicaid. Rosenbaum says federal law allows the Department of Health and Human Services to “waive or modify certain provisions of federal Medicaid law to fund states’ efforts to cover additional people, provide services not normally recognized under federal law, and simplify the enrollment and renewal process.”
It’s been done before -- after 9/11 in New York City, after Hurricane Katrina in 2005, and after the Iowa floods of 2008. It could be used, for example, to cover the cost of any future vaccine and to waive cost-sharing for coronavirus diagnosis and treatment. Thus far, she says, the federal government instead appears more focused on offering states “the most limited guidance possible.”
Some states are taking matters into their own hands. California last week announced that residents can file a disability insurance claim if they are unable to work after being exposed to or sickened with COVID-19. They are also entitled to file a paid family leave (PFL) claim if they are caring for an ill or quarantined family member with COVID-19.
“That will really encourage people to stay home. That’s great,” Gould says about the state’s new policy.
Overall, 12 states and Washington, D.C., require paid sick leave, according to the National Conference of State Legislatures.
For most Americans, though, it’s a personal choice whether they can afford to miss work.
Shaista Kazmi, who runs a home care agency in southeast Michigan called Apna Ghar, says her agency is simply too small to offer sick leave or health insurance to its home care workers.
She says another hindrance to taking sick time is that caregivers often lose a prized position when they have to step away for a few days to deal with an illness. Unlike some agencies, hers will guarantee that a worker can return to the same family when they recover. To help her workers, she will also try to slip a caregiver a few extra hours or some gas money to help them make ends meet.
Just the other day, Kazmi says, she got a call from a woman looking for a new caregiver for her mother. The previous caregiver, from another agency, was coming to work so sick that the woman feared for her mother’s health. “They really can’t afford to take that time off,” Kazmi notes. But now, the sick caregiver has no job at all.