By Catherine Sevier, RN, DrPH
I am sure this is not a mystery to anyone reading a blog on the Care4Carolina website. COVID-19 is the disease that keeps on giving and taking. The pandemic has claimed lives, accelerated already existing societal challenges, and shined a light on the many inequities we face in assuring access to health care.
Keeping me up at night is the disproportionate challenges COVID-19 has placed on the aging population. Among those challenges are the highest mortality rate of all age groups (90+%); the greater risk that symptoms will last more than one month; the growing number of unemployed and their slow path to finding a new job; and the inability to access and afford health care.
Before 2020, the 50+ population was already one of the more highly vulnerable groups seeking access to affordable health coverage and care. Today, more people are struggling to find affordable care and they live with the constant threat that a preexisting condition will make these challenges even greater.
An AARP Public Policy Institute report in 2020 found uninsured midlife adults experience a range of potentially harmful emotions. Uninsured adults experience significantly more stress than those with health insurance coverage. Emotions like long-term stress, depression, and shame can have detrimental effects on health. Before gaining Medicaid coverage, many midlife adults in the AARP study experienced negative emotions related to being uninsured.
Even more negative emotions are rooted by the fact that uninsured people are more likely to go without needed health care than their insured counterparts are. In 2018, one in five uninsured adults went without needed medical care due to cost even as delaying it can exacerbate underlying health conditions, worsen health outcomes, and negatively affect one’s sense of wellbeing.
Here in North Carolina, we also hear from aspiring entrepreneurs and older workers hoping to either start a small business or start their retirement. However, giving up employer-related health benefits is their biggest obstacle given the uncertainties of affordable health coverage options.
While the Affordable Care Act has provided a safe haven for purchasing insurance (even for those with pre-existing conditions), and Medicaid has covered some limited-income and disabled North Carolinians, these programs don’t extend to many who are underemployed or who comprise the working poor. In addition, many family caregivers are forced to leave the workforce or reduce their hours to provide uncompensated care to their loved ones.
In 2020, each of these circumstances has worsened. COVID-19 unemployment in NC has risen, and we are seeing a dramatic growth in the number of uninsured. What was already a significant health care coverage gap in North Carolina is widening.
Furthermore, the disease has disproportionately affected people of color, once again shining a light on the higher mortality rates and disparities in health care. Finally, while there has been some relief provided to those diagnosed with COVID-19, it is unclear what the long-term effects of the disease will be and how the resulting chronic disease management will affect cost of their care and their insurability.
What we do in the aftermath of COVID-19 is not clear to me, thus insomnia persists. I do believe if we enact some of the innovative solutions already on the table, and look boldly for more, we could make a difference to the health of North Carolinians.
There are three thing we can do now that will make a difference:
- Find a legislative pathway that closes the coverage gap for the growing number of uninsured.
- Increase access to healthcare services by updating nursing licensure and removing out of date restrictions on advance practice nurses,
- Expand broadband technology in order to capitalize on telehealth capabilities, especially in rural and underserved areas. These initiatives are all doable in 2021 if our legislature takes action.
AARP in North Carolina is working hard to help people live the kind of lives they want to live as they age. As the state continues to battle the coronavirus pandemic, access to care is even more important for adults of any age who may have untreated health conditions—like type 2 diabetes, chronic kidney disease, or obesity—that increase their risk for serious illness and death from the virus. Now is the time to implement cost-effective ways for the state to improve and maintain our health during the current pandemic and after its eventual end.
Catherine Sevier, RN, DrPH
AARP North Carolina