The Added Challenges of a Pandemic Without Universal Coverage in America

Blog by Sonia Ruparell

Photo courtesy of the author


A 25 year-old woman walked into the ER carrying a portable oxygen tank, wearing a colorful homemade mask. I noticed her heart rate was high as she laid down on the gurney, complaining of terrible pain in her arms and legs. In her backpack was a notebook with all of the medications she was taking, written out neatly line by line: Hydroxyurea, Plaquenil, Imuran, Tizanidine, Dilaudid, Promethazine, Prednisone—the list went on. She had a carefully labelled pill pack that contained the many medications she took for pain.

She told me she had a history of Sickle Cell Disease, Antiphospholipid Syndrome and Lupus – all chronic conditions that require a lot of medical care. She rolled up her sleeve to reveal a catheter that helps deliver medication closer to the heart.

I found out she had a port (a more direct venous entry into the chest) but it was removed recently due to a blood clot that formed inside of it. She arrived from Texas two weeks ago and planned to go back to get a new port and remove staples that were covering a fresh wound where her previous port had been. A pain crisis brought her to the ER, a common complication of Sickle Cell Disease.

I wondered why she was in New York seeking care instead of in Texas. It turned out that she had left Texas because she’d been furloughed from her job as a teacher. Unable to pay her rent, she was evicted, and with nowhere else to go, she’d flown here to stay with her grandmother.

In medicine, we use the term “medical home” to describe the place where patients receive most of their care. It is always safer and easier to coordinate a patients’ care at their medical home, rather than across different hospitals. Hers was in Texas, not New York—she’d traveled here as an immunosuppressed individual with three chronic conditions, to the epicenter of the pandemic, putting not only her own health at risk, but the health of her grandmother as well. All this despite clear federal government and CDC recommendations not to travel. She didn’t do this to defy recommendations or because she wanted to leave her friends and community. She was forced to leave because she could no longer afford food, rent, medicine or medical care. In short, she had nowhere else to go.

We need to acknowledge that while the current situation puts a spotlight on the stories of patients like this young woman, they are not unique to this moment. I see patients frequently who miss appointments and fail to take necessary medication after losing their jobs because they can’t afford them. I wish these cases were few and far between, but they’re not.

The stories we have heard about so many times in recent weeks were a reality for millions of Americans before the pandemic started. In 2018, up to 27.5 million individuals were living in the United States without health insurance. This marked an increase from 25.6 million individuals in 2017 – largely the result of rollbacks of legislation related to the Affordable Care Act.

I’m scared to think about all the secondary health impacts that will come from the economic downturn due to COVID-19. Most Americans rely on employer-based health insurance to pay for their medical care. From 2008-2018, about 55% of Americans received health insurance through their employer.

We are currently swimming in uncharted seas and drowning. Compared to the 8.8 million jobs that were lost over three years during the Great Recession. What will happen to those 30 million individuals and their families if they get sick? How many are already sick?

If it wasn’t already clear during the Great Recession, it should be exceedingly clear now: the American healthcare system is not designed to handle massive layoffs. An economic downturn should not prohibit individuals from seeking healthcare. If there was ever a time to create a system that guaranteed universal coverage, that time is now.


Sonia Ruparell (MD) is a Pediatric Resident at Weill Cornell Medical Center of New York, Member of the American Academy of Pediatrics and Member of the Council for Sports Medicine and Fitness. She is a graduate of the Royal College of Surgeons, in Dublin, Ireland. She tweets at @soniaruparell.

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