What are the implications of a long COVID for employment and health insurance?

Long COVID has been described as our “next national health disaster” and the “pandemic after the pandemic,” but we know little about how many people are affected, how long it will last for those affected, and how it may change the employment and health coverage landscapes. This policy watch reviews what we know and outlines key issues to watch for regarding employment and coverage outcomes. We continue to monitor research on who is most at risk of prolonged COVID and whether there are interventions that can reduce its frequency, duration or severity. The numbers are already frightening and infections continue to grow. The newest subvariant — BA.5 — easily infects vaccinated and previously immune individuals. Vaccines and previous immunity protect against severe illness and death, but it is unclear whether they protect against prolonged COVID. A VA health care system study found that the risks of prolonged COVID increased with each subsequent re-infection.

Prolonged COVID includes a range of potentially debilitating 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 they were first infected with the virus that causes COVID-19,” according to the CDC. Patients report a wide range of physical and mental health conditions, including malaise, fatigue, breathing problems, cardiovascular abnormalities, migraines, and mental health impairments. There is no standard presentation or treatment for prolonged COVID. This is a new phenomenon, and the ICD-10 code for identifying medical claims only became available in October 2021. It is also unknown how long people with long-term COVID will stay sick, although one study reported that 29 percent of long-term patients COVID self-reported symptoms for more than a year. The prevalence of prolonged COVID is equally uncertain, with studies finding that the percentage of working-age adults with COVID who develop prolonged COVID may be 10 percent, 20 percent, or 33 percent. If we conservatively assume that 100 million working-age adults have been infected, that means 10 to 33 million may have long-lasting COVID.

Preliminary data suggest that there may be significant employment implications: Studies show that among adults with long-term COVID who were working 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 inability to concentrate—limit people’s ability to work, even if they have jobs that allow telecommuting and other conditions. Two studies of people with prolonged COVID who were working before infection found that between 22% and 27% of these workers were out of work after getting prolonged COVID. By comparison, among all working-age adults in 2019, only 7% were unemployed. Given the large number of working-age adults with prolonged COVID, the implications for employment may be profound and are likely to affect more people over time. One study estimates that prolonged COVID already accounts for 15 percent of job vacancies.

It’s too early to have comprehensive data or a clear picture of employment outcomes, but there are reports that long-term COVID-related claims are up for disability insurance, workers’ compensation and group health insurance. These higher claims could increase costs for insurers and ultimately employers. It is unclear how long-term these challenges will be and whether health insurance costs will increase due to prolonged COVID. It’s also unclear how the employment implications will spread across industries, but some industries are likely to be disproportionately affected — especially those with higher rates of initial infection, such as health care.

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

An important question for the future is whether federal disability programs will count long COVID as a disability. The Office for Civil Rights at the US Department of Health and Human Services has determined that prolonged COVID can be a disability under the Americans with Disabilities Act if an individual evaluation finds that it significantly limits one or more major life activities. Despite the recognition that prolonged exposure to COVID can be a disability, in order to qualify for federal programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), applicants must be unable to work and have ongoing health problems at least one year or resulted in death. At this point, it is unclear how many people with long-term COVID will qualify for disability benefits under this definition. If people with long-term 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 usually eligible for Medicaid. If people with prolonged COVID are unable to work, federal disability programs can play a key role in helping these patients access the health care they need to recover.

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