The long covid has been described as “oursthe next national health disaster” and “pandemic after 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 hour examines what we know and outlines key questions to address about employment and coverage outcomes. We continue to follow research on who is most at risk of prolonged COVID and whether there are interventions that can reduce its incidence, length or severity. The numbers are already frightening and infections continue to rise. The newest subvariant –BA.5- infects easily vaccinated and persons with previous immunity. Vaccines and earlier immunity protect against severe disease and death, but it is unclear whether they protect against long-term COVID. A study of VA Health System found that the risks of prolonged COVID increased with each subsequent reinfection.
Prolonged Covid includes a range of potentially disabling 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 “a wide range of new, reoccurring, or ongoing health problems that people experience after they are first infected with the virus that causes COVID-19,” according to to the CDC. Patients report a wide range of physical and mental health conditions, including malaise, fatigue, breathing challenges, cardiovascular abnormalities, migraines, and mental health impairments. There is no standard presentation or treatment for long-term COVID. It is a new phenomenon ICD-10 the code to identify medical claims only became available in October 2021. It is also not known how long people will stay sick with COVID, although one study reported that 29 percent of long-term COVID patients had self-reported symptoms for more than a year. The prevalence of prolonged COVID is equally uncertain with studies finding that the proportion of working-age adults with COVID who develop during COVID may be 10 percent, 20 percentor 33 percent. If we assume conservatively 100 million Working-age adults have been infected, meaning 10 to 33 million may have long had COVID.
Preliminary evidence suggests that there may be important implications for employment: Surveys show that among adults with long-term COVID who were working before infection, over half are out of work or working fewer hours (Figure 2). Many long-term COVID-related conditions — such as fatigue, fatigue, or the inability to concentrate — limit people’s ability to work, even if they have jobs that allow for telecommuting and other accommodations. Two surveys of people with long-term COVID who had worked before infection showed that between 22% AND 27% of those workers were out of work after a long time with COVID. In comparison, only among all working-age adults in 2019 7% they were unemployed. Given the large number of working-age adults with prolonged COVID, the employment implications could be profound and will likely affect more people over time. A study estimates that the long Covid already constitutes 15 percent of jobs unfilled.
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 increasing for disability insurance. workers’ compensation, and group health insurance. These higher claims may increase costs to insurers and eventually, employers. It is unclear how long-term these challenges will be and whether health insurance costs will increase due to prolonged COVID. It is 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 related to prolonged COVID. Over 60% of working age adults have their own health insurance coverage through an employer. Therefore, changes in employment would have significant effects on people’s health insurance resources. People who are no longer able to work may eventually lose their existing coverage and would also experience a loss of income. Some may be newly eligible for help paying for private health insurance through the ACA marketplaces. Others may become newly eligible for Medicaid — though eligibility is more limited in dozens of states that haven’t expanded the program under AKK. Those with high medical expenses may qualify for Medicaid through medically necessary programs.
An important question for the future is whether federal disability programs will count for a long time as a disability. The Office for Civil Rights within the US Department of Health and Human Services determined that the long-term COVID it may be a disability under the Americans with Disabilities Act if an individual evaluation determines that he or she substantially limits one or more major life activities. Despite the recognition that long-term COVID can be a disability, to qualify for federal programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), applicants must be unable to work and have health conditions that last for at least a year or result in death. At this point, it is unclear how many people with him 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 qualify for SSDI become eligible for Medicare after a 2-year waiting period, and people who qualify for SSI generally qualify for Medicaid. If people with COVID are unable to work for a long time, federal disability programs can play a key role in helping those patients access the health care they need to recover.
