Intersection of COVID-19 and SDoH

Employment security, health insurance, and mental health are issues that are dominating care management.

The dramatic rise in unemployment has received considerable focus across the country, with so many experiencing challenges with health insurance, access to care, and added numbers of persons at risk for issues associated with the social determinants of health (SDoH). One in 10 eligible workers have filed for claims since the pandemic escalation in mid-March, with Hawaii, Kentucky, Michigan, and Rhode Island seeing one out of every five workers filing. New York State alone has the highest unemployment rate since the Great Depression, currently at 1.4 million jobless claims. Other states are seeing comparably exorbitant claims rates, including especially high percentages in California, Florida, Georgia, Michigan, Pennsylvania, and Texas.

A new combined report by SRSS and the Commonwealth Fund has confirmed the stark realities of the situation, highlighting the historic intersection of the pandemic, employment security, health insurance, and necessary access to healthcare. Over 1,000 people were surveyed the second week of April, with the following results:

• Roughly 32 percent of adults reported they lost their job;
• 19 percent had hours cut;
• 9 percent experienced pay cuts, with 3 percent of those persons losing their health insurance;
• 20 percent of those who lost jobs or had hours or pay cut did not have health insurance before the pandemic hit. This fact reinforces how many of the jobs in this population were in industries that still fail to offer health benefits.
  • This rate is higher than the overall 12 percent of working-age people who did not have health insurance before this crisis. 

The survey also mentioned the gross rise in anxiety among those who experienced a loss of employment or cuts to hours or salary. Much has been written about the massive impact of the pandemic on mental health of all populations, but this survey specifically found that:

• 18 percent were worried they would lose their insurance.
• 41 percent were dealing with employment, and simultaneously found themselves challenged by health coverage insecurity.
• The Kaiser Family Foundation found that nearly 50 percent of persons who lost a job or their income felt that the virus was having a negative effect on their mental health.
• 47 percent of people sheltering in place reported negative mental health symptoms resulting from their preoccupation specific to coronavirus, versus 37 percent of persons who were not sheltering in place. Mental health challenges from social isolation are known to be more common among older adults and households with adolescents, as these populations are also at greater risk for depression or suicidal ideation.
• Unemployment is associated with increased rates of behavioral health issues, including depression, anxiety, stress, and low self-esteem, all potentially leading to higher rates of substance use and suicide. 

Increased costs, decreased revenue, and rapidly rising numbers of uninsured are all of deep concern to healthcare organizations. This is reflected by the fact that over 160 health systems across the country have furloughed or laid off employees, with other entities soon to join this unfortunate club. Healthcare organizations are struggling with massive costs. However, they will soon add unprecedented numbers of healthcare employees to the growing tally of those dealing with socioeconomic and psychosocial challenges, issues previously considered only for marginal and disenfranchised populations and communities served by their employers.

This week’s Monitor Mondays Listeners Survey asked listeners about their experiences with respect to the number of patients reporting lack of health insurance. The results are viewable here, yielding considerable concerns moving forward for the health and well-being of all persons.

Programming Note: Ellen Fink-Samnick is a permanent panelist on Monitor Mondays. Listen to her live reporting every Monday at 10-10:30 a.m. EST.