Wednesday, Dec. 23, 2020 | 2 a.m.
Throughout 156 years of statehood, Nevadans have celebrated shared prosperity. This was true during our frontier days, the building of the Hoover Dam, and the early days of legalized gambling. Nevada was a place where, with initiative and a little luck, everyone — prospectors, laborers, valets — could strike it rich. Inversely, during COVID-19, we are all suffering together. Even those who do not work directly in hospitality or entertainment have been affected by strain on our school districts, grocery stores and health care systems. Nearly one year into this pandemic, you likely know someone who has contracted COVID-19 and experienced the fear, frustration and worry associated with being sick, missing work and accessing COVID-related health care.
Access to affordable health care is crucial for individual well-being and the protection of public health, especially during a pandemic; but the proportion of Nevadans without insurance is growing. Prior to COVID, approximately 6% of American kids were uninsured (Nevada fared worse, with 8% uninsured) — and according to a recent report from the Annie E. Casey Foundation, that number has doubled in recent months. The uninsured rate will undoubtedly continue to grow as parents lose employer-sponsored coverage during this extended economic downturn. Many newly uninsured children qualify for programs like Medicaid or CHIP, but parents may be unaware of their eligibility or unwilling to enroll due to fears of stigma.
Thirty-six percent of Nevadan children have at least one parent who is an immigrant, one-third of whom are undocumented. According to the American Academy of Pediatrics, children of immigrants born in the United States, and therefore eligible for Medicaid and CHIP, are nearly twice as likely to be uninsured as nonimmigrant children. Researchers call this phenomenon the “chilling effect,” in which families do not enroll eligible children in programs due to fear of the public charge rule. Immigrant children and adults without documentation are ineligible for Medicaid unless their condition is severe and their health is in serious jeopardy. Unfortunately, this often means uninsured and/or undocumented families delay seeking health care until the situation is dire.
We must diagnose and treat everyone infected with COVID-19 if we want to slow the spread in Nevada. The virus does not discriminate based on ethnicity, income or immigration status. While COVID testing is now widely available at low or no cost, non-emergent treatment (like doctor’s visits and prescriptions) is not. If undiagnosed, COVID-positive individuals will continue to work, shop, dine and spread the infection in their communities. Whether the cause is loss of employer-sponsored coverage or ineligibility due to immigration status, the result of a lack of insurance is the same: Health care is delayed until there is an emergency or it is provided by underfunded Federally Qualified Health Centers (FQHCs) at reduced cost. FQHCs are overwhelmed by uninsured patients seeking COVID diagnosis and treatment, which limits their capacity to treat other ailments and causes them to divert patients to overcrowded emergency rooms.
Nonprofits and Managed Care Organizations must increase outreach to those eligible for, but not covered by, Medicaid and CHIP. Additionally, Nevada should authorize Emergency Medicaid for COVID-19 testing and treatment for all residents regardless of immigration status. By expanding authorization for all COVID-related medical expenses, patients could receive treatment anywhere Medicaid is accepted. This would improve detection and self-quarantine rates to decrease community spread of the coronavirus. It would also increase the ability of FQHCs to treat non-COVID patients and decrease the caseloads of emergency rooms and hospitals. We encourage Nevada to follow the example of states such as Washington, Oregon, California, Illinois, New York, Massachusetts, and the District of Columbia, which have passed legislation for all children to access coverage regardless of immigration status.
An investment in basic health care during this time of crisis will pay off in the future. Research demonstrates long-term benefits of Medicaid coverage for children, including improved health and lower rates of disability in adulthood, higher educational attainment, greater financial security, and a strong return on governmental investment. Nevada can stop the spread and return to shared prosperity, but only if we all have opportunities to change our luck.
Dr. Randi Lampert is chair of the Immigrant Health Committee at the Nevada Chapter of the American Academy of Pediatrics. Dr. Kelly Bumgarner is director of health policy at the Children’s Advocacy Alliance.