THURSDAY, June 11, 2020 (HealthDay News) — A total of 16.9 percent of those at increased risk for severe COVID-19 were inadequately insured at the start of the outbreak, according to a study published online June 10 in the Journal of General Internal Medicine.

Adam W. Gaffney, M.D., M.P.H., from Cambridge Health Alliance in Massachusetts, and colleagues analyzed data from the 2018 Behavioral Risk Factor Surveillance System to identify individuals at increased risk for COVID-19. High-risk individuals included those 65 years and older and nonelderly adults with chronic obstructive pulmonary disease, asthma, heart disease, severe obesity, kidney disease, and diabetes. The rate of inadequate insurance within the high-risk population was explored.

The researchers found that relative to whites, blacks, American Indian/Alaska Natives, and those of other races were significantly more likely to be at increased risk for COVID-19, while Asians were significantly less likely to be at increased risk. Persons with lower incomes and those living in rural counties, Medicaid nonexpansion states, and states that had not issued a stay-at-home order were also more likely to be at increased risk. Overall, 16.9 percent (18.2 million individuals) of those at increased COVID-19 risk were uninsured or underinsured. Among those at increased risk, higher rates of inadequate insurance were seen for those with low incomes, residing in a rural area, and of nonwhite race. The odds of being inadequately insured were 52 percent higher for high-risk individuals living in Medicaid nonexpansion states versus those in expansion states, and the odds were 23 percent higher for those residing in states without stay-at-home orders.

“When people avoid testing and care because they fear the costs, it fuels the epidemic’s spread,” a coauthor said in a statement.

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