How City Leaders Can Ensure Their Residents Have Access to Health Care

Thirty six million Americans have filed for unemployment over the past 60 days as a result of the coronavirus pandemic. Local government employees are particularly at risk, with over 800,000 having lost their jobs in April alone. And since most Americans receive health insurance through their workplace, many more people and families are currently without it. According to a new report by the Kaiser Family Foundation, 27 million Americans have recently lost their health coverage – in addition to the 28 million Americans who were uninsured before the coronavirus outbreak. The good news is that many of these individuals are eligible to enroll in a new healthcare plan, but they need to do it RIGHT NOW.

The reason for the urgency has to do with the provisions around signing up for health coverage outside the open enrollment period, or during what is called a special enrollment period. Individuals who experience certain life events, like getting married, having a baby, or most relevant here, losing their job and the associated health coverage, qualify for this special enrollment period. But they have only 60 days to enroll; otherwise, they may have to wait until open enrollment, which is typically in the fall. Considering that Americans are approaching that 60-day mark since many states have officially issued stay-at-home orders, the clock is ticking.

Now is a crucial time for cities to focus on resident outreach because windows will soon be closing for those who lost their employer-sponsored health insurance. What cities can do is advertise to their residents that they must go to if their state uses that for its insurance exchange, show that they have lost their health coverage, and enroll in a new plan. Approximately 80 percent of the 27 million Americans who recently lost their health coverage have other options either through Medicaid, the Children’s Health Insurance Program, or subsidized health plans on the Affordable Care Act’s marketplaces. The remaining 20 percent, however, may be out of luck because they live in one of the 24 states that have not expanded Medicaid under the Affordable Care Act.

In a time when many people are postponing their healthcare check-ups, cancelling hospital procedures, and avoiding hospitals altogether, why is it so important to have health coverage? In addition to treatment for COVID-19, people with chronic conditions may need healthcare services to address or prevent acute episodes. And many residents are feeling the mental and physiological effects of staying home. While isolating in their homes, people face decreased access to opportunities to exercise, less frequent visits from social services, as well as forego necessary but non-emergent health care. These all increase physical and mental stress and health-damaging implications.

The American Psychological Association and the Centers for Disease Control and Prevention both recommend coping with fear of the unknown and stress from physical distancing by limiting news consumption, taking care of physical health by exercise and balanced meals, setting aside time to relax, and keeping in contact with loved ones virtually. And cities play a key role in helping staff and residents manage their physical and mental health during the crisis. In recent years, cities are embracing initiatives such as health risk assessments and employee wellness programs to help manage healthcare costs, increase productivity, and reduce absences.

Cities are best poised to address the adverse effects of quarantine by connecting residents to virtual wellness counseling, or by opening more public spaces for exercise and monitored, physically distanced activities. Cities can encourage virtual fitness classes, psychological counseling, virtual social activities, and access to nature. For example, the Conejos, California Parks and Recreation Department has created a “Virtual Recreation Center” webpage which includes video-led yoga, soccer, and other workouts, as well as a virtual library and links to activities for children. Likewise, Baltimore’s Virtual Recreation Center contains virtual tours of the city’s botanical garden and live streams of the zoo and aquarium.

Some cities are encouraging their employees to check on vulnerable residents, such as those suffering from severe mental illness or substance abuse. For example, the Upper Arlington Commission on Aging in Upper Arlington, Ohio manages an “I Am Fine Telephone Check-In” system in collaboration with the city Police and Fire Divisions to provide support for older adults. The system calls older adults enrolled in the service at a pre-determined time(s) of day and if the adult does not pick up after several tries, a designated keyholder will go to the house to check on the resident.

Finally, cities are engaging with their employees and residents in innovative digital ways to provide resources for mental stress. In late April, the city of Rochester, New York hosted an online town hall meeting aimed at informing youth and families about strategies to cope with the pandemic. Likewise, Louisville, Kentucky hosted an online event, which featured two local licensed therapists who answered questions from residents about the best ways to talk to their children about mental health. Boston, Massachusetts; Madison, Wisconsin; Greensboro, North Carolina; and many more cities have added virtual check-up services to their employee healthcare programs or created resource documents with advice for employees on the front lines of the pandemic response to cope with stress.

We must ensure that as many individuals who have lost their health coverage as a result of the pandemic are able to enroll in a new health insurance plan as possible, and quickly, and that creative approaches are adopted to prevent additional lasting public health issues associated with lack of access to care during the pandemic. Cities are essential to address the adverse effects of isolation – funding for employee health resources, digital outreach programs, and innovation are essential to ensuring that employees and residents receive the care they need to stay healthy at home.


About the Authors

Anita-Yadavalli-smallAnita Yadavalli is the Program Director of City Fiscal Policy at NLC. Anita leads NLC’s Public Sector Retirement initiative, with a focus on research and education for city leaders on retiree healthcare benefits, as well as research and programming on other city fiscal policy issues.


Grabowski Headshot.jpgErica Grabowski is a senior program specialist in the research area of City Solutions. Her current focus is the urban-rural economic divide.