Eldercare Voices: Older Adults and Access to Health Care During COVID-19

Taneika Duhaney, MHAP
Health and Aging Policy Fellow, Community Catalyst Dental Access Project
 

As the COVID-19 pandemic continues to spread, school closings are increasing, public gatherings are discouraged and public health officials continue to warn that, as testing increases, so will the number of positive cases. Older adults with chronic illnesses are urged to take precautions and contact their primary care provider if they become sick. However, many older adults lack Medicare or Medicaid coverage and don’t have a primary care provider to call. The absence of a primary care provider, especially during a public health crisis such as this pandemic, underscores the barriers many older adults experience in accessing routine care, resulting in delayed care and poorer health outcomes. Several key populations of older adults are at particular risk for experiencing barriers to care, especially during this current public health crisis: 

Older Adults Who Do Not Qualify for Medicare 

Many older adults, especially immigrants, do not qualify for Medicare because they or their spouses do not have the requisite ten years of Medicare-qualifying employment. These barriers are not equitably distributed: People of color, low-income communities and women are disproportionately impacted. Additionally, older adults who worked as farmworkers or domestic laborers may not be eligible for Medicare if their earned income was below the Social Security Administration coverage threshold. Workers in these occupational groups were excluded from the protections and benefits of the Social Security Act of 1935, which prioritized commerce and industry employment, sectors which excluded a significant percentage of African Americans and women. Income earned below the coverage threshold is non-taxable and does not count towards Social Security benefits. Without access to Medicare, many older adults do not have a primary care provider or access to other routine medical, dental or mental health care and may rely on emergency rooms (ER) for care. ERs are never the appropriate site for receiving routine care, but especially during the COVID-19 pandemic, seeking care in an ER is particularly dangerous. 

Dually Eligible Older Adults  

Even for individuals who do qualify for Medicare, and especially for the nine million low-income older adults who are dually covered by Medicare and Medicaid, barriers to accessing care are worsened by the Trump administration’s continued attacks on health care and public programs. Dually eligible older adults may not be able to access their doctor because they rely on public health insurance programs, which are often prioritized lower than private health insurance in part because private insurers reimburse at higher rates than Medicare and Medicaid. Also, many health systems and specialty providers prioritize private payers opt-out of Medicare/Medicaid enrollment or limit enrollment of these beneficiaries, putting dually-eligible older adults at increased risk of facing barriers to access care. 

Immigrant Older Adults 

Attacks on Medicaid and other public programs are especially harmful to immigrant older adults because of the new public charge rule, which would penalize immigrants if they use social programs such as Medicaid, the Supplemental Nutrition Assistance Program and public housing. Though the public charge rule makes several exceptions, many immigrants may not understand these nuances and, out of an abundance of caution, may elect to forgo Medicaid benefits or seek needed care. Making the difficult decision not to access health care, especially when ill, could worsen chronic health conditions and make older adults more susceptible to secondary illnesses and infections, including COVID-19. 

Older Adults Living in Rural Areas 

Older adults living in rural areas may be unable to access primary care because no doctors are available in their area. Currently, more than 77 million people live in health professional shortage areas and rural areas are more likely to experience provider shortages. The absence of primary care doctors and hospitals leaves many rural Medicare beneficiaries relying on urgent care centers for primary care. Urgent care centers provide timely care for aging adults; however, they are not a sufficient substitute for a primary care provider. Additionally, between 2013 and 2017, 64 rural hospitals closed. Without access to a hospital, rural older adults may struggle to access testing and treatment for COVID-19 or other acute or chronic illnesses. 

The public health experts’ recommendation to “call your doctor” if you suspect you’ve been exposed to COVID-19 leaves a significant portion of the older adult population without options. As the pandemic spreads across the country, older adults, adults with disabilities, older adults of color and LGBTQ+ older adults continue to be disproportionately marginalized by existing health care practices and policies that perpetuate existing inequities. Failure to address this issue could increase mortality and morbidity among those most at risk. These inequities can be addressed by opening a special insurance enrollment period across all states, relaxing Medicare and Medicaid eligibility requirements, and eliminating the public charge rule. These initial steps may improve access for many older adults to get tested and receive care for COVID-19, as well as other existing chronic health conditions, before it’s too late.  

Taneika Duhaney, MHAP, is a Health and Aging Policy Fellow working with the Community Catalyst Dental Access Project. Taneika is the Department Head of Patient Administration for Naval Health Clinic Patuxent River. In this capacity, she provides administrative support and services to military members, dependents and retirees. Having served over 18 years on active duty, Taneika’s interest in advocating for older adults stemmed from advocating for a family member. Taneika received her Master in Health Administration and Policy from Uniformed Services University of the Health Sciences and her Bachelor of Business Administration, specializing in Health Service Management from Saint Leo University. She is also a registered dental hygienist and has completed the Duke University Non-Profit Management Certificate.