27 million Americans may have lost employer health insurance amid pandemic

In the near future, most unemployed Americans will have access to government-subsidized programs. But that's set to change in 2021.

NEW YORK, NY - MAY 07: Luis Mora stands in front of the closed offices of the New York State Department of Labor on May 7, 2020 in the Brooklyn borough in New York City. 3.2 million Americans have filed for unemployment insurance this week bringing the total number of workers who have applied for aid to 33 million in the past two months.

Stephanie Keith / Getty
  • A new report from the Kaiser Family Foundation estimates that nearly two-thirds of the 31 million recently laid-off Americans had relied on employer-sponsored health insurance.
  • The coverage gap could expand rapidly in 2021 when unemployment benefits expire for Americans living in states that have not expanded Medicaid coverage under the Affordable Care Act.
  • In June, the Supreme Court is set to issue a decision on the constitutionality of the Affordable Care Act.

Nearly 27 million Americans may have lost their employer-sponsored health insurance amid the COVID-19 pandemic, according to a new Kaiser Family Foundation report.

Between March 1 and May 2, unemployment in the U.S. soared to Depression-era rates, with more than 31 million Americans filing for unemployment benefits. The report estimates that 61 percent of these unemployed Americans had relied on employer-sponsored insurance.

Most of these people will have access to government-subsidized insurance.

"Among people who become uninsured after job loss, we estimate that nearly half (12.7 million) are eligible for Medicaid, and an additional 8.4 million are eligible for marketplace subsidies, as of May 2020," the report states.

Unemployed Americans may also continue their employer-sponsored coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), which requires insurance programs to continue covering qualified unemployed Americans for up to 18 months after leaving employment. However, the report states that this "is typically quite expensive since unemployed workers generally have to pay the entire premium – employer premiums average $7,188 for a single person and $20,576 for a family of four – plus an additional 2%."

Although coverage will be more expensive for some, the vast majority of Americans will not go completely uninsured.

"We project that very few people fall into the coverage gap immediately after job loss (as of May 2020) because wages before job loss plus unemployment benefits (including the temporary $600 per week federal supplement added by Congress) push annual income for many unemployed workers in non-expansion states above the poverty level, making them eligibility for ACA marketplace subsidies for the rest of the calendar year," the report states.

Kaiser Family Foundation

But the report estimates that the coverage gap could grow by 80 percent in January 2021. That's when unemployment insurance benefits are set to expire in states that did not expand Medicaid coverage under the Affordable Care Act (ACA). Three of those states are Texas, Georgia, and Florida — all of which have suffered especially high job-loss rates amid the pandemic.

Texas v. United States

The Trump administration and Republican lawmakers in 20 states are currently seeking to strike down the ACA, arguing that the act's individual mandate provision is unconstitutional. (The individual mandate requires most Americans to maintain a minimum level of health insurance). In June, the Supreme Court is expected to issue a decision on Texas v. United States, the lawsuit challenging the act's constitutionality.

The court could decide to leave the act as is. It could invalidate just the individual mandate provision. Or it could overturn all or most of the ACA, which would leave millions of Americans without health insurance, assuming there's no replacement program.

The Kaiser report concludes by highlighting the importance of health care during a pandemic.

"Given the health risks facing all Americans right now, access to health coverage after loss of employment provides important protection against catastrophic health costs and facilitates access to needed care," the report states. "Unemployment Insurance filings continue to climb each week, and it is likely that people will continue to lose employment and accompanying ESI for some time, though some of them will return to work as social distancing curbs are loosened."

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The surprise reason sleep-deprivation kills lies in the gut

New research establishes an unexpected connection.

Reactive oxygen species (ROS) accumulate in the gut of sleep-deprived fruit flies, one (left), seven (center) and ten (right) days without sleep.

Image source: Vaccaro et al, 2020/Harvard Medical School
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We don't have to tell you what it feels like when you don't get enough sleep. A night or two of that can be miserable; long-term sleeplessness is out-and-out debilitating. Though we know from personal experience that we need sleep — our cognitive, metabolic, cardiovascular, and immune functioning depend on it — a lack of it does more than just make you feel like you want to die. It can actually kill you, according to study of rats published in 1989. But why?

A new study answers that question, and in an unexpected way. It appears that the sleeplessness/death connection has nothing to do with the brain or nervous system as many have assumed — it happens in your gut. Equally amazing, the study's authors were able to reverse the ill effects with antioxidants.

The study, from researchers at Harvard Medical School (HMS), is published in the journal Cell.

An unexpected culprit

The new research examines the mechanisms at play in sleep-deprived fruit flies and in mice — long-term sleep-deprivation experiments with humans are considered ethically iffy.

What the scientists found is that death from sleep deprivation is always preceded by a buildup of Reactive Oxygen Species (ROS) in the gut. These are not, as their name implies, living organisms. ROS are reactive molecules that are part of the immune system's response to invading microbes, and recent research suggests they're paradoxically key players in normal cell signal transduction and cell cycling as well. However, having an excess of ROS leads to oxidative stress, which is linked to "macromolecular damage and is implicated in various disease states such as atherosclerosis, diabetes, cancer, neurodegeneration, and aging." To prevent this, cellular defenses typically maintain a balance between ROS production and removal.

"We took an unbiased approach and searched throughout the body for indicators of damage from sleep deprivation," says senior study author Dragana Rogulja, admitting, "We were surprised to find it was the gut that plays a key role in causing death." The accumulation occurred in both sleep-deprived fruit flies and mice.

"Even more surprising," Rogulja recalls, "we found that premature death could be prevented. Each morning, we would all gather around to look at the flies, with disbelief to be honest. What we saw is that every time we could neutralize ROS in the gut, we could rescue the flies." Fruit flies given any of 11 antioxidant compounds — including melatonin, lipoic acid and NAD — that neutralize ROS buildups remained active and lived a normal length of time in spite of sleep deprivation. (The researchers note that these antioxidants did not extend the lifespans of non-sleep deprived control subjects.)

fly with thought bubble that says "What? I'm awake!"

Image source: Tomasz Klejdysz/Shutterstock/Big Think

The experiments

The study's tests were managed by co-first authors Alexandra Vaccaro and Yosef Kaplan Dor, both research fellows at HMS.

You may wonder how you compel a fruit fly to sleep, or for that matter, how you keep one awake. The researchers ascertained that fruit flies doze off in response to being shaken, and thus were the control subjects induced to snooze in their individual, warmed tubes. Each subject occupied its own 29 °C (84F) tube.

For their sleepless cohort, fruit flies were genetically manipulated to express a heat-sensitive protein in specific neurons. These neurons are known to suppress sleep, and did so — the fruit flies' activity levels, or lack thereof, were tracked using infrared beams.

Starting at Day 10 of sleep deprivation, fruit flies began dying, with all of them dead by Day 20. Control flies lived up to 40 days.

The scientists sought out markers that would indicate cell damage in their sleepless subjects. They saw no difference in brain tissue and elsewhere between the well-rested and sleep-deprived fruit flies, with the exception of one fruit fly.

However, in the guts of sleep-deprived fruit flies was a massive accumulation of ROS, which peaked around Day 10. Says Vaccaro, "We found that sleep-deprived flies were dying at the same pace, every time, and when we looked at markers of cell damage and death, the one tissue that really stood out was the gut." She adds, "I remember when we did the first experiment, you could immediately tell under the microscope that there was a striking difference. That almost never happens in lab research."

The experiments were repeated with mice who were gently kept awake for five days. Again, ROS built up over time in their small and large intestines but nowhere else.

As noted above, the administering of antioxidants alleviated the effect of the ROS buildup. In addition, flies that were modified to overproduce gut antioxidant enzymes were found to be immune to the damaging effects of sleep deprivation.

The research leaves some important questions unanswered. Says Kaplan Dor, "We still don't know why sleep loss causes ROS accumulation in the gut, and why this is lethal." He hypothesizes, "Sleep deprivation could directly affect the gut, but the trigger may also originate in the brain. Similarly, death could be due to damage in the gut or because high levels of ROS have systemic effects, or some combination of these."

The HMS researchers are now investigating the chemical pathways by which sleep-deprivation triggers the ROS buildup, and the means by which the ROS wreak cell havoc.

"We need to understand the biology of how sleep deprivation damages the body so that we can find ways to prevent this harm," says Rogulja.

Referring to the value of this study to humans, she notes,"So many of us are chronically sleep deprived. Even if we know staying up late every night is bad, we still do it. We believe we've identified a central issue that, when eliminated, allows for survival without sleep, at least in fruit flies."

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