Prevalence of Pre-existing Conditions Among Community Health Center Patients With COVID-19: Implications for the Patient Protection and Affordable Care Act

Discussion

One in 3 CHC patients with COVID-19 did not have a pre-existing condition before March 2020. We found a greater percentage of non-Hispanic Asian, Hispanic, and non-Hispanic black patients with COVID-19 had no prior pre-existing conditions. Non-Hispanic Asian, Hispanic, and non-Hispanic black adults are facing the largest increases in unemployment,⁷ which also puts them at increased risk for losing employer-sponsored health insurance. Our findings highlight that minority patients would be most impacted if the ACA mandate differentiating coverage based on pre-existing conditions was altered or revoked and COVID-19 was designated a pre-existing condition. Dismantling other provisions of the ACA (such as Medicaid expansion) could also lead to reduced access to health insurance and chronic disease management. These reductions will likely be worse for minority patients, especially those suffering from long-term COVID-19 effects. Although 61% of all CHC patients had at least 1 pre-existing condition before March 2020, nearly 65% of patients with COVID-19 had prior pre-existing conditions, supporting reports that patients with existing health problems are at increased risk for COVID-19.⁸ Our numbers could be underestimated because some patients may have undocumented chronic conditions or may have received a positive result for COVID-19 outside the OCHIN network. Although the future of the ACA is uncertain,² it is clear that ensuring protection for patients with pre-existing conditions is essential to achieving health equity.