Intended for healthcare professionals


Covid-19: Trump proposes tax cuts and improved health insurance, but millions are not covered

BMJ 2020; 368 doi: (Published 11 March 2020) Cite this as: BMJ 2020;368:m993

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  1. Janice Hopkins Tanne
  1. New York

The US president, Donald Trump, has proposed eliminating the payroll tax to ease the financial pain faced by US people and businesses owing to the covid-19 outbreak. He also suggested help for the country’s cruise ship industry and airlines.1

The payroll tax, paid both by US employees and employers, provides funds for Social Security pensions, Medicare (health insurance for elderly people), and many other government programs. The tax brings in over a trillion dollars (£773bn; €883bn) a year and is an important part of the federal budget.

New York, Massachusetts, and Connecticut have joined Washington state, California, Colorado, and Rhode Island in declaring states of emergency after cases of the virus increased. The president said that he had not been tested for covid-19, although he had attended meetings with two Congressional representatives who were self-quarantining because they had been exposed to the virus. Trump said that testing was not a big deal but that he might do it, adding, “I feel extremely good.”2

He said that the nation was prepared and that “we’re doing a great job with it. It will go away. Just stay calm. It will go away.”

Healthcare flaws

Trump and his vice president, Mike Pence, announced that they had met with the heads of health insurance companies that insure around 160 million US people. The companies promised to waive all co-pays (the amount an insured person must pay) for covid-19 testing and to extend coverage for covid-19 treatment in all of their plans. They also agreed to cover telemedicine and to avoid “surprise billing.”3

They did not discuss providing care for the estimated 30 million people who lacked health insurance in the US, the 44 million who had inadequate insurance, or the 11 million undocumented immigrants.

Sara Collins, vice president of the Commonwealth Fund, said that the virus outbreak exposed flaws in US healthcare. “A lot of people won’t be able to access the healthcare system,” she told The BMJ.

Collins and the Commonwealth Fund’s president, David Blumenthal, have proposed expanding the federal state Medicaid program of health insurance.4 Collins told The BMJ, “Medicaid is a very flexible way to respond to a health crisis. People can enroll at any time. States have flexibility to waive enrollment requirements. The secretary of health and human services could allow states to expand coverage to allow people with a diagnosis of coronavirus to be covered. It’s been done in other emergencies like Hurricane Katrina.”

Not all states have joined the program. Texas, with 30 million people, has not.

Containment zone

New York state’s governor, Andrew Cuomo, has called out the National Guard to manage a “containment zone” around the prosperous New York City suburb of New Rochelle, which has a cluster of more than 100 cases. The state has more than 170 cases overall, including some in other New York City suburbs.5

The National Guard is made up of soldiers who have civilian jobs or are college students while maintaining part time military training, and they can be called out to deal with emergencies. In New Rochelle they will clean schools and deliver food to quarantined residents, including thousands of students whose schools will be closed for two weeks. Large gatherings have been forbidden.

The cluster of cases began with a lawyer who lives in New Rochelle and commutes to his office in midtown Manhattan. He was first admitted to a local hospital and then transferred to a medical center in Manhattan after covid-19 was recognized. His infection spread to his family, to healthcare workers, and to friends. His son and daughter attend local schools and universities, and these have been closed.6

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