'A dangerous path': Americans risk their lives by returning to work - or face losing unemployment and healthcare

As states begin to allow businesses to reopen, their employees will be lured back with the promise of a steady paycheck after weeks of unemployment, layoffs or furloughs during the coronavirus pandemic that has killed more than 60,000 people in the US and infected more than 1 million.

But Americans who refuse to return to work if they don't feel safe could be denied unemployment benefits, despite warnings from epidemiologists and other health officials that the public health crisis is all but over.

Republican lawmakers who have pushed to strip funding for unemployment benefits and public health insurance coverage in their states are eager to reopen, as they brace for a surge in claims for Medicaid and unemployment with a looming recession, declining tax revenues and no plans to raise taxes to fill their coffers.

Without guarantees that there are enough tests or personal protective equipment, re-openings have highlighted a socioeconomic chasm between Americans: one that can afford to stay home, and another that can't afford not to.

"This is a dangerous path to go down," said former health insurance executive turned whistleblower Wendell Potter. "If that indeed happens — businesses open prematurely, more people are exposed and spreading the virus — it defies logic."

Following Donald Trump's invocation of the Defence Production Act to force meatpacking plants to reopen, those workers are on the latest frontline in the president's war against the "invisible enemy" of the coronavirus.

David Michaels, former Assistant Secretary of Labour for Occupational Safety and Health and George Washington University epidemiologist, said officials are telling workers "come in, or stay home and don't get unemployment insurance."

"It's your money, or your life," he said. "That's a terrible choice to offer people."

Another 3.2 million Americans filed for unemployment insurance benefits at the end of April, adding to unprecedented jobless claims that have now topped more than 30 million within only a month following the outbreak. Economists say the numbers merely glimpse the scope of the unemployment crisis.

The Economic Policy Institute reported that for every 10 people who successfully filed for unemployment over the last month, three to four others tried to apply but couldn't get through the system, and another two people were unable to because the process was too difficult.

Iowa Governor Kim Reynolds never issued a stay-at-home order for her state, among only a handful without any such orders.

Now the state's furloughed workers have been warned they will lose their unemployment benefits if they don't return to work when their employers reopen. Iowa Workforce Development said their absence will be considered a "voluntary quit" that disqualifies them from benefits.

Georgia, South Carolina and Tennessee have issued similar warnings.

"The reality is that we cannot stop this virus," Governor Reynolds said during a press briefing on Monday. "It will remain in our communities until a vaccine is available. Instead we must learn to live with coronavirus activity without letting it govern our lives."

The CARES Act has temporarily expanded eligibility for unemployment through the Pandemic Unemployment Assistance programme, including people who are caring for a sick patient in their home, people told to by a doctor to self-quarantine, and people with compromised immune systems.

Under Labour Secretary Eugene Scalia, who has suggested extended unemployment benefits during the crisis are too generous, the department has explicitly stated that workers can't collect unemployment benefits if they quit working because they are "afraid of getting coronavirus from customers coming to the store".

As states begin to phase limited re-openings of some businesses, the people most likely to be able to return to work are front-facing, low-wage retail employees, from hairdressers and nail technicians to staff at restaurants and bowling alleys.

In roles that are likely to expand as states reopen businesses, essential jobs during the crisis are held mostly by women of colour.

One in three essential workers are women, according to a New York Times analysis of labour and Census data. Women make up nearly nine out of 10 nurses and nursing assistants, respiratory therapists, pharmacists and other pharmacy staff, according to the report.

More than two-thirds of people working as a grocery store checkout worker and behind the register at fast food restaurants are women.

Less than one in five black workers and roughly one in six Hispanic workers are able to work from home, according to the Economic Policy Institute. Less than 10 per cent of workers in the lowest quartile of the wage distribution are able to telework, compared with 61.5 per cent of workers in the highest quartile, the report said.

The Paycheck Protection Program under the CARES Act triggered $350 billion in loans to companies with fewer than 500 employees. A second $310 billion was approved after the funds were exhausted within days. The Small Business Administration will forgive the loans — if companies keep their pre-pandemic payrolls over two months.

In some states with low work wages, "enhanced" unemployment benefits have outpaced their paychecks. An additional $600 a week for unemployed workers, which has been extended through July, is significantly higher than the $247 weekly benefits paid out by the Louisiana Workforce Commission in that state, for example. The state uses the federal minimum hourly wage of $7.25.

Republican lawmakers in the state have organised against Governor John Bel Edwards' extension of a statewide stay-at-home order through 15 May, despite alarmingly high per capita death and infection rates that have outpaced some of the largest cities and counties in the US despite having just a fraction of the population.

Internal documents from the state's party show a coordinated campaign to undermine health warnings and the only Democratic governor in the deep South.

Senate Majority Leader Mitch McConnell, meanwhile, has said that states facing a fiscal crisis could declare bankruptcy and has objected to "blue state bailouts" suggesting that Democratic leaders would "take advantage of this pandemic to solve a lot of problems that they created themselves".

A high-level estimate from Health Management Associates says between 12 to 35 million people who receive health coverage through their employer, including their family members who also rely on those plans, could lose their coverage after layoffs during the pandemic.

"Since most adults in this country who are working, and their families, get their coverage through the workplace, it's really showing the absurdity of people having access to healthcare through their employment," Mr Potter said.

Twenty-six million Americans were already uninsured before the pandemic.

Medicaid enrolment could increase from 71 million to 82-94 million, according to Health Management Associates, which is likely to put a crunch on state budgets already constrained by pandemic response.

It's unclear whether states are prepared for a surge in new claims for the federal health plan that serves poor Americans.

Fourteen states have not yet expanded the programme under the Affordable Care Act over fears that their state budget can't cover the cost of the remaining costs of the federally supported programme, leaving millions of America's so-called "working poor" uninsured. The expansion covers the gap in coverage between people previously ineligible for Medicaid but who can't afford insurance through private or employer-provided plans.

Medicaid funding could be in "dire straits" as states are facing a "double whammy of a decrease in tax revenue and the need to pay out more so people have unemployment and access to healthcare" during the crisis, Mr Potter said.

The Department of Health and Human Services has indicated that hospitals and providers will be able to bill the federal government for Covid-19 care to uninsured people, and they'll be reimbursed at Medicare rates, according to Secretary Alex Azar. But details of that plan have not been revealed.

Democrats in Congress have pitched an expansion of COBRA benefits, which allow people to continue health coverage they had under their employer after they've left that job. The programme's intended use as a short-term coverage gap between jobs underscores how dependent Americans are on employment for their healthcare.

A plan from House Democrats would subsidise COBRA premiums for laid-off workers. Private insurers sent a letter to Congress endorsing the plan.

Mr Potter calls it a bailout.

"It would restore all the revenue companies are standing to lose, with all the elective procedures being cancelled," he said. "Insurance companies will by far come out the biggest winners in this pandemic."

Only 10 per cent of Americans who are eligible for COBRA take advantage of the programme, which leaves former employees responsible for picking up not only their end of the tab but also the share previously covered by their employer, along with other fees. The Kaiser Family Fund found that the average 2019 premium for an employer-sponsored family plan was $20,576 per year.

With millions of newly unemployed Americans, the Democrats' plan still requires participants to absorb other out-of-pocket costs and would lock in existing health inequalities. Americans who aren't eligible for COBRA coverage wouldn't be able to access subsidised care through the plan, and high-cost plans serving higher-income workers would be subsidised along with low-cost, low-coverage plans.

"You still would have a lot of unevenness among those who are newly uninsured," Mr Potter said. "A lot of people will be seeing their health plans continue but they'll still be on the hook for a lot of money out of their own pockets."

Progressive lawmakers have pitched emergency legislation to reimburse out-of-pocket costs for Covid-19 treatment without relying on for-profit insurers. A bill from Senator Bernie Sanders and Congresswoman Pramila Jayapal would cover costs for the uninsured through Medicare.

"It is mind boggling that [Congress] would be willing to spend more money, more taxpayers' dollars, to make sure people have access to care they need" under the COBRA plan, Mr Potter said. "It is maddening to think our elected officials would think that's the preferred choice."