Clean Up the COVID Booster Mess by Returning to a Single-Payer System

Rebecca Singer, RN
Rebecca Singer, RN
7 Min Read

Singer is a nurse and a professor of population health.

Single-payer health systems make it easier for anyone to access life-saving care at healthcare facilities, pharmacies, or community centers.

We got a taste of a single-payer system during the COVID-19 public health emergency, when the government paid for vaccines and medications to fight the unprecedented pandemic. But now, this system is no longer available. The CDC recently rolled out the new 2023-2024 COVID-19 vaccine for children and adults. Yet, without the single-payer system, those who are insured are required to use insurance to pay for the vaccine. As with most preventive care, the vaccine should be covered in full by insurance, but many people are experiencing denials of coverage. Amid all the confusion, the uninsured may not be aware that the government is providing vaccines for them at no cost.

A friend of mine who has what she considers “good” insurance, covering her medications for a chronic illness, was told that the vaccine was not covered and that she’d have to pay out of pocket. Her chronic condition makes vaccination especially important, but she was not prepared to pay the full cost. She is not alone.

It does not have to be this way. As cases of COVID are spiking again and the flu season is imminent, it is more important than ever to reignite a single-payer system for vaccine coverage to ensure and encourage preventive care for all.

One program in Chicago offers a great example of what is possible when payment is not a barrier. Along with infectious disease physician Stockton Mayer, DO, I co-lead the Outbreak Response Team, an academic-community partnership between the University of Illinois Chicago and the Chicago Department of Public Health (CDPH). This started in the early days of the pandemic with testing for COVID-19 in shelters for the unhoused, nursing homes, residential treatment centers, and jails.

When the initial COVID vaccine roll-out began, the city of Chicago asked our team of approximately 50 graduate student workers and faculty to focus on the communities most at risk of poor outcomes from COVID. The city provided the vaccine and the funding — over $1.5 million since 2020 — for the team to administer vaccines and develop trusting relationships. Together with the city, the team identified community members most at risk and most likely to lack access to the traditional healthcare system. Many have trouble accessing healthcare due to barriers such as a lack of insurance, a mistrust of the healthcare system, poverty, and challenges with transportation, to name a few.

The team offered vaccination at all the places where people were tested, as well as senior living centers, subsidized housing complexes, community centers, and community-based events. In total, they administered over 7,150 COVID shots and 385 flu shots at over 541 events through August 2023. The team took on a similar initiative when the mpox outbreak started, going to bars, bath houses, parks, sidewalks, and street fairs to provide over 4,800 vaccines.

By going to the community, it was possible to save lives and reduce hospitalizations from COVID and mpox by pulling down barriers to access. This is possible in every city in the nation.

In the single-payer system, the COVID-19 vaccines were paid for by the government, so the team only had to show up and engage with community members. Anyone showing up could get a vaccine. The entire process, including registration and consent, could take less than 10 minutes depending on how many vaccines people wanted and how many questions they had.

But today, with the end of the public health emergency, COVID cases increasing, and the requirement for folks to pay for the vaccine (usually with their insurance), that ease is imperiled. This successful real-time experiment with a single-payer system has ended.

The Outbreak Response Team is feeling the impact. The CDC is making efforts to vaccinate uninsured or underinsured people by offering a Bridge Access Program, and the team will provide those vaccines at select sites where the most vulnerable people live. Unfortunately, we will no longer be able to provide vaccines at community events, bars, street fairs, or community centers.

We have figured out a temporary work-around so that insured folks will be able to access vaccines at our events. The CDPH will pay up front, and then we will collect their insurance information with the plan to have CDPH reimbursed. Others outside our circle may have to wait for coverage or pay out of pocket. While going to a local pharmacy or to a provider might seem like an easy task for many, the barriers might be too high for those on the margins of society, living in poverty, or with a deep-seated mistrust of the healthcare system.

Unfortunately, with the all too brief experiment with a single-payer system ending, the doors are shutting for many to easily access vital preventive care. For many in this case, it is not us staying away from the healthcare system, but rather our healthcare system closing the doors on us.

Luckily, there is a key to opening the door: a single-payer system.

Rebecca Singer, DNP, RN, is a registered nurse and clinical assistant professor at University of Illinois Chicago College of Nursing, and a Public Voices fellow of The OpEd Project.

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