Hyde’s analysis with lead author Angran Li of Zhejiang University in China shows that on a state-by-state basis, for each 3.1% drop in health coverage, the COVID-19 testing rate declined by 27.4% during March 2020, when the virus was rapidly spreading across the United States.

The authors note the link between lower health insurance coverage and testing remained even after controlling for case rates, public health interventions, and demographic differences such as race and poverty rates.

“Our research suggests that the U.S. system relying on private health insurance, which leaves millions of Americans uninsured, is likely a hindrance to coronavirus testing, thus exacerbating the transmission of the virus and casualties associated with the pandemic,” Li and Hyde wrote.

The COVID-19 relief act passed by Congress and signed by President Trump in late March made testing for the virus free and provides hospitals with funding to pay for unreimbursable care. Yet some health industry analysts have argued that some uninsured or underinsured people still may refrain from seeking a free test. This is because the cost of treatment and possible in-patient care resulting from a positive diagnosis is beyond them. Others may rely on hospitals for their care, counting on relief act subsidies to health care providers to help offset their bill. That could increase the strain on the hospital system, analysts have argued.

The study also suggests that lack of health coverage may increase racial and class inequality for testing and treatment for COVID-19. People with lower incomes and people of color are more likely to be uninsured in the United States.

In future analyses that will be submitted to peer-reviewed journals, the authors plan to disentangle the relationships between lack of health insurance, race, poverty, population density, and other factors that may explain variation in coronavirus testing across U.S. states.

The article, “A Slow Start on an Urgent Crisis: How Lack of Health Insurance Helps Explain Deficiencies in Coronavirus Testing in U.S. States,” appears in Contexts, a publication of the American Sociological Association. The article has not been peer reviewed.

The School of History and Sociology is a unit of the Georgia Institute of Technology Ivan Allen College of Liberal Arts.