The devastating effects of the COVID-19 pandemic go far beyond public health; with many industries on hold and unemployment increasing worldwide, the global economy is approaching the deepest recession in living memory. In the USA, where health insurance is largely provided by employers and more than [30 million people](https://www.cnn.com/2020/04/30/economy/unemployment-benefits-coronavirus/index.html){#interrefs10} have filed for unemployment in the past 2 months, such a recession could cause an unprecedented surge in uninsured or underinsured people. Indeed, an [analysis](https://www.rwjf.org/en/library/research/2020/05/how-the-covid-19-recession-could-affect-health-insurance-coverage.html){#interrefs20} published on May 4, 2020, has estimated that if unemployment in the USA reaches 20%, 25--43 million people could lose their health insurance. For patients with cancer, for whom care is already expensive and long lasting, this could be a fatal blow.

A recent [report](https://www.iqvia.com/insights/the-iqvia-institute/covid-19/shifts-in-healthcare-demand-delivery-and-care-during-the-covid-19-era){#interrefs30} has estimated a delay in more than 22 million cancer screening tests and a 20% decrease in the number of interactions between patients and their oncologists in the USA during the COVID-19 pandemic. The report also states that US doctors are prioritising patients with more aggressive tumours. Although this approach is understandable at this time, delayed screening and reduced treatment of early stage disease could result in the need for longer and more complex treatments for more advanced stage disease. Coupled with the anguish and mental health effects associated with the uncertainty of treatment plans and outcomes, the demands on cancer care will inevitably increase in the future, driving individual health-care costs even higher, just at a time when patients\' ability to pay is hugely compromised.

The options for US patients with no health insurance are scarce. Some companies and charities are fighting to improve health insurance access, but a large increase in out-of-pocket health expenses could drive many patients into bankruptcy. Although some might find respite in opting for Medicaid or [COBRA](https://www.marketplace.org/2020/05/13/cobra-health-insurance-covid-19-jobs/){#interrefs40} (a federal mechanism that extends health insurance after employment ends), not everyone is eligible for the former, and the latter can be unaffordable.

Although efforts to fight the COVID-19 pandemic are of paramount importance, in the USA, measures are urgently needed to avoid severe economic and social outcomes, and a tighter regulation on health-care prices, with a particular focus on private community oncology providers, is needed urgently.

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