The coronavirus has lead to an unprecedented upheaval of the U.S. health care system. A report earlier this year from California’s health insurance marketplace warned the cost of coronavirus care could be as high as $250 billion, and that health insurance premiums could rise as much as 40%.

Despite the huge commitment of resources needed to tackle COVID-19, the overall financial picture of the health care system is complicated.

“Paradoxically, at the same time that the (segment of) the health care system caring for coronavirus patients is overwhelmed, the segment of the health care system that takes care of all of our other health care needs is wildly underemployed,” said Katherine Baicker, dean of the University of Chicago’s Harris School of Public Policy. “You have financial strain on some aspects of hospitals (and) health care providers from lack of patients at the same time that you have shortages of ICU beds and ventilators.”

“So far most health insurers, especially the large publicly traded ones … are bringing in a lot of premium (income), but they are not spending a lot on medical care,” said Shelby Livingston, who covers the insurance industry for Chicago-based publication Modern Healthcare. “That’s because we’ve been putting off routine care (and) delaying expensive procedures like knee replacements and hip replacements, so for the most part health insurers are sitting on a lot of cash.”

Despite being flush, insurers are concerned about what the coming months will look like in terms of COVID-19 infection rates and the return of non-coronavirus patients to the health care system. Livingston says we’re just starting to see premium rate requests made public, and for the most part, they’re modest increases “but it’s important to say that a lot of insurers are couching their rate requests.

“There’s not an indication yet that there’s going to be a massive rate increase due to COVID-19, but … things could change if we get another wave of the pandemic or if patients start swarming hospitals for needed care that they’ve put off,” Livingston said.

Baicker says another key question as insurers try to set their premiums is what the pool of patients will look like, especially as layoffs cause people to lose their employer-provided coverage.

“As people move from their own employer-sponsored health insurance plan to Medicaid, or to being uninsured, or onto a spouse’s plan, the risk pool that insurers have may be changing substantially, and in a way that’s unpredictable until we know what the change in employment rates is likely to look through the rest of the year,” Baicker said.