Mid- April, another grueling shift for certified registered nurse anesthetist Derrick Smith. He was working primarily with COVID-19 patients in New York City hospitals administering anesthesia and caring for them before during and after medical procedures. By April, the city had more confirmed cases than China, the UK and Iran. Nurse Smith had seen a lot of sickness and death. Yet he was not prepared for what happened as he was about to place a man — close to death — on a ventilator.

The patient struggling for air gasped out a desperate question to Smith: “Who’s going to pay for it?” Smith told CNN the question made him “very sad” and a little horrified” and added, “They were last words I’ll never forget.”

It’s unconscionable that this patient who should have been focused on conserving his oxygen, was, instead, worried about being able to afford treatment that could save his life. Ironically, he was in the hospital just days after Congress passed the CARES ACT, which includes federal money to reimburse hospitals for treating patients with coronavirus related illness. Maybe.

It’s not exactly clear how the money for the hospitals will be distributed. It is possible that uninsured Americans could be on the hook for thousands of dollars, and even insured Americans could end up with huge out of pocket costs. With most coronavirus patients in the hospital for weeks, some for months, how many more will either wonder or ask, “Who will pay for it?”

COVID-19 has put health insurance — or the lack of it — in the center of public debate once again. With 12 percent of Americans who are uninsured, there are millions who can’t afford to get sick. A lot of them have been playing a long game of putting off preventive care and getting intermittent care in emergency rooms or through a patchwork of free clinics. 12 percent is about half of all who didn’t have insurance before the Affordable Care Act, known to many as Obamacare. Studies confirm that the health law, which turned 10 years old this year, boosted the overall health of Americans. Nevertheless, President Trump tried many times to repeal it though most of the law remains intact even after a federal appeals court ruled that the individual mandate was unconstitutional.

Good thing it didn’t go away, now that nearly 40 million Americans have lost their jobs and with that, their health insurance. While some may still be able to sign up for the Affordable Care program and get Medicaid, others will have to find free care through the ever-dwindling resources available to the poor and low income. The Heroes Act recently passed by the House would pay for nine months of Cobra Health benefits so laid off or furloughed employees could stay on their health care plans. But both Senate Majority Leader Mitch McConnell and President Trump have pledged not to support the bill.

The stalemate puts the newly uninsured in the middle of a political battle that impacts their health long term --possibly leaving them even more vulnerable to illness, more vulnerable to spread of the virus. And all this in the middle of the pandemic. We’re not going to solve the problem of the health care system in America right now, but COVID-19 will likely reshape the debate about it.