As states begin to allow businesses to reopen, their employees will be lured back with the promise of a steady paycheck after weeks of unemployment, layoffs or furloughs during the coronavirus pandemic that has killed more than 60,000 people in the US and infected more than 1 million.

But Americans who refuse to return to work if they don't feel safe could be denied unemployment benefits, despite warnings from epidemiologists and other health officials that the public health crisis is all but over.

Republican lawmakers who have pushed to strip funding for unemployment benefits and public health insurance coverage in their states are eager to reopen, as they brace for a surge in claims for Medicaid and unemployment with a looming recession, declining tax revenues and no plans to raise taxes to fill their coffers.

Without guarantees that there are enough tests or personal protective equipment, re-openings have highlighted a socioeconomic chasm between Americans: one that can afford to stay home, and another that can't afford not to.

"This is a dangerous path to go down," said former health insurance executive turned whistleblower Wendell Potter. "If that indeed happens — businesses open prematurely, more people are exposed and spreading the virus — it defies logic."

Following Donald Trump's invocation of the Defence Production Act to force meatpacking plants to reopen, those workers are on the latest frontline in the president's war against the "invisible enemy" of the coronavirus.

David Michaels, former Assistant Secretary of Labour for Occupational Safety and Health and George Washington University epidemiologist, said officials are telling workers "come in, or stay home and don't get unemployment insurance."

"It's your money, or your life," he said. "That's a terrible choice to offer people."

Workers could lose unemployment benefits if they don't return to work

Another 3.2 million Americans filed for unemployment insurance benefits at the end of April, adding to unprecedented jobless claims that have now topped more than 30 million within only a month following the outbreak. Economists say the numbers merely glimpse the scope of the unemployment crisis.

The Economic Policy Institute reported that for every 10 people who successfully filed for unemployment over the last month, three to four others tried to apply but couldn't get through the system, and another two people were unable to because the process was too difficult.

Iowa Governor Kim Reynolds never issued a stay-at-home order for her state, among only a handful without any such orders.

Now the state's furloughed workers have been warned they will lose their unemployment benefits if they don't return to work when their employers reopen. Iowa Workforce Development said their absence will be considered a "voluntary quit" that disqualifies them from benefits.

Georgia, South Carolina and Tennessee have issued similar warnings.

"The reality is that we cannot stop this virus," Governor Reynolds said during a press briefing on Monday. "It will remain in our communities until a vaccine is available. Instead we must learn to live with coronavirus activity without letting it govern our lives."

Operation Gridlock: Anti-lockdown protests in Michigan Show all 13 1 /13 Operation Gridlock: Anti-lockdown protests in Michigan Operation Gridlock: Anti-lockdown protests in Michigan A protester holds a sign comparing Michigan governor Gretchen Whitmer to a Nazi during a demonstration at the State Capitol in Lansing over coronavirus lockdown measures AP Operation Gridlock: Anti-lockdown protests in Michigan An armed protester taking part in a demonstration against coronavirus lockdown measures outside the State Capitol in Lansing, Michigan EPA Operation Gridlock: Anti-lockdown protests in Michigan Vehicles sit in gridlock during a protest in Lansing, Michigan over lockdown measures during the coronavirus pandemic AP Operation Gridlock: Anti-lockdown protests in Michigan People protest against coronavirus lockdown measures in Lansing, Michigan AP Operation Gridlock: Anti-lockdown protests in Michigan An armed man stands outside the State Capitol in Lansing, Michigan during a protest against lockdown measures during the coronavirus pandemic AFP via Getty Images Operation Gridlock: Anti-lockdown protests in Michigan A 2020 Trump Unity sign is displayed during a protest against coronavirus lockdown measures at the State Capitol in Lansing, Michigan AP Operation Gridlock: Anti-lockdown protests in Michigan A protester calls for the impeachment of Michigan governor Gretchen Whitmer during a demonstration against coronavirus lockdown measures in Lansing EPA Operation Gridlock: Anti-lockdown protests in Michigan A slogan on the back of a truck during a protest against coronavirus lockdown measures in Lansing, Michigan EPA Operation Gridlock: Anti-lockdown protests in Michigan Drivers sit in gridlock as part of a protest against lockdown measures in Michigan outside the State Capitol in Lansing during the coronavirus pandemic AFP via Getty Images Operation Gridlock: Anti-lockdown protests in Michigan Protesters wave US flags outside the State Capitol in Lansing, Michigan, during a demonstration against lockdown measures during the coronavirus pandemic AFP via Getty Images Operation Gridlock: Anti-lockdown protests in Michigan People protest against coronavirus lockdown measures at the State Capitol in Lansing, Michigan AFP via Getty Images Operation Gridlock: Anti-lockdown protests in Michigan A protester holds up a banner directed at Michigan governor Gretchen Whitmer during a demonstration against coronavirus lockdown measures near the State Capitol in Lansing AFP via Getty Images Operation Gridlock: Anti-lockdown protests in Michigan People take part in a protest against lockdown measures during the coronavirus pandemic at the State Capitol in Lansing, Michigan AFP via Getty Images

The CARES Act has temporarily expanded eligibility for unemployment through the Pandemic Unemployment Assistance programme, including people who are caring for a sick patient in their home, people told to by a doctor to self-quarantine, and people with compromised immune systems.

Under Labour Secretary Eugene Scalia, who has suggested extended unemployment benefits during the crisis are too generous, the department has explicitly stated that workers can't collect unemployment benefits if they quit working because they are "afraid of getting coronavirus from customers coming to the store".

As states begin to phase limited re-openings of some businesses, the people most likely to be able to return to work are front-facing, low-wage retail employees, from hairdressers and nail technicians to staff at restaurants and bowling alleys.

In roles that are likely to expand as states reopen businesses, essential jobs during the crisis are held mostly by women of colour.

One in three essential workers are women, according to a New York Times analysis of labour and Census data. Women make up nearly nine out of 10 nurses and nursing assistants, respiratory therapists, pharmacists and other pharmacy staff, according to the report.

More than two-thirds of people working as a grocery store checkout worker and behind the register at fast food restaurants are women.

Less than one in five black workers and roughly one in six Hispanic workers are able to work from home, according to the Economic Policy Institute. Less than 10 per cent of workers in the lowest quartile of the wage distribution are able to telework, compared with 61.5 per cent of workers in the highest quartile, the report said.

The Paycheck Protection Program under the CARES Act triggered $350 billion in loans to companies with fewer than 500 employees. A second $310 billion was approved after the funds were exhausted within days. The Small Business Administration will forgive the loans — if companies keep their pre-pandemic payrolls over two months.

In some states with low work wages, "enhanced" unemployment benefits have outpaced their paychecks. An additional $600 a week for unemployed workers, which has been extended through July, is significantly higher than the $247 weekly benefits paid out by the Louisiana Workforce Commission in that state, for example. The state uses the federal minimum hourly wage of $7.25.

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Republican lawmakers in the state have organised against Governor John Bel Edwards' extension of a statewide stay-at-home order through 15 May, despite alarmingly high per capita death and infection rates that have outpaced some of the largest cities and counties in the US despite having just a fraction of the population.

Internal documents from the state's party show a coordinated campaign to undermine health warnings and the only Democratic governor in the deep South.

Senate Majority Leader Mitch McConnell, meanwhile, has said that states facing a fiscal crisis could declare bankruptcy and has objected to "blue state bailouts" suggesting that Democratic leaders would "take advantage of this pandemic to solve a lot of problems that they created themselves".

Laid-off workers face losing their health insurance

A high-level estimate from Health Management Associates says between 12 to 35 million people who receive health coverage through their employer, including their family members who also rely on those plans, could lose their coverage after layoffs during the pandemic.

"Since most adults in this country who are working, and their families, get their coverage through the workplace, it's really showing the absurdity of people having access to healthcare through their employment," Mr Potter said.

Twenty-six million Americans were already uninsured before the pandemic.

Medicaid enrolment could increase from 71 million to 82-94 million, according to Health Management Associates, which is likely to put a crunch on state budgets already constrained by pandemic response.

It's unclear whether states are prepared for a surge in new claims for the federal health plan that serves poor Americans.

Fourteen states have not yet expanded the programme under the Affordable Care Act over fears that their state budget can't cover the cost of the remaining costs of the federally supported programme, leaving millions of America's so-called "working poor" uninsured. The expansion covers the gap in coverage between people previously ineligible for Medicaid but who can't afford insurance through private or employer-provided plans.

Medicaid funding could be in "dire straits" as states are facing a "double whammy of a decrease in tax revenue and the need to pay out more so people have unemployment and access to healthcare" during the crisis, Mr Potter said.

The Department of Health and Human Services has indicated that hospitals and providers will be able to bill the federal government for Covid-19 care to uninsured people, and they'll be reimbursed at Medicare rates, according to Secretary Alex Azar. But details of that plan have not been revealed.

Democrats in Congress have pitched an expansion of COBRA benefits, which allow people to continue health coverage they had under their employer after they've left that job. The programme's intended use as a short-term coverage gap between jobs underscores how dependent Americans are on employment for their healthcare.

A plan from House Democrats would subsidise COBRA premiums for laid-off workers. Private insurers sent a letter to Congress endorsing the plan.

Inside US hospital: A day fighting the coronavirus Show all 13 1 /13 Inside US hospital: A day fighting the coronavirus Inside US hospital: A day fighting the coronavirus Cheryll Mack, 46, a registered nurse in the emergency department, poses for a photograph after a 12-hour shift outside the hospital where she works. "The Covid-19 spread has affected a lot of livelihood, a lot of people's lives. It has created a crisis, death in general. So I would like to ask not one single person, but all people worldwide, to converge and join the platform that this is something that nobody can fight individually," said Mack. Reuters Inside US hospital: A day fighting the coronavirus Dr Laura Bontempo, 50, an emergency medicine doctor wears her personal protective equipment she uses when she sees patients, while posing for a photograph after a nine-hour shift, outside the hospital. "The hardest moments have actually been separating families from patients, there is a no-visitor policy now and taking people away from their loved ones is very challenging," Bontempo said. "I'm used to treating sick patients. I treat sick patients all the time. It's very different knowing that the patient you are treating, is actually a risk to you as well. That's the main difference here. No one who works in hospitals is afraid of treating sick people. Just want to keep staff safe and the patients safe at the same time." Reuters Inside US hospital: A day fighting the coronavirus Ernest Capadngan, 29, a registered nurse who works at a biocontainment unit poses for a photograph after a 12-hour shift, outside the hospital. "The hardest moment during the shift was just seeing Covid patients die helpless and without their family members beside them," Capadngan said. Reuters Inside US hospital: A day fighting the coronavirus Martine Bell, 41, a nurse practitioner in an emergency department, poses for a photograph after a six-hour shift outside the hospital where she works. "The hardest thing in all of this, has been taking care of fellow healthcare providers. It really hits home and it's really scary when you see someone that could be you coming in and now you're taking care of them. It's also hitting home that once healthcare providers start getting sick, who is going to be taking care of the public," Bell said. "It's very stressful, everyone is on edge. We don't know who's coming in next, or how sick they're going to be, or if we are going to get a whole bunch of people or if we're not going to get no one. It's a really stressful and just a completely unusual time for all of us." Reuters Inside US hospital: A day fighting the coronavirus Kaitlyn Martiniano, 25, a registered nurse who works at a biocontainment poses for a photograph after a 12.5-hour shift, outside the hospital. "We have a lot of patients and they are pretty sick right now but we have not yet been hit as hard as New York or Seattle, so I feel like we are very lucky with that so far. Every day you have to just be optimistic." Said Martiniano. "I think the reason that we are not being hit as hard right now is because so many things are closed, and because so many people are staying at home." Reuters Inside US hospital: A day fighting the coronavirus Tracey Wilson, 53, a nurse practitioner in an intensive care unit (ICU), poses for a photograph after a 12-hour shift, outside the hospital where she works. "I had a patient fall out of bed today and I had to call his wife and tell her and she couldn't come see him, even though she pleaded and begged to come see him," Wilson said. "There is a lot of unknowns and with that unknown is a lot of anxiety and stress that we're not used to dealing with." Reuters Inside US hospital: A day fighting the coronavirus Meghan Sheehan, 27, a nurse practitioner in an emergency department, poses for a photograph after a 12-hour shift, outside the hospital where she works. "I think the hardest moment has been the fear that lives within all of us. There is a lot of unknown right now. We fear what's going to happen tomorrow, how the emergency department will look next week when we come in. We have fears about our own colleagues, whether they will fall ill. We also fear that we could be asymptomatic carriers and bring this virus home to our families and our loved ones. There has been a lot of fear over our supplies and whether we'll run out. And then obviously there is the fear that we will see patients and not be able to do everything we normally can to help save patients' lives," Sheehan said. Reuters Inside US hospital: A day fighting the coronavirus Kimberly Bowers, 44, a nurse practitioner in an ICU, poses for a photograph after a 13-hour shift, outside the hospital. "The hardest moment was a young woman who died and her family wasn't able to be here with her," Bowers said. "I think right now, it's just frustrating and scary just not knowing what comes next." Reuters Inside US hospital: A day fighting the coronavirus Tiffany Fare, 25, a registered nurse who works at a biocontainment unit poses for a photograph after a 13-hour shift, outside the hospital where she works. "One of the hardest moments was having to see a family member of a Covid patient, say goodbye over an iPad, rooms away. That was a tough one, I can't imagine how hard it would be to be saying goodbye, you can't see your loved one and then they're gone," Fare said. "My team has been really great to me. We've worked really well together and we've really come together in this crisis. We don't really know each other, we all come from different units within the same hospital, so for us to come together and work so well as a team, it's been a journey but I think that's what is giving me hope." Reuters Inside US hospital: A day fighting the coronavirus Dr Kyle Fischer, 35, an emergency medicine doctor, poses for a photograph after a 12-hour shift, outside the hospital where he works. "Since it's a new virus, we don't have any experience with it. For most diseases I am used to seeing it and taking care of it and this, I don't have any starting place. I know what I'm hearing from New York, I've read all of the papers it seems like, but no one knows what the correct answers are, so there's a huge amount of uncertainty and people are really, really sick. So it's hard to second guess whether or not you are doing the right thing when you think you are but you never quite know," said Fischer. Reuters Inside US hospital: A day fighting the coronavirus Julia Trainor, 23, a registered nurse at a surgical ICU, poses for a photograph after a 14-hour shift, outside the hospital. "The hardest moment was having to put a breathing tube in my patient who could no longer breathe for herself and after the breathing tube went in, we called her family and the husband, of course, couldn't visit her because of visitor restrictions at the hospital. So I had to put him on the phone and hold the phone to her ear, as he told her that he loved her so much and then I had to wipe away her tears as she was crying," said Trainor. "I'm used to seeing very sick patients and I'm used to patients dying but nothing quite like this. In the flip of a switch, without the support, they're completely isolated. They're very sick. Some of them recover and some of them don't. But the hardest part, I would think, is them having to go through this feeling like they are alone." Reuters Inside US hospital: A day fighting the coronavirus Lisa Mehring, 45, a registered nurse who works in a biocontainment unit with Covid-19 patients, poses for a photograph after a 12.5-hour shift, outside the hospital where she works in Maryland. "Seeing these new moms have babies has been the hardest moment along with having do their pumping for the new moms and them not being able to be with their newborn children, it's hard to think of the family that they are missing," Mehring said. Photos Reuters Inside US hospital: A day fighting the coronavirus Jacqueline Hamil, 30, a registered nurse in an emergency department, poses for a photograph after a 12-hour shift outside the hospital. "The hardest moment of my shift today, I was in charge, and we had a really sick patient that was in a really, really small room and usually, when we have sick crashing patients, we can have a ton of resources and a ton of staff go in and help with the nurse and the doctors that are taking care of that patient. But due to the patient being ruled out for the coronavirus, we could only have five or six people in the room at a time and putting on all the gowns and gloves and masks and face shields to protect us in case the patient does have coronavirus, it takes a while, so the nurse that was in there, ended up being in the room for you know 6, 7 hours with minimal breaks and it was hard being in charge and knowing that she was stuck in the room and really nothing I could do to help her," Hamil said. Reuters

Mr Potter calls it a bailout.

"It would restore all the revenue companies are standing to lose, with all the elective procedures being cancelled," he said. "Insurance companies will by far come out the biggest winners in this pandemic."

Only 10 per cent of Americans who are eligible for COBRA take advantage of the programme, which leaves former employees responsible for picking up not only their end of the tab but also the share previously covered by their employer, along with other fees. The Kaiser Family Fund found that the average 2019 premium for an employer-sponsored family plan was $20,576 per year.

With millions of newly unemployed Americans, the Democrats' plan still requires participants to absorb other out-of-pocket costs and would lock in existing health inequalities. Americans who aren't eligible for COBRA coverage wouldn't be able to access subsidised care through the plan, and high-cost plans serving higher-income workers would be subsidised along with low-cost, low-coverage plans.

"You still would have a lot of unevenness among those who are newly uninsured," Mr Potter said. "A lot of people will be seeing their health plans continue but they'll still be on the hook for a lot of money out of their own pockets."

Progressive lawmakers have pitched emergency legislation to reimburse out-of-pocket costs for Covid-19 treatment without relying on for-profit insurers. A bill from Senator Bernie Sanders and Congresswoman Pramila Jayapal would cover costs for the uninsured through Medicare.