When Emma Dzula got laid off from her job at TruTV last year, one of the first questions that crossed her mind was how she would get health insurance for her family.

In the short term, she was set. She got a generous severance package that would let herself, her husband, and her son stay on her health plan at the employee rate through April 2020. In that pre-COVID-19-era, she was hopeful that she would find another full-time job with health insurance by the time her severance package was set to expire. By the time April rolled around, a lot had changed, and millions of other Americans became unemployed.

“I’m trying to find a full-time job that has benefits, but obviously with the job market being what it is, it’s not easy,” said Dzula, who currently has a freelance gig in TV production. “A lot of jobs I’m seeing out there are freelance.”

Dzula figured her best option would be to continue on her old employer-based coverage through the Consolidated Omnibus Budget Reconciliation Act, better known as COBRA. The federal program is supposed to prevent people who lose their jobs from becoming uninsured.

But when Dzula saw the monthly premium cost under COBRA, she got sticker shock. Her employee contribution at her old job and during her severance had been around $425 per month; under COBRA, she would have to pay $1,848.

“We’re middle class and I know we’re lucky, but it’s a struggle,” Dzula said of the hefty cost of health insurance.

Dzula isn’t alone. Most people who are eligible to continue on their employer-based health coverage through COBRA find it too expensive to use.

Employers typically cover most of the monthly cost of health insurance for their employees, but under COBRA the former employee is responsible for paying the entire premium, plus a 2% administrative charge. In 2019, the average premium for an employer-based family plan at full cost was $1,715 per month--a 54% increase from a decade prior. For an individual plan, the average premium was $599 per month.

The massive unemployment and income insecurity caused by the coronavirus pandemic is also disrupting people’s health insurance. Although unemployment in New York has started to decline as the state reopens, the economic impact because of the virus still ripples throughout, and people are still getting laid off. In the week ending June 6th, New Yorkers statewide filed 95,150 new claims for unemployment insurance, according to the U.S. Department of Labor.

So far, coronavirus has led to a spike in enrollment in public health plans, according to state Health Department data. Many who are getting laid off in New York qualify for government-run insurance through Medicaid or the Essential Plan, which are free or nearly free. Those whose household incomes are too high to qualify can enroll in insurance through the Affordable Care Act marketplace, where many New Yorkers are eligible for subsidies. As it stands, premiums for marketplace plans tend to be lower than those under COBRA.

But a new coronavirus relief bill being considered in Congress could make staying on employer-based coverage through COBRA a more appealing option. The $3 trillion HEROES Act, which passed the House and is currently pending in the Senate, would waive premiums for COBRA coverage entirely between March 1st, 2020 and January 31st, 2021 and would also cover the employee portion of health care premiums for anyone who has been furloughed.

There is some debate as to whether the subsidies, which would cost an estimated $106 billion over two years, would be the best use of taxpayer dollars, given how expensive employer plans can be. But there are some advantages to COBRA, if people can afford it.

“In general, employer plans tend to have more provider choice and bigger networks of [health care] providers than marketplace plans,” said Sabrina Corlette, who co-directs the Center on Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy.

COBRA can also help people avoid interrupting their medical care by having to switch doctors.

“If you’re somebody who is chronically ill and in the middle of a course of treatment, like if you have cancer or are dealing with a serious medical issue where continuity of care is important, that might tilt the scale more toward COBRA,” Corlette said. “But if you’re not in that situation, a marketplace plan is probably better.”

Dzula took this into consideration when comparing the plan under COBRA with other insurance options, since her two-year-old son sees specialists for a genetic disorder known as a carnitine deficiency. She also considered the fact that her family had already spent down their deductible for the year under her employer plan and would have to start over with a new deductible if they switched coverage. But, ultimately, the high cost of COBRA pushed her in a different direction.

Dzula decided to temporarily enroll in a high-deductible plan through her current freelance gig, which ends in November, paying a monthly premium of $1,158, which she says is “slightly less” than the cheapest option she found for her income bracket on the marketplace. After that, she’ll turn to the marketplace for coverage.

Fully subsidizing COBRA could help preserve health coverage for up to tens of millions of Americans, according to the Kaiser Family Foundation. It could also help financially ailing hospitals by keeping people on employer health plans, which tend to pay more for medical services than government plans like Medicaid. And it would generate a windfall for insurance companies, which have so far done fine during the pandemic but say they may see their costs spike in coming months.

Still, Corlette says, “To me, the best use of money right now would be to help states with Medicaid and to make marketplace coverage more affordable and generous for people. I just think that is a better bang for the taxpayer dollar.”

Many who are getting laid off during the pandemic wouldn’t benefit from a COBRA subsidy. In the restaurant industry, which has been hit the hardest by coronavirus in New York, workers often don’t have health coverage through their employer to begin with. Still, the measure could provide a helping hand to middle-class New Yorkers who don’t qualify for free coverage but still find other options unaffordable.

The effort to stabilize the employer-based health insurance system comes at a time when some are fighting to overhaul it completely. Coronavirus has become Exhibit A for those arguing that health insurance should not be tied to employment at all. As Jeneen Interlandi put it in a New York Times op-ed this week, “Nothing illuminates the problems with an employer-based health care system quite like massive unemployment in the middle of a highly contagious and potentially deadly disease outbreak.”

Dzula says she liked the insurance she had through her old employer, but felt constrained by the way the system was set up. “I didn’t leave my job because I had health care,” she said of the position she held for 11 years. “I didn’t explore other employment options because I needed that.”

This story is part of PriceCheckNYC, a collaborative project promoting transparency in health care from Gothamist, WNYC and ClearHealthCosts. We want to hear from you! Email us at healthcosts@gothamist.com to share your stories about shopping for health insurance during the pandemic. You can also share other health care stories via email or submit recent health care bills to our interactive health cost database below.