If there has been a silver lining to this terrible Covid-19 pandemic, it is that the rate of Americans without health insurance has dropped to a near-record low, thanks to several federal initiatives related to the government-declared public health emergency.
Now, with the acute phase of the pandemic seemingly coming to an end, millions of low- and middle-income Americans are at risk of losing health insurance. The United States could see one of the steepest increases in years in the country’s uninsured rate.
When the Covid-19 federal public health emergency ends, as it is currently scheduled for April 15, while it is likely to be extended, so will many of its associated insurance protections. That includes a rule that prohibited states from kicking anyone out of Medicaid while Covid-19 was raging, which came along with a 6.2 percentage point increase in federal Medicaid funding to keep these most vulnerable patients insured. .
Before the pandemic, states regularly reviewed people’s eligibility for Medicaid benefits and removed people who no longer qualified. But with that practice suspended, Medicaid enrollment has grown 12 percent since the start of the pandemic; as many as one in four Americans are now insured under the program.
When the public health emergency expires and additional federal funding is gone, states will need to once again review the continued eligibility of enrollees. Millions of people could be lost in the process, up to 15 million over time by some estimates. That includes people whose income has increased, those who have moved to another state, or people who simply haven’t returned the complicated paperwork to prove their continued eligibility. That’s a byzantine process even in normal times, completed by mail in many states, making it particularly unreliable given how many people have moved during the pandemic.
Many of the millions of people who lose Medicaid coverage, either because they no longer qualify or are removed from state rolls, sometimes by mistake, are likely to find out they don’t have insurance only the next time they seek care. such as when you visit a clinic or go to a pharmacy to refill a prescription.
And that’s in a country where an inhaler can cost anywhere from $50 to $100, a visit to the doctor typically costs more than $100, and a hospital stay for Covid-19 can cost tens of thousands of dollars.
On top of all that, enhanced government subsidies for buying Affordable Care Act health plans (American Rescue Plan provisions that make insurance more affordable for low- and even middle-income people) expire at end of the year. For example, premiums for a “silver level” health plan that would normally cost $560 a month on average were reduced to just $390 with additional government support for someone earning $55,000 a year, resulting in an annual savings of more than $2,000.
When those enhanced subsidies expire, many low-income Americans could be left with the prospect of paying double for health coverage.
The Build Back Better bill, which passed the House in November, would have extended the most generous subsidies to purchase ACA health plans. But the bill was declared “dead” by Sen. Joe Manchin of West Virginia this year, who refused to support it. Democratic leaders now hope to negotiate a stripped-down version of the bill, but it is unclear whether a bill with the provision it contains will materialize.
It’s a dangerous time to push low- and middle-income Americans over the insurance cliff: A new sub-variant of Omicron is spreading, and a program that provided free coronavirus testing and covid treatment for the uninsured has expired. in March because the government ran out of funds to support it. Another program that provided free vaccinations to patients will end this month.
The public health emergency phase of the pandemic may be coming to an end. Deaths are currently averaging around 700 a day and are declining. Schools and offices are reopening, some without masks. But about a third of Americans are still unvaccinated. And going forward, will newly uninsured low- and middle-income Americans be inclined to pay out of pocket for a shot? If they get Covid, how will they pay for the pills to treat it, when the government bought Pfizer’s Paxlovid treatment at $530 a course and consumers could pay even more on the open market?
Patients vulnerable to losing their health insurance may not be ready for the change. There has been little general disclosure about the changes to come, and many people may not read government advisories or understand the ins and outs of pandemic health policy.
If people lose Medicaid this year, they will have the opportunity to enroll in an ACA health plan; the current enhanced subsidies mean they are likely to pay little or nothing in premiums until the end of the year. At that point, insurance could become unaffordable and they would fall back over the insurance cliff.
Preserving insurance proceeds for low- and middle-income people is an important opportunity that grew out of our two-year national calamity. It should not be wasted. After all, covid-19 is just one of many diseases unduly affecting the poorest people who are uninsured. The Kaiser Family Foundation survey in March found that Americans are more concerned about “unexpected medical bills” than being able to afford food.
The government has promised to provide 60 days’ notice before the public health emergency period finally ends, when states will have to cut their Medicaid rolls. The ACA’s enhanced subsidies don’t end until December 31. There is still time to find financing and act. As the risk of contracting a serious case of Covid-19 decreases, the risk of being uninsured should not increase.