Recently, despite the calls from the industry and a number of governors, the Trump administration decided not to open a Special Enrollment Period (SEP) in response to the novel coronavirus for the 37 states that operate on the Federally Facilitated Marketplace (FFM). Twelve of the 13 state-based exchanges created additional SEPs to allow for uninsured consumers who did not previously enroll to sign up for a health care plan, as the new cases of infections continue to climb across the country. Instead of opening SEPs for states on the FFM, the administration offered to reimburse hospitals from a $100 billion fund for their treatment of COVID-19 patients. So, where does that leave the uninsured?
We’re seeing record levels of unemployment right now. For the 8.7 million US workers who filed for their first week of unemployment benefits over the last two weeks, they’ve experienced a qualifying life event, so they will have access to a special enrollment window, no matter where they live. (This is also true for anyone that has moved, had a baby, or gotten married or divorced. For a full list of qualifying life events, visit healthcare.gov’s SEP page.)
For the newly unemployed, incomes could be drastically reduced depending on their state’s unemployment program. Subsidies and cost-sharing options are available to help pay for insurance premiums through the Affordable Care Act (ACA) to help make coverage more affordable. In states that have expanded Medicaid (all but 14 States), even with the extra $600 a week everyone will receive under the new federal relief law, many will still qualify for Medicaid. Politico writes, some of the working poor who normally can’t get Medicaid in states that didn’t expand Medicaid might be able to qualify for Affordable Care Act (ACA) coverage because aid they will get from the federal stimulus package might help them meet the income threshold.
As far as Medicaid is concerned, having access is good for those seeking health coverage, but it will also put a big strain on states’ budgets. For example, America’s Health Insurance Plans (AHIP) put out a report that estimated the impact of COVID-19 to Commercial, Medicare Advantage, and Medicaid managed care plans over a two year period. “Assuming a 20% infection rate among the study population, the report estimates that more than 50 million Americans will become infected, with at least 5.5 million requiring hospitalization – of which 1.3 million will require intensive care. For each person admitted into intensive care, costs, on average, could exceed $30,000.” All told, AHIP estimates the healthcare costs of the COVID-19 pandemic in the US to be between $56B and $556B over 2 years.
As of this last enrollment period, 9 percent of Americans remain uninsured. That 9 percent equals roughly 28 million people. Of those, just under 11 million people live in states that have opened special enrollment periods, which leaves 17 million people without coverage. Many of these people will fall ill, leaving them with no primary care doctor or urgent care options, just emergency rooms, driving up the number of people who will fill hospitals. And after their visit, they are still uninsured.
So what does the future hold for all of these groups of people? Time will tell. But we will say again, if you can get insured, you should get insured.