If there is any silver lining to this horrific Covid-19 pandemic, then the number of Americans without health insurance has all but fallen historical lowthanks to various federal initiatives related to the health emergency declared by the government.
Now, as the acute phase of the pandemic appears to be drawing to a close, millions of low- and middle-income Americans are at risk of losing their health insurance. The United States could see one of the steepest increases in the country’s uninsured rate in years.
When the Covid-19 federal health emergency ends – as currently scheduled for April 15, although likely to be extended – many of the associated insurance protections will also end. That includes a rule that banned states from throwing anyone off Medicaid while Covid-19 was raging, which came with one Increase of 6.2 percentage points in federal Medicaid funding to keep these most vulnerable patients covered.
Before the pandemic, states regularly reviewed the eligibility of individuals for Medicaid benefits and removed individuals who no longer qualified. But since that practice has been suspended, enrollment with Medicaid has taken place increased by 12 percent since the beginning of the pandemic; as many as one in four Americans are now insured by the program.
When the public health emergency expires and the additional federal funding goes away, states will have to reassess the continued eligibility of enrolled individuals. Millions of people could be dropped, by some up to 15 million over time estimates. That contains Individuals whose income has increased, individuals who have moved to another state, or individuals who simply have not sent back the complicated paperwork proving their continued eligibility. Even in normal times, that’s a Byzantine process that’s being completed by mail in many states, making it particularly unreliable given the many people who have moved during the pandemic.
Many of the millions of people who lose Medicaid coverage, either because they no longer qualify or because they are otherwise, sometimes incorrectly, removed from the state’s schedules, are unlikely to realize they are uninsured until after next time they seek medical help, e.g. when they visit a clinic or go to a pharmacy to refill a prescription.
Plus the reinforced government subsidies Buying Affordable Care Act health plans — provisions of the American Rescue Plan that make insurance more affordable for people on low and even some middle-income people — expire at the end of the year. For example, premiums for a “silver-level” health plan that would normally cost $560 per month on average were reduced to just $390 with the additional federal subsidy for someone making $55,000 a year, resulting in an annual saving of over $2,000.
When these enhanced discounts expire, many low-income Americans could be left with the prospect of paying double for health insurance.
The Build Back Better Bill, which the House passed in November, would have extended more generous subsidies for ACA health plan purchases. But the bill was declared “dead”. by Senator Joe Manchin of West Virginia, who refused to endorse him. Now, Democrat leaders are hoping to negotiate a slimmed-down version of the bill, but it’s unclear whether a bill with the provision it contains will materialize.
It’s a dangerous time to throw low- and middle-income Americans off the insurance cliff: A new sub-variant of Omicron is distributionand a program that provided free coronavirus testing and Covid treatment for the uninsured expired in March because the government ran out of funds to provide support. Another program that made vaccines available to patients free of charge should end this month.
The public health emergency phase of the pandemic may well be coming to an end. The number of deaths is currently around 700 per day on average, and the trend is rising. Schools and offices open again, sometimes without masks. But about a third of Americans are still unvaccinated. And in the future, will newly uninsured low- and middle-income Americans tend to pay out of pocket to get a chance? If they get Covid how will they afford the pills to treat it when the government bought Pfizer’s Paxlovid treatment? $530 one course and consumers could pay even more on the open market?
Patients at risk of losing their health insurance may not be prepared for the change. There has been little publicity about the coming changes, and many people may not read the government advice or understand the specifics of the pandemic public health policy.
If people lose Medicaid this year, they have the option to enroll in an ACA health plan. Due to the current increased subsidies, they would probably pay little or no premiums by the end of the year. At that point, insurance could become prohibitive and they would fall off the insurance cliff again.
Preserving insurance profits for low- and middle-income people is an important opportunity that has emerged from our two-year national disaster. It shouldn’t be wasted. After all, Covid-19 is just one of many diseases that are disproportionately affecting poorer people without insurance. Kaiser Family Foundation surveyg in March found that Americans worry more about “unexpected medical bills” than about being able to afford groceries.
The government has promised to provide it 60 days notice period before the public health emergency period finally ends, when states have to cut their Medicaid roles. The extended ACA subsidies do not end until December 31st. There is still time to find funding and act. As the risk of getting a severe case of Covid-19 decreases, the risk of not being insured should not increase.