The Affordable Care Act, facing its first test during a deep recession, is providing refuge for some, but not all, who have lost health coverage as the economy has been hit by the pandemic. of the coronavirus.
New studies from federal and private research groups generally indicate that when the country experienced an abrupt job loss from March to May, with more than 25 million people forced to leave work, the loss of health insurance was less dramatic.
This is in part because a large number of mostly low-income workers who lost their jobs during the crisis were in jobs that no longer offered health insurance. It helped that many employers opted to put workers out of work and temporarily on the company’s insurance plan.
And others who lost health benefits along with their job immediately looked for alternatives, such as coverage through a spouse or parent’s job, Medicaid, or plans offered in the ACA state markets.
However, from June to September things were not so optimistic. Even though the unemployment rate fell from 14.7% in April to 8.4% in August, many temporary job losses became permanent: some people who found a new job did not get one that came with health insurance and others just no. they could afford the coverage. .
The result, studies show, is that even with the new options and the expanded safety net created by the ACA, by late summer, a record number of people were ready to go uninsured for the first time.
What’s more, those losses could deepen in the coming months and into 2021, if the economy doesn’t improve and Congress doesn’t offer more assistance, health policy experts and insurers say.
“It’s a very fluid situation,” said Sara Collins, vice president of health care coverage and access for the Commonwealth Fund, a New York-based health research group.
Coverage was already on the decline
Approximately 20 million people were covered between 2010 and 2016 under the expansion of Medicaid and its ACA insurance marketplaces for people without employer-based coverage. The percentage of the population without health insurance fell from around 15% in 2010 to 8.8% in 2016.
But then, even as the economy continued to grow after 2016, coverage began to decline as the Trump administration and some Republican-led states took steps that undermined the main goal of the law – expanding coverage.
The accelerating decline is helping fuel anxiety about the fate of the ACA following the death of Supreme Court Justice Ruth Bader Ginsburg. The high court is scheduled to hear a case in November brought by Republican state officials and backed by the Trump administration, which seeks to repeal the entire law.
In July, researchers from the Urban Institute, a think tank in Washington, DC, predicted that about 10 million workers and their dependents would lose employer coverage by 2020.
A more recent report from the Urban Institute, published on September 18, and using 2020 data from the Census Bureau, estimated that of the roughly 3 million people under 65 who had lost job insurance between May and July, 1 , 4 million found coverage elsewhere. . . . . most through Medicaid and 1.9 million were uninsured. It should be noted that 2.2 million of those who lost their coverage were between 18 and 39 years old; 1.6 million were Hispanic.
The impact of the marketplaces
Hedging gains and losses in the ACA market are still unclear, experts say. The Trump administration issued a report in June indicating that 487,000 people had enrolled, between January and June, in an ACA plan through the federal website, healthcare.gov. But that report didn’t say how many people dropped out of an ACA plan in that period, for example, because they could no longer pay premiums.
A study by Avalere, a healthcare research and consulting firm in Washington, D.C., has estimated that enrollment in ACA markets since March could have increased by roughly 1 million. That includes new members in the 13 ACA markets served by the states and the District of Columbia. Many of those states had a “special enrollment period”
About 11 million signed up for an ACA plan in February. Open enrollment for coverage that would begin January 1, 2021 begins November 1.
Jessica Banthin, a senior health policy researcher at the Urban Institute and, as of 2019, deputy director of health for the Congressional Budget Office, said no one knows how many people who lost their job coverage this year will choose this option. He said numerous factors will influence people’s health insurance decisions this fall and into 2021.
The main one is to assess whether they will soon be able to get a new job or make up a previous job that offers insurance. That may prevent some people from signing up for an ACA plan this fall, Banthin said. Also, buying insurance can be too expensive, especially for families most concerned with paying for housing, food, and childcare without a paycheck.
