In midst of COVID crisis, a special health care enrollment period would save lives
The administration dealt a significant blow to those at greatest risk for developing the worst COVID-19 cases when it announced it would prohibit uninsured or underinsured Americans from enrolling in long-term health plans established under the Affordable Care Act (ACA). As the president said when asked by a reporter about people facing the illness without health insurance, “It doesn’t seem fair.” The decision threatens to prolong the public health crisis and worsen the economic burden for millions of Americans, especially those with serious and chronic health conditions, including cancer, heart disease and diabetes.
Rarely has the need for comprehensive health coverage been more pressing than it is now. While the administration has said it may cover treatment costs related to COVID-19, it is unclear how the administration intends to provide coverage and who may be eligible. People are going to need consistent access to health care for all conditions. The most severe COVID-19 patients will not only need access to a full range of medical services, which can include diagnostic testing, advanced hospitalization, days or weeks in intensive care, and lengthy rehabilitation, but some of these patients will also have life-long COVID-related heart, lung and other conditions, all of which require quality, long-term health coverage.
An estimated 27.5 million people in the United States were uninsured before the pandemic, and millions more had inadequate coverage for the care they need at a cost they could afford should they become ill with COVID-19. Research has repeatedly shown that having quality health coverage leads to improved health outcomes, greater adherence to common prevention measures and longer-term survival rates. These benefits certainly apply to those facing COVID-19, as well.
Recognizing this need, a dozen states have made the decision to open special enrollment periods to accommodate an increased need for coverage. Other states, still reliant on federal health insurance exchanges, need the federal government to make that determination. Where you live shouldn’t dictate if you live, and no American should have to weigh whether to seek care for this potentially life-threatening virus against the possibility of unaffordable long-term medical bills.
Those bills will be especially daunting as millions of Americans — another 6.6 million last week — lose their jobs as a result of this public health crisis. For patients with cancer, heart disease and diabetes, who represent some of those most vulnerable to the life-threatening effects of this pandemic, the stakes couldn’t be higher. The economic impact of the virus could threaten their income and their life-sustaining health coverage — at the same time others’ inability to get coverage could accelerate the pandemic and potentially increase the risks for everyone.
While loss of job-based health insurance coverage can currently trigger a special enrollment period, there are many Americans for which this option will not apply: individuals who were uninsured, have reduced hours, furloughs or other income impacting events. These situations could make it extremely difficult to afford an individual’s share of the premiums. COBRA coverage will be nearly impossible to afford as most Americans cannot pay an unexpected expense of $400 or more, let alone scrape together hundreds or thousands of dollars each month for health insurance. This may lead some to turn to bare bones short-term health plans. These plans, which have been heavily promoted by the administration as a viable alternative, often do not provide the kind of coverage people need to treat the severe effects of COVID-19 or any other serious or chronic illness patients may face. Furthermore, short-term plans can deny people coverage based on pre-existing conditions, making them largely unavailable to the 60 percent of Americans who already have at least one chronic health condition.
What people need more than ever is access to health plans that comply with the patient protections in the ACA to ensure they can get the care they need as soon as they need it, without interruption, and without exacerbating a rapidly accelerating pandemic. For a cancer patient on a time-sensitive chemotherapy regimen, a person with diabetes who needs medication or a device to regulate blood sugar, or a heart disease patient who can’t access blood pressure medication, the consequences can be life-altering and even life-threatening.
The health of our country is dependent on individuals and their family members being able to access health care without delay. Considering the serious life-and-death consequences of this decision, the administration should move swiftly to reconsider and allow a special enrollment period for comprehensive ACA plans amid the COVID-19 pandemic so residents in every state have an opportunity to access quality health coverage. If the administration does not take that step, Congress should pass legislation requiring a special enrollment period. Anything less risks compounding the physical and financial strain of this pandemic for millions of people, especially those who are most at risk.
Gary Reedy is CEO of the American Cancer Society and American Cancer Society Cancer Action Network. Tracey D. Brown is CEO of the American Diabetes Association. Nancy Brown is CEO of the American Heart Association,
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