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Coronavirus double whammy: unemployed and uninsured

Coronavirus double whammy: unemployed and uninsured
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Millions of Americans have lost their jobs because of the coronavirus pandemic — but many also lost their employer-sponsored health insurance, dealing a double whammy to suffering workers.

While many of those people are now eligible for insurance through the Affordable Care Act (ACA) marketplaces or Medicaid, the White House isn’t promoting either of those options. The Trump administration in recent years has also added more red tape and obstacles for people looking to sign up for those programs and hasn't shown any signs it will waive those requirements because of the pandemic.

In addition, the Trump administration has declined to reopen the ACA marketplaces to most new customers, including 28 million people who were uninsured before the pandemic hit, despite making exceptions in the past for natural disasters.

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As a result, only people who recently lost employer-based health insurance can sign up for coverage at healthcare.gov; people who have been laid off but didn't get insurance through their jobs are not eligible.

“I would do almost everything different from what's being done right now,” said Andy Slavitt, who ran the Medicaid, Medicare and ACA exchanges during part of the Obama administration.

“If this is indeed wartime, as the president has said, and if indeed the president doesn’t care for regulation and red tape, this is the perfect time to show that by essentially saying to American people: ‘We want to make sure you’re covered.’ ”

Nearly half of Americans get their insurance through their employer, an arrangement that becomes more precarious during a global crisis that threatens both the economy and the health of millions.

Nearly 17 million people have already filed claims for unemployment benefits since late March, when social distancing requirements aimed at slowing the spread of the coronavirus led to mass layoffs.

It’s not known how many of those workers also lost their health insurance; layoffs disproportionately hit sectors of the economy that don’t offer health benefits to their employees, like the service industry.

But it’s likely that millions of people have lost coverage and are struggling to figure out their options during an uncertain time.

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If layoffs continue, as economists are forecasting, between 12 million and 35 million Americans could lose their employer-sponsored insurance. That figure includes workers and their family members, according to an estimate from Health Management Associates.

Experts are worried because COVID-19 treatment can be expensive without insurance, especially if it involves multiple days of hospitalization. People without insurance might also delay care, which can lead to worse health outcomes.

But the administration hasn’t promoted the fact that people who lose job-based health coverage qualify to sign up for insurance on healthcare.gov outside of the standard open enrollment period, which runs through November and part of December.

The administration also has not waived rules it put in place in 2017 that require people submit documentation proving they lost their job-based insurance before they’re allowed to sign up outside open enrollment, despite doing so for natural disasters in the past.

"The federal government could make it easier, but so far they've set the system up so you have to jump through all these hoops," said Karen Pollitz, a health insurance expert with the Kaiser Family Foundation. 

Tara Straw, a senior policy analyst at the Center on Budget and Policy Priorities, said it can be difficult for people to get the necessary documentation if their employer has already closed up shop. She thinks those requirements should be waived and the administration should reopen the marketplaces for everyone. 

“It’s really hard to introduce people to our fractured health care system at a time when people are scared, losing their jobs, and losing their insurance, but that’s basically what we have to do,” Straw said.

“The administration hasn’t made it easy, which makes it a really hard message to convey to people and to get them connected to coverage, even when they are eligible for resources.”

Individuals have 60 days from the time their job-based coverage ends to enroll in a marketplace plan, and may have to submit more documentation to qualify for premium subsidies that help cover the cost of the plan. That requires estimating expected income for the rest of the year, which can be hard to do for someone who was laid off.

People looking for in-person help signing up for ACA plans after losing their job-based coverage could face challenges because the Trump administration has cut millions of dollars in funding in the last few years for enrollment assistants and navigators.

Advocates and health experts said they were stunned when the administration said it wouldn't reopen the ACA exchanges and was instead "exploring other options."

In addition, 27 million people were uninsured even before the pandemic hit.

“This is such a scary time, both because of the pandemic and because of what’s happening to our economy,” said Sabrina Corlette, a research professor at Georgetown University. “Health insurance is supposed to provide peace of mind. If you get sick, there’s a safety net there, you’re not going to go bankrupt. So I guess the fact that coverage is still being used to service a political agenda is just mind-boggling to me.” 

However, 12 states that run their own marketplaces, including California and New York, are letting uninsured people sign up for coverage now.

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People who are uninsured or lost their-job based coverage may also qualify for Medicaid in 36 states and Washington, D.C., which expanded the program under ObamaCare to cover low-income adults under 138 percent of the poverty line — about $1,467 a month for a single person. Unlike with ObamaCare’s marketplaces, people can sign up for Medicaid at any time.

Still, job-based insurance losses are expected to hit people hardest in the 14 states, including Texas and Florida, that haven’t expanded Medicaid because eligibility is generally restricted to pregnant women, people with disabilities and very low-income adults with children.

People living in those states fall in the Medicaid “coverage gap,” where they don’t qualify for traditional Medicaid, but don’t make enough to qualify for ACA subsidies.

Karen Pollitz, a health insurance expert with the Kaiser Family Foundation, noted that some people who collect unemployment benefits could make just enough to qualify for ACA subsidies.

Another option for laid-off workers is COBRA, a federal law that lets people continue participating in their employer-sponsored health plan for up to 18 months.

But Pollitz of the Kaiser Family Foundation noted this option tends to be expensive because the employer will no longer chip in to help pay premiums.

Getting treated for COVID-19, the disease caused by the coronavirus, can be costly without health insurance.

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The Trump administration has indicated it may use a portion of the $100 billion earmarked for hospitals in the $2.2 trillion coronavirus relief package signed into law last month to reimburse hospitals for caring for COVID-19 patients.

But that won’t help people who are uninsured get treatment for other diseases and illnesses.

“There are a lot of holes when you decide you will reimburse for treatment one thing. People have ongoing needs and need insurance for the long haul,” Straw said.

Updated at 10:15 am.