The end of the COVID crisis could mean a huge loss of health insurance

Editor’s note: Find the latest news and guidance on COVID-19 at Medscape’s Coronavirus Resource Center.

If there has been a silver lining to this terrible covid-19 pandemic, it is that the rate of Americans without health insurance has dropped to a near record lowin response to various federal initiatives related to the public 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 health insurance. The United States could see one of the steepest increases in years in the country’s uninsured rate.

When the federal COVID-19 public health emergency ends, as it is currently scheduled for April 15, while it is likely to be extended, so will many of its associated insurance protections. That includes a rule that prohibits states from kicking anyone off Medicaid while Covid-19 raged, which came along with a 6.2 percentage point increase in federal Medicaid funding to keep these most vulnerable patients insured.

Before the pandemic, states regularly reviewed people’s eligibility for Medicaid benefits and removed people who no longer qualified. But with that practice discontinued, Medicaid enrollment has grown by more than 12 million since the start of the pandemic; as much as 1 in 4 Americans they are now insured by the program.

When the public health emergency expires and additional federal funding is gone, states will need to once again review the continued eligibility of enrollees. Millions of people could be wiped out in the process, up to 15 million over time per some estimates. What includes people whose income has increased, those who have moved to another state, or people who simply have not returned the complicated paperwork to prove their continued eligibility. The process is byzantine even in normal times, being completed by mail in many states, making it particularly unreliable given how many people have moved during the pandemic.

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Many of the millions of people who lose Medicaid coverage, either because they no longer qualify or because they are removed from state rolls, sometimes by mistake, are likely to find out they are uninsured only the next time they seek care. , such as when you visit a clinic or go to a pharmacy to refill a prescription.

And that’s in a country where an inhaler can cost between $50 and $100, a doctor’s visit normally it costs more than $100, and hospitalization for covid-19 can run tens of thousands of dollars.

On top of all that, the enhanced government subsidies to buy Affordable Care Act health plans, provisions of the American Rescue Plan Act that make insurance more affordable for people with low and even middle incomes, expire at the end of the year. For example, premiums for a “silver level” health plan that would normally cost $560 a month on average they were reduced to just $390 with additional government support for someone earning $55,000 a year, resulting in an annual savings of over $2,000.

When those enhanced subsidies expire, many low-income Americans you could be left with the prospect of paying twice as much for health coverage.

The Build Back Better legislation, passed by the House in November, would have extended the most generous subsidies for purchasing ACA health plans. But the account was declared “dead” this year by Democratic Sen. Joe Manchin of West Virginia, who declined to endorse him. Democratic leaders now hope to negotiate a stripped-down version of the bill, but it is unclear whether a bill with the provision it contains will materialize.

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It’s a dangerous time to push low- and middle-income Americans off the insurance cliff: a new omicron subvariant is spreadingand a program that provided free coronavirus testing and covid treatment for the uninsured expired in march because the government ran out of funds to support it. Another program that provided free vaccinations to patients is scheduled to end this month.

The public health emergency phase of the pandemic may be coming to an end. Deaths are currently averaging around 700 a day and are declining. Schools and offices are reopening, some without masks. But about a third of Americans are still unvaccinated. And, going forward, will recently uninsured low- and middle-income Americans be inclined to pay out of pocket for a vaccine? If they get covid, how will they pay for the pills to treat it, when the government bought Pfizer’s Paxlovid treatment for $530 the course and consumers could pay even more in the free market?

Patients vulnerable to losing their health insurance may not be ready for the change. There has been little general disclosure about the changes to come, and many people may not read government advisories or understand the ins and outs of pandemic health policy.

If people lose Medicaid this year, they will have the opportunity to enroll in an ACA health plan; the current enhanced subsidies mean they are likely to pay little or nothing in premiums until the end of the year, at which point insurance could become unaffordable and they would fall back off the insurance cliff.

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Preserving insurance proceeds for low- and middle-income people is an important opportunity that grew out of our two-year national calamity. It should not be wasted. After all, covid is just one of many diseases unduly affecting the poorest people without insurance. KFF poll in March found that Americans are more concerned about “unexpected medical bills” than being able to afford food.

The government has promised to provide 60 day notice before the public health emergency period definitively ends, when states will have to cut their Medicaid rolls. The ACA’s enhanced subsidies don’t end until December 31. There is still time to find financing and act. As the risk of getting a serious case of covid recedes, the risk of being uninsured shouldn’t grow.