Healthcare options for jobless and uninsured
The COVID-19 pandemic has dramatically exposed the failures of our overly complicated “free-market” healthcare system based largely on employee coverage. Another 3.2 million people filed for unemployment benefits for the week ending May 1, making a total of 33 million people with their jobs suddenly upended by the pandemic and subsequent government lockdowns (New York Times, May 7).
Along with their job, many people lose their employer-provided health insurance—as of April 30, more than 12.7 million workers (Economic Policy Institute estimates). A law known as COBRA (available to companies with at least 20 employees) allows laid-off workers to keep their insurance for up to 18 months—but only if the worker pays all the costs, which average about $28,000 annually. This comes as a rude shock to many people, who are unaware of how much their company contributes to their policy. Suddenly they are faced with unaffordable premiums or no insurance at all. About 10 percent of eligible workers actually use COBRA. (Robert Kuttner of the EPI.)
The need for universal health care has become more and more obvious. Still, it will take several years to plan and implement an “Improved Medicare for All”-type program, and it will happen only if Democrats gain control of both Congress and the Presidency in November. In the meantime, everyone should have access to affordable healthcare. This is in the interest of everyone, because if infected people don’t see a doctor due to costs, the virus will only spread further. Let’s examine the options.
Affordable Care Act federal marketplace exchange. If you have a “life-changing” situation, you can enroll in the ACA outside of the short enrollment period that begins November 1 for 2021. Such situations include, for example, divorce or a death in the family resulting in the loss of health insurance, or loss of a job that included health coverage. According to Heidi Rupp, an Ohio insurance agent, several obstacles, however, could stand in your way. If you’ve just lost hours, but have not lost your health care coverage, you do not qualify for the ACA’s existing Special Enrollment. Similarly, if you lost your job but did not have insurance through your job—the job loss itself doesn’t qualify. Furthermore, if you do meet the special criteria, you have 60 days from the loss of your health care coverage to apply under the ACA. If you wait longer than that, you are locked out until the next the open enrollment period (beginning November 1).
Other examples of people who would not qualify for the ACA’s Special Enrollment, even during the pandemic, include: someone who had bought a cheap, but skimpy-coverage plan touted by the Trump administration; a business owner who can no longer afford his robust private insurance plan; and a low-wage worker who has several jobs, none of which offers health insurance.
A new ACA Special Enrollment that is driven by the pandemic is clearly needed. But that can happen only with Congressional and Presidential approval. A while back, the President actually suggested doing this, but then—surprise!—he changed his mind.
State-based marketplace exchanges. The original intent of the ACA was for each state to create its own exchange, allowing the states more flexibility. Only 14 states and the District of Columbia (D.C.), however, did this, and they are able to determine their own enrollment periods. In response to the pandemic, 11 of these states plus D.C. expanded open enrollment until a date in April, May, or June of this year (and some may revise the end date in view of the continuing rise in job losses). Unfortunately, Pennsylvania’s own exchange is not yet operational. Regular open enrollment for 2021 will begin in November—in time, at least, for a possible second wave of the pandemic.
Medicaid expansion. Designed to extend Medicaid coverage to everyone living in or near poverty, the Medicaid expansion is the ACA’s signature success story. Pennsylvania is among the 36 states (plus Washington, DC) that have taken advantage of this program. To date, more than 15 million people have healthcare through these expansions. During the pandemic, about a quarter of people in the country who have lost their employer-sponsored healthcare are expected to end up on Medicaid. In the 14 states that still refuse to expand Medicaid, however, about 40 percent of people who lose their jobs and their health insurance will end up with no coverage at all. (Vox, May 5)
The immediate danger of the courts destroying the ACA is gone, as Trump allowed the May 6 deadline for the review of the Texas challenge case to pass. Still, Trump told reporters that he will forge ahead with trying to toss out the entire 2010 law, (Washington Post, Daily 202, May 7). If Trump ultimately is successful, that would also spell the end of all Medicaid expansions, which are already in danger of drastic Federal budget cuts. With the GOP often called “the Party of No Care,” and even “the Party of Death,” Republicans in Congress are hopeful that Trump’s wishes will not be satisfied until after the November election.
In the meantime, 1.8 million workers in Pennsylvania have filed for unemployment (Office of Unemployment, uc.pa.gov, May 7). Others are in the process of filing or have yet to file, so the number of jobless is undercounted and extremely fluid. During the pandemic, it is especially important for everyone to have access to healthcare. This not only protects individuals and their loved ones, but also helps prevent further spread of the virus.
Indeed, this is an ever-changing environment, with limited and confusing options for the newly uninsured. If you don’t have healthcare coverage and don’t know where to turn, contact the help line of Pennsylvania Health Access Network (PHAN): 877-570-3642. PHAN’s trained navigators will assess your situation and guide you to whatever program is available to you.
Jeanne Duffy, Ph.D., has served as a college professor, an analyst and project manager for several large companies, and a college administrator in charge of foundation and government support. She is current chair of Gettysburg Democracy for America’s healthcare taskforce.