With 10 million Americans suddenly jobless due to the Covid-19 pandemic, a smack in the face may be coming to partisans who have spent a decade assailing the Affordable Care Act, the landmark measure that offers people help with their health insurance.
Obamacare, studies have shown, already has helped to reduce the ranks of the uninsured by 20 million.
It may play a significant role now in helping the unemployed, too many of whom not only lost their steady income but also their employer-provided health insurance. The preponderance of Americans — more than 150 million of us — get our health coverage through our workplaces.
With the ACA, the newly jobless have more options than before in trying to safeguard themselves, their health, and their finances with different coverage options.
They, no doubt, will be stunned by the cost of health insurance. It’s way too expensive, no matter how it’s looked at.
That said, and without delving into the specifics (which you may read more about here or here), individuals and families because of their unemployment have gone through what the ACA recognizes as “life changing events,” so they may qualify to seek coverage through Obamacare exchanges, which otherwise are open only during short annual renewal times.
There, they will find different levels of coverage, depending on price. They also may learn that, due to their income, they may qualify for subsidies for the cost of their coverage.
Individuals who previously bought coverage on ACA exchanges also may find that by returning to the exchanges, their coverage costs also will be altered by subsidies, with their whole financial situation getting more settled at the next tax time.
Some individuals and families also may find their joblessness has reduced their income so much that they qualify for Medicaid, the federal program that helps to provide health coverage to the poor. Residents who live in states that expanded Medicaid under the ACA may more readily qualify for this help for the poor.
The newly jobless may want to look at these options before diving into the option known as COBRA (aka the Consolidated Omnibus Budget Reconciliation Act). It lets individuals keep their employer provided coverage for as long as 18 months — but often at steep costs. That’s because the jobless now must pay not only their share of the insurance’s expense, but also their employer share and an administrative fee. That can be a big bite, with recent research showing that average sum forked out by employees and employers for health insurance for a family of four, even with rising deductibles, ran around $20,576 — about the cost of a new economy car.
It’s true that some employer and the federal government have anted up assistance to workers let go to reduce COBRA costs, and this option may be a choice for individuals or families with chronic conditions and in need of continuing their care with the same doctors and hospitals.
Now that some of these key coverage options have been outlined, here is where politics, policies, and reality collide.
Thirty-seven states have expanded Medicaid under the ACA, but 14 — most of them with Republicans in control of their statehouses — did not. And, as the independent, nonpartisan Kaiser Health News service reported, quoting experts like Matt Salo, who heads the National Association of Medicaid Directors:
“The majority of states have expanded their Medicaid programs since 2014 to cover more low-income adults under a provision in the Affordable Care Act. That may help provide a cushion in those areas. In the 14 states that have chosen not to expand, many of the newly unemployed adults will not be eligible for coverage. It’s possible the pandemic could change the decision-making calculus for non-expansion states, Salo said. ‘The pandemic is like a punch in the mouth.’”
States that declined to expand Medicaid cannot get the same level of federal cost-sharing help as those that did so. That means that these states, most of them Republican, will take an even harder budget hit due to the pandemic.
To be sure, all Medicaid programs, as well as the ACA, will be under unprecedented strain due to the Covid-19 pandemic. Officials will struggle to serve constituents, as well as to figure how to deal major new costs in the program.
But there’s yet another wrinkle in the nation’s coronavirus-related health insurance challenges: Eleven states and the District of Columbia have decided, because of the pandemic, to loosen rules about when applicants may seek health coverage on their ACA exchanges. They have thrown open the exchange for a limited time to newcomers, who, typically before, could seek coverage only once a year or if they underwent a “life changing event,” like a move, divorce, or, as mentioned, joblessness.
The Trump Administration — which since its outset has campaigned to kill the ACA and is still doing so, notably in a pending federal appellate court case with GOP state attorneys general — has taken heat for declining to help Americans more with health coverage during the pandemic, notably with Obamacare.
Vice President Mike Pence, a science denier and the titular head of the White House pandemic task force, offered such a mouthful of nothingness when asked about the issue in a news conference that Trump himself was taken aback, telling reporters: “I think that’s one of the greatest answers I’ve ever heard because Mike was able to speak for five minutes and not even touch your question. I said that’s what you call a great professional.”
The administration answer, in brief, about opening ACA exchanges was, “No.”
Trump and his men are so loathe to do anything that looks favorable to the ACA that they will not open the exchanges and they, instead, have thrown up a different distraction — a claim that the government will provide a large and undetermined sum in cash to hospitals to pay them to treat uninsured Covid-19 patients, or those needing virus testing, provided that the institutions also do not bill individuals directly or hit them with unexpected charges.
Details of this plan are to be released. But officials slowly have been letting on that the money Trump discussed would come from the $100 billion allocated to hospitals in the recent $2-trillion pandemic economic rescue package just approved by the Congress and signed by the president.
The health care system, advocates argued, would need every bit of the that $100 billion — and likely more — as it dealt with the staggering demands due to the coronavirus care, so exactly how and how much of it now could be pushed away from such costs to cover health care for millions of newly jobless?
The proposal also doesn’t cover doctor bills — with many doctors sending patients hefty charges, separate from their hospital expenses. It also may have geographic inequities built in, assisting states hit later in the pandemic, while giving less assistance to those in places like Washington, New York, and California where the outbreak occurred earlier.
Here’s one of the glaring issues, though, with the fuzzy Trump proposal: It may help hospitals and Covid-19 patients, but it isn’t a substitute or assistance with any other kind of health care coverage, besides coronavirus diagnosis and treatment. If jobless families struggle with needs, say a child’s broken arm, or a mom’s cancer diagnosis, or dad’s heart attack — those won’t be part of the president’s plan.
Congress may need to step in, for example, by opening the ACA exchanges on a nationwide basis and increasing subsidies for coverage there, or by assisting the jobless with COBRA costs.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription drugs, too many of which have proved to be dangerous drugs. And that was in recent and more normal times.
The ACA is imperfect, and a decade in, it — and the American people — could benefit if one of the major health care experiments of recent times underwent some thoughtful fixes and improvements. Obamacare’s evidence-based record of accomplishment, combined with the dire circumstances faced now by the globe — and including by millions facing the harsh reality of unemployment — should be reason for partisans to act in the interests of people in need, not in advancing a harsh and rejected theology that government should be absent from the health care system.
It may be of little surprise that many of the states opposing the ACA also have leaders who have been slow to safeguard their citizens from the deepening pandemic. These states also are not exempt from rising coronavirus infections and deaths, nor from spiking unemployment. Their residents, like Americans across the country, are relying on middle class, working poor, and poor people to keep their lives going — whether in keeping grocery shelves stocked, in keeping hospitals hygienic and their medical staffs fed, or in growing, harvesting, and shipping food and making human necessities.
The nation has recognized their heroic toil, as well as the brave and praiseworthy efforts of first responders and medical caregivers. But somehow, for a giant number of people who struggle to make ends meet in low-paying work, health care and insurance for it remains not a right but a privilege — which partisans persist in trying to keep away. We’ve got a lot of work to do, starting by remembering toward November, who reacted and how when our great country was in the throes of a deadly outbreak of disease.