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Reviews |  Americans on Medicaid could soon lose their health insurance


If there’s been a silver lining to this terrible Covid-19 pandemic, it’s that the rate of Americans without health insurance has fallen to near historic lows, thanks to various federal initiatives related to the health emergency. public declared by the government.

Now, as the acute phase of the pandemic appears to be coming to an end, millions of low- and middle-income Americans are at risk of losing their health insurance. The United States could see one of the largest increases in the nation’s uninsured rate in years.

When the federal Covid-19 public health emergency ends – as it is currently scheduled for April 15, although it is likely to be extended – so will many of its associated insurance protections. This includes a rule that prohibited states from kicking anyone out of Medicaid while Covid-19 raged, which was accompanied by a 6.2 percentage point increase in federal funding for Medicaid to provide insurance for those most vulnerable patients.

Before the pandemic, states routinely reviewed people’s eligibility for Medicaid benefits and kicked out people who no longer qualified. But with that practice suspended, Medicaid enrollment has increased 12% since the start of the pandemic; as many as one in four Americans are now insured through the program.

When the public health emergency expires and the additional federal funds disappear, states will again need to review the continued eligibility of enrollees. Millions of people could be left behind in the process, up to 15 million over time by some estimates. This includes people whose income has increased, those who have moved to another state, or people who simply haven’t returned the complicated paperwork to prove their continued eligibility. This is a byzantine process even in normal times, completed by mail in many states, which makes it particularly unreliable given the number of people who have moved during the pandemic.

Many of the millions of people who lose their Medicaid coverage, either because they are no longer eligible or because they are removed from state rolls, sometimes wrongly, are unlikely to find that they are not insured only when they seek medical care, for example when they visit a clinic or go to a pharmacy to refill a prescription.

And that’s in a country where an inhaler can cost $50 to $100, a doctor’s visit typically costs more than $100, and hospitalization for Covid-19 can cost tens of thousands of dollars.

On top of all that, enhanced government subsidies to buy Affordable Care Act health plans — provisions of the US bailout that make insurance more affordable for low- and even middle-income people — expire at the end of the year. ‘year. For example, premiums for a “silver level” health plan that would normally cost $560 per month on average have been reduced to just $390 with additional government support for someone earning $55,000 per year, which has resulted in annual savings of over $2,000.

When these improved subsidies expire, many low-income Americans could find themselves with the prospect of paying double for health coverage.

The Build Back Better Bill, which passed the House in November, would have extended the more generous subsidies for purchasing ACA health plans. But the bill was declared “dead” by Senator Joe Manchin of West Virginia this year, who declined to support it. Now Democratic leaders are hoping to negotiate a slimmed down version of the bill, but it’s unclear if any bill will go through with the provision it contains.

It’s a perilous time to throw low- and middle-income Americans off the insurance precipice: A new subvariant of Omicron is spreading, and a program that provided coronavirus testing and Covid treatment at no cost to uninsured expired in March because the government ran out of funds to support it. Another program that provided vaccinations at no cost to patients is scheduled to end this month.

The health emergency phase of the pandemic may well be coming to an end. Deaths are currently averaging around 700 a day and falling. Schools and offices are reopening, some without masks. But about a third of Americans are still unvaccinated. And in the future, will newly uninsured low- and middle-income Americans be willing to pay out of pocket to get vaccinated? If they catch Covid, how will they be able to afford the pills to treat it, when the government bought the Paxlovid treatment from Pfizer for $530 a course and consumers could pay even more on the open market?

Patients at risk of losing their health insurance may not be prepared for the change. There has been little mainstream awareness of the upcoming changes, and many people may not read government notices or understand the ins and outs of pandemic health policy.

If people lose Medicaid this year, they will have the option to enroll in an ACA health plan; the current enhanced subsidies mean they would likely pay little or nothing in bonuses until the end of the year. At that point, insurance might become unaffordable and they would fall off the insurance cliff again.

Preserving insurance gains for low- and middle-income people is a significant opportunity that grew out of our two-year national calamity. It shouldn’t be wasted. After all, Covid-19 is just one of many diseases that unduly affect the poorest people without insurance. A Kaiser Family Foundation 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 days’ notice before the public health emergency period finally ends, when states will have to reduce their Medicaid rolls. ACA Enhanced Grants do not end until December 31st. There is still time to find funding and to act. As the risk of contracting a serious case of Covid-19 recedes, the risk of being uninsured is not expected to increase.

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