How Has the Pandemic Affected Health Coverage in the U.S.? | KFF
Job losses caused by the coronavirus pandemic have threatened to disrupt health coverage for millions of people, as most working-age adults obtain coverage for themselves and their families through their jobs. tracking real-time changes in coverage and the uninsured rate is difficult to do with much precision because the large national surveys that produce these estimates are lagged by months or years, and private surveys generally lack sufficient samples to measure coverage changes accurately. Many real-time surveys have faced challenges of high non-response rates (not responding to the survey or particular questions), particularly among populations most likely to be affected by the economic downturn, including the Census Bureau’s Household Pulse Survey. . however, various administrative data sources allow us to piece together what might be happening to health coverage rates in the midst of the pandemic.
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The declines in employer-sponsored insurance are much smaller than the overall declines in employment. first, using insurers’ administrative data file with state regulators (compiled by mark farrah associates tm), we can see how enrollment in employer plans has changed through the end of September. Although employment rates fell 6.2% from March to September, enrollment in the fully insured group market fell by only 1.5% over the same period.
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If we extrapolate this finding to the entire group market, including self-insured employer plans, this would suggest that a total of approximately 2 to 3 million people may have lost employer-based coverage between March and September. To be very clear, this is just a rough estimate. We don’t have reliable data for self-insured employers (which insure about 6 in 10 people with employer coverage and tend to be larger), and those employers may have made different decisions about layoffs than fully insured employers did. and if and how to do it. maintain coverage for employees.
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loss of employer-based coverage may have been offset by strong enrollment in medicaid and the marketplaces. Many of those who lost work-based health coverage would have qualified for Medicaid or a special enrollment opportunity to purchase health coverage from the individual marketplace (either in or out of the marketplace). preliminary administrative data from the medicaid program shows enrollment increased by 4.3 million people (6.1%) from february to july 2020. the most recent data from 30 states shows enrollment in managed care plans increased by about 5 million, or 11.3%, from March to September 2020. Nationwide, MCOS covers more than two-thirds of Medicaid recipients. States attribute these increases to rising unemployment (and loss of employer-sponsored insurance), as well as “maintenance of eligibility” (MOE) requirements tied to a 6.2 percentage point increase in the federal match rate ( fmap) authorized by the Families First Response to Coronavirus (FFCRA), which prevents states from de-enrolling Medicaid recipients if they accept the additional federal funds.
Using the same administrative data above (from mark farah associates tm), we found that enrollment in the individual market was fairly consistent from March through September 2020. In normal years, there is typically more attrition during these months as more people leave. the market that they enter during special enrollment periods (September). however, September enrollment was higher this year on healthcare.gov and state exchanges.
While much is unknown, a review of administrative data suggests that the rate of uninsured has not changed much during the pandemic to date. There’s still a lot we don’t know, and these administrative data don’t account for other changes like people aging for Medicare and population growth. however, it appears that the decline in employer-sponsored health insurance coverage may have been offset by gains in Medicaid and largely steady enrollment in the individual market.
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There are several possible explanations for the relatively modest decline in employer-based coverage despite massive job losses. First, many of those who have lost their jobs probably never signed up for coverage through their job in the first place; lower-paid workers are less likely to be covered by their employer’s plan, and similarly, job losses have been higher and more sustained among industries that tend to have lower coverage offer rates (for example, retail, services, hospitality). Second, many people who lost their jobs may have been able to keep their health coverage temporarily. several employers chose to keep furloughed or laid-off workers enrolled in their company’s plan at least in the short term. In addition, an unknown number of permanently laid off employees may have elected to collect (which would be classified as group coverage) at their expense, although this number is likely to be small due to the high costs of such coverage. Employment rates are starting to pick up, but a larger share of people filing unemployment claims say their job loss is permanent compared to earlier in the pandemic, suggesting there may be more loss of coverage to come.
The fact that the uninsured rate has not changed substantially this year could be taken as both good and bad news. A largely flat uninsured rate would be good news because health insurance coverage rates tend to fall whenever there is an economic downturn in the United States. Among many employers maintaining coverage and the Affordable Care Act in conjunction with Medicaid serving as a safety net for those who lost coverage, the U.S. uninsured rate. uu. it doesn’t seem to have increased as much as it could have, given the magnitude of the job losses.
The bad news is that, if the uninsured rate has held steady, there are still tens of millions of people without health coverage during the worst pandemic to hit the country in a hundred years. Despite some recent laws and administrative measures intended to protect the uninsured from some of the costs associated with COVID-19 testing and treatment, the uninsured still face enormous health and financial risks.
four out of ten people who were uninsured before the pandemic could get health insurance coverage for free, either through medicaid or a zero-premium bronze plan on the exchange. Open enrollment for 2021 coverage on the ACA exchanges is now in its fifth week and early figures show that while overall enrollment is strong, new enrollment is about the same as in previous years. The Trump administration has slashed funding for ACA’s outreach and marketing activities, as well as for the navigators that help people sign up for Marketplace coverage. President-elect Biden has pledged to restore funding for ACA’s navigation, outreach and marketing programs. the federal open enrollment period will be over by the time biden takes office, but he could open a new sep with no limitations on who qualifies to enroll.