Center On Budget & Policy Priorities: ‘COVID Relief Provisions Stabilized Health Coverage, Improved Access And Affordability’ – InsuranceNewsNet – Insurance News Net – DC Initiative on Racial Equity
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WASHINGTON, March 10 (TNSRep) — The Center on Budget and Policy Priorities issued the following report entitled “COVID Relief Provisions Stabilized Health Coverage, Improved Access and Affordability”:

The report was written by senior policy analyst Farah Erzouki, Gideon Lukens, director of research and data analysis, and Jennifer Sullivan, director of health coverage access.

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The COVID-19 pandemic and economic downturn prompted widespread expectations of severe declines in health insurance coverage, as people lost their jobs and saw their incomes plunge. But the federal government swiftly enacted relief legislation and took other policy actions that stabilized health insurance coverage, increased affordability, and mitigated adverse impacts on health care access and equity during the public health emergency. These actions point the way to additional policy changes that would build upon the help provided in this crisis by expanding access to stable, affordable coverage.

The wave of expected health coverage losses would have hit at the worst possible time. The health impacts of the pandemic have been devastating: over 950,000 lives lost and approximately 80 million documented illnesses as of March 2022, disproportionately borne by people with low incomes and people of color. Coverage losses would have exacerbated declines in health care access directly caused by the pandemic, hindered people’s ability to seek testing and treatment for COVID-19, and raised economic burdens for people who were already struggling.

But the federal government implemented policies that proved highly successful in preventing coverage loss, improving access to critical services, increasing continuity of coverage, and making coverage more affordable when people needed it most. The policies include a temporary requirement to keep people enrolled in Medicaid; greater financial assistance to help people afford coverage in the Affordable Care Act (ACA) marketplaces; expanded coverage of COVID-19 testing, treatment, and vaccines; and funding to allow people to receive health care safely at home.

Relief provisions also helped mitigate the pandemic’s outsized impacts on people of color. For example, due in large part to structural inequities resulting in their overrepresentation in low-wage jobs lacking employer coverage, Black and Latino people are disproportionately likely to be enrolled in Medicaid. The Medicaid continuous coverage provision is especially likely to have benefited groups with high Medicaid enrollment rates and who would have otherwise experienced coverage gaps when access to care was especially crucial. Significant shares of Black and of Latino adults were also eligible for zero-premium marketplace plans due to the American Rescue Plan’s marketplace affordability provisions. President Biden and Congress should take steps to build on these policies that promote equitable access to care beyond the public health emergency.

Relief Measures Stabilized Coverage, Increased Affordability

In the initial months of the pandemic, analysts projected that roughly 10 to 30 million workers and their dependents would lose their employer-based coverage and 2.9 to 8.5 million people would become uninsured.[1] Rising unemployment is linked to increases in the number of people without health coverage, as only some of those who lose their employer-based coverage along with their jobs enroll in other coverage.[2]

Avoiding widespread coverage loss was especially important during the pandemic, when incomes plummeted beginning in March 2020. Access declined during the pandemic due to factors such as strains on health care capacity and avoidance of care due to risk of COVID-19 exposure.

And people without health coverage are much more likely to delay or forgo medical care due to cost, to have difficulty paying medical bills, and to lack a usual source of care.[3] The link between lack of affordable health care and lower access is especially strong for low-income groups: in the year prior to April 2021, 53 percent of non-elderly parents with incomes below 138 percent of the poverty level who delayed or went without care cited cost concerns as a reason, more than twice the rate for non-elderly parents above 138 percent of the poverty level.[4]

The prospect of millions losing their jobs and income and facing severe health and financial risk due to lack of health coverage amid a deadly pandemic helped spur federal action. Multiple data sources indicate that the uninsured rate did not increase in 2020, and preliminary evidence suggests that it may now even be lower than before the pandemic.[5] (See Figure 1.)

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Figure 1: Uninsured Rate Stabilized During Pandemic and Data Suggest Recent Declines in 2021

[Link to figure at bottom of document.]

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Public Coverage Growth Offset Declines in Employer Coverage

In large part, health coverage did not decline — and may even have risen — thanks to relief legislation and other policies enacted during the pandemic. Under the Families First Coronavirus Response Act — and effective March 2020 through whenever the public health emergency (PHE) ends — states have been required to maintain continuous coverage for Medicaid enrollees in order to receive a 6.2 percentage point increase in the share of Medicaid costs the federal government covers (known as the Federal Medical Assistance Percentage or FMAP).[6] That is, enrollees aren’t subject to coverage redeterminations, which often result in lost coverage due to income fluctuations or to administrative “churn” ( losses of coverage that are often due to difficulties navigating the administrative requirements or glitches in state processes).

As a result of this FMAP incentive, Medicaid and Children’s Health Insurance Program (CHIP) enrollment grew by 13.6 million, from 71.2 million in February 2020 to a historic high of 84.8 million in September 2021.[7] (See Figure 2.) Analysis of data from state websites, which are more timely than federal administrative data, suggests continuing gains in Medicaid and CHIP enrollment through at least December 2021.[8] Moreover, although declines in employer coverage were concentrated among adults with low and moderate incomes, these declines were more than offset by increases in public coverage among this population.[9]

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Figure 2: Medicaid Enrollment Has Risen Rapidly Due to Relief Legislation

[Link to figure at bottom of document.]

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While it is typical for some workers who lose employer-based coverage to enroll in Medicaid, the increase in Medicaid enrollment is mostly not driven by a large influx of new enrollees, but rather by Medicaid enrollees remaining in coverage for longer because of the continuous coverage provision (combined with some number enrolling each month, which always occurs). After a steep decline in March and April 2020, employment increased nearly every month, by 20 million workers from April 2020 through February 2022.[10] Yet while employment recovered, Medicaid enrollment continued to increase every month, by 12 million workers from April 2020 through September 2021 (the latest month for which national-level data are available).[11]

Further, administrative data show that after a spike in new Medicaid applications in April 2020, new applications fell below 2019 levels every


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