Solidifying Coronavirus Policies Might Improve Access to Coverage

Advance premium tax credits and other coronavirus policies may have bolstered access to coverage during the pandemic, a RAND Corporation report stated.

The researchers simulated nonelderly adult enrollment for both 2020 and 2021 in New York state using public data sources like the US Census Bureau’s Survey of Income and Program Participation and the Kaiser Family Foundation and the Health Research and Educational Trust’s annual Employer Health Benefits Survey, among other sources.

The report analyzed four policies based on the availability of continuous Medicaid enrollment (continuance) and furlough. Individuals could have neither continuous Medicaid enrollment nor furlough options, only furlough options, only continuance options, or both options available.

The researchers observed how these four scenarios influenced insurance loss during the coronavirus pandemic.

In the most favorable scenario in terms of net insurance losses, if New Yorkers had access to both furlough and continuance options, there would have been no overall loss in insurance. Around 560,000 people would have lost their employer-sponsored health plans, but those losses would have been entirely offset by gains in other areas, mostly Medicaid and CHIP.

By only introducing access to continuance, the state would have seen a net loss of 50,000 in the insured population. The shifts in this scenario were the most volatile: 690,000 people would lose their employer-sponsored health plan, but 520,000 New Yorkers would gain Medicaid and CHIP coverage, with the remaining 120,000 or so ending up in other health plans.

With access to furloughs alone, the health insurance industry would have experienced an overall loss of 120,000 people. But 300,000 would lose their employer-sponsored health plans, 200,000 would gain Medicaid or CHIP coverage, and 30,000 individuals would end up in another form of insurance.

Continuance more than doubled Medicaid and CHIP enrollment, the researchers found. Without continuance, enrollment would have hit between 200,000 and 240,000, but with continuance these public programs would have gained from 460,000 to 520,000 enrollees. However, continuance also may be associated with employer-sponsored coverage losses.

In economically normal times, lower-income individuals are at higher risk of uninsurance. However, during the pandemic, uninsurance may rise among populations with higher incomes and fall among lower-income communities, the report revealed.

“These results suggest that the pandemic could lead to a distributional shift in the composition of the uninsured, with some lower-income people gaining (or retaining) coverage as a result of continuance policies and some higher-income people losing coverage because of job loss,” the survey explained.

Outside of the pandemic, expanding access to advance premium tax credits could offset pandemic-related coverage declines, the researchers also discovered. Continuance might boost that even further, though possibly at the cost of employer-sponsored healthcare coverage.

Not only did enhanced advance premium tax credits support enrollment in 2020, but the researchers projected that it would continue to have an impact on 2021 enrollment as well.

“Without the help of temporary provisions, the safety net might not have been robust enough to fully offset pandemic-related declines in employer coverage,” the researchers concluded. “This evidence indicates that modifications to the ACA might be necessary to ensure that the U.S. health insurance system is prepared for future recessions.”

Since the early days of the pandemic, experts have been trying to assess the impact that the coronavirus pandemic had on employer-sponsored healthcare coverage and other forms of health insurance. In 2020, unemployment dropped but employer-sponsored coverage did not improve.

Many factors could have led to lower rates of employment and coverage during the pandemic. For example, in 2020, an Avalere study revealed that the COVID-19 pandemic has exacerbated disparities in access to coverage based on race.