14M Workers In Vulnerable Industries Are Medicaid, ACA Eligible

Over 14 million workers in industries hit hard by coronavirus are eligible for Medicaid or subsidized healthcare insurance on the ACA marketplace if they become unemployed, regardless of whether they are accepting unemployment compensation, a recent report published by the Urban Institute found.

For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.

Researchers identified the industries that were most likely to experience major layoffs or unemployment as non-essential services, for example, home health care services, retail, transportation, restaurants, and cleaning services, among others.

The researchers then looked at family income, unemployment compensation, and assumed that unemployment lasted through 2020.

The report does not estimate how many will go unemployed, but rather how many would be eligible for Medicaid or subsidized ACA insurance should they find themselves unemployed.

In all, nearly half (48 percent) of the vulnerable workers that the Urban Institute studied were on an employer-sponsored health insurance plan—mostly, not through their own company, but rather through the employer of a parent or spouse—prior to the pandemic. Another 33 percent already had coverage through Medicaid or Children’s Health Insurance Program (CHIP) or another public plan.

Of the 19 percent who remain and could receive unemployment compensation, 60 percent would be eligible for Medicaid, CHIP, or a subsidized ACA plan. However, eligibility varies widely based on state, with those in Medicaid expansion states having a much higher likelihood of having access to one of these plans.

There are three reasons why people who can receive unemployment compensation might not be eligible for Medicaid, CHIP, or a subsidized ACA plan:

• Their income is too high
• Their immigration status
• They were uninsured before the pandemic and there is no state or federal special enrollment period in their state

Of the 19 percent who do not receive unemployment compensation, their ability to access public healthcare coverage would hinge even further on Medicaid expansions. Around 75 percent of vulnerable workers without unemployment compensation in expansion states would be able to access a public plan, but in nonexpansion states 42 percent would have that option.

Public health coverage eligibility for those with no unemployment compensation would be influenced largely by the state’s Medicaid expansion status, followed closely by the individual’s immigration status.

Worker eligibility for Medicaid, CHIP, or subsidized ACA coverage fell along clear economic trends. Of those who have no access to a public health plan or employer-sponsored health insurance through a family member, nearly half (49 percent) had incomes under 250 percent of the federal poverty level. Still, 40 percent were likely to be over 400 percent of the federal poverty level, while those without access to unemployment compensation in the same situation were only 27 percent likely to have incomes over 400 percent of the federal poverty level.

In view of these findings, the Urban Institute researchers outlined four potential policy options.

First, they suggested a national special enrollment period on the individual health insurance marketplace. The special enrollment period would not take prior coverage into account, so previously uninsured individuals could enroll on their state-based or federal health insurance marketplace. Thirty-nine states rely on the federal marketplace site healthcare.gov to give resident access to their ACA plans, which prohibits them from opening special enrollment on their own.

Second, the researchers recommended further injection of federal funds into state Medicaid programs, which will need the boost.

CMS increased federal matching by 6.2 percent due to the coronavirus in late March, when the pandemic was ramping up.

Some have argued, however, that more is needed. In fact, this is not the first time that the Urban Institute itself has called for more funding to Medicaid programs, but rather an echo of its recommendations in early April to increase Medicaid matching used on its analysis of the unemployment rate.

Third, the Urban Institute urged assistance for unemployed workers living in nonexpansion states. Fifteen states have not yet expanded their Medicaid programs. For these states, states could enact measures such as eliminating the 100 percent of FPL eligibility cut off.

Kaiser Family Foundation has also suggested a several of ways that states can enact Medicaid expansion during the coronavirus pandemic, namely:

• Broadening eligibility
• Ensuring that those already eligible enroll in Medicaid
• Use CMS waivers which grant flexibility to gain greater coverage for residents

Lastly, Urban Institute experts suggested that states could increase subsidized coverage on the ACA marketplaces. This would increase enrollment on these marketplaces and decrease uninsurance, they argued.

As states face the mounting unemployment rate, researchers are beginning to chorus a couple of strong steps to take to protect coverage for vulnerable populations. However, in some cases such as opening a special enrollment period, it will take state and federal forces cooperating to pursue action.