Reopening Obamacare Is Best Way to Help Uninsured, Advocates Say

Reopening the Obamacare exchanges is the most efficient way to let uninsured Americans buy coverage amid the coronavirus pandemic, health-care advocates say.

But so far that seems to be a quixotic hope for many.

The Trump administration signaled Tuesday that it won’t reopen the HealthCare.gov exchange to allow more people to sign up for health insurance. Instead, Vice President Mike Pence said Thursday that some of the $100 billion in federal funds earmarked to help hospitals cope with the pandemic will cover bills for the uninsured. The funds would go directly to the medical facilities, he said.

The Department of Health and Human Services has also said that people may be able to qualify for a special enrollment period (SEP) if they’ve lost a job due to the crisis. Special enrollment periods allow people to sign up for coverage if they have a life-changing event, such as losing a job or having a child.

But those actions won’t be enough to help many uninsured people—now about 10 million people—get the care they need, policy analysts and health-care supporters say. The special enrollment process in particular is complex and has actually deterred people from signing up, Karen Pollitz, a senior fellow with the Kaiser Family Foundation, said in an interview.

“There are multiple steps under the current rules, and there’s a reason why people don’t sign up for SEPs by and large,” she said.

The HHS didn’t immediately respond to a request for comment on how many people have applied for a special enrollment period.

Complex Process

The Trump administration, prior to the pandemic, tightened regulations for special enrollment periods to prevent people from getting coverage when they are sick and dropping it when they no longer need it.

There’s a 60-day period to apply for an SEP, and people must provide documentation that they have lost coverage before they can sign up for plans or determine their eligibility for subsidies, Pollitz said. After that, applicants must “wait to hear from the marketplace and see if they accept your verification,” she said.

Once accepted, people can then apply to enroll in a plan. But their applications must be based on an estimate of what their income in 2020 will be.

Since the estimated income of applicants who have lost their jobs probably won’t match their most recently filed federal income tax return, inconsistencies in the data are likely to arise, Pollitz said. HealthCare.gov will then demand documentation to prove that applicant’s income estimate is reasonable, she said.

Reduced Help

Funding cuts to state programs that help people sign up for Affordable Care Act coverage may be another obstacle to getting uninsured people coverage.

The Trump administration has slashed funding for state navigators, people the ACA authorized to help sign up for ACA coverage. That’s made it difficult to provide the assistance that people need to get insured, Jodi Ray, director of Florida Covering Kids & Families, Florida’s navigator program, said.

“People are having a really tough time right now navigating through the Medicaid enrollment process,” Ray said. “But the challenge is that we’re so understaffed because of the cuts in in-person assistance in Florida that we don’t have the infrastructure to provide the level of assistance that people need.”

Lack of Enrollment

Many people generally don’t buy health coverage because the subsidies for premiums are too low to make plans affordable, Pollitz said.

“We already had 28 million uninsured when we started all of this,” Pollitz said. “There are people who maybe didn’t, couldn’t, didn’t get around to getting coverage at the last open enrollment who may now be feeling pretty strongly like they would like to get some coverage before they are visited by this virus.”

Of the 11.4 million people who enrolled during the normal open enrollment period for 2020, 8.3 million were in the 38 states that use HealthCare.gov. Nationally, 87% of ACA enrollees receive premium subsidies, and 71% have incomes below 250% of the federal poverty level, making them eligible to also receive subsidies that cover most out-of-pocket costs.

People are now increasingly looking to get insured as the virus spreads and businesses shut down.

Ray said she has seen more people expressing interest in signing up for ACA coverage over the last two weeks.

“We’re overwhelmed because our Medicaid system is backed up,” Ray said. “People are not just trying to apply for marketplace, they’re trying to apply for Medicaid, they’re trying to apply for CHIP,” she said, referring to the Children’s Health Insurance Program.

Meanwhile hospitals are taking a wait-and-see approach to the administration’s funding plan to cover bills of the uninsured.

“We have encouraged the administration to focus CARES Act funding on hospitals with the most limited cash reserves and that serve the most vulnerable patients and communities, Erin O’Malley, senior director of policy for America’s Essential Hospitals, said.

—With assistance from Alex Ruoff