July Research Round Up: What We’re Reading

By Mari Tikoyan

We are more than halfway through 2020, and the glass is half full of new health policy research. In July, we read studies on the role of the Affordable Care Act (ACA) in addressing health insurance disparities among Asian Americans, the impact of the novel coronavirus (COVID-19) on health insurance coverage, and the price of COVID-19 testing.

Gunja, B, et al. Gap Closed: The Affordable Care Act’s Impact on Asian Americans’ Health Coverage. The Commonwealth Fund, July 21, 2020. With the 10-year anniversary of the ACA this year, researchers at the Commonwealth Fund examined how the law helped close the health insurance coverage gap among nonelderly Asian American adults and provided recommendations on ways to reduce persisting coverage inequalities in Black, Latino, and other racial and ethnic communities.

What It Finds

  • In 2010-2011, Asian American adults were more likely to be uninsured (19.5 percent) compared to white adults (15.3 percent). In 2018, Asian American adults had the lowest uninsured rate of any racial/ethnic group in the U.S. at 7.9 percent, while the uninsured rate among white adults dropped to 8.5 percent.
  • Since the ACA’s passage, the uninsured rate among Asian American adults fell among all subgroups within the Asian American population, although Korean, Vietnamese and other Asian American adults were more likely to be uninsured compared to Chinese, Filipino, and Indian adults in 2017-2018.
  • Between 2010 and 2018, the coverage disparity between Asian American adults and white adults ceased across all income levels, with the greatest reduction within those earning 138 to 399 percent of the Federal Poverty Level (FPL).
  • Coverage disparities were eliminated between Asian American adults and white adults in both states that expanded Medicaid under the ACA and non-expansion states, but Asian American adults living in non-expansion states face higher uninsured rates than those living in Medicaid expansion states. Over 80 percent of Asian American adults live in states that have expanded Medicaid, compared to 66 percent of the total U.S. adult population and 54 percent of Black adults.
  • The implementation of the ACA helped reduce the uninsured rate among all races and ethnicities, though coverage disparities persist for Latino, Black, Native Hawaiian/Pacific Islander, Native American/Alaskan Native adults. These populations suffer higher uninsured rates compared to their white and Asian American counterparts. Authors recommend a number of policy changes to help achieve greater equity:
    • Expand Medicaid in all states, without restrictions like work requirements
    • Enhance and extend financial assistance in the ACA’s marketplaces
    • Fund consumer assistance and community-based outreach in all marketplaces
    • Continue data collection efforts to assess demographic coverage disparities

Why It Matters

At this 10-year anniversary of the ACA, it is important to assess whether the ACA accomplished its intended goals. While the ACA eliminated the coverage gap between Asian American adults and white adults, this study highlights that there are other racial and ethnic minorities that still face significant coverage disparities. Understanding the impacts of the ACA on the Asian American population illustrates the importance of the ACA’s coverage expansions and it illuminates existing coverage gaps. Policymakers should consider the authors’ recommendations to reduce the disparities that persist for other racial and ethnic groups.

Banthin, J, et al. Changes in Health Insurance Coverage Due to the COVID-19 Recession: Preliminary Estimates Using Microsimulation. The Urban Institute, July 13, 2020. To assess the impacts of the COVID-19 recession on coverage, researchers at the Urban Institute conducted a microsimulation to examine loss of employment and health insurance.

What It Finds

  • In March and April of 2020, the U.S. unemployment rate reached 14.7 percent, or 23.1 million people.
  • In the last three quarters of 2020, an estimated 48 million nonelderly people will live in families with a member experiencing job loss related to COVID-19, with 10.1 million losing health insurance tied to loss of employment. Of those 10.1 million people, researchers estimate:
  • 32 percent (3.3 million) will gain insurance coverage through a family member;
  • 28 percent (2.8 million) will enroll in Medicaid and CHIP;
  • 6 percent (0.6 million) will enroll in the nongroup market (with the majority in marketplace coverage); and
  • 34 percent (3.5 million) will become uninsured.
  • Overall, the researchers estimate that losses in employer-based health insurance coverage will be less than expected because job losses are disproportionately impacting workers who did not have employer-based coverage. This hypothesis aligns with evidence that the COVID-19 recession is particularly affecting workers in the retail, hospitality, and entertainment sectors, many of whom do not receive health insurance through their jobs.
  • People living in states that have not expanded Medicaid under the ACA are more likely to face uninsurance after losing employer-based coverage, with an estimated 55 percent of people losing employer-based insurance becoming uninsured in non-expansion states compared to 34 percent in expansion states.

Why It Matters

The COVID-19 pandemic and associated safety measures have caused millions of people to lose jobs and income. This study projects the extent to which employer-based health insurance – the source of coverage for the majority of nonelderly adults – will be impacted by the economic crisis. With millions losing their employer health plans, public programs, including Medicaid, as well as the ACA’s marketplaces will serve as crucial safety nets. And while the number of people losing job-based coverage is lower than anticipated, the disproportionate impact of the pandemic on low-wage workers and others without job-based coverage highlights the need for expanding access to health insurance and affordable care beyond the bounds of employer plans.

Nurani, P, et al. COVID-19 Test Prices and Payment Policy. The Kaiser Family Foundation, July 15, 2020. Researchers at the Kaiser Family Foundation’s Peterson-KFF Health System Tracker evaluate some of the pricing and payment policies associated with COVID-19 diagnostic testing, by reviewing the cost of COVID-19 testing at 102 of the largest hospitals in the U.S.

What It Finds

  • Other than Medicare, there are no federally regulated prices for COVID-19 diagnostic testing. Medicare covers testing costs without any cost sharing and reimburses providers either $51 or $100 per diagnostic test (depending on the test type).
  • The CARES Act requires hospitals to publicly post price information for COVID-19 tests, which is the amount insurers would pay for out-of-network care they are required to cover. Seventy-eight of the 102 hospitals examined provided this information online.
  • Among the 78 hospitals that made COVID-19 testing costs available online, researchers discovered 134 distinct prices listed, ranging from $20-$850 per diagnostic test, with a median price of $127. More than half the listed prices (51 percent) were between $100-$199 and 19 percent were $200 or more.
  • Thirteen of the hospitals examined clearly posted list prices for specimen collection, a cost related to COVID-19 testing, with prices ranging from $18 to $200.

Why It Matters

As COVID-19 cases continue to grow and the need for testing persists, it is important to address the affordability of those tests. This study underscores the wide range of testing costs, many of which far exceed Medicare prices, which could ultimately be passed on to consumers through higher premiums or additional cost sharing. The price variation also illuminates the reasoning as to why patients could face high out-of-pocket costs even if they are insured due to gaps in the federal requirement to cover COVID-19 testing. Cost is often the main reason people avoid seeking care. Policymakers should consider how high testing costs, lack of transparency, and loopholes in federal requirements to cover COVID-19 testing impact access, and subsequently the health and safety of individuals, families and communities.

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