By Rachel Swindle

Summer months are fleeting, but health policy research is here to stay. As we keep an eye on federal legislative developments and the upcoming open enrollment period, a couple of studies caught our attention here at CHIR.

The Uninsurance Rate Held Steady during the Pandemic as Public Coverage Increased – Michael Karpman and Stephen Zuckerman, Urban Institute, August 18, 2021.

Using the Urban Institute’s Health Reform Monitoring Survey data from March 2019 through April 2021, the authors of this report determined that the uninsurance rate for non-elderly adults did not increase significantly during the COVID-19 pandemic.

What It Finds

• The uninsurance rate stayed around 11 percent between March 2019 and April 2021, but the coverage landscape shifted.
  • The share of non-elderly adults covered by employer-sponsored insurance (ESI) declined by 2.7 percentage points (65 percent to 62.3 percent).
  • The share of adults enrolled in public coverage increased by 3.9 percentage points overall (13.6 percent to 17.5 percent).
    • In states that have opted not to expand Medicaid under the Affordable Care Act (ACA), the proportion of adults enrolled in public coverage increased from 10.7 percent to 14.3 percent; in Medicaid expansion states, the increase was greater, rising from 14.9 percent to 19.2 percent of adults.
  • The proportion of adults covered by non-group coverage, which includes coverage through the ACA’s marketplaces, remained at approximately 8 percent between 2019 and 2021; the authors indicate that the consistency of this data point may suggest that new marketplace enrollment did not offset the number of people transitioning from marketplace coverage to Medicaid.
• The uninsurance rate in Medicaid non-expansion states was more than 10 percentage points higher in 2021 than in expansion states (18.2 percent and 7.7 percent, respectively); the proportion of low-income adults who were uninsured in 2021 was more than 20 percentage points higher in non-expansion states compared to expansion states (37.7 percent compared to 14.5 percent, respectively).

Why It Matters

COVID-19 ushered in the most precipitous shock to the American economy since the 2008 financial crisis. As the authors note, COVID-19 constitutes the first major “stress-test” of the ACA. Given widespread job losses, many feared that the economic crisis would lead to a spike in the number of uninsured adults as people lost access to ESI. The findings from this report suggest the ACA offered considerable protection for those vulnerable to loss of coverage due to economic shocks, particularly the Medicaid expansion provision of the law made more effective by a temporary federal policy protecting Medicaid enrollees from being removed from coverage rolls during the Public Health Emergency. Given the eventual expiration of the Public Health Emergency, other components of the coverage safety net, such as the ACA’s marketplaces and temporarily enhanced subsidies under the American Rescue Plan, may play a larger role in preventing increases in the uninsured rate. Policymakers should take steps to ensure the transition between insurance programs does not result in coverage gaps, and keep in mind the importance of ensuring marketplace coverage is affordable for those who need it.

Most private insurers are no longer waiving cost-sharing for COVID-19 treatment – Jared Ortaliza, Matthew Rae, Krutika Amin, Matthew McGough, and Cynthia Cox, Kaiser Family Foundation, August 19, 2021.

In the early days of the pandemic, some states required insurers to cover the cost of COVID-19 treatment, and some insurers voluntarily waived patient cost-sharing. As the pandemic has progressed, some of these temporary state policies and insurer initiatives protecting patients from the cost of care have expired. Researchers at the Kaiser Family Foundation’s Peterson-KFF Health System Tracker checked in on the status of cost-sharing waivers for COVID-19 treatment.

What It Finds

• Among 102 health plans (the two largest in each state and the District of Columbia) representing 62 percent of enrollment across fully insured individual and group markets, all plans implemented cost-sharing waivers for COVID-19 treatment at some point since 2020.
  • Seventy-two percent of plans are no longer waiving cost-sharing for Covid-19 treatment, with almost half of all plans ending cost-sharing waivers by April 2021 when vaccines became more widely available.
  • Another 22 percent of plans are currently expecting to end cost-sharing waivers by the end of 2021.
• Among employers offering health insurance coverage, preliminary data shows that larger employers were more likely than smaller firms to waive cost sharing for ESI recipients this year. Between January and July 2021, 44 percent of firms with 1,000+ workers waived cost sharing for COVID-19 treatment while 34 percent with 50-199 workers provided similar waivers.

Why It Matters

As many hospitals reach capacity due to an influx of COVID-19 patients, it is clear that people will continue to require treatment for this disease. The availability of a vaccine coincides with shifts in cost sharing: vaccination is free and highly effective at preventing serious illness if the vaccinated individual does experience a “breakthrough” infection. It is largely the unvaccinated now experiencing costly medical care due to COVID-19, and insurers have responded by sending them the bill for that care.