Summer is here, and we at CHIR are soaking up the sun and new research. This month, we read studies on the novel coronavirus’ (COVID-19) potential impact on insurance coverage, individual market enrollment trends during the COVID-19 pandemic, and the role provider directories play in surprise billing.

Collins S, et al. An Early Look at the Potential Implications of the COVID-19 Pandemic for Health Insurance Coverage. The Commonwealth Fund, June 23, 2020. With the unemployment rate struggling to return to normal amidst the current public health and economic crises, researchers at the Commonwealth Fund and survey research firm SSRS explored the early impact of COVID-19 on insurance coverage, conducting a national survey of U.S.

What It Finds

• Of the respondents who indicated that they and/or their partner were working full- or part-time before the pandemic, 21 percent reported that they and/or their partner were either laid off or furloughed due to COVID-19. Hispanic respondents and respondents making less than $50,000 in annual income were affected at significantly higher rates than white respondents and people with annual incomes above $50,000.
• Two of five respondents who reported they and/or their partner lost a job or were furloughed due to the pandemic had health insurance coverage through the impacted job.
• One of five adult respondents who reported that they and/or their partner had coverage through their impacted job reported that they and/or their partner are now uninsured.
• Fifty-nine percent of respondents who indicated that they and/or their partner lost their job or had been furloughed did not have health coverage through that job. About 30 percent of those who lost their job were uninsured prior to the COVID-19 pandemic.
• When asked if they would support a government-regulated and subsidized health plan as an option alongside job-based coverage at a similar cost, 74 percent of respondents said yes.

Why It Matters

The United States is unique in tying health insurance to employment, with the majority of non-elderly adults accessing coverage through their job. During the public health and economic crisis brought by COVID-19, experts have increasingly questioned the workability of this structure, which disproportionately leaves out Black and Latino people. As policymakers think through how to implement meaningful health reform in the short- and long-term, expanding and enhancing affordable coverage sources outside the employer market, such as through public programs or the Affordable Care Act’s (ACA) health insurance exchanges, should be high on the list of priorities.

Special Trends Report: Enrollment Data and Coverage Options for Consumers During the COVID-19 Public Health Emergency. Centers of Medicare and Medicaid Services (CMS), June 25, 2020. In light of the COVID-19 pandemic and subsequent economic crisis, people across the country experienced significant life changes – such as the loss of job-based coverage – that make them eligible for a Special Enrollment Period (SEP) in the individual market. CMS released a report of current SEP-related trends in the federally facilitated marketplace (FFM).

What It Finds

• In 2020, the FFM experienced a 46 percent increase in the number of consumers gaining coverage through a loss of minimum essential coverage (MEC) SEP between the end of Open Enrollment and the end of May 2020, compared to the same period in 2019.
• April was the busiest month for the FFM, with loss of MEC SEP enrollments increasing by 139 percent compared to April 2019.
• Compared to 2019, overall SEP enrollments in 2020 from the end of Open Enrollment through May are up by 27 percent. Loss of MEC SEP enrollments account for 82 percent of the increase.

Why It Matters

The ACA’s marketplaces are a critical source of coverage for people experiencing major life changes. Understanding SEP trends during the COVID-19 pandemic is an important measure of job-based insurance loss and an indicator of the myriad other issues consumers are facing during the crisis, including income loss and other upheavals that reduce access to insurance. Almost every state-run health insurance marketplace established a new temporary SEP to broadly allow the uninsured to enroll for a period during the COVID-19 pandemic, but the federal government declined to implement a similar SEP on the FFM. Some state-based marketplaces have reported significant enrollment since launching a COVID-19-based SEP. Further data collection, reporting, and analysis on SEP enrollments will help policymakers understand the coverage landscape during and after the COVID-19 pandemic – including who is and isn’t able to access marketplace or public plans – and hopefully help them fill in the gaps.

Busch S and Kyanko K. Incorrect Provider Directories Associated with Out-Of-Network Mental Health Care and Outpatient Surprise Bills. Health Affairs, June 2020. Surprise medical bills continue to make the news. Most research on surprise billing focuses on emergency care and situations where a patient cannot choose their provider, with less attention given to the importance of provider directories in informed decision making. This issue is particularly important in accessing mental health care, which is up to six times as likely as general medical services to be delivered by an out-of-network provider. Researchers conducted a national survey of privately insured patients who used outpatient specialty mental health services to understand the impact of inaccuracies in provider directories on the probability of receiving a surprise out-of-network medical bill.

What it Finds

• Of the 44 percent of respondents who used a provider directory in the previous year to find mental health services, 53 percent faced directory inaccuracies.
• Over a quarter (26 percent) of respondents reporting provider directory inaccuracies found a provider listed in their directory that did not actually accept their insurance.
• Forty percent of patients who faced provider directory inaccuracies were treated by an out-of-network provider, compared to 20 percent of patients who did not face directory inaccuracies.
• Among mental health provider directory users, patients who encountered at least one directory inaccuracy were four times as likely (16 percent versus 4 percent) to receive a surprise bill, suggesting that they weren’t aware they were seeing out-of-network providers prior to their initial appointment. 

Why It Matters

Surprise medical bills often hit patients when they are most vulnerable: in emergency situations, when recovering from a serious illness or surgery, or while coping with a chronic condition. Inaccurate provider directories that hinder a patient’s ability to make the best decision can have serious financial consequences, yet insurers and providers have faced limited accountability when they’re not kept up to date. Policymakers and regulators need to hold insurers and providers to high standards for directory accuracy, and impose penalties when they don’t meet those standards.