Millions losing health insurance


Trump, Florida offer little help

President Donald Trump wearing – a mask in public for the first time since the Covid-19 pandemic began in February-arrived at Walter Reed National Military Medical Center on July 11 to visit with wounded military members and front-line coronavirus healthcare workers in Bethesda, Md.



WASHINGTON – As millions of people lose jobs in the coronavirus outbreak, jeopardizing their health benefits, the Trump administration and many states are doing little if anything to connect Americans with other insurance coverage.

The U.S. Health and Human Services Department hasn’t launched any special effort to publicize the availability of Medicaid, the Children’s Health Insurance Program or health plans being sold on marketplaces created by the Affordable Care Act, known as “Obamacare” or the ACA.

And federal officials haven’t made any substantial new commitment of money for outreach or to help people enroll in coverage.

State fights Obamacare

As Florida continues to deal with the pandemic, the state has signed onto a legal brief asking the U.S. Supreme Court to strike down the Affordable Care Act, Florida Attorney General Ashley Moody joined Texas and 16 other states that are arguing the federal law should be wiped out completely.

The elimination of Obamacare could have a significant impact in Florida. Even though the state did not expand Medicaid as allowed under the ACA, Florida residents use the federal health-insurance exchange included in the law more than any other state. About 1.9 million Floridians used the federal exchange for insurance coverage in 2020.

Also, prior to Obamacare, Florida insurance law did not require insurers to sell plans to people with pre-existing conditions, a feature of ACA that is popular with Americans.

Florida lawmakers in 2019 agreed, however, to put some protections into state law, in case the U.S. Supreme Court struck down the federal healthcare mandate.

No price protection

But the protections the Florida Legislature passed last year pale in comparison to those in the federal law. Florida law requires that all health insurers and HMOs licensed in the state be required to offer at least one policy to people with pre-existing conditions. The state law doesn’t include any price protections for consumers, though.

In California and 11 other states that operate their own insurance marketplaces, state governments have created special enrollment periods to give people more time to enroll in health coverage during the pandemic.

But patient advocates around the country say many state governments have been largely silent, as well, leaving nonprofit groups, health clinics that serve poor patients and others scrambling to get the word out to people losing health insurance in the outbreak.

“People are really struggling, but there is virtually no communication,” said Jodi Ray, project director of Florida Covering Kids & Families, which works to expand health coverage in the state.

Self-funded campaigns

The Association for Community Affiliated Plans, a trade group representing health insurers, was so concerned about inaction by the Trump administration that it launched its own advertising campaign last month to direct people to online marketplaces.

“Tens of millions of people have lost employer-based coverage, but federal agencies aren’t helping to lead people to the best resources available: the state and federal insurance marketplaces,” said Margaret A. Murray, the group’s chief executive.

The federal Centers for Medicare & Medicaid Services, or CMS, which oversees government health plans, did not detail its work to help uninsured Americans, despite questions sent by the Los Angeles Times to the agency last week.

The full count of how many people have lost coverage isn’t yet known, though some estimates put the number in the millions.

Different administration

The weak federal effort to confront those coverage losses marks a notable departure from the last economic downturn in 2009. At that point, the Obama administration backed nationwide efforts to help states stem the loss of health coverage.

The Trump administration has taken a different approach to the safety net, calling repeatedly in White House budgets for large cuts to Medicaid and backing legal and legislative efforts to eliminate the ACA.

The latest legal challenge to the health law is to be considered by the Supreme Court this fall. The administration has asked the court for a ruling that would eliminate coverage for tens of millions of Americans.

Shortly after Trump took office, the administration cut funds to help people enroll in marketplace coverage through the law.

Another burden on recipients

Administration officials, led by CMS administrator Seema Verma, have strongly backed efforts by conservative states to restrict access to Medicaid, including by imposing work requirements. Federal courts have blocked work requirements, deeming them inconsistent with Medicaid’s purpose of providing health coverage, but Tuesday, the administration asked the Supreme Court to reverse that.

“CMS’ political agenda over the last few years has been to create barriers to Medicaid coverage,” said Joan Alker, director of the Georgetown Center for Children and Families. “It comes as no surprise that we see no national effort to inform families of their public coverage options.”

The number of people who have lost coverage is uncertain in part because many who are out of work likely have found ways to retain coverage. Some may have switched onto a spouse’s health plan. Others may have found their own way to Medicaid or a subsidized health plan on an insurance marketplace created by the 2010 health law.

Fred Ammons, executive director of Community Health Works, which helps uninsured Georgians find coverage, said many people who have called during the pandemic are already familiar with government health insurance options, perhaps because employers are sharing the information.

But Ammons warned that limited resources to educate the newly unemployed will likely hamper efforts to reach the newly uninsured, many of whom may not realize that government assistance may be available.

Outreach is necessary

“Whenever you have a major downturn in the economy, you have people who don’t have prior experience with public programs,” said Cindy Mann, who oversaw Medicaid and the Children’s Health Insurance Program, or CHIP, in the Obama administration.

That is one reason why Congress and the Obama administration in 2009 provided states with additional funding to do outreach for CHIP, a government health plan for the children of working parents who make too much to qualify for Medicaid but not enough to afford commercial insurance.

“There was an understanding that even if you build it, they may not come,” said Donna Cohen Ross, who oversaw the 2009 outreach effort.

Today, some states with Democratic governors are following the same playbook, stepping up efforts to ensure that residents who lose job-based coverage can find other options.

Noam N. Levey of the Los Angeles Times / TNS contributed to this report. Information from
the News Service of Florida was also used.




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