The COVID-19 pandemic combined with the Affordable Care Act has resulted in a historically high percentage of Americans receiving health coverage. What is behind this historic record? Two experts from Manatt Health examined trends in access to care through Medicare, Medicaid and the commercial health insurance market in a webinar Thursday.
Between 2011 and 2021, the percentage of Americans covered increased by 7.4% to 91.7% of the population, said Julian Polaris, partner at Manatt Health. More than half of Americans receive health insurance through an employer, with employer coverage rates fluctuating between 54% and 57% between 2010 and 2021. When unemployment rises, the number of people benefiting from coverage by the employer generally decreases. However, in 2021 the American Rescue Plan Act subsidized COBRA coverage for those who quit or lost their jobs, allowing more people to remain insured.
Although more people are covered, “the quality of this cover has eroded over time, with out-of-pocket costs increasing steadily”.
—Julian Polaris, Partner at Manatt Health
Although more people are covered, Polaris said, “the quality of this coverage has eroded over time, with out-of-pocket costs steadily increasing.”
From 2011 to 2021, the average annual family premium – the employer and employee contribution to health insurance – has increased by nearly 50%, from $15,000 to over $22,000. Since 2009, the percentage of workers covered with an annual deductible over $2,000 has quadrupled, from 7% to 29%. Nearly half of small business employees have an annual deductible of this order.
ACA enrollment increases sharply
After rising under the Obama administration and falling under the Trump administration, the number of Americans covered by Affordable Care Act market plans has risen sharply during the pandemic, Polaris said. In 2021, 3.5% of Americans — about 14 million people — were enrolled in ACA coverage.
When ARPA was signed into law in March 2021, the law significantly improved subsidies in the ACA market by eliminating premiums for people with incomes between 100% and 150% of the federal poverty level and increasing subsidies for people whose income is above 400% of federal poverty. Level.
These grants have supported increased ACA enrollment during the pandemic. Other factors that have led to an increase in enrollment include the rising unemployment rate and the associated loss of employer health coverage, as well as policies such as special enrollment periods intended to promote the ACA registration.
The Inflation Reduction Act, passed in August, extended the enhanced subsidies through 2025 and it is unclear whether Congress will extend them further.
Health insurance: an aging population leads to an increase in enrollment
Medicare coverage rates are increasing as the U.S. population ages, Polaris said. Over the past decade, the number of Americans age 65 and older has grown 12 times faster than the number of Americans under age 65. During this period, the proportion of Americans covered by Medicare increased by 4 percentage points. In 2021, Medicare covered 60.2 million Americans, or 18.4% of the total population.
Although the 2020 Democratic presidential primary featured discussion of “Medicare for All,” there are currently no active legislative proposals to expand Medicare eligibility, he added.
Medicaid/CHIP shows trend toward broader eligibility
Medicaid enrollment has increased steadily over time, due to expanding eligibility parameters, said Kinda Serafi, partner at Manatt Health. More recently, under ARPA, Congress authorized states to extend postpartum coverage for Medicaid recipients from 60 days to one year.
As of June, Medicaid and the Children’s Health Insurance Program covered more than 89 million people, or more than 27% of all Americans. Of these, 82.3 million were covered by Medicaid and 7.1 million were enrolled in CHIP.
These are historically high levels, Serafi said. She noted that more than half of children in the United States are covered by CHIP or Medicaid, and Medicaid covers more than 40% of births in the United States.
One Medicaid trend that Serafi has noted is that the majority of Medicaid beneficiaries are now receiving services through private managed care organizations.
Medicaid is a key driver of health equity, she said, with Medicaid enrollees more likely than the general population to have low income, be people of color or have a disability or special health care needs.
During the COVID-19 pandemic, Medicaid enrollment has steadily increased, in part because the Families First Coronavirus Response Act gave states a temporary boost to federal Medicaid funding. This funding is subject to compliance with Medicaid Beneficiary Protections, including the requirement to maintain enrollment of nearly all Medicaid enrollees during the COVID-19 public health emergency.
The requirement to maintain continuous coverage under Medicaid is one of the reasons Medicaid enrollment has increased 25% since the pandemic began, Serafi said. Other factors include reduced household incomes due to pandemic-related economic factors.
When the public health emergency ends, states must re-determine the eligibility of nearly all Medicaid enrollees, which Serafi described as “a significant undertaking.”
States must develop an operational plan for what has been called “the grand denouement”. If a person is determined to no longer be eligible for Medicaid, the state should assess that person’s eligibility for other coverage, such as ACA coverage, and facilitate their transition to that coverage.
Susan Rupe is an editor for InsuranceNewsNet. She previously served as communications director for an association of insurance agents and was an award-winning journalist and editor. Contact her at [email protected]. Follow her on Twitter @INNsusan.
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