Congress and the administration should take steps to help secure health coverage
More than 40 million Americans have lost their jobs because of the COVID-19 pandemic, and many of them have already lost their employer-sponsored health insurance coverage or will be losing it soon. During this unprecedented global crisis, that means people are losing their health care coverage right when they need it most.
People with existing chronic illnesses, like high blood pressure, diabetes and kidney disease, are more likely to have severe cases of COVID-19. Ensuring that these individuals have access to care is essential for their health. Since your health insurance plan dictates which doctors are in your network and what your out-of-pocket costs are, changing health plans due to loss of insurance can mean the doctors you have been seeing are no longer in-network along with possible increases to your out-of-pocket costs.
Congress and the Trump administration can take a number of steps during this pandemic to help ensure that those who are uninsured can obtain coverage and those with existing health insurance can keep it:
- Open a special enrollment period for qualified health plans (QHPs) bought through the Marketplace/Exchange. People who have lost their insurance can enroll in a QHP, also referred to as an Affordable Care Act (ACA) or “Obamacare” plan. They can do this through the “Marketplace” or “Exchange” website for their state that helps people find ACA insurance plans. Anyone who was uninsured to begin with or who missed the open enrollment period, though, is not eligible to do so. People who are underinsured, meaning they are enrolled in non-ACA plans like short-term insurance plans that provide sub-par coverage, are also not eligible to enroll in ACA plans, even if their short-term coverage ends. A special enrollment period that accounts for these exceptions would allow more Americans to obtain health coverage.
- Operationalize enrollment into Marketplace/Exchange plans for people with comprehensive off-exchange plans. People who have comprehensive “off-exchange” plans not purchased through the Marketplace or Exchange are legally able to opt into Marketplace/Exchange plans, but this transition has not been operationalized. The federal government can make that change. Comprehensive “off-exchange” plans are compliant with ACA regulations, but the main difference is that “off-exchange” plans are not eligible for advance premium tax credits (APTC). APTC are funds the federal government pays directly to the insurance company to cover part or all of your premium, depending on your income. Some people may wish to opt into a QHP if their income has been reduced and they become now eligible for the APTC, which could substantially lower the cost of their health coverage.
- Prohibit QHP insurers from canceling policies for failure to pay the premium. Some states are requiring insurance plans to extend coverage, even when someone cannot pay for their health insurance premium. In these cases, a payment plan would be worked out so the person can begin paying their premiums once the COVID-19 emergency is over. Making this a national policy would ensure that people do not lose their coverage when they need it most.
- Require Medigap insurers to offer grace periods for Medicare beneficiaries who cannot pay their premiums. Medigap (Medicare supplemental) plans are private plans that cover many costs that Medicare does not pay. Medigap is especially essential for dialysis patients because of the high costs of care. Some state and private insurance companies have announced that they will provide a grace period, meaning that Medicare beneficiaries will have more than 30 days after payment is due to pay their premium. During this time, their policy will not be canceled for non-payment. The federal government should require all Medigap insurers to provide a grace period.
- Provide a COBRA subsidy. COBRA allows people who have recently lost their jobs to keep their employer’s health insurance for 18 months by paying the entire health insurance premium. For example, if your monthly premium is $300 and you paid 50% ($150) while you had your job and your employer paid the other 50%, under COBRA, you would have to pay the entire $300. During the financial crisis of 2008, a 65% COBRA subsidy was created to help people retain their insurance, which lasted until May 31, 2010. The federal government should implement an expanded version of this policy so people can keep their doctors and have continuity of care, especially when remaining insured is so important. The Health and Economic Recovery Omnibus Emergency Solutions Act (HEROES Act), which passed in the U.S. House of Representatives on May 15, 2020, included a 100% subsidy to cover the entire COBRA payment for people newly uninsured due to job loss.
- Ban surprise bills. Surprise bills are health care bills you didn’t know were coming. These bills can be much higher than normal copays or coinsurance, and they have led to financial hardship and even ruin for many people. An example of a surprise bill would be when you go to an in-network hospital for care, but the doctor or nurse who treated you is out of your insurance network because they may be contracted by the hospital. Your health insurance company will usually pay a portion of what the out-of-network provider billed, but you would be required to pay the remaining amount, which is typically much higher than what you would normally pay for in-network services. AKF had already been working to ban surprise billing before the COVID-19 pandemic, but it is crucial that they are banned now because so many people are facing economic hardships. Congress should fully protect consumers from surprise bills, ensure any solution to this problem doesn’t increase health care costs for consumers and protect consumers across all health plans and provider settings.
- Extend immunosuppressive drug coverage. People who are living with a kidney transplant rely on immunosuppressive drugs to ensure that their body does not reject their transplanted organ. Medicare only covers immunosuppressive drugs for 36 months after the date of the transplant surgery. After those three years, if the patient is under the age of 65, Medicare will no longer cover the transplant recipient or the medicines they need to keep their new kidney. If a kidney transplant recipient cannot find alternative health insurance and cannot afford to pay for their immunosuppressive drugs out-of-pocket, they will go through rejection, lose their kidney and must go back on dialysis in order to survive. In cases where kidney transplant patients cannot find alternative health insurance and they cannot afford to pay for their immunosuppressive drugs out-of-pocket, they ultimately lose their kidney and must go back on dialysis—and again become eligible for Medicare.
H.R. 5534 and S. 3353, the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019, would extend Medicare coverage of immunosuppressive drugs for the life of the transplant. The Department of Health & Human Services projects significant Medicare savings if immunosuppressive drug coverage were extended to all Medicare ESRD beneficiaries indefinitely. The Office of the Assistant Secretary for Planning and Evaluation (ASPE) projects Medicare would save $73.4 million over 10 years, while the Centers for Medicare & Medicaid Services Office of the Actuary (OACT) projects savings of $300 million over 10 years.