• August 31, 2021

It appears that the number of uninsured Americans did not increase during the pandemic.

Sometimes it is news when nothing bad happens. The history of health insurance coverage during the pandemic appears to be one such occasion.

In early 2020, when COVID-19 began forcing businesses to close, unemployment soared and the number of uninsured Americans seemed certain it would skyrocket as well. But a couple of new reports, one of them released early Tuesday morning, suggest that the uninsured rate remained basically the same in the first year of the coronavirus pandemic.

The results of these reports are not reliable. Both are based on surveys, which are inaccurate under the best of circumstances and even less reliable now because social distancing practices have made information gathering difficult.

But a significant increase in the number of uninsured Americans would likely have been seen in at least one of the surveys, if not both. And it’s not hard to imagine what could have prevented that increase from happening: Federal initiatives, including pandemic relief legislation and the Affordable Care Act, made it possible for people to be covered.

In other words, some government programs did precisely what they were supposed to do.

The explosion without insurance that was not

Tuesday’s report came from the federal government and contained preliminary results of an ongoing and ongoing process. National Health Insurance Survey.

In 2020, according to the report, only 13.9% of working-age Americans were uninsured. The previous year, 14.7% had no coverage.

Yes, the government survey did indeed detect a slight decrease in the uninsured rate. But given the margin of error, it’s hard to be sure of that, which is why the report’s authors wrote that the 2020 rate “is lower than, but not statistically different” from the 2019 rate.

That was also the conclusion of last week. report, which came from Urban Institute, a group of policy experts in Washington, with funding from the Robert Wood Johnson Foundation. That report was based on a separate survey that the Urban Institute has conducted on an ongoing basis since 2013. It found that the number of uninsured working-age Americans held steady through 2020, and held steady through early 2021 as well. (The Urban Institute survey has more recent information than the NHIS survey.)

This is not the outcome that many experts expected and feared when COVID-19 hit, prompting widespread business shutdowns in an effort to quell the spread of the virus. With so many people losing their jobs, it seemed inevitable that many would lose their insurance and end up without coverage, just like in last recessions.

But it seems that that did not happen.

Thanks, Obamacare

One likely reason is the Affordable Care Act, also known as Obamacare, which makes private health insurance available to anyone not covered by an employer, and offers subsidies to people based on their income.

The Affordable Care Act also provides states with additional money to expand their Medicaid programs, so that anyone with income below or just above the poverty line qualifies. To this day, all but a dozen states have.

The redoubts are found primarily in the south and include Florida, Georgia, and Texas. Tellingly, the uninsured rate in these states is twice as high as in the expanding Medicaid states, according to NHIS and Urban Institute surveys.

“This pandemic-driven economic crisis has been unprecedented in many ways, but one important way is that the Affordable Care Act created a health insurance safety net that never existed before in a recession.” Larry levitt, senior vice president of the Henry J. Kaiser Family Foundationhe told HuffPost after the Urban Institute’s report was released last week.

“Along with the ACA, Medicaid has been a lifesaver that has kept many people from ending up without insurance, particularly in states that expanded eligibility under the ACA,” Levitt added.

Thank you, COVID Relief

But the Affordable Care Act alone probably can’t explain why the uninsured rate remained stable. The COVID-19 relief measures of early 2020 almost certainly played a huge role as well, both by subsidizing companies so they could keep workers on payroll and by giving the unemployed extra money so they could support the health policies of your former employers through what is known as COBRA.

(COBRA is short for the insurance provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985, which made it possible for people who lose their jobs to keep your benefits for up to 36 months if they can continue to pay the premiums on their own).

Another, less understood way that COVID-19 relief legislation helped prevent insurance losses was by prohibiting states from requiring people to reverify their Medicaid eligibility. Such requirements typically cause people to drop out of the program, sometimes because they are no longer eligible, and sometimes because they do not present proper documentation. That produces a constant “turnover” in Medicaid enrollment.

COVID-19 relief packages have provided states with extra money for Medicaid, but have conditioned that funding on allowing people to stay in the program without showing proof of eligibility, in part because it has simply kept people covered, regardless. specific financial circumstances. the top priority during the pandemic.

Another factor in the stable uninsured rate may have had nothing to do with government programs. The pandemic job losses disproportionately affected low-wage industries, where many workers never had employer-provided health benefits, meaning they had no job insurance to lose.

Thanks, Bidencare – Maybe

The sustained level of health coverage does not mean that all Americans can get care when they need it. Many millions remain uninsured, while many millions more cannot pay their bills because their policies carry high out-of-pocket costs.

In this sense, the United States remains an international outlier. No other economically advanced country has a significant fraction of the population without health insurance.

President Joe Biden and the Democrats have been trying to bring America closer to truly universal coverage, in part based on the Affordable Care Act. the American rescue plan that Congress passed and Biden signed in March boosted the private financial assistance available through the Affordable Care Act so that now more people are eligible for grants and those who already receive them can get even more help than before.

The net effect has been to make coverage significantly more affordable, and this year’s license plate numbers they suggest that even more people are signing up for coverage. The uninsured rate may already be at a new low, even if data sources like the NHIS survey and the Urban Institute have yet to spot that change.

That increase in Affordable Care Act subsidies is temporary. The human infrastructure legislation that Biden and the Democrats want to pass this fall would make the momentum permanent. Too lower the price of prescription drugs and provide insurance to low-income people living in states that have not expanded Medicaid.

The same legislation would serve a lot of other thingsI also like to help young people pay for college, subsidizing Paid vacations for new parents and funding home care for the elderly and people with disabilities.

Each of these initiatives would involve its own tradeoffs, and most would involve new expenses, which in turn would require finding new revenue, cutting other expenses, or tolerating higher deficits. But the payoff could be a material improvement in the lives of all Americans, like improving their access to health care.


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