President Donald Trump said he is considering using federal programs like Medicare and Medicaid to cover the rising ranks of the uninsured after his administration decided it would not reopen the Obamacare insurance markets to address the coronaivrus crisis.
Both Trump and Vice President Mike Pence on Wednesday were very vague about any forthcoming proposals that would flesh out their promise that people wouldn’t have to worry about the costs of treating the coronavirus. But at the daily White House task force briefing, they indicated they were looking at some version of Medicaid and Medicare to fill in at least some cost gaps.
“I’m not committing,” said Trump. “I have to get approval. I’ve got a thing called Congress. It’s something to look at and we have been looking. “
Trump’s refusal to reopen Obamacare enrollment, first reported by POLITICO on Tuesday, angered Democrats and health advocates, who said the health care law could provide much-needed financial security to millions of uninsured Americans worried about huge health bills from Covid-19.
“This callous decision will cost lives. Period,” Joe Biden wrote on Twitter.
Despite Trump’s decision on Obamacare, people who lost their workplace health insurance amid a record surge in employment are still likely eligible for coverage through a special enrollment period for people experiencing certain life circumstances. But millions of more uninsured Americans who don’t qualify for a special allowance will remain shut out from the marketplaces until they reopen in the fall.
Sources familiar with discussions between insurers and the administration believe Trump’s decision was ultimately made to avoid muddling the administration’s position on the Affordable Care Act as Trump urges the Supreme Court to throw out the law. A senior administration official, when asked if the decision was politically motivated, said there were “better options” to help uninsured Americans, pointing to special enrollment periods and temporary workplace coverage for laid-off workers.
Medicaid, the low-income health care program, can catch some of the newly unemployed, though its reach will be limited in the 14 red states that have refused the Obamacare expansion to poor adults. Republican governors in those holdout states have shown no signs they’re reevaluating their opposition as the virus appears poised to spread through their communities.
During Wednesday’s briefing, when asked about Medicaid expansion, Trump did not explicitly say if he would make sure holdout states broadened their programs or whether he would open the program to higher incomes. He and Pence, without providing details, both indicated they were looking at a range of options drawing on those two entitlements.
Advocates who report being flooded with questions about health insurance in recent weeks have said they don’t expect much help from the Trump administration to spread the word about insurance options during this crisis. Many enrollment groups funded by federal grants have also seen their support significantly cut during the Trump era, leaving few resources to conduct outreach between annual enrollment seasons.
“Since there’s no communication and no marketing or information to inform people coming out of the federal level, it’s putting an onus on those of us in the states that have minimal budgets,” said Jodi Ray of Florida Covering Kids and Families, the largest federally funded group helping with Affordable Care Act enrollment.
Trump’s decision not to reopen HealthCare.gov came as a surprise to many closely following the issue, despite the president’s longstanding opposition to Obamacare. Insurance sources said that federal health officials overseeing the Obamacare enrollment site, which serves about two-thirds of states, had been preparing to relaunch enrollment late last week before the White House shut down an idea the administration itself had floated.
The HealthCare.gov homepage, as it typically does after the annual enrollment period closes, still alerts visitors they may be able to buy insurance after experiencing a life change and that they may qualify for low-income coverage through Medicaid or the Children’s Health Insurance Program. A blog post lower down on the page explains how insurance status could be affected by the coronavirus.
And on the government’s HealthCare.gov Twitter account last month, there wasn’t a single post encouraging people to check if they were eligible to get coverage as the virus surged through the nation.
The coronavirus pandemic could exacerbate the difference between the Obamacare haves and have-nots. States that expanded Medicaid under the law have typically had lower uninsured rates, and health experts think those states will fare better through the pandemic.
Nearly all of the 13 states running their own Obamacare marketplaces, including the District of Columbia, have reopened enrollment in recent weeks — and some are reporting sharp increases. In Maryland, more than 10,000 people enrolled in Medicaid or an Obamacare plan in the past two weeks, and nearly half were under 34, which is typically the most difficult age group to coax into buying coverage. The state on Wednesday extended its sign-up window another two months until mid-June.
In Connecticut, officials said they’ve been overloaded with calls ahead of the Thursday deadline for the state’s special enrollment period. Washington state, the first to reopen enrollment as it became the country’s first coronavirus hot spot, also announced it’s extending sign-ups for another 30 days, through May 8.
But the majority of states, which are dependent on HealthCare.gov, face a much tougher road.
Joshua Peck, a former Obama administration official who co-founded the nonprofit Get America Covered to encourage enrollment, said his group is still evaluating how best to promote Obamacare for people who have just lost their job and may qualify for special enrollment. Whatever the group decides to do, he said, it will be limited compared to the resources the federal government could have marshaled.
“Even in the best-case scenario of what a small nonprofit like us can do in the face of tens of millions of people who need to hear about resources that are available to them — we’re just not equipped to operate at that scale,” he said.
Ray said the Florida enrollment group she heads is trying to sort through a “mess” as it faces a flood of questions about insurance options. In Florida, one of the Medicaid expansion holdout states, there’s an estimated 390,000 low-income uninsured adults who don’t earn enough for subsidies to buy private insurance but who make too much to qualify for Medicaid.
“I think we’re not creating a good scenario for people to feel they can safely access care and that they’re being protected,” Ray said. “We’re finding out how weak our safety net is.”
And other poor non-expansion states are starting to grapple with their outreach challenge. Roy Mitchell, executive director of the Mississippi Health Advocacy Program, said he’s still trying to assemble the resources for some “rudimentary” outreach after his program’s outreach budget lost considerable funding from a foundation.
“The loss of public and private funding for community outreach and education on health coverage could not have come at a worse time,” he said.
For Obamacare critics and supporters alike, the pandemic has also spotlighted the law’s flaws — namely, high premiums and deductibles for customers not receiving generous subsidies. But in a health system largely based around job-based insurance, the soaring unemployment rates mean that for a growing number of Americans, the law proves to be their only guarantee of insurance during a pandemic.
“The top priority is meeting the needs of the day,” said Stan Dorn of the liberal advocacy group Families USA.
A senior administration official pointed out many of the newly jobless may still qualify for a special enrollment period under the law, and they may be able to temporarily keep their workplace plans under the health insurance law known as COBRA. That’s a particularly pricey option, though, so laid-off workers would have to pay the plan’s full cost without employer help.
Doug Badger, a visiting fellow at the conservative Heritage Foundation, said the debate over reopening Obamacare enrollment should be moot after the most recent massive stimulus package flooded more money into the health care system. He said this should alleviate any immediate need to expand the health care law, since Congress has already guaranteed free testing and allocated $100 billion to help health care providers cover the cost of treatment.
“Opening more people up to premium subsidies will benefit the insurance companies but is not the most effective way to help the uninsured,” he said.
Still, there’s no guarantee treatment will be covered for uninsured or even all insured coronavirus patients, and Democratic lawmakers said their next rescue package should ensure no one gets a bill. The major health insurance lobbies, who supported reopening HealthCare.gov, haven’t signaled what they’ll push for in the next round of congressional negotiations after the third package mostly left them out.
But Ceci Connolly, president of the Alliance of Community Health Plans, which represents small nonprofit insurers, said her organization keep up messaging around special enrollment.
“Community health plans will be spreading the word,” she said.
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