The largest healthcare transition since the ACA is about to occur
WHEN IT COMES TO SILVER LININGS from the COVID-era, you’d be hard-pressed to find one better than our nation achieving record healthcare coverage, with a historic-low 8 percent uninsured rate heading out of the pandemic.
But this national success story could soon turn into a national nightmare, with continuous Medicaid enrollment provisions of the American Rescue Plan (ARP) set to expire in April, causing up to 15 million residents to lose coverage.
Across New England, 700,000 residents could lose coverage, according to a review of Medicaid data and projections.
This would be a sad bookend to history. A parade of presidents, from Harry S. Truman, to LBJ, to Barack Obama labored to achieve such near-universal coverage, but President Joe Biden ultimately got it done during the global pandemic.
During the last two years, the Biden Administration worked with states to implement multilingual Marketplace outreach, expanded subsidies and continuous Medicaid enrollment under the ARP. As a result, Latino and Black residents both experienced close to a 50 percent jump in Marketplace coverage, according to the Washington Post. At the same time, 15 million new adults and children accessed coverage through Medicaid.
While some conservatives have derided this as an “expansion of the welfare state,” President Biden and his partners in the states should be proud of this accomplishment and must now double-down to keep coverage rates intact.
Biden’s Administration recently signaled April 2023 as the end of the public health emergency when continuous Medicaid enrollment provisions will expire. At that point, the nation’s health coverage gains will be in serious jeopardy, leaving states to undergo a massive redetermination of who is eligible.
Estimates from the Department of Health and Human Services (HHS) suggest that as many as 15 million people will be disenrolled in Medicaid, including nearly 7 million who will likely still be eligible. This will mark the single largest health coverage transition event since the first open enrollment period of the Affordable Care Act.
“Culturally-appropriate outreach and education is the key piece to solving this puzzle,” says Dr. Joseph Betancourt of Massachusetts General Hospital and recently named incoming president of The Commonwealth Fund.
Nearly one-third of those predicted to lose coverage are Latino (4.6 million) and 15 percent (2.2 million) are Black. Children and young adults will be also disproportionately impacted, with 5.3 million children and 4.7 million residents aged 18-34 predicted to lose Medicaid/CHIP coverage.
Local healthcare Navigators, coupled with multilingual advertising and outreach through the exchange, helped states like Massachusetts achieve near-universal coverage, and will be critical to maintaining it.
“Community members come to us with little English or knowledge of which plan they are enrolled in,” says Kesia Moreta, a health insurance navigator in Lawrence Massachusetts. “These changes will further complicate their busy lives. We are ready to serve them, but many places around the country may not be.”
Focus groups conducted by the marketing firm I founded show Latino and Black residents disproportionately lacking access to information about their coverage due to cultural and linguistic barriers. Nationwide these groups will be more likely to be left in the dark, and ultimately uninsured.
“States must shift communications into overdrive to keep diverse patients covered with Medicaid or Marketplace plans during this unprecedented transition,” adds Dr. Betancourt. “If not, emergency departments nationwide will be pushed past the breaking point.”
Those emergency rooms are already “gridlock and overwhelmed,” according to national medical advocates, who point to a recent exodus of physicians and nurses.
State Medicaid agencies, health organizations and local partners must not wait for 2023 — they must act now. This time is critical to saturate our most vulnerable communities with multicultural outreach and education campaigns about these changes.
This will help prevent those eligible from losing Medicaid and ensure others can seamlessly transition into Marketplace plans. Congress has already extended the expanded Marketplace subsidies into 2025, which makes plans more affordable for families dealing with inflation and other pressures.
Now state agencies and healthcare organizations must act to ensure our national coverage success story stays on the right side of history.
1* — 700,000 figure based on CMCS 7/22 New England Medicaid/CHIP population of 4M and estimate of 17.4 percent to be impacted by upcoming transition