COVID-19 Sequela: Millions More Eligible for Medicaid, ACA Subsidies

Massive unemployment means that about 27 million Americans have lost employer-based health insurance, and half of them are likely eligible for coverage by their state’s Medicaid program, according to a report issued this week by the Kaiser Family Foundation.

The report argues that the ACA is providing something of a safety net with respect to healthcare coverage during the COVID-19 outbreak. Medicaid and ACA exchange plan subsidies are counter cyclical, the report says: They are likely to expand as the economy contracts, people lose their jobs and their incomes take a hit (although in some states the weekly $600 unemployment supplement means some people on unemployment are collecting more than they would have earned had they stayed employed).

The foundation estimates that 12.7 million Americans, or just under half of the people who lost employment-based healthcare coverage in March and April, will be eligible for Medicaid. Another 8.4 million will be eligible for the tax credits that offset the cost of the premiums for plans sold on the ACA exchanges, according to the quartet of Kaiser experts who wrote the report, Rachel Garfield, Gary Claxton, Anthony Damico and Larry Levitt.

Whether Americans who are eligible will actually sign up for Medicaid coverage or buy ACA exchange coverage is an open question, and the authors  make a point of mentioning that their report is framing insurance coverage as an eligibility issue, not actual enrollment.

“As policymakers consider additional efforts to aid people, expanding outreach and enrollment assistance, which have been reduced dramatically by the Trump administration, could help people maintain coverage as they lose jobs,” the report editorializes.

Here are some other number - most of them couched as estimates - from report:

• 78 million Americans were part of a family in which someone lost a job between March 1 through May 2.
• Of those 78 million, 47.6 million (61%) were covered by employer-based health insurance.
• Of those 47.6 million, 26.8  million will lose employer-based health insurance while 19.2 million will retain it in some form, usually through coverage that a spouse or a parent has.
• Of those 26.8 million, about 23 million (roughly 80%) are eligible for some kind of public assistance with health care coverage, either by getting coverage through a Medicaid program or taking advantage of the tax credits that help defray the cost of the premium for an ACA exchange plan.
• Presuming that unemployment benefits are not extended, the foundation experts foresee many more Americans becoming eligible for Medicaid come January 2021. In May, they estimate that about half were (12.7 of 26.8 million). By January 2021, they estimate that proportion will increase to 62% (16.8 of 26.8 million).
• In May, relatively few (150,000) Americans fell into the “coverage” between eligibility for Medicaid and eligibility for ACA subsidies. By January 2021, the Kaiser experts calculate that number will mushroom to 1.9 million, although that presumes, again, that unemployment benefits will run out for people who lost employer-based coverage in March and April.