Preparing the Health Insurance Marketplaces for the COVID-19 Recession

Abstract

Researchers at the Urban Institute recently estimated that 25 to 43 million people in the US will lose their employer-sponsored insurance as a result of the coronavirus disease 2019 pandemic. 1 These coverage losses have created an urgent need to transition those who have newly lost insurance to other forms of health insurance, lest they avoid seeking medical care or incur catastrophic medical debt for doing so. The Health Insurance Marketplaces created by the Affordable Care Act will play a large role in providing nonelderly Americans with health insurance during the COVID-19 recession. The same Urban Institute study estimated that 6 to 10 million Americans will regain health insurance coverage through the Marketplaces. 1 Continuous insurance

State versus federal health insurance marketplaces: A bigger deal for Medicaid and a smaller deal for the individual mandate

“…Although previous research has examined inter-state administrative burdens related to Medicaid enrollment--finding that states adopting greater administrative easing, like automating eligibility decisions, have seen higher Medicaid uptake [10] , [36] , [15] --to our knowledge, this framework has not been applied to examine differences between marketplace types. For example, due to state-based data capacities, state marketplaces may be better positioned to adapt to “churning”i.e., quickly transitioning individuals between private insurance and public insurance in response to changes in income, household, or employment circumstances [1] , [6] . Alternatively, administrative burdens may be higher in the federal marketplace, as unintended consequence, or as Peeters suggests [27] , a result of deliberate design--a fitting description, perhaps, for the Trump administration’s 2017 decision to eliminate in-person assistance for Healthcare.gov and to shorten the federal marketplace open enrollment period [23] .…”

Health Care Payers COVID-19 Impact Assessment: Lessons Learned and Compelling Needs

“…Beyond federal action, many state insurance commissioners and Medicaid programs also introduced new fl exibilities and requirements for commercial health plans (e.g., requiring waivers of cost-sharing, requiring guarantees of network adequacy) [40]. Additionally, special enrollment periods for state-based (in 2020) and federal (in 2021) insurance marketplaces enabled plans to expand access to health insurance for individuals who may have lost coverage during the pandemic [41].…”