With jobless claims topping three million last week, the universe of uninsured people is growing. For now, the Affordable Care Act is still the law of the land and in 12 states, as of March 25, there is a special enrollment period in which people now without insurance, either through unemployment or because they haven't yet bought insurance, can enroll.
Those states, California, Colorado, Connecticut, the District of Columbia, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont, and Washington, all run their own exchanges. The Trump administration, even while arguing in the Supreme Court that the law should be overturned, is considering opening the federal exchange for new customers. "There's no economic or public health rationale to not open the doors wide in the face of the pandemic," Peter Lee, the executive director of Covered California, told The New York Times.
"If open enrollment were more broad, and there were fewer barriers, that could make it easier for people to sign up," said Cynthia Cox, a vice president at Kaiser Family Foundation about a potential nationwide opening of the ACA exchanges. KFF has found that there are about 17 million uninsured people—before this wave of job losses—who qualify for marketplace coverage. About a quarter of them could get a bronze-level plan that would be entirely paid for by federal subsidies. There's another population—people who have purchased the junk plans that the Trump administration has allowed—that could now enroll in an ACA-compliant plan that would provide the comprehensive coverage a potential coronavirus diagnosis could require.
Another, more expensive, option for the newly unemployed is COBRA, under the federal law known as the Consolidated Omnibus Budget Reconciliation Act. They can obtain coverage for as long as 18 months under it. But, again, it’s expensive since the enrollee would have to pay the full cost of their premiums, both their part as well as what their employer paid.
There are still people whose income is too low to qualify for federal subsidies on the ACA marketplace who fall into the Medicaid gap in the 14 states that have still refused to expand Medicaid under the law. For all the newly unemployed low-wage workers in the rest of the states, the good news is Medicaid is available to them. The better news is that the large unemployment insurance benefits they will now get do not figure into Medicaid eligibility—the $600/week boost to regular UI won't prevent them from qualifying for Medicaid or the Children's Health Insurance Program for their kids. The other temporary good news is that the Trump administration has withdrawn a proposed rule that would have cracked down on states' Medicaid eligibility determinations, so states will not have to jump through additional federal hoops to add people to their rolls. Additionally, the previous stimulus bill passed last week increases the federal matching funds to states by 6.2%, padding states' Medicaid budgets.
That could be incentive for the remaining 14 states that haven't expanded Medicaid to do so, but since those are the states that are governed by the same people who believe in Trump more than medical professionals and science, it doesn't seem likely. At least not yet.
