More than half the states have allowed businesses to reopen, but millions of Americans have already forfeited their employer-provided health insurance benefits due to coronavirus-related job loss.
States with limited Medicaid coverage are the hardest-hit, where uninsured Americans are much less likely to get tested for COVID-19 or seek medical treatment. Thirty-seven US states across the political aisle have expanded Medicaid; fourteen conservative states including Texas, Missouri, Oklahoma and Georgia have not.
In Texas — the state with the highest uninsured rate in the country — the Center for Public Policy Priorities along with 20 local and statewide advocacy groups conducted a virtual rally this week to call on governor Greg Abbott to expand Medicaid.
“During a pandemic, the immorality of leaving people without access to healthcare is magnified,” Laura Guerra-Cardus, deputy director of the Children’s Defense Fund, said in a press conference on Zoom. “That is what brings us to say that it is unacceptable to continue to leave millions of Texans without health insurance.”
Under the Affordable Care Act, Medicaid coverage is extended to all low-income adults with incomes at or below 138% of the federal poverty level ($26,347 for a family of three, or $15,417 for an individual). In Texas, this means an additional 1.5 million people in the “expansion gap” would be covered.
Without expanded Medicaid, eligibility for subsidized health insurance is restricted to protected groups including children, pregnant women, disabled people receiving Supplemental Security Income and those over the age of 65 earning 75% or less of the federal poverty level.
In March, president Donald Trump signed the Families First Coronavirus Response Act to make coronavirus testing free even for the uninsured, but it does not cover the cost of medical treatment.
Pandemic highlights vulnerability of low-wage workers
Low-wage earners, gig workers and part-timers don’t typically qualify for employer-provided health insurance benefits. Ironically, they also comprise the bulk of essential employees who have continued to staff grocery stores, fast food chains and pharmacies during the pandemic, trading the safety of staying at home for the ability to pay rent and buy food.
Essential businesses have done little to shield their employees from the dangers of working on the front lines; Whole Foods has been condemned for suggesting its team members share paid sick time among themselves, while grocery delivery services like Shipt and Instacart have skimped on PPE for gig workers.
“Overwhelmingly, those of us on the front lines are people of color and low-wage earners, and we’re being asked to sacrifice our health to support our communities but we’re given no support in return,” said Wendy Martinez, a full-time student at the University of Houston who works part-time at H-E-B, a local grocery chain. Martinez said the only protection the store has provided to its workers is “additional cleaning supplies.”
The economics of Medicaid expansion
While Medicaid expansion comes with an upfront cost to states, it also unlocks access to federal funds. The cost of expansion in Texas would total approximately $5.6 billion, but in return, the state would receive $65.6 billion in federal funding and save $34.3 billion per year in reduced ER and hospital visits from the uninsured.
“For every dollar the state puts in, the federal government puts in $9. It is a 90:10 match,” said Sen. Nathan Johnson (D-TX). “It’s a heck of a deal.”
With state revenues declining following coronavirus stay-at-home orders, fiscally conservative governors may bristle at the price tag. However, economists estimate that expansion would bring about $8 billion into the Texas economy annually, increase gross state product by $29.4 billion in the first two years, and generate a 331% return on investment over 10 years.
”These are just numbers, but they’re big intensive numbers and they should get the attention of everybody, irrespective of ideology,” Sen. Johnson added.
If you’ve lost your job, you may still qualify for Medicaid
Those who have been laid off due to COVID-19 may qualify for Medicaid even if they live in a state without Medicaid expansion — particularly those already receiving unemployment insurance.
“If you’re getting that extra $600 a week in unemployment insurance, that may actually help you qualify for subsidized insurance with lower premiums, lower deductibles and lower co-payments in the marketplace,” said Anne Dunkelberg, associate director at the Center for Public Policy Priorities.
- Parents with children under the age of 19 whose income falls below the federal poverty line may qualify through the pre-ACA eligibility pathway for parents of dependent children.
- People losing employer-based coverage will qualify for a special enrollment period, which allows them to enroll up to 60 days after losing their job.
- People who were uninsured while working will not qualify for a SEP based on coverage loss. However, in most state-run marketplaces they will be able to sign up because their state has re-opened enrollment for all residents.