Dive Brief:
- Pandemic-era policies spearheaded by the federal government led to improved healthcare affordability in the U.S. between 2019 and 2022, according to a Robert Wood Johnson Foundation report released Tuesday.
- Adults reported less difficulty paying medical bills and were less likely to forgo needed medical care due to costs in 2022 than in 2019. Black and Hispanic adults experienced greater affordability changes than White adults, helping to narrow existing healthcare disparities.
- But, without congressional action, the end of COVID-19 Medicaid continuous enrollment provisions could “halt or reverse recent progress in health care affordability” according to the report.
Dive Insight
The report demonstrates the positive health impacts of bolstering the federal safety net. Healthcare costs — which, as of this year, can run a typical family of four an average of over $31,000 through private insurance — have been cited as a barrier to care and a source of debt or financial hardship.
Medicaid is associated with more emergency department visits than private insurance plans, perhaps reflecting difficulty accessing outpatient care, but it is less expensive than private insurance. Total costs for marketplace plans tend to run Americans 83% more than Medicaid, due to higher prices, including cost sharing for covered services, and higher out-of-pocket costs.
Prior to 2020, Medicaid beneficiaries faced lapses of benefits as they navigated the system, due to annual eligibility reviews. Under the Medicaid continuous coverage requirement, guaranteed by March 2020’s Families First Coronavirus Response Act, states could not kick Americans off of Medicaid until the HHS declared the public health emergency over.
The provision prompted 18 million Americans to enroll in Medicaid between February 2020 and June 2022. Congress also increased federal economic relief by expanding unemployment insurance benefits, COVID economic impact payments and child tax credits.
However, states were allowed to begin disenrolling Medicaid enrollees in April and over one million enrollees have been disenrolled so far, according to KFF. In a letter sent to governors Tuesday, HHS Secretary Xavier Becerra offered aid to states in an attempt to stem coverage gaps from redeterminations, especially losses due to procedural reasons.
“Nobody who is eligible for Medicaid or the Children’s Health Insurance Program should lose coverage simply because they changed addresses, didn’t receive a form or didn’t have enough information about the renewal process,” Becerra said in a statement on the letter.
Authors warn it could be difficult to preserve the positive health impacts observed over the past three years should the GOP continue its efforts to tie Medicaid to work requirements (an effort that has so far failed to gain traction on the national stage).
Cumulatively, expanded federal safety net programs allowed Americans’ access to uninterrupted healthcare to improve, according to the report. Between December 2019 and December 2022, the percent of adults reporting problems paying family medical bills over the past 12 months declined from 18.7% to 15%. There was a 25% reduction in adults reporting unmet needs for medical care because of costs. Prior to the pandemic, these numbers had remained steady — year after year 18% of Americans reported barriers to care.
