COVID-19 has both created health care dilemmas unique to the pandemic, and also illuminated and exacerbated existing problems with healthcare access, affordability, and equity. Can the pandemic speed us on the path to universal health care? We believe there is a strong case to be made! With your help, HCFA-WA can add to the growing voices urgently calling for universal health care.
Our state’s responses to COVID-19 point to ways around some of the barriers to care that our current health system creates. Some responses are targeted, temporary and stop-gap, and while welcome and needed, they are band-aids and patches. They show the value of a comprehensive approach.
Our public and elected officials are recognizing the need for government action to protect people’s health and economic well being in the time of the Coronavirus. But these many stop-gap and targeted measures only highlight the urgent need for comprehensive health care transformation that, had it been in place before the pandemic, would have made all these efforts unnecessary. Health coverage not tied to employment. No one uninsured or underinsured. Everyone eligible for insurance regardless of income. No economic hardship such as co-pays or deductibles preventing people from getting tested or obtaining needed care.
Targeted, Temporary: Co-pays, deductibles and grace periods
Washington State Insurance Commissioner Kreidler took early steps to help people retain their coverage and access care during this emergency.
He instituted orders incumbent on insurers to:
- ★ bar cost-sharing for Coronavirus testing and services related to testing,
- ★ prohibit prior authorization requirements on Coronavirus testing and treatment,
- ★ allow early prescription refills,
- ★ expand use of telemedicine services
- ★ provide longer grace periods for employers and individuals to pay their health insurance premiums
- ★ provide ways to expand eligibility for employees with reduced hours or laid off
He also created a Special Enrollment Period (SEP) for the Health Benefit Exchange, extending enrollment to May 8, 2020.
|Regardless of the presence of a pandemic, cost sharing, requiring deductibles, and provider network limitations all serve to add to administrative costs and delay and deter patients from obtaining needed care. Eliminating these barriers to care is essential to protect individual health and preventing the spread of infectious diseases. Grace periods would never be needed if continuous coverage, independent of employment or eligibility was prioritized.|
Stop-Gaps: Making the Individual Market (ACA) more Affordable
WA Insurance Commissioner Kreidler recently sent a letter to the WA Congressional Delegation requesting that they push to revive the federal reinsurance program for the ACA. The goal is to reduce premiums on the individual market for the ACA, as we are expecting a surge in applications (anywhere between 18K to 52K) as more people lose their employer-sponsored health insurance. For more on what reinsurance is all about, click here.
This measure would put health insurance in reach for many more people at risk of loss of coverage because of job loss, but it falls far short of a guarantee of affordable and universal coverage. It also does not address controlling the administrative costs and high prices of health care and prescription drugs in the current system. Only a comprehensive approach can do that. (The Universal Health Care Work Group is tasked with this very project in Washington state.)
Now and Beyond COVID-19
Medicare for the Uninsured and Under-Insured
Bernie Sanders and Primala Jayapal have put forward the Health Care Emergency Guarantee Act, that would “empower Medicare to cover all healthcare costs for the uninsured and all out-of-pocket expenses for those with insurance for the duration of the coronavirus crisis.” Additionally, the legislation would ban surprise billing and prevent private insurance companies from limiting coverage or hiking co-pays and deductibles until a COVID-19 vaccine is available.
Paying for COBRA coverage when laid off or furloughed
Another proposal, from House Democrats, is the Worker Health Coverage Protection Act. This is for people who lost employer-based health insurance due to job loss. It would pay 100% of the person’s premiums for COBRA benefits if laid off or furloughed. One advantage of this bill is that it would involve a much smoother transition than applying for other coverage under the ACA exchanges or Medicaid. But enrollees would still be responsible for insurance co-pays and deductibles, which are predicted to rise.
It is gratifying to see that our public and elected officials are recognizing the need for government action to protect people’s health and economic well being in the time of the Coronavirus. But these many stop-gap and targeted measures only highlight the urgent need for comprehensive health care transformation that, had it been in place today, would have made all these efforts unnecessary. Health coverage not tied to employment. No one uninsured or underinsured. Everyone eligible for medical care regardless of income. No economic hardship such as co-pays or deductibles involved in accessing care.
Leaving you with this final thought, courtesy of Ed Kilgore, of NY Magazine:
“...perhaps the cost and complexity of keeping the whole rickety system in place during a pandemic and a deep recession will, in the longer term, build support for a simpler system like Medicare for All or some other form of universal health coverage.”