The COVID-19 pandemic has disrupted the economy and is changing how people are covered by health insurance. Many people get their health coverage through their employers, others receive Medicaid coverage, some get coverage through an Affordable Care Act (ACA) plan, and before the pandemic, between 6% and 7% of Ohioans were uninsured. As a result of the pandemic, businesses were shut down, resulting in many Ohioans losing their jobs and their employer sponsored health coverage. In the past 11 weeks, 1.3 million Ohioans applied for unemployment.
In certain circumstances, those who lose their employer sponsored insurance will have family income that is above the Medicaid eligibility threshold and are likely to choose Marketplace coverage. Others who are newly unemployed may have been purchasing a plan through the Marketplace, but due to their reduced income, are now eligible for Medicaid. If the economy is slow to recover, those who initially signed up for an ACA plan after their job loss are likely to become eligible for Medicaid at the end of the year.
Many uninsured Ohioans and those who have lost their employer insurance have turned to Medicaid for coverage. In April, 140,000 Ohioans were added to the insurance program, which now covers about 25% of Ohioans. Maureen Corcoran, Ohio Medicaid Director, expects an additional 200,000 enrollees through the end of June and even more enrollees through the end of 2020. Because of a loss of revenue, the Ohio Medicaid budget for May and June has been cut by $210 million. There is expected to be additional cuts to state Medicaid spending for the next fiscal year, but the state’s budget strategy protects the program’s federal funding. Congress has approved an increase in the federal share of Medicaid funding by 6.2% to help states withstand the increase in enrollment. The increase in federal funding is contingent on Ohio maintaining current eligibility and covered service levels.
Health Management Associates projects that in a high unemployment scenario, by 2022, as many as 1.3 million Ohioans may lose their employer sponsored insurance and roughly 950,000 Ohioans will gain Medicaid coverage as a result of the pandemic. Those who lost insurance through their employers are able to enroll in a health plan through the ACA Marketplace. However, if a worker was uninsured, they are unable to enroll in such a plan. While one may apply for Medicaid at any time, if the uninsured worker does not qualify for Medicaid coverage, they will remain uninsured.
ACA enrollment has been expanded in other states that have their own exchanges, but because Ohio’s on the federal exchange and the federal government has not declared a special enrollment period, Ohioans cannot enroll in an ACA plan until open enrollment. This means that uninsured Ohioans will need to wait until next year to get coverage through the ACA. With the passage of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, there is now funding for health care providers for the treatment of uninsured COVID-19 patients. Providers can only receive this funding if the uninsured patients are not billed for any of the treatment expenses.
The pandemic has caused major shifts in how Ohioans are getting their health coverage. How Ohioans will be covered by health insurance largely depends on how many people become unemployed and the rate at which the economy recovers. As historic unemployment continues, many people who have lost their employer sponsored health insurance will be searching for other options.