The COVID-19 pandemic is shaping up to be a stress-test for the
post-Affordable Care Act insurance market. The crisis has already caused mass
layoffs, and experts say the individual health insurance exchanges and Medicaid
could see record enrollment in the coming months as a result.
"This would be the first recession since the Affordable
Care Act went into effect, so we are in somewhat uncharted territory in terms
of what might happen in a recession under both the ACA marketplace and the
Medicaid expansion," Larry Levitt, executive vice president for health
policy at the Kaiser Family Foundation, said during a March 18 conference call
with reporters.
Levitt said the ACA marketplace is likely to see rapid growth in
enrollment as workers lose jobs or hours, making them eligible for special
enrollment periods in some cases.
"Household income is going to tend to fall, and that will
put more people into that lowest income category with the broadest enrollment
in the ACA marketplace," Levitt said. That influx of enrollees, he added,
"has the potential to improve the risk pool in the ACA marketplace and
shouldn't, by itself, have a big effect on premiums."
Meanwhile, "as people lose their jobs and their incomes
fall below 138% of poverty in those states that have expanded Medicaid, we're
likely to see growth in Medicaid enrollment — as we typically do during
recessions," Levitt said.
"Medicaid traditionally has been countercyclical….It's an
economic balancer," says David Anderson, a health policy researcher at
Duke University's Margolis Center for Health Policy. "In 2009 [during the
last economic recession], the federal government raised the federal payment
rate — the federal share of Medicaid — by 6.2 points. What that did is it gave
states breathing room in their budget…That extra federal share takes a little
bit of pressure off the rest of the state budget."
To that end, President Donald Trump on March 18 signed the
Families First Coronavirus Response Act, which, among a host of other
provisions, temporarily increased the Medicaid federal medical assistance
percentage by 6.2 points.
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