By BRITTANI HOWELL • SEP 3, 2020
There are few aspects of life that have not been affected
by the COVID-19 pandemic. Side Effects Public Media has launched a Facebook
Live series called “Because of COVID-19” to examine these ripple effects and
offer solutions and resources.
Our first edition looked at the way many people have lost
their jobs and their employer-provided health insurance due to layoffs and
business closures.
Community engagement specialist Brittani Howell spoke
with Mark Fairchild, Director of Public Policy at Covering Kids & Families
of Indiana; Calvin Roberson, Vice President of Planning and Program Development
at the Indiana Minority Health Coalition; and Adam Mueller, Director of
Advocacy at Indiana Legal Services. The following is a summary of the
conversation.
What do we know about the number of
Hoosiers who have lost their jobs, or currently don’t have jobs, and have lost
their insurance?
In April, Indiana saw about 560,000 Hoosiers losing
employment, Fairchild said. The number is now lower than 400,000 and trending
downward.
“We've recovered dramatically, but that still is going to
leave over 10% of Hoosiers without a job. And related to that, of course, the
insurance that goes with that impacts not just them, but their family members
too,” Fairchild said. Counting the spouses and children who may have been
covered by family plans, he estimates that upwards of a million Hoosiers may
have lost employer-sponsored health coverage during the pandemic.
The loss of health insurance doesn’t fall equally on
everyone, as some sectors of the economy have been hit harder than others, like
hospitality and service jobs.
“That's in a sector that has a very high amount of
minority and new immigrant population working on it,” Fairchild said. “So even
if they had health coverage offered, that option is off the table for a massive
amount of folks.” Additionally, the insurance offered may not have been
comprehensive or affordable--if it was accessible at all.
In general, people of color are at higher risk of being
uninsured than white people, according to a 2019 report from the Kaiser Family Foundation.
They are also more likely to live with chronic health conditions,
including many that put people at greater risk for COVID-related complications
and deaths.
When employer-sponsored health insurance is no longer an
option, people can buy private insurance on the marketplace or enroll in their
state’s Medicaid program, such as Indiana’s Health Indiana Plan (HIP). Between
March and May 2020--the first few months of the COVID-19 pandemic--enrollment Indiana’s Medicaid programs enrollment grew by
more than 62,000 individuals. But, Fairchild pointed out, that
number doesn’t cover everyone who has lost their job and insurance because of
the pandemic.
At least some of the increase might be attributed to the
fact that the state has suspended several of the requirements for maintaining
coverage, like monthly contributions to their “Personal Wellness and
Responsibility” (POWER) health savings accounts. Those contributions were one of several reasons enrollees
found it difficult to maintain HIP coverage.
Suspending the premiums has been huge, Mueller said. “We
haven't had people contacting us (Indiana Legal Services) during this time to
say, ‘Hey, what's what's going on, and I can't figure out how to navigate the
system because of my premiums,’ that sort of thing.”
What are the challenges you face when you
don’t have health insurance? Are there any specific challenges caused or
exacerbated by the current pandemic?
For some, health insurance is an immediate need: People
with preexisting conditions, regular medication, and ongoing treatment like
chemotherapy suffer if they don’t have access to necessary, regular
treatments.
Others put off getting health insurance, particularly if
they’re balancing other financial concerns, like food, debts and housing. But
if a sudden need arises, families could be left with a significant bill.
And that in turn can cause problems, Roberson said,
particularly when it comes to making mortgage or rent payments. “The inability
to meet the healthcare expenditures has contributed to folks having to make
decisions that we really don't want people to make if they don't have to,” he
said.
If an uninsured person wants to sign up for
health insurance during the pandemic, what should they do? What resources exist
for a Hoosier without healthcare?
In addition to HIP, the state has its Hoosier Healthwise program, which covers
children up to age 19 and pregnant women. Hoosier Healthwise also encompasses
the Children’s Healthy Indiana Plan (CHIP), which covers kids up to age 19
whose families have a slightly higher income.
Understanding the different income thresholds for
different plans can be complicated. Fairchild recommends finding a health
navigator to help.
“Navigators are simply somebody who can sit down with--or
in these days, talk virtually with--and figure out what your options are and
what you might be eligible for,” said Fairchild. Organizations across the
state, including Covering Kids and Families, offer free
healthcare navigation services. Many federally qualified health centers also
have navigators who can help people sign up for insurance.
The Family and Social Services Administration has
a searchable database for health navigators in
your area, as well as a benefits portal through which you can apply for health
coverage. Fairchild recommends starting there rather than trying to find health
insurance through Google searches, which can turn up a lot of sponsored ads as
well as look-alike sites.
“And when I say ‘look like,’ I mean, there'll be Obamacare.com and
all kinds of things like that, that are really meant to be predatory,”
Fairchild said. “So you've got to take a lot of care when you're researching.”
People also can ask about health navigators at their
health appointments or hospital visits. But that’s not happening as much during
the pandemic.
“But folks are afraid to go to hospitals right now, and
they’re afraid to go to clinics,” Mueller said. “And oftentimes that's the
point of contact for getting signed up for programs.”
Roberson also recommended asking local clinics and health
centers about resources they offer.
Additionally, you can see if you qualify to enroll in a
private health insurance plan through the marketplace.
We’ve had several readers ask how the
pandemic is changing health insurance. What changes do you think are coming
because of COVID-19?
Advocacy groups have been pressing for some time for the
state to drop the work requirements and premiums from HIP. Indiana Legal
Services has filed litigation challenging both measures, arguing that they
don’t advance Medicaid’s ultimate goal of getting more people covered by health
insurance.
Those requirements have been waived for the duration of
the pandemic.
“We're hoping right now the state's actually doing some
analysis and saying, ‘Is this actually working better, not having them? And not
having to chase those payments, the amount of bureaucracy involved and the
amount of staff time involved?’” Fairchild said. Additionally, he said, the
economic fallout of the pandemic is going to go on well after the end of the
public health emergency. If the factors that caused people to lose HIP come back
suddenly, “We could see, you know, a potentially large cliff that people are
going to hit and a large pool of coverage loss as a result.”
Roberson said the HIP stipulations were put in place to
promote personal responsibility, and he doesn’t think the impetus behind them
is going to change because of the pandemic. He’s hopeful other changes might be
coming, though. Telehealth has seen a lot of growth during the pandemic. For
people who don’t have the transportation to get to the doctor, that could be a game-changer--though
internet access issues add a layer of inequity even to that. Some demographics,
including many minority communities, immigrant and refugee groups, and the
elderly, don’t utilize or have access to internet resources the way other
communities do.
“We're having groups of people that we're having to
orient to technology just so they can access service,” he said.
Predicting anything when it comes to the healthcare
industry is a challenge, Fairchild said. However, the last time the US faced a major
economic downturn during the Great Recession in 2008, Indiana responded by
creating HIP.
“So at least as a state, we do have a history of reacting
appropriately and seeing health coverage as a real immediate need,” Fairchild
said. “We see the economic impact on hospitals and the state itself when people
aren't healthy and aren't involved. So we'd like to think that messaging is
slowly grinding in the right direction, that we're moving from the idea of
healthcare coverage is something that you really should have to something
closer to a right that everybody should have.”
Brittani Howell is community engagement specialist f Side
Effects Public Media.
https://www.sideeffectspublicmedia.org/post/because-covid-19-people-are-losing-health-insurance
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