Millions of Americans gained health insurance coverage during the pandemic due to new federal legislation — but experts fear progress could be reversed as a key Medicaid provision comes to an end this month.
In 2020, the Families First Coronavirus Response Act (FFCRA) was signed into law, requiring states to keep people with Medicaid enrolled in the program during the COVID-19 public health emergency.
Previously, enrollees had to reapply for benefits every 12 months, but under FFCRA, they’re automatically reenrolled. States received additional funding for executing the policy, and uninsured rates hit record lows.
This could change as automatic enrollment expires on March 31, putting 15 million people from low-income households at risk for coverage loss.
According to a new survey released by the Commonwealth Fund — a private healthcare policy-focused foundation — uninsured rates for Black adults ages 19 to 64 dropped by 2 or more percent in Oregon, North Carolina, Virginia, and several other states between 2019 and 2021.
Overall, the country saw a coverage increase of five million people between 2020 and early 2022 and a historic uninsured rate of 8 percent.
Too many Black and Hispanic adults are still unable to get insurance or the health care they need, which contributes to inequitable health outcomes. SARA R. COLLINS, VICE PRESIDENT FOR HEALTH CARE COVERAGE AND ACCESS AND TRACKING HEALTH SYSTEM PERFORMANCE AT THE COMMONWEALTH FUND
Joseph R. Betancourt, president of the Commonwealth Fund, said it’s going to take courage to maintain the gains made.
“Health insurance is critical to assuring all Americans get the health outcomes they deserve for the enormous investments we make,” he said in a statement.
“The pandemic demonstrated what we can achieve with common-sense strategies to expand coverage — broadening access to care and diminishing longstanding disparities in insurance rates. We must have the courage to maintain these gains, and close the Medicaid gap for good. Going backwards, with millions losing coverage, should not be an option.”
The end of Medicaid’s automatic enrollment isn’t the only policy researchers say could harm low-income and people of color when it ends. They’ve also got their eyes on the Affordable Care Act.
The 2014 legislation made it possible for states to expand eligibility for their Medicaid programs. In those states, adults under age 65 with incomes up to 138% of the federal poverty level became eligible ($17,774 for an individual and $36,570 for a family of four in 2021).
21 million people in more than 40 states and territories gained coverage because of the expansion.
But despite increased financial incentives, 11 states have chosen to opt out — including Texas, Mississippi, Alabama, Georgia, Florida, and most other southern states with high populations of Black residents.
These same states suffer from high maternal and stroke-related death rates.
Sara R. Collins, vice president for health care coverage and access and tracking health system performance at the Commonwealth Fund, said the expansion efforts have made it possible for more Black and Brown folks to get coverage, but more work needs to be done.
“The Affordable Care Act’s coverage expansions have helped drive historic progress in reducing racial and ethnic gaps in health insurance coverage, but we still have a long way to go,” she said in a statement.
“Too many Black and Hispanic adults are still unable to get insurance or the health care they need, which contributes to inequitable health outcomes. If we want to continue making progress toward a more equitable health system, it’s critical to ensure that all people are continuously covered, not just during a pandemic.”
