Hospitals should partner with community groups to help educate the recently unemployed about exchange enrollment options

• The national unemployment rate is somewhere in the vicinity of 13%, according to a story in The New York Times.
• Due to unemployment, the number of individuals covered by employer-sponsored insurance could decline between 12 million to 35 million, according to recent analysis by Health Management Associates.
• Medicaid coverage also could increase from 71 million individuals to somewhere between 82 million to 94 million individuals, and the number of uninsured could increase by up to 11 million, according to the same Health Management Associates analysis.

The New York Times is estimating that, after another week of horrific job losses, the national unemployment rate is somewhere in the vicinity of 13% (from a historically low rate less than a month ago). This would eclipse all previous economic crises save the Great Depression.

 A recent analysis by Health Management Associates projects the number of individuals covered by employer-sponsored insurance could decline between 12 million to 35 million while Medicaid coverage would increase from 71 million individuals to somewhere between 82 million to 94 million individuals. And the uninsured could increase by up to 11 million.

Takeaway

First, this is a human tragedy of immense proportions. Beyond those suffering from COVID-19, there’s a lot of talent and energy that’s been sidelined as a result of shutting down the economy. And as I’ve discussed, providers need to rethink their account resolution policies to adjust for this new reality in the labor market. Health systems also need to increase resources for financial counseling.

While many of the state-run exchanges have re-opened for enrollment, as of April 3, the federal exchange indicated that it will not re-open. Instead, the administration will cover the costs of caring for the uninsured who contract COVID-19 with funds from the $100B appropriation to the Public Health and Social Services Emergency Fund (PHSSEF) that are earmarked to support hospitals and other providers who have incurred significant expenses in preparing for COVID-19 while experiencing revenue declines through canceled elective procedures.

However, many, of the recently unemployed will qualify for a special enrollment period (SEP) through the federal exchange (or state exchange if the federal exchange hasn’t reopened). Most aren’t aware of this window and the subsidies that are available.

And given the limited enrollment period associated with SEPs, hospitals and health systems will want to partner with community organizations to get the message out that many of the recently unemployed may qualify for heavily subsidized coverage on the exchanges.

Second, a lot has been written about the revenue declines suffered by health systems as a result of canceling elective procedures. Probably even more has been written about the costs incurred by hospitals for extra space, labor, equipment and PPE as they have prepared for (and in some markets faced) the surge of COVID-19 cases.

So far, nothing’s been written about the third leg of the stool, a deteriorating payer mix, that will prolong the pressure on health system finances once the crisis passes. While this won’t count as lost revenue in claims filed for reimbursement from the PHSSEF, it should. Or, at a minimum, the administration should open the federal exchanges and Congress increase subsidies for the duration of the public health emergency instead of trying to cover the cost of care for uninsured COVID-19. There are other, more appropriate sources for that.