Remember Medicaid? Back in the distant, misted past of 2019, access to affordable health insurance was a constant legislative campaign, with Texas Impact and our partners in the Cover Texas Now coalition advocating for Medicaid expansion, as well as more targeted improvements like expanded postpartum coverage. During COVID, Congress stepped in to make coverage available to millions of Americans, by expanding access to Medicaid and the Marketplace. But now that the COVID public health emergency is winding down, access to special pandemic coverage is winding down, too…and concerns about Texas’ perennial uninsured crisis are ramping up.
On the Affordable Care Act front, millions of Americans benefitted from special ARRA health insurance premium tax credits that eliminated or reduced out-of-pocket premiums, as well as more generous eligibility guidelines for those tax credits. According to the Center on Budget and Policy Priorities, “These affordability improvements also increased health coverage, prompting a record 14.5 million people to select marketplace plans during the 2022 open enrollment period, up from 12 million in 2021 and 11.4 million in 2020. Nearly one-third of enrollees selected a plan for $10 per month or less, and average monthly premiums fell 23 percent compared to the year before the enhancements. But the enhancements are set to expire at the end of the year. If Congress does not act this summer, the large majority of the 14.5 million people who signed up for marketplace coverage this year, including those in low- and moderate-income households, will either lose coverage or pay much more for premiums in 2023.”
Over in Medicaid, the situation is just as bad. In Every Texans’ blog, Melissa McChesney explains how a provision in the Families First Coronavirus Response Act (FFCRA), enacted in March 2020, helped Texas families maintain their Medicaid coverage—and how Texas’ unnecessarily accelerated wind-down of that provision now threatens to knock still-eligible families off the plan. Melissa points out that this would have implications beyond just hurting those families:
Widespread coverage loss among eligible people would also wreak havoc on Texas’ health care system. When individuals lose Medicaid coverage, have a gap in coverage and then re-enroll, their health care costs are often higher than if they received continuous coverage. A gap in coverage may lead to interruptions in access to medications, therapies, and other medical treatments. Delayed or skipped treatment often leads to worsening conditions and greater use of high-cost care. Safety net providers, already reeling from pandemic-related disruptions and demands, would face increased uncompensated care. Further, the ongoing health risks associated with the pandemic make it of the utmost importance that Texas take the necessary steps to avoid massive coverage losses in 2022.
The cherry on top of this distressing sundae is the status of Medicaid postpartum coverage. Last year, maternal health advocates felt they finally had scored a significant win in HB133 by Rep. Toni Rose, which expanded Medicaid postpartum coverage from two months to six months effective September 1, 2021. Upon closer inspection, though, there appear to be some bugs in the system: because lawmakers were only willing to cover six months rather than a full year, HB133 must be implemented through a special federal waiver that, as of May 9, had not even been submitted to the federal government for approval. In theory, the six-month coverage will be available starting in October 2022, but that’s only if the waiver is approved quickly once it finally is submitted. Meanwhile, The 19th reports that a number of other states have gone with 12-month postpartum Medicaid coverage—with immediate federal approval.