As the country tentatively prepares to return to school and the office this fall, there seems to be little certainty except that the coronavirus threat will be with us for a long while. Social distancing and economic uncertainty will remain a part of everyday life. The pandemic has highlighted the fragility of our social safety net and the intractability of the barriers that hamper access to care for many. As a result, more Americans will turn to Medicaid. Although that may create challenges for states with limited budgets, increased Medicaid enrollment can help to ensure care for vulnerable populations. Access to care will lessen the effects of the COVID-19 pandemic and help the country avoid potential downstream health issues.
The Centers for Disease Control and Prevention case surveillance has highlighted the disparities among patient populations during the pandemic: Black patients are more than twice as likely to be hospitalized with COVID-19 as white patients. Patients with preexisting conditions such as cardiovascular disease, diabetes and chronic lung disease are hospitalized six times more often and are more than 12 times as likely to die. People on Medicaid, self-pay or with no insurance are twice as likely to be hospitalized. And COVID-19 patients from lower-income ZIP codes were more likely to be hospitalized than those from higher-income ZIP codes.
Pandemic response, office closures, self-quarantine, fear of going to the hospital or clinic, and job loss or economic concerns have hampered patients’ access to care. The May Health Tracking Poll from the Kaiser Family Foundation (KFF) showed that Americans are deferring medical care: Nearly half of respondents say they or someone in their household have postponed or skipped medical care due to the coronavirus outbreak. One-third (31%) of those surveyed say they have had problems affording expenses such as health insurance coverage. Skipped or deferred medical care can have huge implications for the health of our nation, such as preventable deaths and further illness.
In the KFF study, 30% of Black adults and 26% of Latino adults say they have skipped meals or relied on charity or government food programs during the outbreak. Further, there are documented disparities in access to timely COVID-19 testing and treatment driven by socioeconomic factors and insurance coverage.
These challenges point to an increase in Medicaid enrollment. According to the May KFF poll, most adults (55%) say the Medicaid program is personally important to them and their families. Many new enrollees are likely: Nearly one-quarter of adults not currently on Medicaid say it is likely they or a family member will turn to Medicaid for insurance in the next year; the number rises to 31% among those who lost income due to the pandemic. As of late May, nearly 27 million people were at risk of losing their employer-sponsored health insurance, according to the Center for Health Care Strategies, which estimates that Medicaid enrollment could increase by 5 million to 18 million.
Medicaid insurers are planning for an influx of new enrollees, according to Craig Kennedy, CEO of Medicaid Health Plans of America. “We are sustaining our current infrastructure and working to address a wide range of social determinants, but we also need to help these newly enrolled individuals navigate their new insurance coverage,” he says. “Changing health insurance plans is always a stressor for people, but with all the challenges facing America today, we need to make sure this transition to Medicaid goes as smoothly as possible. We’ve seen enrollment increases in the past, so we’re prepared for the cyclical nature of Medicaid’s enrollment, but we also need to recognize the environment of our country and the pandemic that is continuing to threaten lives and livelihoods across our country.”
Medicaid spending accounts for a substantial portion of state budgets, so, naturally, increased Medicaid enrollment raises looming financial issues. States face significant budget shortfalls — as much as 20% in California, Colorado and New Mexico, according to estimates by the National Conference of State Legislatures.
States are incentivized not to decrease Medicaid spending through the maintenance of effort conditions of the Families First Act, which include suspending eligibility redeterminations and a ban on limiting eligibility and changing beneficiary cost-sharing. Further, every dollar of state spending cut from its Medicaid budget will bring at least a dollar reduction in federal dollars.
States will be forced to make spending trade-offs as a result of this budgeting crisis. They will need to make decisions that drive wise use of resources, such as ensuring access to care for those who need it most. If there’s a silver lining, it’s this: The need for careful budgeting and prioritization of resources can help bring evidence-based, high-value care to the fore. As our nation’s health care system continues to be ravaged by COVID-19, it is more crucial than ever that our dollars are spent wisely.
Dan Leonard is president and chief executive officer of the National Pharmaceutical Council.