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May 13, 2020 02:00 AM

Most newly uninsured are eligible for subsidized ACA coverage, analysis finds

Shelby Livingston
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    Modern Healthcare Illustration / Getty Images

    As job losses mount amid the COVID-19 crisis, so will health insurance losses. A new analysis estimates that based on job losses from March to May, nearly 27 million people may have lost employer-based health coverage and become uninsured.

    Most of those people would be eligible for Medicaid or an Affordable Care Act marketplace subsidy, according to the Kaiser Family Foundation analysis published Wednesday. However, about 5.7 million people likely wouldn't qualify for subsidized insurance and would have to pay the full cost of an individual insurance plan, which may be unaffordable.

    Of those, a small number of uninsured—150,000 people—would fall into the so-called "coverage gap" in states that did not expand Medicaid eligibility under the ACA, meaning they earn too much to qualify for the state's Medicaid program, but not enough to qualify for financial assistance on the exchanges.

    The number of people in the coverage gap could increase to 1.9 million by January 2021, assuming those people don't get another job with health benefits, according to the analysis.

    "Unlike in past recessions, most of those who lose their job-based coverage will be eligible for health coverage because of the Affordable Care Act, though some may find coverage unaffordable even with subsidies," Larry Levitt, KFF's executive vice president for health policy, said in prepared comments. "As unemployment benefits expire, however, about two million more people in states that did not expand their Medicaid programs under the ACA will move into the Medicaid coverage gap and have no affordable option."

    The U.S. economy has buckled due to the COVID-19 pandemic. The unemployment rate reached 14.7% in April, the highest rate since the Great Depression, as businesses shuttered and laid off workers. More than 30 million people have filed for unemployment benefits since mid-March.

    According to the Kaiser Family Foundation analysis, of the 26.8 million people could become uninsured after losing their jobs and employer-sponsored insurance, about 12.7 million of them would be eligible for Medicaid and another 8.4 million would be eligible for a subsidy on the ACA exchange. Others would be ineligible for subsidized coverage because they earn too much, could join a family member's employer health plan, or do not meet citizenship or immigration requirements.

    By January 2021, when unemployment benefits run out for most people, more people will be eligible for subsidized coverage, according to the analysis. It's likely that 16.8 million of those uninsured would be eligible for Medicaid and 6.2 million would be eligible for a marketplace subsidy. Still, a larger number of people would fall into the Medicaid coverage gap.

    The analysis notes that even though millions of people who lose job-based plans would be eligible for other coverage, they may not enroll. They may not know about the other options or may face challenges with the application and enrollment processes. Others may find marketplace coverage unaffordable even with subsidies.

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