The pandemic demands new approaches for affordable access to care

When it comes to affordable access to care, COVID-19 has uncovered a variety of significant challenges and urgent public health priorities in the United States. During the early days of the pandemic, the healthcare system struggled to create and support a testing infrastructure. Now, the nation’s attention has turned to rapid, widespread vaccine deployment. 

On top of the public health issues related to COVID-19 testing and immunization, the country is also grappling with increasing numbers of individuals who are unemployed and have lost their employer-sponsored health insurance. 

The question facing healthcare policy makers and government agencies is how to strike a balance between providing continuous access to health insurance coverage, while maintaining the fiscal integrity of public health and safety net programs. Solutions lie in new approaches to data analysis, technology-enabled consumer engagement and coordination of benefits. 

In the race to administer COVID-19 tests and vaccines, many states have turned to non-traditional sites and professionals for help. From a public health perspective, this has increased access. On the other hand, it has also made the coordination of benefits processing more complex. When a consumer’s commercial insurance information is gathered at the point of registration or point of service, the third party payer can be billed. If that information isn’t captured, however, the test or vaccine costs must be paid with government funds. 

To identify other primary coverage options for people receiving COVID-19 testing or vaccines, some states are proactively matching each individual against a national claims and eligibility database. This ensures that the appropriate commercial insurers or other third parties are billed, preserving limited state and federal funds for individuals who truly need those resources. 

Across the nation, the economic fallout from COVID-19 has been brutal. According to the Kaiser Family Foundation, two to three million Americans have lost employer-sponsored health insurance during the pandemic. These individuals have the option of paying for continued coverage through COBRA. For many unemployed people, however, COBRA simply isn’t a realistic alternative since it is often the most expensive choice for health insurance. 

ACA marketplace plans are another route, but these plan premiums have also been on the rise. Many middle income Americans who don’t qualify for premium tax credits are struggling to afford ACA marketplace coverage. As the number of jobless people grows, these problems aren’t going away.

The current realities facing America’s unemployed haven’t been lost on the federal government. As part of the American Rescue Plan, President Biden has proposed a 100% federal subsidy for COBRA premiums and a cap of 8.5% of an enrollee’s income for ACA plan premiums. The success of these programs and others, however, depends heavily on consumer awareness. 

As the pandemic continues, staying abreast of government assistance programs isn’t a top priority for most struggling individuals and families. Employers, unemployment agencies and the Department of Labor must develop tools and techniques to communicate with consumers. Multi-channel outreach, including electronic communications, is a proven way to meet consumers where they are. In our digital environment, people are accustomed to getting information through emails, text messages and cellphone calls. Why should this be any different?

Federal and state government agencies have found that for unemployed people with high-cost health conditions, it is often more cost effective to subsidize the cost of COBRA or other available insurance than to provide coverage through Medicaid or another program. The Health Insurance Premium Payment (HIPP) program can offset potentially high long-term costs, while keeping individuals connected with familiar providers from their employer-sponsored plans.

The Biden Administration is reopening Healthcare.gov under a special enrollment period. Evaluating COBRA eligibility and implementing a premium assistance model through the health insurance exchange may serve as a public health and cost containment measure. At the same time, this would support continuity of coverage and strengthen the healthcare safety net for those in need. 

In the coming months, healthcare leaders must ensure affordable access to care for beneficiaries and families, while acting as stewards of limited government funds. The path ahead won’t be easy, but creative thinking and use of technology can help. To learn more about the trends shaping the healthcare industry, check out the HMS HealthIdeas blog. 
 

HMS advances healthcare by helping organizations reduce costs and improve health outcomes. Through our industry-leading technology, analytics and engagement solutions, we save billions of dollars annually while helping consumers lead healthier lives. HMS provides a range of payment accuracy and population health management solutions that help move healthcare forward.