COVID-19 Emergency Extension & End

The Biden Administration announced (January 30) that it will officially end the COVID-19 Public Health Emergency (PHE) on May 11. The last PHE period extension was issued on January 11.

This designation has implication, in particular, for the management of Medicaid-supported health care. States will lose special Medicaid subsidies supporting beneficiaries after the PHE expires. States are then expected to the restart eligibility determinations of an estimated 80 million current enrollees. Anywhere between 5 million and 14 million persons could be deemed ineligible and lose Medicaid coverage. Many, if not most, persons losing Medicaid coverage may not seek (at least immediately) alternate insurance coverage.

(updated: 2-2-23)

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U.S. Health Insurance - Uninsured Population

The Biden Administration announced (January 25) that enrollment in Affordable Cares Act (ACA) insurance coverage reached record levels for the most recent enrollment period. More than 16.3 million Americans signed up for insurance on HealthCare.gov and the state-based Marketplaces, double the enrollment levels from the first enrollment period in 2014.

Last August (2022), the Department of Health and Human Services released a report finding that the U.S. uninsured population fell to just 8% during the January-March, 2022 period. This was the lowest level since the previous low of 9% in 2016.

While healthcare coverage has fluctuated since the initial implementation of the ACA, the uninsured population is down significantly from an estimated 16.6% level in 2013. HHS attributes recent declines to a combination of factors including premium subsidies implemented as part of the American Rescue Plan, the continuous enrollment provision in Medicaid, recent state Medicaid expansions, and program outreach.

(updated: 1-25-23)

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Medicaid Reduces Post-Birth Hospitalization

A study published in Health Affairs (January 2023) found that in states with Medicaid expansions under the Affordable Healthcare Act (ACA), postpartum healthcare coverage reduced hospitalization significantly.

The study examined longitudinal hospitalization data between 2010 and 2017 for states that expanded Medicaid under the ACA, and those that did not. The study found a 17% reduction in hospitalizations during the first 60 days postpartum associated with the Medicaid expansions, and a smaller but still significant 8% decrease in hospitalizations between 61 days and and six months postpartum.

According to the Commonwealth Fund, 52% of pregnancy-related deaths occur after delivery (i.e., postpartum). About 40% occur between one and six weeks postpartum. Severe bleeding, high blood pressure, and infection are the most common contributors to maternal deaths. Research suggests US women experience more late maternal deaths than women in other high-income countries.

(posted: 1-10-23)
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Health Care Insurance Subsidy Extension

The Inflation Reduction Act (IRA), enacted in August 2022, included a three-year extension of health insurance premium (i.e., until the end of 2025).

The 2020 American Rescue Plan helped reduce the cost of healthcare coverage for many middle-income Americans with insurance coverage under the Affordable Healthcare Act (ACA) by eliminating the cap on persons eligible for subsidized coverage -- i.e., where a "benchmark" plan's premium is no more than 8.5% of household income and amounts above that level are supported by the program. Prior to the ARP, if household income exceeded 400% of the poverty rate, a person/family would not receive subsidized coverage.

Without the IRA extension, households with income more than 400% above the poverty rate would have fallen off the subsidy "cliff” starting in 2023, which could have led to many dropping health coverage given affordability concerns. Now this concern is punted for several years.

(updated: 8-25-22)

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