States that operate their own health-care exchanges are leading the way in helping the uninsured find coverage amid the coronavirus crisis.
Twelve states and the District of Columbia have their own Obamacare exchanges, and all but one of them—Idaho—have opened special enrollment periods to allow uninsured people to buy health coverage during the pandemic.
And a surge of new applicants—particularly among people in their 20s—suggests that those who had once chosen to go without coverage are now welcoming the chance to protect themselves as the fear of contagion spreads.
The goal of the states that have set up special enrollment periods is to ensure that as many people as possible have coverage for coronavirus testing and treatment, which is seen as crucial in the fight to slow the pandemic.
Around 10% of the non-elderly population in the U.S.—around 17 million people—remain uninsured and eligible for marketplace plans, according to a 2019 report from the Kaiser Family Foundation.
Enrollment in exchanges set up under the Affordable Care Act is normally limited to a short time window in the fall of each year. The restriction is meant to prevent people from gaming the system by waiting until they are sick to start paying for insurance.
A special enrollment period refers to a period outside the open-enrollment window when new applications are accepted, sometimes because of a national disaster, a job loss, or other life-changing event.
The other 38 states have exchanges run by the federal government, and federal officials so far have declined to open up enrollment during the crisis.
A representative of the Centers for Medicare & Medicaid Services told Bloomberg Law on Friday that the agency is “evaluating offering a Special Enrollment Period specifically designated for COVID-19.”
Meanwhile, people who suffer jobs losses due to the crisis may be able to sign up for coverage on the federal exchange because that is considered a life-changing circumstance, the representative said.
The Trump administration has been supporting a lawsuit that could overturn the Affordable Care Act, which created the exchanges. The Supreme Court will hear that lawsuit later this year.
Surge of Applicants
Washington state, the first hotspot for coronavirus in the U.S., led the way by opening a 30-day special enrollment period March 10.
Washington Healthplanfinder call centers have received over 3,100 requests for enrollment since the period began, with 1,325 becoming fully enrolled, according to a spokesman for the exchange.
Colorado has had a similar experience with its special enrollment period, which opened March 20, according to a spokeswoman for Connect for Health Colorado. New enrollments in the first five days totaled just over 2,400, a much higher volume than is normal at this time of year, she said.
The portal serving Minnesota’s exchange, MNsure, received over 1,600 applications on March 23, the first day of its special enrollment period, tripling the average number of applications from earlier in the month.
Minnesota, like many states, has a combined portal serving both its exchange and its Medicaid program, an exchange spokeswoman said. Some of those applications were routed to the Medicaid program, she said.
Other states that have opened special enrollment periods include California, Connecticut, Maryland, Massachusetts, Nevada, New York, Rhode Island, and Vermont.
Time of Fear
The surging enrollment numbers in those states reflects “the fear that people are feeling over what it means at this time to not have health insurance,” said Mila Kofman, the executive director of DC Health Benefit Exchange Authority, the exchange for the District of Columbia.
“We could tell even before the enrollment period opened up,” she said. “The numbers of calls we were getting at the call center started to go up a month ago, and we could tell that people were getting worried.”
March is normally a quiet time for the health-care exchanges, but that’s not the case this year, said Lindsay Lang, director of HealthSource RI, the exchange in Rhode Island.
“Our call volume is up and our applications are up. People are really getting the message,” Lang said. “And we’re doing everything we can to make sure that everyone is aware that they can get coverage at this time.”
Michele Eberle, executive director of Maryland Health Connection, said it’s frustrating that it takes a pandemic to make people realize the importance of health insurance.
“From a public health standpoint, it’s dangerous during a pandemic to have a lot of uninsured people who may not be able to afford testing and treatment,” she said.
This realization applies also to adults in their 20s who choose to forgo health insurance in greater numbers than those who are older, Eberle said.
But the message of the pandemic is getting through. “We’re seeing a lot more young people than we normally do,” she said.
The latest figures show that 57% of enrollments during Maryland’s special enrollment period, which began March 16, have been people under 34. Those numbers include people who will end up on Medicaid, she said.