Covid19 |

As Pandemic Flexibilities Unwind, Here’s How Enrollment In Different Types Of Coverage Could Change

As flexibilities rolled out during the COVID-19 pandemic wind down, there will be plenty of factors at play that could impact uninsured rates in the coming years.

Analysts at the Congressional Budget Office (CBO) project that while the rate will increase from current levels, it will decline over the next decade from pre-pandemic levels. They estimate that 10.1% of people will be uninsured in 2033, down from 12% in 2019, according to a new study published in Health Affairs.

By comparison, the CBO estimated that 248 million people under 65 in the U.S. have coverage this year, and 23 million people in that age group, or about 8.3%, are uninsured.

“Importantly, those projections take into account many estimated components, including demographic, economic and behavioral variables, and are conditioned on the assumption that current laws stay in place,” the researchers wrote.

The CBO analysts said that the current record lows in the number of uninsured people are tied to continuous coverage provisions in Medicaid and expanded subsidies for plans on the Affordable Care Act’s (ACA’s) exchanges. Those continuous coverage mandates have expired with the public health emergency, and states have begun the lengthy process of working through that backlog of eligibility determinations.

CBO projects that 9.3 million people under aged 65 will move from Medicaid to other forms over coverage over the next two years, and 6.2 million people will become insured.

The enhanced ACA subsidies led to record enrollment in exchange plans, and those were extended for several years. However, should they expire in 2025 as they’re currently set to do, it will likely lead to 4.9 million people signing up for marketplace coverage, according to the report.

Some of this population will shift to unsubsidized group coverage or employer plans, and some will become uninsured, CBO projected.

Even as these coverage shifts occur, the CBO analysts said that employer-sponsored coverage will remain the largest source of insurance. They projected that average monthly enrollment will be between 155 million and 159 million over the next decade.

In addition to examining how people may move between types of coverage, the CBO report also estimates how premiums could change over the next several years. The researchers projected that premiums will go up by 6.5% in 2023 and then by an average of 5.9% between 2024 and 2025.

In the 2026 to 2027 time frame, premiums could increase by 5.7% on average and then by an average of 4.6% from 2028 to 2033.

“The higher short-term growth rates partly reflect a bouncing back of medical spending from the suppressed levels of utilization during the initial months of the COVID-19 pandemic in 2020,” the analysts wrote.

Superior Court Upholds CMA Legislation Mandating Reimbursement For COVID-19 Testing And Vaccination

Man receiving vaccination

In a ruling issued this week, the Los Angeles Superior Court upheld the constitutionality of a state law requiring health plans to fairly reimburse health care providers for the costs of COVID-19 testing during the COVID-19 state of emergency.

Senate Bill 510, which the California Medical Association (CMA) sponsored, mandates that health plans and health insurers reimburse health care providers, regardless of network status, for COVID-19 testing and vaccination services. The law requires that health plans and insurers cover testing and vaccination without any cost-sharing or prior authorization requirements. SB 510 extended those provisions retroactively to March 4, 2020, the date Governor Gavin Newsom declared a state of emergency for the pandemic.

In his ruling, Judge Mitchell L. Beckloff dismissed the arguments made by the California Association of Health Plans (CAHP) challenging the constitutionality of SB 510’s requirement that CAHP’s health plan members pay health care providers for COVID-19 testing rendered during the period from the March 4, 2020, state of emergency declaration through December 31, 2021. Recognizing that health plans do not operate as a matter of right, but rather must comply with state law, the court found it improper for those health plans to force health care providers to shoulder the responsibility for the cost of COVID-19 diagnostic testing through unfair contracting practices.

Judge Beckloff found that SB 510 was passed “to combat COVID-19 and its community spread by ensuring access to and encouragement for…screening and testing [and to] protect access to COVID-19 diagnostic and screening testing by ensuring the overall financial stability of the healthcare system.” His order further states that the health plans’ attempt to impose unreasonable contract terms on health care providers could frustrate this purpose by “diminish[ing] access to quality care.”

“CMA was proud to sponsor SB 510 when it was introduced by then-Senator Richard Pan, M.D., and we’re thrilled to see it’s been rightly upheld in court,” said CMA President Donaldo Hernandez, M.D. “SB 510 is a vital, life-saving bill that ensured all Californians were able to access COVID-19 testing throughout the duration of the pandemic and will require coverage for testing and vaccination during future public health emergencies.”

Prior to the passage of SB 510, CMA asked the California Department of Managed Care and the California Department of Insurance to investigate concerns that certain payors were illegally impeding patients’ access to COVID-19 testing and profiting at the expense of treating physicians.

CMA sponsored SB 510 to ensure that those barriers to testing were removed, physicians were reimbursed fairly by health plans, and patients did not have to incur out-of-pocket expenses for testing.