Millions are about to lose health care. Will we be able to help them? l Opinion

Apr. 04, 2022

By Heather Howard and Christine Zizzi

Princeton University scholars applaud the resiliency of the ACA for narrowing racial health disparities, protecting those with pre-existing conditions and serving as a lifeline during the public health emergency during COVID.

Twelve years ago, President Obama signed the Affordable Care Act (ACA) into law. The resiliency and strength of the law is more apparent than ever, as it continues to hold up its promise of improved access to quality, affordable health coverage. The ACA has expanded coverage, narrowed racial health disparities, protected those with preexisting conditions and saved lives.

The ACA has shown its resilience time and again, from weathering challenges before the Supreme Court to surviving over 50 congressional attempts to repeal or weaken the law. When the pandemic hit, catastrophic coverage losses and rising rates for the uninsured loomed. Instead, the ACA was a vital lifeline, and members of Congress used COVID-19 relief legislation to bolster the foundation of the ACA.

Specifically, early in the pandemic, Congress increased federal spending to state Medicaid programs in recognition of the increased need and the strain on state budgets. At the same time, to ensure continuous coverage for the most vulnerable, Medicaid dis-enrollment was put on pause until the end of the public health emergency (PHE) — so no one would lose their coverage and access to care.

Then, in 2021, in the American Rescue Plan Act (ARPA), Congress expanded and enhanced the federal tax credits for insurance coverage. ARPA money made insurance a lot more affordable, helping drive record-high enrollment numbers. As a result, the feared rise in those uninsured was successfully prevented. We saw record enrollment numbers across the country in the ACA marketplaces, with almost 2 million more people signing up for coverage, for a total of 14.5 million Americans, a historic high, and Medicaid enrollment is at an all-time high.

The question, however, remains: are these enrollment numbers sustainable?

The stakes are high. An estimated 13 to 16 million people are at risk of losing coverage when Medicaid dis-enrollment restarts later this year — coverage that has been stable the past two years thanks to that continuous coverage requirement. The good news is that most people should be eligible for affordable coverage either in Medicaid or in the marketplaces. But to sustain record enrollments and preserve access to care, states will need to approach the unwinding carefully to ensure that people don’t fall through the cracks.

In addition, Congress should extend the additional ARPA subsidies that have made health insurance so much more affordable; unfortunately, those subsidies expire this year and their extension is caught in the continuing debate of federal spending bills. Finally, if the 12 remaining states that have refused to expand Medicaid under the ACA won’t budge, Congress needs to fill the coverage gap and protect the more than 2 million people — disproportionately people of color — who would qualify if expansion was implemented in those states.

Redoubling the commitment to continue the success of the ACA will allow our country to make progress on the effort to achieve health equity. The events in the summer of 2020 led to a deep reckoning of our nation’s history of racial injustices. The legacy of these injustices are seen in the disproportionate representation of people of color among COVID-19 cases and COVID-19 associated deaths, with persisting disparities in cases for Latino(a) people and deaths for Black people. Both Black and Latino(a) individuals were more than twice as likely to have been hospitalized or to have died as a result of COVID-19.

People of color are overrepresented in Medicaid and, at the same time, are more likely to experience unpredictability in employment, income, and housing due to a long history of structural racism. Consequently, people of color are more at risk of losing coverage when the PHE continuous coverage ends. While we continue to reckon with our nation’s racial injustices, we must center health equity in our plans for the end of the continuous coverage requirement.

New Jersey has taken significant steps toward advancing health equity. In bipartisan action under Governor Chris Christie in 2014, the state expanded Medicaid under the ACA. In January 2021, First Lady Tammy Murphy unveiled the Nurture NJ Maternal and Infant Health Strategic plan to reduce maternal and infant mortality and racial disparities in maternal outcomes.

And just last fall, New Jersey received approval to extend Medicaid coverage for an estimated 8,700 women for 12 months after the end of their pregnancy, a vital step in reducing unnecessary postpartum illness and death. Other states are following New Jersey — 26 states as of March 10, 2022, have approved state action for Medicaid postpartum coverage extensions.

As the pandemic enters an endemic phase, other health and public health crises persist. The opioid crisis has worsened during the pandemic, with overdose deaths rising toward 100,000 per year. And Americans now find themselves facing another crisis — worsening mental health.

We have battled through grief, trauma, and physical isolation for the last two years. Now, two in five adults are reporting symptoms of anxiety or depression and communities of color are still facing substantially lower access to behavioral healthcare, despite having similar rates of behavioral health disorders. In New Jersey, students are reporting that they too are facing a pandemic-related mental health crisis, especially in the wake of significant provider shortages.

COVID-19 has shown us the progress we can make when we build on the foundation of the Affordable Care Act. Yet, progress made can also be rolled back. In upcoming midterm elections, congressional power may change hands, stalling efforts to build on the ACA. The ACA has survived many threats, from lawsuits to legislative attacks to operational challenges. It’s time to ensure that it will continue to work for New Jersey and the whole country.

Heather Howard is a professor of the practice at Princeton University’s School of Public and International Affairs and served as New Jersey’s commissioner of health and senior services from 2008-2010.

Christine Zizzi is a graduate student at Princeton’s School of Public and International Affairs.

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published this page in News and Politics 2022-04-05 03:30:04 -0700