The validity of private insurance in the United States during Covid-19

In an insurance-based health system, it is the insurance companies that pay the bill for epidemic care. Bob Rohr discovers that the epidemic is complicating an already complex system

At the beginning of the epidemic, American health insurance companies planned to treat covid-19 like any other medical condition: People generally pay a percentage of the costs that their plan considers legitimate.

This changed on March 10, with good news for patients. United States Vice President Mike Pence told reporters that the nation's private and government insurance programs will change the way they do business. He said: "All of our major health insurance companies have joined Medicare and Medicaid and agreed to waive all payments [and] cover all treatments for those who are infected with the coronavirus." "They promised not to bill suddenly, and they promised to promote telemedicine."

But any relief for people with health insurance coverage will be mitigated by unemployment caused by the new coronavirus. A Commonwealth Fund survey conducted in May and released on June 23 found that 41% of American respondents who said that they or their partner had lost their jobs since February relied on this job for health insurance. Now they have to find a way to pay for insurance or medical care themselves.

"This survey demonstrates how our phased approach to health insurance coverage in the United States leaves many people without coverage, or simply to fire them from a loss," said Sarah Collins, vice president of the Commonwealth Fund. About two-thirds of Americans are covered by private health insurance, and the rest are covered by various government programs.

Relying on work for health insurance premiums is just one of many factors that could threaten the health insurance industry in the United States as the epidemic continues 19. However, although some of its clients may suffer , the industry is fine.

While there are occasional instances of exceptions to the insurance company's promise of full coverage by insurance companies, the errors were primarily due to an error in the billing system or a self-insured company trying to evade its obligations. Public exposure to incorrect invoices has proven to be effective enough to correct the error without regulatory interference.

In 2018, private health insurance paid $ 1243 billion (£ 1 trillion; € 1.1 trillion) for the costs of medical care, which is one-third of total health spending in the United States. This year may fall as Americans avoid seeking medical attention for fear of infection and physical closure. Hospital visits in the US dropped nearly 55% in March and April, in an analysis by Strata Decision Technology.

Medicare, the federal health insurance program for the elderly and the largest driver in the United States, has been a source of stability, driving payments to various parts of the health care system to help cover the income shortage. Some private insurance companies have done the same on a more limited basis.

When insurance companies agreed in March to cover all associated costs and forego out-of-pocket payment, most considered the due dates to be temporary and attached. Some companies have extended their starting dates, and public defense group Public Citizen is lobbying others to extend the waivers that are about to expire. Kaiser Permanente, the largest insurance company with 12.2 million members, extended its exemption until the end of the year.

It is unclear how many delayed or canceled procedures will be performed at a later time, but some will certainly not happen, either because the patient is dead or because staff and physical space have limited capacity to accommodate the cumulative request.

However, despite declining returns, the insurance industry does not expect to make big windfalls: it is heavily regulated at the national and state levels. One of the Obamacare (Affordable Care Act) provisions requires insurance companies to pay the minimum fixed percentages for the premiums they charge for medical services (at least 80% for individual and small group policies ; 85% for large groups). If the profit margin increases due to measures postponed in the epidemic, it will only be within a narrow margin, and "surplus" income must be returned to policyholders. Some insurance companies have already started sending discounts to their clients.

Meanwhile, some insurance policies will likely cost more buyers in the future. Corporations in New York City are looking for double-digit increases in insurance premiums next year, while very few provide services in upstate New York, which has been less affected by the epidemic, require modest cuts in rates.

Most American health insurance is obtained through the workplace, and people who have lost their jobs lose their health insurance on the last day of the last month at work.

Laid off workers may, by law, choose to pay the full cost of staying under the company's health insurance plus a 2% administration fee for up to 18 months, through a program with an impractical name but known by its COBRA. However, unless a person is eligible for government support, choosing a cobra can be expensive: up to $ 600 per month for individual coverage, and family coverage can cost three times that amount. The original Workplace Policy may require additional payments for visits and medications.

But workers must exercise this option within 60 days of its termination or loss. This window is now closed for the first wave of people who became unemployed during the epidemic. Many new unemployed will be eligible to receive benefits to help them buy health insurance under Obamacare. But many of those who think they will be back to work soon just don't care, and not everyone will be looking for new jobs - this epidemic has disrupted public transportation and made transportation difficult.

Furthermore, the bureaucracy has become more difficult than usual because many government agencies tasked with administering the job reintegration and welfare programs now operate remotely.

"You can't talk about health equity without talking about Medicaid in a pandemic," said Sarah Rosenbaum, professor of health policy, at a press conference organized by the Alliance for Health Policy. "This is the largest public health response we have."

Medicaid, a program that provides health insurance to the poorest people in the United States, is co-financed by the federal and state governments. Rosenbaum warned that Medicaid is under threat across the country.

Significant cuts in Medicaid funding are likely to occur in democratic states and the Republic, where social isolation has led to a significant drop in revenue that states generally collect on sales, restaurants, and income taxes. By law, states cannot operate with a deficit: if incomes fall, then spending must be reduced

California faces a revenue deficit of $ 54 billion, almost 37% of its current public budget. Despite the big federal role, Medicaid is in many cases "the largest state budget line" and, therefore, an attractive target for cuts, says Tom Betlach, a partner at Speire Healthcare Consulting.

For example, use Arizona, where you ran Medicaid. "To get $ 33 million in state savings, we had to cut $ 100 million from the delivery system," says Betlach, according to the previous version of the epidemic, with a federal match. However, as federalists get a higher share of spending, a $ 33 million cut in state participation will also reduce federal participation and result in a reduction in Arizona Medicaid spending of about $ 135 million in money. total.

House Democrats seek to increase federal participation in Medicaid, but the Republican-controlled Senate is waiting longer to see additional spending. This impasse is unlikely to resolve until September at the earliest, when Congress returns from its summer vacation.