“COVID-19 has exposed the terrible wound of where we’re at in health coverage in this country,” said Dawn Randolph, a consultant and lobbyist on disabilities and mental health issues.
Randolph recounted a friend who’s between jobs and without insurance telling her that during COVID-19, she’s not going out shopping even when businesses are reopening, because of the risk of catching the virus or anything else. “She says, ‘I can’t afford to get sick. I can’t afford to have a hangnail. It’ll wipe me out.’”
Many of those who lost jobs are eligible to continue their group health coverage through a federal law known as COBRA, approved by Congress decades ago as an insurance safety net. But the laid-off employee must pick up the entire cost, plus an administrative fee. That is so expensive that for many who’ve just been laid off, it’s not a realistic alternative.
For Marshell Cleveland of Baldwin County, it would have been $700 a month. “I don’t understand how people think you can pay $700 a month for health insurance when you lost your job,” she said.
Instead, Cleveland purchased insurance through the Affordable Care Act, also known as Obamacare. Such policies are more affordable for people on working-class incomes because of federal subsidies that lower the cost. For those nearest the poverty level — $12,760 for an individual, or $26,200 for a family of four — policies are free or almost free.
After federal subsidies, Cleveland’s plan cost her just $55 a month.
There’s a problem, though. If she doesn’t find a job next year, her annual income will fall to zero. That will make her ineligible for ACA subsidies, and if she wants to continue her plan she would have to pay full price.
The U.S. government, meanwhile, may have to boost spending to subsidize ACA policies. That will be “the first financial stress test” for the ACA as a safety net insurance program, said Rachel Garfield, co-director of the Kaiser Family Foundation’s program on Medicaid and the uninsured.
The Congressional Budget Office has not yet projected the potential additional cost but expects to do so by September. How many will apply for ACA is an open question.
Macon-based Community Health Works has fielded more than 1,000 calls from Georgians who’ve been laid off in the pandemic or expect to be, looking for guidance. “Folks are apprehensive,” said Fred Ammons, the organization’s president. “They want that insurance card.”
Medicaid will be a refuge for some. In Georgia, Medicaid covers poor children, some poor elderly adults who need nursing homes, and some poor adults who've been declared disabled by the government.
Almost all poor Georgia children are eligible. Medicaid and its Georgia adjunct Peachcare for Kids already pay for more than half of Georgia births. As more than 100,000 Georgians have newly enrolled since January, Georgia’s Medicaid rolls have increased to 1.9 million.
Medicaid is paid for by state and federal dollars. In the pandemic, the federal government has increased its share. That's a piece of luck for Georgia budget writers. In addition, although there are more Medicaid patients in Georgia right now, in the pandemic they haven't been going to the doctor, afraid of catching something in the waiting room. That's bad for their health, but it has saved the state money.
And, along with the extra money that Congress passed to prop up Medicaid during the pandemic, it is helping the state of Georgia refrain from slashing services as the Legislature negotiates the budget this month. As the Department of Community Health cuts costs by 14% with the rest of state government, it says it is managing to hold Medicaid services steady.
But as time goes on, no one is sure that will last. Sen. Dean Burke, R-Bainbridge, a physician and hospital administrator whose subcommittee oversees the DCH budget in the Senate, does not know if major cuts to Medicaid are in store next year, for example if the recession deepens and patients go back to normal behavior. He already sees people starting to do that in his own setting.
“I think this year more than any other year since I’ve been here…there are just so many unknowns,” Burke said. “We don’t know what it’s going to look like.”
In the gap
Medicaid and the ACA don't cover everybody. The ACA doesn't cover people who make less than the poverty level, because the law's writers assumed that states would expand Medicaid to do that. Georgia is one of 14 states that have not expanded Medicaid to cover most of its poor. That is one of the main reasons Georgia has the nation's third-highest rate of uninsured people.
As working-age adults in Georgia, neither Cleveland nor Amofah, nor Amofah’s husband or son, are eligible for Medicaid.
Kaiser estimates that the pandemic will eventually add 400,000 or more people to the state’s pool of uninsured.
The federal government has made efforts to pay for COVID-19 expenses including for the uninsured.
But for other health issues, going without insurance can endanger patients. Studies show that those with coverage are more likely to go to the doctor for small things before they become big things.
A spike in the number of uninsured also will strain hospitals, which by law must provide care to anyone who comes to an emergency department to be stabilized and treated.
Monty Veazey, a lobbyist for Georgia community hospitals, has heard the new numbers. After hospitals lost millions of dollars canceling elective surgeries in the pandemic, he said, “I honestly don’t know how much more we can take.”
Amofah, for the moment, remains among Georgia’s uninsured, along with her husband, an Uber driver, and son, a member of the military reserves. She just learned that she is one of a handful of employees who can return to work this week. They didn’t say what will happen to her insurance, but she wavers between assuming and praying that it will be restored.
After all, she says, she’ll be dealing with the public in a pandemic.