It’s time our jobs and our health coverage get divorced

Our first virtual roundtable in the Advancing Young Adult Health series focused on disparities in health coverage among young people, remaining coverage gaps, and how those disparities are being exacerbated during the COVID pandemic. This first panel was held a few weeks after the murder of George Floyd, as protests and demonstrations against police brutality were being held in all 50 states accross the country, and throughout the world. Fittingly, much of the panel focused on how racism has impacted access to health coverage and the health outcomes of people of color. As our panelist Sarah Coombs of the National Partnership for Women and Families points out, we were already facing a  maternal health crisis  before the current crisis;  black women are 3 to 4 times more likely to die in childbirth compared to white women.

 

Much attention has been paid to how COVID-19 has disproportionately impacted communities of color, with Black and Latino Americans more likely to be test positive for the Coronavirus, and have higher mortality rates compared to their share of the population, according to most states reporting data. But these disparities in health care access are nothing new.

The COVID pandemic did not create these disparities, but it did create the spotlight. And now, more than ever before, it’s clear that we need universal health coverage – for every individual residing in this country – no matter their income level, employment status or immigration status. There was much consensus on the panel that one of the most effective ways to close coverage gaps is to expand Medicaid in all 50 states.

The lack of Medicaid expansion in 14 states, primarily across the south, leaves 2.8 million Americans in the Medicaid coverage gap – those who do not qualify for traditional Medicaid, but don’t make enough money to qualify for premium assistance through the Affordable Care Act marketplace. Millions of young people, some of whom work in grocery stores, pharmacies, and other essential services that kept society running while all other sectors shut down or went remote, are left without any affordable comprehensive option for coverage. If all 50 states expanded their Medicaid programs, an estimated 4.7 million could gain Medicaid coverage.  Others, such as DACA recipients, aren’t allowed to purchase individual coverage through the ACA market even with incomes that would allow them to do so.

While millions who lost their jobs due to the pandemic have also lost their job based health coverage, many young people who have been hit the hardest economically, didn’t have job based coverage to begin with. Recognizing that significant gaps already exist in our system and are being greatly exacerbated in the current climate, one could make a strong argument that we not only need to fill in the remaining gaps, but we also need to take bold action to strengthen coverage for all.

Young people are generally new to buying health insurance on their own, and they need guidance in navigating a complex system. The current administration has cut funding for outreach and enrollment support by 90 percent, and cut funding for direct enrollment assistance by 84 percent. That leaves millions of young people who age off of Medicaid, CHIP, or their parent’s coverage with little guidance of where to go or how to enroll in a comprehensive plan. Couple that with the expansion of short-term plans that do not have to comply with the ACA’s essential health benefits or financial protections and young people who are newly searching for health coverage during a pandemic are likely to end up in a cheap, skimpy plan that is unlikely to be there for them when they truly need it.

Where do we go from here 

The public health crisis and extreme economic fallout of the pandemic should be a reckoning for how we think about access to health care in this country. There has been strong bipartisan support for free COVID testing and treatment for all to ensure the spread can be contained, and that those who are infected do not avoid care due to fear of high medical bills. However, if you ask young people, they’ll tell you this should always be the case, regardless of public health crises. Young people overwhelmingly believe health care is a right, and access and quality should not be dictated by income, geography, employment, or any other factor. Two ways we can immediately improve access and affordability are to expand Medicaid in all 50 states, and work to increase affordability in the individual market.  

Young people will need to be a part of the conversation about how we create bold action. We look forward to ensuring they are a part of these conversations now and in the future.