Healthcare Reform The outbreak of the COVID-19 pandemic has transformed the face of healthcare reform around the world, highlighting the need for major healthcare reforms that will ultimately promote universal access to affordable care. The U.S. healthcare sector has faced incredible challenges in the wake of this pandemic and is expected to encounter more. The way U.S. providers deliver care and the way patients pay for it is especially crumbling at this crucial time. This, in turn, leaves millions of people vulnerable, requiring strict and swift coordinated policy action to ensure access to affordable care. Prior to the pandemic, approximately half of Americans enjoyed employer-sponsored health coverage. However, with the record number of unemployment insurance claims, millions of Americans have been left without health insurance in the midst of the severe crisis. And even those lucky enough to maintain insurance coverage are struggling to find affordable care.

Research and Suggestions for healthcare Strategeis

Research suggests that more than half of Americans with employer-sponsored health insurance tended to delay or postpone their recommended treatment prior to the pandemic, primarily because of the associated costs[1]. With the outbreak of the pandemic, the entire situation is expected to worsen further, due to job and health insurance losses. A recent survey found that 68% of adults identified that the out-of-pocket costs they might have to pay would be perhaps the most important factor affecting their decision to seek medical care if they had symptoms of COVID-19[2]. Ultimately, failure to undergo testing and treatment for cost reasons will only exacerbate the already adverse impact of the pandemic. Congress has passed two major pieces of legislation to address the myriad issues raised by the COVID-19 pandemic. And more are expected. For example, the Families First Coronavirus Response Act (FFCRA) requires all private insurers, Medicare, Medicare Advantage and Medicaid to cover COVID-19 testing, as well as eliminating all costs associated with testing services, including co-payments, deductibles and co-insurance payments.  Also, $1 billion has been designated for the Public Health and Human Services Emergency Fund to cover testing for uninsured Americans in Medicaid plans. Although the FFCRA eases the costs of testing, patients are still vulnerable to the costs associated with treatment. Hospitalization costs are their biggest concern, especially until they receive the annual out-of-pocket maximum, which ranges from $8,000 for an individual to $16,000 for a family.

Economic Criteria during COVID-19 Healthcare

The $2.2 billion Coronavirus Assistance, Relief, and Economic Security (CARES) Act is another important piece of legislation that requires all private plans to cover COVID-19 testing and future vaccines. However, it does not eliminate cost-sharing for COVID-19 treatment. Nevertheless, many private insurers have agreed to waive cost-sharing for plan members. These include Humana, Cigna, UnitedHealth Group and Blue Cross Shield. The CARES Act has allocated $100 billion to healthcare reform providers and hospitals, with the condition that providers agree not to bill insured patients more than their cost-sharing amounts. In addition, they are required not to bill uninsured patients for COVID-19 treatment. The federal government will reimburse providers for Medicare fees for treating uninsured patients. In addition, the CARES Act also offered significant tax credits, loans and emergency grants to help businesses keep their employees on the payroll, while increasing unemployment benefits for those who lose their jobs due to COVID-19.

Policy Requirements

While these pieces of legislation offer crucial help, additional thoughtful policies are needed to ensure that Americans continue to have access to affordable, quality care in the midst of the public health emergency. In my view, first and foremost, policymakers should freeze people’s insurance status as of April 1, 2020 to keep as many people as possible in their current plans. People who were previously in employer-sponsored plans should be able to continue with their plans during the crisis, even if they lose their jobs or are unable to pay their premiums. The first step in this direction has been the introduction of grace periods in several states for the payment of premiums for all insurance[3].  For example, the Ohio Department of Insurance has extended a 60-day grace period for premium payments to help insurers retain employees and their health benefits[4]. Second, ensuring coverage must be a priority for policymakers, especially for people who have already lost their jobs in the wake of the pandemic. Eleven states and the District of Columbia have introduced new enrollment periods in their state ACA marketplaces to encourage enrollment[5]. Individuals who have lost their jobs in the past 60 days or who could lose their jobs in the next 60 days can enroll in an ACA marketplace, despite President Trump’s announcement not to open enrollment in the 38 states with ACA plans.

Encouraged Patient’s Enrollment

Nearly all states have received 1135 Medicaid waivers in response to the pandemic in order to meet the medical needs of their most vulnerable residents[6]. Most states applied for such waivers to reduce COVID-19-related cost-sharing and to facilitate health care providers while encouraging patient enrollment. In addition, many states that had already applied for and received a Medicaid waiver will stop disenrollment to receive a higher federal match rate, as determined by FFCRA. Finally, no state is currently enforcing work requirements to maintain Medicaid eligibility. State or federal governments may also implement plans similar to the Disaster Relief Medicaid (DRM) program put in place in New York following the 9/11 incident. These temporary public health insurance programs can be tailored to the size and scope of the pandemic in different states. The DRM allowed nearly 350000 people in New York to easily and quickly access Medicaid benefits through increased eligibility thresholds and the use of abbreviated applications. Under this program local residents were provided with 4 months of emergency Medicaid coverage and then gradually transitioned to other coverage plans. A similar emergency program in other vulnerable states can plausibly increase eligibility thresholds beyond Medicaid expansion levels to ease people through the crisis period. The third intervention strategy could be designed around state and federal officials continuing to address out-of-pocket costs, including surprise medical bills and cost-sharing. The shortage of reimbursement to hospitals and providers can easily be covered by CARES Act appropriations.

Affordability Need for Healthcare Reform

Healthcare reform The COVID-19 pandemic has also created unique challenges related to the affordability factor associated with surprise medical billing, which can occur when a patient receives treatment from an out-of-network physician at an in-network facility. Such situations arise from other challenges such as staffing shortages and triage protocols. In addition, provider shortages can force providers to fill care gaps for many medical conditions other than COVID-19, which ends up expanding the possibilities for out-of-network care and surprise billing in periods of crisis such as this. Policymakers must necessarily eliminate out-of-network provider billings that exceed in-network cost-sharing limits for all medical treatment received during the public health emergency. Comprehensive protection planning requires intervention at the federal level as states strive to lead on COVID-19 policies. The Employee Retirement Income Security Act of 1974 (ERISA) prohibits state laws governing health insurance from applying to self-insured employer plans. As a result, nearly 60% of Americans with employer-sponsored health insurance will be deprived of current state surprise billing protections, cost-sharing prohibitions and coverage mandates. Thus, ERISA leaves millions of Americans without the protection of state health reforms. However, states can avoid some of ERISA’s challenges by directly prohibiting healthcare reform providers from charging cost-sharing fees for COVID-19 treatment, as well as surprise billing.

Global Healthcare Circumstances

One thing that has become very evident over the course of this global pandemic is the fact that healthcare reform, finance and the social fabric are closely intertwined and interdependent. Never has it been more evident than today that health reforms are the need of the hour in order to ensure universal access to affordable care for all Americans. As such, our health policies must necessarily reflect this reality, both during and after the pandemic.