As millions of Americans slip into unemployment and lose their health insurance during a public health crisis, Senate Republicans still see no need to act on health care.
More than 36 million people have filed for unemployment benefits due to the economic fallout from the coronavirus pandemic, meaning millions will be left without health insurance. In mid May, left-leaning think tank Economic Policy Institute estimated 16.2 million people have lost health insurance once provided by their employer — how roughly half of Americans get their health insurance. That number could be as high as 26.8 million if those who lost their jobs don’t sign up for other coverage, the Kaiser Family Foundation found.
But the Republican majority in the Senate isn’t interested in pursuing additional emergency relief for those who suddenly find themselves uninsured.
“I’d like us to put in place a better program than the one we have, the Obamacare program, but getting that in place for the country to take advantage of in the next few weeks is just not very likely,” Sen. Mitt Romney (R-Utah) said.
Staff for Susan Collins referred HuffPost to previous comments the Maine senator made to Bangor Daily News that she was “disappointed” in President Donald Trump for not allowing a special enrollment period for the Affordable Care Act, but did not comment on Congress taking further action on health care specifically.
“I think that the enrollment period should have been reopened,” Collins said in the interview. “One of the reasons that I pushed the paycheck protection program so hard is that if we can keep people on their regular payroll, many more people will continue to receive their health insurance.”
The Paycheck Protection Program gives employers loans primarily to keep workers on payroll during the pandemic. Collins is part of a bipartisan push advocating an extension of these loans.
Sen. Lamar Alexander’s office declined to comment on what Congress should do on health care, saying they had “nothing to add” at this time. The Tennessee Republican is the chairman of the Health, Education, Labor, and Pensions committee in the senate. Offices for Sens. Bill Cassidy (La.), Tim Scott (S.C.), Lisa Murkowski (Alaska), Mike Braun (Indiana) and Rob Portman (Ohio), who sit on either the HELP committee or the Senate Finance Committee, which collectively have purview over Obamacare, Medicaid and Medicare, did not respond to requests for comment.
Sen. John Cornyn (R-Texas), who has repeatedly voted to repeal the ACA, encouraged Americans to sign up for Obamacare if they lose their health insurance.
“The good news is that if you lose your employer-provided coverage, which covers about a 180 million Americans, that is a significant life event, which makes you then eligible to sign up for the Affordable Care Act,” Cornyn said in a PBS Austin interview. “As you know, it has a sliding scale of subsidies up to 400% of poverty. So that’s an option for people.”
To get covered, Americans will have to navigate the country’s fragmented health care system ― there’s the ACA, known as Obamacare, public options like Medicaid, and COBRA, the federal program that lets individuals continue their former employer’s health care plan at personal cost. As HuffPost’s Jeffrey Young explained, there are barriers to all these options.
The Kaiser Family Foundation estimates there are 5.7 million people who are not eligible for financial subsidies under Obamacare, and who would have to pay for the entirety of their private insurance plan. COBRA too is cost-prohibitive for many families. The average monthly cost for individual coverage in an employer-sponsored plan is $490, amounting to nearly $6,000 a year — a steep cost for someone without an income.
And not all Americans will qualify for Medicaid, the public health program for low-income Americans.
“Unlike in past recessions, most of those who lose their job-based coverage will be eligible for health coverage because of the Affordable Care Act, though some may find coverage unaffordable even with subsidies,” Larry Levitt, who runs health policy at KFF, said in a statement. “As unemployment benefits expire, however, about two million more people in states that did not expand their Medicaid programs under the ACA will move into the Medicaid coverage gap and have no affordable option.”
The implication of leaving millions uninsured is a matter of life and death. A 2019 report on Medicaid expansion found there could have been 15,600 fewer deaths if all 50 states expanded Medicaid under the Affordable Care Act. There’s a growing body of research that has shown expanded public insurance has improved health outcomes, increasing preventative care and saving patients with chronic illnesses, like kidney disease.
To be sure, it’s hard to make a clear comparison between Medicaid expansion and growing numbers of uninsured, especially because health care providers have only recently begun loosening restrictions around preventative care checkups and other services that were deemed “nonessential” during the early weeks of the pandemic.
“You want a social safety net that gives you things when you lose your job — that’s why we have unemployment insurance. It would be nice if your health side also looked more like that across the U.S.”
That said, Sarah Miller, a health economist with University of Michigan, pointed out there are still real financial and health impacts.
“Even at a time when doctors offices are closed and elective procedures are not going on — though as time goes on those things are going to be open — even being able to pay for your prescriptions is where having insurance versus not having insurance is going to make a big difference,” Miller said.
Miller also described the potential for a downward financial and health spiral for some Americans, calling it a “double hit.”
If you’re caught in an insurance trap, where COBRA is too expensive, you live in a state that didn’t expand Medicaid, and aren’t eligible for subsidized private insurance through Obamacare, what happens when you need to go to the ER, Miller asked rhetorically: “You lose your labor market income and you can potentially face some financial hits if you need necessary medical care — you go to the ER — that can have an impact on your credit score.”
“You want a social safety net that gives you things when you lose your job — that’s why we have unemployment insurance,” Miller said. “It would be nice if your health side also looked more like that across the U.S.”
Senate Majority Leader Mitch McConnell (Ky.) and many Republicans have pushed back against the need for additional stimulus during the pandemic, saying they see no “urgency” in passing a fifth relief package. But among the ideas Republicans have put forward, like expanding the PPP program, implementing tax credits for hiring workers or bonuses for rehired workers, health care has largely been left out of the emergency relief debate.
Health care has been a politically damaging issue for Republicans, who before the pandemic repeatedly attempted to repeal Obamacare, end Medicaid expansion and significantly cut Medicaid funding. The Trump administration has continued to support a GOP lawsuit to dismantle the Affordable Care Act and pushed an effort to add work requirements for Medicaid. Since the pandemic, the Trump administration promised to use some of the coronavirus stimulus funds to reimburse hospitals treating uninsured patients with COVID-19, but there has been no plan to address the growing millions of uninsured Americans more generally.
For weeks, Democrats have been in an internal policy debate around the issue of health insurance. House Democrats’ latest relief package included several health care provisions, expanding how much the federal government chips in on Medicaid payments, and subsidizing COBRA at 100%. In other words, it would have the federal government temporarily foot the bill for the health insurance plans employers were once covering.
Progressives have balked at the idea, calling it a giveaway to private insurance companies and big corporations that run their own health insurance plans. Subsidizing COBRA would direct federal funds toward private companies that pay higher rates than public programs like Medicare and Medicaid. Other health care proposals that have been championed by progressives in both the House and Senate would have Medicare cover Americans’ out-of-pocket medical costs during the pandemic, or allow Americans who have filed for unemployment to be eligible for Medicare.
But for now, Republicans aren’t interested in another health care fight.
Igor Bobic contributed reporting.
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