Medicaid's enrollment soared during the pandemic, with nearly 10 million Americans joining the public health program for the poor, a government report released Monday showed.
Eighty million people were insured under Medicaid, a record. This reflected an increase of nearly 14 percent over the twelve month period ended January 31. The number also includes participation in the children's health insurance program, which covers children whose parents earn too much for Medicaid but too little to be able to afford any other coverage.
The increase in enrollments shows the increasingly important role of Medicaid not only as a safety net, but also as a pillar of the American healthcare system that protects a quarter of the population.
"This tells us that Medicaid is an important program for American families," said Chiquita Brooks-LaSure, the Biden government official who oversees Medicaid. "What we have seen during this pandemic is people want access to affordable health insurance and how important it is during a public health crisis."
The Affordable Care Act transformed Medicaid from a targeted health service designed to help specific groups – such as expectant mothers and people with disabilities – to a much broader program that provides largely free insurance to most people below a certain income threshold. A notable exception are the 12 states – mostly in the south – that have declined to accept Medicaid under the A.C.A. to expand.
Medicaid, where the state and federal government share the cost, covers all adults with incomes up to 138 percent of the poverty line, which would be about $ 17,420 this year for a person who would qualify.
Medicaid's expansion in most states since most of the A.C.A. It came into force in 2014 and provided a source of state coverage for the newly unemployed that did not exist ten years ago. Adult enrollment in Medicaid grew twice as fast as child enrollment, suggesting that the widespread job loss associated with the pandemic has created a large group of newly eligible adults.
"In previous economic downturns, there has been significant growth in Medicaid enrollments, but they have been focused on children," said Rachel Garfield, co-director of the Kaiser Family Foundation's program for Medicaid and uninsured. "This time around, it's interesting that a lot of the enrollment is among adults."
She also noted that Medicaid enrollment increased much faster during the economic contraction of the pandemic than in previous downturns. In 2009, at the start of the Great Recession, fewer than four million Americans took part in the program.
There may also be increased interest among uninsured Americans who were already eligible for Medicaid but only chose to enroll because of heightened health concerns during the pandemic.
"So often when we look at who's not insured, it's people who are eligible but not enrolled," said Ms. Brooks-LaSure, the Medicaid officer. "Right now we see that if we make it easy for people to enroll, they will."
In the years leading up to the pandemic, the number of Medicaid enrollments had decreased. More than a million children lost insurance coverage between December 2017 and June 2019, a trend that rocked health care advocates. Many attributed the changes to new rules during the Trump administration that made it more difficult to log in and stay logged in.
That changed last spring when the pandemic hit and Congress gave states additional money to fund their Medicaid programs. Congress announced a 6.2 percent increase in spending on condition that states do not de-register patients or tighten eligibility requirements.
For example, a woman who gave birth would normally have lost coverage 60 days after giving birth, but due to legislation, she could stay on Medicaid for the duration of the pandemic. These rules will remain in effect until the federal government declares the public health emergency over.
Three states – Utah, Idaho, and Nebraska – expanded Medicaid last year after voters approved voting initiatives; these countries recorded particularly large swings in school enrollment. A fourth, Oklahoma, will expand Medicaid to most low-income adults starting next month.
Even after growing under the Affordable Care Act, the Medicaid program has loopholes that are difficult to fix. The 2012 Supreme Court ruling that upheld the law's individual insurance mandate also made the expansion of Medicaid optional for states.
As a result, millions of low-income adults in the 12 holdout states that include Florida and Texas are still without insurance. A recent study on JAMA found that Medicaid enrollments grew faster during the pandemic in states participating in the expansion, most likely because many more people were eligible for coverage.
Generous financial incentives offered by the latest stimulus package weren't enough to convince any of the 12 states to expand Medicaid, but senior Biden government officials say they continue to hope some get on board.
"We hope we can encourage them," said Xavier Becerra, the secretary for health and human services, in a call to reporters last week. "We want to make sure that they expand the care and that it is affordable."
