There are few aspects of life that have not been affected by the COVID-19 pandemic. Side Effects Public Media has launched a Facebook Live series called “Because of COVID-19” to examine these ripple effects and offer solutions and resources.
Our first edition looked at the way many people have lost their jobs and their employer-provided health insurance due to layoffs and business closures.
- Next time: How evictions are playing out across Indiana | Sept. 24 at 1 p.m.
Community engagement specialist Brittani Howell spoke with Mark Fairchild, Director of Public Policy at Covering Kids & Families of Indiana; Calvin Roberson, Vice President of Planning and Program Development at the Indiana Minority Health Coalition; and Adam Mueller, Director of Advocacy at Indiana Legal Services. The following is a summary of the conversation.
What do we know about the number of Hoosiers who have lost their jobs, or currently don’t have jobs, and have lost their insurance?
In April, Indiana saw about 560,000 Hoosiers losing employment, Fairchild said. The number is now lower than 400,000 and trending downward.
“We've recovered dramatically, but that still is going to leave over 10% of Hoosiers without a job. And related to that, of course, the insurance that goes with that impacts not just them, but their family members too,” Fairchild said. Counting the spouses and children who may have been covered by family plans, he estimates that upwards of a million Hoosiers may have lost employer-sponsored health coverage during the pandemic.
The loss of health insurance doesn’t fall equally on everyone, as some sectors of the economy have been hit harder than others, like hospitality and service jobs.
“That's in a sector that has a very high amount of minority and new immigrant population working on it,” Fairchild said. “So even if they had health coverage offered, that option is off the table for a massive amount of folks.” Additionally, the insurance offered may not have been comprehensive or affordable--if it was accessible at all.
In general, people of color are at higher risk of being uninsured than white people, according to a 2019 report from the Kaiser Family Foundation. They are also more likely to live with chronic health conditions, including many that put people at greater risk for COVID-related complications and deaths.
When employer-sponsored health insurance is no longer an option, people can buy private insurance on the marketplace or enroll in their state’s Medicaid program, such as Indiana’s Health Indiana Plan (HIP). Between March and May 2020--the first few months of the COVID-19 pandemic--enrollment Indiana’s Medicaid programs enrollment grew by more than 62,000 individuals. But, Fairchild pointed out, that number doesn’t cover everyone who has lost their job and insurance because of the pandemic.
At least some of the increase might be attributed to the fact that the state has suspended several of the requirements for maintaining coverage, like monthly contributions to their “Personal Wellness and Responsibility” (POWER) health savings accounts. Those contributions were one of several reasons enrollees found it difficult to maintain HIP coverage.
Suspending the premiums has been huge, Mueller said. “We haven't had people contacting us (Indiana Legal Services) during this time to say, ‘Hey, what's what's going on, and I can't figure out how to navigate the system because of my premiums,’ that sort of thing.”
What are the challenges you face when you don’t have health insurance? Are there any specific challenges caused or exacerbated by the current pandemic?
For some, health insurance is an immediate need: People with preexisting conditions, regular medication, and ongoing treatment like chemotherapy suffer if they don’t have access to necessary, regular treatments.
Others put off getting health insurance, particularly if they’re balancing other financial concerns, like food, debts and housing. But if a sudden need arises, families could be left with a significant bill.
And that in turn can cause problems, Roberson said, particularly when it comes to making mortgage or rent payments. “The inability to meet the healthcare expenditures has contributed to folks having to make decisions that we really don't want people to make if they don't have to,” he said.
If an uninsured person wants to sign up for health insurance during the pandemic, what should they do? What resources exist for a Hoosier without healthcare?
In addition to HIP, the state has its Hoosier Healthwise program, which covers children up to age 19 and pregnant women. Hoosier Healthwise also encompasses the Children’s Healthy Indiana Plan (CHIP), which covers kids up to age 19 whose families have a slightly higher income.
Understanding the different income thresholds for different plans can be complicated. Fairchild recommends finding a health navigator to help.
“Navigators are simply somebody who can sit down with--or in these days, talk virtually with--and figure out what your options are and what you might be eligible for,” said Fairchild. Organizations across the state, including Covering Kids and Families, offer free healthcare navigation services. Many federally qualified health centers also have navigators who can help people sign up for insurance.
The Family and Social Services Administration has a searchable database for health navigators in your area, as well as a benefits portal through which you can apply for health coverage. Fairchild recommends starting there rather than trying to find health insurance through Google searches, which can turn up a lot of sponsored ads as well as look-alike sites.
“And when I say ‘look like,’ I mean, there'll be Obamacare.com and all kinds of things like that, that are really meant to be predatory,” Fairchild said. “So you've got to take a lot of care when you're researching.”
People also can ask about health navigators at their health appointments or hospital visits. But that’s not happening as much during the pandemic.
“But folks are afraid to go to hospitals right now, and they’re afraid to go to clinics,” Mueller said. “And oftentimes that's the point of contact for getting signed up for programs.”
Roberson also recommended asking local clinics and health centers about resources they offer.
Additionally, you can see if you qualify to enroll in a private health insurance plan through the marketplace.
We’ve had several readers ask how the pandemic is changing health insurance. What changes do you think are coming because of COVID-19?
Advocacy groups have been pressing for some time for the state to drop the work requirements and premiums from HIP. Indiana Legal Services has filed litigation challenging both measures, arguing that they don’t advance Medicaid’s ultimate goal of getting more people covered by health insurance.
Those requirements have been waived for the duration of the pandemic.
“We're hoping right now the state's actually doing some analysis and saying, ‘Is this actually working better, not having them? And not having to chase those payments, the amount of bureaucracy involved and the amount of staff time involved?’” Fairchild said. Additionally, he said, the economic fallout of the pandemic is going to go on well after the end of the public health emergency. If the factors that caused people to lose HIP come back suddenly, “We could see, you know, a potentially large cliff that people are going to hit and a large pool of coverage loss as a result.”
Roberson said the HIP stipulations were put in place to promote personal responsibility, and he doesn’t think the impetus behind them is going to change because of the pandemic. He’s hopeful other changes might be coming, though. Telehealth has seen a lot of growth during the pandemic. For people who don’t have the transportation to get to the doctor, that could be a game-changer--though internet access issues add a layer of inequity even to that. Some demographics, including many minority communities, immigrant and refugee groups, and the elderly, don’t utilize or have access to internet resources the way other communities do.
“We're having groups of people that we're having to orient to technology just so they can access service,” he said.
Predicting anything when it comes to the healthcare industry is a challenge, Fairchild said. However, the last time the US faced a major economic downturn during the Great Recession in 2008, Indiana responded by creating HIP.
“So at least as a state, we do have a history of reacting appropriately and seeing health coverage as a real immediate need,” Fairchild said. “We see the economic impact on hospitals and the state itself when people aren't healthy and aren't involved. So we'd like to think that messaging is slowly grinding in the right direction, that we're moving from the idea of healthcare coverage is something that you really should have to something closer to a right that everybody should have.”
Brittani Howell is community engagement specialist f Side Effects Public Media.
