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Research Summary June: What We Read HEALTH INSURANCE

Summer is here and we at CHIR are absorbing the sun and new research. This month, we’re reading studies on the potential impact of the novel corona virus (COVID-19) on insurance protection, individual market enrollment trends during the COVID-19 pandemic, and the role providers’ directories play in surprising billing.

Collins S. et al. An early look at the potential impact of the COVID-19 pandemic on health insurance coverage. The Commonwealth Fund, June 23, 2020. With the unemployment rate struggle to return to normal In the midst of the current public health and economic crisis, researchers from the Commonwealth Fund and survey research firm SSRS examined the early effects of COVID-19 on insurance protection and conducted a national survey in the United States.

What it finds

  • Of the respondents who stated that they and / or their partner worked full or part time before the pandemic, 21 percent indicated that they and / or their partner were either released or given leave due to COVID-19. Hispanic respondents and respondents with an annual income of less than $ 50,000 were affected significantly more often than white respondents and people with an annual income of more than $ 50,000.
  • Two out of five respondents who stated that they and / or their partner lost a job or were on leave due to the pandemic were covered by the affected job.
  • One in five adult respondents who stated that they and / or their partner were insured by their affected job, stated that they and / or their partner were not now insured.
  • Fifty-nine percent of respondents who stated that they and / or their partner lost their job or were on vacation were not covered by this job. About 30 percent of those who lost their jobs were not insured before the COVID-19 pandemic.
  • When asked whether they would support a state-regulated and subsidized health plan as an option in addition to work-related coverage at similar costs, 74 percent of those questioned said yes.

Why is it important?

The United States is unique in linking health insurance to employment majority not older adults who have access to cover through their workplace. During the public health and economic crisis caused by COVID-19, experts increasingly questioned the Processability this structure that is disproportionate omits Blacks and Latinos. While policymakers are thinking about how to implement meaningful health care reforms in the short and long term, they are broadening and improving affordable insurance sources outside the employer market, such as: public programs or the Affordable Care Act (ACA) Health insurance exchangesshould be at the top of the priority list.

Special Trends Report: Registration dates and coverage options for consumers during the COVID-19 Public Health Emergency. Centers of Medicare and Medicaid Services (CMS), June 25, 2020. With the COVID-19 pandemic and the subsequent economic crisis, people across the country have seen significant life changes – such as the loss of work-related coverage – that they are eligible for a Special registration period (SEP) in the single market. CMS published a report on current SEP-related trends in the federalized market (FFM).

What it finds

  • In 2020, the FFM saw a 46 percent increase in the number of consumers receiving insurance coverage from the loss of SEP (Minimum Essential Coverage, MEC) between the end of open registration and the end of May 2020, compared to the same period in 2019 .
  • April was the busiest month for the FFM. The loss of MEC SEP registrations increased 139 percent compared to April 2019.
  • Compared to 2019, SEP enrollments rose by 27 percent in 2020 from the end of open enrollment to May. The loss of MEC SEP registrations accounts for 82 percent of the increase.

Why is it important?

The ACA marketplaces are an important source of coverage for people experiencing major changes in life. Understanding the SEP trends during the COVID-19 pandemic is an important measure of job loss and an indicator of the myriad of other problems facing consumers during the crisis, including loss of income and other upheavals that affect access Limit insurance. Almost every state health insurance market established a new temporary SEP that broadly enables uninsured people to enroll for a period of time during the COVID-19 pandemic, but the federal government declined to implement a similar SEP on the FFM. Some government marketplaces have reported significant enrollment since launching a COVID-19 based SEP. Further data collection, reports and analysis of SEP registrations will help policy makers understand the coverage landscape during and after the COVID 19 pandemic – including those who may and may not access marketplaces or public plans – and hopefully help them to close the gaps.

Busch S and Kyanko K. Incorrect provider lists in connection with psychosocial care outside the network and invoices for outpatient surprises. Health issues, June 2020. Surprise medical bills continue to make the news. Most surveillance billing research focuses on emergency care and situations in which a patient cannot choose their provider, with less attention given to the importance of provider directories for informed decisions. This problem is particularly important for access to psychiatric care, which is up to six times more likely than the general medical services provided by a provider outside the network. The researchers conducted a national survey of privately insured patients who used specialized mental health outpatient services to understand the impact of inaccuracies in provider listings on the likelihood of receiving a surprising medical bill outside the network.

What it finds

  • Of the 44 percent of respondents who used a directory of providers to find psychiatric services in the previous year, 53 percent were faced with inaccuracies in the directory.
  • Over a quarter (26 percent) of the respondents who reported inaccuracies in the provider directory found a provider listed in their directory who did not accept their insurance.
  • Forty percent of the patients who faced inaccuracies in the provider directory were treated by a provider outside the network, compared to 20 percent of the patients who did not experience any directory inaccuracies.
  • Among users of mental health provider directories, patients who had at least one directory inaccurate were four times more likely to get a surprise calculation (16 percent vs. 4 percent), suggesting that they did not know they were previously providers outside the network had seen her first appointment.

Why is it important?

Surprising medical bills often hit patients when they are most vulnerable: in emergency situations, when they are recovering from a serious illness or surgery, or when they are dealing with a chronic illness. Inaccurate provider listings that affect a patient’s ability to make the best decision can have serious financial consequences. However, insurers and providers are only accountable to a limited extent if they are not kept up to date. Policy makers and regulators must insurers and providers maintain high directory accuracy standards and penalties if they fail to meet these standards.

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