Democratic vice presidential nominee Senator Kamala Harris speaks during the vice presidential campaign debate with U.S. Vice President Mike Pence held on the campus of the University of Utah in Salt Lake City, Utah, October 7, 2020.
Lucy Nicholson | Reuters
During the vice presidential debate on Wednesday night, Sen. Kamala Harris, D-Calif., had a warning: “If you have a preexisting condition — heart disease, diabetes, breast cancer — they’re coming for you,” Harris said. “If you love someone who has a preexisting condition, they’re coming for you. If you are under the age of 26 on your parents’ coverage, they’re coming for you.”
Of course, Harris was referring to President Donald Trump’s efforts to strike down the Affordable Care Act. The law bans insurers from denying coverage or charging more to people with preexisting conditions, which some 1 in 4 Americans report having.
The Patient Protection and Affordable Care Act, signed into law on March 23, 2010, also required insurers to cover dependents until their 26th birthday.
In a statement, Ken Farnaso, deputy national press secretary for the Trump campaign, denied that the president would leave millions of Americans without health insurance.
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“President Trump has fought to safeguard patients with pre-existing conditions, lower prescription drug prices, lower premiums, and will always put the health of patients first,” Farnaso said.
Yet it may make sense to heed Harris’ words of caution.
The Supreme Court is soon slated to hear oral arguments in a case seeking to overturn the law, commonly known as Obamacare, in November after the presidential election. As many as 30 million people could be stripped of their insurance if the law was cancelled.
And even without those losses, the coronavirus pandemic has caused the ranks of the uninsured to swell. Amid historic levels of unemployment, as many as 12 million Americans may have lost their health insurance since February, according to a recent study by the Economic Policy Institute.
Finding coverage while the ACA is still in place
Many people who’ve been laid off are in a fragile state, said Caitlin Donovan, a spokesperson for the National Patient Advocate Foundation. Trying to get re-insured can feel overwhelming, she said, but it’s important to move quickly.
“The last thing you want to do is remain uninsured,” Donovan said.
You want to first talk with someone in your company’s human resources department to understand when your coverage technically ends. There’s no blanket rule, she said: ”For some, coverage may end immediately; for others, it may go until the end of the month.
“Either way, you should immediately start planning to transition to a new plan,” she added.
If you’ve been furloughed, an increasingly common circumstance amid the public-health crisis, there’s a chance your coverage will not end. If your employer is allowing you to stay on the group plan while you’re not working, you should still ask how it is handling the employee contribution, said Colleen Carey, a health-care expert and assistant professor at Cornell University.
Some companies have said furloughed employees don’t have to pay their premiums while they’re out of work, which makes sense, experts say, since they’re not receiving a paycheck from which the company can deduct the monthly payment. However, expect to have to pay those premiums when and if you’re brought back to your job, Carey said.
Navigating the health insurance landscape on your own can be stressful and confusing. There are resources you can turn to for help.
If you have a diagnosed condition, including cancer, lupus or diabetes, you may be able to get support deciding on and enrolling in a plan with the National Patient Advocate Foundation, Donovan said.
You can also consult with a local health-care “navigator.”
Generally, newly laid off and uninsured people will have three ways to get coverage: through COBRA, on the Affordable Care Act subsidized marketplace (for now) or by enrolling in a public plan like Medicaid or Medicare. In some cases, if your spouse still works at a job that offers family coverage, you can request to join their group health plan, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. Keep in mind you’ll typically have to do this within 30 days.
COBRA, or the Consolidated Omnibus Budget Reconciliation Act, allows people who work at companies with 20 or more employees to pay to continue their workplace insurance plan for certain periods of time. The option is pricey – $600 a month, on average – because you’re now shouldering the cost of the entire plan.
“Most people find this option to be too expensive without their employer subsidies,” Donovan said. However, she pointed out that if you have a Health Savings Account, you can dig into it for your COBRA premiums. Under this option, you also don’t have to fret about meeting a new plan’s deductible or losing your current doctors.
You have 60 days from the loss of your job to sign up for COBRA, Carey said. And because the coverage will be retroactive to when you were laid off, if you’re in-between jobs, you could wait and see if you need care, and only enroll in COBRA if you find you do, Carey said.
If you take this route, however, proceed with caution.
“The person should make sure they know the price of COBRA, and have that money set aside,” Carey said, adding that they should also understand the exact enrollment steps should they need to quickly take them.
For many people, the ACA marketplace will provide more affordable options.
“Depending on where you live, you can access either the federal marketplace or your state marketplace,” Donovan said. “Losing your job will qualify you for a special enrollment period for either option.” The enrollment window online at HealthCare.gov lasts 60 days.
Still, some plans on the marketplace will be costly, especially if you’re newly unemployed. Because the subsidies are based on annual income, someone who makes a good living and is only out of work for a short time may find it difficult to qualify for them, Carey warned. Also: Any unemployment benefits you’re receiving could be counted when applying for subsidies on the marketplace, Pollitz said.
To figure out if you can afford a given plan on the marketplace, Donovan recommends asking yourself these questions:
- What is the maximum you can spend per month on a premium?
- Do you have any predictable health-care expenses, like regular medications you take or appointments you need to keep?
- Then, evaluate how much a given plan will cost you, not just the premium, but the co-pays, deductibles and co-insurance expenses, too.
Confused? Here are some definitions:
- Deductible: how much you’ll have to shell out before a plan’s coverage kicks in.
- Co-pays: the fixed amount you’ll pay for health-care services after you’ve paid your deductible.
- Co-insurance: the percentage you’ll still be on the hook for with covered services after your deductible is paid.
The National Patient Advocate Foundation has a calculator to help you determine what your costs on the ACA marketplace will be.
If you have certain doctors you don’t want to give up seeing, find out if they’ll accept a new plan before you sign up for it. Another option is to ask your current doctor if she would consider joining the provider network of your new health plan, Pollitz said. Still, she added, “whenever you change health coverage, there’s a chance you might need to change doctors.”
Many jobless Americans will turn to Medicaid. One of the main ways that the ACA sought to expand coverage is by opening eligibility for the program.
“Medicaid has zero premiums in most states so, if cost is a problem, Medicaid should be the preferred option,” Carey said.
She pointed out another benefit: “Medicaid eligibility is based on monthly income so even a short-run decline in income should make someone eligible for Medicaid for those months.” (Still, collecting unemployment may impact your eligibility.)
If you were on your employer’s plan and are over the age of 65, now might be the time to sign up for Medicare. There are time limits for this, as well.
Keep in mind that other options, including short-term health insurance plans and Christian ministry plans, are not regulated by the ACA. That means they do not have to cover essential services and can cap their benefits, potentially leaving you with an enormous bill if you’re hospitalized.
In most cases, you shouldn’t wait until you’re employed again to get health insurance coverage.
“You can always cancel your plan if you get a new job,” Donovan said. “But most people don’t know when that will be.”