The Affordable Care Act—which gave health insurance to hundreds of thousands of Illinoisans—is turning out to be a critical weapon in the fight against COVID-19.
By expanding the state’s Medicaid program and establishing a health insurance marketplace for uninsured individuals, the ACA increased the number of people in Illinois with health insurance by more than 800,000. An unknown additional number have gained coverage under ACA provisions banning insurers from rejecting people based on pre-existing conditions and allowing young adults to stay on their parents’ insurance until age 26.
Even more could get covered if President Donald Trump authorizes a special sign-up period for those in need of health insurance amid the coronavirus pandemic, a step the administration is considering.
Boosting the ranks of insured people ultimately means more money for hospitals as they treat an onslaught of patients, some of whom won’t be able to pay for care. With hospitals canceling lucrative elective surgeries, clinicians working overtime and many facilities begging for donations of protective equipment, that money would go a long way.
“If it wasn’t for the ACA, it would be very difficult for us right now,” says Loretto Hospital CEO George Miller. “If (the West Side hospital) had to absorb a larger portion of the population that had no insurance, we would not be able to survive.”
Yet health care providers could lose that financial lifeline just when they need it most. A lawsuit brought by a group of states challenging the constitutionality of the ACA has reached the U.S. Supreme Court. If the court invalidates the law, the number of patients without health insurance could explode.
“Health systems bear the cost when the uninsured population increases,” says Wendy Netter Epstein, professor and faculty director of DePaul University’s Jaharis Health Law Institute. “This disproportionately effects safety-net hospitals that can’t pass the cost on to privately insured patients. We can’t afford to have those hospitals close.”
In dealing with an easily transmissible virus expected to infect between 40 and 70 percent of Americans, the cost of uncompensated care is just one concern.
Uninsured patients might not seek timely testing or treatment for COVID-19 for fear that doing so would bankrupt them, Epstein says. In addition to harming themselves, and leaving hospitals to deal with even sicker patients later on, those people could end up spreading the virus to others in the community, she says.
Loretto Hospital and other local safety nets that treat large numbers of low-income people have seen an increase in patients without insurance within the last two years, Miller says.
Unlike other outbreaks, COVID-19 has required that hospitals transform to deal with the expected surge of patients. This includes canceling nonemergency, elective surgeries to free up beds, clinicians and personal protective equipment like face masks. The move could take a financial toll on facilities, most of which operate on thin margins.
Without the ACA, local hospitals would incur even more unreimbursed costs providing free care to patients that might otherwise qualify for Medicaid. More than 500,000 additional people in Illinois are covered by the government-funded health insurance program for the poor and disabled as a result of the law.
Illinois also is among states taking advantage of a federal waiver that removes bureaucratic barriers to testing and treatment for Medicaid patients. The waiver temporarily suspends requirements that doctors obtain prior authorization from insurers before providing medical care and allows out-of-state clinicians to treat Illinois’ 3 million Medicaid patients, among other things.
Source: Crain’s Chicago Business