During AHIP’s Institute & Expo Online 2020, the conversation focused on the impact the pandemic has had on health coverage and what can be done to improve health equity, among other issues.
During AHIP’s Institute & Expo Online 2020, Bruce Japsen, a senior contributor for Forbes, kicked off the Town Hall panel by asking everyone to think about the current situation in the United States amid unemployment created by the coronavirus disease 2019 (COVID-19) pandemic and its resulting effects on health care coverage.
“Can anything happen at the federal level, and what do you see happening in states?” he asked.
“It's really the most important question I think that we're facing right now. We are truly in the middle of an economic crisis that we haven’t seen in at least 100 years,” said David Merritt, AHIP’s executive vice president for public affairs and strategic initiatives.
Based on the polling AHIP has done of their members, “access and coverage are of absolute critical importance to everyone,” he said, citing safety-net programs like Medicaid, as well as coverage available through the Affordable Care Act, Medicare, or employer-sponsored insurance.
State budgets are under pressure, which could hurt Medicaid coverage, Merritt said. “So, federal action is what people are looking for right now, and Congress has certainly stepped up in the initial phases of the epidemic. In this economic crisis, there's more action to be done, and the American public certainly is looking for Washington to act.”
Liz Goodman, JD, MSW, DrPH, executive vice president of government affairs and innovation, said Medicaid enrollment is increasing, “driven by the Families First Act and CARES Act requirements that states maintain people on Medicaid who were on Medicaid when the pandemic began, and some of it related to people losing their jobs as a result of the COVID pandemic.”
AHIP is working to support governors and state Medicaid directors to receive an additional increase in the federal Medicaid match. To cope, states are looking at budget cuts. “Anything that requires state resources is being put on the back burner. What that means for ordinary people is that their options in terms of coverage continue to be limited.”
Turning to public health, Japsen noted that after the H1N1 epidemic in 2009, permanent changes were made, such as allowing pharmacists to give vaccinations. What “substantive changes” do you think will come out of COVID-19 long term in health care, he asked.
Telehealth, said Jeanette Thornton, AHIP's senior vice president, product, employer, and commercial policy. “It's really going to be a new way that health care is delivered moving forward. I wouldn't want to see us go backwards on this.”
Another thing to watch will be home-based care, said Goodman, citing the spread of COVID-19 in nursing homes and assisted living facilities, combined with the fact that home-based care has enhanced what they can deliver.
Historically, CMS has preferred to pay for care in a skilled nursing facility. During the Obama administration, CMS’ Center for Medicare and Medicaid Innovation created the Independence at Home demonstration project. That model has proven itself she said. She also cited Medicare reimbursement changes for home infusions as well as other policy changes that were beginning as the pandemic began.
Japsen also asked the panelists to think about what insurers can do to improve health equity. Including equity as a quality measure is one of the biggest steps, Goodman said, as well as state and federal legislation.