The end of the Public Health Emergency (PHE) marks a crucial point in healthcare. With its termination scheduled for May 11th, the impacts on medical debt are significant. Originally declared in January 2020, the PHE allowed swift governmental responses to COVID-19, including mandates for coverage of COVID tests without cost-sharing. It also brought policy flexibility and innovation support, such as relaxed HIPAA requirements for telehealth. With the PHE ending, these flexibilities will shift, affecting access to healthcare and financial stability for many.
Financial stress is a growing concern. The termination of SNAP benefits as part of the Consolidated Appropriations Act leads to a loss of $95 a month for families in over 30 states. According to the Center on Budget and Policy Priorities (CBPP), this loss exacerbates financial instability, especially during inflation and economic uncertainty. Families already stretched thin face further challenges, increasing the risk of unpaid medical bills. Research shows that medical debt is a significant social determinant of health, similar to food access.
Loss of health coverage is another critical issue. Medicaid, now decoupled from the PHE, faces an unwinding date of April 1. Over the past three years, nearly 20 million more people have relied on Medicaid for health coverage. States, given additional funding, were required to continuously cover these individuals. However, as redeterminations for eligibility begin, millions could lose their health coverage. According to KFF, state level systems might struggle, causing inappropriate terminations of coverage. A new brief predicts that over 18 million people will lose Medicaid, with about 4 million remaining uninsured. Uninsured individuals often avoid accessing necessary healthcare, leading to higher medical debt.
Health coverage navigation remains a challenge. Purchasing health insurance independently can be overwhelming despite ACA Marketplace improvements. Navigators, assisters, and Consumer Assistance Programs (CAPs) play crucial roles in getting and keeping people insured. Although the Biden Administration invested in health insurance navigation, more support is necessary. CAPs, essential for enrolling in coverage, appealing insurance denials, and settling medical bills, lack congressional funding since the ACA passage. Most states do not invest in CAPs, leaving people at risk of medical debt due to inadequate navigation services.
High out-of-pocket (OOP) costs add to the burden. The Inflation Reduction Act made ACA plans more affordable, with premiums at zero for incomes below 150% of the Federal Poverty Level. However, ACA plans differ from Medicaid, having out-of-pocket maximums and cost-sharing responsibilities. These plans often have different drug formularies, provider networks, and benefit designs. Increased ongoing cost burdens might deter people from seeking care or maintaining coverage. States must implement tested strategies to support patients in navigating new health insurance plans to prevent medical debt.
Lack of awareness about financial assistance programs could also lead to increased medical debt. Predictions indicate millions may become uninsured in 2023. Uninsured individuals delay care due to fear of medical bills, are less likely to receive preventive care, and more likely to avoid treatment for chronic conditions. Nonprofit hospitals’ financial assistance programs (FAPs) offer relief but are often underutilized due to a lack of awareness and navigability issues. Hospitals must elevate these programs and enhance accessibility to mitigate medical debt.
The PHE’s end highlights weaknesses in our health coverage system. Easing transitions across programs, increasing affordability, and ensuring access to essential services are key strategies to protect people from medical debt. As we navigate this period, we hope stakeholders will collaborate to keep patients protected from debt. We focus on guiding individuals through these transitions, supporting their efforts to avoid medical debt and maintain health coverage.
