Despite the political polarization over basic public health measures, nearly 500,000 COVID-19 deaths and severe societal disparities exacerbated by the pandemic, one bright spot is that the “health coverage safety net” has held, said a panelist during a 2021 AMA State Advocacy Summit session on protecting and advancing health care in a time of crisis.

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There hasn’t been a loss in coverage comparable to the Great Recession—which lasted from December 2007 to June 2009 and saw 5 million U.S. adults lose their employer-sponsored health insurance—noted the panelist, Aviva Aron-Dine, PhD. She is vice president for health policy at the Center on Budget and Policy Priorities, a Washington think tank.

Aron-Dine explained that there were two reasons why coverage has been maintained:

  • The health insurance marketplaces and Medicaid expansion created by the Affordable Care Act (ACA).
  • Swift action by Congress to provide resources to state Medicaid programs at the beginning of the pandemic.

The lesson learned, Aron-Dine said, is an old one that apparently needs to be learned again and again.

“It makes a big difference whether you make it easy or hard for people to get coverage and care,” she said. “It's about whether you put out a welcome mat versus indicating to people that you don't really want them to access health care.”

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Some states “opened the doors wide” to the ACA marketplaces and Medicaid expansion, while others put up barriers such as excessive paperwork required for renewal.

Samantha Artiga, MPH, vice president and director of the racial equity and health policy program at the Kaiser Family Foundation, said the pandemic’s hard times has refocused the nation’s attention.

“When I look for areas of hope or opportunity in this situation, I look to the increased level of awareness and understanding and focus on health disparities, and the opportunity to use this moment of awareness and opportunity to translate that into meaningful change that can hopefully advance equity,” Artiga said.

One lesson that has hit home during the pandemic is the importance of having comprehensive and consistent data available to measure and monitor disparities as well as to use them to work toward progress in addressing those disparities, Artiga said.

Find out more about early moves by President Joe Biden to enable broader access to insurance coverage under the ACA.

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No room for uncoordinated care

Whether it’s a hurricane, pandemic or other emergency, Medicaid is relied on “to shoulder a significant burden” in terms of the immediate and long-term responses, said Matt Salo, executive director for the National Association of Medicaid Directors.

Salo said state Medicaid directors have been focused on three things: The pandemic, the economic downturn and addressing inequities.

The pandemic has also reinforced the trend toward value-based purchasing, Salo said. And he noted that most Medicaid beneficiaries are enrolled in some type of managed-care arrangement but people with disabilities and residents of long-term care facilities are being left behind.

“The traditional unmanaged, uncoordinated fee-for-service system really isn't nimble enough or sophisticated enough to be able to deal with challenging situations like a pandemic,” Salo said.

Medicaid managed care enrollment rose 11.3% from March through September last year, according to data collected in 30 states by KFF. Total Medicaid enrollment was at 77.3 million in September, up 8.6% from February 2020.

Learn more with the AMA about how, when put in context, data can help expose and fix health inequities.

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