Payers, Legal

ACA could help millions of uninsured gain free coverage

Millions of Americans without healthcare insurance could be eligible to get coverage for free, or nearly free, through financial assistance offered under the Affordable Care Act. But many who recently lost their employer-based coverage may not be aware of the options available to them.

A majority of the uninsured population in the U.S. are likely eligible to get financial help for healthcare coverage through the Affordable Care Act in 2020, meaning that millions could have access to free, or nearly free, health insurance, according to data analyzed by the Kaiser Family Foundation.

Though there is no way of knowing how many people are currently uninsured in the country, data shows that there were 28.9 million nonelderly individuals who were uninsured in 2019, up by more than 1 million from 2018. The number of uninsured people in the U.S. increased for the third year in a row in 2019.

According to Kaiser, the number of uninsured people has grown this year due to the Covid-19 pandemic and resulting job losses and economic recession, “but it will be months before we have reliable government surveys to measure the true impact.”

Before the pandemic, about 6.7 million uninsured people (24%) were eligible for Medicaid, and 9.2 million of the uninsured (33%) were eligible for financial assistance on the ACA marketplaces. In total, 57% of the uninsured were eligible for financial assistance to help them get health insurance coverage, and most could get insurance for free or for a nominal amount, Kaiser reports.

The 24% of uninsured people eligible for Medicaid typically would not have to pay a premium to sign up, and the 4.5 million uninsured people (16%) eligible for a free Bronze plan would also not need to pay a premium. The remaining 4.7 million (17%) could get insurance for a reduced price under the ACA.

President Barack Obama’s signature healthcare law has seen several challenges in the decade since it was first passed in 2010. But despite Republicans attempts to dismantle the law, it has largely endured. With Justice Amy Coney Barrett’s Supreme Court confirmation in October, many wondered if the now conservative-majority court might try to strike down the ACA, but recent oral arguments showed that the country’s highest court seemed hesitant to do so.

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A Deep-dive Into Specialty Pharma

A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.

However, it may be hard now for the general public to find out about the financial help offered by the ACA as the Trump administration slashed funding for marketing and outreach activities by nearly 90%, Kaiser reports. In addition, many who lost job-based coverage amid the pandemic may not have had any prior experience with the marketplaces or Medicaid, and so they may not be aware of the financial help available. In October, the national unemployment rate was 6.9%, representing 11.1 million people who lost their jobs, according to the U.S. Bureau of Labor Statistics.

The open enrollment period for plans available through the ACA marketplaces began at Nov. 1, and numbers released by the Centers for Medicare and Medicaid show that since then, more than 2.3 million people have selected plans through the marketplaces, of which more than 500,000 are new consumers.

Photo credit: Nuthawut Somsuk, Getty Images