Too many of my patients are losing their health insurance, and don’t even know it
On multiple occasions, I’ve had families come to appointments who weren’t aware that they had lost coverage until they were already in the office with their sick child.
For a parent, there are few things that can invoke more stress and worry than when their child is sick. Between fear of what may happen, figuring out where to seek care, and taking time off work, things get overwhelming quickly. This is stressful enough without having to also worry about how to pay for treatment.
Yet too many families in our area are worrying about this very thing.
Health insurance is supposed to provide reassurance to families that they can seek care without becoming bankrupt in the process. Yet, as a pediatrician in Philadelphia, I see families grappling with the financial strain and medical debt from staggering health-care-related costs, even with insurance. In fact, fears about these costs unfortunately lead many families to delay seeking care or ration medications.
In 2020, with the onset of the pandemic, the federal government sought to allay these concerns for our most vulnerable families and children with the Families First Coronavirus Response Act, which required state Medicaid programs to continue insuring people throughout the duration of the COVID-19 public health emergency in exchange for increased funding support from the federal government. For three years, the policy guaranteed ongoing Medicaid coverage for eligible families and helped lead to record-low uninsured rates for children nationwide, dropping from 6.4% in 2020 to 4.2% by early 2023.
Sadly, that era has since ended.
Many of the policies enacted during COVID have begun unwinding, including the Medicaid continuous enrollment practices, which ended in March of this year. In Pennsylvania, people enrolled in Medicaid now have to reapply for coverage annually.
Roughly 15 million people across the country are expected to lose Medicaid coverage over the course of the year. In Pennsylvania, an estimated 185,000 people have already lost coverage since unwinding began, and I expect that number to grow.
As a provider, there’s a lot that concerns me about this. What I find most disturbing, though, is that most people recently disenrolled from Medicaid haven’t lost coverage because their income now exceeds the limits. Rather, three-quarters of disenrollment nationally has been due — at least in part — to so-called “procedural” reasons, such as outdated contact information for beneficiaries, or failure to complete a new application.
But after years of continuous enrollment, many families were not even aware they needed to reapply. In fact, the Kaiser Family Foundation found that the overwhelming majority of surveyed Medicaid enrollees did not know that states were allowed to disenroll beneficiaries.
I have seen this firsthand in my own practice. On multiple occasions, I’ve had families come to appointments who weren’t aware that they had lost coverage until they were already in the office with their sick child.
Fortunately, rates of losing Medicaid for procedural reasons are lower in Pennsylvania than national averages, but they are still staggering (44%), especially since thousands of those losing coverage are still eligible to receive it. As a pediatrician, I am particularly troubled that more than a quarter of terminations in Pennsylvania have been coverage for children.
I believe no child should be uninsured, and certainly no child should lose their insurance for mere bureaucratic reasons. However, many of our recent gains in access to health care are likely to evaporate as children continue to be removed from Medicaid programs nationwide. For this reason, several states have been required by the federal government to pause procedural disenrollment, while others have chosen to do so voluntarily.
I believe no child should be uninsured.
Pausing procedural disenrollment is an immediate action state leaders can take to protect Pennsylvania families, until better systems can be enacted. More broadly, this calamity has shown the need to modernize and streamline our processes to support families and prevent unnecessary lapses in coverage.
If you or a family member receives coverage through Pennsylvania Medicaid (Medical Assistance), check your renewal date and, if eligible, reapply via Pennsylvania’s COMPASS tool or call its office at 866-550-4355.
Medicaid was designed as a safety net to protect those with the greatest need. We should be focusing on ways to make it easier — not harder — for children and their families to obtain, and keep, coverage.
Jeremy Jones is a pediatric resident physician in Philadelphia.