Coverage gains for Black and Hispanic people during pandemic could be lost with end of public health emergency

Federal actions during the pandemic led to uninsured rates falling to to record lows, especially among Black and Hispanic people, but a new report released by the Commonwealth Fund suggests these improvements are vulnerable to being lost once the COVID-19 public health emergency officially ends in less than two months.

Congress passed the Families First Coronavirus Response Act nearly three years ago exactly, requiring states to keep people on Medicaid continually enrolled throughout the coronavirus public health emergency. The Biden administration announced in January that the emergency declaration is set to end on May 11, which will allow states to begin unwinding the Medicaid expansions.

The Commonwealth Fund’s report found that uninsured rates fell across all states in the first two years of the pandemic among Black, Hispanic and White adults, shrinking the disparity in coverage across the groups.

Uninsured rates for Black and Hispanic adults fell by two percentage points or more in 14 and 19 states respectively. A majority of states, however, saw no changes in uninsured rates for Black adults or did not have available data. The report noted that White adults experienced modest improvements in healthcare coverage in nearly all states.

The organization’s study cited four reasons for improved coverage: lower than expected declines in employer coverage, expansions under the Affordable Care Act, the mandates issued by the Families First Coronavirus Response Act and the enhanced premium tax credits made available through the American Rescue Plan.

The Centers for Medicare & Medicaid Services is requiring states to develop operational plans for unwinding Medicaid expansions and Medicaid has released guidance on a 12-month unwinding period after the public health emergency ends. State Medicaid and Children’s Health Insurance Program (CHIP) agencies will be permitted to begin their unwinding periods one month before the public health emergency ends, the same month it ends or one month after.

“Despite this progress, key health outcomes such as life expectancy and maternal mortality have worsened during the pandemic, particularly for people of color,” the report stated. “Achieving full equity in insurance coverage is critical to reversing those trends, particularly since certain COVID-19 treatment and testing benefits are scheduled to sunset when the public health emergency ends in May.”

The study authors noted that 11 states have not expanded Medicaid. They advised that Congress create a “federal fallback option for Medicaid-eligible people in these states.”

The Department of Health and Human Services (HHS) estimates that up to 15 million enrollees in Medicaid and CHIP could lose coverage with the end of the public health emergency. About 6.8 million people may lose coverage despite still being eligible.

“Black and Hispanic people are disproportionately enrolled in Medicaid and thus are especially at risk of losing coverage as states begin to redetermine eligibility on April 1, 2023,” the Commonwealth Fund report stated.