'Devastating' number of Mainers could lose health insurance as pandemic continues

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Up to 221,000 Maine residents could lose the health insurance they receive through their jobs if unemployment levels this year reach Great Depression heights, ultimately increasing the ranks of Maine's uninsured by almost 50 percent, a new analysis shows.

More than 15 percent of Maine's workforce has filed for unemployment during the last six weeks due to the economic slowdown caused by the coronavirus pandemic. New claims have slowed over the past two weeks, but that could change this week as people who previously were not covered by the unemployment system -- those who are self-employed and work as contractors -- start to receive benefits.

The official unemployment rate in the state and country hovered around 4 percent in March, but that rate covered the period before most pandemic-related job losses began to happen.

Some analyses are anticipating dire increases: the Federal Reserve Bank of Chicago predicted total unemployment may have reached 25 percent in April, a level not seen since the Great Depression. Financial firm JP Morgan made a slightly less grim prediction in early April, estimating a 20 percent job loss by last month, CNBC reported.

Those job losses would have a direct effect on health coverage for those who receive insurance through their employers. About 48 percent of Mainers received health insurance through an employer in 2018, according to the Kaiser Family Foundation.

A newly released study from the Robert Wood Johnson Foundation and the Urban Institute created two scenarios for how deep the loss of health insurance could be.

In the low scenario, 72,000 people in the state could lose their employer-sponsored health insurance if unemployment climbs to 15 percent, and up to 131,000 would lose it if unemployment increases to 25 percent. Its forecast for the high scenario is that 122,000 to 221,000 people would lose employer-provided insurance under 15 and 25 percent unemployment respectively.

According to the U.S. Census Bureau, about 106,000 Maine residents, or 8 percent, were uninsured in 2018.

About 77 percent of those who lose employer health insurance would seek insurance through Medicaid or the Affordable Care Act marketplace, the analysis projects. In the worst-case scenario, that would leave about 51,000 more people uninsured; 17,000 more people would have no insurance in the 15 percent unemployment scenario.

Those who lose insurance "may be newly eligible for Medicaid or marketplace-based subsidized coverage but not realize it," the study notes. More people are likely to get covered by Medicaid in states that expanded coverage under the Affordable Care Act, which Maine did last year.

Such a loss would be "devastating," said Mitchell Stein, an independent health policy consultant in Maine.

"It's just mind-boggling if you think about the fact that our population is only about 1.3 million," he said. "These numbers of additional uninsured would just kind of blow up our support system."

Stein also noted the change could have a detrimental effect on primary care providers. Those practices get most of their revenue from non-emergency care services, which providers largely canceled or delayed as the state's health care system prepared for a potential surge of coronavirus cases. That's creating "incredible financial pressure," he said.

Even when those services return -- providers were allowed to start offering more care again this month, although they were advised to prioritize care for time-sensitive conditions -- people may not have the ability to pay, he said.

That shift in health care has already changed the economic landscape. The health care sector of the economy shrank by 2.5 percent in the first quarter of the year, according to estimates from the U.S. Department of Commerce's Bureau of Economic Analysis. National gross domestic product is believed to have dropped overall by 4.8 percent.

Rebecca Boulos, the executive director of the Maine Public Health Association, said the situation shows how precarious access to health care coverage can be when it is tied to employment.

"While employer-based health insurance is often a benefit that people seek when they look for employment, if that benefit ends, it not only impacts the individual, but also everyone else in their family who was covered," she said.

A record amount of people have enrolled in MaineCare since the pandemic began, and applications are surging. But it's hard to know how many people will seek health insurance through Affordable Care Act marketplace coverage.

While someone can enroll in Medicaid anytime, a person is entitled to a special enrollment period in the marketplace only when they lose their employer-provided health coverage.

The Trump administration has so far declined to open a special, nationwide enrollment period for marketplace plans that would allow others without insurance coverage to enroll. The typical enrollment period for those plans opens in November.

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