Policy Matters Ohio: Hundreds of Thousands of Ohioans Could Lose Health Care During Pandemic

COLUMBUS, Ohio, June 26 -- Policy Matters Ohio, a 501(c)3 non-profit and nonpartisan state policy research institute, issued the following news release:

Despite the COVID-19 pandemic and recession, the Trump administration and 18 state attorneys general filed briefs asking the Supreme Court to strike down the entire Affordable Care Act (ACA). If the lawsuit succeeds, hundreds of thousands of Ohioans and their families who lost their jobs and health insurance will lose options for coverage through the ACA's marketplace exchange or Medicaid expansion. Hundreds of thousands of others who currently receive coverage because of the ACA also would lose coverage.

A Kaiser Family Foundation study estimates 1,002,000 Ohioans and their family members lost employer-sponsored health insurance in the first two months of the pandemic lock-down. But essential economic security programs - the ACA and Medicaid - protected most of them. Of those who lost employer health coverage in the initial pandemic lock-down, 267,000 became eligible for premium tax credits to help purchase coverage through the ACA's health insurance marketplace. Another 531,000 became eligible for Medicaid.

"Both the Medicaid expansion and the premium tax credits that help moderate-income people afford private coverage would be eliminated if the Supreme Court strikes down the ACA," said Wendy Patton, senior project director at Policy Matters Ohio. "It is hard to imagine a worse time for state leaders to actively work to reduce access to health care - during a pandemic."

The Supreme Court is likely to decide the case in the first half of 2021, when the unemployment rate is still expected to be about 10 percent and the public health crisis may still be ongoing. If the court overturns the ACA, it would not only hurt the newly unemployed, but also people and families of low and modest income who have been getting health care through Medicaid and the ACA marketplace plans. The 628,000 low-income Ohioans insured through the Medicaid expansion in April 2020 would all lose health coverage, since the Medicaid expansion is part of the ACA. The 196,806 Ohioans enrolled in ACA marketplace plans in 2020 before the pandemic started would also lose coverage.

Research shows the ACA has increased the number of people with health coverage, made people more financially secure, and improved people's health - with strong evidence that both Medicaid expansion and coverage through ACA marketplaces save lives. Reversing these coverage gains could worsen all of these outcomes. The adverse effects would be even greater with more people depending on the ACA for coverage during the recession.

The ACA also significantly narrowed racial disparities in health coverage, and the lawsuit would widen them. Based on pre-crisis estimates, repeal would cause nearly 1 in 10 non-elderly Black people, and 1 in 10 non-elderly Hispanic people, to lose their health insurance, compared to about 1 in 16 white people.

Coverage losses from the lawsuit would also lead to spikes in uncompensated care costs that would add to the financial burden on state and local budgets during an unprecedented state budget crisis. Caring for people without being paid would harm providers at a time when many will likely still be reeling from the large drop in their revenues due to the pandemic. Uncompensated care costs as a share of hospital budgets in Ohio fell by 49% as the ACA's major coverage provisions took effect. COVID-19 is threatening the survival of some safety net and rural hospitals: If the cost of uncompensated care rises, the health care system that serves all Ohioans may be weakened.

Meanwhile, striking down the ACA would also eliminate other policies and protections important to addressing and recovering from the public health crisis. Once again, insurance companies could charge higher premiums for Ohioans with pre-existing health conditions - including COVID-19 - or deny them coverage altogether. Insurance companies would no longer have to cover preventive services, including vaccines, without cost sharing, and could go back to putting annual and lifetime limits on coverage.

"The damage this lawsuit would impose on Ohioans is devastating," said Patton. "It is disdainful and disrespectful of the lives of working people and families."