ACA Provides Safety Net to Workers During COVID-19 Pandemic

September 30, 2020by Alex Strautman

COVID-19 has underscored the importance of health insurance for Americans across the country. Harvard researchers Sumit Agarwal and Benjamin Sommers, tackle this topic in their online article. The article was published in August 2020 in the the New England Journal of Medicine. Agarwal and Sommers explore how the protections provided by the Affordable Care Act (ACA), have increased as we deal with COVID-19.

The researchers reference data from the U.S. Department of Health & Human Services, including its Medical Expenditure Panel Survey of individuals and families, medical providers, and employers. They compare actions taken by those who lost their jobs in 2014 (before the ACA took effect) and those losing their jobs more recently.

Argawal and Sommers point out the differences versus the pre-ACA health insurance market. Today, a wide range of insurers offer guaranteed issue coverage and are mandated to cover essential health benefits. This contrasts to a pre-ACA market with fewer insurer regulations, no pre-existing condition limitation, skimpier plans with coverage dollar limits (annually or lifetime), and often-unaffordable rates with no available subsidies.

They also note the expansion of coverage through the ACA that permits children to be covered on a parent’s health plan though age 26, as well as the expansion of Medicaid programs (Medi-Cal in California) to give new options for coverage unrelated to employment.

State and Carrier Actions

With the onset of COVID-19, health insurance carriers and states made coverage available to those previously declined during open enrollment. Some opened a special enrollment period (SEP). California’s public health exchange, Covered California, gave eligible uninsured individuals the opportunity to apply from March 20 to June 30. That SEP was extended to July 31, and then extended further to August 30.

Although the Centers for Medicare & Medicaid Services (CMS) did not authorize a nationwide SEP (where anyone who is uninsured could enroll), the agency reported higher enrollment through existing SEPs. A June report cited more than 892,000 individuals used a SEP to enroll for coverage through May 2020 – an increase of 27% compared to 2019. Loss of employer-sponsored coverage or coverage through a spouse are among several life events that can trigger an SEP. More information on Covered California qualifying life events is available here.

Coverage Options

For individuals who lose their employer-sponsored health insurance, coverage options include:

  • Converting to coverage under a spouse’s health plan, if available;
  • Continuing coverage on the employer’s plan (if available) through COBRA;
  • Applying for coverage through Medicaid (Medi-Cal in California);
  • Purchasing insurance directly through the ACA marketplace (e.g., Covered California);
  • Getting coverage for an eligible child through the Children’s Health Insurance Program (CHIP). More information on CHIP is available at

While short-term (limited duration) health insurance plans are available in many states, they are not an option for Californians. The legislature eliminated availability in Senate Bill (SB) 910, which was enacted in 2018 and became effective in 2019.

Court Review

The U.S. Supreme Court is schedule to hear arguments in the case challenging the constitutionality of the Affordable Care Act the week following the November 2020 election. With the recent death of Associate Justice Ruth Bader Ginsburg, the case could be delayed. A ruling by the Court to end the ACA could disrupt health care coverage for millions of Americans. This includes those getting coverage through their employers, the state and federal exchanges, Medicaid, and elsewhere.

The lawsuit centers on a case brought by Republican attorneys general who argue the ACA’s individual mandate provision was made unconstitutional when the penalty for not having ACA-compliant health insurance was reset to zero under a 2017 tax overhaul implemented by the Trump administration. That position stems from the Supreme Court’s prior ruling in a 2012 case that upheld the ACA because it found the law was an appropriate use of the power of Congress to tax.

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