Medicaid enrollment may hit like a tsunami

While we all hope the novel coronavirus pandemic starts to wane throughout the country (and world), there is another public health storm approaching that stems from two opposing forces. First, the economic downturn will inevitably lead to all states reducing their budgets after collecting less income and sales tax. Simultaneously, many unemployed Americans have lost their health benefits and will be newly eligible for Medicaid, adding to the Medicaid rolls. Currently, the largest portion of states’ budgets is Medicaid, accounting for more than 25 percent.

Hence, state health officials across the country — whether from red or blue states — will be facing tough choices about how to support the health of their residents with significantly fewer resources.

With the coming “Medicaid tsunami,” the Global Healthy Living Foundation (GHLF) urges policymakers to focus on the long-term fiscal health of their states while not sacrificing the physical and mental health of their residents. Members of GHLF patient communities live with chronic illnesses including all forms of arthritis, Crohn’s disease, ulcerative colitis, psoriasis, HIV, migraine, cardiovascular disease, and many others.

Many of our members spent years finding the medical therapies that are best for them.  For example, one of our patients took seven years to find an effective treatment for Crohn’s disease. Years of suffering from physical pain, missed time at work, and the mental pain of not being able to adequately describe her non-visible symptoms to loved ones greatly diminished her quality of life.

Health insurance gives patients access to lifesaving therapies, but many of the newly unemployed will have lost that benefit. Without reliable access to quality and affordable health care and prescriptions, chronic disease patients are at risk for serious and potentially life-threatening complications.

Plus, they will certainly increase their health care utilization compared to a patient whose symptoms and underlying diseases(s) are stable. If these patients do succeed in securing insurance, they may then crash into additional and unexpected insurance barriers, such as non-medical switching, which is a payer protocol that impacts the cost-sharing burden by patients.

To reduce costs, non-medical switching is practice health insurers use to make changes to their formulary in the middle of a plan year, which may force patients that are stable on their current therapies to switch to cheaper treatment options if their current prescriptions suddenly aren’t covered. Non-medical switching, without physician input, can be harmful to patients and result in additional side effects, symptoms, disease progression, and flares.

These impacts can lead to more medical appointments and even hospitalization, which increases overall healthcare costs. Importantly, when people go from commercial insurance to Medicaid, they are likely to encounter non-medical switching. Although there would likely be an immediate cost-saving, it is critical patients remain on the drug that helps them stay stable to reduce intermediate and long-term healthcare increases.

Formerly healthy patients are going to require more costly hospital visits as their conditions worsen. This will not save money for states, but merely delay and increase payments for hospital visits. Further, these same people living with serious, chronic illnesses will be less productive members of our economy just as states look to rebound. 

The good news is that four years ago our member with Crohn’s disease and her doctors landed on an effective treatment strategy, which enabled her to stay fully employed and participate meaningfully in daily life. However, her health is at risk if she and the millions of other people with chronic health needs seek Medicaid. It’s clear that we are facing a forthcoming public health crisis — the coming Medicaid Tsunami. That’s why it is vital that patient communities, like ours, public health officials, and the government work collaboratively to ensure we do not lose our life preservers as we find our way through the storm.

Steven R. Newmark, J.D., MPA, is the director of Policy and General Counsel, Global Healthy Living Foundation.