Jaime King Calls for Critical Health Care Reform Amid COVID-19

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Professor Jaime King

UC Law SF professor Jaime King published an opinion piece in the New England Journal of Medicine today calling for sweeping changes in how Americans receive health care and health insurance coverage during the pandemic. More than ever, King argues, we need health care reforms that promote universal access to affordable care.

“The patchwork way we govern and pay for health care is unraveling in a time of crisis, leaving millions of people vulnerable and requiring swift, coordinated political action to ensure access to affordable care,” King writes. Millions of Americans have lost jobs and their health care coverage. “While states should continue leading the way on Covid-19 policies, comprehensive protections demand federal intervention.”

The article notes that in a recent poll, 68% of adults said the out-of-pocket costs they might have to pay would be very or somewhat important to their decision to seek care if they had symptoms of Covid-19.  “Failure to receive testing and treatment because of cost harms everyone by prolonging the pandemic, increasing its morbidity and mortality, and exacerbating its economic impact.”

King, who holds a J.D. and Ph.D. and is Associate Dean and Faculty Director (UCH) of the UCSF/UC Law SF Consortium on Science, Law and Health Policy, calls for lawmakers to address three critical areas.

King suggests that policymakers should freeze people’s insurance status as of April 1, 2020, to keep as many people as possible in their existing plans and with their current providers. “People who had employer-sponsored insurance or an Affordable Care Act (ACA) marketplace plan as of that date should be able to remain on that plan through the end of the public health emergency, even if they lose their jobs or cannot pay their premiums,” she writes.

Second, King writes that policymakers should secure coverage for people who have already lost their jobs by expanding access to ACA marketplace plans and Medicaid. Eleven states and the District of Columbia have opened new open enrollment periods for their state ACA marketplaces to encourage enrollment, she noted.

Third, state and federal officials should continue addressing out-of-pocket expenses, such as cost sharing and surprise medical billing. Lawmakers can follow Massachusetts, New Mexico, and Washington, D.C., by eliminating cost sharing for Covid-19–related treatment. Hospital and provider reimbursement shortages can be covered by CARES Act appropriations.

She also advocates for changes to ERISA. “The Employee Retirement Income Security Act of 1974 (ERISA) prohibits state laws governing health insurance from applying to self-insured employer plans, typically offered by large employers such as Apple, Intuit, and Microsoft. As a result, current state surprise-billing protections, cost-sharing prohibitions, and coverage mandates will not apply to nearly 60% of Americans with employer-sponsored health insurance (nearly 30% of the population).”

She concludes: “Never before has the interdependence of all our health, finances, and social fabric been so starkly visible. Never before has the need for health care reforms that ensure universal access to affordable care for all Americans been more apparent. Our policies on health and health care, both during this pandemic and in the future, should reflect this reality, and we should not let the lessons of this crisis pass us by.”

Read the entire Perspective article here.