The many cliffs of American health care
This piece was originally published by Ohio Capital Journal; it is reposted here with permission.
Arbitrary limits on age, income, and funding prevent many Ohioans from accessing health care when they need it most.
I saw the Instagram ads before a birthday party had even crossed my mind. Scrolling through my social media feed months before, the federal government started reminding me — in Instagram ads, Facebook ads, and emails — that as of my 26th birthday, I would no longer be eligible for the health insurance I depended on. As someone with a long medical history, I didn’t need to be reminded.
As a young person with a rare blood disease, I have been thinking about my health insurance costs and access to care since I was a teenager. Like many others who live with chronic health conditions, I have made major life decisions with my 26th birthday in mind. I chose to receive my bone marrow transplant at 20 to be sure I had time to graduate college, get a job, and secure health insurance before I turned 26. I got married before the age of 26 to secure my spouse’s health care benefits in preparation for this very moment. I saved money for months before leaving my job to ensure that I could pay for health expenses out of pocket just in case there was a lapse in coverage.
The conversation around age and health coverage isn’t new. In 2016, six years after the Affordable Care Act (ACA) was passed, I was a senior in high school with a rare, high-cost medical condition. Before the ACA, not only would I have no longer been covered by my parents’ health insurance, but I also would have likely accrued well past the “lifetime medical spending limit” that many insurance companies at the time were allowed to impose. The ACA saved my family from bankruptcy. It also created what I call a health care cliff at age 26, after which a person is dropped from their parent’s insurance.
Turning 26 is, officially, a Qualifying Life Event (QLE): a key moment when someone may lose coverage for a reason they can’t typically control. The policy creates problems for many young adults, particularly those with chronic conditions and people with disabilities. For example, many young adults with diabetes, suddenly unable to afford their medication, are forced to ration it. Some have died as a result. Young adults with chronic health conditions also face challenges when transitioning from pediatric to adult health care providers, complicating consistency of care during a critical period.
Young people today face additional challenges in terms of cost. In Ohio, the average federal student loan debt per borrower is more than $34,000, which has begun to come out of people’s paychecks again when loan repayments resumed on the first of this month. The high — and rising — cost of rent also impacts a person’s ability to pay, even if they have insurance coverage. And for those who do seek care, health costs are still a challenge: In the 2022 KFF Care Health Debt Survey, 1 in 3 American adults reported say they have skipped a recommended medical treatment due to cost.
The combination of these factors means that Ohioans will have to make hard choices to pay for medical costs and maintain health care coverage. The fact that one unforeseen bill, job change, or lapse in health coverage could prevent people from getting medication, hospital treatment, or even end-of-life care is an exceptionally cruel American nightmare.
Ohio’s Medicaid Health Care Cliff
Ohio is currently facing a large-scale health care cliff brought on by the end of expanded federal funding from the pandemic, often referred to as the Medicaid unwind. During the pandemic, states received additional funding through the Families First Coronavirus Response Act to maintain continuous Medicaid coverage: States that received this funding could not remove people from their Medicaid rolls. But now that the program has ended, the state has begun redetermining who is eligible and who will lose their coverage as a result.
The Ohio Department of Medicaid has set up a publicly available dashboard to follow this process, county by county. In July and August alone, more than 69,000 people were removed from Ohio’s Medicaid program, often for simple mistakes like not responding to a letter or phone call to reverify information. (Correction: An earlier version of this commentary said 32,000 people had been removed from Medicaid in July and August. Updated figures show it was actually 69,000.) For those who no longer qualify for Medicaid coverage because of the unwind, it is considered a Qualifying Life Event (QLE), allowing people to enroll in another plan outside of the typical open enrollment period. However, there may still be gaps in coverage as people scramble to get new care that fits their family’s needs.
While the pandemic has officially ended, the idea that the long-term chronic health conditions the pandemic created have disappeared — and people no longer need access to expanded medical coverage — is, frankly, ridiculous. Data collected by the Centers for Disease Control (CDC) in 2022 found that 1 in 5 American adults who had COVID-19 had developed long COVID (or symptoms lasting more than three months after onset of symptoms). COVID-19 is not gone, nor are the strains it produces on the health care system.
Beyond COVID, Medicaid redeterminations also show the need for expanded health care access in general. Overall, studies have shown that people with Medicaid have better access to care and preventative services than those without health insurance and Medicaid expansion has been linked to improved mortality outcomes. Historically, Medicaid expansion is a key tool to address racial health disparities and improve maternal health outcomes.
Removing thousands of Ohioans from Medicaid will only make health coverage disparities worse while many are dealing with the compounding effects of new, chronic health conditions, the high cost of care, and the continued challenges presented by inflation. After a once in a century pandemic, lawmakers are again choosing to remove people’s health insurance for arbitrary reasons like age, employment, or funding, rather than living up to their responsibility to close the gaps and eliminate the cliffs that threaten so many Ohioans.