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The Kaiser Family Foundation has published an illuminating comparison of one possible and two existing means of subsidizing coverage for those who lose job-based health insurance in the Covid-19 pandemic. The two existing options are Medicaid, for which 47% of the newly uninsured are eligible by Kaiser's estimate, and subsidized marketplace coverage, for which 31% may be eligible. The third option, federal subsidization of 100% of COBRA* premiums, is provided in the HEROES Act passed by the House - and could conceivably win some Republican backing, as it would be a windfall for employers, healthcare providers and insurers as well as the individual recipients.
There's a certain symmetry between fully subsidized COBRA and Medicaid. Both options would be zero-premium in almost all cases (a few states have imposed premiums on higher income Medicaid enrollees). The tradeoff: employers' relatively robust provider networks versus Medicaid's zero-to-minimal out-of-pocket costs.
According to Kaiser, the average actuarial value of an employer-sponsored plan is 85%, meaning it's designed to cover 85% of the average enrollee's medical expenses. The average deductible in employer-sponsored insurance is $1,655, and the average out-of-pocket maximum for individuals is about $4,000. AV for Medicaid is effectively 100% or very close to it. Medicaid is also a much better deal for taxpayers. As Kaiser points out, private insurers (including self-funded employer plans) pay almost twice Medicare rates, and a still higher multiple of Medicaid rates.
The clear loser in this triple comparison is marketplace coverage, as for most of those who lose job-based coverage it requires higher premiums (which are zero in the other two options), higher out-of-pocket costs, and provider networks often as narrow as Medicaid's.
The Kaiser Family Foundation has published an illuminating comparison of one possible and two existing means of subsidizing coverage for those who lose job-based health insurance in the Covid-19 pandemic. The two existing options are Medicaid, for which 47% of the newly uninsured are eligible by Kaiser's estimate, and subsidized marketplace coverage, for which 31% may be eligible. The third option, federal subsidization of 100% of COBRA* premiums, is provided in the HEROES Act passed by the House - and could conceivably win some Republican backing, as it would be a windfall for employers, healthcare providers and insurers as well as the individual recipients.
There's a certain symmetry between fully subsidized COBRA and Medicaid. Both options would be zero-premium in almost all cases (a few states have imposed premiums on higher income Medicaid enrollees). The tradeoff: employers' relatively robust provider networks versus Medicaid's zero-to-minimal out-of-pocket costs.
According to Kaiser, the average actuarial value of an employer-sponsored plan is 85%, meaning it's designed to cover 85% of the average enrollee's medical expenses. The average deductible in employer-sponsored insurance is $1,655, and the average out-of-pocket maximum for individuals is about $4,000. AV for Medicaid is effectively 100% or very close to it. Medicaid is also a much better deal for taxpayers. As Kaiser points out, private insurers (including self-funded employer plans) pay almost twice Medicare rates, and a still higher multiple of Medicaid rates.
The clear loser in this triple comparison is marketplace coverage, as for most of those who lose job-based coverage it requires higher premiums (which are zero in the other two options), higher out-of-pocket costs, and provider networks often as narrow as Medicaid's.
