Health Insurance HQ: An Update on the Health Care Landscape | Entertainment Community Fund

Health Insurance HQ: An Update on the Health Care Landscape

Welcome to Health Insurance HQ—coming to you from the experts at The Actors Fund's Artists Health Insurance Resource Center and special guests!

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Dear Friends,

At the start of a new year, I want to reflect on some of the good things that have come out of these last 12 months. And yes, there are some good things.

COVID-19 has suddenly and permanently changed the way we deliver, use and pay for health services in the United States. This pandemic has fully exposed the weaknesses of our fragmented, for-profit approach to healthcare to a broad spectrum of the public. Most people have seen first-hand the cost of undervaluing preventive care and public health measures. And while we struggled in the past to find market-based solutions to our systemic problems, Mother Nature, the ultimate change agent, essentially lied in wait. Now, she has struck, and we have the opportunity to open the doors to innovation.

Here are 9 good, innovative things that have happened in health care in the last year:

  1. A terrible virus appeared and raced across the globe, but scientists responded with unprecedented speed and focus, cooperating across national lines to decode it, and then discover and deliver vaccines to stem the disease.
  2. To address public health and insurance issues, Congress passed two significant pieces of legislation. The Families First Coronavirus Response Act required all private insurers, Medicare, Medicare Advantage plans and Medicaid to cover Covid-19 testing, and eliminate all cost sharing (copayments, deductibles and coinsurance payments) associated with testing during the “public health emergency”. It also appropriated $1 billion to cover testing for uninsured individuals.
  3. The CARES Act, a $2.2 trillion relief bill that passed a few weeks later, required all private insurance plans to cover Covid-19 testing and future vaccines. In addition, many private insurers, including Humana, Cigna, UnitedHealth Group and Blue Cross Blue Shield, agreed to waive cost-sharing payments for plan members treated for Covid-19. The CARES Act also appropriated $100 billion for hospitals and health care providers, which was conditioned on providers’ agreement not to bill insured patients more than their in-network cost-sharing amounts, and not to bill uninsured patients at all for Covid-19 treatment. The CARES Act also provided substantial tax credits, emergency grants and loans to help businesses keep employees on the payroll or on furlough, while extending and increasing unemployment benefits for those who lost their jobs.
  4. The federal government allowed those who had lost insurance coverage more than 60 days ago and after January 1, 2020, and who were prevented from enrolling in health coverage due to the national COVID-19 emergency, a special enrollment period. This meant that those who normally would have had to wait until the next Open Enrollment period (in most states, November 1–December 15), could enroll in insurance right away. (Note: Voluntarily dropping coverage doesn't qualify you for a Special Enrollment Period, unless you also had a decrease in household income).
  5. In addition, because the Affordable Care Act created state insurance Marketplaces, which are responsive to changes in your income, if you were enrolled in a Marketplace plan and you lost your job or got furloughed, you could update your income and receive additional subsidies to lower (and in some cases, eliminate) the cost of your monthly insurance premiums. If you received subsidies, you also had a three-month grace period during which your coverage couldn’t be terminated for not paying your premiums. This was not possible if you bought insurance directly from an insurance company.
  6. In general, if you lose your job-based coverage, you have 60 days to choose to continue it under a law called COBRA.  However, under new regulations, this 60-day period was waived. If, for example, you were eligible for COBRA 5 months ago and chose to remain uninsured, you could go back to your employer or union and sign up for your COBRA coverage now.  In addition, the initial premium payment, which is due 45 days after you choose COBRA, and then usually monthly after that, must be paused during the outbreak period as well. This effectively means that you will accrue the cost of your monthly COBRA premium, but cannot be disenrolled from coverage for non-payment due to the public health emergency. This regulation expires 60 days after the emergency declaration ends, at which time you would, conceivably, owe any and all outstanding COBRA premiums. (It is currently still in effect).
  7. Great strides have been made in the expansion and affordability of telehealth services. Health care providers won’t face administrative sanctions for waiving co-pays or co-insurance for telehealth services paid for by federal or state health care programs, such as Medicare and Medicaid. Administrative barriers to practicing telehealth across state lines were also removed, and Federally Qualified Health Centers and Rural Health Clinics were allowed to provide telehealth services to patients wherever they were located, including in their homes. Telehealth is especially beneficial for patients who are at a higher risk when leaving home to commute to the doctor’s office. For doctors, expanded telehealth eases the burden on the health system, allowing hospitals to care for people who need it most, while limiting the exposure of health care workers to the disease. Health insurance providers have expanded their telehealth offerings to cover mental and behavioral health care as well. All of this is designed to improve public health outcomes during a pandemic.
  8. Qualifying doctors, including primary care physicians, can prescribe buprenorphine to patients with opioid use disorder based on a telephone evaluation. This greatly expands access to life-saving substance abuse treatment at a time when overdose deaths are soaring.
  9. More than 3 million adults lost job-based health insurance during the COVID-19 pandemic—but because of coverage options created by the Affordable Care Act (ACA), there was not a corresponding increase in the uninsured rate. In fact, the losses in job coverage were mostly offset by increases in Medicaid/CHIP and Marketplace coverage.

So, what do these things tell us? The current crisis has shone a spotlight on our system, and brought into sharp focus the need for health care reforms that promote better access to affordable care. It is starkly apparent that public health is connected to the economy, which is connected to a strong social fabric. But it is also apparent that things that we thought were impossible are possible. We can do it. We have removed barriers that we thought were immovable, financed enormous programs with billions of dollars practically overnight and  developed solutions to problems in record time. We have a unique opportunity right now to further mobilize political forces to expand the government’s role in financing and delivering an effective, affordable health care system. To let your state and federal elected officials know how important that is to you, visit https://www.usa.gov/elected-officials. The work has begun. Let’s keep moving forward.

Yours in good health,


Renata Marinaro

Do you work in performing arts and entertainment and have questions about health insurance? The Actors Fund provides assistance nationally. Please contact the regional office closest to you to connect with a counselor.

New York City
Visit actorsfund.org/ahirc

Los Angeles
Visit ehisca.com