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HANM Recommendations for Federal Action on COVID-19

COVID-19 has exposed major holes in our health care system and social safety net. Bold action is needed to ensure that New Mexicans have the resources they need. The Families First Coronavirus Response Act (FFCRA) was a critical first step in this effort.

However, additional steps will be necessary. The State of New Mexico, local clinics, and the New Mexicans who are weathering this crisis need more resources to ensure an adequate response. To that end, Health Action New Mexico has developed a series of health-related recommendations to help individuals and families access care and feel more financially secure, bolster the state’s capacity to respond, and assist clinics who help vulnerable populations. While this is by no means a comprehensive list of the steps necessary to address this crisis, we hope it provides useful insight on critical health coverage and access issues facing New Mexico and the United States.

Create a Universal Coronavirus Crisis Health Insurance Program.
While FFRCA guarantees free testing for uninsured Americans, treatment costs may deter individuals from seeking necessary services. According to the Robert Wood Johnson Foundation, while “costs clearly pose a barrier for the uninsured, the likelihood of significant cost-sharing, combined with a wariness about out-of-network billing, may deter even those with insurance from seeking care.” That is why it is imperative for the federal government to establish a COVID-19 Coronavirus Health Insurance Program built upon the framework of Medicare.

Because our health insurance system is so fractured, it is difficult to have a coordinated response to a global pandemic. Medicare’s provider network, billing system, and consumer protections are well-suited to take on this challenge. In addition, health insurers did not anticipate the resources necessary to cover COVID-19 and will likely require a bailout if they are overwhelmed by those costs. Creating a federally financed and administered program to offset those costs and logistical challenges is prudent. As the authors of a recent article on this approach describe, there are four major upsides to this type of program:

  1. “In one step, Congress could stop financial barriers from interfering with coronavirus care — a threat that will otherwise grow as more people lose employment and their health insurance. There is little value in providing free diagnosis if patients who test positive are reluctant to go to the hospital as their condition deteriorates. Every delay in treatment is an opportunity for the virus to spread deeper into communities.
  2. “A second advantage is better data. A new program using a single billing system could aggregate information quickly about where and how much illness is occurring. Places like Taiwan and South Korea are each using a single data set to identify and track changes in demographic and clinical factors associated with infection and hospitalization. A single billing system can also improve the ability to track the total number of tests performed, which is helpful for gauging disease prevalence. This information can then be used to drive local recommendations for social distancing and clinical care.
  3. “A third advantage is a more sustainable national response. Insurance companies did not include the potential massive expense of care for novel coronavirus in their actuarial calculations and are at risk for massive losses in the coming year that could not have been predicted. Rather than wait for the insurance industry to need bailouts or much higher premiums in ensuing years, the federal government can assume the expense directly. Doing so will also relieve the unexpected burden of coronavirus on self-insured employers, reducing the pressure for layoffs.
  4. “A fourth and final advantage is a mechanism for everyone to benefit from medications and vaccines for the novel coronavirus. A new program can negotiate for a global purchase of critical medical advances for the entire population at a fair price for the companies that have invested to develop them.”

It is vital that this program be universal, so that no one goes without necessary testing and treatment. This effort should be carried out in conjunction with other measures to help as many people as possible sign up for comprehensive health insurance. We recommend the swift adoption of a Universal Coronavirus Crisis Health Insurance Program.

Further enhance the Medicaid Federal Matching Assistance Percentage (FMAP).
State budgets are going to be under immense pressure, as officials decide how to meet the increased demand for effective public services while the economy is in freefall. The FFRCA provides some relief by increasing the Medicaid FMAP by 6.2%. States should not be forced to cut Medicaid at a time when our health care system is under so much strain. We recommend that, at a minimum, the Medicaid FMAP be increased by an additional 5.8%, for a total 12% increase when combined with the provisions of FFRCA. The provision should also include a mechanism to automatically increase the FMAP if economic conditions worsen.

Restore the 100% FMAP for Medicaid expansion.
In addition to providing relief for state budgets, our hope is that restoring the 100% FMAP for Medicaid expansion will encourage other states, including our neighbors in Texas, to reconsider expanding their program during this difficult time. Because the communities along the border of New Mexico and Texas are so interconnected, poor access to medical services on the other side of the state line puts New Mexico at heightened risk. We recommend that Congress restore the 100% FMAP for Medicaid expansion for the duration of the crisis and maintain the matching rate until state budgets have fully recovered.

Provide additional health care resources to Native Americans, Indian Health Service (IHS), and tribal public health programs.
First and foremost, Native American tribes and nations should be consulted to determine their priorities and needs. IHS is chronically underfunded and will likely require additional capacity to administer tests and take precautions necessary to keep health care workers safe. Tribes also need additional resources for public health programs. To reduce barriers to health coverage, premiums should be waived for Native Americans who qualify for Marketplace coverage. We recommend adopting measures to address the health needs prioritized by tribal leaders.

Provide an infusion of resources to private non-profit clinics, Federally Qualified Health Centers (FQHCs), and FQHC look alikes.
As clinics that disproportionately serve the uninsured prepare for a major surge in services, clinic finances are of great concern. These clinics in particular operate on very thin margins and rely on donations, private foundation grants, and patient co-pays to keep their doors open. Many of these funding sources may be strained in the coming months, even as the clinics have an influx of patients. Federal grants should be made available to private non-profit clinics, with additional resources made available to those who serve a higher proportion of uninsured patients. FQHC funding should also be increased. We recommend that Congress provide an infusion of resources to private non-profit community clinics, FQHCs, and FQHC look alikes.

Ensure rural providers have the resources they need.
Because the Coronavirus has reached urban centers first, there are concerns that states will be financially pressured to divert resources towards hospitals in those areas. We recommend the establishment of a Rural Provider Emergency Fund that providers can tap into if hospital or clinic financing takes a downturn during the pandemic.

Create a Special Enrollment Period (SEP) on the federal Health Insurance Marketplace and waive Marketplace premiums for certain populations.
States like New Mexico that currently rely on the federal Health Insurance Marketplace platform (Healthcare.gov) cannot establish SEPs. Instead the federal government sets SEPs. Despite requests from a variety of leaders and stakeholders, the Trump administration has not yet established a COVID-19 SEP. We recommend a general SEP lasting through April and a rolling SEP for qualifying uninsured individuals who contract COVID-19. One way to provide targeted economic relief for families and encourage uninsured New Mexicans to sign up for coverage is to eliminate premiums for Marketplace coverage in the coming months. We recommend that Congress adjust Marketplace advance premium tax credits so that they cover premiums for individuals under 400% FPL in their entirety for the next three months.

Give states the authority to work directly with the World Health Organization (WHO) and other countries to secure COVID-19 testing kits.
The federal government’s response to developing and distributing COVID-19 testing kits has been a failure. The Trump administration chose not to secure tests from WHO when they were first available. Given that there is still a massive shortage of testing kits, states need to be able to get effective kits however they can. We recommend that Congress pass measures allowing states to work directly with WHO and other countries to secure COVID-19 testing kits.

Bolster production of personal protective equipment for all who need it and combat price gouging for basic medical and sanitary supplies.
Medical professionals and medically vulnerable populations need personal protective equipment. Shortages of respirators have been alarming and there are reports of individuals purchasing the respirators en masse. The federal government should take steps to boost production of equipment and make sure that they are immediately available to those who need it. In addition, basic medical and sanitary supplies should be readily available to consumers, but reports of price gouging have been on the rise in recent weeks. We recommend subsidizing the production of personal protective equipment, creating processes for ensuring those who need it most have access, and combat price gouging for basic medical and sanitary supplies, including medications.

Immediately reverse the public charge rule.
While US Customs and Immigration Services announced a temporary suspension of public charge rules, Health Action New Mexico has heard from several partner organizations that families continue to fear that public charge rules will be used against them in the future. We need to make sure that no one fears using public services that they qualify for during this global pandemic. We recommend amending federal statutes to reverse recent changes to public charge rules.

Forgive medical debt for those diagnosed with COVID-19.
When people are diagnosed with COVID-19, the last thing they should worry about is medical bills, especially as the overall economy is on a downward trajectory. According to a study published in the National Center for Biotechnology Information, “problems paying medical costs are associated with higher credit card debt, more calls from bill collectors, increased bankruptcy rates, and diminished access to care.” We recommend forgiving medical debt for all people diagnosed with COVID-19.

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We need bold, decisive action as soon as possible to ensure that all people can access the services they need . If you agree with our recommendations, please share this with your Members of Congress. Find your Representative and Senator here.

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