Laurel Schwass-Drew was shell-shocked when, a few months into the pandemic, she lost her job of 38 years as an art educator and, along with it, her health insurance.
A broker helped her enroll in an individual health plan through healthcare.gov. But even more surprising — and upsetting — was when the broker told her that if her income continued to decline, she may qualify for Medicaid, the publicly funded health program for low-income adults and children.
“I’m not ready to wrap my head around it,” said Schwass-Drew, 59, of Mount Airy, who is experiencing unemployment for the first time in her adult life. She doesn’t think there’s anything wrong with Medicaid or accepting help. She just never pictured herself needing the help.
“You feel like you did everything correctly,” she said. “I just never thought I’d experience this in my life.”
Medicaid enrollment among adults has soared during the pandemic: New Jersey’s adult enrollment was up 27% in January compared to this time last year, and up 13% among Pennsylvania adults in December compared to the same month last year.
The rise in enrollment is largely driven by unprecedented unemployment that has brought to the program thousands of adults who have been covered by employer-sponsored health insurance most of their lives. Now supported by a government poverty program many never anticipated needing, a growing number of Americans must reconsider their view of Medicaid and the stigma associated with the public safety net.
“We’re seeing people for the first time who can’t pay their rent, can’t pay their mortgage … a fair number are applying [to Medicaid] for the first time,” said Robin Stockton, a senior program director at Center For Family Services, which helps New Jersey residents enroll in Medicaid and ACA marketplace plans. “It is nobody’s fault that the pandemic has affected them the way it has. It’s not a reflection of who you are as a person or how hard you’ve worked your whole life.”
‘Unprecedented’ Medicaid growth
Medicaid, a joint program of the federal and state governments, used to be mainly for the very poor, pregnant women, and children. The Affordable Care Act, created during the Obama administration, provided states with money to loosen up the rules somewhat. In states that expanded Medicaid eligibility under the Affordable Care Act, including New Jersey and Pennsylvania, people are eligible if their monthly household income is within 138% of the federal poverty level — about $1,468 for a single person and $3,013 for a family of four.
Adults who qualify for Medicaid under the expansion rules are driving new enrollment in New Jersey. As of January, total enrollment — which includes children, pregnant women, elderly, and disabled individuals who have always been able to qualify for coverage — was up 14% compared to the year-ago month. Among adults, many of whom newly qualified under expansion rules, enrollment was up 27%.
A bad economy always swells Medicaid rolls, but the rise of Medicaid in New Jersey during the pandemic is “unprecedented,” said Maura Collinsgru, the health care program director for NJ Citizen Action, which advocates for consumer health issues and helps people enroll in coverage.
“This isn’t like 2009, where it was an economic crisis. This is a health crisis that prompted an economic crisis — health insurance is all the more important,” Collinsgru said.
In Pennsylvania, total Medicaid enrollment in December was up 11%, while enrollment among adults was up 13% compared to the same month the previous year.
When William Allen lost his buffet server jobs last year, he gained health coverage through Medicaid. Allen, 60, of Philadelphia, used to earn too much to qualify for Medicaid, but not enough to afford an individual plan, and never got insurance through an employer.
Allen wants to get back to work, but he now sees the benefits of having health coverage.
“It’s a weird trade-off. Before, I was working and couldn’t get health insurance. Now I’m not working and I can get health insurance,” he said. “Where do I go from here?”
The pandemic has drawn attention to predicaments like Allen’s, which are common year-round. Collinsgru said she hopes the spotlight the pandemic has cast on the challenges people face affording health care will encourage lawmaker to do more to address the high costs.
“People having their health insurance tied to their jobs creates a lot of turnover and keeps a lot of people out of coverage,” Collinsgru said. “We believe the expansion of public programming is essential if we are going to see a maintenance of coverage across the board.”
Tackling Medicaid’s stigma
Pennsylvania’s Medicaid enrollment has grown steadily since the beginning of the pandemic, but not as much as administrators anticipated.
“Given that so many people were losing their jobs or having their hours reduced, we expected that we would see a surge in enrollment across our programs,” said Teresa Miller, Pennsylvania’s Department of Human Services commissioner. “We thought we’d see the impact, frankly, of the human suffering that was going on.”
Normally, states have a steady churn of people joining and leaving Medicaid, as they find jobs with better pay and benefits, or fail to complete the annual renewal process and get kicked out of the program. But as a condition of receiving federal COVID-19 funding, states agreed to stop disenrolling people from Medicaid. That means anyone who was covered when the pandemic started will remain so for the duration of the federal health emergency.
The rule change has kept Medicaid enrollment high, but does not explain why Pennsylvania didn’t see the expected spike in sign-ups. To figure that out, the Department of Human Services partnered with the University of Pittsburgh to survey residents about their situation and knowledge of services available to them.
“What we’re finding is that people are optimistic … they didn’t want to or didn’t feel they needed assistance,” Miller said.
Miller said she hopes the increased need will begin to change people’s opinion of public assistance programs.
“No one wants to need services from DHS, but they are really important in a pandemic to make sure everyone’s basic needs are met,” she said.
Sylvia Thelemaque, 28, is among those who never envisioned needing that kind of help. Through college she was covered under a parent’s health plan, and then bought insurance through her employer.
After losing her job earlier this year, Thelemaque, who lives in Burlington County, signed up for a marketplace health plan, but later found out she qualified for Medicaid. She was “hesitant” about enrolling in Medicaid, worried about the quality of the plans. She has found, however, that the coverage is good and a lot more affordable.
“I am simply grateful to have coverage,” she said.