By Rose Hoban

Who knew? The tens, if not hundreds, of thousands of North Carolinians who have lost health insurance since the onset of the coronavirus pandemic might have a new option.

They should check out the federal marketplace created by the Affordable Care Act.

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A change quietly enacted on the federal website sometime in August creates a “special enrollment period” for anyone who lost employer-sponsored insurance since January.

Usually, someone who doesn’t have insurance through their employer and wants to get something on the marketplace needs to wait until open enrollment, which is to begin this year on Nov. 1 and run through Dec. 15. A person seeking insurance can also sign up if they’ve had a “life-changing event” such as marriage, giving birth or losing a job.

The catch? You have to complete your enrollment within 60 days of the life change. This spring, as many as 190,000 North Carolinians lost their insurance along with their jobs, they may not have been aware that they were eligible to get on the exchange and missed that 60-day window of opportunity.

And despite calls from advocates for these special enrollment periods to be extended, the Trump administration declined for months to lengthen that window.

Then it did. But there was no fanfare, no announcement from the president at one of the many press briefings he held this summer.

According to Julieanne Taylor who runs the health insurance navigator program at the Charlotte Center for Legal Advocacy, a North Carolina navigator was assisting a client with getting on the marketplace when they noticed a new question on the website.

“It said, ‘Since January 1, have you lost your health coverage?’” Taylor said. It was a new question and a new criteria for being able to sign up for insurance.

screenshot of insurance marketplace website with questions, "SEe if you qualify for a special enrollment period"
Screenshot of website captured on Sunday, Sept. 27 noting how applicants can qualify for a special enrollment period of they have lost employer-sponsored insurance since January.

“Oftentimes when we see something like that, it’s usually a glitch,” she said. So her agency called the Centers for Medicare and Medicaid Services, which manages the website to be sure.

It turns out the federal agency had realized that within the Affordable Care Act, a special enrollment period could be triggered in the case of a disaster declaration such as the one for COVID-19.

Without notice

What was strange to Taylor about this new special enrollment period was that CMS did no advertising about it: no announcement, no press release, nothing from an agency that issues multiple press releases a day. During the week of Sept. 14-18 alone, the agency issued 17 press releases.

“Usually we get CMS notices and updates but we didn’t get anything,” she said. “It’s bizarre, and frustrating that they’re not advertising it. It’s kind of up to us to do it.”

“The Centers for Medicare & Medicaid Services implemented a technical update to to automate the process of applying for the existing special enrollment period (SEP) in effect during a FEMA-declared natural disaster, national public health emergency (PHE), or major disaster,” confirmed a CMS spokesperson in an email. “This exceptional circumstances special enrollment period (SEP) is available to people who lost minimum essential coverage (MEC), but were prevented by the public health emergency (PHE) from enrolling during their routine loss of coverage SEP for which they were eligible.”

Tara Straw from the Center for Budget and Policy Priorities, based in Washington, D.C., said it was unfortunate the agency didn’t do a wider announcement.

“You always want people to have every opportunity to enroll in the coverage they’re entitled to receive,” she said.

Straw noted that back in the spring, advocates had asked the Trump administration to extend the 60-day window for people to sign up for coverage on the federal marketplace after losing their jobs.

In about a dozen states and the nation’s capital, which run their own marketplaces, the window was opened for the newly unemployed and uninsured to get coverage. But in the 38 states that use the federal marketplace, people were out of luck.

“It does help people who could have enrolled earlier, but failed to enroll,” Straw said. “People’s lives were exceptionally chaotic, around, you know, the spring and summer when people were losing coverage… They probably didn’t have the bandwidth to pursue that because, you know, people were experiencing all sorts of other needs like housing, food, and, you know, homeschooling their kids and everything else.”

Straw herself was unaware that the special enrollment period had been initiated until she talked to the folks at Taylor’s agency, who’d noticed it and flagged it to her.

“People were going through the application and they were seeing some strange questions,” she said. “You could see that something different was happening, just by the questions they were asking.”

A missed opportunity

Estimates based on data from the Commonwealth Fund find that as many as 191,000 North Carolinians lost employer-based insurance coverage this spring. For many people, paying for a COBRA insurance policy turns out to be prohibitively expensive.

Some of those people may have gotten their jobs back in recent weeks and months, but there’s likely a large number of workers who have become uninsured and stayed that way. That same Commonwealth Fund report found that about a fifth of people who lost jobs this spring were uninsured to start with.

So, even if there’s a special enrollment period for people who lost coverage, many people never had coverage to begin with and they’re still shut out of the marketplace.

According to recent data from the U.S. Census, North Carolina’s rate of uninsurance ticked up half a percent in 2019, from 10.7 percent in 2018 for those between the ages of 18 to 64 to 11.3 percent. That means North Carolina has the ninth highest rate of uninsured people in the country (tied with Arizona).

“You can’t lose something you’ve never had,” Straw said. “It doesn’t say anyone can come in right now and have their eligibility determined for financial assistance.”

A recent report from the Urban Institute found that across the country, as many as 3 million people lost insurance coverage and 2 million became uninsured. Analysts from the organization also estimated that more than half the people who became uninsured would be eligible for subsidized coverage on the marketplace, but had not taken advantage of it.

“I would think this would be a good opportunity to, to get folks enrolled and help folks that were affected by this pandemic,” said Mark Van Arnam, who manages health insurance navigators and assisters all over the state. He said many of those people would likely have signed up sooner had CMS put out the word.

“We encourage folks to really go to an assister or a navigator and just let them help you to figure out your income, figure out what the best plan might be for your budget and your needs,” Van Arman added. “We stand really ready to help and eager to help as many folks as we possibly can.”

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...

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