Opinion | Americans on Medicaid Could Soon Lose Health Insurance – The New York Times

The Build Back Better Bill, which passed the House in November, would have extended the more generous subsidies for purchasing A.C.A. health plans. But the bill was declared “dead” by Senator Joe Manchin, Republican of West Virginia, this year, who refused to support it. Now Democratic leaders are hoping to negotiate a slimmed down version of the bill, but it’s unclear whether a bill will materialize with the provision in it.

It is a perilous time to throw low- and middle-income Americans off the insurance cliff: A new Omicron subvariant is spreading, and a program that provided coronavirus testing and Covid treatment at no cost to the uninsured expired in March because the government ran out of funds to support it. Another program that provided vaccination at no cost to patients is set to end this month.

The public health emergency phase of the pandemic may well be winding down. Deaths currently average about 700 a day and are dropping. Schools and offices are reopening, some without masking. But about one-third of Americans are still not vaccinated. And going forward, will newly uninsured low- and middle-income Americans be inclined to pay out of pocket to get a shot? If they get Covid, how will they afford the pills to treat it, when the government bought Pfizer’s Paxlovid treatment for $530 a course and consumers could pay even more on the free market?

Patients vulnerable to losing their health insurance may not be prepared for the change. There’s been little mainstream outreach about the coming changes, and many people may not read government advisories or understand the ins and outs of pandemic health policy.

If people lose Medicaid this year, they will have a chance to enroll in an A.C.A. health plan; the current enhanced subsidies mean they would be likely to pay little or nothing in the way of premiums until the end of the year. At which that point insurance could become unaffordable and they would fall of the insurance cliff again.

Preserving insurance gains for low- and middle-income people is an important opportunity that grew out of our two-year-long national calamity. It shouldn’t be squandered. After all, Covid-19 is just one of many diseases that unduly affect poorer people without insurance. Kaiser Family Foundation polling in March found that Americans are more worried about “unexpected medical bills” than about being able to afford food.

The government has promised to provide 60 days’ notice before the public health emergency period ends for good, when states will have to trim their Medicaid rolls. The enhanced A.C.A. subsidies don’t end until Dec. 31. There’s still time to find funding and act. As the risk of contracting a serious case of Covid-19 recedes, the risk of being uninsured shouldn’t grow.