Health insurers see roles shift amid coronavirus pandemic

It goes without saying that many aspects of the health care industry have been fundamentally altered by the outbreak of coronavirus, and certainly health insurers are among the corners of the market affected by such a sea change. Given the fluidity of the situation overall, these shifts are likely to keep coming for the foreseeable future.

One of the big initial changes seen in mid-March – as part of the Families First Coronavirus Response Act already passed into law – was that health insurers would be required by the federal government to waive certain costs associated with obtaining care around the coronavirus. Forbes notes these include copays, co-insurance and deductibles associated with getting tested for the virus, as long as that test was approved by the FDA, as well as telehealth services, doctor's visits and so on related to coronavirus concerns.

Meanwhile, individual states are passing their own requirements to promote public health related to COVID-19 at this time, including boosting access to testing and treatment, but also prescription refills that would otherwise require an in-person doctor's visit. Moreover, once a vaccine for coronavirus is developed, similar regulatory changes would likely be made to ensure everyone has free or low-cost access to it as well.

Health insurers need to be cautious at this time.

However, given the patchwork of policy changes – both those already in place and yet to come – health insurers will likely need to remain nimble at this critical time so they can respond appropriately to individual mandates as they arise.

The employment situation
Of course, with the virus comes not just the health risks, but the potential for a recession and the surge in jobless claims in the initial wake of orders to stay at home and close all non-essential businesses. According to Kaiser Health News, with millions losing their jobs and, along with them, their health coverage, a number of states have reopened enrollment in their public insurance markets to make sure people have coverage at a time when it's absolutely critical.

The initial wave of states reopening their exchanges included many that run their own, rather than relying on the federal government's. Of course, each has its own rules for enrolling these days, with Massachusetts extending options through the end of April, and California doing so through the end of June. By and large, they say this is not just a matter of making sure people have access to insurance, but to prevent the further proliferation of the virus. Simply put, people without coverage are less likely to seek testing or treatment, and could unwittingly spread it as a consequence.

Growing pressure
This also comes at a time when health care providers are stretched thin, facing more people coming through their doors and the necessity to cancel the kinds of treatments they rely on for revenue, such as imaging scans or surgeries, according to Harvard Law Review. That could, consequently, lead them to run out of money in relatively short order, and lay off health care workers or even close altogether – creating a potentially dangerous situation in which there aren't enough care providers in a given area to meet demand.

For that reason, there may soon be growing pressure on health insurers – including Medicare and Medicaid – to start transferring premium money directly to care providers in a more timely fashion than they usually do. By doing so, they would help keep care networks afloat, and given that this is already money insurers have on hand, experts argue there wouldn't be as significant an issue in terms of the impact on their own long-term bottom lines.

Whether such changes to how premium dollars get directed to care providers are actually mandated remains to be seen, but it's certainly something for health insurers to monitor.

To get through this pandemic safely, everyone will need to pull in the right direction. With all this in mind, it's critical for health insurers to make plans for just about any contingency so they can react appropriately to any shifting issues when the time comes.