Tagged Insurance

Becerra Has Long Backed Single-Payer. That Doesn’t Mean It Will Happen if He’s HHS Secretary.

“Becerra supports Bernie’s government takeover of your health care, eliminating your employer-provided coverage.”

TV ad funded by Cotton for Senate, Feb. 22

A digital ad running in Georgia and New Hampshire says Xavier Becerra, President Joe Biden’s nominee for Health and Human Services secretary, supports “Medicare for All.”

“Becerra supports Bernie’s government takeover of your health care, eliminating your employer-provided coverage,” the narrator says.

The ad, funded by the campaign PAC of Sen. Tom Cotton (R-Ark.), is part of a blitz from conservative groups against Becerra’s confirmation. It first aired last week and will continue until the Senate’s confirmation vote. The gritty, foreboding ad includes a range of other attacks, including criticisms of California’s covid-19 response and Becerra’s role in legal cases on reproductive rights.

Another ad, this one funded by Heritage Action for America and airing in the Washington, D.C., market, uses similar talking points, including Becerra’s support for “government-run health care.”

Becerra underwent two Senate hearings last week in which he faced questions about his support for Medicare for All.

“Your long-standing support for single-payer, government-run health care seems hostile to our current system from my perspective,” Sen. Mike Crapo (R-Idaho) said during Wednesday’s Senate Finance Committee hearing. “What assurances can you give to Americans who currently have private insurance, including through Medicare Advantage, and are satisfied with their insurance provider that they will not lose their coverage in the future to some sort of Medicare for All approach or federal takeover of health care?”

Becerra responded that he was asked to serve at the pleasure of Biden, who has made it clear he wants to build on the Affordable Care Act. “That will be my mission,” he said.

Since a vote on Becerra’s nomination could happen this week, we thought it was important to check the claim from this ad and give context to what power HHS secretaries actually have.

We reached out to Cotton’s press team to ask for evidence to support the ad but didn’t hear back. The ad does cite a December New York Times article with the headline “Becerra Supports ‘Medicare for All’ and Could Help States Get There” to back up the claim.

Noah Weinrich, press secretary for Heritage Action for America, did provide evidence of Becerra’s support for Medicare for All. Weinrich sent clips of press interviews, as well as links to House of Representatives Medicare for All bills that Becerra co-sponsored over his years in Congress.

Where Becerra and Biden Stand on Health Care

Xavier Becerra was elected as a Democrat to represent a Los Angeles district in the U.S. House in 1993. He stayed in Congress 24 years. He resigned in 2017 to accept the position of attorney general of California, which was offered to him by then-Gov. Jerry Brown.

As attorney general, Becerra brought more than 100 legal challenges against the Trump administration for various health, environmental and immigration issues. One of his best-known lawsuits was in support of the Affordable Care Act. California took the lead with 18 other states in arguing against overturning the law before the U.S. Supreme Court. That decision is expected by the end of June.

Since Becerra was first elected to Congress, he has been an advocate for single-payer, or universal, health coverage. This type of coverage can take many forms, but by most definitions, it means the federal government would have some role in funding and administering health insurance for the public.

“I do, as I said before, join my colleagues who support the single-payer plan,” Becerra said during a congressional hearing in 1994. “For me, meaningful health care reform means that we must have universal coverage. We must have portability. We must have choice of provider.”

More recently, this approach took on the moniker of Medicare for All, in reference to Sen. Bernie Sanders’ (I-Vt.) health care bill with the same name. Sanders’ bill, first introduced in 2017, was designed to eliminate private health insurance after phasing in government-run health care, funded by raising taxes.

In 2017, Becerra said he would “absolutely” support Sanders’ bill. “I’ve been a supporter of Medicare for All for the 24 years that I was in Congress,” Becerra said during a Fox News interview. “This year, as attorney general, I would fight for that if we had an opportunity to put that forward in the state of California, because I think what we do is we give people that certainty that they’re going to be able to access a doctor or a hospital.”

And in 2019, Becerra told KHN’s Samantha Young he’s “been a single-payer advocate all my life.”

Reviewing Becerra’s statements, it’s clear he does support Medicare for All or similar plans.

But, if confirmed as head of the Department of Health and Human Services, Becerra will be a member of Biden’s Cabinet, and the president dictates policy priorities. During the Democratic presidential primaries, Biden was unwavering in his opposition to Medicare for All, instead throwing his support behind implementing a public option health plan and expanding the ACA. A public option is a government-run health insurance plan that would exist beside private health insurance coverage as a choice in the ACA marketplace.

It’s also important to note that while the ad says Becerra supports Medicare for All, thus “eliminating your employer-provided coverage,” that doesn’t mean your health insurance would be eliminated. Rather, it would be replaced by government-run health insurance.

“The notion that by having Medicare for All you’re going to lose insurance coverage is bizarre,” said Mark A. Peterson, a professor of public policy, political science and law at UCLA. “The whole point of Medicare for All is that everyone has health insurance.”

What an HHS Secretary Can Actually Do

Since Biden doesn’t support Medicare for All, would Becerra’s stance really matter?

No, said Joseph Antos, a health care scholar at the right-leaning American Enterprise Institute.

“He will not be able to, in this role, push the executive branch or the Congress in this direction in any perceptible way,” said Antos. “About all he could really do is use the waiver process and loosen up the various restrictions that the Trump administration tried to impose on states in the Medicaid programs. But that’s not the same thing as single-payer.”

Antos was referring to waivers that states can ask for in order to change how they administer the ACA exchanges or Medicaid.

Larry Levitt, executive vice president for health policy at KFF, said it certainly is possible Becerra could be called upon to consider state waiver proposals to implement single-payer systems. (KHN is an editorially independent program of KFF.)

“He would likely look more favorably on waivers like that than the Trump administration, which was quite clear they wouldn’t consider them. He might also view such waivers more positively than an HHS secretary that has not supported Medicare for All,” Levitt wrote in an email. “However, Becerra would not be making decisions on state waivers of such consequence unilaterally. He would certainly consult with the White House.”

Levitt added that it seems unlikely at this point any state could implement a single-payer system. Vermont dropped its efforts to do so after it became clear how much taxes would increase. California does have significant support for single-payer, but it seems unlikely to be realized in that state.

Plus, establishing a national single-payer system would require the support of both the president and Congress — and neither is ideologically there.

The White House maintains Becerra would be focused solely on Biden’s priorities and not Medicare for All.

Andrew Bates, a transition spokesperson for Biden, said in a statement that “Xavier Becerra will support and work to enact President Biden’s health care agenda — building on the ACA with a public option — as was made clear immediately after he was selected.”

But Heritage Action’s Weinrich took a different view: “The HHS secretary holds considerable policy-making and rule-making power, and Becerra’s long record indicates he would use that power to expand government’s role in health care in any way he can, with the ultimate goal of a single-payer option.”

Rhetoric Around Medicare for All, ‘Radical’ Californians

In the 2018 and 2020 elections, it was common for Republicans to paint Democrats as “socialists.” Sometimes this was illustrated through their support for Medicare for All or simply being from California.

The same rhetoric is being employed here, said Peterson.

“That Biden, by bringing in these officials from California, and the fact that Nancy Pelosi is speaker of the House, they’re arguing it’s just showing the infiltration of the radical socialist California state into the federal government,” he said. “But this is ridiculous, because there are not socialist politics, per se, happening in California, and often the California Democrats in Washington are moderate.”

Ultimately, though, the goal of an ad like this is to lay the groundwork for future campaigns.

“In a Senate that is split 50-50 and that 50th Democrat is a conservative Democrat, there is opportunity and leverage for Republicans to try and stand in the way,” said Peterson. “The less effective the Biden administration can be, the more effective campaigning will be for Republicans.”

Our Ruling

The ad states, “Becerra supports Bernie’s government takeover of your health care, eliminating your employer-provided coverage.”

Becerra’s past remarks illustrate he does support Medicare for All or other programs in which the government would run and fund health insurance.

We rate this claim True.

Sources:

California Healthline, “With Becerra as HHS Pick, California Plots More Progressive Health Care Agenda,” Dec. 10, 2020

CNBC, “Biden Suggests He Would Veto ‘Medicare for All’ Over Its Price Tag,” March 10, 2020

CNS News, “California AG Would ‘Absolutely’ Support Medicare for All Plan,” Oct. 23, 2017

Congress.gov, S.1804 — Medicare for All Act of 2017, accessed Feb. 24, 2021

C-SPAN, HHS Secretary Nominee Xavier Becerra Testifies Before Senate Finance Committee, Feb. 24, 2021

Email interview with Larry Levitt, executive vice president for health policy at KFF, Feb. 23, 2021

Email statement from Andrew Bates, transition spokesperson for Joe Biden, Feb. 23, 2021

JoeBiden.com, Health Care, accessed Feb. 24, 2021

KHN, “Xavier Becerra in His Own Words: ‘Health Care Is a Right,’” Dec. 7, 2020

KHN, “For California Attorney General Xavier Becerra, Resistance Is Personal,” Feb. 4, 2019

KHN, “What to Know as ACA Heads to Supreme Court — Again,” Nov. 9, 2020

KHN, “Politicians Hop Aboard ‘Medicare-for-All’ Train, Destination Unknown,” Oct. 22, 2018

The New York Times, “Biden Picks Xavier Becerra to Lead Health and Human Services,” Dec. 6, 2020

The New York Times, “Becerra Supports ‘Medicare for All,’ and Could Help States Get There,” Dec. 10, 2020

Office of Attorney General of California, Attorney General Xavier Becerra, accessed Feb. 24, 2021

Phone interview with Anthony Wright, executive director of Health Access, Feb. 23 and 24, 2021

Phone interview with Mark A. Peterson, professor of public policy, political science and law at UCLA, Feb. 24, 2021

Phone interview with Joseph Antos, Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute, Feb. 24, 2021

Politico, “A Trio of Conservative Groups Tries to Torpedo Two Top Biden Nominees,” Feb. 18, 2021

Twitter, @ddiamond tweet, Dec. 6, 2020

TomCotton.com, “Senator Cotton Launches Ads in Georgia and New Hampshire Targeting Xavier Becerra,” Feb. 22, 2021

U.S. House of Representatives History, Art & Archives, Becerra, Xavier, accessed Feb. 24, 2021

YouTube, “Becerra Can’t Be Trusted — New Hampshire,” accessed Feb. 24, 2021

YouTube, “Becerra — Not the Right Choice,” accessed Feb. 24, 2021

KHN’s ‘What the Health?’: Staffing Up at HHS


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More than a month into President Joe Biden’s term, nominees to fill some of the top posts at the Department of Health and Human Services are finally getting confirmation hearings in the Senate, starting with the nominee for secretary, California Attorney General Xavier Becerra. Barring something unexpected, it appears that Becerra, along with the surgeon general nominee, Vivek Murthy, and the nominee for assistant secretary for health, Rachel Levine, will all be confirmed, despite criticisms raised by some Republicans.

Meanwhile, the Supreme Court agreed to hear a case challenging the Trump administration’s rules for the federal family planning program that effectively evicted Planned Parenthood from participation. And the Biden administration asked the court to cancel oral arguments scheduled for late March about work requirements approved by the Trump administration for adult Medicaid recipients in some states.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Margot Sanger-Katz of The New York Times and Tami Luhby of CNN.

Among the takeaways from this week’s podcast:

  • Republican complaints that Becerra may not be qualified for the job of HHS secretary because he’s not a medical doctor were surprising to many. Since HHS was separated from the Department of Education, there have been 12 secretaries and only three have been physicians.
  • Democrats seem confident that Becerra weathered Republican criticism about his qualifications and his support for reproductive rights and that he will be confirmed.
  • The Republican arguments about Becerra’s positions on abortion may signal a shift away from the GOP’s emphasis on repealing the Affordable Care Act and back to traditional issues that galvanize conservative voters.
  • The people Biden has chosen to work on health policy by and large have strong backgrounds in management and many were in the Obama administration working on the implementation of the ACA. They are likely coming in with a mission to make changes and do so quickly.
  • The Biden administration is expected to seek to reverse the Title X rule at issue in a case just accepted by the Supreme Court before the justices hear the matter. But even if the administration can do that, conservatives may still ask the court to proceed.
  • The covid relief bill moving through Congress includes several measures that would make health insurance plans sold on the ACA marketplace more affordable, but those changes would last only two years. ACA advocates reason it would be hard, however, for future lawmakers to take those benefits away.

Also this week, Rovner interviews HuffPost’s Jonathan Cohn, whose new book, “The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage,” is out this week.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: The Washington Post’s “The Joy of Vax: The People Giving the Shots Are Seeing Hope, and It’s Contagious,” by Maura Judkis

Margot Sanger-Katz: Covid19-projections.com’s “Path to Normality: 2021 Outlook of COVID-19 in the US,” by Youyang Gu

Tami Luhby: The Guardian and KHN’s “’It Doesn’t Feel Worth It’: Covid Is Pushing New York’s EMTs to the Brink,” by Martha Pskowski

Alice Miranda Ollstein: KHN’s “Covid Vaccine Websites Violate Disability Laws, Create Inequity for the Blind,” by Lauren Weber and Hannah Recht


To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

New California Law Makes It Easier to Get Care for Mental Health and Substance Abuse

Karen Bailey’s 20-year-old daughter has struggled with depression and anxiety for years. Since 2017, she’s been in three intensive group therapy programs and, each time, the family’s insurer cut her coverage short, says Bailey.

“At a certain point, they would send us a form letter saying: We have determined that she is all better, it’s no longer necessary, so we are not covering it anymore,” says Bailey, 59, who lives in Los Angeles. “And believe me, she was not all better. In one case, she was worse.”

In making coverage decisions about mental health and addiction treatment, insurers frequently use “their own kind of black box criteria, not knowable to enrollees and not consistent with standards of care,” says Julie Snyder, director of government affairs at the Steinberg Institute, a Sacramento-based mental health policy and advocacy group.

A California law that took effect Jan. 1, SB-855, should make it much harder for state-regulated commercial health plans to do so. It requires them to use nationally recognized clinical standards established by nonprofit associations of clinical specialists to determine which mental health and addiction treatments they’ll cover — and for how long.

This means, for example, that insurers will find it more difficult to limit a client to only a week of residential addiction treatment when 30 days is the clinical standard, or to treat only the most immediate physical symptoms of anorexia and not the underlying psychological drivers, says Snyder.

“It’s a very strong law, and it has the potential to really be a game changer,” says Karen Fessel, executive director and founder of the Mental Health and Autism Insurance Project, which supported the legislation.

There could hardly be a better time to beef up mental health coverage, as we approach the anniversary of a pandemic that’s been tied to an increase in depression, anxiety, substance use and suicidal thoughts.

Crucially, the new law, which updates and replaces California’s previous mental health parity statute, dramatically expands the number of conditions insurers must cover.

The state law in force until this year required coverage for only nine “severe” mental illnesses, including schizophrenia, bipolar disorder and major depressive disorder, and for “serious emotional disturbances” in children. SB-855 mandates coverage for conditions ranging from mild to severe.

Federal law already required broader coverage, but in vague terms that health plans have frequently circumvented with their restrictive definitions of what’s medically necessary, patient advocates say.

By expanding the range of conditions health plans are obliged to cover and holding them to stiffer standards on the type and amount of care they must pay for, the new law closes “loopholes you could drive a Mack truck through,” says state Sen. Scott Wiener (D-San Francisco), who authored the legislation.

For years, many health plans declined to cover mental health treatment until a patient was in crisis, Wiener says. The new law “makes sure people will be able to get care early while they still have a home, a family, a job.”

Another key aspect of the law is that it requires health plans to cover out-of-network providers at in-network costs if an enrollee is unable to find timely treatment a reasonable distance — generally, 15 miles or 30 minutes — from their home.

“That is something we run into all the time,” Bailey says. The family has spent $100,000 over the years on out-of-network mental health providers for their two kids, she says.

Opponents of the new law, including the California Association of Health Plans and the California Chamber of Commerce, have argued it will significantly increase health care costs, subject insurers to continuous litigation and — through its stringent definition of medical necessity — impede the ability of providers to decide what’s best for their patients.

Proponents say the medical necessity guidelines spelled out by the specialists’ associations allow providers wide discretion to decide the best treatment for each patient. An analysis conducted for state legislators by the California Health Benefits Review Program estimated that in the first year of the law’s implementation, premiums and enrollee cost sharing would rise a mere 0.002%.

The new law won’t help everybody: It applies only to state-regulated commercial health plans covering some 13 million Californians — about one-third of the state’s population. It excludes Medi-Cal, which insures another third of state residents, as well as federally regulated commercial plans, which cover nearly 6 million.

Because only a minuscule share of patients fight their health plans over denials of care, mental health advocates hope that diligent enforcement by the Department of Managed Health Care, which regulates plans covering the vast majority of commercially insured Californians, will discourage insurers from denying necessary care in the first place.

Rachel Arrezola, a spokesperson for the agency, which opposed provisions of the legislation last year, said it fully intends to ensure compliance and has begun to do so.

But if your health plan still denies you the care you believe you need, fight it, patient advocates and health care attorneys say.

“You need to be vigilant, and you need to advocate for yourself and you need to appeal denials, and you need to do it in writing,” says Cari Schwartz, a Los Angeles lawyer who represents patients.

If you appeal a decision over the phone, take detailed notes, write down the time and day of the conversation and get the name of the person you spoke with, Schwartz says. Build a file of all communications and other information related to your case, she says.

And be persistent. “I think insurance companies bank on individuals giving up the fight,” Schwartz says.

If you need help, contact the Health Consumer Alliance (1-888-804-3536 or www.healthconsumer.org), which offers free advice and legal services.

If your mental health provider requested a certain type of treatment in 2020 that was denied by your health plan, ask the provider to resubmit it this year, because the changed legal landscape might work in your favor, says the Steinberg Institute’s Snyder.

With most commercial health plans, you have 180 days from the date you receive a denial to file an appeal. You must first appeal to your insurer. If it fails to respond after 30 days, or upholds its decision, you can take it to the agency that regulates your policy.

In most cases, that will be the Department of Managed Health Care (www.dmhc.ca.gov or 1-888-466-2219), which has a help center and allows you to file a complaint online. If your regulator is the California Department of Insurance, you can call its helpline at 1-800-927-4357 for advice, and file a complaint on its website (www.insurance.ca.gov).

Most Californians enrolled in commercial health plans are entitled to a review by independent medical experts if they are denied care because the insurer deems it unnecessary, or it’s experimental — or the insurer won’t reimburse them for emergency care.

The reviews, which can be requested through state regulators, are well worth the effort: About 60% of Independent Medical Reviews filed through the Department of Managed Health Care result in the patient getting the treatment that was initially denied, Arrezola says.

Be sure to open an archive on the managed care department’s website (https://wpso.dmhc.ca.gov/imr/), in which you can search past decisions for cases similar to yours. They can help you frame your arguments.

Ultimately, the utility of the new law depends on the will of regulators to enforce it and of consumers to avail themselves of it.

“With any luck, it means people won’t have to take out a $50,000 mortgage on their house to pay for their children’s opioid treatment,” says Snyder. “Unfortunately, that is all too common.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

New Single-Payer Bill Intensifies Newsom’s Political Peril

SACRAMENTO — A group of Democratic state lawmakers introduced legislation Friday to create a single-payer health care system to cover all Californians, immediately defining the biggest health policy debate of the year and putting enormous political pressure on Gov. Gavin Newsom.

The Democratic governor faces the increasingly likely prospect of a Republican-driven recall election later this year. The single-payer bill adds to his political peril from the left if he doesn’t express support, and from the right if he does.

State Assembly member Ash Kalra, author of AB 1400, said the coronavirus pandemic has exposed a broken health care system that has left millions without reliable and affordable health coverage. His bill would address those gaps in the system, he said, effectively eliminating private health insurance by shifting responsibility for administering and financing health coverage to the state government.

The new system, called CalCare, would expand coverage to nearly 3 million uninsured Californians and provide rich benefits, including dental care, generous prescription drug coverage and long-term care, according to the bill language, which was obtained by California Healthline before the measure was introduced.

The move, however, faces monumental financial and legal barriers, and would likely require new taxes. While the measure does not assign a price tag to the overhaul, a separate single-payer bill that failed in 2017 would have cost an estimated $400 billion each year.

“People are dying and suffering. They’re going bankrupt and starting GoFundMe pages just in order to survive in the wealthiest state in the wealthiest nation on earth,” said Kalra, a liberal Democrat from San Jose. “We now have a Democratic White House, and forward-thinking Democrats like Xavier Becerra going to Washington who can be incredibly helpful.”

Nearly 20 other Assembly Democrats signed on to the legislation, which is among the first state-based single-payer proposals to be introduced under the Biden administration. Massachusetts lawmakers this year introduced similar legislation, and other states are considering it.

Sponsored by the California Nurses Association, a powerful union and political force in Sacramento, the single-payer bill is expected to ignite a fierce health care fight among liberal and moderate Democratic lawmakers, and draw intense opposition from deep-pocketed health industry groups, including insurers, doctors and hospitals.

“Eliminating private health coverage in California will always be unworkable for a number of reasons. It would cost $400 billion a year, which we can’t afford,” said Ned Wigglesworth, spokesperson for Californians Against the Costly Disruption of our Healthcare, which includes major private health insurers and the state doctor and hospital lobbying groups, which also opposed the 2017 single-payer bill.

“Shifting to an entirely government-based health system would be especially harmful and disruptive now, as California’s health care community is focused on meeting the acute health care needs of our state during a pandemic,” Wigglesworth added.

Assembly member Jim Wood (D-Santa Rosa), who as chair of the Assembly Health Committee controls which health policy legislation gets a hearing, cast doubt on the feasibility of single-payer late last year, saying the state should instead build on the Affordable Care Act. Supporters fear his potential opposition could block the bill.

California’s proposal, if approved, could test the Biden administration’s willingness to grant states freedom to enact sweeping health care reforms such as a single-payer system. Becerra, California’s attorney general, has expressed unwavering support for single-payer and would be positioned to weigh in on the plan should he be confirmed as President Joe Biden’s Health and Human Services secretary. Becerra’s Senate confirmation hearings start Tuesday.

“The president himself doesn’t necessarily have to support single-payer on a national level to allow states to move forward,” Kalra said.

The introduction of a single-payer proposal this year forces Newsom into a delicate position. The first-term governor, who said he supported the creation of a state-based single-payer health care system when he ran for governor in 2018, has since distanced himself, expressing doubt that California can embark on such a massive transformation on its own.

Newsom’s office did not respond to a request for comment.

Newsom, once seen as a rising Democratic Party star, faces a burgeoning recall effort driven by state and national Republicans. The embattled governor is under fire for a clumsy and confusing vaccine rollout; backlogs and fraud at the state’s unemployment agency; and violating his own public health rules when he dined maskless last year at the ritzy French Laundry restaurant. Democrats have also criticized the governor for his pandemic response, including his inability to reach a legislative deal to open schools to in-person instruction.

With the March 17 deadline looming for the recall to qualify for the ballot, Newsom will undoubtedly be asked to weigh in on the single-payer proposal.

“It’s not a factor in this calculation,” said Stephanie Roberson, lead lobbyist with the California Nurses Association, which campaigned for Newsom during his gubernatorial run. “Our concern is people are dying and losing their health care. We’re sorry if this parallels some untimely political event for the governor.”

Last year, Newsom convened a commission to study the possibility of a single-payer system and other ways to cover more Californians. But the pandemic stalled its progress and the commission hasn’t met since August.

The exorbitant cost of developing a new system is a major hurdle. In 2017, the last time California lawmakers floated a single-payer proposal, a state legislative analysis pegged the projected cost at $400 billion a year. Assembly Speaker Anthony Rendon shelved the proposal, calling it “woefully incomplete,” in part because it was unveiled without a financing mechanism.

Kalra, who has not identified a way to pay for the massive transformation and said he’s unsure whether it would require higher taxes, will undoubtedly face similar skepticism over how to fund it.

His bill calls for CalCare to cover comprehensive health services far beyond what’s required under the Affordable Care Act, including traditional medical services, dental care, prescription drug coverage, long-term care, and mental health and substance use treatment.

It would also end all out-of-pocket patient costs — including premiums, copays and deductibles — and ban health care providers participating in CalCare from operating in the private marketplace. CalCare’s governing board would determine health care prices and set rules for providers.

While single-payer would require a significant initial investment, Kalra argued, the state might be able to reroute federal dollars for Medicare, Medicaid and other programs into CalCare. The system would also eventually cost less, he said, because it would simplify health care financing, end for-profit care and cut out private middlemen.

“Look, we’re already paying more than $400 billion a year for our current system,” Kalra said. “We currently have the most expensive health care system in the world, and our outcomes certainly don’t get us what we pay for.”

The latest estimates, based on federal data, show health care spending in California is about $450 billion a year, according to Gerald Kominski, a professor of health policy and management at the UCLA Fielding School of Public Health.

But switching to single-payer isn’t as simple as transferring those expenses to a new system, he said. Somehow, the money that employers and employees contribute to private health insurance plans needs to be funneled into a unified system.

“The mechanism you use to do that is almost certainly some form of taxation,” Kominski said. “It’s literally impossible for a single-payer system to move forward without capturing those current expenditures. They’re too substantial.”

While the proposal would not ban all private health insurance, it would allow only for coverage that supplements CalCare. The aim is to enroll all Californians, eliminating the need for private health coverage, said Carmen Comsti, a regulatory policy specialist with the California Nurses Association who is also on the state’s single-payer commission.

But that could present enormous challenges. Nearly 6 million Californians are enrolled in private health coverage regulated by the federal government. Enrolling them in CalCare could require a change in federal regulatory law, and would likely require changes to the state constitution — which, in addition to passing tax increases, could force single-payer backers to obtain voter approval.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Why Biden Has a Chance to Cut Deals With Red State Holdouts on Medicaid

President Joe Biden has an unexpected opening to cut deals with red states to expand Medicaid, raising the prospect that the new administration could extend health protections to millions of uninsured Americans and reach a goal that has eluded Democrats for a decade.

The opportunity emerges as the covid-19 pandemic saps state budgets and strains safety nets. That may help break the Medicaid deadlock in some of the 12 states that have rejected federal funding made available by the Affordable Care Act, health officials, patient advocates and political observers say.

Any breakthrough will require a delicate political balancing act. New Medicaid compromises could leave some states with safety-net programs that, while covering more people, don’t insure as many as Democrats would like. Any expansion deals would also need to allow Republican state officials to tell their constituents they didn’t simply accept the 2010 health law, often called Obamacare.

“Getting all the remaining states to embrace the Medicaid expansion is not going to happen overnight,” said Matt Salo, executive director of the nonpartisan National Association of Medicaid Directors. “But there are significant opportunities for the Biden administration to meet many of them halfway.”

Key to these potential compromises will likely be federal signoff on conservative versions of Medicaid expansion, such as limits on who qualifies for the program or more federal funding, which congressional Democrats have proposed in the latest covid relief bill.

But any deals would bring the country closer to fulfilling the promise of the 2010 law, a pillar of Biden’s agenda, and begin to reverse Trump administration efforts to weaken public programs, which swelled the ranks of the uninsured.

“A new administration with a focus on coverage can make a difference in how these states proceed,” said Cindy Mann, who oversaw Medicaid in the Obama administration and now consults extensively with states at the law firm Manatt, Phelps & Phillips.

Medicaid, the half-century-old health insurance program for the poor and people with disabilities, and the related Children’s Health Insurance Program cover more than 70 million Americans, including nearly half the nation’s children.

Enrollment surged following enactment of the health law, which provides hundreds of billions of dollars to states to expand eligibility to low-income, working-age adults.

However, enlarging the government safety net has long been anathema to most Republicans, many of whom fear that federal programs will inevitably impose higher costs on states.

And although the GOP’s decadelong campaign to “repeal and replace” it has largely collapsed, hostility to the health law remains high among Republican voters.

That makes it perilous for politicians to embrace any part of it, said Republican pollster Bill McInturff, a partner at Public Opinion Strategies. “A lot of Republican state legislators are sitting in core red districts, looking over their shoulders at a primary challenge,” he said.

Many conservatives have called instead for federal Medicaid block grants that cap how much federal money goes to states in exchange for giving states more leeway to decide whom they cover and what benefits their programs offer.

Many Democrats and patient advocates fear block grants will restrict access to care. But just before leaving office, the Trump administration gave Tennessee permission to experiment with such an approach.

“It’s a frustrating place to be,” said Tom Banning, the longtime head of the Texas Academy of Family Physicians, which has labored to persuade the state’s Republican leaders to drop their opposition to expanding Medicaid. “Despite covid and despite all the attention on health and disparities, we see almost no movement on this issue.”

Some 1.5 million low-income Texans are shut out of Medicaid because the state has resisted expansion, according to estimates by KFF. (KHN is an editorially independent program of KFF.)

An additional 800,000 people are locked out in Florida, which has also blocked expansion.

Two million more are caught in the 10 remaining holdouts: Alabama, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Wisconsin and Wyoming.

Advocates of Medicaid expansion, which is broadly popular with voters, believe they may be able to break through in a handful of these states that allow ballot initiatives, including Mississippi and South Dakota.

Since 2018, voters in Idaho, Nebraska, Utah, Oklahoma and Missouri have backed initiatives to expand Medicaid eligibility, effectively circumventing Republican political leaders.

“The work that we’ve done around the country shows that no matter where people live — red state or blue state — there is overwhelming support for expanding access to health care,” said Kelly Hall, policy director of the Fairness Project, a nonprofit advocacy group that has helped organize the Medicaid measures.

But most of the holdout states, including Texas, don’t allow citizens to put initiatives on the ballot without legislative approval.

And although Florida has an initiative process, mounting a ballot campaign there is challenging, as political advertising is expensive. Unlike in many states, Florida’s leading hospital association hasn’t backed expansion.

Another route for expansion: compromises that could win over skeptical Republican state leaders and still get the green light from the Biden administration.

The Obama administration approved conservative Medicaid expansion in Arkansas, which funneled enrollees into the commercial insurance market, and in Indiana, which forced enrollees to pay more for their medical care.

Money is a major focus of current talks in several states, according to health officials, advocates and others involved in efforts across the country.

The health law at first fully funded Medicaid expansion with federal money, but after the first three years, states had to begin paying part of the tab. Now, states must come up with 10% of the cost of expansion.

Even that small share is a challenge for states, many of which are reeling from the economic downturn caused by the pandemic, said David Becker, a health economist at the University of Alabama-Birmingham who has assisted efforts to expand Medicaid in that state.

“The question is: Where do we get the money?” Becker said, noting that some Republicans may be open to expanding Medicaid if the federal government pays the full cost of the expansion, at least for a year or two.

Other efforts to find ways to offset state costs are underway in Kansas and North Carolina, which have Democratic governors whose expansion plans have been blocked by Republican state legislators. Kansas Gov. Laura Kelly this month proposed using money from the sale and taxation of medical marijuana.

Some Democrats in Congress are pushing to revise the health law to provide full federal funding to states that expand Medicaid now. Separately, in the stimulus bill unveiled last week, House Democrats proposed an additional boost in total Medicaid aid to states that expand.

Other Republicans have signaled interest in partly expanding Medicaid, opening the program to people making up to 100% of the federal poverty level, or about $12,900, rather than 138%, or $17,800, as the law stipulated.

The Obama administration rejected this approach, but the idea has gained traction in several states, including Georgia.

It’s unclear what kind of compromises the new administration may consider, as Biden has yet to even nominate someone to oversee the Medicaid program.

Some Democrats say it’s time to give up the search for middle ground with Republicans on Medicaid.

A better strategy, they say, is a new government insurance plan, or public option, for people in non-expansion states, a strategy Biden endorsed on the campaign trail.

“Democrats can no longer countenance millions of Americans living in poverty without insurance,” said Chris Jennings, a Democratic health care strategist who worked in the White House under Presidents Bill Clinton and Barack Obama and served on Biden’s transition team.

“This is why the Biden public option or other new ways to secure affordable, meaningful care should become the order of the day for people living in states like Florida and Texas.”

Los mercados de seguros de salud reabrieron. Esto es lo que necesitas saber

Para quienes han estado sin seguro médico durante la pandemia, el alivio ya está a la vista.

En enero, el presidente Joe Biden firmó una orden ejecutiva para abrir el mercado federal de seguros de salud durante tres meses, desde el lunes 15, para que las personas sin seguro puedan comprar un plan y o cambiar de cobertura si ya tienen uno.

Defensores de los consumidores aplaudieron la iniciativa. Desde 2016, el número de estadounidenses sin seguro médico ha ido en aumento, llegando a 30 millones en 2019. La crisis económica causada por el coronavirus ha empeorado lo que ya era una mala situación, privando a millones de personas de sus planes médicos.

La medida contrasta con el enfoque de la administración Trump. Mientras covid-19 se afianzaba la primavera pasada y la economía implosionaba, expertos en salud le rogaban a la administración Trump que abriera el mercado federal para que las personas pudieran comprar un seguro durante la peor emergencia de salud pública en un siglo.

La administración se negó, señalando que quienes se encontraban, repentinamente, sin cobertura porque perdieron sus empleos, podían inscribirse en el mercado bajo las reglas ordinarias. También citaron la preocupación de que los enfermos que se habían resistido a comprar un seguro antes lo hicieran ahora y aumentaran las primas.

El gobierno de Biden se ha comprometido a gastar $50 millones en actividades de divulgación y educación para dar a conocer el nuevo periodo de inscripción.

Esto es fundamental, según expertos. Aunque el número de personas que se inscriben en los planes de la Ley de Cuidado de Salud a Bajo Precio (ACA) se ha mantenido a buen nivel, el número de nuevos consumidores que se inscriben en el mercado federal ha disminuido cada año desde 2016, según la Kaiser Family Foundation, coincidiendo con los recortes de financiación para mercadeo y divulgación.

“Hay muchas personas sin seguro que, incluso antes de covid, eran elegibles para los altos subsidios del mercado o para Medicaid y no lo sabían”, dijo Sabrina Corlette, profesora de investigación en el Centro de Reformas de Seguros de Salud de la Universidad de Georgetown.

Una campaña de marketing puede llegar a una enorme cantidad de personas y, con suerte, atraerlas, independientemente de que, a causa de covid, hayan perdido su seguro o no, añadió Corlette.

A continuación, las respuestas a las preguntas sobre la nueva opción para inscribirse.

¿Cuándo pueden inscribirse los consumidores y en qué estados?

La ventana de inscripción estará abierta durante tres meses, del 15 de febrero al 15 de mayo. Los residentes sin seguro de cualquiera de los 36 estados que utilizan la plataforma federal cuidadodesalud.gov pueden buscar planes durante ese tiempo e inscribirse.

Los estados que operan sus propios mercados, y el Distrito de Columbia, están estableciendo períodos de inscripción especiales similares al nuevo federal, aunque pueden tener plazos o reglas de elegibilidad algo diferentes.

En Massachusetts, por ejemplo, la ventana de inscripción permanece abierta hasta el 23 de mayo, mientras que en Connecticut se cierra el 15 de marzo. Por su parte, Colorado ha reabierto la inscripción en su mercado para los residentes que carecen de seguro, pero cualquiera que ya esté inscrito en uno de los planes del mercado estatal no podrá cambiar de plan hasta el período regular de inscripción abierta en otoño.

¿Pueden inscribirse durante el nuevo período de inscripción las personas que perdieron su empleo y su seguro médico hace muchos meses?

Sí, la ventana de inscripción está abierta a cualquier persona que no tenga seguro y que normalmente sería elegible para comprar cobertura (las personas que están cumpliendo penas de prisión o cárcel y los que están en el país sin papeles no pueden inscribirse).

Las personas con ingresos de hasta el 400% del nivel federal de pobreza (unos $51,500 para una persona o $106,000 para una familia de cuatro miembros) pueden calificar para créditos fiscales para pagar las primas que pueden reducir sustancialmente sus costos, incluso hasta $0.

Normalmente, se puede comprar un plan del mercado sólo durante el período anual de inscripción abierta en otoño o si se vive un acontecimiento vital, como un nacimiento o una mudanza, o la pérdida del seguro por despido, en lo que se denomina período especial de inscripción.

Pero, por lo general, las personas deben inscribirse en el mercado dentro de los 60 días siguientes al acontecimiento.

Con el nuevo período de inscripción, el tiempo que una persona ha estado sin seguro no es relevante, ni tampoco tiene que proporcionar documentación de que ha perdido la cobertura basada en el trabajo.

“El mensaje es muy sencillo: vengan y apliquen”, explicó Sarah Lueck, analista política del Center on Budget and Policy Priorities.

¿Qué pasa con las personas que ya están inscritas en un plan del mercado? ¿Pueden cambiar su cobertura durante este nuevo período?

Sí, siempre que tu cobertura sea a través del mercado federal. Si, por ejemplo, alguien está inscrito en un plan de oro, pero quiere cambiar a un plan de bronce más barato con un deducible más alto, puede hacerlo. Sin embargo, como se ha mencionado anteriormente, algunos mercados estatales no ofrecen esta opción.

Muchas personas han perdido ingresos importantes durante la pandemia. ¿Cómo pueden decidir si un plan del mercado con subsidios es mejor para ellos que Medicaid?

No tienen que decidirlo. Durante el proceso de solicitud, el mercado les pide información sobre sus ingresos. Si los ingresos anuales están por debajo del umbral de Medicaid (para muchos adultos en la mayoría de los estados, el 138% del nivel federal de pobreza, o alrededor de $18,000 para un individuo), se les dirigirá a ese programa para obtener cobertura.

Si las personas son elegibles para Medicaid, no pueden obtener cobertura subvencionada.

Las personas pueden inscribirse en Medicaid en cualquier momento del año; no es necesario esperar a un período de inscripción anual o especial.

Las personas ya inscritas en un plan del mercado cuyos ingresos cambien deben volver al mercado y actualizar su información de ingresos lo antes posible. Tal vez puedan optar a mayores subsidios para las primas o, si los ingresos han disminuido considerablemente, a Medicaid.

Del mismo modo, si los ingresos han aumentado y no se ajustan a las estimaciones del mercado, se podría tener que hacer frente a los pagos excesivos de subsidios cuando hagan la declaración de impuestos.

¿Qué pasa con las personas que se inscribieron en la ley federal COBRA para continuar con la cobertura de su empleador después de perder su trabajo? ¿Pueden renunciar a ella e inscribirse en un plan del mercado?

Expertos en salud afirman que pueden dar ese paso quienes viven en los estados del mercado federal. En virtud de la ley COBRA, se puede exigir a las personas que paguen el importe total de la prima más una tasa administrativa del 2%. La cobertura del mercado es casi con toda seguridad más barata.

Normalmente, si las personas tienen cobertura de COBRA y la abandonan a mitad de año, no pueden inscribirse en un plan del mercado hasta el período anual de inscripción abierta de otoño. Pero este nuevo período otorgará esa opción.

Related Topics

Insurance Noticias En Español The Health Law Uninsured

The ACA Marketplace Is Open Again for Insurance Sign-Ups. Here’s What You Need to Know.

For people who’ve been without health insurance during the pandemic, relief is in sight.

In January, President Joe Biden signed an executive order to open up the federal health insurance marketplace for three months as of Monday so uninsured people can buy a plan and those who want to change their marketplace coverage can do so.

Consumer advocates applauded the directive. Since 2016, the number of Americans without health insurance has been on the rise, reaching 30 million in 2019. The economic upheaval caused by the novel coronavirus has made a bad situation worse, throwing millions off their insurance plans.

The move is in stark contrast to the Trump administration’s approach. As covid-19 took hold last spring and the economy imploded, health experts pleaded with the Trump administration to open up the federal marketplace so people could buy insurance to protect themselves during the worst public health emergency in a century. The administration declined, noting that people who suddenly found themselves without coverage because they lost their jobs were able to sign up on the marketplace under ordinary rules. They also cited concerns that sick people who had resisted buying insurance before would buy coverage and drive up premiums.

The Biden administration is promising to spend $50 million on outreach and education to get the word out about the new special enrollment period. That’s critical, experts said. Although the number of people signing up for Affordable Care Act plans has generally remained robust, the number of new consumers enrolling in the federal marketplace has dropped every year since 2016, according to KFF, corresponding to funding cuts in marketing and outreach. (KHN is an editorially independent program of KFF.)

“There are a lot of uninsured people who even before covid were eligible for either hefty marketplace subsidies or for Medicaid and not aware of it,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. A marketing blitz can reach a broad swath of people and hopefully draw them in, regardless of whether they’re uninsured because of covid or not, she said.

Here are answers to questions about the new enrollment option.

Q: When can consumers sign up, and in which states?

The sign-up window will be open for three months, from Monday through May 15. Uninsured residents of any of the 36 states that use the federal healthcare.gov platform can look for plans during that time and enroll.

Most of the states and the District of Columbia that operate their own marketplaces are establishing special enrollment periods similar to the new federal one, though they may have somewhat different time frames or eligibility rules. In Massachusetts, for example, the sign-up window remains open until May 23, while in Connecticut, it closes March 15. Meanwhile, Colorado has reopened enrollment in its marketplace for residents who lack insurance, but anyone already enrolled in one of the state’s marketplace plans won’t be allowed to switch to a different plan until the regular open enrollment period in the fall.

At this point, only Idaho has not announced plans to open their marketplaces, said Corlette. It may still do so, however.

Q: Can people who lost their jobs and health insurance many months ago sign up during the new enrollment period?

Yes. The enrollment window is open to anyone who is uninsured and would normally be eligible to buy coverage on the exchange (people who are serving prison or jail terms and those who are in the country without legal permission aren’t allowed to enroll).

People with incomes up to 400% of the federal poverty level (about $51,500 for one person or $106,000 for a family of four) are eligible for premium tax credits that may substantially reduce their costs.

Typically, people can buy a marketplace plan only during the annual open enrollment period in the fall or if a major life event gives them another opportunity to sign up, called a special enrollment period. Losing job-based health coverage is one event that creates a special sign-up opportunity; so is getting married or having a baby. But usually people must sign up with the marketplace within 60 days of the event.

With the new special enrollment period, how long someone has been uninsured isn’t relevant, nor do people have to provide documentation that they’ve lost job-based coverage.

“The message is quite simple: Come and apply,” said Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities.

Q: What about people who are already enrolled in a marketplace plan? Can they switch their coverage during this new enrollment period?

Yes, as long as their coverage is through the federal marketplace. If, for example, someone is enrolled in a gold plan now but wants to switch to a cheaper bronze plan with a higher deductible, that’s allowed. As mentioned above, however, some state-operated marketplaces may not make that option available.

Q: Many people have lost significant income during the pandemic. How do they decide whether a marketplace plan with premium subsidies is a better buy for them than Medicaid?

They don’t have to decide. During the application process, the marketplace asks people for income information. If their annual income is below the Medicaid threshold (for many adults in most states, 138% of the federal poverty level, or about $18,000 for an individual), they will be directed to that program for coverage. If people are eligible for Medicaid, they can’t get subsidized coverage on the exchange.

People can sign up for Medicaid anytime; there’s no need to wait for an annual or special enrollment period.

Those already enrolled in a marketplace plan whose income changes should go back into the marketplace and update their income information as soon as possible. They may be eligible for larger premium subsidies for their marketplace plan or, if their income has dropped significantly, for Medicaid. (Likewise, if their income has increased and they don’t adjust their marketplace income estimates, they could be on the hook for overpayments of their subsidies when they file their taxes.)

Q: What about people who signed up under the federal COBRA law to continue their employer coverage after losing their job? Can they drop it and sign up for a marketplace plan?

Yes people in federal marketplace states can take that step, health experts say. Under COBRA, people can be required to pay the full amount of the premium plus a 2% administrative fee. Marketplace coverage is almost certainly cheaper.

Normally, if people have COBRA coverage and they drop it midyear, they can’t sign up for a marketplace plan until the annual fall open enrollment period. But this special enrollment period will give people that option.

Travel Insurance During Coronavirus Pandemic: What To Know

When the pandemic struck, many travel insurance policies failed to cover Covid-19-related trip interruptions and cancellations, often because they excluded pandemics. But in the intervening months, the travel insurance industry has introduced a spate of new policies covering the disease just as many foreign destinations begin to require them.

“We’ve seen progress in that many plans will now treat Covid like any other unexpected sickness or illness,” said Stan Sandberg, a co-founder of the comparison website Travelinsurance.com. “If you have a trip and travel insurance and came down with Covid-19, which made it impossible to travel, that would fall under cancellation coverage as an unexpected illness that prevents you from traveling.”

Likewise, policies now including Covid-19 would cover holders in the event that a doctor diagnosed them with the virus while traveling under the trip interruption benefit.

Not all travel insurance excluded pandemics when the coronavirus began to spread early this year; Berkshire Hathaway Travel Protection was one exception. But the broader change partially arises from consumer demand, a better understanding of the virus — including mortality rates and hospital costs — and the industry’s eagerness for travel to resume.

“People who are traveling are more conscious of their risks and thinking about protecting themselves and their investment,” said Jeremy Murchland, the president of the travel insurer Seven Corners. The company launched policies that included Covid-19 coverage in June; they now account for more than 80 percent of sales.

But, like all insurance, the devil is in the details when it comes to understanding travel insurance, including what’s covered, destinations where it’s required, and the inevitable caveats, as follows.

How travel insurance covers Covid-19

The new Covid-inclusive insurance generally covers travelers from the day after purchase until their return home. During that period, if you become sick and a doctor determines you cannot travel (because of the virus or another illness), trip cancellation and trip interruption benefits would kick in.

These benefits vary by policy, but a search to insure a $2,000 weeklong trip to Costa Rica in December on Travelinsurance.com turned up a $69.75 Generali Global Assistance Standard policy with Covid-19 benefits that would be triggered if you, your host at your destination, a travel companion or a family member tested positive for the virus.

If this happened before your departure, the policy would cover your prepaid travel expenses. If you or your travel companion contracted Covid-19 during the trip and were diagnosed by a physician, it would reimburse prepaid arrangements, such as lodgings, and cover additional airfare to return home — once a doctor deems it safe to travel — up to $2,500. Should you be required to quarantine and can’t travel, travel delay coverage for lodging, meals and local transportation would pay up to $1,000. The policy also covers medical expenses for up to one year, even after you return home, up to $50,000 — though the policy also states that a holder would have to exhaust their own health insurance benefits before seeking coverage under the travel insurance plan.

Travelers should read these policies carefully to understand the benefits (for example, some rules vary by your state of residence), but brokers like TravelInsurance.com, InsureMyTrip and Squaremouth are making them easier to find through filters, F.A.Q.s and flags.

The new more comprehensive policies don’t necessarily cost more. On a Squaremouth search for insurance for two 40-year-olds on a two-week trip costing $5,000, the site turned up a variety of policies with or without coronavirus exclusions from $130 to $300, with no apparent premium for Covid-19 coverage.

Not every Covid-19-related expense is covered by many of these policies, including tests for the virus that many destinations require before arrival (those may be covered by private insurance).

Many policies include medical evacuation to a nearby facility, but won’t necessarily transport you home. For those concerned about treatment abroad, Medjet, a medical evacuation specialist, now offers Covid-19-related evacuations in the 48 contiguous United States, Canada, Mexico and the Caribbean that will transport you to the hospital of your choice in your home country (trip coverage starts at $99; annual memberships start at $189).

“Covid-19 requires special transport pods to protect the crew and others, which adds logistical issues,” said John Gobbels, the vice president and chief operating officer for Medjet.

In addition to the Medjet plan, travelers would need separate travel insurance with medical benefits to cover treatment costs and trip interruption.

Destination insurance requirements

Travelers aren’t the only ones worried about health. A growing list of countries are mandating medical coverage for Covid-19 as a prerequisite for visiting, often along with other measures like pre-trip virus testing and health screenings for symptoms on arrival.

Many Caribbean islands are among those requiring travel medical insurance, including Turks and Caicos and the Bahamas. St. Maarten requires health insurance coverage and strongly recommends additional travel insurance covering Covid-19.

Farther-flung countries also require policies that cover Covid-19, including French Polynesia and the Maldives.

Some destinations specify the required plan as a way to ensure travelers have the correct coverage and to expedite treatment. Aruba requires visitors to buy its Aruba Visitors Insurance, regardless of any other plans you may have.

“Insurance through a destination typically only covers Covid and infection while you’re there,” said Kasara Barto, a spokeswoman for Squaremouth.com. “If you catch Covid before, they don’t offer cancellation coverage. If you break a leg, the policy may only cover Covid medication. It varies by country.”

Costa Rica also requires insurance that includes an unusual benefit stipulating a policy cover up to $2,000 in expenses for a potential Covid-19 quarantine while in the country.

In response to the new requirement, which Costa Rica announced in October, insurers, including Trawick International, have begun introducing policies that meet the standard.

“It was a pretty quick and nimble reaction,” Mr. Sandberg of TravelInsurance.com said.

Normally, travel insurance varies by factors including the age of the traveler, destination, trip length and cost (most range from 4 to 10 percent of the trip cost). But some destinations are providing it at a flat fee, with most policies spelling out coverage limits and terms for emergency medical services, evacuation and costs associated with quarantines.

Jamaica, which will require insurance, but has not said when the new rule will go into effect, plans to charge $40 for each traveler. The Bahamas will include the insurance in the cost of its Travel Health Visa, an application that requires negative Covid-19 test results, which runs $40 to $60 depending on length of stay (free for children 10 and younger). The Turks and Caicos is offering a policy for $9.80 a day, and Costa Rica’s policies, if purchased locally, cost roughly $10 a day.

Expect this list of destinations to grow. In January, the Spanish region of Andalusia plans to require travel medical insurance and is working on finding a provider to make it easy for travelers to buy it.

Gaps in travel insurance

Policies that cover Covid-19 as a medical event that may cause trip cancellation or disruption, or those that provide coverage for medical treatment and evacuation still don’t necessarily cover travelers who have a change of heart when they learn they will have to quarantine upon arrival, even if they don’t have the virus. Nor are policies necessarily tied to conditions on the ground, like a spike in infections, State Department travel warnings, a government travel ban or the cessation of flights to and from a destination.

For those events, there’s Cancel For Any Reason, or CFAR, an upgrade to plans that generally only returns 50 to 75 percent of your nonrefundable trip costs.

“Prior to the pandemic, we wouldn’t necessarily recommend CFAR because most of travelers’ concerns were covered by standard plans,” Ms. Barto of Squaremouth.com said. “It’s about 40 percent more expensive and we didn’t want travelers to pay for additional coverage.” Now, she added, there’s been a surge in interest in the upgrade, including in 22 percent of policies sold at the site since mid-March.

Industry experts predict some of these outstanding issues may work their way into policies of the future as they adapt to enduring realities, much as they did after 9/11 in covering travelers in case of terrorist events, which was not the norm before.

The pandemic “was unprecedented, but once it happened, the industry has been pretty quick to react and create coverage, and that’s in the spirit of how this industry is trying to define itself, to be one of those subtle but valuable assets,” Mr. Sandberg said. “Once the world opens back up, we expect travel insurance to be much more top of mind with travelers.”


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What You Need to Know Now About Travel Insurance

When the pandemic struck, many travel insurance policies failed to cover Covid-19-related trip interruptions and cancellations, often because they excluded pandemics. But in the intervening months, the travel insurance industry has introduced a spate of new policies covering the disease just as many foreign destinations begin to require them.

“We’ve seen progress in that many plans will now treat Covid like any other unexpected sickness or illness,” said Stan Sandberg, a co-founder of the comparison website Travelinsurance.com. “If you have a trip and travel insurance and came down with Covid-19, which made it impossible to travel, that would fall under cancellation coverage as an unexpected illness that prevents you from traveling.”

Likewise, policies now including Covid-19 would cover holders in the event that a doctor diagnosed them with the virus while traveling under the trip interruption benefit.

Not all travel insurance excluded pandemics when the coronavirus began to spread early this year; Berkshire Hathaway Travel Protection was one exception. But the broader change partially arises from consumer demand, a better understanding of the virus — including mortality rates and hospital costs — and the industry’s eagerness for travel to resume.

“People who are traveling are more conscious of their risks and thinking about protecting themselves and their investment,” said Jeremy Murchland, the president of the travel insurer Seven Corners. The company launched policies that included Covid-19 coverage in June; they now account for more than 80 percent of sales.

But, like all insurance, the devil is in the details when it comes to understanding travel insurance, including what’s covered, destinations where it’s required, and the inevitable caveats, as follows.

How travel insurance covers Covid-19

The new Covid-inclusive insurance generally covers travelers from the day after purchase until their return home. During that period, if you become sick and a doctor determines you cannot travel (because of the virus or another illness), trip cancellation and trip interruption benefits would kick in.

These benefits vary by policy, but a search to insure a $2,000 weeklong trip to Costa Rica in December on Travelinsurance.com turned up a $69.75 Generali Global Assistance Standard policy with Covid-19 benefits that would be triggered if you, your host at your destination, a travel companion or a family member tested positive for the virus.

If this happened before your departure, the policy would cover your prepaid travel expenses. If you or your travel companion contracted Covid-19 during the trip and were diagnosed by a physician, it would reimburse prepaid arrangements, such as lodgings, and cover additional airfare to return home — once a doctor deems it safe to travel — up to $2,500. Should you be required to quarantine and can’t travel, travel delay coverage for lodging, meals and local transportation would pay up to $1,000. The policy also covers medical expenses for up to one year, even after you return home, up to $50,000 — though the policy also states that a holder would have to exhaust their own health insurance benefits before seeking coverage under the travel insurance plan.

Travelers should read these policies carefully to understand the benefits (for example, some rules vary by your state of residence), but brokers like TravelInsurance.com, InsureMyTrip and Squaremouth are making them easier to find through filters, F.A.Q.s and flags.

The new more comprehensive policies don’t necessarily cost more. On a Squaremouth search for insurance for two 40-year-olds on a two-week trip costing $5,000, the site turned up a variety of policies with or without coronavirus exclusions from $130 to $300, with no apparent premium for Covid-19 coverage.

Not every Covid-19-related expense is covered by many of these policies, including tests for the virus that many destinations require before arrival (those may be covered by private insurance).

Many policies include medical evacuation to a nearby facility, but won’t necessarily transport you home. For those concerned about treatment abroad, Medjet, a medical evacuation specialist, now offers Covid-19-related evacuations in the 48 contiguous United States, Canada, Mexico and the Caribbean that will transport you to the hospital of your choice in your home country (trip coverage starts at $99; annual memberships start at $189).

“Covid-19 requires special transport pods to protect the crew and others, which adds logistical issues,” said John Gobbels, the vice president and chief operating officer for Medjet.

In addition to the Medjet plan, travelers would need separate travel insurance with medical benefits to cover treatment costs and trip interruption.

Destination insurance requirements

Travelers aren’t the only ones worried about health. A growing list of countries are mandating medical coverage for Covid-19 as a prerequisite for visiting, often along with other measures like pre-trip virus testing and health screenings for symptoms on arrival.

Many Caribbean islands are among those requiring travel medical insurance, including Turks and Caicos and the Bahamas. St. Maarten requires health insurance coverage and strongly recommends additional travel insurance covering Covid-19.

Farther-flung countries also require policies that cover Covid-19, including French Polynesia and the Maldives.

Some destinations specify the required plan as a way to ensure travelers have the correct coverage and to expedite treatment. Aruba requires visitors to buy its Aruba Visitors Insurance, regardless of any other plans you may have.

“Insurance through a destination typically only covers Covid and infection while you’re there,” said Kasara Barto, a spokeswoman for Squaremouth.com. “If you catch Covid before, they don’t offer cancellation coverage. If you break a leg, the policy may only cover Covid medication. It varies by country.”

Costa Rica also requires insurance that includes an unusual benefit stipulating a policy cover up to $2,000 in expenses for a potential Covid-19 quarantine while in the country.

In response to the new requirement, which Costa Rica announced in October, insurers, including Trawick International, have begun introducing policies that meet the standard.

“It was a pretty quick and nimble reaction,” Mr. Sandberg of TravelInsurance.com said.

Normally, travel insurance varies by factors including the age of the traveler, destination, trip length and cost (most range from 4 to 10 percent of the trip cost). But some destinations are providing it at a flat fee, with most policies spelling out coverage limits and terms for emergency medical services, evacuation and costs associated with quarantines.

Jamaica, which will require insurance, but has not said when the new rule will go into effect, plans to charge $40 for each traveler. The Bahamas will include the insurance in the cost of its Travel Health Visa, an application that requires negative Covid-19 test results, which runs $40 to $60 depending on length of stay (free for children 10 and younger). The Turks and Caicos is offering a policy for $9.80 a day, and Costa Rica’s policies, if purchased locally, cost roughly $10 a day.

Expect this list of destinations to grow. In January, the Spanish region of Andalusia plans to require travel medical insurance and is working on finding a provider to make it easy for travelers to buy it.

Gaps in travel insurance

Policies that cover Covid-19 as a medical event that may cause trip cancellation or disruption, or those that provide coverage for medical treatment and evacuation still don’t necessarily cover travelers who have a change of heart when they learn they will have to quarantine upon arrival, even if they don’t have the virus. Nor are policies necessarily tied to conditions on the ground, like a spike in infections, State Department travel warnings, a government travel ban or the cessation of flights to and from a destination.

For those events, there’s Cancel For Any Reason, or CFAR, an upgrade to plans that generally only returns 50 to 75 percent of your nonrefundable trip costs.

“Prior to the pandemic, we wouldn’t necessarily recommend CFAR because most of travelers’ concerns were covered by standard plans,” Ms. Barto of Squaremouth.com said. “It’s about 40 percent more expensive and we didn’t want travelers to pay for additional coverage.” Now, she added, there’s been a surge in interest in the upgrade, including in 22 percent of policies sold at the site since mid-March.

Industry experts predict some of these outstanding issues may work their way into policies of the future as they adapt to enduring realities, much as they did after 9/11 in covering travelers in case of terrorist events, which was not the norm before.

The pandemic “was unprecedented, but once it happened, the industry has been pretty quick to react and create coverage, and that’s in the spirit of how this industry is trying to define itself, to be one of those subtle but valuable assets,” Mr. Sandberg said. “Once the world opens back up, we expect travel insurance to be much more top of mind with travelers.”


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