Several COVID-19 vaccines could be on the market soon. State and federal officials have begun devising strategies for distributing and administering the vaccine and communicating with the public, but an equally important element will be the extent to which health care payers, including private insurers, will cover the costs for recipients. The Affordable Care Act (ACA) requires that most health insurers and employer health plans cover certain preventive services without cost-sharing, including vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). However, ensuring that a COVID-19 vaccine is a free preventive service for all who need it, when they need it, is by no means guaranteed. This expert perspective discusses recent federal efforts to expand private insurance coverage of a vaccine, and provides a roadmap for states to close remaining coverage gaps that could inhibit vaccine uptake.

In April 2020, the Supreme Court ruled that the federal government must restore to health insurers approximately $12.3 billion in risk corridor payments under the Affordable Care Act (ACA). On September 30, the Center for Consumer Information and Insurance Oversight (CCIIO) proposed instructions on how to allocate these risk corridor payments under the ACA’s medical loss ratio (MLR) formula. This guidance means that policyholders will receive an estimated 2.4 percent ($298 million) of the risk corridor payout in the form of MLR rebates. This expert perspective considers ways states could potentially redirect insurers’ extra cash to benefit policyholders and the public.

Updates from the states as of October 23, 2020.

Updates from the states as of October 16, 2020.

This year has presented many unique and unexpected challenges, but as open enrollment approaches states are making concerted efforts to connect residents with public and private health coverage options and are anticipating more churn between programs than ever before amid the COVID-19 public health crisis. Millions have filed for unemployment since the pandemic began, many losing their employer-sponsored health coverage or experiencing income loss in the process. As consumers navigate ongoing changes in their income or health coverage, it is more important than ever to clearly communicate with consumers what health coverage options are available for the remainder of 2020 and heading into 2021. This expert perspective lays out key takeaways on messaging to consumers to enroll in coverage this OEP and highlights examples from two states.

Updates from the states as of October 9, 2020.

As state officials shift their focus towards loosening social distancing policies and reopening, they must now grapple with balancing both economic and public health concerns while also considering how reopening policies will impact residents in very different ways, possibly mitigating or exacerbating preexisting disparities. This expert perspective provides a survey of actions that state and local governments have taken to intentionally incorporate equity into their recovery and reopening policies.

Updates from the states as of October 2, 2020.

As states seek to address the social determinants of health and advance health equity, they face longstanding and persistent challenges in collecting complete, accurate, and consistent race, ethnicity and language (REL) data. This expert perspective provides an overview of current REL data collection standards; ideas for increasing completeness in data by engaging the enrollee and enrollment assisters, and modifying enrollment and renewal interface; and provides suggestions for how states could leverage alternative sources of data in order to improve REL data completeness.

Updates from the states as of September, 25, 2020.