May 20, 2025 • 18 mins
Health Affairs' Rob Lott interviews Thomas Buchmueller of the University of Michigan to discuss his recent paper that explores how during the Medicaid 'Unwinding' of 2023, the reduction in Medicaid-paid prescriptions was offset by increased commercial coverage.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Rob Lott (00:00):
Hello, and welcome to a health podocy. I'm your host,
(00:04):
Rob Lott. During the pandemic,congress passed a law that said
to states, we'll increase thefederal share paid for Medicaid
and CHIP if you implementcontinuous enrollment, a policy
where once someone is enrolledin Medicaid, they can't be
(00:26):
kicked off as long as there'sstill this public health
emergency in place. This led toa boost in coverage, which was
especially vital during thedepths of COVID's darkest days.
But when the public healthemergency ended on 03/31/2023,
states could go back to theirold policies requiring people to
(00:49):
renew their Medicaid enrollmentevery year and removing from the
roles those who were no longereligible.
That process has been called theunwinding And at the time, many
researchers, policymakers, andadvocates raised the alarm that
it would lead to a dramatic lossin coverage across the country.
(01:09):
Now, two years later, thequestion remains, was that
prediction accurate? Did we seea significant rise in the number
of uninsured Americans? That'sthe topic of today's Health
Odyssey. I'm here with Doctor.
Thomas C. Buck Mueller,Professor of Business Economics
and Public Policy at theUniversity of Michigan, and a
(01:30):
visiting fellow at the BrookingsInstitute. From 2023 to 2025,
Doctor. Buck Mueller served asDeputy Assistant Secretary for
Planning and Evaluation in theDepartment of Health and Human
Services. Together with hiscoauthors, Doctor.
Buck Mueller has a new paper inthe May 2025 issue of Health
(01:51):
Affairs. Its title is also itsmain finding. Quote, during
Medicaid unwinding, much of thereduction in Medicaid paid
prescriptions was offset byincreased commercial coverage.
So let's just dig in here andfind out why that's significant.
Doctor.
Thomas Buckmuller, welcome tothe podocy.
Thomas Buchmueller (02:13):
Thanks for having me.
Rob Lott (02:15):
So let's start at the beginning. I in in my
introduction, I sort of gavelittle overview of the
unwinding. How did I do? Did Igive a good sense of what was
going on Awesome.
Thomas Buchmueller (02:28):
You get an a.
Rob Lott (02:29):
Awesome. Thank thank you, professor Buckner. Can you
put us in in the timeline inMarch 2023 what people were
predicting about the unwinding?
Thomas Buchmueller (02:41):
Yeah. I think, at the time and and
during, you know, that firstyear or so, there was an
understandable concern thatpeople were gonna be rolling off
of Medicaid and becominguninsured, losing coverage. And
so we were tracking this,without a lot of great data. So
(03:02):
states were reporting, monthlyinformation on disenrollment,
but that wasn't even giving us acomplete picture of what was
going on with Medicaid becausein any month you have people who
are disenrolling and you haveother people who are coming on
to the program and in some casesthey're the same people. Know
someone would be a bitdisenrolled and then you know
(03:22):
submit their application and getback on.
So so people, I think, were veryalarmed when they saw a large
number of of people beingdisenrolled. A lot of them were
so called proceduraldisenrollments where maybe
somebody forgot to or justdidn't put in their their
paperwork. But we didn't knowwhat was going on with coverage
(03:43):
overall. And generally, we trackhealth insurance coverage using
federal surveys like theNational Health Interview
Survey, the American CommunitySurvey, and those data sets are
available with a considerablelag. So there just wasn't great
real time data on what washappening.
Rob Lott (04:00):
Okay. Well, so let's talk about your research paper.
You look specifically at who waspaying for prescriptions for
patients after the unwinding.Why did you, look at that versus
some other kind of spending?
Thomas Buchmueller (04:13):
We looked at prescription data for a
Rob Lott (04:15):
couple
Thomas Buchmueller (04:15):
reasons. One is the fact that the the data
source we use, which is fromIQVIA, is available more quickly
than other sources of data. Sowe have quarterly data that was
available pretty quickly afterthe end of the quarter. And the
IQVIA data has a very goodcoverage, so it's national in
(04:36):
scope and basically is capturingall prescription drugs in the
country. So we thought we couldinfer something about changes in
coverage from changes inprescription fills.
But then we also were interestedin prescription drugs directly
because obviously the reason wecare about people having
insurance coverage is so theycan get access to the care they
(04:59):
need. And roughly half ofAmericans use prescription drugs
every month, And so this wasgoing to tell us if during the
unwinding people were losingaccess to valuable care.
Rob Lott (05:11):
Okay. So you've got this sort of clever, end run
around the lag, a way to maybeget a sense of things sooner
than you would otherwise. Whatdid your research show? What are
some of the top line findings?
Thomas Buchmueller (05:27):
Yeah, so we looked at a few different
outcomes. So first of all, wewanted to convince ourselves
that the prescription drug data,did track Medicaid enrollment.
So we compared trends in,Medicaid paid fills with the
Medicaid enrollment data And andoverall the data tracked pretty
well. So during the period ofthe the public health emergency
(05:49):
when the continuous enrollmentprovision was in effect, both
Medicaid enrollment and Medicaidfilled prescription paid fills
sort of went up continuously.And then if you look at the end
of, you know, the start of theunwinding period, both of those
started to fall.
So we did some estimates, fourquarters after state began
(06:11):
unwinding, Medicaid enrollmentwas down by about 37%. Medicaid
paid fills were down a littlebit less like about 22%, but but
the general trend, was similar.So so that told us that we were
capturing something that wasgoing on with enrollment. So
then the question is whathappened to the total number of
(06:34):
prescriptions filled? Theobvious concern is that if
people are losing coverage, thenthey are not going to be able to
afford the medicine they need,we're going to see a decline in
prescriptions.
So we looked at we we took thedata and we aggregated Medicaid,
fills, commercial insurance, andcash fills. We we did not look
(06:54):
at Medicare Part D, and welooked to see how that trended
after states began unwinding.And we saw very little change so
there was a slight decrease intotal fills but it was less than
1%, it was not statisticallysignificant. So that gave us
comfort that at least peoplewere not forgoing the
(07:14):
prescription drugs because theylost coverage. The question is
we know that Medicaid fills weregoing down, total prescriptions
were not changing, How arepeople paying for their
prescriptions?
So the last part of theanalysis, we, we broke it down
by payer source. And what wefound was there was an increase
in prescriptions that werepurchased with commercial
(07:36):
insurance. And the size of thatincrease was about 86% as large
as the decrease in Medicaid. Soit looks like most people, were
transitioning to privateinsurance. We saw a slight
increase in the number ofprescriptions, paid for with
cash, but it was very smallrelative to the change in
(08:00):
Medicaid prescriptions.
So overall, the data seem tosuggest that people were
successfully transitioning fromMedicaid coverage to some form
of private coverage.
Rob Lott (08:13):
Okay, so what factors can we potentially attribute
this shift to commercialcoverage to? In other words,
what, you know, what allowedfolks to move into commercial
coverage?
Thomas Buchmueller (08:27):
So I think the biggest, explanation is the
growth in coverage through theACA marketplace. So I should
say, a limitation of our data isthat we don't have we can't
break out, marketplace coveragefrom employer sponsored
insurance coverage, but there'sa lot of other data sources that
(08:47):
suggest that that it's anincrease in marketplace coverage
that was driving it. So first ofall, we know that over this
period between 2020 and 2024,marketplace coverage almost
doubled. It went up from about11,000,000, people to over
21,000,000 people. And we knowfrom from other work that's been
published in health affairsthat, using the the Census
(09:11):
Bureau's household pulse survey,gave sort of rapid data, on what
was going on for adults atleast, there seems to be some
transition from Medicaid to tomarketplace coverage.
And and there's, you know, goodpolicy reasons why marketplace
coverage was increasing. So,number one, it was much more
affordable, you know. So as partof the American Rescue Plan in
(09:37):
2021, the Inflation ReductionAct of 2022, the the size of the
the tax credits that people hadto buy marketplace coverage
increased dramatically, and andmore people had access to these
credits. So so marketplacecoverage is becoming more
affordable, and the Bidenadministration was doing a
number of things to make iteasier for people to enroll in
(09:58):
the marketplaces. So theyestablished, special enrollment
periods for people who were wereleaving Medicaid during the
unwinding, special enrollmentperiods during the the pandemic,
for people who lost theircoverage, special moment period
for people with low income.
And, they also invested heavilyin outreach, through navigators,
(10:20):
you know which are nonprofitorganizations that help people
find coverage and sign up for aplan that's right for them. So
all these things together Ithink made marketplace coverage
more accessible and moreaffordable and that helped
people make a smooth transitionfrom Medicaid to private
coverage.
Rob Lott (10:42):
Great and just a minute I want to ask you about
what that says about our earlierpredictions Before we do though,
let's take a quick break. Andwe're back. I'm here with
(11:11):
Doctor. Thomas Buckmillerdiscussing his paper about the
Medicaid unwinding. So just amoment ago, you gave a great
overview of the factors thatattributed, factors that we can
attribute to the shift towardcommercial coverage.
I'm wondering if you can put usin your shoes when the the first
(11:33):
time you ran your numbers andyou saw that shift, were you
surprised at that time?
Thomas Buchmueller (11:40):
We were a little surprised.
Rob Lott (11:42):
Yeah.
Thomas Buchmueller (11:43):
There were some studies that have been
done, during the the the publichealth emergency using earlier
data to try to project out whatthe coverage effects would be
when the unwinding started andthey were predicting a pretty
sizable increase in number ofuninsured people. And we have
other research that shows thatinsurance coverage has a large
(12:05):
effect on prescription drug use.We were expecting to see a
decline in total fills and maybeeven an increase in the number
of fills that were paid for withcash.
Rob Lott (12:16):
So, you know, we talked about the, you know,
folks raising the alarm in 2023about the potential effect, and
there's a bit of a discrepancyhere between what we feared
perhaps and what the reality is.What do you think explains that
gap?
Thomas Buchmueller (12:36):
So I think there's a couple of
explanations. One is that theprojections were were based on,
pre pandemic data when the taxcredits for for marketplace
coverage were less generous,when, there was less funding
for, outreach navigators. And soI think that they really
(12:58):
couldn't properly account forhow much marketplace coverage
was gonna increase. So that'skind of the most substantive,
you know, policy oriented,explanation. But there's also a
measurement issue.
There's always been a disconnectbetween, Medicaid coverage as
it's measured in enrollmentdata, administrative data, and
(13:19):
as it's measured in surveys.It's called the Medicaid
undercount. And the Medicaidundercount grew during the
public health emergency, and thebest explanation is that, you
know, as people left Medicaid togo on to private insurance, they
still will be counted in the inthe administrative data, but
they when they answered thesurvey, they said they had
private insurance. And otherpeople, didn't realize they were
(13:43):
still covered. And so when theyanswered the survey, they said
that they were uninsured whenthey were showing up in in the
administrative data as as havingMedicaid.
And so a lot of those coveragechanges were already baked in,
and so we we don't see that muchof a change in the survey data,
because the measurement errorincreased and then decreased, as
we returned to kind of normal.
Rob Lott (14:04):
Gotcha. Is that something that sort of lesson we
can learn from that discrepancy,is that something that, might be
relevant to future researchquestions? Can you imagine
researchers asking a similarquestion ten years from now and
saying, oh, don't forget whathappened back during the
(14:25):
pandemic. Is there a relevanceto this finding going forward?
Thomas Buchmueller (14:32):
Yeah, I think there's a relevance both
in terms of how we measurecoverage and how we as
researchers how we track it, butthen also for states as they
communicate with enrolleesbecause if somebody is enrolled
in Medicaid and they don'trealize it then they're not
going get the full benefits ofthat coverage so it's why I
(14:52):
think there's a more a realreason to do a better job of
making sure people understandwhat coverage they have.
Rob Lott (15:00):
Great. And that's perhaps a good segue for my next
question, which is to imagineyour paper in the hands of a
member of Congress or theirstaffer, or perhaps someone at
the state level in a stateMedicaid office. They read your
paper, they understand it andthen they maybe they say to you,
so what? The unwinding hasalready happened. Let's just be
(15:24):
more, you know, let's just begrateful more people than end up
uninsured.
Can you say a little more abouthow you might explain the
applicability of your yourfindings to potential future
policy making decisions?
Thomas Buchmueller (15:40):
Yeah. Well, I think that the the experience
during the, continuousenrollment period, is important
because, you know, now allstates are required to provide
twelve months of continuousenrollment for kids. A number of
states are going well beyondthat to provide continuous
(16:01):
enrollment for kids up to agesix. And so it's going be really
important that familiesunderstand what coverage they
have available to them and, youknow, make sure they know what
they're still covered even iftheir circumstances change. So
that's a very, kind of,operational aspect that I think
is very important.
(16:22):
But then if you think about theexplanation for why we think
things went so smoothly duringthe unwinding, it's all about
the marketplaces. You know? Soso the enhanced tax credits,
made marketplace coveragesignificantly more affordable.
Those enhanced tax credits arescheduled to expire at the end
of this year. So if congressdoesn't act, individual coverage
(16:46):
in The US is gonna get a lotmore expensive.
It's it's probably the case thatnavigators and all the things
that the administration did to,improve information about the
marketplaces to help people signup played an important role in
in helping people make thosetransitions. Well, the Trump
administration has alreadydramatically cut back funding
(17:08):
for navigators. And the specialenrollment periods allowed
people to to sign up, outside ofthe normal open enrollment
period. And I think we saw a lotof, you know, during the
unwinding, a lot of peoplesigning up outside of the open
enrollment period, in in aproposed rule that was recently
issued, the administration islooking to to greatly reduce
(17:31):
those special enrollmentperiods. So I think if you look
at the marketplaces and all thethings that are likely to happen
in the next few months, we'regonna see, probably a
significant reduction inmarketplace coverage and a
significant increase in numberof people who are uninsured.
So that that's something that Ithink, you know, policymakers
really should be looking at.
Rob Lott (17:52):
Okay, well a great agenda for future research as
well, and perhaps a good placefor us to wrap up today. Doctor.
Thomas Buckmiller, thank you somuch for taking the time to chat
with us. This was a lot of fun.
Thomas Buchmueller (18:05):
No, thank you. I enjoyed it.
Rob Lott (18:07):
And to our listeners, thanks for tuning in. If you
enjoyed this episode, tell afriend, smash that subscribe
button, and tune in again nextweek.
Thomas Buchmueller (18:21):
Thanks for listening. If you enjoyed
today's episode, I hope you'lltell a friend about a health
policy.
Hello, and welcome to a health podocy. I'm your host,
(00:04):
Rob Lott. During the pandemic,congress passed a law that said
to states, we'll increase thefederal share paid for Medicaid
and CHIP if you implementcontinuous enrollment, a policy
where once someone is enrolledin Medicaid, they can't be
(00:26):
kicked off as long as there'sstill this public health
emergency in place. This led toa boost in coverage, which was
especially vital during thedepths of COVID's darkest days.
But when the public healthemergency ended on 03/31/2023,
states could go back to theirold policies requiring people to
(00:49):
renew their Medicaid enrollmentevery year and removing from the
roles those who were no longereligible.
That process has been called theunwinding And at the time, many
researchers, policymakers, andadvocates raised the alarm that
it would lead to a dramatic lossin coverage across the country.
(01:09):
Now, two years later, thequestion remains, was that
prediction accurate? Did we seea significant rise in the number
of uninsured Americans? That'sthe topic of today's Health
Odyssey. I'm here with Doctor.
Thomas C. Buck Mueller,Professor of Business Economics
and Public Policy at theUniversity of Michigan, and a
(01:30):
visiting fellow at the BrookingsInstitute. From 2023 to 2025,
Doctor. Buck Mueller served asDeputy Assistant Secretary for
Planning and Evaluation in theDepartment of Health and Human
Services. Together with hiscoauthors, Doctor.
Buck Mueller has a new paper inthe May 2025 issue of Health
(01:51):
Affairs. Its title is also itsmain finding. Quote, during
Medicaid unwinding, much of thereduction in Medicaid paid
prescriptions was offset byincreased commercial coverage.
So let's just dig in here andfind out why that's significant.
Doctor.
Thomas Buckmuller, welcome tothe podocy.
Thomas Buchmueller (02:13):
Thanks for having me.
Rob Lott (02:15):
So let's start at the beginning. I in in my
introduction, I sort of gavelittle overview of the
unwinding. How did I do? Did Igive a good sense of what was
going on Awesome.
Thomas Buchmueller (02:28):
You get an a.
Rob Lott (02:29):
Awesome. Thank thank you, professor Buckner. Can you
put us in in the timeline inMarch 2023 what people were
predicting about the unwinding?
Thomas Buchmueller (02:41):
Yeah. I think, at the time and and
during, you know, that firstyear or so, there was an
understandable concern thatpeople were gonna be rolling off
of Medicaid and becominguninsured, losing coverage. And
so we were tracking this,without a lot of great data. So
(03:02):
states were reporting, monthlyinformation on disenrollment,
but that wasn't even giving us acomplete picture of what was
going on with Medicaid becausein any month you have people who
are disenrolling and you haveother people who are coming on
to the program and in some casesthey're the same people. Know
someone would be a bitdisenrolled and then you know
(03:22):
submit their application and getback on.
So so people, I think, were veryalarmed when they saw a large
number of of people beingdisenrolled. A lot of them were
so called proceduraldisenrollments where maybe
somebody forgot to or justdidn't put in their their
paperwork. But we didn't knowwhat was going on with coverage
(03:43):
overall. And generally, we trackhealth insurance coverage using
federal surveys like theNational Health Interview
Survey, the American CommunitySurvey, and those data sets are
available with a considerablelag. So there just wasn't great
real time data on what washappening.
Rob Lott (04:00):
Okay. Well, so let's talk about your research paper.
You look specifically at who waspaying for prescriptions for
patients after the unwinding.Why did you, look at that versus
some other kind of spending?
Thomas Buchmueller (04:13):
We looked at prescription data for a
Rob Lott (04:15):
couple
Thomas Buchmueller (04:15):
reasons. One is the fact that the the data
source we use, which is fromIQVIA, is available more quickly
than other sources of data. Sowe have quarterly data that was
available pretty quickly afterthe end of the quarter. And the
IQVIA data has a very goodcoverage, so it's national in
(04:36):
scope and basically is capturingall prescription drugs in the
country. So we thought we couldinfer something about changes in
coverage from changes inprescription fills.
But then we also were interestedin prescription drugs directly
because obviously the reason wecare about people having
insurance coverage is so theycan get access to the care they
(04:59):
need. And roughly half ofAmericans use prescription drugs
every month, And so this wasgoing to tell us if during the
unwinding people were losingaccess to valuable care.
Rob Lott (05:11):
Okay. So you've got this sort of clever, end run
around the lag, a way to maybeget a sense of things sooner
than you would otherwise. Whatdid your research show? What are
some of the top line findings?
Thomas Buchmueller (05:27):
Yeah, so we looked at a few different
outcomes. So first of all, wewanted to convince ourselves
that the prescription drug data,did track Medicaid enrollment.
So we compared trends in,Medicaid paid fills with the
Medicaid enrollment data And andoverall the data tracked pretty
well. So during the period ofthe the public health emergency
(05:49):
when the continuous enrollmentprovision was in effect, both
Medicaid enrollment and Medicaidfilled prescription paid fills
sort of went up continuously.And then if you look at the end
of, you know, the start of theunwinding period, both of those
started to fall.
So we did some estimates, fourquarters after state began
(06:11):
unwinding, Medicaid enrollmentwas down by about 37%. Medicaid
paid fills were down a littlebit less like about 22%, but but
the general trend, was similar.So so that told us that we were
capturing something that wasgoing on with enrollment. So
then the question is whathappened to the total number of
(06:34):
prescriptions filled? Theobvious concern is that if
people are losing coverage, thenthey are not going to be able to
afford the medicine they need,we're going to see a decline in
prescriptions.
So we looked at we we took thedata and we aggregated Medicaid,
fills, commercial insurance, andcash fills. We we did not look
(06:54):
at Medicare Part D, and welooked to see how that trended
after states began unwinding.And we saw very little change so
there was a slight decrease intotal fills but it was less than
1%, it was not statisticallysignificant. So that gave us
comfort that at least peoplewere not forgoing the
(07:14):
prescription drugs because theylost coverage. The question is
we know that Medicaid fills weregoing down, total prescriptions
were not changing, How arepeople paying for their
prescriptions?
So the last part of theanalysis, we, we broke it down
by payer source. And what wefound was there was an increase
in prescriptions that werepurchased with commercial
(07:36):
insurance. And the size of thatincrease was about 86% as large
as the decrease in Medicaid. Soit looks like most people, were
transitioning to privateinsurance. We saw a slight
increase in the number ofprescriptions, paid for with
cash, but it was very smallrelative to the change in
(08:00):
Medicaid prescriptions.
So overall, the data seem tosuggest that people were
successfully transitioning fromMedicaid coverage to some form
of private coverage.
Rob Lott (08:13):
Okay, so what factors can we potentially attribute
this shift to commercialcoverage to? In other words,
what, you know, what allowedfolks to move into commercial
coverage?
Thomas Buchmueller (08:27):
So I think the biggest, explanation is the
growth in coverage through theACA marketplace. So I should
say, a limitation of our data isthat we don't have we can't
break out, marketplace coveragefrom employer sponsored
insurance coverage, but there'sa lot of other data sources that
(08:47):
suggest that that it's anincrease in marketplace coverage
that was driving it. So first ofall, we know that over this
period between 2020 and 2024,marketplace coverage almost
doubled. It went up from about11,000,000, people to over
21,000,000 people. And we knowfrom from other work that's been
published in health affairsthat, using the the Census
(09:11):
Bureau's household pulse survey,gave sort of rapid data, on what
was going on for adults atleast, there seems to be some
transition from Medicaid to tomarketplace coverage.
And and there's, you know, goodpolicy reasons why marketplace
coverage was increasing. So,number one, it was much more
affordable, you know. So as partof the American Rescue Plan in
(09:37):
2021, the Inflation ReductionAct of 2022, the the size of the
the tax credits that people hadto buy marketplace coverage
increased dramatically, and andmore people had access to these
credits. So so marketplacecoverage is becoming more
affordable, and the Bidenadministration was doing a
number of things to make iteasier for people to enroll in
(09:58):
the marketplaces. So theyestablished, special enrollment
periods for people who were wereleaving Medicaid during the
unwinding, special enrollmentperiods during the the pandemic,
for people who lost theircoverage, special moment period
for people with low income.
And, they also invested heavilyin outreach, through navigators,
(10:20):
you know which are nonprofitorganizations that help people
find coverage and sign up for aplan that's right for them. So
all these things together Ithink made marketplace coverage
more accessible and moreaffordable and that helped
people make a smooth transitionfrom Medicaid to private
coverage.
Rob Lott (10:42):
Great and just a minute I want to ask you about
what that says about our earlierpredictions Before we do though,
let's take a quick break. Andwe're back. I'm here with
(11:11):
Doctor. Thomas Buckmillerdiscussing his paper about the
Medicaid unwinding. So just amoment ago, you gave a great
overview of the factors thatattributed, factors that we can
attribute to the shift towardcommercial coverage.
I'm wondering if you can put usin your shoes when the the first
(11:33):
time you ran your numbers andyou saw that shift, were you
surprised at that time?
Thomas Buchmueller (11:40):
We were a little surprised.
Rob Lott (11:42):
Yeah.
Thomas Buchmueller (11:43):
There were some studies that have been
done, during the the the publichealth emergency using earlier
data to try to project out whatthe coverage effects would be
when the unwinding started andthey were predicting a pretty
sizable increase in number ofuninsured people. And we have
other research that shows thatinsurance coverage has a large
(12:05):
effect on prescription drug use.We were expecting to see a
decline in total fills and maybeeven an increase in the number
of fills that were paid for withcash.
Rob Lott (12:16):
So, you know, we talked about the, you know,
folks raising the alarm in 2023about the potential effect, and
there's a bit of a discrepancyhere between what we feared
perhaps and what the reality is.What do you think explains that
gap?
Thomas Buchmueller (12:36):
So I think there's a couple of
explanations. One is that theprojections were were based on,
pre pandemic data when the taxcredits for for marketplace
coverage were less generous,when, there was less funding
for, outreach navigators. And soI think that they really
(12:58):
couldn't properly account forhow much marketplace coverage
was gonna increase. So that'skind of the most substantive,
you know, policy oriented,explanation. But there's also a
measurement issue.
There's always been a disconnectbetween, Medicaid coverage as
it's measured in enrollmentdata, administrative data, and
(13:19):
as it's measured in surveys.It's called the Medicaid
undercount. And the Medicaidundercount grew during the
public health emergency, and thebest explanation is that, you
know, as people left Medicaid togo on to private insurance, they
still will be counted in the inthe administrative data, but
they when they answered thesurvey, they said they had
private insurance. And otherpeople, didn't realize they were
(13:43):
still covered. And so when theyanswered the survey, they said
that they were uninsured whenthey were showing up in in the
administrative data as as havingMedicaid.
And so a lot of those coveragechanges were already baked in,
and so we we don't see that muchof a change in the survey data,
because the measurement errorincreased and then decreased, as
we returned to kind of normal.
Rob Lott (14:04):
Gotcha. Is that something that sort of lesson we
can learn from that discrepancy,is that something that, might be
relevant to future researchquestions? Can you imagine
researchers asking a similarquestion ten years from now and
saying, oh, don't forget whathappened back during the
(14:25):
pandemic. Is there a relevanceto this finding going forward?
Thomas Buchmueller (14:32):
Yeah, I think there's a relevance both
in terms of how we measurecoverage and how we as
researchers how we track it, butthen also for states as they
communicate with enrolleesbecause if somebody is enrolled
in Medicaid and they don'trealize it then they're not
going get the full benefits ofthat coverage so it's why I
(14:52):
think there's a more a realreason to do a better job of
making sure people understandwhat coverage they have.
Rob Lott (15:00):
Great. And that's perhaps a good segue for my next
question, which is to imagineyour paper in the hands of a
member of Congress or theirstaffer, or perhaps someone at
the state level in a stateMedicaid office. They read your
paper, they understand it andthen they maybe they say to you,
so what? The unwinding hasalready happened. Let's just be
(15:24):
more, you know, let's just begrateful more people than end up
uninsured.
Can you say a little more abouthow you might explain the
applicability of your yourfindings to potential future
policy making decisions?
Thomas Buchmueller (15:40):
Yeah. Well, I think that the the experience
during the, continuousenrollment period, is important
because, you know, now allstates are required to provide
twelve months of continuousenrollment for kids. A number of
states are going well beyondthat to provide continuous
(16:01):
enrollment for kids up to agesix. And so it's going be really
important that familiesunderstand what coverage they
have available to them and, youknow, make sure they know what
they're still covered even iftheir circumstances change. So
that's a very, kind of,operational aspect that I think
is very important.
(16:22):
But then if you think about theexplanation for why we think
things went so smoothly duringthe unwinding, it's all about
the marketplaces. You know? Soso the enhanced tax credits,
made marketplace coveragesignificantly more affordable.
Those enhanced tax credits arescheduled to expire at the end
of this year. So if congressdoesn't act, individual coverage
(16:46):
in The US is gonna get a lotmore expensive.
It's it's probably the case thatnavigators and all the things
that the administration did to,improve information about the
marketplaces to help people signup played an important role in
in helping people make thosetransitions. Well, the Trump
administration has alreadydramatically cut back funding
(17:08):
for navigators. And the specialenrollment periods allowed
people to to sign up, outside ofthe normal open enrollment
period. And I think we saw a lotof, you know, during the
unwinding, a lot of peoplesigning up outside of the open
enrollment period, in in aproposed rule that was recently
issued, the administration islooking to to greatly reduce
(17:31):
those special enrollmentperiods. So I think if you look
at the marketplaces and all thethings that are likely to happen
in the next few months, we'regonna see, probably a
significant reduction inmarketplace coverage and a
significant increase in numberof people who are uninsured.
So that that's something that Ithink, you know, policymakers
really should be looking at.
Rob Lott (17:52):
Okay, well a great agenda for future research as
well, and perhaps a good placefor us to wrap up today. Doctor.
Thomas Buckmiller, thank you somuch for taking the time to chat
with us. This was a lot of fun.
Thomas Buchmueller (18:05):
No, thank you. I enjoyed it.
Rob Lott (18:07):
And to our listeners, thanks for tuning in. If you
enjoyed this episode, tell afriend, smash that subscribe
button, and tune in again nextweek.
Thomas Buchmueller (18:21):
Thanks for listening. If you enjoyed
today's episode, I hope you'lltell a friend about a health
policy.
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