The unlikely portrait of Medicaid in the time of coronavirus looks like Jonathan Chapin, living with his wife and 11-year-old daughter in a gated community in the Sierra Nevada foothills.
Chapin had a thriving Reno, Nev., production company, We Ain’t Saints, booking bands, managing weddings, hosting 600-strong karaoke nights at the Tahoe Biltmore Lodge & Casino. When the novel coronavirus came, forcing northern Nevada’s entertainment industry to go dark, he said, “everything I knew all disappeared.”
The family’s health insurance gone along with their income, Chapin applied online for Medicaid on April 1, the day after his wife’s job ended and three days before he needed a molar pulled. By the time his mouth was throbbing, Chapin and his family had become early additions to Nevada’s Medicaid rolls — rolls swollen now to record levels while pandemic-inflicted fiscal wounds have damaged the state’s ability to afford the safety-net health coverage.
By the most recent count, the roster of Nevadans on Medicaid has climbed from fewer than 644,000 in February, the month before the state reported its first case of covid-19, the disease caused by the virus, to about 731,000 through August.
That 13.5 percent increase places Nevada among at least three states, along with Kentucky and Minnesota, where the cadre of people on Medicaid has spiked that much, including families, like the Chapins, who have never before asked for government help. But increases are widespread: Caseloads had risen on average 8.4 percent through July in 30 states for which researchers have enrollment information. And in 14 states with enrollment data through August, the average is 10 percent.
If the past is a guide, this is merely the beginning.
During the Great Recession from late 2007 to mid-2009 and previous bad economic spells in the history of Medicaid, Americans have turned to the program more gradually than to unemployment benefits, food stamps and other aid for people sliding out of comfortable lives. Medicaid is insurance for the poor that is a shared responsibility of the federal government and states, begun as a pillar of President Lyndon B. Johnson’s Great Society expansion of government help of the 1960s.
“We believe Nevada has not yet seen the full impact as a result of the covid pandemic,” said the state’s Medicaid director, Suzanne Bierman, echoing expectations elsewhere of experts on the social safety net.
With Nevada’s tourism-fueled economy stalled, the unemployment rate soared to 30.1 percent in April, the highest ever recorded for any state in any month.
“You can pick just about any adjective you like to describe just how unprecedented the numbers are, and you wouldn’t be exaggerating,” said David Schmidt, chief economist for the Nevada Department of Employment, Training and Rehabilitation.
“When all the casinos had to close all at once by the end of March, 95 percent of our members were off work, so it was a complete wipeout,” said Bobbette Bond, director of public policy for the Culinary Health Fund, which provides insurance to about half the cooks and dishwashers, porters and housekeepers and other unionized casino workers. The fund is covering unemployed members for another month.
Some casinos’ lights are back on, but fewer than one-third of workers have returned to their jobs, Bond said, and some have too few hours to qualify for their old health benefits. Even Nevada’s most recent reported unemployment rate — 14 percent for July — is higher than the nationwide rate at the Great Recession’s worst.
With most Americans’ private health insurance tethered to their jobs, this enormous disappearance of work is a central reason Medicaid programs are swelling and strained.
Another reason: Under the Cares Act, a broad set of pandemic relief measures Congress adopted in the spring, states may not remove anyone from their rolls if they accept extra federal Medicaid aid provided by the law. But in Nevada, most of the growth is fueled by people joining, with about two-thirds of the enrollment boom most months attributed to new applicants, according to state estimates.
The spiraling demand for Medicaid is colliding with a diminished ability by the state to pay for it. With Nevada confronting a $1.2 billion deficit and a requirement to balance its budget, the legislature has taken steps to slow the program’s spending — notably, curbing payments to doctors, hospitals and others who care for Medicaid patients to save $53 million through next summer. That 6 percent rate cut is the largest so far in the nation.
“Nevada is the extreme of what’s happening around the country,” said Aviva Aron-Dine, vice president for health policy at the Center on Budget and Policy Priorities, who has been tracking Medicaid in the pandemic. “The fear is that it’s the leading edge.”
Chapin finally posted on his personal Facebook page July 1 what had been true for months: “It’s with a heavy heart and a lot of fantastic memories, I regret to announce the closing of my business of 19½ years. . . . With covid spiking again. Wedding season cancelled, no bars to do Karaoke, no venues to book bands, and no real return for the music and entertainment industry in sight.”
It had been 2001, months into his sobriety, when he launched We Ain’t Saints, with its logo of a devil holding a beer and its motto straight from Alcoholics Anonymous. Over the years, the weddings he hosted twice made Brides magazine. He counted Google, Instagram and Squaw Valley Ski Resort among his clients for events.
The business earned him $80,000 to $140,000, depending on the year. “My company allowed me to raise a family nicely,” Chapin, 49, said. “This is what we do seriously for years and years and years. Bringing live music for people. . . . Making sure your bar is filled on Friday night. Not only is it something financially but emotionally you have all these ties with all these people.”
His wife’s final day as an administrative assistant for an organization working with children who have autism was March 31. Her health benefits ended at once. He already had stopped paying into Access to Healthcare Network, a nonprofit medical discount program that covered him and their daughter for a monthly fee. Chapin was approved for Medicaid hours after he typed up an application — a contrast to delays often vexing people as they try to get unemployment checks flowing.
For the emergency molar extraction, he had to find a dentist open in the pandemic and willing to accept SilverSummit, a Medicaid managed-care plan. Discovering none in Reno, he drove to Carson City, about 30 miles south. But he could still go to Northern Nevada HOPES, a community health center where he gets some of his care, when he awoke in April with a blood clot in his left calf. Medicaid paid for him to have it removed and is paying for a blood-thinning drug. His daughter, who has entered sixth grade online, has just been approved for braces.
If not for Medicaid, “we would have sold things, or we would have gone into debt,” Chapin said. “I think about it all the time.”
As it is, they are scraping by, using savings for house payments. Even without a job, he is finding a way to give back. Before starting his production company, he was a chef. Now, he is raising money, making beef stroganoff and peach and avocado salad, pork loin with mushroom sauce and grilled asparagus, and giving the meals to families in need. A lot of the people picking up his meals are recent exiles from the middle class.
For the emergency molar extraction, he had to find a dentist open in the pandemic and willing to accept SilverSummit, a Medicaid managed-care plan. Discovering none in Reno, he drove to Carson City, about 30 miles south. But he could still go to Northern Nevada HOPES, a community health center where he gets some of his care, when he awoke in April with a blood clot in his left calf. Medicaid paid for him to have it removed and is paying for a blood-thinning drug. His daughter, who has entered sixth grade online, has just been approved for braces.
If not for Medicaid, “we would have sold things, or we would have gone into debt,” Chapin said. “I think about it all the time.”
As it is, they are scraping by, using savings for house payments. Even without a job, he is finding a way to give back. Before starting his production company, he was a chef. Now, he is raising money, making beef stroganoff and peach and avocado salad, pork loin with mushroom sauce and grilled asparagus, and giving the meals to families in need. A lot of the people picking up his meals are recent exiles from the middle class.