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Michelina Moen lost her job and health insurance in April. Only weeks earlier she had begun to feel ill and not her usual energetic self — in what she describes as a textbook case of “really bad timing.”

The Orlando, Florida, resident sought treatment in May. After a series of tests, doctors told Moen she had a rare kidney condition that would require months of treatment.

“Losing the coverage ended up being worse than losing the job,” said Moen, 36, a dancer who had worked for both Walt Disney World and Universal Studios. “It was very stressful.”

Moen rushed to find replacement coverage. With help from a social service agency, she enrolled in a plan through healthcare.gov, the federal Affordable Care Act insurance marketplace. Because she and her husband, Brett, were not working — he had been laid off by Disney, too — they qualified for federal subsidies, so the coverage cost her just $35 a month. Most of her medical expenses, which involve traveling frequently to Jacksonville for specialty treatment, are covered.

Moen’s husband recently found a job, however, and the increase in the couple’s income likely means her subsidy will fall and she’ll have to pay more for health insurance. Moen said she’ll evaluate her options and may switch plans during this year’s ACA open enrollment period, which began Nov. 1 and ends Dec. 15 for coverage starting Jan. 1.

“A priority is to continue seeing my medical team in Jacksonville,” Moen said.

Moen is one of the millions of Americans who have been dropped from their jobs and their employer-provided health insurance since March when the coronavirus first ravaged the economy. Although no official tally exists, studies indicate that at least 10 million workers lost their insurance but that about two-thirds of them found alternative coverage — through a new job, Medicaid, a spouse’s or parent’s plan, or the ACA marketplaces.

That leaves at least 3 million people without coverage, the most added in a single year since accurate record-keeping began in 1968. And experts are worried that, as the virus continues to play havoc with the economy, new rounds of business closings and layoffs could add to that number.

Navigators Want More Resources

The unprecedented situation has health insurance counselors (called navigators), ACA marketplace staff members and insurers scrambling to assist a possible surge of people looking for health insurance during open enrollment.

For the 36 states that rely on the federal ACA enrollment platform — healthcare.gov — the Trump administration awarded grants totaling $10 million for marketing and outreach this year, the same level as in 2019. In 2016, the last year of the Obama administration, navigator grants totaled $63 million.

Many navigator organizations say they don’t have the resources from the federal government to do the job as they would like.

“I’m trying not to panic,” said Jodi Ray, executive director of Florida Covering Kids & Families. “We’ve seen substantially more people needing coverage and help in recent months compared to last year, and more are new to being uninsured.”

Ray said her team is booked with appointments well into November. But she bemoans the fact that she has a third of the counselors she had a few years ago — 50, compared with 150 — and only a tiny ad budget.

Like Ray, Jeremy Smith, program director at First Choice Services in Charleston, West Virginia, said his team is expecting “tens of thousands more people” needing help compared with last year — but no bigger budget to serve them. First Choice provides telephone-based enrollment assistance in West Virginia, New Hampshire, Iowa and Montana with a federal grant of $100,000 per state.

“We are talking to a lot more people who have had job-based coverage for years,” Smith said. “This is the first time they are having to find insurance elsewhere. They don’t know what to do or who to trust.”

In Wisconsin, the governor shifted $1 million into health insurance outreach, in part to make up for a lack of federal funds, said Allison Espeseth, managing director at Covering Wisconsin, the state’s navigator agency. She said the money will go to radio and TV spots, billboards, bus ads and small grants to community organizations.

“A lot of people who lost jobs and insurance didn’t know they could enroll before open enrollment, so we are hoping to see them now,” Espeseth said.

Toula Barber, 60, is happy to be among those who got clear and useful help. “I’m not that savvy with computers and figuring all this stuff out,” said Barber, who lives in Manchester, New Hampshire. After she lost her job as a waitress in August, Barber’s health insurance lapsed at the end of September. A First Choice Services navigator helped her find a plan with coverage that started Oct. 1. She pays $200 a month after subsidies.

Because that plan has a $6,000 deductible, however, Barber said she would look for something better during open enrollment, in consultation with the same navigator.

An analysis published last summer found evidence of a shortage of enrollment assistance. It also pointed out that people who turned to insurance brokers rather than independent navigators for help sometimes we’re presented with the option of plans (such as short-term policies or cancer-only policies) that don’t meet ACA standards.

“The bottom line was that nearly 5 million people who sought help during the last open enrollment could not find it,” said Karen Pollitz, a senior fellow at KFF and one of the authors of the study. “I’m concerned that people will face barriers to finding help this year, too.”

Some States Are Pushing Harder

In contrast to the states that use the federal website, healthcare.gov, many of the 15 states that run their own ACA marketplaces are committing more resources to outreach and marketing this year to meet the higher demand.

“We market aggressively,” said Peter Lee, executive director of Covered California, that state’s marketplace. “We want everyone who needs coverage to get it.” Of Covered California’s $440 million budget this year, Lee said $140 million will go for marketing and outreach. In addition, California is inserting information about the marketplace and subsidized coverage in all unemployment checks.

Just short of 300,000 Californians have enrolled since the pandemic began, and about half did so because they lost employment-based coverage, said Lee.

At the same time, however, about 1 in 4 Covered California enrollees dropped out this year, higher than the normal turnover as some newly qualified for Medicaid and an unknown number could no longer afford the premiums. Still, enrollment was at an all-time high of 1.5 million as of June.

In New York, state officials and private groups have been helping people enroll in Medicaid, marketplace plans or other state-supported programs.

“We’ve been super busy since April,” said Elizabeth Benjamin, vice president of health initiatives at the Community Service Society of New York, an independent advocacy group for low-income residents. “Our governor prioritized this, so it’s going well.”

One challenge Benjamin noted are the fears that a case currently before the Supreme Court might overturn the law. “Our clients keep asking whether the ACA will still be around next year,” she said. “We reassure them it will.”

Madeline McGrath, 27, sought insurance help from the service society in May after her coverage through the Peace Corps expired. The corps laid off all its overseas staff in March. Madeline was in Moldova. She returned home to Chazy, New York. She qualified for Medicaid, and just in the nick of time: A few weeks earlier, she had been diagnosed with Crohn’s disease, a chronic digestive disorder.

“I’ll stick with Medicaid since my copayments are very low,” said McGrath, who is pursuing a graduate degree.

This article originally appeared on Kaiser Health News on November 12, 2020, and also ran on Fortune.

KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.

Subscribe to KHN’s free Morning Briefing.

Kaiser Health News

Kaiser Health News (KHN) is a nonprofit news service committed to in-depth coverage of health care policy and politics. And we report on how the health care system — hospitals, doctors, nurses, insurers,...

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