The Washington PostDemocracy Dies in Darkness

The Health 202: It's taking months for the Labor Department to deliver expanded COBRA benefits

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with Alexandra Ellerbeck

Congress decided in March to fully fund COBRA benefits for laid-off Americans, as yet another way to maximize the number of people with health coverage during the coronavirus pandemic.

Yet for the most part, enrollees were still charged their full monthly premiums during the first two months of the expanded benefits — a sign of how hard it is to quickly implement a new benefit in a system already known for being clunky and confusing.

“It’s not easy for people to even get basic information about what they’re supposed to do,” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University.

The benefits are plagued by confusion and delays.

Under the American Rescue Plan Act signed by President Biden in March, the federal government will cover 100 percent of COBRA premiums for people who were laid off involuntarily for six months, from April 1 through Sept. 30.

That’s a huge plus for people in these plans. Under COBRA, laid-off workers can choose to stay on their former workplace health plan for a limited period, provided they pay the whole premium — including the portion formerly covered by their employer — plus a 2 percent administrative fee. That can often add up to thousands of dollars a month.

The expanded COBRA benefits were among several measures in the coronavirus relief package aimed at getting more Americans into affordable health insurance plans amid the pandemic. Chief among these was expanded subsidies for private plans sold on and state-run individual marketplaces.

The marketplace subsidies took only a few weeks to kick in, and consumers were quickly notified by the Department of Health and Human Services.

But getting the new COBRA benefits to people is much more complicated.

Employers had to wait on the IRS to spell out exactly who qualified for the extra subsidies (they’re only for people laid off involuntarily, but that definition needed more clarifying). That guidance came out just two weeks ago, on May 18. In addition, employers weren’t even required to notify past employees of the benefits until the end of May.

In the meantime, COBRA enrollees were still on the hook for their full premiums in April and May — even though the expanded benefits technically took effect on April 1.

“They shouldn’t be billed for COBRA at all,” said Chris Keller, a principal at Groom Law Group who specializes in health benefits. “Obviously, since it’s taken some time to get rolling, that hasn’t happened.”

Enrollees who paid COBRA premiums in April and May are supposed to get paid back, either through a refund or a credit for future coverage. 

Michael Trupo, a spokesman for the Department of Labor, said those who paid the premiums during those two months should contact their plan administrator to obtain a refund. If they have difficulty, they should contact the agency's Employee Benefits Security Administration for assistance, he said.

But for some, the uncertainty made it hard to decide whether to keep paying hefty premiums or when to get urgent medical care.

Two readers reached out to me with tales of frustration.

Andrew Karam, a 59-year-old Brooklyn resident with prostate cancer, said he delayed getting a biopsy for a few weeks in April while waiting for benefits to kick in. He had been laid off from his job on March 12 and decided to enroll in COBRA because of the extra federal subsidy.

  • Karam said he did pay the full premium for April, along with submitting the paperwork to his employer and the plan administrator, which in this case was a company called WEX. But he still received no proof of insurance, forcing him to delay the biopsy for a few weeks. When he received the procedure, he still didn’t know how much he’d have to pay out of pocket for it, he told me.

A former journalist told me he enrolled in COBRA after being laid off from a major newspaper chain at the end of 2020. While his employer stopped paying its share of the premiums at the end of March, the journalist said he decided to continue the coverage when he heard of the additional federal relief.

  • But he was dismayed in April to receive the full $2,200 premium bill. He said he spent several weeks calling his former company and PayFlex — a company which managed the COBRA benefit — without getting answers. Ultimately, he didn’t pay the bill and has been without coverage until his new employer’s health plan kicks in June 1.
  • “It’s extremely frustrating for me and for my family,” he told me. “When you’re unemployed the last thing you want to worry about is health insurance for your children and your family. When it’s promised this is going to be part of the Recovery Act, they need to deliver on it.”

Ahh, oof and ouch

AHH: The Food and Drug Administration is nearing a deadline to decide about a controversial Alzheimer’s drug.

“By June 7, the FDA is expected to make one of its most important decisions in years: whether to approve the drug for mild cognitive impairment or early-stage dementia caused by Alzheimer’s. It would be the first treatment ever sold to slow the deterioration in brain function caused by the disease, not just to ease symptoms. And it would be the first new Alzheimer’s treatment since 2003,” The Washington Post’s Laurie McGinley reports.

“Approval is far from assured. While everyone agrees there is an enormous need for new treatments — about 6.2 million Americans have Alzheimer’s, a number expected to more than double by 2050 — the drug’s messy, complicated history is sparking a battle among researchers, doctors, patients and advocates about whether the medication works and what regulators should do,” Laurie writes.

Supporters of aducanumab, a monoclonal antibody made by the biotech company Biogen, say that while the clinical data is far from perfect, the drug could help some patients and spur increased research and investment. 

But critics argue evidence for the drug’s effectiveness is weak. One late-stage clinical trial showed a positive impact, but another was negative. An FDA advisory committee last fall recommended against approval and sharply rebuked the FDA for what it considered an overly optimistic appraisal of the drug.

OOF: Industries are lobbying to codify rules put in place during the pandemic.

“From margaritas-to-go to marijuana deliveries to virtual doctor visits, the pandemic prompted states to ease rules to make life at home more bearable. But the looming end of emergency orders has teed up a lobbying frenzy in state capitals to make these Covid-era conveniences permanent fixtures in American life,” Politico’s Dan Goldberg and Sam Sutton report.

The rush to codify pandemic-era rules comes as governors are starting to wind down pandemic-era emergency declarations and state legislatures are preparing to adjourn. 

“Industry representatives and lobbyists for restaurants, telehealth providers and medical marijuana agree this year has been one of the busiest and most successful legislative sessions they’ve ever seen. The American Telehealth Association is tracking roughly 600 bills, six times its usual workload, with many of those permanently extending measures that helped the once-niche industry explode into a major player,” Dan and Sam write.

Here are some of the changes under consideration:

  • In Pennsylvania, advocates are pushing to make permanent rules that allowed patients to get medical marijuana via curbside pickup.
  • In New Jersey, lawmakers are deciding whether to make permanent a rule that allowed nurses and physician assistants to prescribe medication for substance use disorder without physician sign-off.
  • Texas lawmakers recently passed legislation permanently allowing Medicaid to cover telehealth. The state is one of more than a dozen that have moved to codify some of the pandemic’s telehealth rules.
OUCH: 60 percent of kids in the Washington region have not had in-person schooling since March 2020.

Around 40 percent of the 700,000 public school students in the expansive Washington area, encompassing parts of Maryland and Virginia, are learning once a week in a school building. The remaining 420,000 students have been remote since March 2020. In the two school districts that are majority Black and low-income — D.C. Public Schools and Prince George’s County Public Schools — just 28 percent of students are learning in person part of the week, The Post’s Perry Stein, Donna St. George, Hannah Natanson and Kate Rabinowitz report.

“Nationally, in-person learning has been steadily on the rise. By March, 61 percent of students across the country were enrolled in hybrid or full-time in-person learning, according to federal data focused on fourth- and eighth-graders. But across the country, school districts are reporting that low-income families of color were least likely to return to school buildings. These families often live in neighborhoods that have been hit hard by the virus, and where trust in schools and government institutions is low and health outcomes are poor,” our colleagues write.

D.C. Mayor Muriel E. Bowser (D) has said that schools will open full-time starting in the fall with all students attending in person. But she’s offered a caveat: kids may be able to continue virtual schooling if they get a medical exception. It’s unclear how many families will seek exemptions and how doctors will assess patients seeking notes to continue with virtual learning.

The push to vaccinate

A Maryland barbershop offered coronavirus vaccines, along with a cut and a shave.

During a recent vaccine clinic, the Shop Spa, a barbershop in Maryland that serves a predominantly Black and Latino clientele, handed out free fish sandwiches and coupons toward haircuts. Organizers are hoping that it could serve as a national model.  

“As the United States enters what is likely to be the toughest stretch of its ambitious immunization effort, health officials are moving away from mass vaccination sites and focusing instead on small clinics like The Shop Spa that rely on word-of-mouth and use trusted, often nontraditional messengers,” The Post’s Lena H. Sun reports.

A new partnership between business leaders, the University of Maryland and the White House is working to reach out to barbershops and stylists across the country to promote vaccinations. The partnerships come as the administration is racing to promote vaccinations in order to meet Biden’s goal of vaccinating 70 percent of the population by July 4.

More in coronavirus news

  • The Centers for Disease Control and Prevention eased coronavirus guidance for summer schools Friday. The new rules say that vaccinated adolescents do not need to wear masks at camp and younger campers can generally go without masks outdoors, The Post’s Karin Brulliard and Lena H. Sun report.
  • A leading scientist has joined a growing number of experts calling for a full investigation into the origins of the novel coronavirus, The Post’s Steven Zietchik reports. Peter Hotez, a professor of pediatrics and molecular virology and microbiology at Baylor College of Medicine and a leading expert on the virus, warned of a “covid-26 and covid-32” if society fails to understand the origins of covid-19. Hoetz called for a six- to 12-month investigation in Wuhan, China, on NBC News’s “Meet The Press.”
  • The number of Immigration and Customs Enforcement detainees testing positive for the coronavirus has risen from 370 in mid-March to nearly 1,500 last week, The Post’s Maria Sacchetti reports. The rise in cases stands in sharp contrast to the much-larger Bureau of Prisons, which saw just 60 cases last week.
  • A group of 117 unvaccinated staffers from Houston Methodist Hospital filed a lawsuit seeking to avoid the hospital’s coronavirus vaccine mandate, The Post’s Derek Hawkins reports.

Sugar rush

With Brood X beginning to emerge in the billions, scientists are hoping to answer some of the many questions surrounding these cicadas. (Video: Alice Li/The Washington Post)