Madison Richardswas one of more than 7,000 Peace Corps volunteers worldwide evacuated in March when the potential scale of the coronavirus pandemic became clear.

The decision brought Richards, who was serving in Peru, home to Racine. It also left her without a job and without health insurance.

But Richards who has a gastrointestinal condition, a common health hazard when working in a developing country was eligible for subsidized health insurance through the Affordable Care Act.

If I did not have this plan, she said, I would not be getting treatment, to put it simply.

This is the first economic downturn in which people who have lost their jobs can receive federal subsidies to help offset the cost of health insurance.

More than half of the U.S. population gets health insurance through an employer. And millions of people who have lost their jobs because of the pandemic also have lost their health insurance.

Yet insurance brokers in the Milwaukee area generally have not seen a large increase in people buying health plans through the Affordable Care Act.

There hasnt been a big surge as I expected at least yet, said Todd Catlin of TransitionsHealth Benefits in Brookfield.

That, though, is expected to change.

Many employers have continued to provide health insurance for their furloughed workers. But the Paycheck Protection Program, which gave employers forgivable loans if they keep people on payrolls, is coming to an end.

The recent surge in infections has increased the chances of a deeper and longer recession than initially projected. And an unknown number of businesses are unlikely to survive a prolonged downturn.

People who workin low-wage jobs that don't provide health benefits have made up a large share of those now unemployed because of the pandemic.But people who have had coverageare eligible for subsidized health plans through the Affordable Care Act under what is known as a special enrollment period.

This allows people provided they previously were insuredto get coverage after the annual open-enrollment period for certain life events, such as getting married, moving or losing a job. They have 60 days to sign up.

The cutoff for the subsidies, which are pegged to annual income, is $51,040 for one person.

Most people who are unemployedwould be eligible for subsidies. In all likelihood, they also would qualify for additional subsidies available to people with low incomes to help offset deductibles and other out-of-pocket expenses.

Richards is paying about $23 a month, for example, for a health plan with an out-of-pocket maximum of $1,500.

Nationally, about 154,000 more people through May had enrolled in health plans because they lost their jobs than in the same period last year, according to the federal government. It works out to a 46% increase.

(At the end of the open-enrollment period in December, about11.4 million people, including 195,498 people in Wisconsin, had coverage through health plans sold on the marketplaces set up under the Affordable Care Act.)

The increase in enrollment at least through May is relatively small.

Security Health Plan, a subsidy of Marshfield Clinic Health System, and Common Ground Healthcare Cooperative have yet to see a significant increase in people who have gotten coverage through the Affordable Care Act because they lost their jobs.

ButMarty Anderson, chief growth officer for Security Health, said he expects an August cliff when furloughs become layoffs.

Cathy Mahaffey, CEO of Common Ground Healthcare, also expects to see more who lost their jobs to get coverage in the next few months.

I believe its coming, she said, but certainly it hasnt happened yet.

Some signs already are appearing.

The number of people who bought health plans sold by Childrens Community Health Plan from February through June has more than doubled compared with last year, Mark Rakowski, chief operating officer, said in an email. The trend was even stronger in May and June.

Julie Kautzer, who lives Manitowoc, lost her job in mid-June when Holy Family College closed.She immediately signed up for coverage.

I knew I needed to have something, she said.

Kautzer is paying $58 a month for a health plan with an $8,000 deductible. She is healthy and that was enough coverage to give her peace of mind.

If something awful does happen, she said, it is going to cost a lot more than $8,000.

Kautzer who has since contacted several former co-workers to encourage them to get health insurance is grateful for the Affordable Care Act.

The law, though, remains controversial.

In late June, the Trump administration filed a brief with the U.S. Supreme Court arguing that the entire law must be declared invalid because of a change made by Congress in 2017.

The administration supports a lawsuit filed by Republican-controlled states challenging the law. (Under former Gov. Scott Walker, Wisconsin initially was among the states but has since withdrawn from the lawsuit.) The law is being defended by 20 states and the District of Columbia.

The Supreme Court isnt expected to issue a decision until late this year.

Kautzer is among those who opposethe Trump administrations push to end the law.

This is the worsttime to do that, she said. There are so many people who need it.

Yet even supporters acknowledge the law is flawed, in part because the subsidies are too small given the high cost of health care.And public support for the law remains split.

The Kaiser Family Foundation tracking poll found that 50% of those surveyed in April support the law though support for specific provisions, such as coverage for preexisting health conditions, is strong.

Richards medical condition, for instance, would not have been covered before the Affordable Care Act.

I need this, she said. And there are people who need it way more than me.

Many people who have gotten health insurance through an employer, however,may not realize that getting coverage through the Affordable Care Act is an option.

My sense is that for people who have been on employer-sponsored plans, it just doesnt register, said Chris McArdle of MKE Benefits. Its just not on their radar.

Yet someone who was 45 years old and who lost a job at the end of June that pays $45,000 a year would be eligible for a health plan that costs $63 a month, with a $500 deductible and an out-of-pocket maximum of $2,700.

Sometimes they are astounded by how affordable the marketplace can be, McArdle said.

Insurers have been flexible in allowing employers to keep furloughed employers on their health plans,said McArdle, who also sells insurance to small employers. And employers, by and large, have done that.

The question is how long some can continue to do that.

Employers are going to be faced with some tough calls, hesaid.

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