Better Health Coverage, Better Outcomes: The Urgent Need to Make ACA Improvements Permanent

By Nora OBrien-Suric, PhD

Across New York State and the country alike, recent efforts to close the health insurance coverage gap have been making coverage more affordable and accessible. At the Health Foundation for Western and Central New York, our efforts to pursue health equity include advocating for health coverage for all New Yorkers and working to ensure that equitable care and insurance are available and accessible for all people.

That’s why we are concerned to see extremely beneficial improvements to the Affordable Care Act (ACA) are at risk of ending this year—with these decisions potentially being made over the next few months. It is urgent that Congress not only extend these improvements but make them permanent.

According to the Center on Budget and Policy Priorities, without congressional action this summer, people shopping for marketplace coverage will be notified of these looming premium hikes this fall and an estimated 3.1 million people will lose coverage and become uninsured in 2023.

How Have Improvements to the ACA Helped?

The Biden Administration’s American Rescue Plan (ARP) provided the greatest investment in health care access and coverage since the ACA was passed. This federal COVID relief fund containing $1.9 trillion significantly expanded eligibility for subsidies, making health care coverage on the ACA Marketplace more affordable.

In addition, the ARP made more people eligible for premium tax credits, ensuring that enrollees with moderate incomes pay no more than 8.5 percent of their incomes toward premiums.

Here are a few highlights of how these changes have helped:

  • Coverage increased by 21 percent because of expansions of cost-saving subsidies in the ARP.
  • Americans saved an average $800 per person annually because of ARP affordability measures.
  • 8 million new consumers enrolled during the 2021 Special Enrollment and Open Enrollment periods.
  • Thanks to the improvements to the ACA, 219,000 New Yorkers enrolled in the Marketplace during the 2021 open enrollment period—a 3 percent increase.

Why Is It Important to Make These Changes Permanent?

Simply put, better health care coverage leads to better health outcomes. With these improvements to the ACA, fewer Americans have faced the daunting choice between affording medical care and other necessities, or forgoing care overall.

Improving health care coverage is also strongly linked to efforts to improve racial health equity and close disparities by enabling historically uninsured and underinsured communities to access coverage.

In fact, a study published by The Commonwealth Fund in January 2020 found that as a result of previous ACA coverage expansions, uninsured gap rates between Black and white adults fell 4.1 percent, and 9.4 percent between Hispanic and white adults; and all three groups experienced better overall access to care in expansion states. Black adults in expansion states reported coverage rates and access to care measures as good as or better than what was reported by white adults in non-expansion states.

Unfortunately, these important efforts to make health care more affordable for Americans will discontinue soon unless legislation is passed to extend them or make them permanent.

Additionally, the COVID-19 Public Health Emergency (PHE) – initially declared January 27, 2020, and most recently extended on April 12, 2022 – will expire on July 15, 2022, if no action is taken. The PHE allows the U.S. Department of Health and Human Services to provide significant flexibility to Medicare, Medicaid and providers to respond to the COVID-19 pandemic. When the PHE expires, many of these flexibilities will need to be rolled back. These changes will particularly affect older adults, people with disabilities and people with chronic conditions.

It is imperative that these changes are made permanent. We should learn from the COVID-19 pandemic and—rather than waiting for the next public emergency—make long-term, holistic legislative improvements to our health care system to ensure all people will continue to have access to the care they need and deserve.