Congress must not forget about protecting access to affordable health coverage

In 2010, we worked with our Democratic colleagues to achieve historic reforms to our health care system that would, at long last, make affordable and accessible quality health care a reality for tens of millions of Americans for whom it had been an aspiration. COVID-19 has highlighted the efficacy of those reforms. Millions of Americans lost their jobs during this worst-in-a-century pandemic. Because of the Affordable Care Act (ACA), accessible, affordable health care coverage was available to many of them when they needed it most. The pandemic also brought into high relief the need to improve and strengthen the ACA’s foundation and continue our efforts to achieve universal coverage. 

That’s why, immediately after President Biden’s election, we joined with him and our fellow Democrats in Congress to expand coverage and lower health care costs in the American Rescue Plan (ARP). That law increased the number of Americans with access to quality health coverage plans and made the subsidies in the ACA’s health insurance marketplaces more generous. It also provided strong incentives to expand Medicaid to the states that have yet to do so.   

According to the U.S. Department of Health and Human Services, the law’s advanced premium tax credits reduced the cost of health care and made coverage available to 15 million uninsured Americans, lowered the cost of coverage for 9 million more already covered through ACA marketplace plans, and – on average – brought premiums down by $50 per person per month. Moreover, four out of five enrollees in such plans were finally able to identify a plan for $10 or less per month after factoring in tax credits, allowing a quarter of enrollees to upgrade their coverage.

Older Americans between the ages of fifty-five and sixty-four benefitted with the removal of the so-called “subsidy cliff,” giving them access to health care plans that are significantly more affordable by keeping their monthly premium costs at or below 8.5 percent of their income.  

These subsidies, coupled with special enrollment periods, led to coverage of 5.8 million more Americans and an all-time high of more than 35 million people enrolled in ACA plans as of early 2022. According to a new study from the Urban Institute, this surge in enrollment brought down premiums as a direct result of the ARP’s subsidies “that increased the likelihood that healthy people would choose to buy coverage previously deemed unaffordable.” Adding millions of healthy people to the risk pool, it not only made health care more affordable for everyone, it slowed inflation as well.  

Twelve states have refused to expand Medicaid, leaving 2.2 million uninsured people caught in what is known as the “Medicaid coverage gap” – six in ten of them people of color. According to a report by the Center for American Progress, covering this population through Medicaid expansion would save an estimated 7,000 lives each year, shave $2 billion from medical debt, and lead to 50,000 fewer home evictions annually. Also, a recent study by researchers at the American Cancer Society found that expanding Medicaid would contribute to a two-year overall increase in survival rate among patients newly diagnosed with cancer.

That’s why the House passed the Build Back Better Act in November, which addressed both these challenges by extending the premium tax credits and making ACA subsidies available to those in the coverage gap. We must continue to strive for universal eligibility and coverage. Provisions we included in the Build Back Better Act would help achieve this goal.  

In a May 23 letter, twenty-six House Democrats representing competitive districts wrote: “These are historic advances in affordability, coverage, equity – and we regularly hear from constituents about how these significant reductions in health care costs have changed their lives, offering financial relief at a time when American families need it the most.”  Congress must act soon to ensure that these cost-saving measures do not disappear. 

Some states like Maryland have already submitted their proposed premium rates for 2023. Congress needs to act quickly to make permanent the ARP provisions that are keeping Americans covered through ACA plans. In states like South Carolina, which so far have not expanded Medicaid, Congress should free them from the Medicaid gap and provide them access to affordable health care plans. 

It has been 200 days since the House passed the Build Back Better Act. Congress needs to act now to provide certainty and stability for millions of Americans and avoid a worrisome spike in costs. As House Democratic leaders, we will continue promoting legislation to protect accessible, affordable health-care coverage that expands access and reduces costs for individuals and families. We urge our House and Senate colleagues to seek swift agreement on legislation that will provide certainty and reassurance to the millions now at risk of losing access to affordable, quality health care.

Hoyer represents Maryland’s 5th District and is the House majority leader. Clyburn represents South Carolina’s 6th District and is the House Democratic whip.