What the ACA Has Achieved and the Challenges

What the ACA Has Achieved and the Challenges Ahead The ACA and Health Reform in 2021 Michael Miller Community Catalyst Politics of Health Care in 2021 How Universal Coverage Can Be Achieved Via the ACA What States Can Do

Key Achievements of the ACA Preventative services with no out-of-pocket costs Protection for pre-existing health conditions (including pregnancy) Premium Tax credits to help pay for insurance coverage Reduce out-of-pocket drug costs for Medicare beneficiaries Creation of the Insurance Marketplace to compare plans and apply for coverage Allowing individuals under 26 to remain on a parent's health insurance plan Allow States to expand Medicaid to cover all adults below 138% of the Federal Poverty Level (FPL) Strengthen the Medicare Trust Fund

Judicial Threats California v. Texas Others? Political Threats Possible repeal attempt in 2025 Operational Threats Cost Sharing reductions Medicaid Block Grants and Work Requirements Short-Term Insurance Plans Slash funding for insurance navigators and reducing Marketplace participation Threats to the ACA

Politics of Health Care in 2021 • On one hand - pandemic and economic distress pave the way for some modest but important improvements • On the other - narrow Democratic majority and the policy preferences of individual Senators impose significant limitations

Politics of Health Care in 2021 WHAT CONGRESS IS DOING • Expand financial assistance in 2 important ways: • Lower premiums across the income spectrum (for 2 years) • Eliminate the "subsidy cliff" • Offer to pay states to expand Medicaid • Some other things to help the unemployed maintain coverage WHAT'S COMING NEXT • Make the premium improvements permanent • Tackle high cost-sharing in Marketplace plans • Try to figure out what approach to Public Option might have a chance of passage including direct federal coverage of lowincome people if states don't take up the expansion option • Downward pressure on Rx prices

Universal Health Care and the ACA How Do We Get There? EXPAND ELIGIBILITY • Close the Medicaid coverage gap • Address the problem of unaffordable ESI • Expand eligibility to currently excluded immigrants • Make some benefit and cost sharing improvements too MAKE IT EASIER TO GET & KEEP COVERAGE • Enrollment available year-round (at least for some people) • Make signing up for and keeping coverage easier � Standard plans � Enrollment assistance � Continuous eligibility

Increasing Access at the State Level • State can go beyond ACA requirements to: � Make coverage and care more affordable � Make it easier to get and keep coverage • Road to public option (or single payer) runs through the states • States need cooperation from Congress and the Biden Administration to make it happen