ARPA Subsidy Expiration will Impact Reproductive Healthcare Access

Around 850,000 women could lose health insurance coverage and reproductive healthcare access in 2023 if policymakers do not extend the premium tax credits under the American Rescue Plan Act (ARPA), according to an Urban Institute brief.

ARPA increased access to healthcare coverage by increasing Affordable Care Act (ACA) premium subsidies and extending subsidy eligibility. This helped improve access to healthcare for women in the individual marketplace, as the ACA requires qualified health plans to offer ten essential health benefits, including maternity care and mental healthcare.

ACA plans must also cover preventive care services, including reproductive health services, contraception, and cancer screenings, without cost-sharing.

Following the Supreme Court’s decision to overturn the constitutional right to an abortion, maintaining healthcare coverage is even more essential to protecting access to reproductive healthcare.

The ARPA premium tax credits are set to expire at the end of 2022. If leaders do not extend the subsidies, 850,000 women between 19 and 44 years old will be uninsured in 2023. Researchers predicted that this population would experience an insurance rate of 13 percent.

Among these women, 259,000 live in states that have expanded Medicaid eligibility to people up to 138 percent of the federal poverty level, but the other 591,000 live in the 12 states that have not expanded Medicaid.

According to the brief, coverage losses will be more significant in nonexpansion states because they have a larger share of low-income women enrolled in marketplace plans instead of Medicaid. The uninsurance rate in nonexpansion states is slated to be 19.3 percent compared to 10.2 percent in expansion states.

Expanding eligibility for marketplace coverage to include those with lower incomes could help close the coverage gap in nonexpansion states, the brief noted.

The researchers also examined abortion access ratings in each state to determine how ARPA premium subsidy expiration will impact women. Several nonexpansion states were rated as having “most” or “very” restrictive abortion access.

Regardless of Medicaid expansion status, an estimated 2.5 million uninsured women of reproductive age live in states with the most or very restrictive access to abortion. Around 384,000 women in these states would be uninsured if the ARPA subsidies were extended. They would also gain free access to contraception and other reproductive health services.

In addition, these women would have access to comprehensive health insurance benefits that would cover the cost of healthcare services to support a healthy pregnancy and delivery.

Following the decision to overturn Roe v. Wade, healthcare leaders, including CMS Administrator Chiquita Brooks La-Sure, voiced their intention to preserve abortion care access for health plan members.

Women of reproductive age are just one group who may lose insurance coverage if the ARPA premium tax credits expire.

A separate Urban Institute brief found that young adults, Black individuals, and low-income people will likely experience significant coverage losses. Individuals living in rural areas may also lose access to affordable healthcare coverage if the subsidies expire.

HHS recently released a report highlighting how ARPA premium subsidy expiration will lead to increased out-of-pocket healthcare spending. Over one million enrollees may maintain their insurance coverage but could lose their premium subsidies, the report found.