ACHP Urges Policymakers to Solidify Affordable Care Act Changes

The Alliance of Community Health Plans (ACHP) released recommended steps to build on the success of the Affordable Care Act (ACA) and enhance and expand coverage in the individual health insurance market.  

First, ACHP recommended enhancing and expanding marketplace subsidies and making permanent the temporary subsidy changes included in the American Rescue Plan Act. The American Rescue Plan was introduced as part of the Biden administration’s coronavirus relief plan. 

These changes included expanding subsidies above 400 percent of the federal poverty level (FPL) for individuals and families paying 8.5 percent or more of their income, increasing subsidies for individuals and families earning 150-400 percent FPL, and ensuring zero-dollar silver plan premiums for individuals and families earning less than 150 percent FPL.  

The subsidy changes in the American Rescue Plan Act lower costs of premiums and ensure easier access to care for millions of Americans. Making these changes permanent will allow the ACA to further the success of the individual health insurance market. 

The second suggestion that ACHP provided was to establish a federal reinsurance program. Reinsurance programs ensure that consumers’ premiums will not increase when their insurers experience high-cost claims. Many states have implemented successful reinsurance programs, however a federal program would take away the uncertainty of states having the ability to renew the programs due to budgets.  

A federally-funded reinsurance program would lower premium costs, bring younger and healthier individuals into the health insurance market, and make coverage affordable for many people. A state-run but federally-funded program with no state matching requirements would not increase spending for the state or the federal government. 

ACHP also recommended allowing silver-loading to be permanent. After the Trump administration terminated cost-sharing reductions (CSR), payers started to build the cost of CSRs into silver-level marketplace plans. This allows consumers to still receive the benefit of CSRs.  

Silver-loading assures consumers that they will have continued access to affordable coverage. The elimination of CSRs and silver-loading also made premium-free ACA bronze-level health plans available for more consumers due to payers raising their silver premiums.  

The last step that ACHP recommended was to fix the “family glitch.” Under the ACA, an employee can qualify for subsidized marketplace coverage if their employer-sponsored insurance premium costs more than 9.83 percent of their household income. 

However, the law does not extend subsidized marketplace coverage to dependents and other family members. 

This leaves individuals paying more than necessary for coverage because they are not eligible for marketplace plans. The glitch affects more than 5 million consumers. Over half of the affected population are children and six in ten of the adults who are impacted (59 percent) are women. 

ACHP suggests the Biden administration fix the family glitch by severing the employer's responsibility to cover dependents and let dependents find coverage through the individual health insurance market. This would produce a decrease in uninsured dependents and provide them with more affordable access to care.  

With the start of a new year and a new administration, ACHP has released several fact sheets in recent months laying out recommendations for payer-related topics. 

In addition to supporting the ACA, the organization pushed for health equity in telehealth, arguing that current regulations may stifle telehealth’s growth in underserved communities. ACHP also supported implementing a national coronavirus testing strategy and making coronavirus vaccination data available to health plans to boost member engagement. 

A series of fact sheets from ACHP laid out the benefits of Medicare Advantage plans and the opportunities that these plans present to payers in the coming year. 

The fact sheets highlight that, after a strange year under the influence of the pandemic, there is a lot of potential for change and growth in the payer industry in 2021.