Payer Orgs Outline Steps Toward Achieving Universal Coverage

All Americans should have healthcare coverage and six steps can make universal coverage a reality, according to several significant healthcare organizations and entities including America’s Health Insurance Plans, the American Benefits Council, Blue Cross Blue Shield Association, and the US Chamber of Commerce.

“While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable health care market that provides access to high-quality care and affordable coverage for all,” the organizations asserted.

“Achieving universal coverage is particularly critical as we strive to contain the COVID-19 pandemic and work to address long-standing inequities in health care access and disparities in health outcomes. Let’s work together on solutions that are broadly applicable across all types of health insurance – employer coverage, individual market and public programs – to deliver the access to care and health outcomes that the American people deserve.”

While the nation has reason to celebrate some progress toward universal healthcare coverage in the past decade, the organizations pointed to the damage that the coronavirus pandemic wrought on the national insurance rate. Employer-sponsored coverage fell by 3.3 million between the months of April and July 2020 alone, adding 2.0 million to the uninsured population.

Furthermore, the pandemic has only deepened racial disparities in healthcare coverage, data has demonstrated.

Thirteen percent of the Black community and 13 percent of the Hispanic community could have lost their employer-sponsored health plan by the end of 2020—more than double the expected employer-sponsored insurance loss among White individuals, according to an Avalere report.

The organizations proposed six remedies to help move the nation further towards full healthcare coverage, primarily by bolstering the Affordable Care Act and Medicaid.

First, the organizations emphasized the importance of tax credits and cost-sharing reductions tied to health insurance. By enriching these supports, policymakers could reduce the family glitch, the subsidy cliff, and improve financial aid for young enrollees.

Second, since individuals with serious conditions quickly accrue hefty and often debt-inducing healthcare bills when uninsured, policymakers could consider a federal funding mechanism that offers financial support for those with high-cost conditions. Alternatively, such individuals could receive premium discounts or cost-sharing benefits.

Third, the organizations supported automatic enrollment. They recommended not only automatically renewing Medicaid and premium-free marketplace coverage for enrollees, but also automatically enrolling individuals who qualify.

Under the Trump administration, CMS more than once considered ending automatic re-enrollment for those already receiving premium tax credits that reduced premiums to $0, but the proposals never came to fruition.

Fourth, the statement emphasized the need for more federal funding for outreach and enrollment programs.

Since the previous administration reduced federal funding towards federal marketplace navigators down to ten percent of the Affordable Care Act’s original enrollment assistance, two federal marketplace states had no navigator services at all along with several counties in other states, a recent Kaiser Family Foundation issue brief explained.

Special enrollment periods require more federal funding, the brief found. This means that the call for greater funding is even more relevant now since the federal health insurance marketplace is in the midst of a special enrollment period.

“Many of the uninsured today are eligible for, but not enrolled in, coverage with financial assistance through ACA coverage with premium tax credits, Medicaid, the Children’s Health Insurance Program (CHIP), or their employer,” the organizations shared.

“Therefore, efforts to expand coverage must include robust outreach and enrollment efforts to connect people to the programs available to them today. We must pursue new solutions to address gaps in coverage and the affordability of coverage.”

Fifth, the organizations called for Congress to expand federal coverage. In particular, they recommended offering comprehensive coverage for people 138 percent of the federal poverty level. Policymakers should also fund a three-year 100 percent match for Medicaid expansion similar to what occurred in the first three years of the Affordable Care Act, the statement added.

Sixth, the statement recognized that it is not enough to decrease current uninsurance, but rather that policymakers must also seek to prevent future uninsurance increases, particularly as the pandemic continues to ravage the US.

Increasing COBRA subsidies during the pandemic, offering direct loans to employers, and boosting outreach around special enrollment periods are all methods for preventing future uninsurance.

The statement may fall on welcoming ears in the federal government, as the Biden administration's policies appear to align with many of these recommendations already. Recently, for example, the White House released its coronavirus relief plan which included increasing and extending COBRA subsidies and Affordable Care Act premium subsidies, among other initiatives.