United states health care reform progress to date and next steps pdf

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The ACA Marketplaces Are Poised To Weather COVID-19

COVID presents a new test for the nongroup market, which includes individual plans in the ACA marketplace as well as ACA-compliant plans sold outside it and noncompliant forms of coverage, such as short-term plans. Given the massive job losses from the pandemic-driven economic recession, the nongroup market and the financial assistance that the ACA makes possible are playing a vital role in helping Americans stay insured amid the ongoing public health crisis.

This issue brief provides an overview of the ACA marketplaces, including their enrollment levels, financial stability, and levels of insurer participation. It also describes the effects that COVID could have on insurers and enrollment in the nongroup market and provides policy recommendations to strengthen the nongroup market for both consumers and insurers.

Individuals and families who do not receive health coverage directly from their employer or through public programs such as Medicare and Medicaid may seek coverage in the nongroup, or individual, market. Nationally, nearly 9 in 10 marketplace enrollees receive financial assistance toward their coverage. The ACA marketplaces have endured numerous attempts to undermine their stability. This past spring, the U. Supreme Court ruled that the federal government must honor its risk corridor payment obligations.

During the Trump administration, the individual market has faced an intense onslaught of attacks. The Trump administration has also used its executive authority to expand and promote the use of short-term, limited-duration insurance. Short-term plans, which are only loosely regulated, can discriminate against people with preexisting conditions in coverage and pricing. The gravest threat to the marketplaces at present is the ongoing Texas v. California lawsuit, supported by the Trump administration, which could eliminate financial assistance for marketplace coverage and leave 23 million Americans uninsured.

Supreme Court is expected to hear the case this fall and issue a ruling in Unsubsidized enrollment both outside and within the marketplace has fallen due to a number of factors, including migration to short-term plans, less outreach to the uninsured, and the zeroing out of the individual mandate penalty. In addition, more than 1 million people are covered by individual plans that are not ACA-compliant, including grandfathered, pre-ACA plans and short-term plans.

Starting in , the ACA required individual market insurers to spend a minimum share of premium dollars on claims for medical care and quality improvement and provide rebates to the policyholders of any difference. The rebate payments to be disbursed this year, based on claims costs from to , are expected to be even greater according to the average MLR of 77 percent over the time period.

The MLR provision has prevented insurers from capturing excessive profits through overcharging premiums, pressuring them to instead keep premiums flat or reduce them. Similarly, Cigna reported a medical care ratio of Cigna expanded its presence in 10 states this year; 30 insurance giant UnitedHealthcare, which greatly reduced its marketplace footprint in , 31 has discussed reentering multiple states in , 32 including Maryland 33 and Washington state 34 ; and Oscar Health has said it will add four new states in Every county in the United States has been served in the ACA marketplaces by at least one insurer every year.

The timing of the COVID pandemic poses a challenge for insurers in the nongroup market, who will need to lock in premiums for coverage amid the rapidly changing situation and major unknowns about medical spending in the near future. The first U. The COVID relief packages that Congress passed in the spring require insurers to cover testing for the virus without cost sharing. The pandemic has, however, suppressed other types of health care utilization.

Experts predict that not all care postponed during the pandemic will ultimately occur. The Society of Actuaries has developed simulations of the effect of the pandemic on health care expenditures relative to a typical year, underpinned by these assumptions: The costs of testing, treatment, and wide-scale administration once a vaccine is ultimately approved are a major source of uncertainty for insurers.

Another big unknown is to what extent the elective procedures delayed in may result in a surge in or later. Yet preliminary rate filings show that insurers expect that these countervailing factors will largely cancel each other out over time.

Among the 19 states that had made their initial rate filings public as of August 13, insurers attributed, on average, 0. A handful of carriers have requested large increases to potentially cover testing expenses. Many carriers have not requested unusually large rate hikes or are including a disclaimer requesting the right to modify their filings later this summer based on new information.

Still others did not mention COVID at all in their actuarial memorandums accompanying the rate filings. The economic contraction caused by the pandemic is expected to drive workers and their family members who lose job-based coverage to marketplace coverage.

According to a recent report from Families USA, an estimated 5. Many more could lose job-based coverage as the pandemic continues. Millions of people are expected to become eligible for or enroll in marketplace plans over the coming months. A May analysis by the Kaiser Family Foundation estimated that 8. Without particular changes in life circumstances, people can enroll in marketplace coverage only during the annual open enrollment period. The open enrollment period for marketplace coverage ended in December in most states and later in the winter for others.

The most common qualifying event is the loss of health coverage, which could occur due to job loss, getting divorced, becoming ineligible for Medicaid, or other reasons. The SEP enrollment process requires that potential enrollees provide documentation of eligibility, which can be cumbersome under normal circumstances and prohibitively burdensome during the pandemic.

As people who lose their job-based coverage sign up for marketplace plans, however, others who are enrolled in the marketplaces may transfer to Medicaid instead as their incomes fall. Given the great uncertainties about , policymakers should consider ways to encourage insurers to remain in the market and ensure that consumers face fair prices for coronavirus-related care.

The federal government and states should take the following steps. Given the unique circumstances of a global pandemic and widespread job loss, the federal government should offer an opportunity for Americans to enroll in health coverage outside of the open enrollment period. Like actions taken by most of the states that operate their own marketplace, the federal government should open a COVID SEP with broad eligibility to allow Americans to obtain comprehensive coverage and financial assistance.

To maximize insurer participation, competition, and consumer choice in the marketplaces, CMS and states should provide flexibility from the traditional rate filing schedule. Insurers should be allowed to revise rates closer to open enrollment—instead of being forced to commit by mid-summer or earlier—because the spread of COVID, innovations in treatment, and the policy environment are all rapidly changing.

No drug manufacturer, health care supplier, laboratory, or provider—including hospitals and physicians—should be allowed to gain profits due to the pandemic. While the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security CARES Act provide protection to many patients against out-of-pocket costs, unchecked high prices charged to insurers could come back to hurt consumers in the form of higher premiums later on.

The Trump administration rolled back consumer protections on short-term insurance, allowing plans to be offered for up to one year and renewed indefinitely.

The next administration should restore the limits on short-term plans, which would not only reduce the chance that consumers mistake them for comprehensive coverage but also strengthen the ACA-compliant risk pool and lower premiums for comprehensive coverage. The ACA led to a historic expansion of health insurance, yet millions of Americans still remain uninsured or underinsured.

In late June, the House passed H. Meanwhile, states that have not yet created reinsurance programs through the ACA should do so to support the nongroup market during the pandemic and beyond.

Many of the attempts to undermine the legislation have been political; the ACA repeal lawsuit, for example, remains the biggest threat to the nongroup market. Nicole Rapfogel is a research assistant for Health Policy at the Center. This publication was made possible in part by a grant from the Peter G. Peterson Foundation. The statements and the views expressed are solely the responsibility of the Center for American Progress.

Download the PDF here.

Less Coverage and Higher Costs: The Trump’s Administration’s Health Care Legacy

The pandemic crisis is almost certain to change many American industries. It would be a shame if health care is not one of them. A number of major practices have been altered to help the country cope with the extraordinary demands that the pandemic has imposed on the health care system. This article argues that the changes should include allowing physicians to practice across state lines, the broader use of telemedicine, the expansion of the health care workforce, and a new model for health care insurance. Even the most vocal critic of the American health care system cannot watch coverage of the current Covid crisis without appreciating the heroism of each caregiver and patient fighting its most-severe consequences. Hospitals are being built in parks and convention centers, new approaches to sterilizing personal protective equipment PPE for reuse are being implemented, and new protocols for placing multiple patients on a single ventilator have been developed. Most dramatically, caregivers have routinely become the only people who can hold the hand of a sick or dying patient since family members are forced to remain separate from their loved ones at their time of greatest need.

What Will U.S. Health Care Look Like After the Pandemic?

The Century Foundation takes your data security and privacy seriously. That's why we want you to know that, when you visit our website, we use technologies like cookies to collect anonymized data so that we can better understand and serve our audience. For more information, see our full Privacy Policy. The American health care system in beset with inequalities that have a disproportionate impact on people of color and other marginalized groups.

Data are derived from the National Health Interview Survey and, for years prior to , supplementary information from other survey sources and administrative records. The methods used to construct a comparable series spanning the entire period build on those in Cohen et al 8 and Cohen 9 and are described in detail in Council of Economic Advisers For prior years, data are generally but not always biannual.

Forming a Just Health Care System

The Role of the College and Its Membership in Advancing the Reform Agenda

President Biden will deliver bold action and immediate relief for American families as the country grapples with converging crises. President Biden will move quickly to contain the COVID crisis by expanding testing, safely reopening schools and businesses, and taking science-driven steps to address the communities — especially communities of color — who have been hardest hit by this virus. And, President Biden will launch a national vaccination program to inoculate the U. President Biden will take swift action to tackle the climate emergency. The Biden Administration will ensure we meet the demands of science, while empowering American workers and businesses to lead a clean energy revolution.

The health care repeal lawsuit that he helped advance to the U. Supreme Court could invalidate the entire ACA next spring, ending coverage for more than 20 million Americans, driving up costs for those seeking to buy coverage on their own, and eliminating consumer protections for millions of people with preexisting conditions—all in the midst of the COVID pandemic. Since President Trump took office, millions of Americans have lost health insurance coverage. The number of uninsured Americans rose by 2. Census Bureau. Among the 41 states with increases in their numbers of uninsured residents, the largest increases were in Texas , and Florida ,

United States Health Care Reform: Progress to Date and Next Steps.

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