Build on what we have to cover everyone

Over the past 25 years, the nation has made substantial progress in expanding access to health coverage—vastly increasing the number of children and low-income people who are covered and guaranteeing that those with pre-existing medical conditions are able to obtain the coverage and care they need.

As a result, today more than 90 percent of Americans have health coverage through their jobs, the Affordable Care Act (ACA), Medicare or Medicaid.  

Still, the United States falls short in providing universal health coverage and access to care.  It’s imperative to close the gap that leaves 10 percent of the population vulnerable, without disrupting coverage and care for the nearly 300 million people who already are covered.

The Affordable Care Act provides the framework. The health reform law enacted in 2010 protects people regardless of their health status, guarantees a robust set of essential benefits, extends protections for those with employer-based coverage, gives states incentives to expand Medicaid and offers significant financial assistance to eligible individuals who purchase coverage on their own.

It provides a firm foundation on which to build on what we have to ensure everyone has coverage at a more affordable price.

Most of the uninsured today—including three quarters of those recently unemployed due to the COVID-19 pandemic—are eligible for financial assistance to help them obtain coverage through Medicaid, the ACA marketplaces and other programs. In many cases, people simply don't know they are able to access programs that literally could change their lives.

Lawmakers should enhance federal tax credits to help more people afford coverage, enact policies to lower out-of-pocket costs and boost outreach and enrollment programs to encourage people to obtain and maintain insurance. Medicaid should be supported and improved, with an emphasis on closing coverage gaps created by the uneven expansion of Medicaid in the states.

Nearly 20 million people have gained coverage under the ACA, with all states and the District of Columbia having lower uninsured rates today than they did before the law’s implementation. The largest percentage improvements in the uninsured rate have been among people of color

Though they got off to a famously shaky start, the ACA marketplaces have evolved to provide consumers with a choice of plans, stable coverage—and stable premiums. Approximately 11.4 million consumers enrolled in marketplace plans during the 2020 open enrollment period, and for next year, 22 more insurers will offer coverage, the third consecutive year of increased choice for consumers. Premiums are also declining for the third year in a row, with many states seeing double-digit premium decreases.

This is the path to a better, more inclusive health care system.

Additional Resources:

• Read our statement to the House Energy and Commerce Subcommittee on Health on proposals to achieve universal health coverage here.
• Learn more about the Affordable Care Act here.
• Read insights on how states can lower premiums and increase consumer choice here. 
• See our infographic on how reinsurance reduces premiums here.