Want to Improve the Affordable Care Act? Here's How, Suggests ACP

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New policy statement offers specific strategies to ensure appropriate medical coverage for all

April 19, 2019 (ACP) – Believing that much more needs to be done to strengthen the American health care system, the American College of Physicians has created a road map for improving the Affordable Care Act.

In a new policy paper, ACP is calling for federal and state policymakers to embrace common-sense approaches to boost access to care so all Americans can have appropriate medical coverage. Published April 16 in Annals of Internal Medicine, the statement outlines strategies that aim to stabilize the health insurance market, boost enrollment in plans, lower premiums and expand Medicaid.

“Exploring ways to improve the ACA can help us better understand and address the unique needs of patients,” said Dr. Robert McLean, ACP's new president.

“It's important that physicians and other medical professionals account for how the ACA has made major progress in reducing the number of people who are uninsured, but also recognize that major challenges remain in providing access to care,” McLean said. “I believe there's a lot more that can be done to reduce coverage gaps and ensure that every American has affordable health insurance coverage for vital care.”

To that end, the new position paper supports a range of strategies, including:

Improving insurance affordability

To achieve this, ACP is calling for health insurance financial subsidies to be enhanced and extended to more people. “The eligibility requirements for premium tax credits and cost-sharing should be redesigned to enhance individual market insurance affordability,” the policy paper says. “Specifically, the 400% federal poverty level (FPL) premium tax credit eligibility cap should be eliminated, and the amount of premium tax credits for all income levels should be enhanced.”

Stabilizing the insurance marketplace.

Key to this, ACP maintains, is adoption of a permanent reinsurance program. In addition, the policy paper says, “steps should be taken by federal and state regulators to limit the sale of individual market plans that do not comply with ACA regulations, including extended short-term, limited duration plans; association health plans; and ‘grandmothered’ off-marketplace plans.”

Boosting enrollment

“Sustained funding is needed for dedicated outreach, consumer assistance, and education to promote open enrollment, provide in-person and virtual enrollment assistance, and respond to inquiries from the community,” the policy paper says.

ACP also supports federal and state-led auto-enrollment programs to help make sure all individuals can successfully enroll in health care plans.

Expanding Medicaid

ACP wants all states to fully expand Medicaid eligibility. In doing this, states “should not apply financially burdensome premiums or cost-sharing requirements, lock-out periods, benefit cuts or mandatory work or community engagement policies that have the effect of reducing enrollment among vulnerable individuals,” the policy paper says.

Developing a public insurance plan

ACP urges Congress to develop a public insurance plan that would generate competition among insurance companies and ensure that people have a variety of coverage options, no matter where they live. Last year, the policy statement notes, eight states had only one insurer offering coverage, leaving patients with no choices. Instead, ACP says that “eligible people should have the option of enrolling in a public program in all individual insurance markets.” In addition, the statement notes that “potentially, the public option could be expanded to serve as a stepping stone to universal coverage,” which has been a longstanding goal of ACP.

Moving forward, McLean said, “we encourage congressional leaders and the administration, as well as governments at the state level, to embrace patient-centered health care reform, take concrete action to ensure that the ACA continues to protect patients and make the necessary changes that would improve coverage for all Americans.”

A bill recently introduced in the House of Representatives – the Protecting Pre-existing Conditions & Making Health Care More Affordable Act of 2019 – does just that, according to ACP, as it would implement many of the strategies expressed in the new policy statement.

In a letter to House leaders, ACP said it strongly supports the legislation, noting that the bill “seeks to reduce health care costs and improve the accessibility and affordability of health coverage, while also taking steps to prevent current efforts underway to undermine the Affordable Care Act.”

More Information

ACP President, Robert McLean, MD, FACP, explains why ACP is offering recommendations to improve the ACA.

ACP's new position paper on the Affordable Care Act – Improving the Affordable Care Act's Insurance Coverage Provisions: An American College of Physicians Position Paper – is available on the Annals of Internal Medicine website.

ACP's letter of support for the Protecting Pre-existing Conditions & Making Health Care More Affordable Act of 2019 is available on the College's website.

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