Proposed changes to ACA would reduce number of uninsured

A recent report breaks down the impact of two reforms to the ACA being considered as part of the fiscal year 20222 budget process.

By Alan Goforth | September 10, 2021 at 09:49 AM

Health insurance application Making rescue premium subsidies permanent and filling the Medicaid coverage gap would reduce the number of people without insurance by nearly one-quarter. (Photo: Shutterstock)

Congress continues to fine-tune the Affordable Care Act in an effort to expand coverage and hold the line on cost. Legislators are considering two reforms to the ACA as part of the fiscal year 20222 budget process.

Make the American Rescue Plan Act premium subsidies permanent. The act temporarily enhances premium tax credits in the Marketplace for 2021 and 2022. It lowers the limits on premiums paid by families who were eligible for subsidies before the legislation and expands eligibility for subsidies to individuals and families who previously were ineligible because their incomes were greater than 400% of the federal poverty line (more than $106,000 for a family of four).

Recommended For You

Extend eligibility for Marketplace subsidies in non-expansion states. Nearly six million uninsured adults living in the 12 non-expansion states do not have access to affordable health insurance coverage. Although health insurance coverage through the Marketplace is not as comprehensive as Medicaid coverage, expanding eligibility for Marketplace subsidies to this group results in large increases in coverage.

The Commonwealth Fund studied the potential coverage and cost implications of these two reforms. Among the highlights:

  • Making rescue premium subsidies permanent and filling the Medicaid coverage gap would reduce the number of people without insurance by nearly one-quarter, or seven million people, in 2022.
  • All states would see a drop in their uninsured population, with the largest percentage declines in states that have not yet expanded Medicaid eligibility.
  • Enrollment in subsidized Marketplace plans would nearly double, while premiums would fall by 18% on average.
  • Federal spending would increase by an estimated $442 billion over 10 years and, after accounting for increased revenues because of higher wages and some offsetting savings, this reform would increase the federal deficit by an estimated $333 billion if no other changes in policy were made.

"We estimate that making the enhanced ARPA subsidies permanent and filling the Medicaid coverage gap by expanding Marketplace eligibility to those earning below 100% of the federal poverty line would have significant changes on coverage," researchers concluded. "Together, these two policies would broadly expand eligibility for Marketplace subsidies, reduce the number of uninsured people, especially at lower income levels, and lessen household financial burdens for health care."

NOT FOR REPRINT

© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.

Alan Goforth

Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.

By Allison Bell | May 19, 2025

A three-judge panel at the 6th U.S. Circuit Court of Appeals ruled in favor of a disability plan administrator Thursday, and against a worker with long COVID, in a case involving questions about whether the administrator had used a reasonable claim review process.

Federal appeals court sides with disability insurer in long COVID case

By Allison Bell | May 19, 2025

The House Rules Committee is preparing to package the bill for floor action Wednesday.

HSA and ICHRA provisions survive ‘Big, Beautiful’ House tax bill fight

By Allison Bell | May 16, 2025

The common theme at the maker of Wegovy and at UnitedHealth may be investors' sudden awareness of cost-cutting pressure.

Health care giant, Novo Nordisk, pushes its CEO out
Address Your Clients' Evolving Long-Term Care Needs Effectively link

Guide

Sponsored by Trustmark Voluntary Benefits

Demographic shifts and rising costs make long-term care (LTC) a critical concern for employees of all ages. Equip yourself with insights into the LTC challenge and discover flexible hybrid solutions to help your clients prepare.

Broker's Guide to Mastering Client Open Enrollment & Boosting Employee Experiences link

Guide

Sponsored by isolved

Your HR clients often face common open enrollment pitfalls, such as administrative burdens and inadequate employee communication--leading to negative employee experiences. Learn how you can help your clients address these gaps. This guide offers brokers actionable insights to advise on streamlined processes and effective communication plans that will foster employee (and client!) satisfaction.

Employer Trends Across the Benefits Landscape: An HR Pulse Survey link

Report

Sponsored by New Benefits

Rising costs & low engagement challenge employers. This HR Pulse Survey reveals key trends from HR leaders across various industries and looks at the opportunities for brokers to elevate service, address pain points, and demonstrate ROI, especially with non-insured benefits.