She presented several specific recommendations to the committee:

• Make the temporary American Rescue Plan Act Marketplace subsidies permanent.
• Provide a zero-premium, zero-cost-sharing insurance option for Medicaid-eligible adults in the coverage gap in the 12 states that have not yet expanded their programs.
• Inform workers with employer coverage of their options to enroll in subsidized Marketplace plans and Medicaid and, if they lose employer coverage, that they are eligible for a Marketplace special-enrollment period.
• Fix the "family coverage glitch." About five million people are in family plans with premium contributions that exceed that threshold but are ineligible for Marketplace subsidies.
• Lower the "employer firewall" threshold from 9.83% to 8.5% of income. When combined with the fix to the family coverage glitch, this change would mean that no one would have to spend more than 8.5 percent of income for their health insurance.
• Rein in deductibles and out-of-pocket costs in Marketplace plans. One proposal could eliminate deductibles for some people and reduce it for others by as much as $1,650.
• Measures to protect consumers from the devastating consequences of medical debt include expanding the reach of the ACA's financial assistance policies for nonprofit hospitals to cover all hospitals and a broader range of providers; imposing stronger consumer protection rules for medical debt collection; and placing bans or limits on medical debt interest rates.
• Address the high commercial provider prices that are the primary driver of employer premiums and deductibles. This could be pursued by adding a public plan option to the Marketplaces, among other approaches.
• Develop an auto-enrollment mechanism to help people enroll and stay enrolled in comprehensive coverage. Creating a public plan as a default option would be essential to a national auto-enrollment program.

"The cost burden in commercial insurance is an enduring problem in U.S. health care that is undermining America's overall economic well-being," Collins concluded. "This year's U.S. Supreme Court decision reaffirming the constitutionality of the ACA paves the way for Congress to use the tools provided by the law to cover the remaining uninsured and make health care affordable to people covered by both public and commercial insurance. Doing so will help facilitate the country's post-pandemic recovery and its future prosperity."

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