Will the American Rescue Plan Reduce the Number of Uninsured Americans?
The Commonwealth Fund 3/22/21
The Congressional Budget Office estimated the increased financial support in the ARP will cover 2.5 million people who otherwise would have been uninsured between 2021 and 2023. About half of the increase comes from the enhanced premium tax credits, with about 1.3 million uninsured people gaining coverage in 2022. These limited coverage improvements likely stem from the temporary nature of the provisions. There are several additional ways Congress and the administration could get more people covered, including:
- making the ARP premium tax credit enhancements permanent and improving the cost-protection of marketplace plans
- allowing people with incomes below poverty in Medicaid nonexpansion states to enroll in marketplace plans
- fixing the so-called family glitch
- fully reinstating funding for navigators and further expanding advertising and outreach efforts
- encouraging enrollment in marketplace coverage and Medicaid by lifting enrollment barriers, simplifying plan choices, and letting eligible people enrolled in other public programs like food assistance automatically enroll in Medicaid
- offering a choice of a government-operated “public plan” through the marketplaces and creating a mechanism that would automatically enroll uninsured people
- allowing people with offers of employer coverage to enroll in the public plan.
New estimates from the Urban Institute indicate that the first two items alone could insure 7.5 million people in 2022 at a federal cost of $56 billion. Prior research has shown that combinations of these changes could enable the United States to cover all Americans with an increase in annual federal spending of $122 billion to $161 billion. If the Supreme Court upholds the constitutionality of the ACA in California v. Texas, Congress will have the tools it needs to make further coverage inroads. It just needs the political will.
