House Majority Leader Hoyer, Majority Whip Clyburn to The Hill: Congress Must Not Forget About Protecting Access to Affordable Health Coverage

WASHINGTON, June 8 -- House Majority Leader Steny Hoyer, D-Maryland, issued the following joint commentary with Majority Whip James E. Clyburn D-South Carolina, to The Hill:

In 2010, we worked with our Democratic colleagues to achieve historic reforms to our health care system that would, at long last, make affordable and accessible quality health care a reality for tens of millions of Americans for whom it had been an aspiration. COVID-19 has highlighted the efficacy of those reforms. Millions of Americans lost their jobs during this worst-in-a-century pandemic. Because of the Affordable Care Act (ACA), accessible, affordable health care coverage was available to many of them when they needed it most. The pandemic also brought into high relief the need to improve and strengthen the ACA's foundation and continue our efforts to achieve universal coverage.

That's why, immediately after President Biden's election, we joined with him and our fellow Democrats in Congress to expand coverage and lower health care costs in the American Rescue Plan (ARP). That law increased the number of Americans with access to quality health coverage plans and made the subsidies in the ACA's health insurance marketplaces more generous. It also provided strong incentives to expand Medicaid to the states that have yet to do so.

According to the U.S. Department of Health and Human Services, the law's advanced premium tax credits reduced the cost of health care and made coverage available to 15 million uninsured Americans, lowered the cost of coverage for 9 million more already covered through ACA marketplace plans, and - on average - brought premiums down by $50 per person per month. Moreover, four out of five enrollees in such plans were finally able to identify a plan for $10 or less per month after factoring in tax credits, allowing a quarter of enrollees to upgrade their coverage.

Older Americans between the ages of fifty-five and sixty-four benefitted with the removal of the so-called "subsidy cliff," giving them access to health care plans that are significantly more affordable by keeping their monthly premium costs at or below 8.5 percent of their income.

These subsidies, coupled with special enrollment periods, led to coverage of 5.8 million more Americans and an all-time high of more than 35 million people enrolled in ACA plans as of early 2022. According to a new study from the Urban Institute, this surge in enrollment brought down premiums as a direct result of the ARP's subsidies "that increased the likelihood that healthy people would choose to buy coverage previously deemed unaffordable." Adding millions of healthy people to the risk pool, it not only made health care more affordable for everyone, it slowed inflation as well.

Twelve states have refused to expand Medicaid, leaving 2.2 million uninsured people caught in what is known as the "Medicaid coverage gap" - six in ten of them people of color. According to a report by the Center for American Progress, covering this population through Medicaid expansion would save an estimated 7,000 lives each year, shave $2 billion from medical debt, and lead to 50,000 fewer home evictions annually. Also, a recent study by researchers at the American Cancer Society found that expanding Medicaid would contribute to a two-year overall increase in survival rate among patients newly diagnosed with cancer.

That's why the House passed the Build Back Better Act in November, which addressed both these challenges by extending the premium tax credits and making ACA subsidies available to those in the coverage gap. We must continue to strive for universal eligibility and coverage. Provisions we included in the Build Back Better Act would help achieve this goal.

In a May 23 letter, twenty-six House Democrats representing competitive districts wrote: "These are historic advances in affordability, coverage, equity - and we regularly hear from constituents about how these significant reductions in health care costs have changed their lives, offering financial relief at a time when American families need it the most." Congress must act soon to ensure that these cost-saving measures do not disappear.

Some states like Maryland have already submitted their proposed premium rates for 2023. Congress needs to act quickly to make permanent the ARP provisions that are keeping Americans covered through ACA plans. In states like South Carolina, which so far have not expanded Medicaid, Congress should free them from the Medicaid gap and provide them access to affordable health care plans.

It has been 200 days since the House passed the Build Back Better Act. Congress needs to act now to provide certainty and stability for millions of Americans and avoid a worrisome spike in costs. As House Democratic leaders, we will continue promoting legislation to protect accessible, affordable health-care coverage that expands access and reduces costs for individuals and families. We urge our House and Senate colleagues to seek swift agreement on legislation that will provide certainty and reassurance to the millions now at risk of losing access to affordable, quality health care.

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May 23, 2022

To: The Honorable Charles E. Schumer, Majority Leader, United States Senate, Washington, DC 20510

The Honorable Nancy Pelosi, Speaker, United States House of Representatives, Washington, DC 20515

Dear Majority Leader Schumer and Speaker Pelosi,

We write today to strongly urge the inclusion of provisions to permanently lower the cost of health care in upcoming reconciliation legislation. Specifically, we ask that you include provisions to lower out-of-pocket health care costs and establish universal eligibility for health coverage. These provisions have already passed the House of Representatives in the 117th Congress, uniting our ideologically diverse Democratic Caucus around the shared conviction that every American deserves access to high-quality, affordable health care.

Our constituents elected us to lower their health care costs - and through the American Rescue Plan Act, we did just that. Thanks to the enhanced advance premium tax credits in the American Rescue Plan Act, individuals and families have seen their health care costs decrease substantially. Monthly premiums for Marketplace plans have decreased by $50 per person on average, four out of five enrollees can find a plan for $10 or less per month,/1 and families are saving an average of $2,400 on their annual premiums./2 These lower costs have led to historic coverage gains across the country: a record 14.5 million people signed up for Marketplace plans during the Open Enrollment period for 2022 coverage and more than 9 in 10 enrollees can receive premium tax credits./3 Rather than let these policies expire, we must extend them and make them a reliable feature of our health coverage system.

The expanded advance premium tax credits have also been essential in advancing health equity.

Historically, uninsured rates for Black, Hispanic,/4 and rural adults/5 have been higher than rates for white and urban adults - but thanks to the American Rescue Plan Act, these gaps are closing.

Approximately 65.5 percent of Black adults are now able to access a zero-premium plan and 75.5 percent can find a plan for $50 or less per month. Among Hispanic adults, approximately 68.7 percent now have access to a zero-premium plan and 79.9 percent can now find a plan for $50 or less per month./6 The advance premium tax credit expansion is expected to make zero- and low-premium health plans available to 78.7 percent and 88.4 percent, respectively, of current HealthCare.gov enrollees in rural counties./7

These are historic advances in affordability, coverage, equity - and we regularly hear from constituents about how these significant reductions in their health care costs have changed their lives, offering financial relief at a time when American families need it the most. We cannot afford to backslide on this progress. Our constituents cannot afford to go back to paying upwards of 20 percent - or more - of their household income on health care premiums.

These concerns are not hypothetical: earlier this month, insurers in Vermont became the first state to file proposed premiums for 2023 and are seeking approval of premium increases as large as 24.2 percent over 2022 rates./8 Other state-based Marketplaces have also shared data on projected premium increases for 2023 plans if the advance premium tax credit enhancements expire, including anticipated premium spikes of up to 40 percent for Minnesotans and up to 60 percent and 71 percent for Nevadans and Californians, respectively, who did not qualify for advance premium tax credits prior to the American Rescue Plan Act. In Connecticut, more than 65,000 enrollees will see their enhanced financial support reduced or eliminated, resulting in premium cost increases of an average of $1,584 per household per year./9

These out-of-pocket cost increases are imminent: starting this autumn, when enrollees begin receiving notices of their premium increases for 2023 health plans, our constituents will find that the same high-quality coverage that they have been able to afford thanks to the American Rescue Plan will now be out of reach. We cannot allow the progress we have made to be temporary. We must make lower out-of-pocket costs and expanded coverage a permanent pillar of our health care system, and reconciliation is our only chance to get this done.

Reconciliation is also a once-in-a-generation opportunity to extend coverage to millions of low-income people in states that have refused to expand Medicaid under the Affordable Care Act./10 The House-passed Build Back Better Act included a provision to extend coverage to this population and, through reconciliation, we can finally ensure that every American has access to health care - no matter what zip code they live in.

By extending enhanced advance premium tax credits and providing coverage for people in non-expansion states, we will deliver on the promises we made to our constituents to lower their health care costs and protect their care. We will be able to tell our grandchildren that, at long last, Democrats ensured universal eligibility for health coverage in the United States. We stand ready to join you in working to pass this critical legislation through Congress and get it signed into law swiftly. Thank you for your leadership on this urgent and shared priority.

View co-signers and footnotes here: https://www.majorityleader.gov/sites/democraticwhip.house.gov/files/frontliner-letter.pdf