RWJF: How policymakers can build on $1.9T COVID bill to boost coverage access

Policymakers should build upon the foundation of the newly-minted COVID-19 relief package to continue improving access to coverage, according to experts at the Robert Wood Johnson Foundation.

The group released a new collection of policy recommendations that offer a pathway for legislators to further expand coverage access. In it, RWJF analysts argue that the American Rescue Plan offers critical assistance in the short-term, but there's more to be done to ensure long-term gains.

"As both the costs and benefits of medical treatment have increased over time, the consequences of lacking insurance coverage have only grown," the researchers wrote. "Yet our nation has addressed the unmet need for coverage in a piecemeal and inadequate fashion."

The $1.9 trillion relief bill includes funding to boost subsidies for the Affordable Care Act for two years and offers a boost to the Federal Medical Assistance Percentage (FMAP) for that same window to entice recalcitrant states to expand Medicaid.

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Closing the Medicaid coverage gap is a key step to boosting access to coverage, according to the report. There are 2 million people who would gain coverage if Medicaid was expanded nationwide, the analysts said.

Should states not take up the FMAP boost to expand Medicaid, policymakers should look to other ways to extend coverage to this population. The exchanges, including a potential public option, offer a potential solution to cover people who can't access Medicaid otherwise.

Policymakers should also look beyond increased subsidies to improve the affordability of exchange plans, according to the report. Potential steps include increasing the actuarial value of benchmark plans, which would lower out-of-pocket costs, or implementing an income-based cap on out-of-pocket costs.

In tandem, legislators should look for ways to make it easier for workers to choose between ACA exchange plans and the plans offered by their employer, to ensure they enroll in the most cost-effective option for them, RWJF's researchers said.

"Creating a truly equitable coverage system will require significant eligibility expansion, meaningful cost containment, and additional revenue. There are a number of administrative and legislative actions that can be taken to support coverage in the short term," the authors wrote.

"Many are already underway or have been included in the American Rescue Plan Act of 2021. Building on that, policymakers should consider additional actions to create a long-lasting, equitable and affordable system of health insurance coverage," they said.