Americans at risk: Nearly 18 million could lose health coverage by year’s end if Congress does not act 


April 29, 2022

Nearly 18 million Americans could lose health coverage while millions more will see sharp increases in the premiums they pay, as a number of pandemic-related provisions aimed at making health care both more affordable and accessible are set to expire. 

The American Rescue Plan, passed in March 2021, increased affordability under the Affordable Care Act (ACA) by lowering monthly premiums – but only through the end of this year. While the House voted to make the premium subsidies permanent as part of its support for the Biden economic and health package, action has stalled in the Senate. In addition, the Families First Coronavirus Response Act, passed in the early days of the pandemic, suspended Medicaid disenrollment and expanded Medicaid eligibility, but both of these provisions expire when the current federal public health emergency declaration ends – and that could happen later this year. 

“Almost 18 million people could lose coverage due to cost, a frenzied eligibility redetermination process and bureaucratic paperwork,” Families USA said in a report released in late March. The group urged Congress to extend the premium discounts, provide new opportunities for low-income people living in Medicaid non-expansion states to access affordable coverage, and take additional steps to reduce Medicaid coverage turnover. 

The Families USA report states that action taken in the American Rescue Plan was “monumental, taking the most significant step since (passage of the) ACA to lower the cost of coverage and provide coverage to people without health insurance. As a result, total enrollment in the ACA marketplace is up 2.5 million in 2020, a 20 percent increase.” 

And it lays out what is at stake. “On the 12th anniversary of the Affordable Care Act, we have reached the lowest uninsured rate our country has ever had – 8.9 percent. If Congress and the Biden Administration do not act, that may be the lowest the uninsured rate will ever be. More people in the U.S. stand to lose their health coverage over the next 12 months than in any previous 12-month period.” 

In addition, Families USA notes, when the Biden Administration declares an end to the current public health emergency, which could happen this fall, nearly 80 million people who now rely on Medicaid for health coverage will enter a “potentially chaotic eligibility redetermination process in which states have old contact information and enrollment assisters are overwhelmed.” 

The timing of the approaching “health care cliff” is problematic. In a briefing paper released last week, the Center for American Progress explained that the rate-setting process for 2023 marketplace plans is already underway. Issuers are required to submit proposed rates to state regulators beginning in May and to the Centers for Medicare and Medicaid Services by June or July; final rates for states using the federal enrollment platform are due on August 17. 

In October, CAP explains, and state-based marketplaces typically open for “window shopping” to allow consumers to view available plans and compare rates before open enrollment officially begins on November 1. “Passage of legislation that extends the subsidy enhancements before these rate filing deadlines would allow states and insurers to better prepare for 2023 open enrollment,” the CAP paper states. 

Just how high could some Americans’ health insurance premiums climb when the year ends? The Center for American Progress report finds that across the U.S, marketplace insurance-holders would see premiums rise by an average of $59 per month, with a low of $47 per month in Texas to a high of $128 per month in West Virginia. People with incomes ranging between about $35,000 – $92,000 for a family of three would have to pay $1,045 more per year for their insurance premiums. An estimated 3 million people would become uninsured because they could no longer afford the ACA marketplace premiums; they are part of the 18 million estimate cited above. 

The Kaiser Family Foundation offers this warning: 

“In the event (American Rescue Plan) subsidies are allowed to expire, the timing of the resulting impact on insurance affordability could become an election issue. The American Rescue Plan premium subsidy enhancements are set to expire at the end of 2022. Open enrollment begins on November 1, just one week before the midterm election is held on November 8, 2022.” 

Frederick Isasi, Executive Director of Families USA, said the subsidies must not be allowed to expire. 

“This is the moment to build on the ACA’s historic successes in increasing affordability, improving access, and helping millions of families get and keep health care coverage – especially as we battled the worst public health emergency in at least a century,” Isasi said in a statement. “We urge policymakers in Congress, the Biden Administration, and in state governments to act in their constituents’ best interest by protecting these unprecedented coverage gains. Twelve years after health care reform was signed into law let’s honor its promise of ensuring access to affordable health coverage for every person and family in America.” 

Affordable Care Act
American Rescue Plan