Today, March 23, marks the 12th anniversary of the Affordable Care Act (ACA). According to a press release, the U.S. Department of Health and Human Services (HHS) released a report published by the Centers for Medicare & Medicaid Services (CMS), entitled “State of the ACA,” highlighting data on the 2022 Open Enrollment Period and key healthcare coverage gains made under the Biden-Harris Administration.
The release states that “Nationwide, 2.8 million more consumers are receiving tax credits in 2022 compared to 2021. These tax credits are helping families keep more money in their pockets for essentials as we recover from the COVID-19 pandemic.”
Further, “During the first full year of the Biden-Harris Administration, nearly 6 million new consumers signed up for coverage through the Marketplaces nationwide during the 2021 Special Enrollment Period (SEP) and this year's Open Enrollment Period (OEP). This includes 2.8 million people who newly enrolled during the SEP and more than 3 million who newly enrolled during the OEP. Thanks to the ARP, Marketplace plans were more affordable than ever, contributing to a record-breaking 14.5 million consumers nationwide signing up for health care coverage—a 21 percent increase from last year.”
“A report released by the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) showed that more Americans have gained coverage during 2021, as the ARP and other Administration policies took effect,” the release continues. “In addition, without the ARP, the average monthly premium after Advanced Premium Tax Credit (APTC) for HealthCare.gov enrollees would have been $59 per month higher, or 53 percent higher. According to a new ASPE report released today, an estimated 3.4 million Americans currently insured in the individual market would lose coverage and become uninsured if the ARP’s premium tax credit provisions are not extended beyond 2022.”
The release adds that the uninsured rate fell after implementation of the ARP, the 2021 SEP, and expanded outreach efforts—the uninsured rate for the U.S. for the third quarter of 2021 was 8.9 percent, down from 10.3 percent for the last quarter of 2020.
To celebrate this milestone, HHS and CMS hosted a livestream event on March 23. HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure delivered opening remarks about the state of the ACA and how the Biden-Harris Administration is building on the law to expand access to quality, affordable health coverage and care. Additionally, HHS officials from across the Department participated in a panel discussion on the ACA. Panelists include Alison Barkoff, Acting Administrator and Principal Deputy Administrator, Assistant Secretary for Aging; Tom Coderre, Acting Deputy Assistant Secretary for Mental Health and Substance Use, Substance Abuse and Mental Health Services Administration; Diana Espinosa, Deputy Administrator, Health Resources and Services Administration; Elizabeth Fowler, Deputy Administrator and Director, Center for Medicare & Medicaid Innovation at CMS; Dan Tsai, Deputy Administrator and Director, Center for Medicaid and CHIP Services at CMS; and Meena Seshamani, Deputy Administrator and Director at CMS. Melanie Fontes Rainer, Counselor to the Secretary, moderated the panel.
Becerra began by saying that instead of giving shoutouts to the audience one by one, he was going to instead point out what they’ve accomplished together. “We've reduced the number of uninsured Americans in this country by 20 million,” he said. “We have extended insurance coverage through the marketplaces under the Affordable Care Act and through Medicaid and its expansion in close to 40 states. Today, there are 31 million Americans who can count on access to a good doctor [and] quality hospital services as a result of the Affordable Care Act. Today, there are 133 million Americans who don't have to worry again about an insurance company saying, ‘Oh yeah, we don't accept people for coverage who have preexisting medical conditions.”
Before introducing Brooks-LaSure, Becerra added that “I will simply say to you, just as in the 1960s when President Johnson was about to enact Medicare, or just as in the 1930s when President Roosevelt was enacting Social Security—people were naysayers, people were deniers. But we're America. And we make progress. We move forward. And so, to each and every one of you Americans who actually had a hand in drafting, crafting, implementing the Affordable Care Act, thank you so very much.”
Brooks-LaSure then took the stage and said, “Today, the Affordable Care Act is at the strongest point in its history. Thanks to 12 years of diligent implementation efforts, defense in the courts and in Congress, and implementation of the American Rescue Plan Act of 2021. As a result, healthcare costs are historically low. A record high of 14.5 million people signed up for coverage through the health insurance marketplaces during the recent open enrollment period. Two new states have expanded Medicaid over the last year and the healthcare system is providing access to better quality, more affordable care to millions of people across this country. Thanks to the ACA is expansion of the Medicaid program, over 18.7 million adults are now covered across 39 states and the District of Columbia.”
“At CMS, we are dedicated to delivering better healthcare and health coverage for all people,” she added. “Yesterday, CMS staff celebrated these milestones alongside longtime supporters [and] early implementers of the ACA from the Biden-Harris Administration, as well as former CMS administrators. Together, we entered the ACA along with the Social Security Act Amendments of 1965 into the CMS museum to commemorate the incredible impact of the ACA on our country. As you know, I helped draft the ACA as a committee staffer on the Hill and helped implement the law at HHS and at CMS during the Obama administration. Yesterday, it was one of my proudest moments as CMS Administrator to dedicate a redlined copy of the ACA to CMS, and to thank CMS staff for the work that they have done and will do for the American people.”
During the panel discussion, Fontes Rainer asked Seshamani, “How did the ACA change coverage for prescription drugs?”
“As you may know, the Affordable Care Act closed the doughnut hole, which was the gap in coverage and prescription drugs in Medicare,” Seshamani said. “And by doing so, more than 15 million seniors saved more than $60 billion. Just think about how that one provision so dramatically impacted people's access to care. But I think as you all also know, high-cost prescription drugs continue to be an issue for our nation for people with Medicare—people over 65 with end stage renal disease, with disability, who really rely on prescription drugs to keep them healthy. We at CMS are committed to advancing equity driving high-quality person-centered care. But if the medications that you need to take to stay healthy, are unaffordable or too expensive, that prevents us from being able to keep people healthy.”
Seshamani added, “As a physician, I have seen this. When I had a patient [on Medicare] who had an ear infection that wouldn't go away—I'm an ear, nose and throat doctor—I was on my smartphone, on GoodRx, trying to find a prescription that she could afford. And I've seen it also as an economist working on how we build these care models that are going to keep people healthy and keep them out of the hospital. But then the high cost of the medications negates all of the work that you're doing. Being able to have Medicare and negotiate drugs would enable affordable drug prices and foster the scientific innovation for the cures that we need. That is some of the work that we can build on starting from that foundation in the ACA with closing the doughnut hole.”
Later in the panel, Fontes Rainer asked Fowler, “How are we thinking differently [since the law went into effect] about the delivery of care and payment? What are you thinking about and what are you focused on?”
Fowler said, “In terms of value-based care and our movement to value based care, we've realized that it's more of a marathon and not a sprint. We've made significant progress, but we've also recognized that we have quite a bit of a ways to go in the Innovation Center. We've had four models that have been certified to be expanded in duration and scope. But I think that that number belies the real impact that these models have had.”
“We feel like we've made progress, but we've got a way to go in terms of what comes next,” Fowler added. “We're trying to shift to thinking more about the patient as the focal point for care delivery models. In the past, we've thought about moving providers into alternative payment models, and I think that's still important. But really, we have to focus on why we are doing this. It's to improve care for patients. We're really trying to reorient our models to thinking about care improvements and value- based care from a patient perspective. And I think the other point is that we're really thinking about health equity, which has become a real central driving force. It's something that's very important to our Administrator Chiquita Brooks-LaSure, she's encouraged all of us to think about how our work impacts underserved populations. So, we are building in elements of health equity into everything we do from [the] development of models to thinking about how we evaluate the model, the data that we're collecting, and really trying to make sure that we're bringing on board some of those providers that serve underserved populations.”
Fowler commented, “And the last thing I'll say is that we saw during COVID, of course, the vast health disparities and I think that's part of what has motivated this real focus on equity. COVID-19 also showed how vulnerable and fragile our healthcare system is, but what we have seen is that providers that focused on value and had made that transition to value-based care instead of being totally reliant on fee-for-service payments really did better. I think we're also thinking that during a pandemic that there are not very many bright spots. But I think one bright spot is that it does demonstrate that we can build more resiliency into our healthcare system by focusing more on value. That's why I'm really pleased to be back in the department working with Dr. Seshamani, working with the administrator and, of course, our other Deputy Administrator in Medicaid, and all the folks on the panel to think about how we can improve care.”
The press release from HHS concludes that “HHS is hosting a week-long celebration of the 12-year anniversary of the ACA, from March 21 through March 25, highlighting the impact of the law and the Biden-Harris Administration’s commitment to building on its success. The theme of this week-long celebration is: ‘ACA: 12 Years of Advancing Health Equity for All Americans.’ During the week, each day, HHS will spotlight ways in which the ACA has made gains in addressing health disparities of women and families, kids, older adults, people with disabilities, LGBTQI+ and communities of color.”
