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The Affordable Care Act: Next steps after COVID-19

Trends over the last year show how public and private insurance can work together to ultimately achieve universal coverage, a decades-long policy goal.

Photo by engin akyurt on Unsplash
The levels of tragedy and loss caused by the COVID-19 pandemic are almost unimaginable to comprehend. Amidst the loss of 500,000 American lives, we’ve faced economic devastation, school closures, and socially isolating health measures― all leading to associated increases of stress, anxiety and depression.

In less than a year, the COVID-19 pandemic has laid bare many harsh realities about our vulnerabilities as a society. That includes the unavoidable conclusion that our country requires sweeping transformations to ensure all Americans can have access to affordable health care.

Fortunately, the rate of people with strong, baseline health insurance has remained very stable over the past year. As an industry, insurers rallied to make sure that access to COVID-related treatment and testing was widely available at no cost. And yet, we cannot be complacent.

The good news is that updates to the Affordable Care Act in the COVID relief package signed Thursday by President Joe Biden will help millions more Americans achieve coverage. Trends over the last year show how public and private insurance can work together to ultimately achieve universal coverage, a decades-long policy goal.

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Health insurance stability in the pandemic

Economic forecasts released last spring suggested that an uncontrolled pandemic could cause the number of uninsured Americans to grow by tens of millions. To prevent this type of surge, the Federal CARES Act established an “employee retention credit” to encourage continued health care benefits from employers. In addition, Minnesota was one of many states to launch a “special enrollment period” to give consumers more time to purchase individual health plans. And, as is common during a recession, coverage in Medicaid grew significantly.

Dr. Craig Samitt
Dr. Craig Samitt
A national study by the Kaiser Family Foundation confirmed a fortunate turn of events― expected declines in coverage across the country turned out to be significantly lower than anticipated. That was the case in Minnesota, where the state’s uninsured rate of 4.6 percent remained essentially unchanged during the first year of COVID-19.

If not for the expanded coverage put in place by the ACA, it is likely many more people would have gone uninsured. Further, federal assistance likely made maintaining health coverage feasible for many who otherwise would have chosen to forgo health insurance.

What comes next

The just-signed COVID relief package makes several important changes to the ACA, while also strengthening employer insurance. The bill’s improvements include a cap of premium costs at 8.5 percent of household income and, for people who lost their jobs because of the COVID pandemic, a temporary 100% subsidy of COBRA premiums.

To improve affordability and reduce out-of-pocket costs, Blue Cross and Blue Shield of Minnesota also recommends that Congress consider the following:

  • Reduce deductibles and out-of-pocket costs. By increasing the benchmark plan value from 70 to 80 percent of out-of-pocket costs at no additional premium, Congress could ensure that cost is not a barrier to seeking care.
  • Enhance assistance for young people. As a group, young people tend to be healthier. Encouraging more young people to obtain coverage would lower the overall health risks across insured populations, leading to lower premium costs for everyone. This provision is distinct from previous proposals to change “age rating” that would raise costs for some older Americans.

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These changes, coupled with the improvements in the new COVID relief package, would lower consumer costs. Moreover, they would enhance the stabilizing effect seen during the pandemic while putting the individual insurance market more on par with comprehensive employer-based insurance.

The U.S. Supreme Court and additional considerations

While the most recent Supreme Court case to challenge the ACA was met with significant skepticism from the justices, the ACA still faces some risk based on the case heard before the high court back in November. Given the importance of dependable health coverage during the pandemic, Congress should be prepared to quickly correct any Supreme Court decision that could run afoul of all the progress made to date and essentially set back the clock on health reform by at least 10 years.

In addition, a significant portion of those who lost employment during the pandemic were (or are now?) in jobs that are less likely to offer health benefits. That means these ACA changes should be coupled with updates to encourage enrollment of those currently eligible for help. In fact, research by the Congressional Budget Office (CBO) indicates that up to two-thirds of uninsured Americans may already be eligible for insurance help.

A path toward universal coverage

These steps represent a path to universal coverage and access to care for everyone, all without establishing a single new program. Lessons learned from the pandemic have shown a new way forward. Gaps in the system need to be prioritized ― and quickly. The opportunity to build a better and more equitable health care system is limited only by an unwillingness to change. I believe our continued response to making improvements will soon lead to the beginnings of a true recovery.

Craig Samitt is president and CEO of Blue Cross and Blue Shield of Minnesota.


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