Advocacy in action: Covering the uninsured

As physicians, we know all too well that people who lack health insurance coverage live sicker and die younger. And while we have made tremendous advances in providing quality coverage at lower cost to people across the nation, some work remains to place this coverage within reach of all who need it.

Cost has historically been cited as a reason for being uninsured—74% of nonelderly adults in 2019 said they were uninsured because coverage was not affordable. One in three insured adults reported it was difficult to afford to pay their deductible.

The nation’s uninsured rate did drop significantly in 2021 and early 2022, reaching an all-time low of 8% percent for U.S. residents of all ages in the first quarter of 2022, compared to the prior low of 9% percent in 2016.

About 5.2 million people have gained health coverage since 2020. These gains in health insurance coverage are concurrent with the implementation of enhanced subsidies for Affordable Care Act (ACA)  exchange marketplace plans, the continuous enrollment provision in Medicaid, several recent state Medicaid expansions, and improvements in enrollment outreach.

As millions of Americans have gained coverage resulting from the ACA, progress has been made on a longstanding policy priority of the AMA—expanding access to and choice of affordable, quality health insurance coverage.  

Instead of abandoning the ACA and threatening the stability of coverage for those individuals who are generally satisfied with their coverage, the AMA believes that now is the time to invest not only in fixing the law, but also in improving it. 

The AMA plan to cover the uninsured and improve affordability focuses on helping people who:  

• Are eligible for ACA’s premium tax credits yet remain uninsured.  
• Are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) yet who remain uninsured.  
• Remain uninsured and who are ineligible for the ACA’s premium tax credits due to having an “affordable” offer of employer coverage.  
• Remain uninsured because they fall into the ACA’s “coverage gap.”  
• Remain uninsured and who are ineligible for ACA financial assistance due to immigration status. 

Among other steps to cover the uninsured, the AMA supports: 

• Extending beyond 2022 of American Rescue Plan Act subsidies, which increase the generosity of premium tax credits to improve premium affordability and encourage tax-credit eligible people to get covered. 
• Permanently eliminating the subsidy “cliff,” thereby expanding eligibility for premium tax credits beyond 400% of the federal poverty level past 2022. 
• Providing enhanced premium tax credits to young adults. 
• Expanding the eligibility for and increasing the size of cost-sharing reductions. 
• Pursuing auto-enrollment—at the federal or state level—for people who qualify for zero-premium marketplace coverage or Medicaid/CHIP. 
• Adequate funding for, and expansion of, efforts to increase public awareness of ACA’s premium tax credits as well as Medicaid and CHIP outreach and enrollment. 
• Lowering the threshold that determines whether an employee's premium contribution is “affordable,” allowing more employees to become eligible for premium tax credits to purchase marketplace coverage. 
• All states taking the step to expand Medicaid eligibility to 133% of the federal poverty level. 
• Extending eligibility to buy ACA marketplace coverage to undocumented immigrants and Deferred Action for Childhood Arrivals (DACA) recipients, with the guarantee that health plans and ACA marketplaces will not collect or report data regarding enrollees’ immigration status. 

Lack of insurance or inadequate coverage prior to, during and after pregnancy is one of the factors driving inequities in maternal mortality and morbidity. Among other steps to improve maternal health, the AMA supports expanding Medicaid and CHIP coverage to 12 months postpartum. 

The AMA has:

• Successfully urged the Biden administration to fix the “family glitch”—a change the White House estimates will help 1 million Americans gain coverage or save money on health coverage. 
• Pushed for permanent expansion (PDF) of health insurance premium tax credits, ensuring millions of low- and middle-income families continue to have access to affordable coverage in 2023 and beyond. 
• Successfully urged adoption of stronger network-adequacy rules for Qualified Health Plans and Medicare Advantage plans. 
• Supported actions taken by states to extend Medicaid coverage for postpartum women from 60 days to 12 months after birth, including 13 states that have implemented postpartum Medicaid expansions and 19 that have authorized coverage expansions for postpartum women or are in the process to doing so. 

The AMA is:

• Urging the Biden administration to maintain the public health emergency that expands coverage for care and extends key regulatory flexibilities until there is an extended period of greater stability. 
• Fighting in court to defend the ACA’s coverage of preventive services with no cost to patients—a benefit enjoyed by more than 150 million people. 

• Recently adopted AMA policy on health insurance coverage and the Affordable Care Act. 
• “2024 and Beyond: AMA’s Plan to Cover the Uninsured” (PDF). 
• “AMA vision for health system reform” (PDF). 
• Key AMA policies related to health reform. (PDF) 
• AMA Council on Medical Service reports on coverage and choice, Medicare and Medicaid, and delivery reform.

Visit AMA Advocacy in Action to learn more about the advocacy priorities the AMA is actively working on.

The AMA works to generate support for policies critical to the nation’s health care system—and we can’t do it without your help. Learn more about ways to get involved with AMA advocacy.