CHICAGO — Building on the progress of almost 12 million Americans having enrolled in coverage offered through health insurance exchanges this year, the American Medical Association endorsed policies that aim to increase that number while taking steps to make health insurance on the exchanges more affordable.

Premium increases are being announced at the state level for the 2019 plan year, though 83 percent of consumers who buy coverage through exchanges receive subsidies to lower their premiums and will be shielded from such increases because their premium contributions are pegged to a defined percentage of their income. At its Annual Meeting, the AMA supported the policy of extending eligibility for these premium subsidies to individuals and families with incomes up to 500 percent of the federal poverty line ($60,700 for an individual), allowing more people to afford and obtain health insurance coverage. Under the ACA, eligible individuals and families with incomes between 100 and 400 percent ($48,560 for an individual) of the federal poverty line are being provided with refundable and advanceable tax credits to purchase coverage on health insurance exchanges.

The AMA also recommended steps to improve the affordability of exchange coverage for young adults to incentivize them to enroll in exchange coverage. The AMA backed the idea of offering “enhanced” premium tax credits for those aged 19 to 35 who already are eligible for premium subsidies. Under such a plan, young adults could receive a credit in addition to the amount they already are eligible for.

“We must build on the gains of the Affordable Care Act and make coverage more affordable for Americans by extending the eligibility for premium tax credits and increasing tax credit amounts for young adults that will result in greater coverage,” said AMA President David O. Barbe, M.D.

Looking ahead to 2019, as a result of the elimination of the individual mandate penalty, the Congressional Budget Office has projected that more individuals will become uninsured and premiums will increase.

In response to the loss of the federal individual mandate penalty, the AMA also encouraged state innovation, including considering state-level individual mandates, auto-enrollment and/or reinsurance, to maximize the number of individuals covered and stabilize health insurance premiums without undercutting any existing patient protections. To provide more of a lasting solution to stabilize premiums, the AMA also called for the establishment of a permanent federal reinsurance program.