How State and Federal Action Can Drive Health Care Affordability

State-Led Initiatives Depend on Continued Federal Backing 

When the Affordable Care Act (ACA) became law, it made comprehensive quality, affordable health coverage available to millions of people. It gave states new authority, tools and an infusion of federal funds to improve health care coverage and access. Updates to the ACA have made coverage even more affordable for so many people and families. These changes have also helped states tackle out-of-pocket costs, like co-pays and deductibles, that insurance alone doesn’t cover.  

Why Federal Action is Essential: 
Thanks to the Biden-Harris administration, the American Rescue Plan Act and the Inflation Reduction Act, health insurance coverage is more affordable than ever for millions of people across the country – especially low- and moderate-income families, Black and Hispanic individuals, people in non-Medicaid expansion states, and newly-arrived legal permanent residents. With the changes, many people can now get ACA Marketplace coverage without paying a premium – and save hundreds to thousands of dollars on health care costs each year. This means that many who previously struggled to pay for doctor visits can now get the care they need without going into medical debt – providing real financial security to families. 

When health insurance coverage is more affordable and accessible, people are able to take control of their health and avoid potentially devastating medical debt. When Kennita Hickman was diagnosed with several autoimmune disorders, she nearly lost her Medicaid coverage due to her income being considered too high. Thanks to a free ACA Marketplace plan, Kennita was able to access doctors and a therapist to support managing her health. 

What’s more – these federal changes have allowed for and catalyzed innovative efforts at the state level to even further reduce out-of-pocket costs that families face, so that even more people are gaining affordable health insurance and avoiding medical debt. 

Even with these successes, though, we’re facing a major problem. The extra help, called enhanced Premium Tax Credits (PTCs), made health coverage affordable for millions of people and enabled states to do even more to make care affordable. Unfortunately, it is set to end unless Congress steps in.   

Federal action to extend PTCs is crucial and will allow states to continue to come up with solutions that work to get people the care they want and need. Community Catalyst partners with organizations in five states—California, Colorado, Massachusetts, Pennsylvania, and Washington—to further reduce out-of-pocket costs for people who buy their own coverage and for people who have been unnecessarily, oppressively and systematically excluded from access to affordable coverage programs, including immigrants and undocumented residents. Both federal and state action is necessary to lower costs, so we’re advocating for permanent PTCs while we’re harnessing the power within communities to drive state policies that are led by and for the people.  

How States Are Making Care Even More Affordable: 

• Reducing Costs:  Our partners made progress passing, implementing and strengthening programs that make coverage even more affordable in their states, like in Pennsylvania where partners successfully passed legislation to make coverage more affordable for people who buy coverage on their state-based Marketplace.
• Improving Coverage: Partners in California, Washington and Colorado continue to advocate for improvements to Affordable Care Act plans, and both Washington and Colorado saw substantial increases in public option enrollment in their states.
• Expanding Access: States are also expanding coverage to communities that were previously excluded. In Colorado, a new policy allowed over 11,000 undocumented immigrants to enroll in high-quality, no-cost health coverage within just 36 hours.

These changes are helping make health care more affordable and accessible for many more people, demonstrating the impact of state and community-driven policy efforts. 

Read more about our work to make health care more affordable 

The good news is that Congress can take action to prevent millions of people from losing access to affordable health care. By extending the enhanced PTCs, Congress will allow states to continue their work in reducing other health care costs. 

People need a health care system that makes it easy to afford preventive care and visit the doctor when needed. That’s why Community Catalyst, along with local, state, and national partners, is working hard to highlight the benefits of affordable health care and push policymakers to extend them as soon as possible.