Last week Speaker Pelosi and House Democrats offered a pathway to more affordable coverage by introducing the Patient Protection and Affordable Care Enhancement Act (H.R. 1425). Despite coverage gains achieved by the Affordable Care Act, affordability of that coverage remains a challenge for millions of Americans. The onset and continuation of the COVID-19 pandemic has exacerbated the issue, as many people lose employment and access to their coverage – disproportionately people of color. The bill released last week is a strong and urgently needed step toward closing the affordability gap. People across the country, including many of the “essential workers” who have kept the country moving during the pandemic, lack affordable coverage. They need a solution now. Across from Congress at the Supreme Court, the Trump administration is filing briefs to strip health coverage and consumer protections from millions of Americans in their moment of need, arguing for repeal of the ACA in its entirety. The juxtaposition must not go unnoticed.

Affordability is not a new issue.

Even before the pandemic, health coverage and care has been out of the reach of millions of people across the country. Prior to the COVID-19 outbreak, only 55 percent of adults were adequately insured. In 2017, 45 percent of uninsured adults said they remained uninsured because the cost of coverage was too high. The research is clear: people avoid or delay care or the filling of needed prescriptions when faced with high out-of-pocket costs. Even when people get care, they often incur crippling debts that can undermine family financial stability and their ability to pay for basic necessities like food, heat or housing. But rather than building on the foundation laid by the ACA, Republicans in Congress, joined in 2017 by the Trump administration, have spent the past ten years trying to rip coverage away from millions of people.

The coronavirus pandemic has increased the need for affordable coverage

The destabilizing effect of COVID-19 on the economy means that millions now face the prospect of unemployment and reduced or uncertain income. Over 36 million Americans have filed for unemployment as a result of the pandemic, highlighting the importance of improving affordability for those who lack Employer Sponsored Insurance (ESI). This problem is particularly acute for people of color, who are being hit harder by the pandemic. They are more likely to be exposed to the virus, more likely to receive bills for care they cannot afford, and more likely to lose their jobs as a result of the economic crisis COVID-19 has caused. 

And while much has been made of the “heroes” on the front lines of the pandemic – the essential workers putting themselves at risk, from long-term-care workers to mail carriers to grocery store clerks – too many of them are themselves uninsured or underinsured even as they put themselves at risk on a daily basis. They are disproportionately people of color and immigrants, and are often providing critical service to their communities without the protective gear they need to stay out of harm’s way. 

These essential workers are among those most likely to struggle with affording health care coverage. The same folks that are keeping the country running do not earn enough to pay for essential needs and are working in jobs that cannot be conducted remotely, raising their risk of infection and worried about their ability to pay bills – especially medical bills, according to a recent Kaiser Family Foundation poll.  For example, 58 percent of long-term-care workers (including aides, personal care and home health workers) make less than $30,000 and one in six home health workers are uninsured. Retail salespersons and cashiers, including grocery store workers, have the largest number of uninsured workers in the country and often lack paid sick leave. The average food and beverage store cashier earns only $24,990 a year. Building cleaners, janitors and groundskeepers earn an average annual salary of only $31,250 and most struggle to afford insurance. COVID-19 has shown us that even our most essential workers, those putting their health at risk to protect the rest of us, face structural barriers to affording health coverage and care. If we want to thank our heroes, we should ensure that they can access affordable coverage.

What does affordability look like? 

Better affordability tax credits for people without ESI is an idea that has won widespread support – a coalition made up of the U.S. Chamber of Commerce, hospital groups, device makers and others recently sent a letter to Congress urging immediate action. The House bill increases both the size of tax credits and also makes more people eligible for assistance. We applaud this step forward that recognizes the need for a new definition of affordability that is better connected to families’ economic reality and tradeoffs among the most basic needs (food, housing and health care).

A beginning, not an end.

While the new House proposal is a big step in the right direction, more needs to be done to make sure that coverage and care are affordable for all. Community Catalyst recently took a deep dive into the issue of affordability and also offered sweeping recommendations on how coverage, access to care and better health could be promoted in the context of COVID-19. In the weeks and months ahead we will be digging in further on issues related to cost-sharing and particularly on ways to address the long-standing racist policies and practices that undermine the health and economic security of Black and Brown communities and other groups that have suffered from discrimination. In the meantime, we call on Congress to speedily enact the vital improvements contained in H.R. 1425.