Brooks-LaSure Chiquita, Fowler Elizabeth, Mauser Gayle
Chiquita Brooks-LaSure ( CBrooks-LaSure@manatt. com ) is a managing director at Manatt Health Strategies, Manatt, Phelps & Phillips, LLP, in Washington, D.C.
Elizabeth Fowler is executive vice president for programs at the Commonwealth Fund, in New York City.
Health Aff (Millwood). 2020 Mar;39(3):509-513. doi: 10.1377/hlthaff.2019.01411.
The Affordable Care Act (ACA) significantly improved health insurance coverage in the US, but too many Americans remain under- or uninsured. This article examines federal strategies under consideration that build on the ACA to extend comprehensive coverage to all low-income Americans and increase coverage affordability for middle-income Americans. For low-income Americans these policy options include extending the enhanced match rate offered to states that expanded eligibility for Medicaid in the early years of the ACA to states that have not yet expanded Medicaid and increasing Marketplace cost-sharing subsidies. To address the issue of affordability for middle-income Americans, this article considers options for lowering premiums (for example, extending tax credits to people with incomes above the current eligibility threshold, increasing the generosity of tax credits for those currently eligible, and making reinsurance permanent), lowering cost sharing (such as tying premium tax credits to the second-lowest-cost gold plan rather than the equivalent silver plan and extending federal assistance for cost sharing to people with incomes above the current threshold), and establishing a public option.
《平价医疗法案》（ACA）显著改善了美国的医疗保险覆盖范围，但仍有太多美国人未得到充分保险或没有保险。本文探讨了正在考虑的联邦策略，这些策略以《平价医疗法案》为基础，旨在将全面保险覆盖范围扩大到所有低收入美国人，并提高中等收入美国人的保险可承受性。对于低收入美国人，这些政策选择包括将《平价医疗法案》早期向扩大医疗补助资格的州提供的增强匹配率扩展到尚未扩大医疗补助的州，以及增加市场成本分摊补贴。为了解决中等收入美国人的可承受性问题，本文考虑了降低保费的选项（例如，将税收抵免扩展到收入高于当前资格门槛的人群，增加对当前符合资格者的税收抵免慷慨度，并使再保险永久化）、降低成本分摊（如将保费税收抵免与第二低成本的黄金计划而非同等的白银计划挂钩，并将联邦成本分摊援助扩展到收入高于当前门槛的人群）以及建立公共选项。
