ARPA should reduce underinsurance in the ACA marketplace

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• While free bronze plans have been widely available to low income marketplace enrollees since 2018, the American Rescue Plan makes free or very low-cost silver plans with much lower out-of-pocket costs widely available.
  
  
• Bronze plan enrollment at low incomes spiked during Open Enrollment for 2021
  
  
• The American Rescue Plan may already be reversing the drift toward bronze at low incomes

The Urban Institute estimates that if the American Rescue Plan Act's increases to subsidies in the ACA marketplace are made permanent, enrollment will increase by 5.1 million, and the uninsured population will be reduced by 4.2 million. The enhanced subsidies are funded only through 2022 at present.

Urban foresees most of this enrollment increase -- about three quarters of it -- occurring at incomes over 200% of the Federal Poverty Level.  But ARPA should also reduce underinsurance, primarily at incomes below 200% FPL.

While ARPA does not reduce out-of-pocket costs at any metal level, it does make silver plans, which come with strong Cost Sharing Reduction (CSR) subsidies at incomes up to 200% FPL, much more affordable to low income enrollees. 

Getting medical care like it's 1999

In the past year or two, job growth has returned to late-1990s levels. Wage growth has not. But thanks doubtless in large part to the ACA, access to needed medical care has also taken us back to the late Bill Clinton years, more or less.

Below is a chart of one measure of healthcare access from the latest data release of the National Health Interview Survey, including responses from January-September 2015. It's a brief history of lack of access to needed medical care in the U.S.:

Yes, Peter Suderman, the ACA covers the short-term as well as long-term uninisured.

Many people poring over the data still emerging from the ACA's first open enrollment season seem not to grasp  the volatility of Americans' insurance status.  Take Peter Suderman:

Kaiser’s survey finds that the majority of previously uninsured lacked coverage for two years, and that 45 percent reported not having coverage for five years. Which means that more than half of the previously uninsured were covered at some relatively recent point.

Now, many of those people clearly were having difficulty getting coverage for some reason—perhaps as a ripple effect of the recession, perhaps because of some other factor. But many of them appear not to be completely uninsurable. These are not people who couldn’t get insurance under any circumstance. They’re people who didn’t have it for the last several years.

Obamacare’s supporters would no doubt say that the law was designed to help those people just as much as it was designed to help those who never had coverage at all. That’s an entirely reasonable position. But when we talk about Obamacare’s coverage effects, it’s important to be clear about who is being covered: a sizable number of people who were already insured, as well as people who were both eligible for coverage and covered at one point, but had lost their coverage.

It's true that the ACA is designed to help the long-term uninsured. It's also designed to help the millions who fall out of and back into insured status every year. Last fall, healthcare scholars Rick Curtis and John Graves brought those millions into focus: