With the ACA Safe From Attack, It’s Time to Improve the Landmark Legislation

by John Baackes, CEO L.A. Care Health Plan

As another Covered California open enrollment period approaches, the Affordable Care Act (ACA) finally appears safe from what had been repeated efforts to dismantle the law. In June 2021, the U.S. Supreme Court rejected what is widely regarded as its last significant challenge. Now, in the midst of a pandemic, when health coverage is more important than ever, lawmakers must focus their efforts on improving and expanding the ACA. A first step would be to restore the public option, which was in the original version of the legislation, but was stripped before it was signed into law.

When the Affordable Care Act was signed into law in 2010, there were two main goals. As its name suggests, the first was to make health insurance more affordable. The second goal was to increase the number of people with health insurance. The law succeeded in increasing the number of people with health insurance as a record 31 million Americans have coverage through the ACA, but affordability is still another matter. Implementation of the ACA did result in reduced out-of-pocket spending for those with lower incomes, but others continued to experience a high out-of-pocket and premium costs.

State and federal subsidies have always provided additional help for those with lower incomes, and passage of the American Rescue Plan earlier this year significantly increased the number of people who qualified for help. It enabled for healthcare coverage premiums to be as low as $1 per month for those who need it, but that extra help is set to expire at the end of next year. While we support making the additional help permanent, adding a public option to the ACA would be another important long-term solution to the affordability and accessibility issue. Public health plans, without shareholders and a lower cost structure, will provide healthy competition for commercial plans.

L.A. Care Health Plan is such a public option. It is one of 16 public health plans in California, but it is the only plan operating in California’s ACA exchange. L.A. Care, which was originally established in 1997 to serve Medi-Cal beneficiaries in Los Angeles County, chose to enter the Covered California exchange in 2014 to provide that competition for commercial plans. Through the years, L.A. Care saw commercial plans respond to its lower rates by dropping their own.

L.A. Care also entered the exchange to offer continuity of care to members with fluctuating incomes. Since launching, more than 33,000 members have moved from the health plan’s Medi-Cal plan to its L.A. Care Covered plan, or vice versa – all able to retain their providers and maintain coverage. Recently, the state of California passed legislation that supports L.A. Care’s efforts at continuity of care. In July of 2022, the state will begin allowing consumers who transition out of Medi-Cal due to income changes to automatically enroll into the most affordable Covered California plan in their region. In L.A. County, that means healthcare for the upcoming open enrollment period.

The idea of a public option is certainly gaining support. Washington State went live with a public option in January 2021, and Colorado and Nevada passed public option plans earlier this year, set to launch in 2023 and 2026, respectively. Two lawmakers, Sen. Patty Murray, D-Wash., and Rep. Frank Pallone Jr., D-N.J., are working on legislation to establish a nationwide public option, and 20 senators recently reintroduced legislation to create a new Medicaid-based public option, showing that access to care is clearly a top priority for policymakers in Washington, D.C.

All of these lawmakers need only look at L.A. Care to see that this health plan is a perfect example of a successful public option. There is no need to start from scratch when lawmakers can simply expand something that is already working. L.A. Care’s public option is providing access to quality health care at an affordable price to a greater number of people, including workers and their families who don’t have employee-sponsored health plans – people who need access to quality health care to remain productive. A healthy workforce is important for a healthy economy, so supporting efforts to ensure all have access to affordable health care is clearly in the interest of all businesses in Los Angeles County.