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AHIP Announces 12 New Recommendations To Improve Affordability Of Health Care Coverage In The Individual Market

by AHIP

November 14, 2018

WASHINGTON, D.C. –  Around 13 million people currently purchase their own health care coverage through the individual marketplaces, and 5 million of them do not qualify for tax credits or subsidies that help them pay for their plan. These hardworking Americans fall into a gap – earning too much to qualify for financial support, but still struggling to pay their monthly premiums. To improve affordability for those who buy their own coverage, America’s Health Insurance Plans (AHIP) is offering 12 new policies that federal or state leaders can implement to drive down premiums, increase participation in the marketplace, and offer savings to consumers.

From 2017-2018, the price of the least expensive bronze plan for a single 4O year old rose $65 a month, on average, driven primarily by the ever-increasing costs of health care services, such as visits to the doctor, emergency trips to the hospital, or prescription drugs. While health insurance providers negotiate lower prices for the people they serve, federal and state leaders are essential partners in making coverage more affordable for everyone.

“Families making over 400 percent of the federal poverty level are hit the hardest without any financial cushion,” said Jeanette Thornton, senior vice president of employer and commercial plans for AHIP. “The goal of this new paper is to close this gap, ensuring every single American can afford their health coverage regardless of income, health status or pre-existing conditions.”

AHIP’s core recommendations include actions state and federal policymakers* can take that will:

  1. Address rising health care services costs and drug prices,
  2. Offer premium savings to families making over 400 percent of the federal poverty level, or
  3. Increase the number of consumers buying coverage, which will balance the individual market risk pool to bring costs down for everyone.

Specific recommendations are key-coded, indicating whether they can be implemented through federal legislation, federal regulation, state legislation, or state regulation. Solutions include:

  • Reduce surprise doctor bills
  • Increase competition in prescription drugs
  • Expand the use of telehealth
  • Create reinsurance programs
  • Provide savings to consumers who engage in wellness programs

While this report focuses on improving   premium affordability for those who don’t qualify for federal support, many of these recommendations will drive down premiums for everyone. This includes the lowering costs for the 8 million Americans who rely on subsidies to afford their coverage – reducing the financial burden on taxpayers as well.

The full report can be found here.

*For federal and state leaders interested in discussing these solutions in-depth, please contact AHIP directly at affordability@ahip.org.