Happy Birthday ACA! And what federal COVID relief means for your health care

The Affordable Care Act (ACA), signed into law on March 23, 2010, has significantly increased the number of people who have health insurance, expanded access to care, and led to greater financial stability among low-income individuals. It has also cost less money than was originally estimated. Through the introduction of Medicaid expansion and the federal Marketplace, the ACA was a good first step in making it easier to access affordable health care.

The recently passed American Rescue Plan Act of 2021 (ARPA) builds on the success of the ACA and further strengthens the health care safety net. The ARPA will provide many Oklahomans with a new or significantly less expensive pathway to affordable health care by providing additional health-related funding to states and more direct assistance to Oklahomans. 

What does the ARPA mean for the state?

With the passage of the ARPA, the federal government will provide enhanced support to state Medicaid programs through the Federal Medical Assistance Percentage (FMAP) program, which determines the amount of federal matching funds for certain social services and state medical and medical insurance expenditures. The federal government already pays about 60 percent of Oklahoma’s Medicaid costs and will pay 90 percent of the state’s expansion expenditures, and has provided an additional 6.2 percentage-point increase in the base (non-expansion) FMAP during the COVID-19 public health emergency. The ARPA increases the federal government’s investment in Oklahomans’ health by providing an additional 5 percentage-point increase in the base FMAP rates for states that have not yet implemented Medicaid expansion. Under this provision, Oklahoma could receive between $520 million and $860 million, which would more than cover the estimated cost of Medicaid expansion. 

The new bill also provides the state with other investment opportunities. Oklahoma can now easily expand postpartum Medicaid coverage from 60 days to a full year after the birth of a child. This change would begin to mitigate the state’s abysmal maternal mortality rate in which about one-third of all maternal mortality deaths occur in the postpartum period. Through March 2022, Oklahoma will also receive a 10-percentage point increase in the FMAP rate for home- and community-based services. These additional funds will help older Oklahomans and those with disabilities stay in their homes and communities to receive necessary care. Finally, the ARPA provides full federal funding for health care provided through Urban Indian Health Organizations, an important step in fulfilling this country’s responsibilities to provide health care for American Indians.

What does the ARPA mean for individuals?

The ARPA doesn’t just provide more money for states. Many Oklahomans will now be eligible for new or increased discounts as advanced premium tax credits (APTCs) or be able to maintain their health insurance from a previous employer. APTCs provide discounts on monthly premiums for health plans purchased through the federal Marketplace

About 159,000 Oklahomans purchased health insurance through the federal Marketplace in 2020, and 171,000 are expected to enroll in 2021. Before the ARPA was signed into law, people who purchased through the Marketplace and who made between 100 and 400% of the federal poverty line ($26,500 to $106,000 for a family of four) qualified for APTCs. These tax credits ensure low- and middle-income families don’t spend more than a certain percentage of their income on health insurance. The ARPA will make health insurance more affordable by lowering that percentage across the board and making APTCs available to more middle-income families. Additionally, with a few exceptions, anyone who experiences unemployment at any time in 2021 will be automatically deemed to have income at 133% of the federal poverty line ($35,245 for a family of four). This means people who become unemployed will qualify for large APTCs and will be able to continue seeing their providers and accessing necessary medication. The charts below show how the ARPA’s changes will make health care more affordable.

An individual will see larger premium tax credits under the ARPA

Annual Income: Previous Marketplace Premiums:  ARPA Marketplace Premiums: 
$12,880 – $17,130 $266 and $355 $0
$17,130 – $19,320 $531 – $800 $0
$19,320 – $25,760 $800 – $1,680 $0 – $515
$25,760 – $32,200 $1,679 – $2,682 $515 – $1,288
$32,200 – $38,640 $2,682 – $3,798 $1,288 – $2,318
$38,640 – $51,520 $3,798 – $5,064 $2,318 – $4,379
400%+ FPL no premium assistance $4,379
Uninsured at any point in 2021 dependent on other circumstances $0

* Numbers are annual

** Age and other criteria may change individual situations. Find out what APTCs you qualify for at healthcare.gov

Sources: OK Policy analysis of data from Georgetown University Health Policy Institute, Community Catalyst, Department of Health and Human Services. Calculations shown here.

 

A family of four will see larger premium tax credits under the ARPA

Annual Income: Previous Marketplace Premiums:  ARPA Marketplace Premiums: 
$$51,520 – $68,522 $1,066 – $1,418 $0
$68,522 – $77,280 $2,124 – $3,199 $0
$77,280 – $103,040 $3,199 – $6,718  $0 – $2,060
$103,040 – $128,800 $6,718 – $10,729 $2,060 – $5,152
$128,800 – $154,560 $10,729 – $15,193 $5,152 – $9,274
$154,560 – $206,080 $15,193 $9,274 – $17,517
$206,080+ no premium assistance $17,517
Uninsured at any point in 2021 dependent on other circumstances $0

* Numbers are annual

** Age and other criteria may change individual situations. Find out what APTCs you qualify for at healthcare.gov

Sources: OK Policy analysis of data from Georgetown University Health Policy Institute, Community Catalyst, Department of Health and Human Services. Calculations shown here.

In addition to increased premium assistance, the ARPA also provides increased protections for Oklahomans with Marketplace and employer-sponsored health insurance. 

Individuals who have previously been unable to afford to purchase health insurance through the Marketplace should return to www.healthcare.gov/ between April 1 and May 15, 2021 to see if the increased discounts provided by APTCs make their health insurance options more affordable. Similarly, people who are unemployed and unable to maintain health coverage through COBRA due to high costs should reconsider this option to see if the increased federal assistance makes it a more feasible option. Understanding all of these options can be difficult, but enrollment navigators can assist in determining the best course for individual Oklahoma families. To reach free, local, non-profit Health Navigators across the state, call or text: 405-313-1780.

The ARPA provides much needed assistance to states and individuals 

The pandemic and resulting economic recession have hurt the health and financial stability of many Oklahomans. Direct assistance to individuals will make health care more affordable for thousands of Oklahomans, and the ARPA provides the state with a unique opportunity to invest in all its citizens. Increased funding for Medicaid expansion, longer postpartum care, a stronger home- and community-based services program, and full funding for Tribal facilities will provide enhanced support for Oklahomans as the state begins to recover from the COVID-19 pandemic. The ARPA is an important step towards making affordable health coverage for all Oklahomans a reality. 

Actions for Advocates: 

  • If you or someone you know has benefited from Medicaid coverage, visit OKPolicy.org/MyStory and tell us about it.
  • OK Policy will be hosting a “Countdown to Care” to raise awareness about the value of Medicaid expansion, as well as the need to ensure that implementation is done to provide maximum impact for the state and those Oklahomans who urgently need health care. [Register now] 

Additional Resources: 

  • This Health Insurance Marketplace Calculator will help determine how much financial help will be available to you if you purchase insurance through the Marketplace. 
  • This report provides information on Marketplace premiums, broken down by income, age, plan, and state.
  • This report analyzes how the ARPA will increase premium assistance. 
  • Find answers to frequently asked questions here

ABOUT THE AUTHOR

Emma Morris serves as the Health Care and Revenue Policy Analyst at OK Policy. She graduated from the University of Oklahoma in fall 2019 with dual degrees in Women’s and Gender Studies, and Public and Nonprofit Administration. She is an alumnus of OK Policy’s Oklahoma Summer Policy Institute.

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