Expanding health coverage is good. But we also need to fix stingy plans.

Cecille Joan Avila is a policy analyst with the Boston University School of Public Health (@cecilleavila). Paul Shafer, PhD, is an assistant professor of Health Law, Policy, and Management at the Boston University School of Public Health (@shaferpr). Megan B. Cole, PhD, MPH, is an assistant professor of Health Law, Policy, and Management at Boston University School of Public Health (@meganbcole). 

While on the campaign trail, President Biden focused on expanding the Affordable Care Act and addressing the problem of uninsurance through an affordable public option, expanding tax credits, and re-indexing plans. But focusing solely on uninsurance is not going to be enough, especially as enrollment in high deductible health plans has increased over the last decade, with no signs of slowing. Not only can these plans result in delayed care, it can also make existing health inequities worse.

In The Washington Post, Paul Shafer, Megan B. Cole and I go further into this issue. As we write:

Given political realities, however, [the public option] might not see the light of day. So it would be best to target underinsurance directly. Most people with high-deductible plans get them through an employer. Yet unlike in the marketplace plans, the degree of cost sharing in these employer plans is the same for low-income as well as high-income employees. To deal with that problem, the government could offer incentives for employers to expand the scope of health services they cover – which they can’t now – would help some people escape high-deductible plans. The public option would also eliminate premiums and involve minimal to no cost-sharing for low-income enrollees – especially helpful for uninsured (and underinsured) people in states yet to expand Medicaid.

While President Biden’s American Rescue Plan increased the Affordable Care Act subsidies and will help a significant number of those who are uninsured, there is still more work to be done. The focus needs to turn towards those who have health coverage, but only in the form of an unused insurance card.

Read the full piece here. It also appeared in the print edition of The Washington Post on March 7, 2021 on page B05.

Research for this piece was supported by the Laura and John Arnold Foundation.

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