Shaheen Leads Letter to President on Prioritizing Federal Assistance to Lower Deductibles & Out-of-Pocket Costs for Families

May 21, 2021

(Washington, DC) – U.S. Senator Jeanne Shaheen (D-NH) today led 19 Senate colleagues in sending a letter to President Biden to urge stronger federal assistance to reduce deductibles and out-of-pocket health care expenses for American families. In addition, the Senators asked for support for a long-term investment in premium assistance and closing the Medicaid coverage gap for low-income families in states that haven’t expanded Medicaid under the Affordable Care Act (ACA).  

During negotiations around the American Rescue Plan, Senator Shaheen led the push to expand and enhance the ACA’s premium tax credits – and thanks to her advocacy, provisions of her bill, the Improving Health Insurance Affordability Act, were included in the American Rescue Plan on a temporary basis. These changes are projected to reduce premium expenses by more than 37 percent on average. Consistent with Shaheen’s bill, President Biden’s new American Families Plan would make these premium tax credit enhancements permanent, expanding health care coverage to more than 4 million Americans who would otherwise go uninsured. 

But sky-high annual deductibles and out-of-pocket costs continue to deprive families of the care they need, with disproportionate impacts on low-income families and communities of color. If the remaining provisions of the Improving Health Insurance Affordability Act were passed, it is projected that out-of-pocket expenses for consumers would drop by 61 percent on average through reductions in deductibles and co-pays. New estimates predict that on average, individuals would save $1,097 annually per person through reductions in their out-of-pocket costs. In New Hampshire, out-of-pocket costs would drop by $972 annually per person.  

“Too many American families face significant deductible and out-of-pocket costs that threaten their access to the care they need,” the Senators wrote. “High deductibles and out-of-pocket costs can discourage people from even enrolling in health coverage, no matter how much financial assistance they can get with premiums.” 

“To make historic progress toward covering the uninsured, and to ensure that having coverage truly delivers affordable access to health care and improved financial security, additional federal assistance to reduce cost-sharing expenses is critical,” they continued. “To truly deliver accessible and affordable care to Americans across this country, Congress will need to make premium tax credit improvements permanent, as you have proposed, while also making an investment to reduce deductibles and out-of-pocket expenses for individuals and families.” 

Co-signers on Shaheen’s letter include Senators Jon Tester (D-MT), Tina Smith (D-MN), Kyrsten Sinema (D-AZ), Chris Van Hollen (D-MD), Amy Klobuchar (D-MN), Richard Blumenthal (D-CT), Maggie Hassan (D-NH), Angus King (I-ME), Raphael Warnock (D-GA), Bob Casey (D-PA), Sheldon Whitehouse (D-RI), Jacky Rosen (D-NV), Mark Kelly (D-AZ), Jack Reed (D-RI), Tim Kaine (D-VA), Tammy Baldwin (D-WI), John Hickenlooper (D-CO), Gary Peters (D-MI) and Thomas Carper (D-DE).  

Shaheen has led efforts in Congress to protect and improve the ACA. She spearheaded Senate Democrats’ proposal to make health care affordable and accessible for Americans during the COVID-19 public health emergency. Shaheen also led all 47 Senate Democrats on a Senate resolution that would reverse the Department of Justice’s decision to side with U.S. District Court Judge Reed O’Connor’s ruling that would strike down the health care law. This health care sabotage could result in 133 million Americans losing protections for pre-existing conditions, millions more Americans without health insurance, soaring prescription drug costs for seniors and nearly 90,000 Granite Staters losing health care coverage. She introduced the Marketing and Outreach Restoration to Empower (MORE) Health Education Act of 2019 with Senators Tim Kaine (D-VA) and Gary Peters (D-MI) to counteract the Trump administration’s sabotage efforts that slashed funding for health care enrollment advertising and marketing by 90 percent after Donald Trump took office. Senators Shaheen, Tammy Baldwin (D-WI) and Mark Warner (D-VA) called on the last administration to do more to prevent third-party web brokers from steering individuals toward junk health insurance plans that do not provide coverage of pre-existing conditions or essential health benefits.   

The full letter can be found HERE and below. 

Dear Mr. President, 

As your administration works with Congress to develop a policy framework to advance the Build Back Better agenda, we write to urge you to ensure that policies to improve the affordability of health care coverage are central to those efforts. We applaud your proposal in the American Families Plan to permanently extend the critical but temporary improvements in health insurance premium affordability enacted in the American Rescue Plan Act. These premium tax credit enhancements will substantially reduce net premiums paid by American families for Health Insurance Marketplace coverage and begin to reduce the number of people who are uninsured. To truly deliver accessible and affordable care to Americans across this country, Congress will need to make premium tax credit improvements permanent, as you have proposed, while also making an investment to reduce deductibles and out-of-pocket expenses for individuals and families.  

Too many American families face significant deductible and out-of-pocket costs that threaten their access to the care they need. The average deductible for silver-level Marketplace plans in 2021 is nearly $5,000 for individuals, and while low-income people can access plans with reduced cost-sharing, that help is not always sufficient. For example, a person with income of $26,000 a year would still have an average deductible of more than $3,000, a staggering 13 percent of their income. Significant deductibles and cost-sharing expenses are also a barrier to care in employer-based coverage. High deductibles and out-of-pocket costs can discourage people from even enrolling in health coverage, no matter how much financial assistance they can get with premiums. To make historic progress toward covering the uninsured, and to ensure that having coverage truly delivers affordable access to health care and improved financial security, additional federal assistance to reduce cost-sharing expenses is critical.  

Your administration has the opportunity to work with Congress to strengthen Medicaid and the Marketplaces, which have provided a crucial safety net during the COVID-19 health and economic crisis. Your administration’s decision to open an emergency special enrollment period at HealthCare.gov allowed more than one million people to enroll in coverage by early May, with many of them accessing plans with $0 net premiums because of the premium tax credit enhancements under American Rescue Plan. In order to ensure lasting affordability of premiums and long-term reductions in the number of uninsured in this country, we will need to provide a long-term investment in premium assistance and close the Medicaid coverage gap for low-income individuals in states that have not expanded Medicaid under the Affordable Care Act.  

Providing affordable, comprehensive coverage to the nation’s uninsured is a vital component of building a health care system that is equipped to ensure equity in health outcomes regardless of race or ethnicity. People of color are currently disproportionately represented among the uninsured. While increasing health coverage will not solve every health care inequity, having coverage has been shown to increase access to health care services, including preventive services and treatment for chronic disease, which can save lives. 

In the weeks and months ahead, we look forward to working with you on these priorities so that we can ensure that Americans have access to affordable coverage now and in the years to come. Thank you for your attention to these critical issues.   

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