The Work Goes On: Preserving Equitable Access to Affordable, High Quality Health Insurance in Challenging Times

They say that health care wasn’t on the ballot this election. Political scientists will write dissertations about what Americans were voting for (or against) at the polls this year, but by most accounts, health care was not high on the list of priorities. And yet, when it comes to health care access, equity, and affordability, there is so much to lose. In light of the election results, it will require concerted and aggressive efforts among policymakers and advocates to preserve gains in insurance coverage, improvements in health equity, and enhanced health care affordability. At CHIR, our mission has always been, and will remain, to support those efforts through balanced, evidence-based research, analysis, and strategic advice.

Health Access, Equity, and Affordability: Ending on a High Note

The Biden administration will leave office with a record of unprecedented progress in health coverage and affordability. The numbers of people who are uninsured is at an all-time low. Coverage through the Affordable Care Act (ACA) Marketplaces is at an all-time high, thanks in large part to the enhanced premium tax credits (PTCs) enacted in 2021 and extended through 2025 in the Inflation Reduction Act. The enhanced PTCs have dramatically improved coverage affordability for millions of people, saving the average Marketplace enrollee $700 per year.

We’ve also seen significant progress reducing historic inequities in health coverage access for people of color. Under the Biden administration, the number of Latino enrollees in the Marketplaces increased 185 percent, the number of Black enrollees grew 204 percent, and enrollment for American Indian/Alaska Native communities doubled. These gains are attributable to the enhanced PTCs, but also to the significant investments the Biden administration has made in Marketplace outreach and assistance, as well as reductions in paperwork burdens that disproportionately hinder enrollment among people of color. In a recent regulation, the Administration opened the doors for “Dreamers” – Deferred Action for Childhood Arrivals (DACA) recipients – to obtain affordable Marketplace coverage.

This administration ushered in dramatic improvements in affordability for Medicare enrollees, including an annual cap on prescription drug costs, access to vaccines without cost-sharing, and a $35 limit on monthly insulin prescriptions. The Inflation Reduction Act also gave Medicare new powers to negotiate prices with pharmaceutical manufacturers, which is projected to save enrollees $1.5 billion in personal out-of-pocket costs in 2026 alone.

The Biden administration has also consistently defended the ACA’s protections for people with pre-existing conditions, cracking down on “junk plans” that won’t cover people in less-than-perfect health. The current U.S. Department of Justice is also defending in court the ACA’s requirement that insurance companies cover, without cost-sharing, recommended preventive services and life-saving vaccines.

Finally, the administration’s implementation of the No Surprises Act has protected millions of Americans from unexpected medical bills from out-of-network providers. And they continue efforts to ensure that the law’s dispute resolution process does not result in higher overall premiums for consumers, despite legal challenges.

The Work to Come: Navigating Uncertainty, Protecting the Progress Made

The exact health care agenda of the incoming Trump administration is unclear, but policy proposals from the Heritage Foundation’s “Project 2025” and the Republican Study Committee have called for significant cuts in funding for health insurance coverage and a roll back of the ACA’s pre-existing condition protections, as well as the elimination of critical protections for LGBTQ+ people, pregnant individuals, and those who have had abortions or miscarriages. These proposals, if implemented, would result in a significant loss of health care access and an increase in health care costs for millions of Americans.

Over the coming weeks and months we will learn more about the new administration’s health care agenda. For CHIR, we stand ready to work with policymakers and advocates of all political persuasions to preserve the historic gains made in the past four years and build on that progress, at both the federal level and in the states. In acknowledgment of the uncertainty wrought by last night’s election results, and the tremendous amount of work ahead, we share below a quote from the late Senator Edward Kennedy. The Senator was a key architect of the ACA and the most tireless advocate for universal, equitable health coverage in our lifetimes:

“For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.”