Based on initial gains in health care access from the passage of the 2010 Patient Protection and Affordable Care Act (ACA), the American College of Physicians (ACP) offers recommendations on how to improve the law and achieve universal health care coverage. The ACP proposal includes expanding eligibility criteria and Medicaid coverage, providing enrollment assistance, and making room for a public insurance option in the marketplace. This position paper was published in Annals of Internal Medicine.

The authors performed a review of studies, reports, and surveys on the ACA, which were extracted from relevant databases, policy documents, news articles, medical journals, and the Kaiser Family Foundation. Recommendations were informed by the literature review and received input from the ACP’s Board of Governors, Board of Regents, Council of Early Career Physicians, Council of Resident/Fellow Members, Council of Student Members, and Council of Subspecialty Societies.

1. The ACP recommends immediate efforts to strengthen the ACA and prepare for transformational coverage reform that will achieve universal health coverage.

2. Cost sharing and tax credit eligibility requirements should be redesigned to enhance individual market insurance affordability.

3. State and federal regulators should limit the sale of individual market plans that do not comply with the ACA and work to stabilize the insurance marketplace by establishing a reinsurance program.

4. In-person or virtual enrollment assistance (dedicated outreach, consumer assistance, and education to promote open enrollment) should receive sustained funding.

5. Federal and/or state governments should develop an auto-enrollment program — along with penalties and exemptions — to ensure all individuals enroll in coverage.

6. The ACP reaffirms their support for the expansion of Medicaid eligibility and to eliminate policies that effectively reduce enrollment among vulnerable individuals.

7. The ACP encourages Congress to authorize the development of a public insurance plan to promote market competition and as a stepping stone to universal coverage.

This article affirmed the ACP’s interest in transforming the “US health care system into one that attains universal coverage in a less costly and complex way.”

This paper was sponsored exclusively by the American College of Physicians.

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Crowley RA, Bornstein SS, Health and Public Policy Committee of the American College of Physicians. Improving the Patient Protection and Affordable Care Act’s insurance coverage provisions: a position paper from the American College of Physicians [published online April 16, 2019]. Ann Intern Med. doi: 10.7326/M18-3401