Protecting and enhancing access to health coverage under the Affordable Care Act, Medicaid, and employer-sponsored insurance

The elimination of preexisting condition exclusions for health insurance under the Affordable Care Act (ACA) has enabled people with chronic diseases, including kidney disease, to enroll in private commercial health plans that provide comprehensive coverage. Medicaid, which provides health coverage for one in five low-income individuals, plays a vital role in helping enrollees prevent and manage chronic conditions such as chronic kidney disease and its leading causes, diabetes and hypertension. However, administrative actions over the last several years and the COVID-19 pandemic has jeopardized access to affordable, comprehensive coverage for many Americans.

To protect and enhance access to affordable, comprehensive coverage for people with chronic conditions such as kidney disease, AKF supports policies that would: 

• Rescind regulations that have led to the expansion of less comprehensive insurance options, such as association health plans and short-term limited duration plans, which are exempt from covering the essential health benefits or can deny or limit coverage for people with preexisting conditions.
• Ensure the integrity of the ACA essential health benefit (EHB) requirements to safeguard patient access to comprehensive benefits and lifesaving services and treatments such as chronic kidney disease management, dialysis treatment, and kidney transplantation.
• Ensure strong network adequacy standards for qualified health plans on the ACA Marketplace, which is critical for advancing health equity and enhancing patient access to quality, affordable care.
• Strengthen the ACA Marketplace by funding reinsurance programs, cost-sharing reduction payments, ACA enrollment outreach and education activities, and expanding eligibility for cost-sharing reduction subsidies and advanced premium tax credits beyond the current income thresholds. Particularly, we support making permanent the temporary enhanced ACA premium tax credits that have been available to individuals and families in 2021 and 2022.  
• Uphold the core statutory objective of the Medicaid program, which is "to furnish medical assistance [to individuals] whose income and resources are insufficient to meet the cost of necessary medical services."
• Address the coverage gap for individuals who are ineligible for Medicaid because they live in states that did not expand Medicaid coverage under the ACA but are also ineligible for ACA premium tax credits because they have incomes below poverty.    

• Enhance federal Medicaid funding by automatically increasing federal support to state Medicaid programs during economic downturns and link Federal Medical Assistance Percentage (FMAP) adjustments to state unemployment levels.