Middle Class Supports. Access to health care is a critical component of a middle-class standard of living. Skyrocketing health care costs have created a vicious and destabilizing trap for middle-class Americans in which employer-sponsored coverage is offered less frequently and private coverage is increasingly unaffordable. Meanwhile, successful public programs that effectively cover children (SCHIP), the poor (Medicaid), and the elderly (Medicare) are unavailable to middle-class adults. Almost 46 million nonelderly Americans lack health insurance, the majority of whom are low- and middle-income, and the rate of the uninsured has grown significantly since 2000. At the same time, the average worker’s health care premium has increased 128% (to $3,515) since 1999. One study even found that just shy of two thirds of all bankruptcies are due to medical expenses even though the vast majority of these bankruptcies involve families who have health insurance. Because employers, too, have had to absorb similar premium increases, employer-sponsored insurance – the type of insurance most middle-class Americans obtain – has declined significantly in each of the last eight years. The economic downturn has exacerbated this situation and experts estimate that each percentage point increase in the unemployment rate results in substantial increases in the number of uninsured Americans. Given the high costs of obtaining insurance in the private, non-group market, which is nearly impossible without steady employment, many Americans have simply given up coverage over the last several years. In short, a perfect storm of increasing health care costs and a down economy has undermined the financial stability and endangered the wellbeing of the middle class and the aspiring middle class.

The Patient Protection and Affordable Care Act would do much to relieve the financial stress placed on these households by high health insurance costs while also extending health coverage to millions of Americans. The nonpartisan Congressional Budget Office estimates that the bill would reduce the number of uninsured to 23 million, leaving just 6 percent of the population without health coverage. Expanding Medicaid to cover low-income adults is one of the most effective and cost-efficient means of covering more aspiring middle-class Americans. The expansion would enroll about 15 million individuals in Medicaid, providing an important public backstop for aspiring middle-class families. Indeed, public programs have successfully kept millions of children from becoming uninsured, while the lack of such programs for low-income childless adults has led to increased numbers of the uninsured among this population. Similarly, subsidized coverage in the Health Benefits Exchanges would reduce health care costs for tens of millions of households. Premium savings could be as high as $10,000 for a low-income household of four. Such savings are targeted at the very groups that need the most help.

At the same time as it helps reduce health care costs for middle-class and aspiring middle-class Americans, the Patient Protection and Affordable Care Act greatly improves health coverage by enacting strict requirements for the type of insurance that is offered. The bill prevents the nightmare scenarios of being denied coverage just because you have become sick or being forced to pay higher premiums because of a preexisting condition (in many policies, being a woman is effectively considered a preexisting condition). Eventually, it will define minimum benefits and cost limits that must be included in most health insurance plans, not just ones offered by the Health Benefits Exchanges. And it will ensure that health insurers do not use premiums to pay for administrative costs and profits, instead of medical care. In this way, affordable and adequate health insurance that protects individuals and their families during both normal medical events and extraordinary medical hardship will be available to all aspiring middle-class and middle-class households.

Finally, the Act contains cost-cutting strategies to reduce the impact of health care costs on the budget deficit and additional measures to reorient health care delivery to quality, preventive care and away from costly and unnecessary overtreatment. Eliminating overpayments to Medicare Advantage, the ill-advised, Bush-era privatization of a chunk of Medicare and a tax on expensive health insurance plans, which is likely to result in fewer such plans being offered, are effective ways to cut costs without weakening coverage.