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Subsidies should be set on a sliding scale so individuals and families pay no more than a certain percentage of income on premiums as well as other out-of-pocket health care costs. Thus, subsidy calculations should include both family income and actual premium costs that may vary by region or age. AARP asserts that no one should spend more than 10% of their income for health care, including premiums and all other out-of-pocket costs. Those with more limited incomes should pay even less, with exemptions from cost sharing for the poorest for whom any cost sharing can create insurmountable barriers to care. In addition, in order for subsidies to remain affordable and sustainable over time, we must also enact measures to manage skyrocketing costs.

Premium credits and subsidies should be generous enough to effectively help those with modest incomes comply with their new responsibility -- to secure qualifying coverage. Premium credits and subsidies should be provided on a sliding scale; the scale should reach high enough that vulnerable families and older adults will be able to afford both their premiums and health costs. Otherwise, Americans will continue to face the prospect of being uninsured or underinsured and will be forced to seek an exemption from their shared responsibility. Further clarification is needed on how the subsidy would work.

Benefit Packages: We strongly support requiring insurers to cover a broad range of essential benefits, as suggested in draft legislation on this Committee’s website. Preventive services – including services necessary to manage chronic conditions that otherwise result in serious, expensive complications – should be provided with no or minimal cost sharing. We are pleased that the Committee is considering including provisions to provide incentives for providers to encourage care coordination, disease management and similar efforts to improve quality of care and help reduce spending for avoidable and costly institutional admissions, preventable complications, and errors for people with multiple chronic conditions.

Individual and Employer Responsibility: The HELP proposal would require individuals to have health coverage that meets minimum standards and to report such coverage annually. Employers who do not provide qualifying coverage will be required to contribute to the cost of their coverage for their employees, including those who access forms of public coverage.

Requiring everyone to participate is necessary because it greatly reduces insurers’ interest in underwriting based on age or health status and because it ensures that healthier individuals are included in the risk pool. However, AARP can support these requirements only with the assurance of adequate subsides. We cannot support mandated coverage that people or businesses cannot afford – subsidies must be adequate, available, secure and administratively feasible. In order to ensure that subsidies remain affordable and sustainable, we must also enact measures to manage skyrocketing costs while improving quality.

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