Former President Barack Obama signed the Affordable Care Act (ACA) into law on March 23, 2010. The law was designed to decrease the uninsured population in the United States by offering benefits that were more accessible to the general population with expanded Medicaid eligibility, guaranteed issue, subsidies and cost-sharing reductions, essential health benefits, and more. According to the Kaiser Health Foundation, the rate of uninsured has decreased from 17.1 percent in 2008 to only 10.9 percent in 2019 due to increased access.
There has been both positive and negative critiques of the law since its inception, especially with the associated individual mandate that required all Americans have health insurance coverage or face a tax penalty. This mandate was later declared unconstitutional by the Trump Administration in 2017. Additionally, the law came under fire from those whose yearly income exceeds the subsidy thresholds and saw soaring premiums and out-of-pocket costs. What’s more, the lack of public education about the law and its impact on the American health system has led consumers to distrust it.
So who does the plan work for?
Those with “Preexisting Conditions”
Nearly half of “nonelderly” adults have a preexisting condition, including diabetes, COPD, cancer, sleep apnea, etc. Before the ACA, they could have been denied coverage based on their medical history if they wanted to buy individual insurance. The ACA added “rating rules” that prohibit insurers from determining premiums dependent on gender, health status, or age. ACA plans are also considered “guaranteed issue,” which means that insurers must issue policies to anyone, regardless of their health status.
The law also established a set of ten minimum essential health benefits that must be covered, including doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Many of these services were not previously covered. The ACA also prohibited insurers from determining annual or lifetime- limits on benefits.
With the emphasis on these two requirements, guarantee issue and essential health benefits, anyone purchasing health coverage through the marketplace has access to comprehensive coverage for themselves and their family.
Lower Income Individuals
Many states provide consumers with subsidies (tax credits) for households with incomes between 100 and 400 percent of the federal poverty level (FPL). That means an individual earning $54,000 or less a year may be eligible for a subsidy. That amount would increase as the number of people in a household increases. Nearly 9 out of 10 people enrolled through the Marketplace qualify for financial help and more than half receive reduced cost sharing. In most cases, the ACA also reduces copayments, prescription drugs, and immunizations little to no cost.
Enhanced subsidies and affordability mean better access to services, which benefits hospitals as the clients take advantage of their coverage.
Women Who Were Being “Gender Rated”
The ACA also outlawed “gender rating,” which was used by insurers to charge women up to 1.5 times more than men for health insurance. This practice also excluded critical care for women and treated pregnancy as a preexisting condition.
Young Adults and Children
Under the ACA, young adults under age 26, who are less likely to have the option of employer coverage, can remain covered on their parents’ health insurance plan. Once they turn 26, ACA coverage becomes an affordable option. As a result the uninsured rate among those ages 18 to 24 fell to only 15 percent in 2017.
Self Employed and Those Without Access to Employer Benefits
The ACA is also a viable option for those who are self-employed. It was challenging to find coverage in the individual market prior to 2014 for those who were unable find any carrier that would accept their application because the policies where medically underwritten. The self-employed are now also able deduct the cost of their health care premiums, which puts the self-employed on equal footing with larger companies that have always been able to do so.
Those Who Live in Rural Areas
Residents in rural areas have a higher likelihood of being covered by Medicaid. A recent statistic indicates that 22.5 percent of rural Americans and almost half of all rural children receive some sort of Medicaid.
The additional subsidies enabled covered individuals to use services provided by hospitals. The result of these subsidies was financially stable hospitals and communities.
The ACA also has provided resources to both patients and the health care systems in the community to combat the opioid crisis. The crisis has hit the rural areas significantly and the ACA plans are required to cover substance use disorder. Before this mandate only 1 in 3 people covered through the individual market would have had access to such treatment. In addition to expanded services, for the plan year of 2022, in Ohio 76 out of 88 counties will offer at least four different insurance carrier options to their residents. This expansion of carrier offerings provides more options for clients than ever before.
Millions of Americans have now qualified and gained insurance coverage. The law has been instrumental in helping those with lower incomes, women, the self-employed, young adults, and many others, improving lives while providing a stronger healthcare system.