What is the ACA?

Updated 
January 27, 2017

Congress and the president are taking actions to repeal, or at least significantly change, the Patient Protection & Affordable Care Act, also known as Obamacare. You’ve probably heard a lot already about how people feel about the law, whether they are for or against it. But it may have been a long time since you last heard about what the ACA does and how it changed American health care in the past. The ACA has a lot of parts. To help you make sense of the discussion, here’s a summary of the law’s history, what it includes, and what could be lost in a repeal.

Background

The ACA was passed in March 2010 and signed by President Barack Obama. The rising cost of health care in America had been a concern for decades, with failed attempts in the 1970s and 1990s to pass healthcare reform.

The most well-known part of the ACA was designed to help more people get health insurance. But the law also addressed

  • government spending on health care
  • how providers like hospitals and doctor’s offices are paid for services
  • protections for people covered by insurance (a protection is a formal rule that gives you rights)

Expanding Coverage

The ACA was designed to give more people access to health insurance coverage. This was to be done in a few different ways.

Health Insurance Marketplaces/Exchanges

Online health insurance marketplaces/exchanges were opened for each state under the ACA. They are run by either the state or the federal government, depending on the state. Using the marketplace, people can shop for insurance and compare insurance plans and prices, making it easier to choose a plan that fits your needs. You can also find out if you are able to get financial assistance from the government to help pay for insurance coverage. The amount of financial assistance you receive is based on your income.

Medicaidinfo-icon Expansion

The law provided money from the federal government to expand Medicaid, health coverage run by state governments for people with low incomes. This allowed more people to get coverage through the Medicaid program. Since the first states were able to expand Medicaid through the ACA, more previously uninsured people have gotten health insurance coverage through Medicaid than through buying on the marketplace. The U.S. Department of Health and Human Services estimates that 14.5 million more people got coverage through Medicaid expansion and the Children’s Health Insurance Program (CHIP) to date, even though 19 states have decided not to expand the Medicaid program.

Coverage for Young Adults

The ACA required insurance companies to allow adult children to get insurance through a parent’s plan until they turn 26. This allows people to stay covered by a parent’s plan through college and early or part-time work experiences that don’t provide insurance or pay enough to afford private insurance. Before the ACA, states set the age when you could no longer stay on a parent’s health insurance, but they often had other restrictions, like being a full-time student.

Requiring Health Insurance

The individual mandate is the rule that says U.S. citizens and people lawfully present must be insured or pay a fine to the government. The requirement is disliked by many who oppose the ACA, but people who support the law say it is needed. The idea behind it is that the more people who are insured, the easier it is to offset costs when sicker people need their insurance companies to help pay bills. Getting healthy people enrolled was important to many of the popular parts of the law, especially the patient protections.

Patient Protections

In addition to getting more people signed up for health coverage, the ACA installed new protections for people in their coverage. In the past, insurance companies were allowed to deny individual insurance coverage to people with pre-existing medical conditions, or to impose pre-existing conditioninfo-icon exclusion periods on both individual policies and employer-sponsored health plans. Under the ACA, health insurance companies:

  • cannot turn you down or charge more if you have a pre-existing condition, like breast cancer
  • cannot charge you more based on your gender. Women had often been charged more for insurance before the law went into effect
  • cannot put a “cap” on your coverage for essential health benefits, meaning they can’t limit how much they will pay for your health care either yearly or over a lifetime
  • must cover preventative care, appointments meant to help keep you keep track of your health, like screenings and immunizations. And depending on your coverage, you should not be charged a copay, coinsurance amount, or a deductible, for these visits
  • cannot take away your health insurance coverage because you made a mistake on paperwork
  • you have the right to an independent, external appeals process if your insurance company says it will not cover a treatment

Healthcare Providers

Past laws established that hospitals must provide emergency care to everyone, regardless of their ability to pay. Doing this encouraged people to seek care when they needed it, rather than if they could afford it. But the cost of the care doesn’t disappear when people can’t pay, it becomes a loss for the hospital.

The ACA, and the expansion of Medicaid specifically, cover more people with lower incomes, people who likely don’t have the money to pay for emergency procedures out of pocket, according to the New York Times. The idea is that because more people have coverage under Medicaid, hospitals in states that expanded Medicaid more often get paid for their services.

Many hospitals have expressed concern that if people lose coverage, the cost of care will fall back on the hospitals and healthcare providers. Some providers worry this might mean offering fewer programs and services, or closing entirely.

Concerns

The ACA has faced challenges, most notably a large rise in the cost of marketplace premiums going into 2017. Younger, healthier people have not signed up in the numbers needed to offset the cost of people who need more care. This is part of the reason insurance companies stopped offering plans in many states and raised premiums, the monthly payment you make to keep your coverage. With fewer plans offered on the marketplace, people who live in certain areas are finding it harder to get a plan with the coverage they need at a price they can afford.

Republicans in Congress have opposed the ACA from the start and made over 60 attempts to repeal all or part of the law during the Obama Administration. They’ve also tried to undo the law through the courts, most notably in cases that reached the Supreme Court in 2012 and 2015. There are a few plans that have been presented in the past by Republicans like Paul Ryan and Tom Price, but they have not yet proposed a replacement plan in the current debate. Under the Trump Administration, Republicans are likely to see more success with repeal of the ACA and other changes to our healthcare system.

What This Means for You

As someone with breast cancer, many parts of the ACA may have had an impact on your care. The patient protections may have been important to you. Or, maybe your copays and coinsurance were more affordable when you bought a plan on the marketplace. The right to external appeal may also have come into play during your treatment. It’s also possible that your experience with care under the ACA hasn’t felt much different, or that your experience wasn’t good.

The ACA has a lot of parts, some you may agree with and some you may not. Hospital systems, insurance companies, and people getting care have all changed under the law. The new presidential administration has signaled that it will repeal the ACA, but when it will be repealed and what new law or laws will be passed in its place are not known.

The repeal is not likely to take your health coverage away in 2017, as long as you keep paying your premiums. You should make sure you are covered by finding a plan at HealthCare.gov before open enrollment ends January 31 or you can apply for Medicaid year-round.

You have likely been affected by more than one of the changes brought by the ACA. You may be concerned about rising premiums, and you may also worry about losing coverage for preventative care. Speak to your representatives in Congress  to share your opinions.

 

How has the Affordable Care Act affected your health insurance? We would love to hear about your experience with the ACA/Obamacare – whether it’s good, bad or somewhere in between. Share your stories and your vision for healthcare with us, here.