The Affordable Care Act: An update
The Act was signed in by President Barack Obama, and it is informally known as "Obamacare."
It aimed to ensure that more people had more health insurance coverage in the U.S. It also aimed "to improve the quality of healthcare and health insurance, to regulate the health insurance industry, and to reduce health care spending in the US."
However, the change of administration in 2016 brought in some changes to the act, with more on the horizon.
Read on to find out more about where the Act currently stands.
The Affordable Care Act 2010
For many people, it is important to have insurance coverage for a pre-existing condition.
The aim of this law was to improve the health care system of the U.S. by widening health coverage to more Americans, and by protecting existing health insurance policy holders.
There were several parts of the bill that had important implications for many Americans.
These relate especially to coverage for pre-existing conditions, including pregnancy, children on parental plans, and help for small businesses to have their employees insured.
Coverage for pre-existing conditions
Beginning in 2014, insurance companies could not raise premiums for infants or children because of a pre-existing condition or disability.
Adults who previously could not get coverage because of a pre-existing condition, and who had had no insurance for 6 months or more would now get insurance.
The Pre-Existing Condition Insurance Plan (PCIP) was aimed at adults who could not get coverage because of a pre-existing condition, such as diabetes or cancer. From 2014, the Act made access available to them.
As of 2018, health insurers cannot deny or cancel coverage for someone with a pre-existing condition. The insurance must also cover that condition, and insurers cannot charge someone more for having that condition. Pregnancy is still considered to be a pre-existing condition, so insurance now covers all prenatal care and the birth from day one of coverage.
However, President Trump's administration recently said that he would no longer support this provision in the PPACA.
According to the Kaiser Family Foundation, this may head to the Supreme Court for a final ruling in 2019.
Children remain on parental plans
The Act means that young adults can stay on their parents' health plans until they are 26 years old.
- those who do not live with their parents
- those who are out of school
- those are not financially dependent on their parents
- those who are married
A child who has health insurance under their parents' plan will lose coverage on their 26th birthday.
This is considered to be a special enrollment period. It means that they can sign up for a new plan without having to wait for open enrollment at the end of the year.
It is important to recognize that, under this plan, insurance does not cover spouses and offspring of adult children.
Tax credits for small businesses
The Affordable Care Act aims to help small businesses to get health insurance for their workers.
Small businesses were to receive help in funding the cost of providing health insurance. New tax credits made it more affordable for them to buy health insurance for employees.
Employers would benefit from tax credit if they:
- provide health care for their employees
- have no more than 25 full-time workers
- pay an average yearly salary of less than $50,000
Beginning in 2018, there were new processes for signing up for this Small Business Health Options Program (SHOP) tax program and a new eligibility form as well.
Despite the changes, employers would still benefit from a tax credit to help them pay for health insurance if they met the above criteria.
Greater insurance coverage and security for all
Insurance companies could no longer deny health coverage to children aged up to 19 years with any pre-existing condition, disability, or disease that developed before their parents applied for coverage.
From 2014, this was to apply to anybody, regardless of age.
Individuals enrolled in Medicare Part D often fell into a coverage gap, often referred to as a "doughnut hole." These people would now receive a 50 percent discount on brand-named prescription medications and a 7 percent discount on generic ones.
In the past, as soon as a person in Medicare part D had spent a pre-determined amount of money, they had to pay any further expenses fully out-of-pocket. The aim was to eliminate this problem gradually within 10 years.
Medicare patients became eligible for mammograms, colonoscopies, and some other preventive services, and all new health policies had to offer these types of screening and preventive services free of charge.
Changes to the law in 2019
People cannot enroll at any time of year. They can only sign up between November 1 and 15 December 15.
When the law first went into effect, individuals who could afford to pay for health insurance but chose not to purchase a plan could face a tax penalty on their yearly income taxes.
However, this will no longer be the case as of 2019, and it will go into effect with the taxes filed in 2020.
Open enrollment to sign up for a new plan is also significantly shorter this year, only from November 1 to December 15.
Without a special circumstance — such as changing jobs, getting married, having a baby, or adopting a child — anyone who misses these dates will be unable to purchase insurance.
In previous years, the enrollment period went into January or February of the next year.
In 2018, the Centers for Medicare and Medicaid Services (CMS) provided new guidelines that would allow states to implement work requirements for people enrolled in Medicaid.
Another new point that came in with the law in 2017 relates to exemptions. Companies can ask for an exemption that will allow them not to offer or pay for coverage for contraceptives, because of a religious or moral objection.
What do people think?
For now, health insurance covers pregnancy in the U.S.
When the Act was introduced, many people disagreed with it.
There was overall agreement on many points, but most did not support forcing everyone to have health insurance.
After the Act came into being, there was a significant rise in the number of people with health coverage, and it continues to be higher than before.
However, changes to the law could cause the percentage of people with insurance to fall again significantly by 2026.
Concerns about future changes
People are still monitoring the status of the PPACA and its provisions very closely.
This is especially true of the Supreme Court's possible ruling on the protections afforded to people with pre-existing conditions.
According to the Kaiser Family Foundation, "nearly two-thirds (64 percent) do not want to see the Supreme Court overturn these protections compared to half (52 percent) who do not want to see the Supreme Court overturn the Affordable Care Act (ACA) more generally."
The HealthCare.gov website is available for anyone to find out whether they qualify for help, to apply for coverage or to change their status.