The Affordable Care Act is known for providing protections for pre-existing conditions and securing healthcare for nearly 12 million Americans in 2018 alone. However, with the recent ruling by a Texas judge striking down the entire healthcare law, much more is at stake. Here’s a breakdown of everything the ACA has provided.
Pre-Existing Conditions
According to a recent study, more than 100 million – one-third of Americans – lives with a pre-existing condition. Under the ACA, insurers were prohibited from discriminating against individuals with pre-existing by charging more for healthcare or denying healthcare altogether.
Without the ACA, one in three Americans is at risk of paying a higher premium for the same quality healthcare, or forgo healthcare altogether.
Essential Benefits
The ACA requires insurers to provide 10 “Essential Health Benefits” (EHBs), including emergency services, hospitalization, prescription drugs, mental health and substance abuse treatment, and maternity and newborn care.
Without the ACA, the millions of Americans who rely on these services may be forced to pay out of pocket.
Low-Income Subsidies
The ACA provides subsidies for Americans with low income so that they can afford healthcare. 87% of Americans qualified for a subsidy in 2017, including 57% of New Yorkers.
Without the ACA, these subsidies will disappear, leaving every American to pay in full for any healthcare plan they choose.
Insurance Until 26
The ACA requires insurers providing “dependent coverage” – typically employer-based insurance – to make that coverage available to young adults under the age of 26. This allows many young adults to remain on their parents’ healthcare plan and save money until they turn 26.
Without the ACA, many insurers will be able to remove young adults from their parents’ healthcare plan, forcing them to go uninsured through college and after unless they can afford their own insurance.
Medicaid Expansion
The ACA permitted individual states to opt in to “Medicaid Expansion”, wherein the residents of those states would be able to qualify for Medicaid based on income alone (if their income was a certain level below the federal poverty line). As of 2016, 15 million Americans had enrolled in Medicaid in the 31 states that had expanded Medicaid. Today, 37 states have expanded, with several more poised to expand.
Without the ACA, the states that have expanded Medicaid will revert to the Medicaid qualification process that existed prior to the ACA, and millions of Americans enrolled in Medicaid will lose their eligibility.
Medicare Coverage Gap (“Doughnut Hole”)
The ACA provides discounts on prescription drugs when a Medicare beneficiary is in the “doughnut hole”. Medicare Part D drug prescription coverage only covers payments up until a certain point, then no longer covers the prescription until the beneficiary reaches catastrophic-coverage threshold.
Without the ACA, the beneficiary is responsible for full out of pocket costs for any medication during the gap in coverage. In 2018, there were 43 million Medicare Part D enrollees.