THE AFFORDABLE CARE ACT: PATHBREAKING CHANGES TO HEALTHCARE

As of 2010, there were nearly 50 million low- and middle-income Americans who were uninsured because of the high cost of healthcare. Insurers could deny coverage for people with preexisting conditions. Many insured people faced high out-of-pocket costs. There were strict limits on coverage. On March 23, 2010, President Obama signed into law the Affordable Care Act (ACA), making pathbreaking changes to the healthcare system.

By 2023, the uninsured rate had dropped from around 15% to a record low of under 8%, with many of the gains coming from the ACA’s Medicaid expansion and the creation of insurance exchange marketplaces. In New York, the uninsured rate dropped below 5%, aided in part by the offering of Qualified Health Plans and the creation of the Essential Plan, which offers insurance to low-income New Yorkers who earn too much for Medicaid.

How the Affordable Care Act Helps You

Pre-Existing Conditions	Before the ACA, insurers could charge more or deny coverage to people with pre-existing conditions. The ACA prohibited this practice, bringing peace of mind to 133 million Americans with pre-existing conditions.
10 Essential Health Benefits	The ACA requires insurers to provide 10 “Essential Health Benefits” that include emergency services, hospitalization, prescription drugs, mental health and substance abuse treatment, and maternity and newborn care. Without the ACA, millions using these services would be forced to pay out of pocket.
Women’s Health	Women can no longer be charged more for insurance than men. Pregnancy can no longer be considered a pre-existing condition.
Preventive Care	The ACA eliminates copayments and other forms of cost-sharing for preventive services for most health plans. Beneficiaries can get screenings for cancers, blood pressure and other conditions with no out-of-pocket payment.
Young People Covered Until Age 26	The ACA requires insurers to allow young adults to remain on their parents’ healthcare plan until they turn 26. This protects young people from going uninsured through college and after.
Low-Income Subsidies	The ACA provides subsidies for Americans with low incomes so that they can afford healthcare. In 2017, 87% of Americans qualified for a subsidy, including 57% of New Yorkers. Without these subsidies, low-income Americans would have to pay in full for their health plan.
Medicaid Expansion	The ACA permitted individual states to expand Medicaid, allowing millions of people to qualify for coverage who had incomes up to 138 percent of the poverty level (about $20,780 annually for an individual, or $35,630 for a family of three). The federal government covers nearly the entire cost.
Medicare Coverage Gap (“Doughnut Hole”)	The ACA provides discounts for prescription drugs when a Medicare beneficiary is in the “doughnut hole” — the gap in Medicare Part D Drug coverage, when coverage is only up to a point, after which the beneficiary pays full costs until catastrophic coverage. Until then, the beneficiary has to bear full out-of-pocket costs.

THE TEN ESSENTIAL BENEFITS OFFERED BY ALL ACA PLANS

Category	Description
Ambulatory patient services	Outpatient care provided without being admitted to a hospital
Emergency services	Covers emergency care received at a hospital
Hospitalization	Examples include surgery and overnight stays
Pregnancy, maternity, and newborn care	These services are for both before and after birth
Mental health and substance use disorder services	Includes behavioral health treatment, such as counseling and psychotherapy
Prescription drugs	—
Rehabilitative and habilitative services and devices	Includes services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills
Laboratory services	Includes x-rays and other diagnostic services
Preventive and wellness services	Includes chronic disease management
Pediatric services, including oral and vision care	Adult dental and vision coverage are not included as essential benefits

Specific services vary by state. When comparing plans, you’ll see exactly what each plan offers.

Plans must also include the following benefits:

Plans may offer additional benefits, including:

Dental coverage
Vision coverage
Medical management programs (for specific needs like weight management, back pain, and diabetes)

Source: https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

THREATS TO THE ACA

Although American voters have sent loud messages that healthcare is a number one issue, the Trump administration and its allies have made at least 70 attempts to repeal, change or curtail the ACA.

THE AFFORDABLE CARE ACT: PATHBREAKING CHANGES TO HEALTHCARE