The Affordable Care Act’s major policies have provided millions of Americans with improved coverage and health access. Examples of such improvements include:
But the Affordable Care Act (ACA) is far from perfect. Partisan division over its implementation has presented several significant political obstacles – for instance, state resistance to accepting federal funds for exchanges (Jones, Bradley & Oberlander 2014a). Yet despite such difficulties, significant progress has still been made towards improving coverage and health access through this law.
1. The number of uninsured has decreased.
Many have gained coverage thanks to the Affordable Care Act’s reforms, including a ban on preexisting condition exclusions and a requirement that plans provide at least minimum set of benefits. Furthermore, insurers must spend at least part of your premium dollar on medical care or quality improvements or give back as rebate. Furthermore, young adults can remain on their parents’ health plan up until age 26 – further expanding coverage.
The Affordable Care Act also expanded Medicaid eligibility to people earning incomes below 138% of poverty levels and established marketplace tax credits for those making up to 400% of poverty levels, leading to a reduction of uninsured across every state and D.C. However, undocumented immigrants remain ineligible for marketplace subsidies and Medicaid coverage.
2. The number of people with pre-existing conditions has decreased.
Before the Affordable Care Act was implemented, individuals with preexisting conditions found it challenging to secure affordable individual health insurance policies. People suffering from health conditions were subject to premium increases and high copays or deductibles; but now that has changed thanks to ACA. It limits insurers from setting different premiums based on age or gender alone as well as guaranteeing coverage regardless of one’s health status.
As part of its implementation, the Affordable Care Act required states to establish state-based exchanges where individuals and small businesses could purchase coverage, providing tax credits to make premiums more affordable for low and middle-income Americans. Furthermore, eligibility for Medicaid expanded so more individuals were eligible – leading to less people with preexisting conditions without coverage compared with before.
3. The number of people with coverage has increased.
ACA marketplaces enable individuals and small businesses to purchase private health insurance coverage at reduced costs, making the program accessible even to previously uninsured Americans. Since their introduction in fall 2013, significant numbers have obtained coverage through these marketplaces.
This law prohibits insurers from denying or dropping coverage based on preexisting conditions, allows young adults to remain on their parents’ plans until age 26 and prohibits annual and lifetime limits on benefits.
Though some states have welcomed exchanges and Medicaid expansion with open arms, others have rejected either option due to partisan disagreement. As a result, implementation varies significantly across states with nongovernmental organizations helping the newly insured access care, while RAND works on tools that assist millions of policyholders transitioning between coverage and care. Furthermore, the Affordable Care Act’s 80/20 rule mandates insurance companies use at least 80 percent of premium dollars on medical care rather than overhead or executive bonuses.
4. The number of people with high deductibles has decreased.
The Affordable Care Act mandates that insurance companies spend at least 80% to 85% of premium payments directly on care, or refund the difference back. This helps ensure people get value from their premium payments and that health care spending doesn’t outstrip income levels.
Without employer-based coverage, premium contributions and deductibles can comprise a substantial share of incomes for those without coverage through an employer. To mitigate this situation, the Affordable Care Act permits young adults to remain on their parents’ insurance plan until age 26 while also prohibiting insurers from placing annual or lifetime limits on coverage.
These reforms of the Affordable Care Act help lower barriers to health coverage, mitigate financial risk for low-income individuals, improve affordability and accessibility and thereby enable millions of people to gain coverage under its auspices.
5. The number of people with low deductibles has increased.
The Affordable Care Act (ACA) mandates health insurance coverage for all Americans, providing subsidies for those who purchase private plans on health insurance marketplaces. Furthermore, it prevents insurers from setting lifetime dollar limits for essential health benefits and cancelling coverage when someone becomes sick.
ACA also introduced nonprofit health insurance co-ops as competitors of private insurers on exchanges. Low-interest government loans and risk corridor payments help offset their losses so they can offer affordable health coverage options to members.
The Affordable Care Act has enabled over 20 million individuals, previously uninsured or not, to access health care coverage. Furthermore, preventive services have become more readily accessible thanks to cost sharing provisions being eliminated and health plans being required to provide certain preventive services without an upfront deductible payment requirement.