The Affordable Care Act protects consumers against insurance companies that deny coverage, limit benefits or charge more for preexisting conditions; as well as ending discrimination against LGBT individuals.
Individuals whose income falls between the poverty line and 133% of FPL remain in a coverage gap in states that have not expanded Medicaid, leading to financial strain and increased risks of eviction. Studies demonstrate this reality.
Eligibility
The Affordable Care Act (ACA) mandates states to adopt Medicaid policies that comply with federal requirements, such as streamlining eligibility, enrollment and renewal processes as well as updating payments to safety-net hospitals. Furthermore, Section 1115 research and demonstration waivers enable states to offer premium assistance through private insurance exchanges.
Eligibility determinations for Medicaid coverage are made based on an individual’s household income using similar financial methodologies as employed by the Internal Revenue Service to calculate modified adjusted gross income, with certain exceptions. Family size also plays an integral part in eligibility decisions; those in the new adult eligibility group must enroll in a Medicaid alternative benefit plan covering 10 essential health benefits (EHBs).
New York expanded its Medicaid program under a Section 1115 waiver to cover childless adults at 138% of FPL; this coverage will continue under the Affordable Care Act (ACA). Although expansion of Medicaid programs isn’t mandatory under ACA, states who opt for such expansion can take advantage of enhanced federal funding if they decide to do so.
Costs
The Affordable Care Act has significantly expanded Medicaid coverage for low-income Americans while improving access and some health outcomes. These improvements have not resulted in higher state costs; nevertheless, 12 states continue to refuse expansion (Kaiser Family Foundation 2021a). Furthermore, expansions appear to increase labor market participation and raise incomes; such effects may decrease financial-motivated crimes such as aggravated assaults.
The Affordable Care Act’s Essential Health Benefits package mandates coverage of 10 categories of services; however, individual states have discretion in selecting how many will cover. As a result, benefit packages vary across states significantly – which could have dire repercussions for patients with pulmonary or critical illnesses.
Studies have revealed that the Affordable Care Act’s Medicaid expansions reduce medical debt accumulation, which can act as an obstacle to accessing health care. Other studies indicate that they increase incomes in low-income households – an outcome which could benefit health through information effects like reduced hunger and improved food choices or non-health effects such as higher wages and decreased financially-motivated criminal activity.
Taxes
Under the Affordable Care Act (ACA), there are two forms of financial assistance available to enrollees who purchase marketplace coverage: premium tax credits help lower monthly premium costs while cost-sharing reduction reduces out-of-pocket costs for services rendered. Both these measures depend on a household’s modified adjusted gross income (MAGI); usually there is an upper limit, however due to American Rescue Plan and Inflation Reduction Act they have been removed until 2025.
Low-income people tend to experience fluctuating income, making projecting annual earnings difficult. They may receive more premium tax credits than they need and must repay some or all of it when filing their taxes. Furthermore, some sources of income such as social security benefits, veteran’s disability payments, child support payments and worker’s compensation payments aren’t considered in calculating income; other excluded sources include rental real estate income royalties and pass-through profits from businesses.
Coverage
The Affordable Care Act (ACA) has brought many changes to Medicaid coverage. Under this act, children can remain on their parents’ insurance until age 26, and prevents plans from denying coverage due to preexisting conditions. Furthermore, it allows Americans to acquire private health coverage via an Insurance Marketplace.
The Affordable Care Act allows states to expand Medicaid eligibility, increasing access to primary care. Unfortunately, its effects have been difficult to assess – until now. A recent study used an interrupted time series design to measure how the ACA’s Medicaid expansion affected primary care access.
New York State residents eligible for Medicaid can use the Affordable Care Act (ACA) to receive premium assistance and enroll in an Alternative Benefit Plan, which is a limited benefit plan that meets ACA standards for cost sharing limits. Such plans must provide 10 essential health benefits and comply with cost sharing limits set forth by this act.
