What are the major provisions of the Affordable Care Act (ACA)?
The ACA is a health insurance reform law designed to make health insurance more accessible. It includes tax credits that help low- and middle-income families pay for their premiums.
Additionally, this bill expands Medicaid coverage – an essential step that will enable many more Americans to gain access to health care coverage.
Cost-sharing reductions
People who purchase health insurance through the Health Insurance Marketplaces can take advantage of cost-sharing reductions to help cover deductibles, copayments and coinsurance. Furthermore, ACA provisions keep maximum out-of-pocket costs low so everyone in the marketplace has access to care without facing high expenses.
The Affordable Care Act (ACA) offers people with modest incomes the option of affordable health coverage with lower deductibles and out-of-pocket costs by making plans available through the exchanges that have higher actuarial value (AV). This means the plan’s deductible and out-of-pocket expenses are smaller than those for standard silver plans.
People whose incomes are up to 250% of the federal poverty level may qualify for these reductions and can only be applied to silver plans. Unfortunately, in October 2017 the Trump Administration stopped reimbursing insurers for these payments.
Health insurance exchanges
Health insurance exchanges, created as part of the Affordable Care Act, are online platforms that enable individuals and small businesses to compare different health insurance plans side-by-side. Furthermore, these exchanges facilitate enrollment and determine eligibility for tax credits.
One of the key provisions of the Affordable Care Act (ACA) requires each state to create a health insurance exchange. States must determine its governance, financing and operations requirements in accordance with federal standards.
Another key provision of the Affordable Care Act requires all individual and small group health plans to be sold through exchanges, regardless of where they are offered. This requirement is meant to help contain costs by restricting insurers’ ability to pass on costs directly to consumers.
State governments have some discretion in setting exchange governance and organizational structure, yet the ACA restricts their authority when it comes to setting standards for participating plans. Furthermore, the law requires exchanges to provide various pieces of information such as user-friendly comparisons of plan benefits and costs, quality ratings, and other resources.
Medicaid expansion
Medicaid is a federal-state program that offers health insurance coverage to people with low incomes. It covers various services like ambulatory and emergency care, hospitalization, prescription drugs, mental health/substance abuse counseling, maternity/newborn care and more.
Before the Affordable Care Act (ACA), Medicaid eligibility was only available to people with very low incomes. Through ACA expansions, states were now able to extend their programs up to 138% of poverty level – $15,417 annually for an individual and $26,347 annually for families of four in 2021.
As a result of the Affordable Care Act (ACA), 38 states, Washington D.C. and three U.S. territories expanded their Medicaid programs to adult beneficiaries; this resulted in 21 million additional Medicaid enrollees. Unfortunately, 13 states have continued to reject federal funding for expansion despite extensive lobbying from civil rights and health organizations for such services. Unfortunately this has resulted in worse access to care, financial security and health outcomes for millions of Americans.
Preventive health care
Preventive health care is an integral component of the Affordable Care Act and plays a pivotal role in helping to reduce disease, disability and premature death. Services like cancer screenings, vaccinations and tobacco cessation interventions are crucial to avoiding diseases, improving people’s quality of life and saving money on healthcare costs.
According to the Affordable Care Act (ACA), all non-grandfathered major medical plans must cover recommended preventive healthcare services without copays or deductibles. This policy has been demonstrated to increase access to services – including women’s and children’s preventive care – while helping reduce racial disparities in coverage.
However, a lawsuit filed by conservative organizations has threatened to overturn this policy. If courts strike down the requirement, it could create an inconsistent patchwork of health plan benefit designs that requires beneficiaries to pay high deductibles or copayments before receiving certain preventive care services.
