Prior to the Affordable Care Act (ACA), insurance companies could deny coverage to people with preexisting conditions or charge such high premiums that they were priced out of the market. Under ACA rules, insurers are now required to accept anyone and keep premiums under control.
Additionally, this legislation enabled young adults to remain on their parents’ policies until age 26 and offered financial support through an insurance marketplace.
Costs
Before the Affordable Care Act was implemented, most Americans received health coverage either through employer-sponsored plans or state/federal programs like Medicaid. People purchasing private coverage had to cover premium costs themselves; those qualifying for subsidies from government may receive some assistance in covering them.
The Affordable Care Act changed this by mandating that insurers provide affordable, comprehensive coverage at an affordable cost. It also created the Health Insurance Marketplace where people could shop and compare plans. Furthermore, this law prohibited insurance companies from denying coverage or cancelling it prematurely or charging more due to any preexisting conditions or preexisting diseases.
The Affordable Care Act also made important strides toward increasing access to care for women, outlawing discrimination in individual markets and prohibiting insurers from charging more for maternity coverage. Unfortunately, however, it did little to address soaring prescription drug costs or staggering deductibles which remain one of the greatest barriers to health insurance in America. Expanding financial assistance available for premiums would help middle-income families more affordably manage these expenses; however this would increase deficits.
Coverage
Prior to the Affordable Care Act (ACA), private health plans often had annual or lifetime caps that limited how much of your premium was applied towards covered care costs. Now these caps have been removed; insurers must spend at least 80% – 85% of premiums on covered healthcare services.
Additionally, the Affordable Care Act created health insurance marketplaces which enable individuals and small businesses to purchase standard plans with financial support from the federal government. Furthermore, it expanded Medicaid coverage and established income-based subsidies so people with lower incomes can more affordably purchase private coverage.
Experts agree that the Affordable Care Act’s expansion of Medicaid and marketplaces have contributed significantly to lowering uninsured rates, yet recent efforts to undermine it may compromise these gains. Removing individual mandates and cutting funding for outreach and enrollment services will make signing up for coverage options harder, thus potentially increasing uninsured rates again.
Out-of-pocket expenses
Health insurance plans are intended to cover most or all of the cost associated with medical care, yet out-of-pocket expenses such as copayments, deductibles and coinsurance may still be an issue. To alleviate this burden, the Affordable Care Act has helped lower these expenses by eliminating cost sharing for preventive services and encouraging generic drugs; expanding access to brand name prescription drugs through the 340B program; and permitting insurers to return rebates if they spend less than 85 percent of premiums on actual healthcare costs.
Before the Affordable Care Act (ACA), private insurers frequently used medical underwriting practices to ensure that their risk pools had enough healthy people to balance out high-cost enrollees, often leading to higher premiums and denied coverage for those with preexisting conditions (KFF, 2016c). Although this caused higher premiums and denied coverage to people with preexisting conditions (KFF 2016c), other reforms made health insurance more affordable through creating high-risk pools for those who could not afford traditional coverage and mandating plans to cover maternity care as mandates from state governments (KFF 2016c).
Pre-existing conditions
Prior to the ACA, private health insurance in the individual market was often medically underwritten, meaning insurers had the discretion to reject applicants or charge higher premiums; plans often required high out-of-pocket expenses before coverage or reimbursement could be granted or made available for services rendered.
Under the Affordable Care Act (ACA), all marketplace plans must cover treatment for preexisting conditions without discrimination based on health status, as well as covering pregnancy/childbirth with equal coverage between men and women.
Before the Affordable Care Act (ACA), millions of individuals with preexisting medical conditions faced significant barriers in securing individual market coverage. Even for those able to secure coverage, their benefits were frequently restricted through exclusionary riders or higher deductibles. Without comprehensive guaranteed issue protections in place, insurers might use medical underwriting techniques again when evaluating applicants and asking invasive questions about past medical history – including HIV infection, substance use issues or chronic ear infections which caused outright rejection from insurers.
