What is the Affordable Care Act?
By: Robert H. Gillespie, LMSW Outreach Social Worker
Believe it or not I find insurance very confusing. Even though a majority of my job at HoG is helping individuals wade through the weedy world of insurance to find or keep a plan that suits their particular need(s), it is difficult keeping a working knowledge of government funded programs such as Medicare, Medicaid, and Tricare, let alone the hundreds of private policies available. To further befuddle my already confused mind a new program, the Affordable Care Act (ACA) is added to the mix. Did you know that Obamacare and the ACA actually refer to the same federal program? Did you know that the federal website used to enroll in the ACA is often called “the Marketplace?” So what is this new Obamacare/ACA program? Let’s open the door to this Pandora’s Box and see.
After many training workshops, massive amounts of reading, discussion with others learning about the ACA, and helping many people through the process of signing up for the ACA, I have come to realize what a monumental change for the better the ACA is for our country. For example, one of the cornerstone benefits of the Affordable Care Act is eliminating preexisting conditions clauses. Prior to January 1, 2014, insurance companies were able to deny coverage for a preexisting condition. This preexisting exclusion affected many people. Often, even those with insurance found that the policies they held prevented coverage for conditions ranging from heart disease to diabetes to various cancers. Even through employer-based insurance, if the insured individual was without coverage for any amount of time between when the old policy stopped and a new policy began, all the conditions covered by the old policy could be considered as “preexisting.” Since January 1, 2014, however, it is illegal for insurance companies to deny coverage based on a condition, no matter when the condition began.
Prior to the implementation of the ACA, insurance companies could charge women more than men for premiums. Also, insurance companies could charge a person with a certain condition, such as hemophilia, more than a person without a bleeding disorder. Now, luckily, women are charged the same rate as men and medical conditions cannot be used to increase premium rates. The law also removed an insurance company’s ability to place lifetime caps on insurance payouts. As you know, healthcare is expensive. Before the enactment of ACA, if an individual was lucky enough to find coverage, the insurance companies could place a limit on the lifetime amount paid under a policy. When the lifetime cap was exhausted, insurance stopped paying. This often left people who had chronic, expensive conditions with few options and many times bankrupt.
Another cornerstone of the ACA is that all young adults, until the age of 26, can remain on their parent’s insurance. There are some exceptions to this policy, such as if a parent receives Medicare and or Medicaid, the young adult is not covered under the parent, but must apply for the benefit as an individual. The young adult can also be married and have children, but the young adult’s family cannot be covered under the parent’s plan (so spouse and/or or dependent children must find their insurance either through their parent or another way).
I know at this point you are thinking the ACA is pretty great. No preexisting conditions, no lifetime benefit caps, and gender equality. What else is there? Well, a lot, to answer that question simply. For example, the ACA, as another of its cornerstones, allows the insured to seek preventive services without a copay or deductible. It also requires insurance companies to justify large rate increases. They must also spend $0.80 of every $1.00 of premiums on healthcare or healthcare improvement and not on overhead. The law also supports rural community care centers and extends the Medicare trust fund by 10 years.
Although far from perfect and at times confusing, many people can see from these facts how the ACA can be beneficial.
Source: https://www.hhs.gov/healthcare/facts/bystate/ga.html