Top 7 Benefits of the Affordable Care Act…Some of Which May Soon Disappear.

As health care litigators, we are often asked about the benefits of the Affordable Care Act (“ACA” aka Obamacare). The bottom line is that more people have received more comprehensive coverage through the Affordable Care Act because of the following measures:

  1. No preexisting exclusion. Health plans can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer. https://www.hhs.gov/healthcare/about-the-law/pre-existing-conditions/index.html
  2. Young adults can remain as dependents on their parents’ health plans until age 26. Young people generally do not have access to sufficient individual health plans and do not have careers that provide the opportunity for an employer based plan so the opportunity to remain on a parent’s health plan is a great benefit. http://www.forbes.com/sites/emilywillingham/2017/01/25/have-a-teenager-you-should-worry-about-aca-repeal/#4a89ca150604
  3. The employer mandate. As of 2016, employers with at least 50 full-time employees must provide health coverage. Employer plans generally can provide better coverage because they are insuring a group of families and individuals. https://www.irs.gov/affordable-care-act/employers/employer-shared-responsibility-provisions
  4. Closing the Medicare “donut hole” for seniors. The donut hole is essentially a gap in coverage during which beneficiaries had to pay the full cost of their prescriptions out of pocket (after hitting their initial coverage limit) and before catastrophic coverage for prescriptions took effect. The ACA gradually closes the gap by 2020. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-01-13.html
  5. No annual limits. Of particular concern for individuals with costly and longstanding health problems, the annual limit is a cap on their health benefits. The ACA eliminated the annual limit. https://www.hhs.gov/healthcare/about-the-law/benefit-limits/index.html
  6. Increased mandatory coverage. The minimum essential health benefits (“EHB”) includes free preventative services such as immunizations, physical exams, screenings for depression, blood pressure, colorectal cancer, and high cholesterol. https://www.healthcare.gov/preventive-care-adults/
  7. Expanded mental health coverage through mental health parity. The ACA builds onto the incorporates the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA” or the federal parity law) which requires health plans that offer mental health and substance abuse benefits to provide coverage that is comparable to coverage for general medical and surgical care. https://www.samhsa.gov/health-financing/implementation-mental-health-parity-addiction-equity-act

The ACA is in jeopardy and will likely soon be replaced by the American Health Care Act (AHCA, or Trumpcare).  Much is uncertain, but it seems there is a very good chance that some of these benefits will disappear, or at least be reduced.  Forbes Magazine reports once immediate consequence is that with the AHCA’s proposed reduction of Medicaid subsidies, “states may not be able to provide coverage for the growing population of sicker and older Americans.”

Stay tuned…

 

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