The Patient Protection and Affordable Care Act (“ACA”) has been the law of the land since March 23, 2010 and has been fully implemented since January 1, 2014. On Friday, the United States Supreme Court upheld the constitutionality of the ACA for the second time, thereby assuring the ACA’s future ability to provide effective and affordable health care to all Americans. But what does this mean to you? To your parents? To people with disabilities? To all Americans who have a hard time affording to stay healthy? If you are not already conversant with the law and your rights, now is the time …
I do not pretend to be a disinterested reporter. I have believed in and fought for universal health care since before I went to law school. I am one of the early attorneys to have studied the Act and have spoken across the country to lawyer groups and others in the care professions. My article on how the Affordable Care Act affects the elderly and people with disabilities was just published in the most recent edition of the peer-reviewed NAELA Journal. Bottom line … I believe in the purpose of the ACA. I understand its weaknesses. I have witnessed its strengths. It is not perfect but for tens of millions of Americans who have already shifted from no health insurance to being insured, it means a higher quality of life and has often been the difference between life and death.
Before I start with statistics, please try to remember that these are not just numbers but human lives. Each digit represents parents, sons, daughters, babies, or someone’s grandmother or grandfather. These are are real lives. Here are some key facts:
- Your health insurance can no longer have annual or lifetime limits. You may have never known it, but before the ACA, your insurance would cut off completely and suddenly once you reached its limit. This limit would typically only be reached if you were unfortunate enough to have had a serious illness or catastrophic injury. For millions of people, this meant such horrors as losing all coverage in the midst of cancer treatments or other expensive and essential care. This led to unnecessary deaths and financial ruin. No longer is this the case. If you get horribly sick, your coverage is for life due to the ACA.
- Prior to the ACA, if you had been diagnosed with an illness or any disability, the insurers could deny enrollment to you. “Go away. We want only healthy people.” With the ACA and its continued constitutionality, no insurer can deny coverage based on disability or prior conditions. I speak from personal experience when I say that I have seen hundreds of my clients now be able to qualify for real health insurance for the first time in their lives.
- Last Tuesday, the federal government released the latest data on the effect of the ACA on the percentage of Americans having health insurance. 12.6 Million Americans went from being uninsured to insured in just 2014, the first year of the ACA’s full implementation.
- Subsidies and tax credits allow people to buy insurance when they could not otherwise afford to do so. The latest (and likely last major) challenge to the ACA attempted to remove these subsidies. The Supreme Court upheld the constitutionality of the subsidies.
- Prior to the full implementation of the ACA on January 1, 2014, polls showed that as many as 68% of Americans were against the ACA. Last week, after just seventeen months of seeing what the ACA really means, all polls (except one reported on today by FOX News) show that more Americans were for the ACA than against it and the majority of Americans said the Supreme Court should vote to uphold the law.
- Non-elected Democrats and Republicans have begun to reach consensus on support for the ACA’s key provisions even while elected representatives continue to show more division.
- Women can go to a gynecologist or obstetrician without a referral from a primary care doctor due to the ACA.
- You now have the right to a federally guaranteed internal and external appeals process if your insurance company denies coverage for your care.
- Your children can stay on your health insurance until the age of 26 regardless of what is going on their life.
- You can now access preventive care programs through your insurance that were never required to be covered before. More preventive care means healthier families.
- Cost of insurance is down nationally but certain insurance markets can be higher than others. Prices vary depending on where you live, your family income and whether you smoke.
- It is impossible to compare the cost of insurance today to insurance before the ACA because pre-ACA insurance was totally different. Insurance that covers pre-existing conditions with no lifetime or annual limits and with all the new appeal rights and consumer protections should cost a lot more.
- As of February 2015, the average premium before subsidies or credits was $361/month.
- The average employer-provided health insurance plan costs $6,119 per year. The average gold and platinum policies (the two highest categories) purchased through the ACA exchanges is $5,844.
- You now get a check back from your insurance company every year if the insurance company spends less than 80% of the premiums on direct health care. The ACA therefore curbs runaway insurance company profits at your expense. Tens of millions of dollars have already been returned to people (and business) like you and me.
- Medicare has new preventive care and a new welcome healthy check-up process.
- The Medicare prescription drug program has been strengthened by eliminating the coverage gap or “donut hole” by the year 2020.
- If you or a family member have a disability, you have been transformed from being a recipient of Medicaid, the only insurance-like product you could probably get, to having the choice of both or either Medicaid or private health insurance.
- If you are an adult and living in a state which has voted to follow the ACA’s Medicaid expansion, you can now qualify for Medicaid if you cannot afford subsidized health insurance
- If you are an Elder Law and Special Needs Attorney like me, you get to see many of our clients get covered healthcare for the first time in their lives.
It’s an amazing time to be alive! It’s an amazing time to be a lawyer helping people access care.
To read my full article “Report on the Affordable Care Act” published by the National Academy of Elder Law Attorneys, click here.