This Thanksgiving, We’re Thankful for the Affordable Care Act’s Protections

It’s that time of year again. Our team of private insurance experts at CHIR is heading far and wide for Thanksgiving, from the valleys of Western Pennsylvania to the bluffs of Iowa. As we gather around different tables, we’ll be sure to give thanks. One thing on our minds this season is our gratitude for the ongoing insurance protections provided by the Affordable Care Act (ACA).

The ACA’s reforms brought about historic reductions in the number of uninsured. Through coverage expansion, key consumer protections and new market rules, the health law fundamentally changed the insurance landscape. Currently, the ACA is being challenged in federal court, putting nearly 20 million people in danger of losing their health coverage.

The future of the ACA is far from certain, but right now, there’s a cornucopia of protections to give thanks for. We’ve picked a few to savor, so let’s set the table:

Dress Your Turkey with Coverage for Pre-Existing Conditions

The centerpiece is made with the ACA’s principal elements, all critical protections against discrimination. Prior to the ACA, it was common for insurers to practice medical underwriting to assess a consumer’s health status. Insurers could use this information to deny someone a plan entirely, charge them higher premiums, or refuse to cover the care they needed to manage a pre-existing condition. The ACA outlawed this practice, requiring insurers to offer coverage to consumers regardless of health status (guaranteed issue), prohibiting premium rates based on health status (community rating), and banning coverage exclusions for pre-existing conditions.

These key provisions of the ACA protect people who are sick as well as those deemed a “high risk” by insurers, including women of child-bearing age and older individuals. If the law is overturned, states may struggle to maintain those consumer protections. For now, we are grateful that the ACA protects some of the most vulnerable among us.

Pull up Some Extra Chairs for Medicaid Expansion

The more the merrier at the Thanksgiving table, but some state Medicaid programs are still elbowing people out of the program. The ACA expanded Medicaid to millions of people. The enacted law required all states to expand the program, but a 2012 Supreme Court case allowed states to opt out. Today, 36 states and Washington, D.C. have adopted Medicaid expansion, but a handful of states have yet to provide this avenue to coverage for their residents, and 2.5 million low-income uninsured adults are in what is known as the “coverage gap.”

Research has shown that Medicaid expansion increased the number of insured and cut down on uncompensated care costs. Other studies indicate that Medicaid expansion states have improved maternal health outcomes and reduced infant mortality. States have also found savings through Medicaid expansion. It’s no wonder that residents in three states voted to expand Medicaid during the November 2018 election, and ballot initiatives are in the works in a number of others. This holiday we’re hoping more states will pull up a chair at the coverage expansion table.

Pass the Essential Health Benefits, Please!

This dish is chocked full of benefit categories – 10 to be exact. Before the ACA’s enactment, health plans frequently failed to cover basic health services, such as mental health care and prescription drugs. Insurers could design health plans that “cherry picked” healthy individuals by excluding coverage of certain services, such as maternity care and mental health. The ACA established the Essential Health Benefits (EHB) as a minimum standard for most individual and small group health plans, outlining a set of 10 benefit categories including preventive services, pediatric care, and prescription drugs.

The EHB ensure that consumers have access to comprehensive coverage, and curb cherry picking by setting benefit requirements that all non-grandfathered small group and individual products must meet. Insurers also can’t place lifetime or annual dollar limits on these benefits, and must cap enrollees’ annual out-of-pocket cost-sharing for these covered services.

The protections provided by the EHB currently hang in the balance due to the federal court case challenging the ACA’s constitutionality. But this Thanksgiving, we’ll gladly pass around this provision that defends against inadequate coverage.

Keep the Kids Table Covered with Dependent Coverage up to Age 26

One of the most popular provisions of the ACA – more popular with this author than the many years she was stuck at the kid’s table – is the requirement to extend dependent coverage up to age 26. Under the ACA, individuals can stay on their parent’s plan (provided it covers dependents) until they turn 26, even if they do not live with their parents or count as a dependent for tax purposes.

Prior to this provision, children were often kicked off their parent’s health insurance once they turned 19 or graduated from college. Extending dependent coverage up to age 26 reduced the number of uninsured young adults, providing an avenue for coverage to a population that has historically experienced a low rate of coverage. If the ACA remains in effect, parents and their kids can count on this protection to provide access to health insurance during a time that many young adults are in transition. The kids table doesn’t look so bad from that angle.

Grab a Piece of the Pie with Financial Assistance for Premiums and Cost Sharing

Hope you saved some room for pie. The ACA provides federal financial assistance for health coverage, available in multiple flavors: premium subsidies and cost-sharing reductions. The ACA’s premium subsidies are based on income and age, shielding consumers from the impact of rate hikes. Cost-sharing reductions reduce overall out-of-pocket costs, a common source of financial stress.

Consumers with incomes between 100 and 400 percent of the federal poverty level can use premium subsidies to reduce the cost of their health plan if they buy through the health insurance marketplace, and consumers with incomes between 100 and 250 percent of the federal poverty level are eligible for cost-sharing reductions if they purchase a silver plan through the marketplace. Last year, almost 90 percent of people who signed up for coverage through received premium subsidies, while over half received cost-sharing reductions. During this Open Enrollment Period (which is going on now, and runs through December 15th in most states), many consumers may have access to plans with low- or even no-cost premiums through the marketplace. That’s a sweet deal.

Some Food for Thought

Despite extraordinary progress, we have yet to put a chicken (or turkey) in every pot – millions of people still don’t have health insurance, while others have inadequate coverage. As we give thanks for the hard-won gains of the ACA, we also acknowledge the law’s shortcomings. And while we grapple with how to expand access to affordable, quality health insurance in this country, CHIR continues to hope that consumers stay at the heart of that debate.

And that we always have room for pie.

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