14.8.1: The Affordable Care Act
The largest piece of healthcare reform legislation was passed in 2009 under President Barack Obama, titled the Patient Protection and Affordable Care Act (ACA) and known colloquially as “Obamacare”. Different portions of it went into effect over the following years. One key piece of the ACA was the individual mandate - requiring that every U.S. adult provide proof of healthcare coverage or pay a tax fee - was eliminated by Congress during the subsequent administration of President Donald Trump. However, many states continued to enforce such a mandate or impose a state tax. Yet, other provisions have remained, and proved somewhat effective at reforming healthcare for Americans. Below are some of the most important actions of the ACA.
- Protection for pre-existing conditions. Health insurance companies can no longer deny enrollment to people who have pre-existing conditions, charge them higher premiums, or refuse to cover those conditions. These conditions include things like diabetes, asthma, pregnancy, and cancer. Previously, many insurance companies would reduce their financial risk by refusing to enroll people with pre-existing conditions (at the time of enrollment), or enrolling them but refusing to cover services related to those conditions. These practices are now illegal, however some insurance plans that existed before March 23rd, 2010 were given “grandfathered” status to continue without these protections (Assistant Secretary for Public Affairs (ASPA), 2022, U.S. Centers for Medicare & Medicaid Services, 2022).
- Allowance for young adults to stay on their parent’s insurance plans up until age 26. Young adults may be more likely to work part-time jobs and may not be able to afford purchasing health insurance on their own. They may also not be as concerned about getting coverage thinking they are “young and healthy”, yet 1 in 6 in this age group still has chronic health problems (CMS.gov, 2023).
- Expansion of Government subsidies. The ACA expanded Medicaid coverage to anyone earning up to 138% of the federal poverty level (FPL), and allowed states to choose whether or not to participate in the expansion (with up to 90% of the additional cost covered with federal funds). Additionally, federal subsidies for purchasing healthcare via the marketplace insurance plans can provide assistance via tax credits for people who have higher incomes (KFF, 2023).
- Emphasizing preventative care. The ACA made requirements that marketplace healthcare plans cover 10 essential services, which include the typical hospital stays and emergency services, as well as women’s health, pregnancy, maternity and newborn care, preventative and wellness visits, rehabilitative services, mental health and substance use disorder services, pediatric visits, labs and prescription drugs. The ACA also increased funding for Community Health Centers (Assistant Secretary for Public Affairs (ASPA), 2022)
Other provisions also emphasized health equity by establishing the Offices of Minority Health and focusing resources on improving STI and mental health awareness and access to treatment for the most vulnerable populations (Assistant Secretary for Public Affairs (ASPA), 2022).