It’s been 13 years since the Affordable Care Act (ACA) was signed into law. At the time my daughter was in elementary school and I didn’t much think about what would happen to her health insurance – but now as she seems very grown up and is about to graduate from college and search for a job, it’s time to think about it. Hopefully, this won’t be necessary, but I am incredibly grateful for the ACA’s provision that allows young adults to stay on their parent’s plan until age 26.
The ACA is still young; however, it has managed to deliver impressive results while persevering and overcoming many obstacles. Despite countless efforts to destroy the law, it has survived and indeed thrived. The greatest damage was of course inflicted by the Supreme Court in NFIB v Sebelius, which took away the guarantee of Medicaid coverage for low-income adults that the ACA had established as a key pillar to reducing the nation’s high uninsured rate. This setback is slowly being overcome state by state – too slowly of course for those left in the coverage gap – but a goal that I do believe will be achieved nationwide eventually.
The ACA has made huge improvements in health coverage and narrowed racial and ethnic disparities, particularly in Medicaid expansion states. The ACA Marketplace is stronger than ever. It has also made a number of improvements that are now so tightly woven into the health care system that many of us might take them for granted. Today’s young adults like my daughter have no memory of some of the crazy aspects of our health care system that existed pre-ACA.
That was then:
Prior to enactment of the ACA, insurers could limit benefits or deny coverage for people with pre-existing conditions (such as asthma, diabetes, or autism) and impose dollar amount caps on benefits that an individual or family could receive both annually and over a lifetime. Back then, pregnancy could be considered a pre-existing condition (and often was) and children with complex medical needs could hit lifetime caps imposed by their insurance companies within their first years of life.
This is now:
Insurers are no longer able to deny coverage to people with pre-existing conditions or impose dollar amount caps on benefits annually or over a lifetime. Health plans today are required to offer maternity coverage. Also, insurers can no longer charge higher premiums based on health status and gender. Additionally, Medicaid expansion has helped reduce the uninsured rate for women of childbearing age so they can get the care they need before, during, and after pregnancy. (While the rapid adoption in the majority of states opting into 12 months of postpartum Medicaid coverage is not a direct result of the ACA, it builds on its success.)
That was then:
Young adults had a 28% uninsured rate and no national law protected them from being dropped from their parents’ plan.
This is now:
Plans offering dependent coverage are required to allow young adults up to age 26 to enroll in their parents’ plans.
That was then:
Co-payments and limits to coverage deterred families from taking full advantage of preventive services such as well-child visits and other preventive screenings.
This is now:
The ACA removed cost and coverage barriers that could deter families from taking full advantage of preventive care services in private insurance plans. Providing well-child visits and other preventive screenings with no cost sharing helps improve early detection and treatment of health issues before they develop into bigger problems.
That was then:
Families in 21 states faced the prospect of siblings having coverage through different programs – older children were placed in CHIP while younger children were covered by Medicaid.
This is now:
The ACA got rid of this weird “stairstep” eligibility and ensured that all children under 138 percent of the federal poverty line are covered in Medicaid with no premiums and access to the EPSDT benefit.
These are but a few of the many ways the ACA improved health care and made people’s lives better. So today as we observe the 13th anniversary of the Affordable Care Act, while not ignoring the fact that challenges lie ahead, it is good to remind ourselves of the gains that have been made. Happy anniversary of ACA!
