On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA), a historic health care reform bill, into law. The Epilepsy Foundation supported the ACA and continues to support efforts to increase access to affordable health insurance and health care that meets the needs of individuals with chronic conditions like epilepsy. To learn about our current advocacy efforts on the Affordable Care Act, visit our ACA page at advocacy.epilepsy.com/ACA.
The ACA includes four key provisions that meaningfully expanded access to health care for the epilepsy community.
1. Affordable Coverage for Pre-Existing Conditions and Chronic Illnesses. Prior to the enactment of the ACA, insurers in the individual market used medical underwriting to set premium rates for health care plans and to make determinations about whether to offer coverage to specific individuals based on specific characteristics, including medical history. This underwriting frequently led to unaffordable premiums for people with pre-existing conditions or outright coverage denials.
In 2013, before the implementation of the ACA Marketplace, up to 18% of health insurance applicants were denied coverage in the individual (non-employer) insurance market. Under the ACA, insurers cannot deny coverage to people with pre-existing conditions and health insurance rates cannot be priced based on an individual’s medical history. Individuals can also not be dropped from their insurance plan if they become sick. These provisions in the ACA were among the most significant for the epilepsy community and helped to expand access to affordable health care to millions of Americans with pre-existing conditions.
2. Establishment of Health Care Exchanges. The ACA established state and federal health insurance exchanges – or the “Marketplace,” where individuals, families, and small businesses can purchase health insurance. The exchanges allow buyers to comparison shop between health insurance plans and choose the plan that best suits their needs and price range. The ACA provides premium tax credits to help individuals and families purchase insurance that have incomes up to 400% of the federal poverty line, as well as cost-sharing subsidies to help cover out-of-pocket costs for those up to 250% of the federal poverty line. A large majority of those who have signed up for coverage through the ACA Marketplace receive federal assistance to pay for some coverage.
3. Regulations on Private Insurers. The ACA included new regulations on the insurance industry in the individual and small group market to help ensure that all private insurance plans offer high-quality, affordable health care coverage. Plans in the exchanges are required to offer a set of “Essential Health Benefits,” which include hospitalization care, prescription medications, emergency services, preventative care, and chronic disease management. Additionally, insurers are prohibited from imposing annual or lifetime limits on coverage and plans must have caps on out-of-pocket costs that the beneficiary can be required to pay. The ACA also limits the extent to which insurers can raise premiums based on age or geographical location and allows young people to stay on their parents’ insurance plan until they reach age 26.
4. Expansion of the Medicaid Program. The ACA provides states with the option to expand Medicaid to individuals and families with incomes up to 138% of the federal poverty line ($16,643 for a single individual, $33,948 for a family of four). The expansion also eliminated previous federal limitations that prevented most childless adults from enrolling in Medicaid. More than 14 million people have gained health insurance coverage through the Medicaid expansion, which more than half the states have implemented.
Congress passed the ACA with the goal of ensuring that all Americans could have access to affordable health care. Employer-sponsored and existing government health care programs – like Medicaid and Medicare – worked relatively well to ensure coverage for most Americans. However, prior to the bill’s enactment, there were still millions of Americans who could not be part of these systems who suffered from health care discrimination, facing high premiums or coverage denials for even minor pre-existing conditions. Many more Americans did not have health insurance at all. Since the 1990s, there had been discussions in Congress and in Administrations around health care reform, but the ACA was the first successful attempt at comprehensive, national health care reform since the establishment of the Medicare and Medicaid programs.
Since the ACA was implemented, more than 20 million people have gained health insurance. This year alone, 12 million Americans signed up for insurance through state and federal marketplaces. While some work is still needed to fulfill the ACA’s promise of truly affordable, comprehensive health care for all, it was a tremendous step forward in preserving the health and protecting the lives of millions of Americans.