Affordable Care Act

The Patient Protection and Affordable Care Act (ACA) was enacted into law on March 23, 2010 with a phase-in implementation plan and many key provisions becoming effective for the 2014 plan year.

The ACA was primarily designed to make coverage for individuals not covered by employer-sponsored plans or government programs – such as Medicaid or Medicare – more affordable and readily available to consumers, including those with health conditions who had often been denied coverage, or charged more, because of their conditions.

The ACA made significant changes to improve the individual and small group health insurance markets. Individuals who do not have access to health insurance previously are able to shop for and obtain coverage with the availability, for most, of tax credits to help pay for premiums and cost-sharing subsidies to pay for out-of-pocket costs such as deductibles. The ACA also gave states the option to expand their Medicaid program in their state to cover more low-income adults and receive additional federal funds to pay for this new population of beneficiaries.

Another major component of the ACA is the host of patient protections that ensure these individual and small group health plans are adequate and more similar in benefit design to employer-sponsored health plans. Prior to the ACA, many individuals with epilepsy and other chronic conditions did not have access to health insurance that was affordable and sufficient to cover their health care needs. Individuals often could not gain coverage because of pre-existing conditions, exorbitant costs, and mandatory waiting periods before they could gain coverage via a state high-risk pool or Medicare.

Learn more about the basics of the ACA here.

Preserving Patient Protections Created by the Affordable Care Act

The Epilepsy Foundation advocates for access to quality health care that is affordable and comprehensive, and that meets the needs of individuals with serious and chronic health conditions and disabilities. We are dedicated to implementation, strengthening and enforcement of the patient protections created by the Patient Protection and Affordable Care Act (ACA), especially as they relate to health plans offered in the ACA Marketplace and Medicaid expansion.

As Congress and the Administration consider the American Health Care Act (AHCA), the Better Care Reconciliation Act, and related health reform proposals, we continue to raise awareness of the critical role patient protections created by the ACA play in ensuring people living with epilepsy have access to quality care. The ACA allowed millions of individuals – many who had been unable to access health insurance in the past because of denials and exclusions for pre-existing conditions, as well as unaffordable premiums – to gain meaningful access to quality and affordable care though the ACA Marketplace and Medicaid expansion.

The Better Care Reconciliation Act & American Health Care Act Proposals to Repeal Parts of the ACA

The Better Care Reconciliation Act and the American Health Care Act (AHCA) would repeal critical patient protections created by the Affordable Care Act (ACA) and radically restructure the way the federal government supports states’ Medicaid programs.

Learn more below about how these proposals threaten meaningful access to quality care, eliminate or erode existing patient protections, and severely underfund critical health care programs.

Essential Health Benefits

Essential Health Benefits (EHBs) requirements created by the ACA ensure that basic services like prescription drugs, hospitalizations, and emergency services are covered by plans offered in the ACA Marketplace and Medicaid expansion plans. The repeal and replace plans propose to allow states to waive these requirements.

Learn more about Essential Health Benefits and how proposals to allow states to waive EHB requirements would impact access to quality care within and beyond the ACA Marketplace here.

High-Risk Pools

Many people living with epilepsy who before the ACA couldn’t obtain health insurance because of a pre-existing condition, or had to rely on severely underfunded high-risk pools with waiting periods for coverage, could lose access to quality care if the proposals within the Better Care Reconciliation Act and AHCA become law. The proposed solution in these bill is funding for high-risk pools; however, these did not work prior to ACA and will no work again.

Learn more about the history of high-risk pools and why the proposals and funding for high-risk pools may not be enough to ensure access to quality care for people living with complex chronic conditions here.

Medicaid Per Capita Caps

More than 70 million Americans rely on Medicaid and the related Children’s Health Insurance Program (CHIP) for their health care and medication needs – including a third of people living with epilepsy. The Better Care Reconciliation Act and AHCA would radically restructure the way the federal government supports states’ Medicaid programs by instituting per-capita caps that would lead to hundreds of billions in funding cuts over the next ten years, which would result in a reduction of benefits and services.

Learn more about the impact of Medicaid cuts here.

On June 15, the Epilepsy Foundation joined dozens of other organizations representing patients, consumers, and health care providers in a letter to Senate Republican leaders, expressing grave concerns about the AHCA's proposals to restructure Medicaid. Read the letter below.

Patient Groups Letter of Concern - AHCA Medicaid Restructuring (June 15, 2017)

ACA Advocacy News

CMS Announces Streamlined Direct Enrollment Process for Consumers Seeking Exchange Coverage

On May 17, 2017, the Centers for Medicare & Medicaid Services (CMS) announced a simplified direct enrollment process for consumers signing up for individual market coverage through health care exchanges that use HealthCare.gov. Consumers applying for individual coverage through direct enrollment partners will now be able to complete their application using only one website, enabling easier access to healthcare comparison shopping. In the past, consumers who signed up for health care coverage using a third-party website were completed to HealthCare.gov to complete their application.

Learn more about this new direct enrollment process here.

CMS Announces Checklist for State Innovation Waiver Applications

Section 1332 of the Affordable Care Act (ACA) allows states to apply for State Innovation Waivers to pursue innovative strategies for providing high-quality, affordable health coverage to their residents. The Centers for Medicare & Medicaid Services (CMS) has produced a checklist to help states pursuing State Innovation Waivers as they develop and complete the required elements of the application, with specific requirments related to high-risk pools and state reinsurance.

Learn more about the CMS State Innovation Waiver Checklist here.

House of Representatives Votes to Approve AHCA

On May 4, 2017, the U.S. House of Representatives voted on the American Health Care Act (AHCA), which would repeal critical patient protections created by the Affordable Care Act (ACA) and radically restructure the way the federal government supports states’ Medicaid programs. The AHCA would cut Medicaid funding by $840 billion over the next ten years by instituting per-capita caps on federal support to the states for the program; and allow states to eliminate Essential Health Benefits requirements for plans offered in the ACA Marketplaces, which ensure plans cover prescription drugs, hospitalization, and emergency services, among other basic benefits.

Consortium for Citizens with Disabilities (CCD) Reacts to House Passage of AHCA

The Consortium for Citizens with Disabilities (CCD), the country’s largest coalition of national disability groups, is gravely concerned about the House of Representative’s passage of the American Health Care Act. The AHCA will harm tens of millions in the United States, but especially people with disabilities who will face coverage loss, higher costs, and fewer options. Read the full statement below.

CCD Statement on AHCA (May 4, 2017)

Epilepsy Foundation Joins Coalition Letter Urging Congress to Oppose AHCA Because of Cuts to Medicaid

On March 16, 2017, the Epilepsy Foundation joined members of the Consortium for Citizens with Disabilities (CCD) and other national organizations in a letter to Congress expressing serious concerns with the AHCA. The letter urged members to oppose the legislation as currently drafted because of signifant restructuring and cuts to the Medicaid program, which provides lifesaving medications and health care services for more than a third of people living with epilepsy, including children from low-income families and/or with severe forms of epilepsy, as well as children and adults living with disabilities. Read the letter below.

CCD Coalition Letter on AHCA (March 16, 2017)

Epilepsy Foundation Joins Coalition Letter Urging Congress to Protect Medicaid

On March 3, 2017, the Epilepsy Foundation joined 100 national organizations representing older Americans and people with disabilities in a letter to Congressional leadership urging Congress not to make radical structural changes to Medicaid through block grants or per capita caps. These kind of changes would lead to fewer services and higher health care costs for people with epilepsy, putting their care at risk. Read our letter below.

Coalition Letter to Congressional Leadership on Protecting Medicaid (March 3, 2017)

Epilepsy Foundation Joins 200 Patient Advocacy Groups in Letter to HHS Secretary Price

The Epilepsy Foundation, as a leader of the I Am Essential coalition, joined 200 patient groups, including all Epilepsy Foundation chapters and affiliates across the country, in sending a February 10, 2017 letter to recently confirmed Secretary of Health and Human Services Dr. Tom Price, urging him to maintain existing patient protections enacted in the Affordable Care Act. It is especially important to advocate for patient protections like the Essential Health Benefits and patient access to prescription drugs their providers prescribe as Congress and the Administration consider changes to current healthcare laws and regulations.

IAE Letter to HHS Secretary Dr. Tom Price (Feb. 10, 2017)

Read the I Am Essential press release on the February 10 letter here.

Epilepsy Foundation Sends Letter to President-elect and Congressional Leadership Opposing Current ACA Repeal Efforts

On January 11, 2017, the Epilepsy Foundation sent a letter to President-elect Trump and Congressional leadership, highlighting the provisions in the Affordable Care Act that have been important to the epilepsy community. Read our letter at the link below.

Epilepsy Foundation Letter to President-elect Trump and Congress on the Affordable Care Act (Jan. 11, 2017)