Guide to the Affordable Care Act

December 6, 2016

What’s in the Affordable Care Act?

The incoming Republican-controlled House and Senate, along with President-Elect Donald Trump, have announced that one of their first orders of business will be to repeal and replace the Affordable Care Act (ACA), also known as Obamacare.  The ACA has provided insurance to 20 million previously uninsured Americans, but has nonetheless been a controversial policy since it was first introduced.  Much of this controversy has been the result of confusion about what the ACA actually does.  While the ACA is not perfect, repealing it would have an immediate negative effect on millions of Americans who would lose health care coverage, and millions more who would lose essential benefits in their insurance coverage.

Below is an outline of some of the key provisions of the ACA that impact the Prevent Cancer Foundation’s priorities.  During the coming weeks, we will examine each of these provisions in detail, and explore what the proposed replacement policies would mean for them.

Family insurance until age 26

The ACA requires insurance companies to allow children to stay on family insurance plans until age 26.  This provides valuable coverage for young adults during a time when they are often job searching and may not otherwise be able to afford coverage.  An estimated 2.3 million people between the ages of 18 and 26 have acquired insurance coverage from this provision since it came into effect in 2014.

Health care exchanges and subsidies

Health care exchanges, or marketplaces where individuals can purchase insurance, are a well-known part of the Affordable Care Act.  These exchanges work by offering plans that multiple people can buy into in order to keep costs low-similar to a large employer selecting one plan for all employees.  While there are some problems with the exchanges, and they would likely need a legislative fix in the next two years in order to stay functional, the exchanges do provide insurance to more than 12 million people, the majority of whom do not have insurance through employers.  If the exchanges are halted, there is a big question as to what it will mean for those currently covered.

The corollary to this is that 83 percent of those on the exchanges receive some sort of subsidy in order to afford coverage.  (http://www.modernhealthcare.com/article/20160311/NEWS/160319974).  If the law is repealed, we do not know whether or not subsidies will be available.

Guaranteed coverage for pre-existing conditions

This is one of the most popular provisions of the Affordable Care Act.  The ACA requires insurance companies to cover pre-existing conditions, with no exceptions, and limit how much more they can charge in insurance premiums.  Consider this scenario: you decide to be proactive about your health, so you get the recommended cancer screenings—and then receive a cancer diagnosis.  Luckily, thanks to the screening, your cancer was detected early and treated successfully.  But now, without a guarantee about pre-existing conditions, you could be denied insurance.  This is one of the most important changes in health care coverage from the ACA, and we will fight hard to ensure it stays in place. 

Guaranteed coverage for preventive services

The ACA requires insurers to cover essential health benefits—including preventive services.  This includes coverage for cancer screenings such as mammograms, colorectal cancer screenings, and pap smears, and essential preventive services, such as vaccines for human papilloma-virus (HPV), hepatitis A, and hepatitis B.  Most importantly insurers must cover these services completely.  That means there is no out-of-pocket cost for the consumer and no co-pay, regardless of whether or not you have met your deductible.  This is especially important for low-income individuals.  One study shows the rate of women getting mammograms increased by 9 percent when the co-pay was removed. Guaranteeing coverage for preventive care increases access to prevention for all.

 Creation of Prevention and Public Health Fund

The Prevent Cancer Foundation strongly supports the Prevention and Public Health Fund, which was set up by the ACA.  The Fund provides community health grants for culturally-appropriate health education, tobacco cessation programs, screenings, vaccines, and other essential health services.  Unfortunately, the Fund has often been seen as a source of other health funding, and its budget has decreased. 

By prioritizing prevention, the Fund is not only health outcomes, but is also saving money in the long term.  This Fund could exist independent of other ACA reforms.  The Foundation will be advocating for for Congress to continue supporting the Prevention and Public Health Fund and its valuable programs. 

Medicaid expansion

For states that have accepted Medicaid expansion, Medicaid covers everyone 65 years and younger (prior to when they can enter Medicare) who are at or below 133 percent of the poverty line.  In states that have accepted Medicaid expansion, an additional 12 million people have been covered by Medicaid and CHIP (Child Health Insurance Program).  The changes to Medicaid also include an increase in the types of services they are required to cover, providing greater access to preventive care and wellness programs.  Again, our leaders should take pains to ensure any changes to the Affordable Care Act do not result in a loss of coverage for those who are currently covered through Medicaid expansion.  We do not want to see people lose access to guaranteed, quality health care coverage. 

The Affordable Care Act touches almost all aspects of health care in the United States; even the provisions outlined here comprise only a small part of the ACA.  They are, however, the pieces that most directly affect cancer prevention and early detection.

Check back often as we continue to explore the ACA in detail and take a look at what a replacement plan might look like.  To find out what you can do to protect health access, be sure to join our advocacy list.

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