March 2021

Protect Our Care Is Marking the 11th Anniversary of the Affordable Care Act With 11 Days Celebrating the Success of the Health Care Law

Eleven years ago, the Affordable Care Act (ACA) became the law of the land and millions of young Americans gained coverage and critical protections as a result. Almost three million children nationwide gained coverage thanks to the ACA. Millions of young adults also experienced coverage gains and improved access to health care as a result of the health care law. 

After four long years of Republican efforts to repeal and sabotage the ACA, President Biden and Democrats in Congress are now working to build on the strong foundation of the law to expand coverage, lower costs, and reduce racial disparities in health care. On March 11, President Biden signed the American Rescue Plan into law, historic legislation that includes the most significant health care expansion in a decade. Health care for children and young adults is especially important as the nation continues to battle the coronavirus pandemic. As millions of families have lost their health care as a result of pandemic-related job losses, the ACA and Medicaid expansion have given them a place to turn to for comprehensive, affordable coverage. 

Thanks To The ACA:

Young adults can stay on their parents’ plan until age 26. Because of the ACA, roughly 2.3 million young adults have coverage because they can stay on their parents coverage until age 26.

More Than 28 Million Children & Young Adults With Pre-Existing Conditions Gained Protections. Thanks to the ACA, children with pre-existing conditions like asthma and diabetes cannot be charged more or denied coverage by their insurers. Nationwide, 135 million Americans have a pre-existing condition, including more than 17 million people under the age of 18 and 11.3 million people aged 18 to 24. And now, millions of Americans who have contracted the coronavirus are also protected from discrimination by their insurance companies. 

Free Preventive Services And Annual Check-Ups. The ACA guarantees well-child visits with no cost-sharing for patients. These visits help prevent the development of chronic conditions and increase vaccinations among children. Plans sold on the ACA must also cover preventive pediatric health benefits, including oral health and vision services. More than 40 million children with private insurance are also guaranteed access to free preventive care and are protected from lifetime and annual limits.

Ended annual and lifetime limits. Because of the ACA, insurers can no longer put annual or lifetime limits on the care you receive, which is critical for children with complex medical needs. According to First Focus, without these protections, “children with cancer and other pediatric conditions, or babies that were born prematurely and spent the first weeks or months of their lives in the neonatal intensive care unit, could exhaust their annual and lifetime limits in a short time.” 

Improvements To CHIP & Medicaid Coverage. The ACA improved children’s coverage by increasing the federal matching rate for the Children’s Health Insurance Program (CHIP) and standardizing–and in many states, expanding–Medicaid eligibility for children. The ACA also ensures that states provide Medicaid coverage to children in foster care up to age 26. 

Medicaid Expansion Improved Coverage & Access To Care For Young Americans 

Research confirms expanding access to Medicaid for parents has had ripple effects for their children. At the same time, states that continue to reject expansion are limiting children’s health care access: 

Uninsurance Rates Among Young Adults Fell By Nearly Half As A Result Of The ACA’s Medicaid Expansion. “Uninsurance among young adults ages 19 to 25 fell 14.2 percentage points between 2011 and 2018, from 30.2 percent to 16.0 percent (figure 1). The share of young adults covered by Medicaid increased 4.3 percentage points over that period, from 11.1 percent to 15.4 percent. Changes in both uninsurance and Medicaid coverage were concentrated between 2013 and 2016, when most major ACA coverage provisions were implemented, including Medicaid expansion and the establishment of the Marketplaces.” [Urban Institute, February 2021] 

• Medicaid Expansion Improved Access To Care For Young Adults. “Between 2011 and 2018, access to health care improved for young adults in both expansion and nonexpansion states. For young adults in low-income households and young adults with lower educational attainment, Medicaid expansion was associated with an increased likelihood of having a personal doctor. It was also associated with a large decrease in the likelihood of delaying needed care because of cost in the past year among non-Hispanic Black young adults.” [Urban Institute, February 2021] 

Medicaid Expansion Led To Gains In Coverage For Children As Well As Parents. A study in Health Affairs found that “710,000 children gained public coverage when their parents enrolled in Medicaid between 2013 and 2015. If the remaining 19 non-expansion states expanded Medicaid, 200,000 additional children would gain health coverage through existing programs. The effect was largest among children whose parents gained Medicaid eligibility through the expansion.” [Georgetown University Center for Children and Families, 1/12/18]

When Parents Have Medicaid, Their Children Are More Likely To Have Regular Care. As summarized by Georgetown University’s Center on Children and Families, recent research finds that “Parents enrolled in Medicaid have children who are 29 percentage points more likely to receive a well-child visit. The relationship is strongest for families with household incomes between 100% and 200% [of the federal poverty line]. In these families, parents enrolled in Medicaid have children who are 45 percentage points more likely to receive a well-child visit.” [Georgetown University Center for Children and Families, 1/12/18]

Children In States That Have Not Expanded Medicaid Are Almost Twice As Likely To Be Uninsured — And That Gap Is Growing. “Growing numbers of uninsured children are concentrating in states that have not expanded Medicaid. Between 2016 and 2019, the child uninsured rate in non-expansion states grew at nearly three times the rate of expansion states. Non-expansion states saw their child uninsured rate jump from 6.5 percent to 8.1 percent during the period examined while expansion states saw it increase from 3.5 percent to 4.1 percent (see figure 3 ). Moreover, two non-expansion states, Texas and Florida, were responsible for 41 percent of the coverage losses for children over the three-year period.” [Georgetown Center For Children And Families, 2/17/21] 

Protect Our Care Is Marking the 11th Anniversary of the Affordable Care Act With 11 Days Celebrating the Success of the Health Care Law

Eleven years ago, the Affordable Care Act (ACA) became the law of the land and millions of people gained coverage and critical protections as a result. By expanding Medicaid and introducing key protections, the ACA has improved coverage and health care access for the 61 million people with disabilities across the country. 

After four long years of Republican efforts to repeal and sabotage the ACA, President Biden and Democrats in Congress are now working to build on the strong foundation of the health care law to expand coverage, lower costs, and reduce racial disparities in health care. On March 11, President Biden signed the American Rescue Plan into law, historic legislation that includes the most significant health care expansion in more than a decade. Solidifying and expanding the ACA is especially important as millions of Americans have contracted the COVID-19, with some “long haulers” facing the possibility of lifelong disabilities. Without the ACA’s protections, survivors of COVID-19 would likely be deemed as having a pre-existing condition and be at the mercy of their insurance companies who could refuse to pay for needed care. 

The Affordable Care Act Provided Affordable Coverage And Health Security To People With Disabilities: 

The ACA Prevents Insurance Companies From Charging Americans With A Disability More, Or Denying Them Coverage Altogether. Prior to the ACA, insurance companies were allowed to charge people more or deny coverage simply because they had a pre-existing condition. The ACA banned this practice, requiring that insurance companies offer people coverage regardless of their health status. Without the ACA, premium surcharges could once again be in the six figures for some conditions. 

Thanks To The ACA, Insurance Companies Can No Longer Impose Annual And Lifetime Limits On Coverage. Before the ACA, insurance companies could restrict the dollar amount of benefits someone could use per year or over a lifetime. At the time the ACA was passed, 91 million Americans had health care through their employers that imposed lifetime limits. Many such plans capped benefits at $1 million, functionally locking people with complex medical needs out of coverage. 

Under The ACA, Insurance Companies Can No Longer Practice Medical Underwriting, A Process That Lets Insurers Make It Harder For People With Disabilities To Get The Coverage They Needed. Before the ACA, insurance companies could screen applicants for any conditions that might be costly to the company. If someone had condition that was predicted to cost the insurer more, the company would follow a practice called “medical underwriting” that allowed them to charge the applicant a higher premium, specifically exclude coverage for the condition that was expected to be costly, charge the applicant a higher deductible, or limit the applicant’s benefits (for instance, offer a policy that did not cover prescription drugs).

The ACA Requires Insurance Companies To Cover Basic Health Services. The Affordable Care Act established the ten essential health benefits, requiring insurance companies to cover rehabilitative or habilitative services, hospitalization, maternity care, prescription drugs, mental health services, and more. Before the ACA, many people with disabilities had insurance that didn’t cover basic health care needs.

The ACA Allowed States To Expand Medicaid — A Lifeline For People With Disabilities. Nearly 8.7 million adults enrolled in Medicaid have a disability. Of this group, only 43 percent qualify for supplemental security income (SSI). The remaining 5 million beneficiaries do not receive SSI and therefore do not qualify for coverage based on their disability status alone, meaning they rely on the ACA’s Medicaid expansion or eligibility as low-income parents. 

The ACA Boosted Employment For People With Disabilities

Thanks to the ACA, people with disabilities have more flexibility to leave jobs or change career paths without fear of losing access to comprehensive health care. Per the Center for American Progress: “People with disabilities no longer had to weigh serious concerns about accessing coverage—which in the past may have caused them to stay in a job that paid poorly or that they had advanced beyond professionally or even to take a job out of state that offered the benefits they needed. The ACA helped guarantee the disability community was not disproportionately penalized when pursuing a career based on their own desires and personal choices rather than out of fear of losing health care.”

Study: Medicaid Expansion Increased Employment For People With Disabilities. “Individuals with disabilities are significantly more likely to be employed if they live in a state that has expanded Medicaid under the Affordable Care Act, a new study has found. Researchers at the University of Kansas co-authored a study that found a 6 percentage-point difference in employment rates among working-age adults with disabilities in states that expanded Medicaid and those that chose not to.” [The University Of Kansas, 12/21/16] 

Protect Our Care Is Marking the 11th Anniversary of the Affordable Care Act With 11 Days Celebrating the Success of the Health Care Law

Eleven years ago, the Affordable Care Act (ACA) became the law of the land and millions of people gained coverage and critical protections as a result. In addition to expanding coverage to more than 20 million Americans, the ACA improved health care affordability, particularly for patients purchasing prescription drugs. Between 2010 and 2018, the share of non-elderly adults with problems filling a prescription fell by 27 percent, while those with a problem paying a medical bill fell by 17 percent, the share who skipped a test or treatment fell by 24 percent, and the share who didn’t visit a provider when needing care fell by 19 percent.

After four long years of Republican efforts to repeal and sabotage the ACA, President Biden and Democrats in Congress are now working to build on the strong foundation of the health care law to expand coverage, lower costs, and reduce racial disparities in health care. On March 11, President Biden signed the American Rescue Plan into law, historic legislation that includes the most significant health care expansion in a decade. Making health insurance more affordable and accessible is especially important as the country continues to battle the coronavirus pandemic and millions have lost their jobs and their health insurance.

The ACA Included Key Provisions To Help Reduce Drug Prices: 

• GAINED: Requirements that insurance companies cover prescription drugs. 
• GAINED: Nearly 12 million seniors pay less for prescription drugs. 
• GAINED: More than 60 million people gained access to birth control with no out-of-pocket fees. 
• GAINED: Rules that increase competition in the prescription drug market and help Americans access cheaper drugs. 
• GAINED: Consumer protections that prohibit drug companies from paying off doctors behind closed doors to influence the drugs they prescribe to patients.

Guaranteed Coverage Of Prescription Drugs. Because of the ACA, insurers have to cover what are known as “essential health benefits,” such as maternity care, prescription drugs, and mental health treatment. 

Lower Drug Costs For Seniors. Because of the ACA, the Medicare prescription drug donut hole is closed. From 2010 to 2016, “More than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary,” according to a January 2017 Centers on Medicare and Medicaid Services report.

More Than 60 Million Gained Access To Birth Control With No Out-Of-Pocket Fees. The ACA guarantees that private health plans cover 18 methods of contraception and make them available to 62.4 million patients with no out-of-pocket costs. More than 99 percent of sexually-active women have used contraceptives at some point in their lifetimes, and approximately 60 percent of women of reproductive age currently use at least one birth control method. In addition to increasing access to this essential treatment, this ACA provision has saved money for women and their families: women saved $1.4 billion on birth control pills alone in 2013.

Patients Have Access To Cheaper Drugs. The ACA’s Biologics Price Competition and Innovation Act paved the way for the Food and Drug Administration (FDA) to approve biosimilars, cheaper alternatives to expensive biologics. This provision is projected to save $54 billion between 2017 and 2026.

Drug Companies Are Barred From Paying Doctors Behind Closed Doors (To Prescribe Drugs You Don’t Necessarily Need). Thanks to the ACA’s Physician Payments Sunshine Act, Big Pharma can no longer make payments and offer gifts to doctors behind closed doors. When these payments are made with no transparency, they can create conflicts of interest and blur the line between objective and promotional research.