Open Enrollment: Why the ACA Matters (by Jeneva Stone)
Rob Stone, a member of Little Lobbyists, at a physician appointment last year. [image description: A young man sits in a wheelchair, advocacy buttons decorating his vest & headrest. He wears an aqua shirt and has a tracheostomy tube visible. Behind him are an examining table and medical supply cabinets.]
The Affordable Care Act (ACA) appears here to stay--that’s the good news! It has been the subject of multiple lawsuits and dozens of bills that have attempted to overturn it. On December 10, the U.S. Supreme Court heard oral arguments in the latest effort to do away with this crucial piece of legislation, yet court-watchers believe the justices signaled a willingness to let the law stand. We can breathe a small sigh of relief, for the moment.
If you need health insurance, keep in mind that ACA open enrollment has been extended to August 15! You can sign up or renew your plan on Healthcare.gov today! According to the Urban Institute, the average federal subsidy for individuals who purchase their ACA plans through state marketplaces is $5,500, and the recently passed American Rescue Act has extended subsidies EVEN FURTHER, so check your eligibility for subsidies - even if you checked earlier this year! Need advice on selecting a plan? Check out these helpful tips.
Why does the ACA matter? The law has been the victim of a decade-long misinformation campaign, but it provides tons of benefits for Americans. Most people know these basic safeguards, but there are more: protection for people with pre-existing conditions, no caps on annual or lifetime costs, and the ability to keep your children on your plan through the age of 26.
These benefits apply not only to ACA marketplace plans, but to ALL insurance plans issued in the U.S. The ACA has been a game-changer as insurance reform.
The ACA also mandates 10 Essential Benefits to be covered by all health care plans issued in the U.S., which include the ACA marketplace, private, government, and employer-based plans. If the ACA were ever overturned, many insurers would opt out of these benefits:
Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Hospitalization (like surgery and overnight stays)
Pregnancy, maternity, and newborn care (both before and after birth)
Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
Prescription drugs
Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care
When the ACA was passed in 2010, it provided funds for state Medicaid expansion. However, many states refused those funds, and, thereby, hurt their own citizens. In those states that passed Medicaid expansion, the ACA helps both rural and urban hospitals stay open and maintain quality care standards. When people are struggling to make ends meet, they can’t pay their medical bills. More people eligible for Medicaid means more dollars to support the compassionate missions of hospital emergency rooms, where no one is turned away.
In addition, Medicaid expansion under the ACA pays for school nursing for all children, as well as individualized nursing for children with complex medical needs and disabilities, and the physical, occupational, and speech therapies children require. If Medicaid is cut, your child’s school nurse could disappear.
This holiday season, let’s all be thankful that the ACA has withstood so much in its decade of existence and that, under the incoming Biden Administration, its protections are strengthened, ensuring more Americans have access to affordable, quality health insurance.
Jeneva Stone is the Little Lobbyists’ blog manager.