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In , nearly 9 out of 10 , or 87 percent, of marketplace enrollees qualified for financial help with premiums, and roughly half—54 percent—received reduced cost sharing. These changes make it easier for children to be enrolled in and stay covered by coverage with little or no cost sharing. The ACA also accelerated the development and promotion of data-driven systems: As of January , all states allow potential Medicaid beneficiaries to apply online and most allow for application by phone.
Across nearly all health plans, both public and private, the ACA eliminated copayments and other forms of cost sharing for preventive services. This provision allows beneficiaries to seek contraception; screenings for cancers, blood pressure, cholesterol, and other illnesses; and immunizations without out-of-pocket payments.
In addition, the ACA holds private insurance companies accountable for charging fair premiums, whether for individual market policies or for employer-sponsored coverage. The medical loss ratio MLR rules require insurance companies to return money to policyholders and employers if their health plans spend less than 80 percent to 85 percent of premium funds on medical care. The evidence shows that better affordability translates into better access.
Between and , the share of nonelderly adults who skipped a medical test or treatment fell 24 percent. ACA implementation reduced the probability of not receiving medical care due to cost by about one-quarter, and it dramatically increased the share of people who reported having a usual place of care.
Prior to the ACA, women faced unique barriers to adequate care. Insurers in the individual market could charge women up to 1. The ACA outlawed gender rating and prohibited insurers from discriminating against people with preexisting conditions. The latter is a crucial protection for women: About 1 in 2 girls and nonelderly women have a preexisting condition. The ACA mandates that plans include maternity coverage and makes key preventive services available without cost sharing , including breastfeeding support services and supplies; annual well-woman visits; and screenings for cervical cancer, HIV, and interpersonal and domestic violence.
Thanks to the ACA, about 61 million women nationwide can access contraception without any out-of-pocket cost. The ACA also recognized that supporting maternal and infant health required policy changes beyond health coverage. The law mandates that employers provide breastfeeding mothers break time and a private space to express milk during the workday.
About 2. Later on, additional young adults gained coverage though marketplace financial assistance and Medicaid expansion. As a result, the uninsured rate among people ages 18 to 24 fell by half, dropping to 15 percent in The ACA raised standards to ensure that children in low- and middle-income families can access health coverage.
About one-quarter to one-third of new enrollees under Medicaid expansion are children. The ACA also defined pediatric dental and vision care as part of essential health benefits, ensuring that kids covered through both the marketplace and Medicaid have coverage for those services. Further, expanding coverage to adults—through the ACA marketplaces and Medicaid expansion—helps parents stay healthy and provides financial security to the entire family.
Prior to the ACA, 9 percent of individual market plans did not cover prescription drugs. By expanding Medicaid eligibility as well as broadening the Medicaid Drug Rebate Program, the ACA gave more low-income Americans access to brand-name and generic drugs and lowered the costs for taxpayers. The ACA also expanded the B drug discount to include more providers, including critical access hospitals and rural referral centers.
The ACA also laid out a process for faster Food and Drug Administration approval of biosimilars , biologic drugs that are essentially analogous to generic versions of branded drugs. By encouraging competitors for high-cost biologic drugs, the ACA rules on biosimilars can potentially help bring down the price of these types of prescription drug costs and help make new therapies available to patients who need them. These are all important steps toward drug affordability, but there is much more work to be done.
Medicaid expansion is particularly important for coverage and the sustainability of the health care system in rural areas. Rural residents are more likely to be covered by Medicaid: Medicaid expansion reduced the amount of uncompensated care that hospitals provide, boosting the financial viability of rural hospitals relative to their counterparts in nonexpansion states.
While more than rural hospitals have closed in the past decade, the closures have occurred disproportionately in nonexpansion states. The ACA provides patients and the health care system with resources to combat the opioid crisis , which has hit rural areas particularly hard.
Without this requirement, only 1 in 3 people covered through the individual market would have had access to SUD treatment. Many people in rural and other medically underserved communities rely on community health centers and other Federally Qualified Health Centers FQHCs for comprehensive primary care.
Federal grants provide 1 in 5 revenue dollars that community health centers receive, and 70 percent of that funding comes from the Health Center Trust Fund set up by the ACA. Before the ACA closed the coverage gap, about 5 million Medicare enrollees fell into it.
The ACA also invested in other improvements for the Medicare program by establishing the Center for Medicare and Medicaid Innovation , which is responsible for developing ways to improve patient care and lower health care costs. Prior to the ACA, people would be functionally uninsured after hitting arbitrary annual or lifetime coverage limits.
The ACA prohibits insurers from setting coverage limits, as well as from denying coverage or raising prices for preexisting conditions. Medicaid expansion has helped many disabled people and caregivers access care based on their income status.
Not all disabled people qualify for the traditional Medicaid disability pathway. Medicaid expansion allows disabled people to join the workforce without jeopardizing their Medicaid benefits and gives low-income workers a fallback option for coverage if they lose access to employer-sponsored insurance.
Essential health benefits help disabled people access necessary services. Prior to the ACA, 45 percent of individual market plans did not cover SUD services and 38 percent did not cover mental health care. Following ACA implementation, people with mental health conditions became significantly less likely to report unmet need due to cost of mental health care.
The ACA has helped millions of Americans gain insurance coverage, saved thousands of lives, and strengthened the health care system.
The law has been life-changing for people who were previously uninsured, have lower incomes, or have preexisting conditions, among other groups.
Emily Gee is the health economist of Health Policy at the Center. Maura Calsyn is the managing director of Health Policy at the Center. The positions of American Progress, and our policy experts, are independent, and the findings and conclusions presented are those of American Progress alone.
And you may qualify for a tax credit that lowers your monthly premium, as well as for reductions in the amount you pay for deductibles, coinsurance and copayments.
By making these plans available and affordable, the marketplace has reduced the number of uninsured by about 80 percent over the last dozen years. You can apply for marketplace coverage by visiting www. At the Employee Benefits Security Administration, we also have some great resources available to help you make the most of your health benefits.
Thanks to the ACA, Your children can stay on your health plan until they turn Dollar limits for essential health benefits have been banned. You can get preventive care without having to pay out of pocket. Add new comment Your name. About text formats.
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