Good changes came of ACA

It’s easy to forget the appalling practices of insurance companies when improvements to the system have been made. I remember the horror stories told by people who, after paying thousands of dollars into health insurance policies, were told by those same companies that the yearly or lifetime maximum had been met and coverage would no longer be available. Or that families were turned away from insurance companies due to the pre-existing condition of a child or an adult. Imagine being turned away because you were pregnant or suffered from acne or hemorrhoids much less cancer or diabetes! It’s hard to go back to a system that provides less after seeing what it’s like to live with a system that provides fairly well for its citizens.

Here’s what the Affordable Care Act (ACA, also referred to as Obamacare) has given us: expanded Medicaid (before the ACA, Medicaid only paid care for families who had children and made under a certain income, now it pays for all individuals who make under 138% of the federal poverty line — $16,400 for an individual or $33,600 for a family of four); eliminated plans that had an annual or lifetime limit on payouts (insurance companies had the option to set a maximum they would pay for a year or a lifetime per person, it didn’t take long for a person who had major health issues to meet this limit); children can stay on their parents’ plan until age 26; insurance companies cannot refuse to sell someone a plan because of pre-existing conditions; exchanges were created so individuals who do not get insurance through employers and who don’t qualify for Medicaid or Medicare can now buy affordable care; subsidies are provided for people who buy insurance on the marketplace and earn less than 400% of the federal poverty line — $47,550 for an individual or $97,200 for a family of 4; 85% of insurer’s payout has to be for patient care (this encourages them to pay out more for patient care and less for administrative costs such as marketing, advertising, CEO bonuses); plans have been tiered making the benefits available to people easier to understand; insurance companies are now required to pay for essential health benefits such as birth control, mental health care (addiction treatment), outpatient care, emergency services, hospitalization, maternity and newborn care, prescription drugs, physical rehabilitation and devices, lab services, preventative services, pediatric services; you cannot be dropped because you’re sick or you made a mistake on the application; you have the right to a rapid appeal of insurance company decisions; insurers can no longer practice price adjusting such as charging women more for policies than men, (the exception to this is that insurance companies can use price adjusting on the basis of age, geographic location and smoking with a limit in price of 3 to 1); the Children’s Health Insurance Program (CHIP) is now easier for children to get; and the ACA began the process of closing the donut hole of Medicare part D (by 2020 the gap will close to 25% for Medicare recipients).

While the ACA is not perfect, why repeal it when we haven’t even tried to fix it? I hope that before you take a stand on repeal or no repeal of the Affordable Care Act you think carefully about just how far we’ve come in the past seven years. Do you want to go back to the old days when the insurance companies, who were supposed to help their clients in time of need, instead turned to practices that hurt those paying for the policies and made decisions based on increasing the profits of the insurance companies?

Karen Kubota

Lowell