Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

Patients with Pre-Existing Conditions Need Affordable Care Act

Despite the potential benefits of the Affordable Care Act, there has been some strong opposition and calls for a repeal of the healthcare law among various political groups.

By Vera Gruessner

The Patient Protection and Affordable Care Act has undergone both an opposition and an embrace by healthcare experts and politicians around the country. Now that this healthcare law has become embedded within the healthcare delivery system, it is worthwhile to analyze how well it has functioned since its first inception in 2010.

Medicaid Expansion

Ezekiel Emanuel, MD, PhD, of the Perelman School of Medicine, wrote for the Journal of the American Medical Association (JAMA) outlining some of the benefits the Affordable Care Act has brought for the American people. First, it has led the uninsurance rate to drop from 18 percent to less than 12 percent over the last six years. This is a major accomplishment for the healthcare law.

Emanuel cites a Gallup poll that demonstrates as many as 17 million people now have health insurance who didn’t have this opportunity before the Affordable Care Act was implemented. The ACA has also led to the creation of a health insurance shopping platform by creating a federal insurance exchange.

Healthcare cost growth has also slowed down significantly since the Affordable Care Act was passed. Part of this may be attributable to the expansion of high-deductible health plans, which may have led fewer people to seek out healthcare services in order to keep their personal out-of-pocket costs low. Nonetheless, there are specific provisions that the Affordable Care Act has included that have likely also led to a drop in healthcare cost growth.

For instance, the ACA and other healthcare reforms have incentivized a decrease in hospital readmission rates and hospital-acquired infections while also introducing a value-based payment system to the healthcare industry.

READ MORE: Affordable Care Act Replacement Seeks Automatic Enrollment

Nonetheless, despite the potential benefits of the Affordable Care Act, there has been some strong opposition and calls for a repeal of the healthcare law among various political groups. In another report from the Journal of the American Medical Association, a number of health policy experts from the Washington, DC-based American Enterprise Institute described some of their resolutions that could replace the Affordable Care Act.

The report focuses on expanding private insurance through refundable tax credits. Also, the reforms outlined enable states to have more control over the health insurance market by allowing them to run their own exchanges while individuals with pre-existing conditions who have had continuous medical coverage would be safe from any increases in premium charges.

The health policy analysts from the American Enterprise Institute also suggest dividing the Medicaid program into two separate entities. One group would include able-bodied adults and children while the other program would support the elderly and the disabled.

“For the nonelderly and nondisabled population, each Medicaid-eligible household would receive a refundable federal tax credit as their primary support, with Medicaid serving as a supplement to their tax credit. The lowest-income group of individuals would receive assistance that would cover all or most of the cost of a standard plan. Medicaid subsidies would decline gradually for those with higher incomes,” the report stated.

“For the disabled and frail elderly Medicaid recipients, states would be able to design the type of assistance they think is appropriate, including the programs that give beneficiaries greater control over the resources that support their activities of daily living.”

READ MORE: Affordable Care Act Brought Healthcare Coverage to Rural Areas

The Republican Party led by House Speaker Paul Ryan has also brought forward a replacement plan due to their general opposition to the Affordable Care Act and pursuit of a repeal. First, this plan looks to create health savings accounts and the ability for payers to sell health plans across state borders.

Additionally, the replacement plan describes how the Medicare eligibility age would need to be raised from age 65 to age 67 by the year 2020. The plan would also put a stop to Medicaid expansion, which would take away coverage from many low-income families that recently obtained healthcare access.

The plan looks to increase premium costs among the elderly by eliminating a cost threshold that is currently operating under the Affordable Care Act. Individuals with pre-existing conditions who have had continuous coverage would not have to move into high-risk pools but others who’ve had a gap in coverage would be required to enter these high-risk pools.

“All Marketplace plans must cover treatment for pre-existing medical conditions,” outlines on its website one of the major benefits of the ACA. “No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health. Medicaid and the Children's Health Insurance Program (CHIP) also can't refuse to cover you or charge you more because of your pre-existing condition.”

There are various propositions that have come out favoring repeal of the Affordable Care Act and replacing it with new regulations. The upcoming elections will likely play a large role in the future of the Affordable Care Act and healthcare reform, as new political figures have differing plans for the health insurance industry.

READ MORE: Republicans Release Plan to Replace the Affordable Care Act


Dig Deeper:

What Repealing the Affordable Care Act Would Mean for America

Affordable Care Act Brought Healthcare Coverage to Rural Areas


Sign up for our free newsletter:

Our privacy policy

no, thanks