Attacks on the ACA

Overview of the Attacks on the Affordable Care Act (ACA)

On January 20, 2017, the same day that he was inaugurated, President Trump issued an Executive Order stating that his Administration would try to repeal the ACA as quickly as possible.  Although Congress was not able to repeal and replace the ACA through the formal law-making process, the President and various agencies in the Executive Branch have taken significant steps to undermine different sections of the ACA. All of these attacks have the same effect: they make it more expensive and harder for people with disabilities and other pre-existing conditions to get health care.

What are Pre-Existing Conditions?
The ACA made it illegal for health insurers to discriminate against people based on pre-existing conditions, which includes any health issues that you have before you get that insurance. Before the ACA, an insurance company could deny people or charge them more for coverage if they had any medical condition or disability. As a result, people with disabilities had fewer options for health insurance, and they had to pay more money than people without disabilities for the same services. Under the ACA, health insurers must treat people equally. They are not allowed to deny coverage, impose higher costs, or limit access to services for people with pre-existing conditions. And yet, the current Administration is trying many different ways to bring back this form of discrimination against people with disabilities.
Shutting Down Subsidies
The ACA provides multiple forms of financial assistance for low-income people to be able to access healthcare. First, the ACA expanded the Medicaid program so that it could cover all people below a certain income level. However, one of the earliest attacks to the ACA allowed states to choose whether or not to follow this law, so millions of people in states that did not expand Medicaid cannot access affordable health care.

For people whose income is higher than the level that would allow them to receive Medicaid but still low enough that insurance would otherwise be too expensive, there are two types of financial assistance that the government provides. One of these subsidies is the Advance Premium Tax Credits (APTC), which help people cover the costs of the monthly payment to their private insurance companies. The other is the Cost-Sharing Reduction (CSR), which helps people pay for the additional costs of their medical care that their insurance does not cover.

In October of 2017, the Trump Administration announced that it would stop paying for CSRs. The ACA still requires insurance companies to reduce these out-of-pocket costs for the people who get their coverage, but the federal government will no longer help insurance companies pay for these subsidies. As a result, many insurers increased costs for their plans to make up for the difference. These higher costs made insurance unaffordable for many people whose income is not low enough to receive assistance, but not high enough to pay such steep monthly costs.

What’s the Effect? Higher Costs for Everyone

When people with fewer health care needs stop buying full coverage, insurance companies need to raise the price of coverage for the people who know they need to access health care services throughout the year. People with pre-existing conditions and people with disabilities end up facing the same problems as before the ACA, where they have fewer choices and more expensive health care. People who buy these limited plans are not much better off, since they have to pay much more for health care services as issues come up that they cannot predict. When they develop chronic conditions, their insurance does not cover the care they need, and they need to pay for these services on their own.

This disconnected, discriminatory, and misleading system hurts everyone, but it is immediately threatening for people with disabilities. Learn about how you can act now to stop these efforts to take health care away from those who need it!

Sham Plans: Devastating the Individual Marketplace
There are certain types of plans that do not need to obey the law under the ACA. The Trump Administration is trying to make it easier for younger and healthier people to get these plans because they are “cheaper.” The Administration is now changing the requirements for states to offer:

These skimpier plans appear to cost less than traditional insurance plans because they are not what most people would consider to be insurance plans (see FamiliesUSA’s fact sheet on these “sham” plans). Here’s why we’re concerned:

  • The plans do not need to cover all of the benefits that people need
    • They can take away entire categories of services like mental health care or rehabilitative care
    • They can charge more for certain services if they choose not to remove them from the plans
    • The plans can set arbitrary limits for how many times you can receive a service over the year or over your lifetime, and then you can lose your insurance when you hit that amount
  • These plans can require people with pre-existing conditions or people with disabilities to pay more each month for coverage than “healthier” people
  • People who do not have pre-existing conditions are more likely to buy these limited plans because they appear to cost less. However, these price tags are misleading for these people as well, because the out-of-pocket costs are much higher and unlimited.

Protecting the ACA and Pre-Existing Condition Coverage in the 116th Congress
A number of bills have been introduced in this Congress to protect the ACA, including the consumer protection provisions.  Examples include:

H.R. 986, the Protecting Americans with Preexisting Conditions Act of 2019, that would require the Administration to rescind the Section 1332 guidance that allowed states to waive certain requirements of the law, weakening standards for affordability,
comprehensiveness and even what qualifies as “coverage;” 

H.R. 987, the Marketing and Outreach Restoration to Empower Health Education Act of 2019 or  MORE Health Education Act, to restore outreach and enrollment funding to assist consumers in signing up for health care, which has been dramatically reduced;

H.R. 1010, reversing the recent expansion of Short-Term, Limited Duration Insurance (junk insurance plans);

H.R.  1143, the “Educating Consumers on the Risks of Short-Term Plans Act of 2019,” requiring short-term, limited duration insurance to disclose the risks to prospective consumers, including disclosure that it may not cover preexisting conditions, may not cover the costs of medical services, and that coverage may be cancelled if the individual seeks treatment for a pre-existing condition.


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