Introduction
The Patient Protections and Affordable Care Act is a law that was passed in 2010. People call it the Affordable Care Act (ACA). Some people also call it Obamacare, because Barack Obama was the President who helped make the law. “Obamacare” and the Affordable Care Act (ACA) are the same thing.
The ACA made it easier for people to get health insurance. Health insurance helps you pay for health care. ASAN wrote an Affordable Care Act Toolkit for Self Advocates that gives you more information. You can read it here.
In this section, we will talk about how health insurance works, how the ACA made health insurance better, threats to the ACA, and how you can protect the ACA.
How Health Insurance Works
Most health insurance in the United States is private. This means that the health insurance program is run by a company and not the U.S. government. People can get health insurance as an individual or in a group.
Group insurance is when a group buys private insurance to cover a lot of people at the same time. This is usually when companies pay for insurance for their workers. Employers decide what kinds of insurance to offer their employees. The employers will pay for some of the cost.
Individual insurance is when one person, a family, or a small business buys insurance by themselves.
Some health insurance is public. This means that the U.S. government runs it. Medicaid is public health insurance for low-income people and people with disabilities. Medicare is public health insurance for anyone over the age of 65. Some people under age 65 with disabilities can also get Medicare.
Medicaid and Medicare are very important to people with disabilities. Medicaid pays for healthcare and long term services and supports (LTSS) – services many people with disabilities need to live our daily lives. The ACA made Medicaid cover more people.
How The ACA Made Health Insurance Better
The Affordable Care Act (ACA) did really important things that made health insurance better. Here are some of the most important things the ACA did:
- The ACA made it easier for people with pre-existing conditions to get health insurance. People with “pre-existing conditions” are people who were sick or disabled before they tried to buy insurance. This included anything from cancer to ear infections to autism. Before the ACA was passed, insurance companies could refuse to give insurance to people with disabilities and medical conditions. Or, they could make insurance so expensive for us we couldn’t get it. The ACA made it so insurance companies could not do those things anymore.
- The ACA said health insurance companies can’t put annual or lifetime caps on health insurance. Before the ACA, insurance companies could make it so that once the insurance company spent a certain amount of money on your health care, they could stop. You would have to pay the rest. Annual caps were how much money a person can use over a year. Lifetime caps were how much money can be used over their whole life.The ACA made it so insurance companies could not do this anymore.
- The ACA said that most health insurance have to help pay for 10 types of health care. These types of health care are called Essential Health Benefits. These ten types cover most kinds of health care, including hospitalization, vaccines, mental health treatment, emergency services, occupational therapy, and more! Before the ACA was passed, health insurance companies could decide not to pay for these things.
- The ACA helped make it easier to pay for individual health insurance. Before the ACA was passed, a lot of people could not afford to get any health insurance at all. The ACA made it so that when someone who makes less than $47,000 per year buys individual insurance, the government will pay part of the cost. Parents and married couples can make more than that and still get help paying for insurance.
- The ACA made it so that most employers had to pay for your health insurance if you’re employed full-time. This meant that more people could get health insurance through their company.
- The ACA made it so that everyone had to get health insurance. If everyone buys health insurance, health insurance costs less. The ACA required everyone to get health insurance. This is called the individual mandate.
- The ACA said people could stay on their parents’ health insurance until age 26. Before the ACA was passed, children could be kicked off of their parent’s health insurance plans as soon as they turned 18.
The Medicaid Expansion
Medicaid is a really important program for people with disabilities. It helps us get healthcare and the services and supports we need to thrive in the community. For more information, read Medicaid: Let’s Fight for Our Health and Community-Based Services.
One of the most important things the ACA did was make it so that more people could get Medicaid. This is called the Medicaid Expansion. Before the ACA was passed, only a couple types of people could get Medicaid:
- Children whose parents don’t have much money
- Pregnant women who don’t have much money
- People over the age of 65 who don’t have much money
- Some – but not all – people with disabilities
- In some states, some adults who don’t have much money
The government decides who doesn’t have much money by using something called the poverty line. The poverty line is an amount of money the government says is just enough to pay for everything you need to live. But, people can make more than the poverty line still often can’t pay for things they need, like food, rent, and health care. Before the Medicaid expansion, a lot of people need help paying for health care, but still couldn’t get Medicaid.
The Medicaid Expansion made it so that anyone who makes up to 138% of the poverty line can get Medicaid as long as the state decides it wants to expand Medicaid. 138% is a couple thousand dollars more than the regular poverty line. That means many more people can now get Medicaid because of the Medicaid Expansion.
Threats to the Affordable Care Act
Some people want to make it so that the Affordable Care Act (or a part of it) does not work anymore. There are a lot of different ways they are trying to do this, or tried to do this in the past.
- Some Members of Congress want to remove the whole ACA from the law. Undoing or removing a law is called repealing the law. Some Members of Congress want to remove the ACA. They have said they will replace it with something else later, but the replacement ideas they have had in the past leave a lot of people out. This is a problem because it means that people will lose health care.
- They want to take out the part of the ACA that makes it so everyone has to get health insurance. This part of the ACA is called the individual mandate. The problem with taking out the individual mandate is that it makes health insurance more expensive for everyone.
- They want to get rid of the Medicaid expansion. This is a problem because a lot of people – 11 million! – now get their healthcare through the Medicaid expansion. A lot of people would lose their health care right away if this happened.
- They want to get rid of the tax credits and other parts of the ACA that make it easier to pay for health insurance. This is a problem because without these parts of the ACA, some people might not be able to pay for health insurance.
- They want to let insurers discriminate against people with pre-existing conditions again. This is a problem because discrimination is wrong. It also means that people with disabilities would have a harder time getting health care.
- They want to get rid of essential health benefits, and other parts of the ACA that make it harder to sell bad insurance. This is a problem because it means that insurance companies could sell insurance that doesn’t really cover anything. They could leave out important parts of health care. Then, people who need health care won’t be able to get what we need. This is another way to discriminate against people with pre-existing conditions.
All of these changes would be really bad for everyone who wants good health care, including people with disabilities.
How You Can Help Protect The ACA
There are a couple ways that you can help protect the ACA:
- Contact your Members of Congress to tell them why the Affordable Care Act is important to you. You can contact your Senator or your Representative. ASAN’s Affordable Care Act toolkit and its Civic Engagement Toolbox For Self-Advocates tell you how.
- Share a story about how the ACA has helped you with ASAN or another nonprofit organization. You can go to https://autisticadvocacy.org/policy/submit/ to share your story with us, for example!
Write a blog or write on Facebook about why the Affordable Care Act is important. If you like writing, add your voice to the thousands of people who have written about the Affordable Care Act can help change how other people think.