ACA 6th Anniversary: Good Riddance!

As we reflect on the Affordable Care Act on its 6th anniversary this week, it is easy to point to great new things ushered in by the law – like insurance coverage for 20 million previously uninsured Americans and the largest one-year drop in Texas’ uninsured rate to date.
With so much focus on what we’ve gained under the ACA, it is easy to forget all that we’ve lost.  Yes, lost… The ACA ushered out several unfair practices and is eroding some barriers to care.
In honor of the ACA’s 6th anniversary, here is my list of top 6 things we bid good riddance to because of the ACA:

  1. Lifetime limits.  Do you remember 6 years ago when lifetime limits were common in health insurance policies?  Back then some seriously ill individuals (e.g., hemophiliacs, transplant patients) could essentially run out of insurance after the cost of their care exceeded an arbitrary cap. The ACA ended lifetime and annual limits.
  2. Frivolous cancellations.  Prior to the ACA, some insurers used flimsy pretexts to cancel policies for tens of thousands of Americans shortly after they were diagnosed with expensive and life-threatening conditions, an appalling and well-documented practice called “rescission.” The ACA ended this practice.
  3. Being “uninsurable.” Before the ACA, people with “pre-existing conditions” could be refused coverage outright, charged more, or placed in a waiting period until coverage for their existing health conditions took effect. The ACA put an end to these practices in 2014.
  4. Medicare “donut hole.” The ACA is closing the gap in Medicare drug coverage, in which beneficiaries used to have to pay the full cost of prescriptions out of pocket. In 2016, people who fall into the donut hole will receive discounts of 55 percent on brand name drugs and 42 percent of generic drugs. The donut hole will continue to be phased down each year until 2020, when it will be fully closed. Medicare enrollees in Texas have saved nearly $1 billion on prescription drugs since the ACA passed in 2010.
  5. Paying more for being a woman. Prior to the ACA, insurers commonly charged women more than men for the same coverage. Even with maternity coverage excluded (which it was in the Texas individual market before the ACA), women were commonly charged 30 percent more than men, and could be charged up to 85 percent more than men for the same coverage. The ACA ended gender discrimination in premiums.
  6. Missing mental health coverage. Prior to the ACA, federal Mental Health Parity provisions did not apply to insurance for small employers or bought directly from an insurer in the individual market (not through a job), and these types of coverage often lacked good mental health and substance use disorder benefits.  For example, one-in-three individual market enrollees had no substance use disorder benefits and one-in-five had no mental health benefits before the ACA. The ACA extended mental health and substance use disorder benefits and federal parity protections to an estimated 62 million Americans.

Imagine, some young adults navigating insurance on their own for the first time may not even realize that the relics listed above were common features of the insurance market in the very recent past.  Good riddance unfair insurance practices, and happy anniversary ACA.

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