The ACA has brought the United States closer to the goal of universal health care coverage than ever before.

  • Over 20 million Americans have gained health care insurance under the ACA.

“In September 2016, the share of non-elderly Americans without health insurance stood at 10.5 percent, the smallest percentage ever recorded.”

“One of the primary ways it did so was by creating online markets where people who didn’t get insurance through work or the government could shop for a health plan from a private insurer. The law offered subsidies for Americans with lower incomes to help pay their premiums and deductibles.”

The ACA also “provided federal funds for states to offer Medicaid coverage to anyone earning less than about $16,000 for a single person or $33,000 for a family of four. Not every state chose to expand, but most did. . . . The Republican plan is expected to eliminate federal funding for the expansion. An estimated 12.9 million people would lose Medicaid coverage . . . .”

[From The Upshot, The Biggest Changes Obamacare Made, and Those That May Disappear]

  • The ACA requires insurers to offer a minimum package of benefits, with no co-pay for preventive services.

“Before the ACA, there were virtually no nationwide rules on what health insurance plans had to cover. Some states set standards, but a government report found that among enrollees in the individual (i.e., “non-group”) market in 2011:

62 percent lacked maternity coverage;

34 percent lacked coverage for substance use disorder treatment;

18 percent lacked coverage for mental health services; and

9 percent lacked prescription drug coverage.

“Sometimes these exclusions were based on an individual’s pre-existing condition. For instance, a woman with a family history of breast cancer could have breast cancer treatment excluded from her coverage. In other instances, health insurers categorically excluded services such as maternity care because it’s expensive or behavioral health care that attracts expensive enrollees. In the pre-ACA days, this was a permissible way to keep costs down and profits high. And while Americans could save a few dollars every month in premiums due to fewer benefits, they risked insurmountable medical bills if an illness or injury struck. One actuary estimated that individuals had a one-in-ten chance of incurring $30,000 in medical bills in a given year.”

[From The Century Foundation, Refresher: Why the ACA’s Basic Health Benefits Matter]

  • The ACA limits how much more insurers can charge older people than younger people.

“Before the Affordable Care Act, insurance companies could charge people in their 50s and 60s many times more than they’d charge a younger person for the same policy. The affordable care act put a limit on that. Now insurance companies can only charge older people three times as much as they charge people a few decades younger. . . . A study sponsored by the Rand Corporation and the Commonwealth Fund found that if older Americans were charged five times more for insurance than younger people, about 400,000 would no longer be able to afford to buy health insurance.”

[From NPR, Obamacare Repeal Could Threaten Provisions That Help Older Adults]

  • Under the ACA, women can no longer be charged higher rates because of their gender.

“Gender rating is the practice of charging men and women different rates for identical health services. These “different rates” usually translate to higher health insurance premiums for women than for men. Research conducted before the implementation of the ACA showed that women on the individual market could pay up to 1.5 times more than men for health insurance. It also showed that gender rating costs U.S. women approximately $1 billion dollars annually.

“Gender rating has been banned for nearly forty years on the employer-sponsored market. However, before the passage of the ACA, it was legal on the individual insurance market.”

[From Penn Wharton, The End of Gender Rating: Women’s Insurance under the ACA]

This Appendix was posted February 27. 2017. General sources for this Appendix are The Upshot, The Biggest Changes Obamacare Made, and Those That May Disappear (see link above) and Scholars Strategy Network (SSN), What Trump Means for the Affordable Care Act.

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