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Highlights of the Affordable Care Act (Healthcare Reform)

What It Means to Americans

By

Updated June 10, 2014

The Patient Protection and Affordable Care Act, also known as the ACA, healthcare reform, or ObamaCare, is the law passed in March 2010 to help Americans buy, afford, and maintain health insurance or other payer coverage for their health and medical needs.

There was a great deal of dissent over passage of the law, with arguments over costs, coverage, mandates and politics, leading to lawsuits from 26 states, and eventually review by the United States Supreme Court in early 2012.

In June 2012, the Supreme Court ruled that almost all aspects of the law were, in fact, constitutional. While the ruling didn't serve to calm the dissent, the law continues to be implemented according to a specific timetable which will culminate in 2014 with total implementation of the law.

Here are the highlights of the Affordable Care Act, as they affect Americans:

The Individual Mandate and the Purchase of Health Insurance

 

Probably the most contentious issue of the arguments that went to the Supreme Court, the "individual mandate" is the provision of the law that says that all Americans must have healthcare payment coverage or they will be fined. Proponents of the Individual Mandate argued that it was fair, reasonable and responsible for all Americans to pay for their own care, and that it was unfair to expect others to pay for coverage on their behalf. Opponents argued that no one should be required to purchase anything. (One Supreme Court justice even wondered aloud if ruling that the Individual Mandate was constitutional would lead to a requirement to purchase healthy foods like broccoli.)

Learn more about the Individual Mandate, its timetable, and what it means to you.

Pre-Existing Conditions

 

One of the frustrations of patients who have chronic illness or debilitating injury was the inability to buy health insurance coverage if they were not covered by an employer. Prior to passage of the ACA, it was almost impossible for someone with a pre-existing condition to purchase coverage, leaving them with little recourse except to get sicker, suffer increasing pain, and eventually die.

The Affordable Care Act changed the entire insurance experience for Americans with pre-existing conditions. By 2014, they will no longer be legally denied access to health insurance. Further, the government has developed an interim solution to help them get coverage before 2014.

Learn more about ACA and coverage for pre-existing conditions, including the interim solution.

Medical Care for Seniors / Medicare and the Donut Hole

 

Through healthcare reform, a number of changes will take place for seniors which will expand their access to the preventive and screening services they need, and save them money on prescription drugs, eventually eliminating the donut hole - the drug coverage gap that makes many drugs unaffordable for seniors.

Unfortunately senior Americans have also been the target of plenty of disinformation, lies and fraud about the Affordable Care Act, preying on their fears, and convincing them to make decisions that are not in their best interest. From political candidates who tell lies about what reform will mean to seniors (See stories about "death panels), to fraudsters who convince them to pay for services that they should not pay for, seniors are paying the price for the confusion and others' needs to control and make money from them.

Hopefully as time goes on and the ACA is further implemented, these seniors will become less gullible, and smarter about asking questions before they fall for scams and disinformation.

Learn more about what the ACA means to senior Americans.

Coverage for Children and Young Adults

 

There are two important aspects of the law that pertain to children and young adults.

Children with pre-existing conditions benefited from earlier coverage capabilities than adults. As of 2012, insurers could no longer deny care, or raise premium prices for healthcare coverage for children.

Here is more information from the US government about ACA coverage for young adults.

Prior to passage of the ACA, young adults lost their health insurance as soon as they graduated from college, or if they didn't go to high school, they lost coverage upon graduation from high school. One of the earliest implementations of the new health law was to put young adults up to age 26 back on to their parents' health insurance plans, with one of the few exceptions being a young adult who goes to work for an employer who also offers coverage.

Learn more about the ACA and its provisions for young adults.

Preventive Care

 

Provisions of the Affordable Care Act mean that adults and children will have access to preventive screenings and tests at no cost beyond their insurance premiums. Ranging from diabetes and blood pressure screenings, to tests for HIV and other sexually transmitted diseases, to cholesterol or breast cancer screening. That means these screenings will not require any co-pay, or co-insurance.

Here is the ACA list of screenings that Americans will be able to benefit from at no extra cost.

Additional Provisions of the Affordable Care Act

 

Note that some health plans that existed prior to the passage of the ACA in 2010 are grandfathered, meaning, they do not have to expand coverage as described above. If the plan you have existed prior to March 23, 2010 (the day the PPACA was passed), whether or not you were insured with that plan on that date or prior, then there may be some aspects of the healthcare reform law that do not apply to you. Learn more about grandfathered plans from the US government.

What Important Aspects Were Left Out of the ACA?

One reason the passage of the ACA was so contentious was because there were at least three important aspects of necessary reform that were never addressed. Yes, they were discussed, and many felt they were very important. But the ultimate law that was passed did not mention them. They are either left out forever, or will need to be addressed in future amendments to the law.

Those aspects are:

  • The Public Mandate
  • Portability and
  • Tort Reform

Learn more about the aspects of reform that were missing from the original ACA.

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Additional Resources regarding the Affordable Care Act (ObamaCare) and its implementation:

Read the law in its entirety.
Healthcare.gov

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