6 things to celebrate about the Affordable Care Act

Previous week we celebrated the 6^th anniversary of the Affordable Care Act (ACA) and depicted on historic gains in health insurance coverage. About 20 million initially uninsured Americans are now covered. In Texas, we recently saw the greatest one-year drop in Texas’ uninsured rate in decades. And this happened despite Texas’ denial to accept federal Medicaid funding to cover an additional 750,000 low-income, uninsured Texans who lack affordable options today.

With so much concentration on coverage gains under the ACA, it is convenient to forget fundamental changes to the health insurance market that the ACA delivered. Before the ACA, unfair and discriminatory practices excluded millions of people from health insurance and inflated prices for others. To honor the ACA’s 6^th anniversary, here are 6 things to which we have bid good riddance:

• Lifetime limits. 6 years ago lifetime limits were common in health insurance policies. Some seriously sick people, like those with hemophilia and transplants, could run out of insurance advantages after the cost of their care exceeded an arbitrary cap. The ACA ended lifetime limits.


• Frivolous cancellations. Prior to the ACA, few insurers utilized flimsy excuses to revoke the policies of tens of thousands of Americans shortly after they were diagnosed with costly and life-threatening conditions. The ACA now prohibits this appalling practice.


• Being “uninsurable.” Before the ACA, insurers could deny coverage, charge more, or need a waiting period before providing coverage to persons with “pre-existing conditions.” The ACA put an end to these practices in the year 2014.


• Medicare “doughnut hole.” The ACA is closing the gap in Medicare drug coverage that could need enrollees to shoulder significant out-of-pocket costs. Since the year 2010, the doughnut hole has shrunk a bit more each year, already saving Medicare recipients in Texas almost $1 billion on prescription drugs. The doughnut hole disappears in the year 2020.


• Paying more for being a woman. Prior to the ACA, insurers commonly charged women much more than males for the similar coverage. That was real even when maternity was excluded, which was standard practice in pre-ACA Texas “individual market” policies — or coverage bought straightly from an insurer, not through a job. The ACA ended gender discrimination in premiums and needs insurance policies to cover maternity.


• Missing mental health coverage. Prior to the ACA, small employer and individual market health insurance plans mostly lacked profits for mental health and substance abuse treatment. And when mental health benefits were covered, policies often capped those profits at a much lower level of coverage than for physical health services. The ACA extended mental health and substance use disorder benefits to an estimated 62 million Americans, with benefits on par with physical health profits.