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Fact Checked

What is the Affordable Care Act?

The Patient Protection and Affordable Care Act, also called the Affordable Care Act (ACA) or ‘Obamacare’, is a federal statute signed into law by President Obama in 2010. It was intended to expand the American health system and to provide millions more Americans with affordable, high quality healthcare. But what is the Affordable Care Act? How does it try to achieve these goals? What does the Affordable Care Act Cover? And why are services like USA Rx still crucial to so many Americans despite this healthcare reform?

Anyone who is either uninsured or not covered by a job can take advantage of the effects of the Affordable Care Act. During a period each year called ‘Open Enrollment,’ anyone who wants to purchase a healthcare plan can register for coverage and shop for a plan on the online marketplace at HealthCare.Gov (or with a qualified broker). Depending on your income, you could receive substantial subsidies (called “Marketplace Subsidies) or qualify for Medicaid, which was expanded in many, but not all, states under the ACA. And all of these plans must cover ten essential health benefits at no dollar limits (meaning you don’t have a set amount of healthcare money to spend before you’re essentially uninsured):  

  • Outpatient care
    • Services not administered at a hospital, such as at clinics, specialists, or a primary care provider.
  • Emergency services
    • Services treating accidents, sudden illnesses, emergency room visits, and ambulance transportation. 
  • Hospitalization
    • Services received by a patient staying in a hospital, including surgery and nursing home care.
  • Maternity care
    • Services received throughout labor, delivery, and infant care.
  • Mental health services
    • Services that diagnose and treat mental health conditions, including substance abuse. 
  • Rehabilitative services
    • Services that help patients recover from disabling accidents, diseases, and chronic conditions.
  • Preventative services
    • Services such as cancer screenings that may diagnose serious conditions early and prevent them from exacerbating. 
  • Pediatric services
    • Services provided to children and infants, including check-ups, vaccinations, and immunizations, as well as dental care and vision care. 
  • Laboratory services
    • Services that help diagnose ongoing or suspected illnesses and conditions, such as by prostate exams, breast screenings, and blood testing. 
  • Prescription drug costs
    • Services covering the costs of prescription drugs that may be crucial to fighting a disease or condition, or providing ongoing wellness and quality of life to a patient. 

In addition to these required coverages and cost-assistance, the ACA grants Americans numerous benefits, rights, and protections like allowing young adults under twenty-six to remain covered by their parents’ plans, stopping insurance companies from refusing coverage or charging extra based on dangerous professions, pre-existing conditions, or gender discrimination, stopping insurance companies from dropping patients or canceling coverage for any reason but fraud or avoiding payment, limiting cost sharing, preventing unjustified premium spikes, such as those based on health status or illness, and providing tax breaks to small businesses for offering coverage to their employees. 

Despite these positive changes, there are still tens of millions of Americans going without insurance. Why is this? 

First of all, not everyone is insured under the ACA and some people don’t want to be; despite its being touted as universal coverage, or coverage for ‘everybody,’ those without access to accurate information about the ACA registration process are largely left in the dark with regards to their coverage, and since registration is completely voluntary they aren’t learning any more. Undocumented immigrants are given no quarter at all under the ACA, enrollment numbers have been stagnating, and it is a common misconception that ‘more’ healthcare means ‘worse’ healthcare. 

The Trump administration has been working to undo many of the ACA’s changes. When the ACA was first put into effect there was a mandate for every individual to be insured, and a tax penalty was promised to people who did not register for a plan, thus further incentivizing applications. The intent behind this mass contribution was to greatly lower the price of insurance premiums, furthering the affordability of healthcare. This mandate was effectively eliminated in 2019; although it has not been repealed, the ‘cost’ of the tax penalty has been reduced to $0. Healthy Americans who felt more comfortable taking tax penalties than premiums will likely take this development in stride, but experts predict that the end of the mandate will gradually create a massive spike in premium fees and potentially cause upward of ten million currently insured Americans to lose their coverage.

Furthermore, fourteen states have yet to expand Medicaid. Medicaid’s expansion was a provision of the ACA that would see Medicaid eligibility extended to adults up to age 64, and to incomes below 138% of the federal poverty level (FPL). This expansion was intended to be mandatory, but in 2012 the Supreme Court ruled that states could decide their participation in the expansion for themselves. Vast numbers of low-income Americans living in these states have been left without the means to afford their healthcare, even when factoring in subsidies. This is because there exists in these states a thing called the ‘Medicaid Gap,’ and it’s exactly what it sounds like: a hole in the system through which millions of Americans can slip and fall. With subsidies becoming available for families and individuals at 100% of the FPL and the qualifications for unexpanded Medicaid being as low as 48% of the FPL in some states, there is a significant 52% gap. And even in states that did expand Medicaid, those who qualify for Medicaid cannot take advantage of the subsidies they may fall in range of. And those above 400% of the FPL can not receive any cost assistance at all; this is referred to as the ‘Subsidy Cliff.’

Where does USA Rx come in? Well, in the list of ten essential health benefits that the ACA guarantees, prescriptions were put in last place for a reason. 

Analyses have shown that even after the passing of the ACA, or perhaps because of it, the prices of most prescription drugs, even those that save lives daily, have skyrocketed, with some brand-names reported to have doubled. An excuse often used by the pharma industry is that new, innovative drugs are pushing average prices up; but that doesn’t seem to account for the jaw-dropping percentages being reported. The real reasons for this price gouging are simple. The ACA’s expansion of Medicaid drastically increased the mandatory rebate that drug manufacturers have to provide to Medicaid qualified Americans, as well as those on Medicare taking advantage of Part D (an optional insurance strictly for medication) who have fallen into the coverage gap (the space between the end allotted Medicare coverage and the beginning of Catastrophic Coverage), and the ACA has ushered in a new tax on all manufacturers and importers of brand-name drugs. Together, these changes have cost the collective industry tens of billions of dollars. What tips this situation over into bad news for the consumer is the fact that the ACA doesn’t regulate the price of drugs. Margins need to be maintained, and so in the struggle between insurers, the pharma industry, and individual consumers and their families, the difference is increasingly being passed off to the latter collective. Of course, this is still an oversimplification of a much more complex problem. The entire locus of blame doesn’t lie entirely with drugmakers or insurance companies. But absolutely none of it can be blamed on the consumer. So who will be affected by the Affordable Care Act and what can USA Rx  do about it?

USA Rx is motivated by a simple and powerful mission: to improve health for Americans by making medication as affordable as possible. It takes on a vital role in today’s healthcare climate, one that not even the law can perform. Millions of people can find themselves struggling to stay above water in the wake of titanic legislation and subsequent reform, as the slightest oversights can be twisted in the service of profit comfort. 

For millions of Americans, the ACA may as well not have ever existed. Those who cannot be covered under the act will be suffering the exorbitant prices of medications, with little to no recourse. And those who choose to go uninsured due to their youth and relative health may still find the full prices of drugs far too great to pay in the case of catastrophe. 

Along with undocumented immigrants and those healthy Americans who choose to go uninsured, there is a growing trend of employers being unable, or unwilling, to pay for the health insurance the ACA mandates they provide to their employees. They avoid this requirement by hiring contractors, or reducing their employees’ time spent working to fewer than 30 hours a week, rendering them as ‘temporary’ or ‘part-time’ workers. These workers will now struggle with more than just their day to day job. With fewer hours they’ll make less and be able to save little, and without insurance they may fall into the Medicaid Gap. Even if they don’t, they’ll have to contend with the reality of today’s drug prices, and may be forced to join those who ‘ration’ their drugs and follow potentially less beneficial or hazardous medication schedules to make ends meet. 

USA Rx believes in helping all people, but it finds its epos in those whom are forgotten by legislators and slip through the cracks of the ACA. They remain as committed as ever to providing free, riskless, and easy to use service. By simply printing a card and presenting it when filling a prescription, users can save up to 75% of a medication’s cost. USA Rx is becoming increasingly vital to many Americans in the wake of the ACA’s shortcomings and changes, and it is dedicated to providing its services to America as long as it is needed—and that might connote a very long time. 

 

Published January 31st, 2020 by Chris Riley
Fact Checked by Chris Riley

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