What is missing from the debate over the Affordable Care Act? What’s in it for you.

Laura Julstrom, Tracy Rupp, PharmD, MPH, and Diana Zuckerman, PhD

Updated 2015

Do you want affordable, quality health care for yourself and those you love?  Whether you’re insured or not, chances are the Affordable Care Act (ACA), which was passed into law in 2010, has already improved your and your family’s access to health care.   But if you listen to the “experts” shouting about “Obamacare” on TV, you could miss out on how it can help you and your family.

Experts agree that the number of insured Americans increased by about 17 million people under the Affordable Care Act.  In addition, the law helps pay for prescription drugs for Medicare patients, saving them more than $15 billion. It provides free preventive services such as mammograms to screen for breast cancer – benefitting more than 4 million women in Texas alone.   And changes are being made to the health care system to reward the quality of the care you receive, instead of the number of tests or procedures. That means healthier Americans and billions less spent on unnecessary or ineffective treatment.

Even if you’re already insured, you will benefit from the ACA in the following ways:

  • You can now add your adult children (up to age 26) for the same price as younger children.
  • Your insurance company can no longer cancel your policy just because you get sick.
  •  Medicare and insurance companies now have to pay for preventive services, and they can’t exclude children with pre-existing conditions or a disability.

The last of the changes mandated by the legislation went into effect in 2014. While the law is not perfect, it has already helped many Americans get access to better and more affordable health care.

What the health care law has already done for you and your family:

  • Insurance companies can’tr put limits or a lifetime “cap” on how much they will pay for your essential health benefits.
  • Insurance companies can’t cancel your insurance coverage because you get sick or make an honest mistake on your insurance application form.
  • Insurance companies cannot increase (by 10% or more) how much they charge you without justifying it first to your state or federal Rate Review program.
  • Most of the premiums you pay must be used to provide or improve health care (not just to make more money for insurance companies).
  • Seniors can now more easily afford prescription drugs.
  • Many young adults under 26 can be covered by their family’s plan.
  • Insurance must pay for preventative care and provide it free of charge, including contraception, mammograms, and domestic violence counseling, as well as screening for HIV/AIDS, cervical cancer, colon cancer and depression.
  • Patients have direct access to an ob-gyn without needing a referral.
  • Children cannot be denied coverage because of pre-existing conditions.
  • No one can be denied coverage or charged more for coverage because of sex, disability, or medical history.

These sound like big improvements, don’t they?  So, why have members of Congress voted repeatedly to repeal the Affordable Care Act (“Obamacare”)? For many, opposition to the law is political: while Democrats were pushing for Obamacare, Rep. Paul Ryan, the Republican from Wisconsin who is now Speaker of the House, was pushing for an ambitious Medicare reform that bore a strong resemblance to Obamacare. Both Ryan’s Medicare reform and Obamacare planned to give people a subsidy that they could use to purchase insurance coverage on a regulated marketplace or exchange. So why do Republicans oppose Obamacare if they were so enthusiastic about a similar approach in Medicare?

Let’s not listen to the gloom and doom–those who insist the ACA will destroy the country.  This law has already improved the quality of health care and reduced the costs of it for millions of Americans like you and your family.  Get the facts not the hype from www.healthcare.gov.

Important dates for 2016 enrollment

  • November 1, 2015:Open Enrollment started — first day you can enroll in a 2016 insurance plan through the Health Insurance Marketplace. Coverage can start as soon asJanuary 1, 2016.
  • December 15, 2015:Last day to enroll in or change plans for new coverage to startJanuary 1, 2016
  • January 1, 2016:2016 coverage starts for those who enroll or change plans byDecember 15.
  • January 15, 2016:Last day to enroll in or change plans for new coverage to startFebruary 1, 2016
  • January 31, 2016:2016 Open Enrollment ends. Enrollments or changes betweenJanuary 16 and January 31 take effect March 1, 2016.

If you don’t enroll in a 2016 health insurance plan by January 31, 2016, you can’t enroll in a health insurance plan for 2016 unless you qualify for a Special Enrollment Period.