Health Insurance Benefits that Individuals Will Lose if the ACA is Repealed

The Affordable Care Act has been ruled unconstitutional in late December 2018 only based on a change to the federal tax law that removed one of the law’s major provisions that require all Americans to purchase health insurance or suffer a tax penalty. This provision is no more effective from January 1, 2019, and so it was ruled that the ACA could no longer be upheld when a major provision of the law now no more exist. However, later a stay on this ruling was placed and so the ACA is still intact until its determination is heard by the higher courts.

According to experts, millions of Americans who purchase health insurance on their own will find a short-term plan as a health insurance alternative after repealing the ACA. With no requirement to purchase an ACA plan, alternative health plans like short-term plans that are 50% less expensive than normal plans will gain popularity. Short-term is temporary medical coverage providing an affordable alternative to the marketplace plans. These plans can be purchased for 30 days to up to 364 days and can be renewed for an additional two years depending on the state.

ACA-Health Plan Benefits

ACA-mandated provisions that took effect on January 1, 2014, included all the benefits that were deemed by the government essential to any plan. All qualifying individual health insurance plans, both individual health plans and group health plans offered by the employers available on the federal exchange or state marketplace or independently are required to provide all essential benefits. The essential health benefits that Americans have been receiving since 2014 include:

  • No pricing inequalities based on gender
  • No limitations on pre-existing condition
  • Premiums are not priced based on health status.
  • Maternity and Newborn care
  • Pediatric services including oral and vision care for children
  • Mental Health
  • Substance abuse services
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Besides essential benefits, individuals enrolled in the ACA-plans also receive free preventive care and wellness services that include:

  • Blood pressure screening
  • Immunizations
  • UTI screening for women
  • Colorectal screening after the age of 50
  • Annual wellness exams
  • Contraception for women
  • Vision screening for children
  • Autism screening for children
  • Postpartum depression screening for women

Trumpcare can End ACA Benefits 

In the future, if the ACA health reform is repealed then free WellCare services, screenings, pediatric services, and more benefits that are currently covered under the ACA-plans could go away. One ACA component that will have the biggest battle in Washington during the election campaign is the clause of a pre-existing medical condition. All individuals having ACA plans are supposed to pay the same price regardless of their medical condition and insurance companies cannot charge individuals with the pre-existing condition more. It was discovered in a poll that 75% of Americans believe that the pre-existing condition of the ACA is very significant.

Besides pre-existing conditions, premium subsidies have also been threatened under GOP proposed bills. Another popular feature of the Affordable Care Act is the financial subsidies that considerably lower the monthly premium costs and therefore has helped to keep the uninsured rate lower than it has been in the years before the ACA becoming law. If Obamacare ceases to exist, then Medicaid expansion can also be affected in some states. ACA provisions are not just a concern for the individual market but even employer group plans also fall under ACA protection and any change in the law would also affect the employer market equally.

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ACA-Plans Affordability

Individuals whose household income is between 100 and 400% of the federal poverty level, they are likely to qualify for a financial subsidy to reduce their monthly health plan costs. Subsidies for qualifying ACA plans can be determined at healthcare.gov or through their state’s marketplace exchange. However, individuals who are above the federal poverty guidelines can purchase an individual plan at a higher price. With the rise in the cost of the individual health plan, affording this plan without a financial subsidy will be difficult for the people.

Short-term plans in the Interim

Individuals and families who do not qualify for the premium subsidies have the option of short-term plans, as the president’s administration has reduced restrictions on short-term health plans. Individuals while being uninsured and looking for an alternative to permanent health insurance can opt for short term plans to fill the coverage gap. It has been estimated by the Congressional Budget Office estimates that around 1,3 million people will switch to the short-term plan by 2023 due to affordability. Though short-term health plans are not for everyone but can provide protection for unexpected medical care. However, people should carefully research, compare, and read the plan details to determine their suitability for the short-term plan.

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