(CNN) — The Affordable Care Act, also known as Obamacare, still stands.
The dismissal of the Supreme Court Thursday’s most recent Republican-led challenge to the landmark healthcare reform law, widely known as Obamacare, maintains the existing system.
The law, which has survived multiple attempts by Republicans to overturn it in the 11 years since its enactment, has had a major impact on the nation’s healthcare system and the lives of tens of millions of Americans.
About 31 million people have coverage thanks to the Affordable Care Act, including through Obamacare exchanges and the expansion of Medicaid to low-income adults.
The law also allows parents to keep their children in their health insurance plans up to age 26 and allows patients to get free mammograms, cholesterol checks, and birth control.
One of the most popular provisions of the law is the robust protection it offers to people with pre-existing diseases, which includes a ban on insurers denying coverage or charging higher premiums based on people’s medical history.
According to the Kaiser Family Foundation, nearly 54 million Americans, 27% of non-senior adults, have pre-existing conditions that would prevent them from being insured in the individual market before the law. According to an Obama administration report, 133 million Americans could have been denied coverage, had their benefits delayed or reduced, or had to pay more for individual market policies due to their medical history.
For the past year, as the coronavirus pandemic and the ensuing economic recession gripped the nation, the Affordable Care Act acted as a safety net for Americans who lost their jobs, and with them their health insurance, and for the uninsured seeking coverage. Enrollments in both the Affordable Care Act and Medicaid exchanges have increased since the outbreak began in March 2020.
Since taking office, the presidente Joe Biden has strengthened the Affordable Care Act and further integrated it into the nation’s health insurance system, and has moved swiftly to undo many of the country’s efforts. expresidente Donald Trump for weakening the law.
Biden reopened federal listing for Obamacare and has strengthened marketing, outreach and policy assistance. So far, about 1.2 million people have enrolled in the federal market for 2021 coverage during the special enrollment period, which runs from mid-February to mid-August.
And his administration is reversing the Trump administration’s approvals of Medicaid work requirements, which threatened to strip coverage for many people who got it through the expansion of the Obamacare program.
Although several of the provisions of the Affordable Care Act are popular with most Americans, the public remains deeply divided about the law itself. Overall, 54% of people had a favorable opinion and 39% an unfavorable opinion of Obamacare in February, according to the Kaiser Family Foundation.
But broken down by party, 82% of Democrats were in favor of the law, while only 17% of Republicans were. And 75% of Republicans had an unfavorable opinion, compared to 10% of Democrats, according to the Kaiser poll.
A group of Republican state prosecutors brought the case after Republican efforts to repeal the law in Congress failed.
The states argued that the individual mandate of the law became unconstitutional when Congress lowered the penalty for not having coverage to $ 0, and therefore the entire law should disappear. The Trump administration sided with Republican states and urged justices to strike down the law, a position the Biden administration reversed in February.
Here’s how the law has reshaped America’s healthcare system:
The Affordable Care Act has had the greatest impact on the individual market, which was for the most part unregulated prior to the healthcare reform law. In February, some 11.3 million people were enrolled in Obamacare plans for 2021.
In addition to prohibiting insurers from basing coverage on people’s medical history, the law ended insurers’ practice of imposing annual or lifetime limits on benefits, and also put limits on annual non-reimbursable spending. It forces insurers to offer more comprehensive benefits, including medications, maternity, and mental health. It prevents insurers from charging women more and restricts premiums for seniors to no more than three times those for young adults.
Obamacare established health insurance pools so Americans could buy individual policies and created federal subsidies so low- and moderate-income enrollees could buy plans for less than 10% of their income. It also limits deductibles and copayments for lower-income members.
Biden’s $ 1.9 trillion relief plan beefed up subsidies for two years to answer America’s biggest complaint – that the Affordable Care Act was not really cheap. Many middle-class Americans who were ineligible for subsidies had dropped their coverage, claiming that the premiums were too expensive.
With the new law, consumers will not pay more than 8.5% of their income for coverage. In addition, those who earn more than 400% of the federal poverty level, that is about US $ 51,000 for an individual and US $ 104,800 for a family of four in 2021, will be able to receive help. Low-income enrollees can have their premiums waived entirely for two years, and those who collect unemployment benefit can enroll in premium-free coverage in 2021.
Americans can still sign up for 2021 coverage on Affordable Care Act exchanges.
Biden launched a special enrollment period for the federal market that runs through August 15. Most states that run their own exchanges have also given residents more time to select policies. About 1.2 million people They signed up for coverage during the Special Enrollment Period, through May.
Several million more people buy individual plans outside of exchanges. They cannot apply for subsidies, but they receive all other benefits.
The Trump administration tried to undermine the law by expanding alternative coverage options, such as short-term health policies, which do not have to adhere to all of the Obamacare provisions, particularly those that protect people with pre-existing conditions. As a result, many of these plans have lower premiums. Biden intends to reverse many of these measures to strengthen the law.
Before Obamacare, the majority of those enrolled in Medicaid were low-income children, pregnant women, parents, the disabled, and the elderly.
The health reform law opened the program to low-income adults with incomes up to 138% of the poverty line, currently about $ 17,800 for a single person, in states that chose to expand their Medicaid programs. The provision allowed more low-income parents to enroll and provided a new avenue for adults without minor children to get coverage.
So far, 38 states and the city of Washington have expanded Medicaid or passed ballot measures to do so. According to the Biden administration, some 14.8 million Americans have been covered by this provision, as of December.
The federal government paid 100% of the expenses of the expanding population during the first three years and gradually reduced the reimbursement rate to 90%, where it will remain.
The stimulus package provides an incentive for the 12 states that have been left out to expand Medicaid. They will receive a 5 percentage point increase in their regular federal Medicaid reimbursement rate for two years. More than 4.3 million uninsured Americans will be able to access Medicaid if these states expand the program.
The Affordable Care Act has meant lower premiums, deductibles and cost sharing for the more than 61 million seniors and disabled Americans enrolled in the program.
The health reform law made many changes to Medicare. It reduced the growth of payment rates to hospitals and other providers, reduced payments to Medicare Advantage plans, and improved benefits for members.
With Obamacare, Medicare beneficiaries receive free preventive benefits, such as screenings for breast and colorectal cancer, heart disease, and diabetes.
And the Affordable Care Act helped close the gap in Medicare drug coverage, which was completely eliminated in 2020.
However, the law led to increased costs for higher-income beneficiaries. Initially, the law froze the threshold for the Medicare premium supplement at $ 85,000 for individuals and $ 170,000 for couples, thus increasing the number of people required to pay it. This measure has been lifted, so the thresholds are updated annually. They are currently at $ 87,000 for individuals and $ 174,000 for couples.
The Affordable Care Act also added a supplement to the premium for drug coverage for higher-income members.
Employer Sponsored Insurance
Obamacare requires companies with at least 50 employees to provide affordable insurance to their employees who work more than 30 hours a week.
This mandate did not have a major impact on the more than 150 million workers who are insured through their jobs. Most large companies already offer coverage to full-time workers. However, setting the standard at 30 hours per week led some companies to extend coverage to a greater number of employees, as many companies had considered that threshold as part-time.
In addition, the law allows children to remain in their parents’ plans until they are 26 years old. This has proven to be one of the most popular provisions of the Affordable Care Act and has contributed to reducing the uninsured rate for this age group.
Workers no longer have to pay for birth control and preventive tests like colonoscopies and mammograms. The law requires them to be free.
The Affordable Care Act also prohibits companies from imposing annual or lifetime limits on benefits and limits non-reimbursable spending.
Obamacare has also had an impact on employees working in companies with fewer than 50 workers. Insurers can no longer ban workers with pre-existing conditions or ask them to pay more. Plans are required by law to cover a number of benefits, such as maternity, mental health, and prescription drugs. And it limits the ability of insurers to charge older workers premiums equal to three times those of younger workers.
George is Digismak’s reported cum editor with 13 years of experience in Journalism