While many provisions of the Patient Protection and Affordable Care Act have been considered necessary for the safety and health of all uninsured Americans over Obama’s presidency, one that may often be overlooked but is considered to be crucial is located in Subtitle B: Immediate Action to Make Coverage Affordable and More Available. Within Subtitle B, Section 1101 ensures immediate access to insurance for Americans who have a preexisting condition, which has been considered anything from a previous cancerous condition, to having flat feet . When initially enacted, the provision allowed for a temporary insurance program to be put in place for all individuals with a pre-existing condition by way of a financial assistance program. The individual must have been without insurance for at least six months, and were promised insurance at basic premium rates . The federal government provided up to $5 billion dollars for Section 1101, until such a time that the $5 billion dollars ran out, or the American Health Benefit Exchanges were up and operational, which happened in 2014 . The provision allowed for a smooth transition between ACA and AHBE for all enrolled individuals without disruption to regular and necessary healthcare.
In terms of healthcare costs, Section 1101 was specifically intended to lower costs in the interest of the patient. For example, an individual with a preexisting condition like diabetes would have been denied private insurance prior to ACA being enacted. Insurance through an employer would have been available, but deductibles even based on the lowest premiums could have been up to $15,000 . However, as the ACA was enacted and the expansion of Medicare was accepted in several states allowing for a blueprint of universal coverage mirroring what is available in other states, over five years accountable care organizations, or ACOs amounted to 220, saving the healthcare industry $17 billion in 2013 . Moreover, enacting Section 1101 helped slow the growth of insurance costs per capita by half, lowering costs of health care to its slowest rate in over fifty years. Essentially, the provision was intended to insure more Americans at a higher, more efficient, and cheaper rate, providing preventative care for preexisting conditions in an effort to drive down costs even through an expanded Medicare program. Over the Obama presidency, it appears to have worked. Finally, consumers have been able to save $9 billion since 2011 and stand to save another $1 billion based on a law demanding insurance companies spend eighty percent of each dollar on health care, while also empowering each state to negotiate individual insurance premiums for the insured.
The provision was also created to improve access to healthcare. Prior to the existence of the ACA, if an individual did not have insurance before a diagnosis they could be denied insurance, or be faced with crippling debt due to high premiums and deductibles. Insurance companies also had the option to challenge a diagnosis, accusing the patient of knowing about a diagnosis prior to purchasing coverage. Those with preexisting conditions, whether occurring at birth, in childhood, or otherwise, were at the whim of insurance companies, as well as their bank accounts. At the time the ACA came into existence, it was estimated that seventy-five percent of all Americans living with preexisting conditions were living as middle class citizens or below the poverty line; it would have been impossible for them to purchase healthcare, or they would have quickly lost financial stability in an effort to remain healthy or alive. Section 1101 prevented private insurers, as well as insurance through employers from dropping those with preexisting conditions. Moreover, the expansion of Medicare allowed for those living below the poverty line, as well as the unemployed to obtain health coverage at a reasonable price, regardless of their condition or when it was discovered. Simply, the provision was designed to offer coverage to all Americans regardless of socioeconomic status or condition.
Provisions demanding individuals with preexisting conditions were meant to improve quality of care in a variety of ways and for obvious reasons. Prior to the Affordable Care Act, individuals suffering from a cancer relapse may have been faced with the choice to die, or go into irrevocable and unrecoverable debt in a struggle to survive based on previous insurance rules, i.e. they received no coverage and would need to pay out of pocket . In some cases facilities did not have to offer care to individuals regardless of their condition if they were not insured, effectively handing them a death sentence in some cases. The ACA demanded every individual would receive the same standard of care whether they had an upper respiratory infection, or had discovered they had a brain tumor at the age of thirty-seven. As of today, it is estimated fifty percent of Americans have preexisting conditions and nearly seventy-five percent of all medical costs in healthcare go to treating these conditions, most of which are chronic illnesses, that are either preventable or more manageable with proper healthcare and insurance . After five years in effect, preventative medicine and care, as well as stipulations such as insurers are no longer allowed to place lifetime caps on coverage have allowed for those suffering from chronic illnesses and preexisting conditions to receive necessary care in order to control their illnesses. In addition, conditions concerning obesity related illnesses and some neurological disorders have decreased sometimes by up to seven percent .
Many believed insuring those with preexisting conditions would cripple the economy, forcing the insurance companies, as well as the healthcare industry to take on more than it could handle. This was assumed based on the enormous quantity of individuals who were assumed to have such preexisting conditions at the time. Boosted demand for healthcare and insurance was not taken into account, however. With one in two individuals in the country in need of adequate healthcare, but with no way to obtain it, the demand for such a service was high when the marketplace opened. With the added benefit of tax credits, citizens drove down the price of what was originally relatively expensive healthcare based on demand while also helping decrease the cost of healthcare costs. Today over twenty million people utilize the ACA’s insurance whether through the Marketplace, CHIP, or expanded Medicare, which has also helped provide jobs in the medical sector. Finally, insuring and providing appropriate healthcare for nearly half of America has improved their health status, making individuals who were once on disability, or unemployed, able to work. Production has driven the workforce forward and dropped the unemployment rate to the lowest it has been since 1990, making this one of the most prosperous times in America’s history. It is owed to health Americans, and that is owed to coverage for those who were once unable to find coverage, and unable to work. Section 1101 changed the economic face of the nation for the better.
In sum, while the Patient Protection and Affordable Care Act were not perfect, there were many provisions that did well for the country and its citizens. Section 1101, ensuring insurance for those with preexisting conditions was one such provision. Those who needed coverage but were unable to obtain it finally received adequate healthcare. In some cases, chronic illnesses became more manageable or became avoidable based on the ACA’s provision. Because of this, individuals who once were too sick to work became productive members of the workforce again, showing how important some parts of the ACA were and are.
References
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Golden, A. (2015). Financial Questions About the Patient Protection and Affordable Care Act. The Journal for Nurse Practitioners, 572-573.
Han, X., Yabroff, K. R., Guy Jr., G. P., Zheng, Z., & Jemal, A. (2015). Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States? Preventative Medicine, 58-91.
Redhead, C. S., & Kinzer, J. (2013). Implementing the Affordable Care Act: Delays, Extensions, and Other Actions Taken by the Administration. Washington D.C.: CRS Report.
