The Affordable Care Act
(ACA)
and Health Care for
People with Disabilities
Presented by Lisa D. Ekman
Director of Federal Policy, Health & Disability Advocates
DC Advocacy Partners is the District Class
May 9., 2104
What this presentation will cover:
Why was the ACA needed ?
What was actually in the ACA?
How is implementation going?
What barriers still exist to people with
disabilities to getting quality care?
Why was the ACA needed?
55 million people did not have any
health insurance
Individual health insurance policies
were not covering what people needed
Health care costs were increasing
55 million people uninsured
Why does that matter?
People’s health matters AND
Health care related bankruptcies
No preventative care
Everyone pays more when
uninsured get treatment
Private Insurance Problems
Inadequate benefits/insurance policies
Lack of access for people with pre-existing
conditions
Not affordable for people with any illness
Caps on what policies would spend
Canceled policies when people need them
Health Care Costs
• The United States spends much more per
person than other countries on health care
but doesn’t get good outcomes
• Almost 1 in 5 dollars created by our
economy goes toward health care costs
• The aging of the baby boomers will cause
that share to increase
The ACA Had 2 Main Goals
1.Expand access to affordable
comprehensive coverage AND
2.Help control health care costs
How the ACA Expands Access to Coverage
How do people get health insurance?
• Private Insurance
• Employer Sponsored
• Individual Market
• Public Insurance
• Medicare
• Medicaid
How the ACA Expands Access (cont)
• Private insurance problems were mostly in the
individual market – no pooling of risk
• Some people could not get a policy at all – preexisting condition ban
• For some it was too expensive if had any health
issues
• Rescission – dropping people when sick
How the ACA Expands Access (cont)
• The ACA created new “risk pools” –
• To make the individual market more
like the employer market
• They are called marketplaces – some
states have their own and some use the
Federal one
•Individual and Employer Mandates
How the ACA Expands Access (cont)
The ACA reformed private insurance requirements:
• Ban on considering pre-existing conditions
• Cannot charge people more for premiums because sick
• No annual caps/no lifetime caps
• Cannot drop people when they get sick
• All policies must cover essential health benefits
What Are Essential Health Benefits (EHB)?
• ambulatory patient services;
• emergency services;
• hospitalization; maternity and
newborn care;
• mental health and substance
use disorder services,
including behavioral health
treatment;
• prescription drugs;
• rehabilitative and habilitative
services and devices;
• laboratory services;
• preventive and wellness
services and chronic disease
management;
• and pediatric services,
including oral and vision care.
Other Private Insurance Reforms
• Coverage for dependent children up to age 26
• Community Rating – everybody pays same
regardless of health status or gender
• Increasing transparency – insurance companies
have to do a better job of telling people what is
covered under the policies
• Online information so people can make apple to apple
comparison
How the ACA Makes Coverage Affordable
Subsidies and Limits on Costs
• People making between 138% of FPL and 400% of
FPL can get help paying for their health insurance
premiums
• There is a cap on the total amount people must
spend per year on health care
How the ACA Expands Coverage (cont)
Medicaid Expansion
• Every state was supposed to offer Medicaid to:
• Adults whose income was up to 138% of the federal
poverty line
• Did not have a limit on resources like other
Medicaid eligibility categories
• Would include EHB services as required services
How the ACA Expands Care (cont)
Access to Home and Community Based Services
Under Medicaid
• Home and Community-Based Services State Plan
Option
• Community First Choice
• State Balancing Incentive Payments Program
• Money Follows the Person (MFP)
How is implementation going?
Private Health Insurance
• Every state is offering private insurance that meets
the new requirements.
• Most states are participating in the Federally
Facilitated Marketplace or FFM but some states are
running their own
• DC has its own marketplace
• More than 8 million people have insurance through
the Marketplaces!
How is implementation going?
Medicaid
• 27 states have expanded Medicaid
• 5 states are still considering it
• 19 have said they won’t move forward at this
time
• About 3.9 million people insured through
Medicaid expansion
Barriers for People with Disabilities
Some benefits are still not adequate
• Can’t have annual spending caps but can have limit on
the number visits or number or types of devices
• Prescription coverage
• Durable medical equipment like wheelchairs
• Supplies
• Habilitation
Barriers for People with Disabilities (cont)
With private insurance there are still:
• Some policies that don’t include enough or the
right specialists
• Some doctors offices that are not accessible
• Some insurance policies might discriminate
against people with certain conditions
Barriers for People with Disabilities (cont)
In Medicaid:
• Some people can’t get the long-term services and
supports (LTSS) they need
• Some programs are expiring or haven’t been taken up:
• Money Follows the Person expires in 2016
• Only 8 states took up Community First Choice option
Discussion