This week, the U.S. Supreme Court heard arguments against the Affordable Care Act (ACA) in a case that could lead to the law’s unraveling.
Millions of Americans have reason to worry.
Beyond approximately 130 million Americans with preexisting conditions who could lose protections from insurance discrimination and 2.3 million young adults who currently get insurance on their parents’ plan, virtually every American has something to lose if the court overturns the ACA.
Here are 11 less obvious yet widely applicable consumer protections that are at risk:
1. Free preventive care. Have you noticed that your doctor’s office hasn’t charged you a copayment for checkups in years? That’s not because they’re especially generous; the ACA requires private insurers to cover preventive care without any out-of-pocket costs for consumers.
2. Outlawing gender discrimination in insurance premiums. Before the ACA, it was legal for health insurers to charge women higher premiums for the same coverage. The ACA prohibits insurers from setting different rates for the same coverage solely based on gender.
3. Coverage for birth control, mental health, and other essential services. Insurers used to sell policies without coverage for services such as birth control, maternity care, or mental health care. The ACA required private insurers to cover 10 Essential Health Benefits, including preventive care such as cancer screenings and well visits, outpatient care, emergency services, hospitalizations, medications, lab services, pediatric care, and rehabilitation.
4. Elimination of annual and lifetime coverage caps. Before the ACA, health insurers could cut off coverage if consumers cost too much. After paying for a lot of services, such as for cancer treatment or other serious illness, insurers could simply refuse to pay for more services that year or ever. The ACA ended that practice.
5. Limits on total out-of-pocket costs. Out-of-pocket costs feel out of control, but without the ACA, it could be worse. The ACA limits consumers’ annual out-of-pocket spending, indexed to inflation. Once consumers reach the maximum, they no longer have to pay copayments, coinsurance, or deductibles for covered services. In 2021, the out-of-pocket maximum will be $8,550 for individuals and $17,100 for families.
6. Consumer rebates to curb insurance company profits. The ACA requires health insurers to spend at least 80% or 85% of premiums on medical claims, for large and individual or small group plans, respectively. This Medical Loss Ratio (MLR) standard specifies that insurers must pay out most of every dollar in premiums for medical care, limiting insurers’ administration, marketing and profit to 15 or 20 cents on the premium dollar. In 2020, due to lower healthcare spending and record insurer financial performance during Covid-19, 11.2 million people will be due $2.5 billion in rebates.
7. Shopping for health insurance. Virtually everyone knows about the insurance marketplaces, but fewer may remember how hard it was to shop for health insurance before the ACA. There was no centralized place to compare plans, if options existed at all. Today, Healthcare.gov and 21 state health insurance marketplaces provide an online comparison shopping experience, with 181 insurers offering plans for 2021, 22 more than last year.
8. Subsidies for moderate-income people. The ACA created two kinds of subsidies—cost-sharing reductions and premium tax credits—to offset insurance costs for people earning up to 250% and 400% of the federal poverty level—$31,900 and $50,040 per year, respectively.
9. Prohibitions on age discrimination. Insurers used to set prices based on individuals’ specific risks and likely costs, which the ACA no longer allows. Insurers can still charge more for older people who are more likely to use services, but the ACA limits the difference between rates for the oldest and youngest adults to a 3:1 ratio.
10. Improvements to Medicare. Nearly 70 million Medicare beneficiaries can thank the ACA for eliminating their out-of-pocket costs for recommended preventive services covered by Medicare and waiving the Medicare deductible for colorectal cancer screening. The ACA also closed the infamous “donut hole,” a gap in Medicare Part D prescription coverage that disadvantages people taking brand-name medications.
11. “Plain-language” consumer disclosures. Health plan information is full of jargon, but the ACA improved insurance disclosures by requiring all plans to publish standard summaries of benefits and coverage so consumers can compare plans more easily. Insurers must also report enrollment, disenrollment, denials, and other claims-related data. Though most consumers never read this data, it’s available for those who want to scrutinize insurance companies before they enroll.
Covid-19 Has Raised The Stakes On Preexisting Conditions
Though most Americans are aware of and concerned about preexisting condition protections, many may not realize what used to count as a preexisting condition. Pregnancy, prior Cesarean sections, and even a history of domestic violence could be grounds for being declined coverage or being charged more for it.
Looking ahead, Covid-19 could qualify as a preexisting condition. Those who have tested positive, even if they were asymptomatic, could be declined coverage or charged more on the grounds that they could be at greater risk for future health costs. With more than 10 million positive tests and counting, preexisting condition protections could become even more vital to more Americans.
If the Supreme Court overturns the ACA, Americans may get a clearer view of the consumer protections they’re losing. By then, it’ll be too late for the ACA. Americans will need to look to Congress, or their state, for solutions.