Save the ACA


The Affordable Care Act (ACA), sometimes called Obamacare, is legislation designed to help people who cannot get health insurance through their employers buy affordable health care.

It requires companies to cover pre-existing conditions which had made insurance unavailable at any price to many people.  It also eliminates lifetime caps on coverage that in the past forced people with serious illness into bankruptcy. Finally, it requires companies to cover essential services necessary to maintain good health and recover from illness or accidents. Those services include outpatient, emergency and rehabilitative services; hospitalization; maternity/newborn care; mental health, substance abuse services; prescription drugs; laboratory services; preventive and chronic disease management; and pediatric care. Even if you are healthy and don’t expect to need any of those services, you are covered if you do. With preventive care covered, people stay healthier and serious conditions can be caught earlier when they are easier and cheaper to treat.

The ACA also requires insurers to cover women at the same cost as men. It limits premiums for older people to 3 times that for younger people. It allows young people to stay on their parents’ plans until age 26, giving them more time to establish careers and afford their own insurance.

What does the ACA mean for Maryland?  In Maryland, only 54% are covered by employer-based insurance. Those who are self-employed, working for small organizations, between jobs or who lose a job find themselves without insurance. The ACA solves this problem by helping people who cannot get health insurance through their employers.

Thanks to the ACA, 309,202 more people in Maryland have health insurance now than before the law was implemented. The ACA accomplished this by using federal funds through subsidies and tax credits to help those who could not afford insurance plans.

Though it has been controversial, and has some problems that need resolving, the ACA has enjoyed popular support. An October 13 Kaiser poll found that 71% of those polled wanted legislators to keep the ACA and fix the problems rather than adopting proposals designed to make it fail. Despite the fact that a majority of people would rather keep the ACA and resolve its problems, it has been under attack since the 2016 election, with several failed attempts to “repeal and replace” it.

With Congress unwilling to repeal the ACA, President Trump has now tried to undermine it using executive actions that do not require congressional approval. Last week, he signed two such orders that will undermine the ACA and make it more likely to fail.

The first executive order promotes small group insurance plans to be sold with no essential services required.  So while the premiums might be cheap, the policies would not cover services most people need, and insurance companies could exclude pre-existing conditions or charge sky-high rates to cover them. These policies might be attractive to healthy people, but they are useless if those people get sick. They could also exclude older, sicker people or charge them so much that they would be forced to go without. Trump’s proposal returns health insurance to the scatter-shot coverage the ACA was designed to correct.

We’ve been here before. Prior to the ACA, insurers could sell bare-bones plans many people bought because premiums were lower. Those plans were popular with younger, healthy people, but they were useless to people who got sick or were injured because they did not cover many services. That’s why they were so cheap! That’s also why so many people found themselves with serious medical debt or unable to obtain affordable healthcare.

The second executive order immediately ends federal subsidies to insurance companies that had helped insurers offer affordable plans to lower-income people. Under the ACA, insurance companies used that funding to subsidize the costs of deductibles and out of pocket expenses for people who otherwise could not afford insurance.  Without that federal funding, insurance companies still have to cover lower-income people but they will have less money to do so.  That means that they will have to raise rates for everyone, making health insurance costs out of reach for many people.  Their alternative is to stop offering plans on the individual market. If many insurers stop offering plans, that leaves fewer plans from which consumers can choose, making rate increases even more likely.

The ACA is under attack, but the fight to save it is not over. The are several bi-partisan proposals being discussed in the Senate, including one by Republican Lamar Alexander and Democrat Patty Murray, that would keep the features of the ACA most people want while finding solutions for the problems.  If you or someone you love depends on the ACA for health care, or if you believe that everyone ought to have access to affordable health care, contact your representatives in Congress and urge them to find a way to keep the benefits of the ACA while resolving the problems:

Senator Ben Cardin: or call: (202) 224-4524

Senator Chris Van Hollen:  or call: (202) 224-4654

Representative Andy Harris: or call: (202) 225-5311

Linda Cades

Kent and Queen Anne’s Indivisible

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