The Affordable Care Act of 2010 (ACA) is 1 year old this week, and although it remains controversial, it is taking root. A recent poll shows that about 1 in 8 Americans believe they’ve already been helped by the changes effected by the law—well before the main push to cover the uninsured, scheduled for 2014. The only thing that might derail it is a Supreme Court decision against it, or at least against some provisions.
Even as some states are suing to nullify the ACA, they nonetheless are proceeding with implementing the new system. Families, small businesses, and seniors are starting to feel the impact of dozens of insurance reforms already put in place. Parents with sick adult children are able to get them into one of the high-risk insurance pools created under the law, or sign them up for a parent’s workplace plan under a provision extending coverage for adult children up to age 26—even though the high-risk pools are faltering. The latest count shows fewer than 12,500 people have signed up, mainly because of waiting periods and high premiums.
However, the law has other complexities and even injustices. Young children with birth defects may not be covered. The law requires insurers to accept children regardless of preexisting health problems—a safeguard that will extend to people of all ages in 2014. But if the parents are self-employed and the family buys its own coverage, things won’t work out as expected. Certain “grandfathered” plans selling individual coverage are exempt from the law’s requirement to cover kids. That means parents will have to apply for a whole new policy, and if one or the other parents is, say, a cancer survivor, they are unlikely to be accepted. The alternative: The parents may be able to put the child on Medicaid.
Small businesses aren’t signing and taking advantage of new tax breaks because the math doesn’t work for them: A typical employer with 10 workers would have to pay about $31,000 a year for health insurance and would recover only 10% to 15% of that through the new tax credit.
So far, senior citizens, haven’t found that Medicare cuts are compromising their care, but Democratic lawmakers engineered the cuts to take effect gradually, while new Medicare benefits are being provided up front. Topping the list this year is a 50% price cut on brand-name prescriptions for Medicare recipients who fall into the coverage gap called the “doughnut hole.”
As implementation shakes out, it seems there aren’t enough checks on insurance carriers—who still are able to charge probitively high premiums. And this is the one big kink that must be worked out if the ACA is to achieve its primary objective: stopping the most egregious practices of the insurance companies, and thus making health care insurance affordable for all Americans!