The Affordable Care Act (ACA): It Gets Personal, Very Quickly

I (Gary Jacobson) am part of that aging demographic called the “Baby Boomers.” You know us. We are the older faculty and clinicians. We are the ones who are still having fun working mostly because we enjoy it, not necessarily because we have to.

Unfortunately, there are more than a few of us Boomers who have another reason to continue working. That reason is having one of the myriad of pre-existing health conditions that could make us completely uninsurable (or, at least, uninsurable for the health condition/s about which we are most concerned), if we were forced to purchase health insurance privately.

By now, you have no doubt heard of the Affordable Care Act (ACA). The issue of how to secure health insurance after retirement became a major issue for individuals not yet eligible for Medicare when the current presidential administration made one of its goals the repeal of the ACA.

Provisions of the Affordable Care Act stipulate that: 1) uninsured individuals may purchase comprehensive health insurance through health insurance marketplaces, or exchanges, and 2) these individuals cannot be denied coverage even if they have a pre-existing medical condition. The latter provision means that even individuals who were uninsurable previously because they had health challenges could secure a health insurance policy that would cover any pre-existing conditions. In addition, the ACA includes a provision that prohibits health insurers from imposing an annual or lifetime limit on benefits. This was designed to protect patients with very high cost or long-lasting conditions from “maxing out” their health insurance benefits.

This editorial is not meant to be a debate on the merits or demerits of the ACA. It is a look at what the ACA and its protections mean for our patients. It is well-known that the success of the ACA was dependent, in part, on the willingness of young and healthy individuals to purchase insurance on the exchange to offset the costs of enrolling older and sicker individuals.

• REFERENCE

• Claxton G, Cox C, Levitt L, Pollitz K. 2016 Pre-existing conditions and medical underwriting in the individual insurance market prior to the ACA. https://www.kff.org/health-reform/issue-brief/pre-existing-conditions-and-medical-underwriting-in-the-individual-insurance-market-prior-to-the-aca