Health Care Reform
The new Administration and the 115th Congress have stated that they will repeal and replace the Patient Protection and Affordable Care Act (ACA). The ACA eliminated pre-existing condition exclusions and waiting periods and established new health insurance options. While the ACA provides protections for people with pre-existing conditions, health care reform is still needed to ensure that everyone has affordable access to coverage.
Affordable Care Act (ACA), Essential Health Benefits, and Pre-existing Conditions
Congress has taken no final action to repeal ACA (or Obamacare). The administration, however, has made several decisions that could restrict or end guaranteed access to affordable health insurance for people with pre-existing conditions such as PKD. Read our monthly summaries for the most recent information.
- The premium tax credits, CSRs, and Medicaid expansion are all intended to help people afford their health care.
- The funding included in Graham-Cassidy would expire in 2026 without additional Congressional action.
- Pay higher premiums
- Have greater difficulty finding plans that cover all of their needed medicines and services
- Have no limit to their out-of-pocket expenses
- Be subject to lifetime and annual limits on their coverage
- By Congress reducing hundreds of billions of dollars in Medicaid payments to the states, states could cut enrollment, limit benefits, or reduce payment rates to providers and plans.
- This could mean that fewer low-income patients have access to health insurance through Medicaid or to additional benefits offered by Medicaid. What about bipartisan efforts to improve the ACA? While the Senate considers Graham-Cassidy, there is a better option: a bipartisan stabilization effort being led by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA), who have held a series of hearings to explore options to stabilize the existing markets. These conversations have stalled in the wake of the announcement of Graham-Cassidy.
- Essential Health Benefits. Currently, all health care plans under the ACA require minimum essential benefits; including doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. The AHCA as amended will let states choose to opt out of EHB requirements. States will be able to set their own EHB categories, meaning benefits will vary state by state.
- Annual and lifetime caps. The ACA eliminated annual and lifetime caps for services that fall into the ten EHB categories. States may choose to only mandate coverage for certain EHBs which will result in fewer services that apply to the lifetime and annual benefits limits and maximum out-of-pocket cost limits.
- Insurance cost for people with pre-existing conditions. The ACA established adjusted community rating meaning that insurers cannot raise premiums based on health status, medical claims or gender. Through the AHCA, states can opt out of the requirement that insurers charge the same premium for people with pre-existing conditions (like PKD) as they charge for people without pre-existing conditions. High-risk pools have been proposed as a way to provide insurance to everyone; however, this would allow states to put people with pre-existing conditions into high-risk insurance pools. These pools would likely be more expensive and many individuals with pre-existing conditions could still be charged at a higher cost.
More resources from member organizations
National Health Council
The PKD Foundation is a member of the National Health Council (NHC). The NHC has taken a leadership role to ensure that people with chronic disease, like PKD, are considered in any effort to replace the ACA. The PKD Foundation supports NHC’s domains and values for health care reform.
- Ensure meaningful and affordable access
- Coverage for pre-existing conditions
- Eliminate annual and lifetime benefit caps
National Organization for Rare Disorders (NORD)
The PKD Foundation is also a member of the National Organization for Rare Disorders (NORD). In February 2017, NORD put forward a set of Principles for Health Coverage Reform.