Top Reasons Why The Arc Supports the Affordable Care Act (ACA)

Health insurance Reforms in the ACA

  • Eliminates pre-existing condition exclusions
  • Bans annual and lifetime limits
  • Ends the practice of rescissions (insurance coverage is cancelled when a person develops a serious health condition)
  • Improves appeals process including independent reviews
  • Requires that 80% of health insurance premium dollars are paying for health care
  • Enhances state capacity to regulate unfair increases in insurance rates
  • Prohibits considering health status in calculating premiums (2014)
  • Requires guaranteed issue and renewals (2014)
  • Prohibits discrimination based on health status (2014)

The ACA Expanding Access to Coverage

  • Establishes temporary high risk pools to cover those who are currently uninsured (until 2014)
  • Allows coverage for dependents until age 26
  • Creates health insurance Exchanges for individuals and small employers to purchase insurance (2014)
  • Provides significant subsidies to assist low income individuals to purchase coverage in the Exchanges and provides tax credits to help small employers
  • Includes coverage of dental and vision care for children in the Exchanges
  • Includes mental health services, rehabilitative and habilitative services and devices, and other critical disability services in the health plans sold in the Exchanges

The ACA Expands Medicaid

  • Expands Medicaid eligibility to 138% of the federal poverty level
    • New method of income disregards
    • No asset test
  • 16 million new beneficiaries by 2019
  • Federal government pays 100% till 2016 (phase down to 90% in 2020)

The ACA and Long Term Services and Supports

  • Establishes the Community First Choice Option for states to cover comprehensive community attendant services under the state’s optional service plan
  • Improves existing Section 1915(i) option for home and community based services
  • Creates a new state balancing incentives to reduce institutional bias of Medicaid
  • Extends “Money Follows the Person” Demonstration
  • Authorizes the CLASS program

Other Medicaid and Medicare Improvements

  • Gives states the option to provide health homes for Medicaid enrollees with chronic conditions
  • Allows a free annual Medicare well visit with assessments and individualized prevention plan
  • Eliminates Medicare Part D (drug coverage) co-pays for dual eligibles receiving waiver services
  • Improves Medicare Part D access to key anti-seizure, anti-anxiety and anti-spasm medications

Selected Prevention, Provider Training, Data Collection and Accessibility Issues Addressed by the ACA

  • Eliminates co-pays for critical prevention services
  • Creates the Prevention and Public Health Fund (PPHF) to provide new funding for transformational investments in promoting wellness, preventing disease, and other public health priorities
  • Increases opportunities for training of health care providers (including dentists) on the needs of persons with developmental and other disabilities
  • Authorizes new training programs for direct support workers who provide long term services and supports
  • Improves data collection on where people with disabilities access health services and where accessible facilities can be found
  • Adds disability as a category to measure health disparities and in health care quality reporting surveys
  • Requires the establishment of criteria for accessible medical diagnostic equipment

Key disability Data Regarding Access to Health Care

According to the Centers on Medicare and Medicaid Services (CMS)

15% of the uninsured have at least one disability (HHS/ASPE Analysis of 2010 CPS self-reported data)

12% of uninsured adults with incomes below 138% of the federal poverty level report limited ability to work or unable to work (Urban Institute Analysis of 2006 MEPS data)

Altman, B. Bernstein A. Disability and health in the United States, 2001-2005.  Hyattsville, MD National Center for Health Statistics 2008

  • Adults 18-64 with cognitive difficulty, 13.6 % had no insurance, 32.1% private insurance, 41.0% Medicaid, and 27.0% Medicare.
  • Adults 18-64 with disabilities are less likely than those without disabilities to have private health insurance coverage – 46.3% for those with complex activity limitation and 61.3% with basic actions difficulty (61.3%) compared to 75.2% with no disability.

U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Children with Special Health Care Needs in Context: A Portrait of States and the Nation 2007.  Rockville, MD: U.S. Department of Health and Human Services 2011.

  • Children with special health care needs – 29. 4% had inadequate coverage compared to 22.1% of children without special health care needs. Inadequate insurance is a far more prevalent problem than gaps in insurance or lack of insurance among children with special health care needs. (29.4% inadequate insurance whereas 12.3% had gaps in insurance or no insurance).
  • Children with special health care needs have unmet needs for specialty medical care—27% had problems accessing specialists and of the children with emotional, behavioral or developmental conditions, 48.4% did not receive mental health services.

Children with special health care needs are defined in the National Survey of Children’s Health as those who have one or more chronic physical, developmental, behavioral or emotional conditions for which they require an above routine type or amount of health and related services.   14-19% of children in the U.S. meet this need.

9 thoughts on “Top Reasons Why The Arc Supports the Affordable Care Act (ACA)

  1. While I agree 100 % with the need to provide better care to our citizens with disabilities I have to disagree 100 % with the way this goes about trying to do it. The massive expansion of the federal government will not only cause the system to bog down in bureaucrtic red tape the cost will be upwards of ten times the congressional estimates. It will utimately hurt a lot of the people it is trying to help and force all of us into a government run single payer system that will end in financial ruin for the United States.

    I am very disappointed that ARC has taken this position which I cannot in good conscience support.

    • Hi Steven,

      Thank you for your comment. We appreciate your input even if we disagree on this issue. The largest expansion of health insurance coverage in the Affordable Care Act (ACA) is through the creation of private health insurance market places. Also, The Arc has a long history of supporting Medicaid expansions including efforts to cover more low income adults many of which have disabilities. For the reasons mentioned in this blog post, we will continue to work aggressively on the implementation of the ACA.

    • Well said Steven!! I have a daughter with DS and I am VERY disappointed with the ARCs public stance on this issue as well.

    • Hi Lucas,

      Thanks for your comment. The CLASS program has been put on hold but is still a part of the ACA which was signed into law. The Arc and other organizations continue to work with Congress and the Obama Administration to find a way to make the program viable.

  2. We are giving up the whole cake so we can taste the icing!
    Governments promises mean little. I don’t understand how people who have had to deal with the Medicaid and Medicare systems could possibly want the government to have More control.
    There are better, less intrusive solutions to our healthcare problems.I suggest you check out Heritage Foundations proposals for different solutions to the same problems. Solutions that protect our individual rights, our care providers rights and integrity and provide better care.

  3. Margaret…Couldn’t agree more…and there is absolutely nothing in the so called “Affordable Care Act” that made anything to do with health care more affordable for the people that are supposed to be benefiting from it…which would be all of us. I can promise you this you will not see your doctor visit cost go down, your cost of xray and lab work will not go down and the cost of drugs will not go down. But you can bet your insurance premium will go up. By the way, the ARC says this is the biggest expansion of private insurance…that would be the so called health exchanges which are controlled by the government but the insurance companies assume all the risk. Where do i sign up for a deal like that with my money???

  4. Bravo!! Lets get ACA moving. I am tired of waitng sometimes years for referrals. I am sick to death with 18 diagnosis everything is a pre-existing condition. I am repulsed at the fact they cancel our son and or impose outrageous premiums no one could afford. We have been uninsured for over 7 years due to the cost. I am tired of insurance companies advertising affordable rates and then they double even for our healthy teenager. It is high time we hold these insurance companies accountable!

    • What do you mean hold the insurance companies accountable? In 2008, a national study found that insurance companies only make pre-tax profits of 2% or less on their premiums (1). This is a lot less than other industries. For instance, Nestle and Microsoft both made profits close to 30% of revenue in 2011 (2). A business cannot continue to provide services if it is not profitable, and we cannot expect insurance companies to provide insurance if they cannot make money. By putting more restrictions on insurance companies, we are forcing them to either make profits in possibly more dubious ways or go out of business.

      Perhaps you would prefer that the government takes over health insurance and we move to a single-payer system, like Canada or Taiwan. Personally, I would rather have choices with my health insurance and not rely on the government. I would rather pay for health insurance from my own pocket rather than pay it through taxes. I think such a system would ultimately be more cost-effective than government insurance.

      I do however see many good parts of the ACA. For instance, the individual mandate is a smart idea. Hospitals are already required to stabilize any patient that needs help whether they have insurance or not, so we are already paying for the 16% of the population that doesn’t have health insurance, at least when they need care. Of course if insurance is required, then subsidies need to be offered to those who can’t afford it, so I also support the use of subsidies.

      Thanks for reading! Hopefully, this was useful to the debate.

      1)http://media.hoover.org/sites/default/files/documents/9780817910440_1.pdf

      2)http://money.cnn.com/magazines/fortune/global500/2011/performers/companies/profits/

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