The Patient Protection & Affordable Care Act (ACA) was passed by Congress and then signed into law by President Barack Obama in March 2010. This is considered the largest overhaul of the US healthcare system since Medicaid and Medicare were passed in 1965 (Samora & Hettrich, 2012). In general, the ACA was passed in order to expand accessibility to health care coverage, as well as improve the quality of care provided. More specifically, the legislation required that “marketplaces” be set up in all states so that the uninsured can shop for individual plans. While most “blue” states have set up their own marketplace, most “red” states did not, and allowed the federal government to do so instead (Sanger-Katz, 2015). We will discuss why this has caused problems later in the blog post.
The Affordable Care Act has had three major implications in terms of the expansion and improvement of mental health care:
1. It has expanded mental health and substance abuse benefits to 62 million Americans.
2. Health care plans are now required to cover preventive measures like depression screenings or behavioral assessments, as well as provide mental health parity. In other words, many health insurance plans are now required to provide equal access to mental health care as provided for other chronic conditions like diabetes.
3. Health care plans and insurers can no longer deny coverage based on preexisting conditions, including mental illness.
Current research suggests that the Affordable Care Act has been effective in terms of decreasing the number of uninsured Americans and providing more affordable options (Sanger-Katz, 2015). However, more progress is needed as 12.9% of American adults are currently uninsured (Levy, 2015).
Current Controversy surrounding the ACA
Currently, middle and low income Americans can quality for federal subsidies in order to receive affordable healthcare through the Obamacare marketplace. Specifically families with an annual income between 100% and 400% of the federal poverty line can qualify for federal subsidies (Health Insurance Marketplace, 2015).
King v. Burwell is a Supreme court case regarding whether federal subsidies can go to all insurance purchasers, or just those managed by the state government (Sanger-Katz, 2015). This discrepancy has com from the ACA legislation as it stipulates that the health care subsidies should flow through the marketplace “established by the state.” However, only 13 states are currently managing their own marketplace, while 3 states have federally supported, state marketplaces and the remaining 34 are completely managed by the federal government. Therefore, this ruling could have a major impact on who can afford health insurance. The Kaiser Family Foundation (2015) estimates that approximately 7.5 million people in 34 states qualify for subsidies and some estimates suggest that approximately 7 million Americans could lose their subsidies if the Supreme court rules against the government (Sanger-Katz, 2015).
If the Supreme Court rules against the government, it could create a major problem by setting the precedence for reading each legislative bill literally. Intentionality of a law is the current standard for interpretation; often, constitutional lawyers will refer to the founding father’s ‘intentions,’ instead of literal interpretation. Further, some laws and policies are hundreds or even thousands of pages long and some politicians may not even read a bill, especially in its entirety. Therefore, this case could open a floodgate of additional lawsuits for any bill that is currently enacted.
Health Insurance Marketplace. (2015). Income levels that qualify for lower health coveragehttps://www.healthcare.gov/lower-costs/qualifying-for-lower-costs/
Kaiser Family Foundation. (2015). Marketplace Enrollees Eligible for Financial Assistance as a Share of Subsidy-Eligible Population. Retrieved from http://kff.org/health-reform/state-indicator/marketplace-enrollees-eligible-for-financial-assistance-as-a-share-of-subsidy-eligible-population/
Levy, J. (2015). In U.S., Uninsured rate sinks to 12.9%. Gallup. Retrieved from http://www.gallup.com/poll/180425/uninsured-rate-sinks.aspx
Samora, J. B. & Hettrich, C. M. (2012). Where the Candidates Stand on Healthcare. Retrieved from http://www.aaos.org/news/aaosnow/oct12/advocacy2.asp
Sanger-Katz, M. (2015). Is the Affordable Care Act Working? New York Times. Retrieved from http://www.nytimes.com/interactive/2014/10/27/us/is-the-affordable-care-act-working.html?_r=0#/
Sanger-Katz, M. (2015). Obamacare, Back at the Supreme Court: Frequently Asked Questions. New York Times. Retrieved at http://www.nytimes.com/interactive/2015/02/03/upshot/obamacare-back-at-the-supreme-court-frequently-asked-questions.html?abt=0002&abg=0