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National Policy Matters The Affordable Care Act: What Disability Advocates Need to Know The Aordable Care Act What Disability Advocates Need to Know Introduction 3 5 How does the ACA expand reform private health insurance? 6 How does the ACA expand coverage? 8 How does the ACA expand essential benefits? 11 How does the ACA impact Medicaid? 13 How does the ACA expand long-term services and support? 15 How does the ACA emphasize prevention? Are there other provisions important to 16 people with intellectual and/or developmental disabilities? Introduction Now that the U.S. Supreme Court has af- How many people with I/DD are uninsured or firmed the constitutionality of the Affordable underinsured? Care Act (ACA), the disability community must work to better understand the law and While exact numbers are not available for 1 the many benefits it can provide to people persons with I/DD specifically, a recent study with disabilities. This will be critical to the found that of adults age 18-64 with cognitive community’s role in helping to move states difficulty, 13.6 % had no insurance, 32.1% pri- forward with implementation. vate insurance, 41.0% Medicaid, and 27.0% Medicare. (Table below) Numerous ACA provisions related to both acute care Health Insurance Status of Persons and long term services and with Cognitive Difficulty* supports hold great prom- ise for improving the health and wellbeing of people Medicare with disabilities. This issue of National Policy Matters Medicaid provides information about the major provisions and the status of their imple- Private mentation. Insurance Why does The Arc support No Health implementation of the Insurance Affordable Care Act? The Arc has long support- 0% 10% 20% 30% 40% 50% ed expanding Medicaid to cover more low income individuals and * People with intellectual disability would be expanding private health insurance options a subset of people with cognitive difficulty to achieve universal coverage. The law which also includes people with Alzheimer’s, contains significant nondiscrimination provi- dementia, and other conditions. sions and improvements to the Medicaid long term services and support system that Many people with I/DD are not in the labor are critical to meeting the needs of people force and lack access to employer spon- with I/DD. For too long, insurance companies sored insurance. Even when people have have been able to charge people higher employer sponsored health insurance, they rates because of their health conditions, may not have access to the services and deny insurance coverage of people with I/ supports they need because many private DD, and limit coverage of needed health insurance plans do not cover many disability care treatments, services and supports. related therapies and services. 3 How does this impact the health of people How will the ACA reduce costs for individuals? with I/DD? Expanding Medicaid and private health in- People who have access to comprehen- surance options: Individuals who are current- sive and affordable health insurance are ly uninsured and become insured will spend more likely to receive the prescription drugs, less of their income paying for needed health therapies, and medical treatment they need care services. The health insurance reforms to be healthy and maintain the ability to mean that insurance will cover more of the function in the community. People with I/ services that people with pre-existing condi- DD often have multiple health conditions tions need, thereby reducing costs to the in- and are at risk of developing secondary dis- dividual. The inclusion of essential benefits in abilities without quality health care. Studies health insurance plans means that a core set have documented a higher prevalence of of health care services that people with I/DD adverse conditions, inadequate attention need will be covered by many health plans. to health care needs, inadequate focus on Subsidies and cost sharing for low and middle health promotion, and inadequate access to income people with make health insurance quality health care services. coverage more affordable for people pur- chasing insurance in the exchanges. (These How will the ACA reduce costs for states? issues are described in more detail later in this update). The ACA will help ensure that individuals have access to health care to prevent costly Expanding the risk pool: Since the law re- hospitalizations and institutionalizations that quires most individuals to purchase insurance occur when individuals forego treatment. or face penalties, it is expected that more For example, expanding home and commu- people will purchase health insurance. This nity based long term services and supports will allow for the law’s private insurance (LTSS) will reduce the need for nursing home reforms to work without sky-high premiums. and other institutional settings. In the long For example, requiring insurance companies run, these investments in health care and to insure people with pre-existing conditions home and community based services (HCBS) can only be affordable if healthy people also will improve health and reduce dependence share the risk before they need medical care on costly institutions. Investments in improv- due to illness or injury. ing public health and coverage of preven- tion services will also save money by reduc- Covering preventive services: Eliminating ing the cost of treating health conditions that cost-sharing for preventive services saves could have been prevented. money for individuals and families immedi- ately and reduces medical costs over the long term. 1Altman, B. and Bernstein, A. Disability and Health in the United States, 2001-2005. Hyattsville, MD National Cen- ter for Health Statistics 2008 4
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