Summary

After several failed attempts to repeal or defund the Affordable Care Act, conservative candidates are persisting in making the destruction of the landmark health care reform law a campaign issue, with many promising to do away with the law come 2013. But the benefits in the law are already kicking in, and repealing the law would affect millions of Americans who are already seeing lower health care costs, better services, and protection against industry abuses.

Repeal Would Kick Millions Off Their Insurance

Up To 30 Million Could Lose Coverage Gained As A Result Of The Affordable Care Act. From the Congressional Budget Office: “CBO and JCT now estimate that the ACA, in comparison with prior law before the enactment of the ACA, will reduce the number of nonelderly people without health insurance coverage by 14 million in 2014 and by 29 million or 30 million in the latter part of the coming decade, leaving 30 million nonelderly residents uninsured by the end of the period.” [CBO.gov, July 2012]

Up To 6.6 Million Young Adults Would Lose Health Care Coverage Through Their Parents’ Plans. From the Los Angeles Times: “President Obama’s healthcare law helped as many as 6.6 million young adults stay on or get on their parents’ health plans in the first year and a half after the law was signed, a new survey indicates. […] Earlier surveys by the federal government found that the number of people ages 19 to 25 without insurance declined after the law was signed, reversing years of erosion in health coverage for young adults.” [Los Angeles Times, 6/8/12]

70,000 Americans With Pre-Existing Conditions Would Lose Insurance Coverage. According to the Department of Health and Human Services, as of May 31, 2012, 73,333 people were enrolled in the Pre-Existing Condition Insurance Plan (PCIP) created by the Affordable Care Act. [HealthCare.gov, 7/13/12]

About 20,000 People Per Year Would Again Face Losing Coverage Because They Reached Their Lifetime Coverage Limits. From Time: “Insurers are no longer allowed to set a lifetime limit on benefits. This is particularly helpful to people with very expensive or long-term health problems. The government estimates that about 20,000 people in the U.S. hit their lifetime limits every year.” [Time, 9/23/10]

Those With Costly Health Conditions Would Again Be More Likely To Lose Coverage When They Reach Their Annual Limits. From Time: “The law also begins phasing out annual limits on coverage. Except for individual plans purchased before March 23, 2010, which may have ‘grandfathered status,’ all plans issued or renewed between Sept. 23, 2010, and Sept. 23, 2011, will not be able to set annual limits lower than $750,000. (The limit is raised each year until it is eliminated in 2014.)” [Time, 9/23/10]

• The Minimum Annual Limit For Plans Starting Between September 23, 2011, And September 23, 2012, Is $1.25 Million. From Families USA: “For plan years beginning on or after September 23, 2011, but before September 23, 2012, the annual limit amount rises to $1.25 million.” [Families USA, September 2010]

Repeal Would Mean Higher Costs For Medicine And Services

5.2 Million People Would Have To Pay More For Prescription Drugs. From the Centers for Medicare and Medicaid: “As a result of the Affordable Care Act, over 5.2 million seniors and people with disabilities have saved over $3.9 billion on prescription drugs since the law was enacted.  The Centers for Medicare & Medicaid Services (CMS) also released data today showing that in the first half of 2012, over 1 million people with Medicare saved a total of $687 million on prescription drugs in ‘donut hole’ coverage gap for an average of $629 in savings this year. […] Coverage for both brand name and generic drugs in the gap will continue to increase over time until 2020, when the coverage gap will be closed.” [CMS.gov, 7/25/12]

Over 35 Million Seniors Would Lose Access To Free Preventive Services. The Centers for Medicare and Medicaid Services [CMS] report that 35,106,598 people were enrolled in Medicare Part B in 2011. CMS also reports:

Beginning January 1, 2011, the Affordable Care Act eliminated Part B coinsurance and deductibles for recommended preventive services, including many cancer screenings and key immunizations. The law also added an important new service — an Annual Wellness Visit with a health professional — at no cost to beneficiaries.

According to preliminary numbers, at least 25,720,996 million Americans took advantage of at least one free preventive benefit in Medicare in 2011, including the new Annual Wellness Visit.  This represents 73.3% of Medicare fee-for-service beneficiaries, including 2,404,792 African-American beneficiaries, 537,110 Hispanic beneficiaries, 104,393 American Indian beneficiaries, and 508,398 Asian-American beneficiaries. [CMS.gov, 2/15/12]

An Estimated 54 Million Americans With Private Insurance Would See Costs Increase For Preventive Care Like Colonoscopies And Mammograms. From the Department of Health and Human Services:

The Affordable Care Act requires many insurance plans (so-called ‘non-grandfathered’ plans) to provide coverage for and eliminate cost-sharing on certain recommended preventive health services, for policies renewing on or after September 23, 2010.  Based primarily on guidelines from the U.S. Preventive Services Task Force, this includes services such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, flu shots for all children and adults, and many more.

While some plans already covered these services, millions of Americans were previously in health plans that did not. According to the Kaiser Family Foundation’s Employer Health Benefits Survey in 2011, 31% of all workers were covered by plans that expanded their list of covered preventive services due to the Affordable Care Act.  The most recent data from the Census Bureau show that 173 million Americans ages 0 to 64 currently have private coverage.  Putting these facts together, we estimate that approximately 54 million Americans received expanded coverage of at least some preventive services due to the Affordable Care Act in 2011. [HHS.gov, February 2012, citations removed]

Over Four Million Small Businesses Would Lose Eligibility For Tax Credits. According a report from Small Business Majority and Families USA: “Starting this year, businesses with fewer than 25 workers and average wages of less than $50,000 will be eligible to receive a tax credit for the health insurance that they provide for their employees. The value of the credit this year (and until 2014) is up to 35 percent of the employer’s costs for employee coverage (and up to 25 percent of the costs for nonprofit employers). The smallest firms with the lowest wages—those that employ 10 or fewer workers who earn an average wage of less than $25,000—are eligible for the full 35 percent tax credit (or 25 percent for nonprofits). From there, the size of the credit will phase out on a sliding scale. […] More than 4 million (4,015,300) small businesses will be eligible to receive a tax credit for the purchase of employee health insurance in 2010. That’s 83.7 percent of all small businesses in the country.” [Small Business Majority, July 2010, emphasis original]

• Two Million Workers Could Find Health Care They Obtained Last Year Through Their Small Business Employer Threatened. From Congressional Quarterly HealthBeat: “In 2011, about 360,000 of the estimated 6 million small business employers in the United States are expected to benefit from the existing tax credit. That means about 2 million workers will be helped to get insurance, Karen Mills, head of the Small Business Administration, and Small Business Majority CEO John Arensmeyer noted on a phone call with reporters.” [Congressional Quarterly HealthBeat via Nexis, 2/16/12]

Medical Students Who Have Pledged To Work In Underserved Areas Would Lose Loan Repayments. From the American Medical Association: “Seventy-seven fourth-year medical students will receive $9.1 million in loan repayments for participating in a new National Health Service Corps program aimed at encouraging more young people to go into primary care. […] The Health Resources and Services Administration estimates that 17,722 primary care professionals are needed in medically underserved areas to meet a target of having one primary care professional for every 2,000 U.S. residents. Students in the pilot program, funded through the Patient Protection and Affordable Care Act, will receive up to $30,000 annually for four years. In exchange, they must agree to practice at least 40 hours a week for three years or at least 20 hours a week for six years in medically underserved rural and urban communities. [American Medical Association, 2/28/12]

Repeal Would Reopen The Door To Industry Abuses

Consumers Would Lose Rights Regarding Appealing Insurance Companies’ Denial Of Claims. From the Department of Health and Human Services: “The Affordable Care Act ensures your right to appeal health insurance plan decisions–to ask that your plan reconsider its decision to deny payment for a service or treatment. New rules that apply to health plans created after March 23, 2010 spell out how your plan must handle your appeal (usually called an ‘internal appeal’). If your plan still denies payment after considering your appeal, the law permits you to have an independent review organization decide whether to uphold or overturn the plan’s decision. This final check is often referred to as an ‘external review.’” [HealthCare.gov, 7/27/10]

Millions Of Children With Pre-Existing Conditions Would Lose Protection Against Insurance Company Discrimination. From CNN: “House Republicans began debate Tuesday on repealing the [health care reform] measure, which requires insurers to cover children with pre-existing conditions and gives people with health conditions access to a temporary program providing insurance coverage. […] And the [Health and Human Services] agency said between 4 million and 17 million children have a pre-existing condition, and that 2 million of those are uninsured.” [CNN, 1/18/11]

More Than 10,000 People Per Year Could Be Kicked Off Their Insurance Plans For Inadvertent Application Errors. From Time: “Insurance companies are no longer allowed to retroactively cancel policies just because people made inadvertent errors on their enrollment forms. Such action by insurers, while rare, is often egregious and a way for insurers to avoid paying for care when their customers become very ill. The new rule states that insurers can only rescind policies if enrollees are found to have committed fraud. The ban on unfair rescissions is, like coverage of pre-existing conditions in children, wildly popular but will affect only a small number of people. The government estimates that there are about 10,700 rescissions every year.” [Time, 9/23/10]

Americans Would Again Be Subject To Unreasonable Insurance Rate Hikes With No Transparency. From the New York Times: “The law, signed by President Obama in March 2010, set detailed federal standards for health insurance, which had for decades been regulated mainly by the states. The law calls for the annual review of ‘unreasonable increases in premiums.’ Under rules issued last year by Ms. Sebelius, rate increases of 10 percent or more must be reviewed by state or federal officials.” [New York Times, 1/12/12]

States Would Lose Funding For Oversight Of Unreasonable Rate Hikes. From the Centers for Medicare and Medicaid’s Center for Consumer Information and Insurance Oversight: “The Affordable Care Act makes $250 million available to States to take action against insurers seeking unreasonable rate hikes. To date, 43 States and the District of Columbia are using $44 million in grants provided by HHS to help them improve their oversight of proposed health insurance rate increases.” [CMS.gov, accessed 3/1/12]

• Thousands Of Americans Have Already Avoided Rate Hikes Thanks To State Oversight. From the Centers for Medicare and Medicaid’s Center for Consumer Information and Insurance Oversight:

State rate review activities are paying off for consumers:

• Rhode Island’s Insurance Commissioner used his rate review authority to reduce a proposed increase by a major insurer in that State from 7.9 percent to 1.9 percent.
• Californians were saved from rate increases totaling as high as 87 percent after a California insurer withdrew its proposed increase after scrutiny by the State Insurance Commissioner.
• Nearly 30,000 North Dakotans saw a proposed increase of 23.7 percent cut to 14 percent following a public outcry.
• Connecticut’s Insurance Department rejected a proposed 20 percent rate hike by one of the State’s major insurers. [CMS.gov, accessed 3/1/12]

Consumers Would Lose Access To Transparent Information About How Their Insurance Companies Are Spending Their Premiums And Wouldn’t Get Rebates From Overspenders. From the Department of Health and Human Services: “Health and Human Services Secretary Kathleen Sebelius announced today that consumers will soon begin receiving unprecedented information on the value of their health insurance coverage, and some will receive rebates from insurance companies that spend less than 80 percent of their premium dollars on health care.The Affordable Care Act requires that insurance companies this year begin notifying customers how much of their premiums they have spent on medical care and quality improvement.  Beginning in 2011, insurers were required to spend at least 80 percent of total premium dollars they collect on medical care and quality improvement.  Insurance companies that do not meet the 80/20 standard  (also known as the Medical Loss Ratio) are required to pay rebates to their customers this year.”[HHS.gov, 2/16/12]