The Big Picture

Expanding Coverage by Reforming the System

Before 2010, about 50 million Americans did not have any sort of health insurance. The Affordable Care Act of 2010 (ACA) is a law that has expanded the health care system that was already in place in the United States in order to make coverage available to more Americans. A big misunderstanding that people have is that the ACA created a government-run health care system. This is not correct. The ACA built off of public and private insurance systems that were already there, to get coverage to more people. For the most part, the ACA has not drastically changed our nation’s health care system. You can think of this law as a patchwork solution that created many new patches to cover the gaps, rather than creating a brand new approach.

This overview article highlights some of the main ACA reforms that impact you directly. We will not cover all of the reforms of the ACA in detail here. If you are interested in learning more about the ACA, you can start at Health Reform Minnesota.

New Coverage Options

In the past, one of the main ways you could get health insurance was through a job that offered it. If you lost your job, you might lose your insurance. Now, your ability to get health coverage is no longer tied to your job, because there are other health care options. However, most people will continue to be covered through their jobs, as before.

Today, insurance options fall into three main groups:

  1. Public coverage: These are health coverage plans provided by the government. Usually, you qualify for public plans based on some sort of criteria (for example, low income, pregnancy, age, or disability). Medicare and Medical Assistance are the largest public health programs. Public coverage expanded under the ACA.
  2. Private coverage: This is insurance sold through a private company. Private insurance can be offered through an employer, or you can buy it directly from the insurance company. Under the ACA, there are consumer protections that give people more access to private coverage and limit the costs of private plans. There are also marketplaces in each state for buying private coverage, known as health insurance marketplaces. In Minnesota, this marketplace is called MNsure. These health insurance marketplaces offer a place for individuals and small businesses to buy coverage which meets set standards of quality.
  3. Private coverage subsidized by the government: In the past, many people could not afford to buy private coverage. Now, under the ACA, if your income is low, you can qualify for a government subsidy, which means that the government will help you pay for a private insurance plan.

Rights and Protections for Consumers

Another major part of the ACA is that it created many new rights and protections for consumers who use health insurance. For example, it is illegal for insurance companies to deny people coverage because they have a pre-existing condition. There is more information about patient rights later in this article.

Insurance Mandate for Employers

There is an employer mandate which requires employers with 50 or more employees to offer affordable insurance to their employees, or pay a penalty.

Note: It is very important to have health coverage, but starting in 2019 there is no tax penalty for individuals who don't have coverage.

Reducing Inequalities in Health Care

In the United States, the experience of health care has not been equal for everyone. Some people have gotten worse quality health care, have had a harder time getting health care, or have had more health issues because of their disability, race, ethnicity, sexual orientation, or income.

The ACA took several steps to try to fix these inequalities:

  • More affordable coverage options through Medical Assistance, MinnesotaCare, and MNsure help more people in all income levels get insurance.
  • Both public and private insurance plans have to provide preventive services for free. This means that people in groups that have had higher levels of illnesses like cancer, diabetes, and HIV/AIDS are able to get free screenings for these diseases.
  • The ACA makes it illegal for insurance companies to discriminate based on gender, sexual orientation, or pre-existing conditions. So if you have a pre-existing condition such as HIV, you are guaranteed to be able to get coverage.