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The Commonwealth Institute: After 10 Years, The Affordable Care Act Is Poised For an Even Bigger Role in Virginia

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From the Commonwealth Institute for Fiscal Analysis:

After 10 Years, The Affordable Care Act Is Poised For an Even Bigger Role in Virginia

Ten years ago today, the Patient Protection and Affordable Care Act — commonly known as the Affordable Care Act (ACA) — was signed into law, introducing landmark health coverage reform and expanding the availability of comprehensive and affordable health coverage across the nation. This law has had a considerable impact on the lives of hundreds of thousands of families in Virginia and should be protected during and beyond this uncertain time.

Ongoing concerns about the health and well-being of Virginia families due to the COVID-19 pandemic have highlighted the need for accessible, comprehensive health coverage. While further improvements are needed in order for everyone to have access to adequate health coverage, the ACA has played and will continue to play a critical role in making sure health coverage and services are available to families when they need it most.

By expanding Medicaid in 2018 under ACA guidelines, Virginia lawmakers have positioned the program to help respond to the economic repercussions of the pandemic for families or individuals who have low incomes and people who are experiencing changes to employment or income status.

Since the implementation of the major aspects of the ACA, Virginia’s overall uninsured rate has dropped from 12.3% in 2013 to 8.8% in 2018. The most recent data available doesn’t include the impact of Medicaid expansion, which is expected to lower Virginia’s uninsured rate even further. Prior to Virginia’s decision to expand Medicaid, only parents with very low incomes and individuals with disabilities were eligible for coverage. With expansion, non-elderly adults with an annual income up to 138% of the federal poverty level (roughly $17,600 for an individual in 2020) are now eligible for coverage as long as they meet other eligibility requirements.

As of March 15, 2020, more than 394,000 adults in Virginia have enrolled in Medicaid due to the new eligibility criteria. Additionally, about 269,000 individuals in Virginia enrolled in health coverage through the individual marketplace during the 2020 open enrollment period. This increase in comprehensive coverage is significant, and research has found that the effects of the ACA are even more pronounced for communities of color. Medicaid expansion has been proven to lower racial disparities in coverage, improve health outcomes, increase utilization, and reduce maternal mortality rates.

Despite the evident success of the ACA, the Trump administration has attempted to undermine the law by instituting several new regulations, including ones to increase the availability of suboptimal health coverage options, and making changes that have resulted in more expensive premiums on the individual marketplace. The administration has also encouraged work reporting requirements for state Medicaid programs, though that policy has been shown to result in significant coverage loss.

The largest threat to the Affordable Care Act is a lawsuit that is currently being litigated by 18 states, led by Texas, that challenges the legality of the individual mandate that was previously in place. The individual mandate penalty has been set to $0 since 2019, which lower courts have found to be unconstitutional because the penalty no longer “produces at least some revenue” for the federal government. Proponents of the lawsuit believe that if the individual mandate is found to be unconstitutional then the rest of the law should be invalidated as well. The case is currently waiting to be heard by the U.S. Supreme Court.

If the ACA is repealed, it would mean the end of Medicaid expansion, the ACA individual marketplace, and anti-discriminatory protections for people with pre-existing conditions. A full repeal of the Affordable Care Act would result in an additional 642,000 non-elderly individuals becoming uninsured in Virginia, almost doubling the non-elderly uninsured rate from 8.9% to 17.4% in the state, according to The Urban Institute.

On the 10th anniversary of this historic policy, we celebrate the fact that the ACA has increased and strengthened access to health care coverage for hundreds of thousands of Virginia families. If the law is repealed or weakened, it would put the safety net of Medicaid expansion in danger during a very uncertain time. After a decade of progress, the nation and Virginia should protect and continue to improve access to comprehensive and affordable coverage for all.

— Freddy Mejia, Policy Analyst

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Learn more about The Commonwealth Institute at www.thecommonwealthinstitute.org