What the Affordable Care Act (ACA) means for women, girls and families:
- Under the ACA, insurance companies are barred from dropping (i.e., rescinding) people's coverage if they become sick.
- Under the ACA, insurance companies cannot impose lifetime limits on health coverage. In other words, insurers cannot set a dollar limit on the amount of coverage a person receives during their lifetime.
- Under the ACA, as of 2014, insurance companies cannot limit the amount they pay toward a person's benefits during one year.
- Under the ACA, women enrolled in new insurance plans are no longer required to get a referral before seeing an obstetrician/gynecologist of their choice.
- Under the ACA, in 2014, insurers will be barred from charging women higher rates than men for coverage.
What the ACA means for persons living with HIV:
- Under the ACA, insurance companies can no longer deny coverage to children because of their HIV/AIDS status or any other preexisting condition.
- In 2014, the ACA will ensure that Medicaid is available to all low-income Americans, including adults without children, living below 133% of the Federal Poverty Line (about $14,500 per person and $29,700 for a family of four). So, low-income adults living with HIV will not have to wait for a diagnosis to be eligible for coverage.
- In 2014, insurance companies will no longer be able to deny coverage or raise charges for persons with preexisting conditions, including HIV/AIDS.
- Under the ACA, AIDS Drug Assistance Program (ADAP) benefits are considered contributions toward a Medicare beneficiary's out of pocket spending limit -- this allows beneficiaries to move through the "donut hole" more quickly.1
- The ACA will make a Preexisting Condition Insurance Plan available in every state.
What the ACA means for the general population:
- Under the ACA, insurers can no longer impose a lifetime dollar limit on essential health benefits.
- Under the ACA, persons without access to employer-sponsored insurance or Medicaid will have the option of buying private coverage from Affordable Insurance Exchanges, which are intended to make insurance easier and affordable.
- Under the ACA, insurers must give user-friendly information that clearly explains to consumers what services are covered and which are not.
- Under the ACA, Medicare and many private insurers must cover recommended preventive services, including HIV screening, mammograms and other cancer screenings, with no cost sharing for patients.
- The ACA expands programs to strengthen cultural competency training for all health providers.
What measures need to be taken in preparation for its passage:
- Stay abreast of the ACA's key provisions.
- Educate TWC clients about their rights under the ACA.
- Support advocacy organizations spearheading efforts to preserve the ACA. This may include signing-on or drafting statements of support for agencies that have filed amicus briefs before the Supreme Court.
Allies in the movement to preserve the ACA and organizations leading the effort:
- Center for HIV Law and Policy
- National Minority Aids Council
- Black AIDS Institute
- National Association of People Living with AIDS
- U.S. Positive Women's Network/WORLD
Why the Affordable Care Act is facing legal challenges:
The Supreme Court is considering three main challenges to the ACA:
- The constitutionality of the individual mandate, which requires most Americans to purchase health insurance by 2014.
- Whether the individual mandate is severable. In other words, whether the entire Act must be stricken if the individual mandate is unconstitutional, or can the individual mandate just be taken out of the Act.
- Whether the ACA's expansion of the Medicaid program is constitutional.
What is the Blunt Amendment?
The Blunt Amendment is a piece of legislation being advanced by Senator Roy Blunt (R-MO). If successful, the legislation will amend the Affordable Care Act (ACA) to permit employers and insurers to deny coverage in their health insurance plans for services that contradict the employer's or insurer's conscience or morals (such as birth control).
What prompted the Blunt Amendment?
The Blunt Amendment comes in direct opposition to the ACA. Advocates of the Blunt Amendment claim that the amendment is needed to protect the moral convictions of employers and insurers.
What the Blunt Amendment may mean for people with HIV
There is concern that the Blunt Amendment may eventually be expanded to allow employers to deny HIV/AIDS treatment, by claiming that such treatment contradicts the employer's morals.
About the "Donut Hole": Medicare is the health insurance program for people 65 or older, people under 65 with certain disabilities, and people with permanent kidney failure. Persons with Medicare have the option of paying a monthly premium for outpatient prescription drug coverage. This prescription drug coverage is called Medicare Part D. This is how Medicare Part D coverage works:
- You pay out-of-pocket for monthly Part D premiums all year.
- You pay 100% of your drug costs until you reach the $310 deductible amount.
- After reaching the deductible, you pay 25% of the cost of your drugs, while the Part D plan pays the rest, until the total you and your plan spend on your drugs reaches $2,800.
- Once you reach this limit, you have hit the coverage gap referred to as the "donut hole," and you are now responsible for the full cost of your drugs until the total you have spent for your drugs reaches the yearly out-of-pocket spending limit of $4,550.
After this yearly spending limit, you are only responsible for a small amount of the cost, usually 5% of the cost of your drugs. Therefore, because Medicare benefits will be counted toward your yearly spending, you can move through the donut hole (between $2,800-$4,550) more quickly.
Birth Control Amendment "Dangerous," Obama Spokesman Says, Huffington Post, Feb. 14, 2012.
Fact Sheet: The Affordable Care Act's New Patient's Bill of Rights, HealthReform.gov (last visited February 23, 2012).
How Does the Affordable Care Act Help People Living With HIV/AIDS?, AIDS.gov (last visited February 23, 2012).
How the Affordable Care Act Helps Women, National Women's Law Center (last visited February 23, 2012).
Legal Challenges to the Affordable Care Act, Healthcare Financial Management Association (last visited February 23, 2012).
Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010).
Proposed Blunt Amendment (S. 1813, 2012).
The Affordable Care Act and People Living With HIV/AIDS, Miguel Gomez, Blog.AIDS.gov (last visited February 23, 2012).
Women and the Affordable Care Act, Healthcare.gov (last visited February 23, 2012).