“Before the ACA, I watched the lifetime coverage cap very closely. My daughter with pulmonary hypertension (PH) and heart disease had used almost half her cap before the passage of the ACA, and she was a toddler. I didn’t know what we’d do if she hit the cap, which she would have done in her childhood. Now, that is not a worry because of the ACA.”
“When I was let go from my job, I was ‘lucky’ enough to get COBRA insurance. However, I wasn’t aware that after a year, the price would increase 150%. We used the ACA to look for more affordable insurance coverage that still covered my PH doctors. We found it.
“The ACA removed caps and limits, which was important when struggling with pulmonary hypertension. Our children were allowed to stay on coverage until 26, which was a relief because some of their jobs did not offer coverage right away.”
The Patient Protection and Affordable Care Act (ACA) was signed into law 10 years ago. The law is complex and affects multiple areas of the U.S. health care system. That complexity creates challenges and benefits for people with PH. PH patients who purchase their coverage through the insurance marketplace created by the ACA might face high premium costs, inadequate formularies and other issues. On the other hand, people with complex chronic health conditions such as PH have benefited from patient protections in the law. Here are four ways:
- Preexisting condition protections. Before the passage of the ACA, health insurance companies could choose not to sell coverage to people with pre-existing health conditions, or they charged exorbitant rates. The current law requires insurance companies to sell coverage at the same price for people with and without pre-existing conditions.
- Annual and lifetime caps. A decade ago, many people with PH worried about limits on how much their health insurance plans would pay on their behalf each year or over their lifetimes. The ACA eliminated those caps.
- Extended coverage for young adults. The ACA allows young people to stay on their parents’ health insurance coverage until they turn 26. That can be especially important for young adults with complex health conditions, who might struggle to secure employment that provides health insurance.
- Essential benefits. Health plans sold through the insurance marketplace created by the ACA must cover a variety of care services, including emergency services and hospitalizations, prescriptions, preventative care, lab tests and mental health care.
As the 10th anniversary of the ACA approaches, the Pulmonary Hypertension Association (PHA) celebrates the lives that have been extended and improved thanks to pre-existing-condition protections, the elimination of lifetime caps and other PH-friendly health care policies. We also recognize the many access challenges PH patients continue to face, and we work to eliminate those barriers.
PHA advocates for prompt, affordable access to the specific therapies prescribed by a PH physician. To learn more and add your voice, visit www.PHAssociation.org/Advocate or contact Advocacy@PHAssociation.org.