Interview: The Affordable Care Act Eight Years Later

Mar 23, 2018

The Affordable Care Act, also called Obamacare, turned eight years old this month — despite a push from many Republicans in Congress to repeal it.  The legislation allows close to six million people in Illinois with pre-existing conditions to obtain health insurance. It also allows those experiencing homelessness to qualify even if they don't have dependents.

Daniel Rabbitt is a health policy expert at Heartland Alliance — an anti-poverty organization in Chicago. He explains the impacts of the ACA and the turmoil it has faced. 

Daniel Rabbitt: There is some controversy around the Act, but you know, I think the eighth year anniversary is something to be celebrated. The law has proven to be remarkably resilient within the last year and a half considering the opposition that it's faced under the Trump administration and the Republicans in Congress. In terms of how it's changed, recently, most of it has come from choices that the Trump administration has made, such as shortening the period that people have to enroll in private insurance – the open enrollment period that happens every year;  cutting the funding for outreach and enrollment assistance navigator programs; and ending what are known as cost sharing reductions, which were payments that the federal government made to private insurance to compensate them for offering lower deductible plans. These among some other changes written resulted in higher costs overall for private insurance in the last year or two. But because of the structure of the ACA, most consumers were protected.

Daisy Contreras: It's been a year since this was signed, how has it helped Illinois residents for those who do use it?

DR: It’s important to remember how the health insurance market worked before the Affordable Care Act, at that time, people with pre-existing conditions. Sometimes conditions are simple and common as high blood pressure or asthma, or diabetes all the way up to cancer or heart disease. People would have to go into a medical bankruptcy to get the care that they needed, and oftentimes, people go without care because they couldn't afford insurance, only to have their conditions worsen and then end up in the emergency room or in the hospital receiving crisis care, and that costs more than what it costs to help them afford coverage and get preventative care on the front end.

So the situation for people who did not get insurance through their job was untenable before the Affordable Care Act. The ACA also expanded access to Medicaid coverage, so that now adults who make under 138% of the federal poverty level, about $15,000 - $16,000 a year, are eligible for Medicaid coverage regardless of whether they have a disability or whether they are responsible for a dependent child. And so for the folks that Heartland Alliance serves who are experiencing homelessness, many of whom were ineligible for insurance before the ACA, it has been a dramatic change – where before the ACA, right around 90% of all homeless adults did not have health insurance. Now 90% DO have health insurance through Medicaid and the Medicaid expansion.

DC: What are some of the concerns when you talk to some of those folks that go to the organization for services, are they aware this is happening, that there's a lot of push to repeal the ACA? What have you heard?

DR: There has been a lot of confusion. It's been a tumultuous eight years and even a more tumultuous year and a half or so for the ACA, no doubt about it. And I would say for the most part, when folks bring this up, they're worried that their health insurance will go away, that they will be left without these protections, that they will not be able to afford health insurance due to an ACA repeal or other policy choices that undermine the way that the system works.