By Laurie McGinley and Amy Goldstein
January 25 2017
The Washington Post
Not everyone realizes that Obamacare and the Affordable Care Act are the same thing. The 2010 law created insurance exchanges — that is, marketplaces — for people to buy private health insurance if they couldn’t get affordable coverage through work. Critics initially used the term “Obamacare” in a disparaging way. But in 2011, President Barack Obama embraced the nickname, saying “I have no problem with people saying Obama cares. I do care.”
For the health plans sold through these marketplaces, the law provides people the first subsidies the government has ever given to help them pay for private insurance. Presumably, both the marketplaces and the subsidies would be dismantled under any legislation to repeal the ACA.
Besides setting up the exchanges, the law has other parts that affect insurance requirements and try to foster innovation in the way health care is delivered. It requires health plans sold to individuals and small businesses to include a set of “essential health benefits.” One popular provision allows young adults to stay on their parents’ plan until age 26. Trump has said he likes that idea, but it isn’t clear how he would implement it because neither his administration nor Congress’s Republican majority has produced its own health-care plan.
What are Essential Health Benefits under the ACA?
The ACA requires health plans sold to individuals and small business, on or off the exchanges, to offer 10 categories of services, including hospitalization, emergency services, mental-health services and prescription drugs. Supporters say this package ensures that consumers get meaningful coverage from health plans sold in the parts of the insurance market that were most troubled in the past. Critics say the government should not dictate insurance benefits and that coverage would be more flexible and less expensive without the requirement.
What Do People Mean when They Say Universal Access or Universal Coverage?
This may sound like a small semantic difference, but the distinction is a big one. The ACA has a goal of covering everyone with health insurance. And while it hasn’t achieved that goal, the years since the law passed have coincided with a major drop in the ranks of the uninsured. Under the law, about 20 million people have gained coverage, according to the best estimates, leaving about 9 percent, or 27 million people, still uncovered.
In contrast, many Republicans say they have a goal of “universal access.” That would mean that everyone would be offered a chance to buy some form of insurance, but not necessarily that everyone will get it.