More people have health insurance as the sign ups start

Tradeoffs at the Reionization of the Affordable Care Act: Highlights from the House Speaker Mike Johnson in Washington, D.C.

Tradeoffs works to promote health policy news. Dan Gorenstein is the executive editor. The story was written by Ryan Levi. Tradeoffs’ Deborah Franklin adapted this story for web. You can listen to the full interview here:

TheACA was a sea change. Regardless of your health, insurance companies have a responsibility to provide coverage. If you are sick, they cannot charge you a higher premium. And there are a set of essential benefits that all insurance companies have to provide.

And if we look back at President Trump’s presidency, his budgets proposed converting both the Affordable Care Act and Medicaid into a block grant to states, meaning removing federal rules and giving states a lump sum of money and giving states flexibility in how to use that money. We have seen similar plans from conservative Republicans in the House that would take Medicaid out of the picture, remove federal protections in the insurance market, and cut federal spending by $4.5 trillion over a decade.

More than 20 million people buy their health insurance from theAffordable Care Act, and the open enrollment period begins this week for next year’s plans.

House Speaker Mike Johnson said at a campaign stop in Pennsylvania last week that there needs to be massive reform of the health law. But he did promise a “very aggressive first-100-days agenda” if Trump wins. Johnson said that health care reform will be a big part of the agenda.

As part of a major speech on Tuesday in Washington, D.C., Harris warned Americans of what could happen if the ACA were to be repealed. “You will pay even more if Donald Trump finally gets his way and repeals the Affordable Care Act — which would throw millions of Americans off their health insurance,” Harris said, “and take us back to when insurance companies had the power to deny people with preexisting conditions.”

The upcoming elections could have an impact on the law, according to Larry Levitt, an executive vice president of KFF. Levitt has studied the law for a long time.

He recently shared insight into the track record of the American Health Care Act and spoke about what Republicans might do on the health policy radio show Tradeoffs. Here are highlights from that conversation.

The impact has been tremendous. If you had a pre-existing condition like a cancer, multiplesclerosis, and being overweight, you wouldn’t be allowed to buy insurance on your own. If you have a health condition that prevents you from being offered health insurance, you can either pay a higher premium or be excluded from coverage.

They had to cover mental health. They have to cover maternity. Substance abuse treatment cost them a lot. It costs money. Premiums went up. People pay a lower amount of the premium out of their own pockets. The federal government helps people pay for their health care with subsidies.

The quality of coverage has, I think, largely gone up. The benefits — the stuff that insurance companies have to provide — are now more comprehensive. It covers preexisting conditions. It covers all of these required benefits.

“Some marketplace plans have very narrow networks — that means that there are very few doctors or hospitals that the insurance company will pay for you to see, so it could be harder to get an appointment,” Cox explains. This is one way to make sure that people with health coverage also have access to health care.

Although health policy has not been a big focus of the presidential race, this whole picture could change depending on the outcome of the November election.

Most states will remain open until Jan. 15. To get coverage that is ready to go on Jan. 1, 2025, though, people need to sign up by Dec. 15. Idaho has an open enroll period from October 15 to December 15.

The makeup of the next Congress could also play a big role in the future of these marketplaces. Unless congress acts to extend or make permanent the federal subsidies that have made premiums so cheap, they will be gone at the end of next year.

Even though 17 states sell their own health insurance marketplaces, everyone can find out how to pick a plan at HealthCare.gov.

This year, premiums are still very affordable — for many people, premiums are $10 or less per month — and there are more plan options than ever. “I think this is really reflecting a turnaround in the ACA marketplaces,” says Cynthia Cox, who directs the Program on the Affordable Care Act for KFF, a nonpartisan health research organization.

“Under President Biden and Vice President Harris, more Americans have access to a doctor, a hospital through their own health insurance than ever in the history of the country,” Secretary of Health and Human Services Xavier Becerra tells NPR. After this year’s open enrollment, he adds, “I have no doubt that we’ll see another record set of Americans who have health care coverage.”

One group that’s newly eligible for these subsidized marketplace plans is Deferred Action for Childhood Arrivals recipients, also known as Dreamers. Secretary Becerra said that 100,000 people are expected to enroll in the program.

“It’s a good day for all these folks because for the longest time they’ve been working [and] paid taxes and not had a chance to get their coverage through the Affordable Care Act — that changes,” he says.

Camila Bortolleto is one of the Dreamers who’s been waiting for this. She came to the U.S. with her family from Brazil when she was nine. She is uninsured since she lost her job with health benefits over the summer. That has resulted in paying out of pocket for urgent care after a dog bit her.

“It is stressful,” she says. I need to have a checkup. I have to go to the dentist. And you never know when a random emergency’s going to strike.” She was going to sign up on Friday.