Today, more than 95 percent of adults and 98 percent of children have health care coverage. Besides providing access to coverage, the ACA included other reforms to protect enrollees as well as funding for public health programs.
ACA consumer protections apply to Oregonians who buy individual plans, both through the Marketplace and directly from an insurance carrier. They include the following:
- Protections for Oregonians with pre-existing conditions: The ACA protects more than 1.6 million Oregonians who have pre-existing medical conditions from being denied coverage or charged higher premiums by insurers.
- Lifetime and annual limits: The ACA made it illegal for insurance companies to place dollar limits on how much they will pay for essential health benefits.
- Mandated contraceptive coverage: Subject to limited exceptions for religious employers, commercial insurers must cover birth control and reproductive health services, including office visits, without charging a co-payment or co-insurance.
- Free preventive care: The ACA requires insurance companies to provide dozens of these preventive services without charging a co-pay or co-insurance.
- The 80/20 rule: To help bring down premium costs, the ACA requires that at least 80 cents of every premium dollar collected be spent on patient benefits and care improvements.
- The ACA prohibits discrimination: Today, insurers cannot discriminate based on a person’s race, color, national origin, sex, gender identity, age, or disability.
- Coverage for patients participating in clinical trials is now required.
Effects of public health initiatives
The ACA funds core public health programs: In 2016, Oregon received $10.4 million in federal funds through the ACA for immunization, teen suicide prevention, and other core public health services. The ACA repeal puts these programs at risk.