The Affordable Care Act (ACA), or Obamacare, was signed into law in 2010. The law represented a major overhaul of the U.S. healthcare system and included multiple provisions that affect families with young children:
- To make it easier for people to afford health insurance, the federal government in partnership with private insurers set up exchanges where people can shop for approved plans. Depending on your family income, many people will qualify for federal subsidies to help underwrite the cost of insurance.
- Insurance companies must insure all people with pre-existing conditions.
- Children can stay on their parent’s insurance policies until age 26.
Since it was signed, the law has been introduced in stages, with major portions of the law (e.g., private insurance exchanges) debuting in October 2013. Because the law is highly complex, and because it represents a major undertaking involving multiple federal agencies and large private insurance companies, there is significant confusion over how the ACA will affect families with young children.
The American Academy of Pediatricians (AAP) has singled out a few specific provisions as especially important for children:
- Insurance companies are now required to cover routine well-care visits.
- Children under the age of 26 can remain on their parent’s insurance. This ensures that a larger number of people can remain insured without the cost of an individual insurance plan.
- Our sickest kids, those with pre-existing health problems such as congenital heart disease, cancer or diabetes, cannot be denied insurance due to their disease, nor can their policy be discontinued. This was previously a pressing issue for families with sick children.
- The ACA no longer allows insurance companies to place a limit on the total dollars spent on your ill child. In the past, insurance policies contained a maximum dollar amount (maximum lifetime benefit) that could be spent on the behalf of the policyholder. This was often a very large number, but if you are the parent of a very ill child, that number could be reached.
As of January 1, 2019 the individual mandate (the government’s requirement that all individuals have health insurance) is no longer in place. A person may now choose to go without insurance without a tax penalty. If you and your family presently have health insurance through your job or through an independent policy, you may keep it. If your child qualifies for Medicaid or a state run health insurance policy such as CHIP, they may keep it unless you no longer qualify financially. If you and your family do NOT have health insurance, you can shop for it through your state’s marketplace.
It is important to remember that the insurance exchanges mandated in the Affordable Care Act offer insurance plans from private companies and are not government-run. Insurance exchanges themselves are run by either the state or federal government although private insurance exchanges are beginning to emerge. If you qualify for Medicaid or CHIP, you can still enroll in a plan at any time. The website will help you determine if you qualify for any governmental help on your monthly premiums. If you currently have private insurance but would like to shop to compare premiums you can also do so.
Reviewed by Dr. Sara Connolly, February 2019
- The ACA eliminates pre-existing medical conditions and a dollar cap for those who develop serious medical conditions.
- The ACA requires insurance companies to cover routine well-care visits.
- If your child currently qualifies for Medicaid or CHIP, he or she can continue their present coverage unless your income level changes.
- The insurance plans sold through healthcare.gov are private insurance plans although governmental help is available if you qualify.