Many families with children with special needs received benefits in health care coverage due to several provisions of the Affordable Care Act (“ACA”).
Such provisions include:
- Allowing adult children, up to the age of twenty-six, to be included in their parents’ health insurance policies;
- Prohibiting health insurance companies from imposing a waiting period for coverage of a pre-existing condition;
- Having a cap on out-of-pocket medical costs each year;
- Prohibiting employer plans from including lifetime limits to coverage; and
- Expanding Medicaid eligibility based on income to 138 percent of the Federal Poverty Level in states that chose to implement the expansion. Applicants who qualify for Medicaid benefits based on this expansion could start receiving benefits while waiting for eligibility based on a disability.
What are the changes taking place now? The Congressional Budget Act of 1974 allows for the expedited consideration of mandatory spending legislation. Recently, the U. S. Senate voted to approve a budget blueprint, by way of a reconciliation bill, to allow the removal of significant components of the ACA, without the interference of a filibuster. The U. S. House of Representative voted to approve a budget blueprint as well. A repeal to reform Medicaid is supported by many in congress.
To date a comprehensive reform bill has not been provided for review. President-elect Donald Trump has expressed approval for a couple of aspects of the ACA, such as the inability of insurer to deny coverage for people with pre-existing health conditions and allowing children to stay on their parents’ insurance policies longer. President-elect Trump’s ultimate goal is to repeal the ACA and replace it with a plan essentially simultaneously. Trump proposes his plan will provide “insurance for everybody” and that pharmaceutical companies are “politically protected but not anymore.”
Unfortunately, one cannot predict whether the two ACA mandates approved by Trump will ultimately be a part of TrumpCare. House Republicans have a Better Way plan that promises to protect patients with pre-existing conditions and allow dependents up to age twenty-six to stay on their parents’ health insurance plans.
Parents of children with special needs have valid concerns if the ACA is repealed. Will their children, especially those over eighteen years old, with pre-existing medical conditions have private health insurance? If not, will Medicaid be an option and if so, how long is the wait for eligibility for benefits?