National 
  Policy
  Matters
        The Affordable Care Act: 
        What Disability Advocates Need to Know
     The Aordable Care Act 
     What Disability Advocates Need to Know
                                                 Introduction
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                 5         How does the ACA expand reform private health insurance?
                 6                   How does the ACA expand coverage?
                 8                How does the ACA expand essential benefits?
                11                   How does the ACA impact Medicaid?
                13         How does the ACA expand long-term services and support?
                15                 How does the ACA emphasize prevention?
                                    Are there other provisions important to 
                16        people with intellectual and/or developmental disabilities?
        Introduction
        Now that the U.S. Supreme Court has af-                  How many people with I/DD are uninsured or 
        firmed the constitutionality of the Affordable           underinsured?
        Care Act (ACA), the disability community 
        must work to better understand the law and               While exact numbers are not available for 
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        the many benefits it can provide to people               persons with I/DD specifically, a recent study
        with disabilities.  This will be critical to the         found that of adults age 18-64 with cognitive 
        community’s role in helping to move states               difficulty, 13.6 % had no insurance, 32.1% pri-
        forward with implementation.                             vate insurance, 41.0% Medicaid, and 27.0% 
                                                                 Medicare. (Table below)
        Numerous ACA provisions 
        related to both acute care                       Health Insurance Status of Persons 
        and long term services and                               with Cognitive Difficulty*
        supports hold great prom-
        ise for improving the health 
        and wellbeing of people                   Medicare
        with disabilities. This issue 
        of National Policy Matters                Medicaid
        provides information about 
        the major provisions and 
        the status of their imple-                   Private 
        mentation.                                Insurance
        Why does The Arc support                  No Health
        implementation of the                     Insurance
        Affordable Care Act?
        The Arc has long support-                             0%       10%        20%        30%        40%       50%
        ed expanding Medicaid 
        to cover more low income individuals and                 * People with intellectual disability would be 
        expanding private health insurance options               a subset of people with cognitive difficulty 
        to achieve universal coverage.  The law                  which also includes people with Alzheimer’s, 
        contains significant nondiscrimination provi-            dementia, and other conditions.
        sions and improvements to the Medicaid 
        long term services and support system that               Many people with I/DD are not in the labor 
        are critical to meeting the needs of people              force and lack access to employer spon-
        with I/DD.  For too long, insurance companies  sored insurance.  Even when people have 
        have been able to charge people higher                   employer sponsored health insurance, they 
        rates because of their health conditions,                may not have access to the services and 
        deny insurance coverage of people with I/                supports they need because many private 
        DD, and limit coverage of needed health                  insurance plans do not cover many disability 
        care treatments, services and supports.                  related therapies and services.
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        How does this impact the health of people                   How will the ACA reduce costs for individuals?
        with I/DD?
                                                                    Expanding Medicaid and private health in-
        People who have access to comprehen-                        surance options:  Individuals who are current-
        sive and affordable health insurance are                    ly uninsured and become insured will spend 
        more likely to receive the prescription drugs,              less of their income paying for needed health 
        therapies, and medical treatment they need  care services.  The health insurance reforms 
        to be healthy and maintain the ability to                   mean that insurance will cover more of the 
        function in the community.  People with I/                  services that people with pre-existing condi-
        DD often have multiple health conditions                    tions need, thereby reducing costs to the in-
        and are at risk of developing secondary dis-                dividual.  The inclusion of essential benefits in 
        abilities without quality health care.  Studies             health insurance plans means that a core set 
        have documented a higher prevalence of                      of health care services that people with I/DD 
        adverse conditions, inadequate attention                    need will be covered by many health plans.  
        to health care needs, inadequate focus on                   Subsidies and cost sharing for low and middle 
        health promotion, and inadequate access to  income people with make health insurance 
        quality health care services.                               coverage more affordable for people pur-
                                                                    chasing insurance in the exchanges.  (These 
        How will the ACA reduce costs for states?                   issues are described in more detail later in this 
                                                                    update).
        The ACA will help ensure that individuals                    
        have access to health care to prevent costly  Expanding the risk pool:  Since the law re-
        hospitalizations and institutionalizations that             quires most individuals to purchase insurance 
        occur when individuals forego treatment.                    or face penalties, it is expected that more 
        For example, expanding home and commu-                      people will purchase health insurance.   This 
        nity based long term services and supports                  will allow for the law’s private insurance 
        (LTSS) will reduce the need for nursing home                reforms to work without sky-high premiums.  
        and other institutional settings.  In the long              For example, requiring insurance companies 
        run, these investments in health care and                   to insure people with pre-existing conditions 
        home and community based services (HCBS)  can only be affordable if healthy people also 
        will improve health and reduce dependence  share the risk before they need medical care 
        on costly institutions.  Investments in improv-             due to illness or injury. 
        ing public health and coverage of preven-
        tion services will also save money by reduc-                Covering preventive services:  Eliminating 
        ing the cost of treating health conditions that  cost-sharing for preventive services saves 
        could have been prevented.                                  money for individuals and families immedi-
                                                                    ately and reduces medical costs over the 
                                                                    long term. 
        1Altman, B. and Bernstein, A. Disability and Health in the United States, 2001-2005.  Hyattsville, MD National Cen-
        ter for Health Statistics 2008
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