As the Trump administration and Republicans in Congress begin maneuvering to dismantle the Affordable Care Act, most of the attention will be on the effects of “repeal and replace” on the individual health insurance market. However, the 2010 health care reform law had a significant impact on employer-provided health coverage, too, and ACA rollbacks could affect the benefits employers can or must offer.
Some of the provisions that could vanish from employer-provided health insurance if the ACA is repealed, according to a report by the Kaiser Family Foundation:
No copays for preventive services: The ACA mandates coverage of many preventive services at no out-of-pocket cost for policy holders. Among them: mammograms, colonoscopies and routine immunizations such as flu shots.
The most costly no-copay preventive service that could go away: contraceptives.
No annual or lifetime limits: Before the ACA was enacted, even the most generous policies capped how much an insurer would pay for treating a particular health condition, either on an annual or lifetime basis. The ACA made those limits illegal.
No annual out-of-pocket caps: The ACA limits the annual amount policy holders may be forced to pay in deductibles, copays and coinsurance. For example, the 2017 out-of-pocket limit is $7,150 for individual coverage, and $14,300 for family coverage.
That’s important, because deductibles and copays have been rising much faster than premiums, as insurers seek to force more cost sharing onto consumers.
No waiting periods to enroll: Under the ACA, employees must be allowed to sign up for employer-provided health benefits no later than 90 days after starting a new job.
No waiting periods to cover pre-existing conditions: Before the ACA was enacted, employers were allowed to hold off on covering pre-existing chronic health conditions by as much as one year.