Healthcare…Insurance…Obamacare

What is the Affordable Care Act and Why Care About it?

Healthcare in the United States has always been a complicated and often frustrating system to navigate, but the Affordable Care Act (ACA), also known as Obamacare, brought significant reforms that changed how millions of Americans access and afford medical care. While the ACA has faced constant political challenges, its impact on protecting those with pre-existing conditions, mandating fairer insurance practices, and expanding access to healthcare cannot be overstated. Yet, misconceptions remain, and many people still blame the ACA for issues that have more to do with the structure of our profit-driven healthcare system. As threats to the ACA persist, it’s crucial to understand exactly what’s at stake if these protections are dismantled and how the law has fundamentally shifted the landscape of health insurance in the U.S.

Why the Affordable Care Act Matters: Protecting Your Access to Healthcare

The U.S. healthcare system has long been criticized for being expensive and inaccessible to many. The Affordable Care Act (ACA), also known as Obamacare, brought significant reforms aimed at addressing some of these problems. It opened the door for millions of Americans to access healthcare, regardless of pre-existing conditions, and set standards for insurance companies, such as requiring a certain percentage of premiums to go directly toward medical care. Yet, despite its benefits, the ACA remains under attack, which raises a critical concern for those who rely on its protections.

The Truth About Losing Your Doctor

One of the most common misconceptions about the ACA is that it forces people to lose their doctors. In reality, the relationship between healthcare providers and insurance companies is a matter of contract negotiation. Providers, like those at PeoplePsych or other medical practices, have the option to choose whether or not to accept the rates set by insurance companies. If your doctor is no longer covered under your plan, it is not the ACA’s doing—it’s the result of your provider deciding whether the reimbursement rates offered by your insurance are fair.

Understanding the Role of Insurance

It’s important to understand that insurance companies are not healthcare providers—they are access points to healthcare. Insurance plans create pathways to care, but under our current, predominantly capitalist healthcare system, these pathways are often dictated by profit-driven motives. This means wellness care, or preventative care, is often less valued or covered, while the system operates largely on a “treatment model,” addressing health issues after they arise. This is why smoking cessation and weight loss drugs tend not to be covered.

Ensuring Insurance Premiums Go To Healthcare Provision

Under the Affordable Care Act (ACA), insurance companies are required to spend a certain percentage of premium dollars on medical care and healthcare quality improvement rather than on administrative costs, marketing, or profits. This is known as the Medical Loss Ratio (MLR).

For large group plans (covering employers with more than 50 employees), insurers must spend at least 85% of premium dollars on medical care and healthcare quality improvement.
For small group plans (employers with 50 or fewer employees) and individual plans, insurers must spend at least 80% of premium dollars on medical care and healthcare quality improvement.

If insurance companies do not meet these thresholds, they are required to issue rebates to policyholders. This provision was designed to ensure that more of the premium dollars people pay go toward actual healthcare services.

The Dark Days Before the ACA

Before the ACA, many people faced extraordinary hurdles when trying to access healthcare, particularly if they had any medical history that labeled them a “risk.” Seeking mental health services, fertility treatments, or even breaking a bone could result in you being denied coverage, regardless of the severity or simplicity of the issue.

15 years ago I remember a friend who could NOT buy health insurance due to receiving fertility treatments. Self employed, she did not have access to employer sponsored health insurance. So as a result of her a healthy 18-month-old child, her previous fertility treatments were enough for insurance companies to refuse her coverage. This was not an isolated incident—it was common practice. Whether you had undergone cancer treatment, suffered a chronic illness, or simply had a complicated pregnancy, insurance companies had the right to deny you coverage based on pre-existing conditions – and that is just what they did.

The ACA made these denials illegal. No longer could insurance companies refuse to cover you for simply seeking medical care in the past. This was a game-changer for millions, and it provided peace of mind that, if a medical crisis occurred, they would be able to afford care.

Why the ACA’s Protections Matter

The ACA isn’t perfect. But it created a healthcare landscape where millions who were previously locked out could finally get in. Politicians calling for the ACA to be repealed or erased are threatening to eliminate your access to healthcare when you need it the most. You may be healthy now, but life is unpredictable. The moment you need coverage is often when it’s too late to get it.

Voting to protect the ACA means voting to protect your right to access healthcare, whether you’re battling a chronic illness or simply trying to stay well. It ensures that when the time comes—and it often comes unexpectedly—you’ll have the coverage you need. The healthcare system in the U.S. is far from perfect, but with the ACA, it’s significantly better than it was before. Let’s not allow those improvements to be dismantled.

Life can be complicated, messy, and rarely progresses in a straight line. PeoplePsych is a Chicago-based psychotherapy group that treats adults seeking profound change in their lives. We provide services that affirm the dignity, worth, and value of all individuals. We strive to create a safe non-judgemental space for clients to explore the issues that bring them. To connect with one of our therapists, please contact our Clinical Coordinator at (312) 252-5252 or intake@peoplepsych.com.