The Patient Protection and Affordable Care Act, often referred to simply as the ACA or Obamacare, was signed into law on March 23, 2010. The ACA is intended to expand access to health insurance coverage for millions of uninsured Americans by expanding eligibility for Medicaid and developing health insurance marketplaces where uninsured persons may be eligible for subsidies to make private health plans more affordable. While expanding access to health insurance is a big part of the ACA, there are many other purposes of the law, including provisions intended to reform the health care delivery system to produce better patient outcomes at lower cost.
AOTA was very active in the legislative process leading up to the passage and signing of the ACA, working to achieve victories such as inclusion of rehabilitation and habilitation in the essential health benefits package. AOTA has also been monitorting the regulatory process at the federal and state levels as the ACA has been implemented, and has been advocating for occupational therapy practitioners and consumers. The dynamic environment created by health care reform creates opportunities, but vigilant monitoring of implementation activities and carefully executed advocacy efforts are necessary to ensure occupational therapy is valued and protected in the future.
Please also see the Health Care Reform Implementation page on AOTA's website at: http://www.aota.org/Advocacy-Policy/Health-Care-Reform.aspx
Two of the big decisions states have to make regarding ACA implementation are whether to expand Medicaid eligibility and whether to create and administer their own health insurance exchanges. Both decisions have implications for occupational therapy practitioners and consumers. In states that expand Medicaid eligibility, there will be more people newly insured, and therefore more potential consumers of occupational therapy services. In states that administer their own health insurance exchanges, there may be additional requirements of the health plans sold on those exchanges, and opportunities to influence the development of those requirements. For example, California decided to create its own exchange, called Covered California. Instead of allowing health plans to develop their own cost-sharing requirements (e.g.,deductibles and copays), the state specified what those requirements will be for different types of plans. In the future, as more states are likely to follow California's model of standardization, it will be important to ensure unreasonable cost-sharing requirements aren't enacted, preventing consumers from being able to access affordable occupational therapy services.
Because some states are still contemplating whether to expand Medicaid eligibility, and there are many variations of health insurance exchange design, it can be confusing to categorize each state. The following maps and charts attempt to do so.
Advisory Board Company Medicaid Map
Kaiser Family Foundation Medicaid and Exchange Chart
Commonwealth Fund Exchange Map
Two more resources from the Center on Budget and Policy Priorities:
Status of Exchanges: www.cbpp.org/.../CBPP-Analysis-on-the-Status-of-State-Exchange-Implementation.pdf
Status of Medicaid Expansion: www.cbpp.org/.../status-of-the-ACA-medicaid-expansion-after-supreme-court-ruling.pdf
Both PDF files have a map of the states along with additional details about the issues.