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
The ACA required states to expand Medicaid eligibility to citizens and certain non-citizen legal residents with incomes below 138% of the federal poverty level (about $27,000/year for a 3-person household in 2013). In June 2012, the U.S. Supreme Court ruled in a case challenging the constitutionality of various provisions of the ACA that the Medicaid eligibility expansion had to be optional for the states. In other words, the federal government could not compel states to expand in the way that it had expected, and only about half the states appear poised to expand in 2014 as the ACA envisioned.
As a result of the Supreme Court's decision, state officials who are reluctant to expand have greater leverage to request waivers from CMS to experiment with alternative Medicaid expansion plans. Arkansas was one of the first to propose an alternative, which would allow the state to use Medicaid dollars to purchase private insurance for Medicaid beneficiaries on the state's health insurance exchange. Iowa has proposed a similar model, and Pennsylvania's Republican governor became the most recent to do so just yesterday. Part of the motivation for reluctant state officials to seek politically acceptable Medicaid expansion options is that the federal government will pay for almost 100% of the costs associated with expansion for the first 3 years, at which point federal funding will gradually drop and be maintained at 90%.
For all states that elect to expand Medicaid, the essential health benefits will have to be covered for new beneficiaries. That includes rehabilitative and habilitative services, which in virtually all cases is expected to include coverage of occupational therapy services. Therefore, as with the expanded access to health insurance that comes with the creation of health insurance exchanges, occupational therapy practitioners in states that expand Medicaid eligibility will see an increase in the pool of potential occupational therapy consumers.