The Affordable Care Act Turns Two: Where We’ve Been, Where We Are & Where We’re Going

Dear Dr. Smith:

Today marks the two-year anniversary of the Affordable Care Act (ACA) becoming law. In the decades of child health advocacy leading up to the law’s passage and throughout these past two years of its implementation, the Academy has been steadfastly focused on making the ACA as strong as possible for children and pediatricians. On the law’s second anniversary, I thought I would take a moment to share a bit about where we’ve been, where we are and where we’re going in terms of health reform for children and pediatricians.

Where We’ve Been: the ABCs of Health Reform

During the debates leading up to the law’s passage, the AAP championed three fundamental priorities for children and pediatricians, which we continue to support today. These are as simple as ‘A-B-C’: Access to health care services, age-appropriate Benefits in a medical home and health care Coverage for all children in the United States. The ACA not only addresses these goals, but provides many additional benefits for children and the pediatricians who care for them.

As of September 23, 2010, the following child health reforms have already taken effect:

• guaranteed health care coverage for children with pre-existing conditions
• no more lifetime coverage limits
• restrictions on annual coverage limits
• essential preventive care services (as recommended by Bright Futures) are provided with no cost-sharing for families with new health insurance plans
• insurance companies are prevented from dropping coverage when a child or adult gets sick
• young adults can stay on their parents’ health insurance plan until they turn 26
• out-of-pocket expenses are capped at $5,950/individual and $11,900/family
• parents can designate a pediatrician as their child’s primary care provider

Where We Are: ACA Implementation

While the ACA was signed into law two years ago, many of its provisions require additional guidance before they take effect. Often, this level of detail comes from federal regulations that further define the law’s many provisions. The Academy has been at the forefront of this level of advocacy, having written numerous public comments to ACA regulations, which you can find in this chart.

Recently, through the regulatory process, the AAP has argued for more clearly defined federal guidelines to ensure that children who enter into the health insurance exchanges in 2014 receive the same comprehensive health benefits as children enrolled in other forms of health insurance.  The Academy will continue to work with the federal agencies overseeing the law’s implementation, advocating for the ACA to provide children with access to the services, coverage and benefits they need to stay healthy.

The Academy is also actively working at the state level with AAP chapters to ensure that state implementation of health reform meets the needs of children and the profession of pediatrics.

Where We’re Going: Supreme Court Decision Looming

Next week, March 26-28, the ACA will be challenged at the highest level of judicial review in the United States: the U.S. Supreme Court. The Court will devote an unprecedented six hours to hear arguments disputing the law’s constitutionality: whether or not the law’s individual mandate is legal, whether the mandate is severable from the rest of the law, whether the Affordable Care Act levies a tax that must take effect before being challenged in court, and whether the law’s proposed expansion of Medicaid is constitutional. The Court has agreed to record these oral arguments and publicize the recordings the same day they occur, another historic commitment to make the process more transparent to the public. A ruling is expected by early July.

Earlier this week, I co-hosted a webinar with keynote presenter Jane Perkins, Legal Director of the National Health Law Program, on this very topic. To access the full presentation, entitled, “Children, the Court and the Constitution: A Preview of Next Week’s Historic Oral Arguments,” visit www.aap.org.

I want to personally take a moment to thank all of you, members of the Academy, who have worked so diligently alongside our state chapters and AAP staff to ensure the promise of real health reform for children. Our work is far from over, and I thank you not only for all it’s taken to get where we are today, but for the collaborative advocacy that will continue for years to come. Together, we can help keep the Affordable Care Act strong for children.

Thank you,

Robert W. Block, MD, FAAP

President, American Academy of Pediatrics

Follow me on Twitter: @DrBobBlock

Where to Learn More: ACA Resources

• AAP News articles on the upcoming Supreme Court proceedings (March 2012), evaluating the law’s pediatric provisions (March 2011); and outlining the law’s child health reforms (September 2010)
• state and federal resources for AAP members, including state e-updates and federal fact sheets;
• e-mail kids1st@aap.org to become a Key Contact and receive timely federal policy updates and targeted requests for advocacy from the AAP Department of Federal Affairs, including details on next week’s ACA court activities; and
• additional resources from the Administration on what the ACA means for children and other constituencies, including state-by-state data and a two-year anniversary report.