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Affordable Care Act: Individuals

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Affordable Care Act: Impact on individualsMost workers who receive health care benefits from an employer should see no change in coverage, but there’s also no guarantee that premiums or deductibles will stop increasing.

Popular provisions in the ACA include guarantees of coverage for patients with pre-existing conditions and coverage for children up to age 26 who are under their parents’ insurance plans, according to a poll from the Kaiser Family Foundation. Talk on Capitol Hill suggests these benefits will be retained.

In contrast, other factors could raise everyone’s premiums. For instance, some lawmakers are targeting for repeal the individual mandate, which requires all Americans to buy health insurance or pay a fine. A Kaiser Family Foundation poll says Americans dislike this mandate. Insurers, however, like it. They rely on the mandate to compel healthy people to enroll. This expands the pool of patients and spreads the risk. Eliminating this mandate would remove some healthy people from the risk pool and drive up premiums for everyone with insurance. “If you repeal the individual mandate, many people who are healthy and risk takers will opt not to have insurance,” said Scott Davis, partner, Health Care Advisory Services.

Insurers have argued that without the individual mandate, the costs would be too high to cover patients with pre-existing conditions.

“If there is an ACA replacement, individuals face the following concerns: whether or not they will be able to get insurance; whether they can pay for it; whether the cost would be affordable if they have pre-existing conditions; and whether they will be offered the same kind of coverage as during the ACA enforcement, or will they be left only with catastrophic coverage or a cap on coverage?” Davis said.