What the ACA Has Meant to Me: Dependent Coverage and No Benefit Caps

Part III of a three-part series.

When I was diagnosed with Rheumatoid Arthritis (RA), I was taking what was supposed to be my final semester of college. As it turned out, I ended up having to drop all of my classes due to the agony and intense fatigue I experienced until my new medical treatment started calming my symptoms. I graduated college at the age of 23, yet I continued to take two undergraduate classes a semester. That’s because my father was a professor at my university, and his insurance plan allowed dependents to be covered until the age of 26 provided they were students. As expensive as college is, it was cheaper than the full price of my healthcare costs.

When I explored my options, the plan that I could get with my pre-existing condition had a premium of $1,800 a month and a $6,000 deductible. As incredibly expensive as such a plan was, some people with pre-existing conditions didn’t even have this unsavory option. Before the Affordable Care Act (ACA) as many as 19% of applicants for health insurance policies were denied coverage due to having a pre-existing condition.¹ The ACA prohibits insurance companies from denying coverage due to health status (I detail how coverage for pre-existing conditions has personally impacted me in part II of this series), and also includes the provision that dependents can be covered on their parents’ insurance until the age of 26. I was very fortunate that my father’s employer was ahead of its time in already making a similar provision for dependents.

Due to my father’s insurance coverage, I had the option of attending graduate school. Had I not been allowed to stay on his plan, I wouldn’t have continued my education, as the insurance plan for students did not cover my expensive biologic drug. It was Enbrel that made it possible for me to return to classes in the first place, so without it, I likely would have had such high disease activity that I could not have made it through graduate school.

With the passage of the Affordable Care Act, almost anyone can stay on their parents’ insurance until they turn 26.² Unlike my father’s plan, the ACA does not require that dependents be enrolled in college courses. Had the ACA been in place when I was diagnosed, I could have saved several thousands of dollars by not taking those additional undergraduate courses after I graduated. I would have started my career with less debt.

Reflecting on how I might not have attained my master’s degree and gone on to a career requiring that level of education, I think of all the young adults today who might not have the option of pursuing their goals if the provision for remaining on parents’ insurance is removed during the ACA repeal and replace effort. Apparently, I’m not the only one pondering this, as a recent poll indicated that 79% of Americans support the provision that allows children to remain on their parents’ insurance plan until they turn 26.³

While having health insurance as a graduate student was important to me when I was younger, another provision of the ACA is increasingly important to me as I approach my 40^th birthday: the ACA did away with lifetime benefit caps. When I was a young professional, my plan had a million dollar lifetime benefit cap. A million dollars sounds like a lot until one starts doing the math of treating a disease like RA.

I’ve been on several different treatment plans in the 17 years since my diagnosis. When factoring in the portions my insurance provider pays, my treatment costs anywhere from $40,000-$60,000 a year. Averaging that, my prior maximum benefit cap of a million dollars would be reached in 20 years. I’m now only three years away from that 20-year mark, but because of the ACA, I haven’t had to worry about it. Yet, if the lifetime benefit caps are reinstated via changes and/or repeal of the ACA, I will have to think seriously about every medical expense I incur.

If we return to lifetime benefit caps, I won’t necessarily be able to follow my doctor’s recommendations, as following the treatment plan that is most beneficial for me might mean reaching a lifetime cap before the end of my lifetime. One’s later years in life are often the most medically expensive, and the thought of contending with RA and old age without insurance coverage is harrowing. I would hope that Medicare would remain in place and provide the treatment I need, but there are no guarantees.

While it is certainly true that medical care costs continue to rise, I hope that our politicians can find some creative solutions that reign in costs without doing away with popular provisions of the Affordable Care Act that are helpful to those of us with chronic conditions. I want to be seen as more than a dollar sign. I would love to be healthy and not be a burden on the health care system. Unfortunately, I don’t have the option of trading in my RA for a better health profile. I hope my political representatives won’t trade in legislation that provides me with some options and safeguards just to reach a bottom line.

Have you been impacted by the Affordable Care Act? What changes would you like to see in a possible replacement for the law?