Guest Blog

How Will the Repeal of the Affordable Care Act Affect Families with Children with Special Need

16 Jan 2017 by Leona E. Filis

From time to time, we like to invite guests to share their perspectives here in our magazine. Today’s guest blog is written by LEONA E. FILIS, an attorney licensed in Texas and North Dakota–Ed.

With the upcoming administration, changes to the House and Senate, and the echo of campaign promises, many parents with children with specials needs have concerns about the continuation of their families’ health care coverage. Several provisions of the Affordable Care Act (“ACA”) are relied upon by our families.  One of the key provisions enjoyed by many families is the mandate that allows adult children, up to the age of twenty-six, to be included in their parents’ health insurance policies.  A number of adult children currently covered by their parents’ policies are disabled and are particularly vulnerable if they are excluded from their parents’ health insurance. Options are quite limited for these children who may not be able to work and have access to job-based health insurance plans.

Additionally, the ACA contains protective provisions that prohibits health insurance companies from imposing a waiting period for coverage of a pre-existing condition. Further, all new-health plans are required to cap out-of-pocket costs each year.  Also, under the ACA, employer plans are prohibited from including lifetime limits to coverage and health insurance coverage will not end when medical costs reach an arbitrary amount.

Another provision of the ACA relied upon heavily by the disability community is the expansion of Medicaid; however, this is limited to states that chose to implement the expansion. In such states, people with disabilities could qualify for Medicaid benefits due to eligibility based on a low income of up to 138 percent of poverty. Qualification for Medicaid benefits could occur earlier in time than qualification for eligibility of benefits based on a disability.

What are the changes taking place now? The Congressional Budget Act of 1974 allows for the expedited consideration of mandatory spending legislation. Recently, the U. S. Senate voted to approve a budget blueprint, by way of a reconciliation bill, to allow the removal of significant components of the ACA, without the interference of a filibuster.  The U. S. House of Representative voted to approve a budget blueprint as well.  A repeal to reform Medicaid is supported by many in congress.

To date a comprehensive reform bill has not been provided for review.  President-elect Donald Trump has expressed approval a couple of aspects of the ACA, such as the inability of insurer to deny coverage for people with pre-existing health conditions and allowing children to stay on their parents’ insurance policies longer.  President-elect Trump’s ultimate goal is to repeal the ACA replace it with a plan essentially simultaneously. Trump’s proposes his plan will provide “insurance for everybody” and that pharmaceutical companies are “politically protected but not anymore.”

Unfortunately, one cannot predict whether the two ACA mandates approved by Trump will ultimately be a part of TrumpCare. A House republicans have a Better Way plan that promises to protect patients with pre-existing conditions and allow dependents up to age twenty-six to stay on their parents’ health insurance plans.

Parents of children with special needs have valid concerns if the ACA is repealed. Will their children, especially those over eighteen years old, with pre-existing medical conditions have private health insurance? If not, will Medicaid be an option and if so, how long is the wait for eligibility for benefits?

Leona Filis

Leona Filis is a Special Needs Attorney who is a partner and a resource to parents by helping them navigate those tough decisions for their children.Her goal as a Special Needs Attorney is to be a partner in the children’s lives and a resource to the parents to help the children from the first step to the very last step.