FACTS: Why safeguarding the Affordable Care Act's ban on annual & lifetime limits matters

In 2024, the RI General Assembly codified the Affordable Care Act's (ACA) ban on annual and lifetime limits in Rhode Island law. This is important because, before the ACA, people struggling with chronic and persistent mental illness, fighting cancer or heart disease, in severe accidents, incredibly sick children, and many others battling chronic conditions regularly lost their health coverage for needed care because they reached their annual or lifetime limit. 

  • Before the ACA, nationally – about 55% of people with commercial insurance faced lifetime limits, most commonly $1 million or $2 million, forcing many into bankruptcy.  (Price Waterhouse Cooper, Prevalence & Impact of Lifetime Limits, Insured but Not Covered, The Problem of Underinsurance, Hearing before US Congress, 2009)
  • Between 2010 and 2016, during the initial implementation of the ACA, data shows that personal bankruptcies declined by nearly 50% nationally.
  • The U.S. Department of Health and Human Services estimated that 374,000 Rhode Islanders (including 89,000 children) benefit from the annual/lifetime limits prohibition.
  • Banning limits has been shown to save Medicaid money because patients who hit a cap often ended up on Medicaid as a last resort.

LEARN MORE:

The Obamacare provision that saved thousands from bankruptcy

FACTS: Why addressing affordability in Rhode Island's Individual Marketplace -- HSRI -- matters

The Affordable Care Act has helped many Rhode Islanders get health coverage by expanding Medicaid and establishing subsidized commercial coverage through the HealthSourceRI (HSRI) marketplace. This has reduced Rhode Island’s uninsured rate to less than 3%, one of the lowest in the nation. 

But still, too many people need help to get the care they need because of high deductibles and copays. In their 2022 Health Information Survey, HSRI documented a 21% increase in out-of-pocket costs between 2020 and 2022 noting this as “the highest reported out-of-pocket spending since the survey began in 2012.” 

  • It is well-documented that even small co-pays mean some people forgo important services, including keeping up with prescriptions and treatments for chronic conditions. 
  • Due to the 'Medicaid unwinding' from pandemic era continuous coverage in Medicaid, many lower-income Rhode Islanders are now transitioning from Medicaid to the Marketplace.
  • Current Federal enhanced premium tax credits have expanded Federal premium assistance beyond the standard pre-covid ACA supports, but this extra assistance is due to sunset at the end of 2025, which means, short of Congressional action, many Rhode Islanders face a potential premium affordability cliff.
  • Currently, nine states supplement marketplace subsidies and offer additional cost-sharing reductions for their residents – California, Colorado, New Jersey, Massachusetts, Maryland, New Mexico, Connecticut, Vermont, and Washington.

Healthcare is fundamental, we need to do all we can to ensure that low- and moderate-income Rhode Islanders get some financial relief so that they can access the health services they need when they need them.

LEARN MORE: 

Building on the Affordable Care Act: Strategies to Address Marketplace Enrollees’ Cost Challenges (CBPP)

FACTS: Why expanding eligibility for Rhode Island's Medicare Savings Program(s) matters

Seniors and people with disabilities on Medicare pay premiums, deductibles, and co-pays.  The current standard Medicare Part B premium is $174.50 monthly, deducted from Social Security Income payments. Thousands of low-income seniors and persons with disabilities on Medicare but not eligible to participate in the state’s Medicaid program struggle each month to pay their Medicare Part B premiums and co-pay costs for services and prescription drugs, causing many to forgo needed health care as they cannot afford to pay the co-payments.

  • According to the U.S. Census Bureau, many older Rhode Islanders have limited incomes. Twenty-seven percent of age 65+ households earn less than $25,000 a year, while 50% earn less than $50,000 a year. 
  • Women comprise a higher percentage of low-income seniors.  The average Social Security benefit of women aged 65 and over ($20,333) is $5,000 less than their male counterparts ($25,204).
  • In 2021, of the 35,085 Rhode Islanders enrolled in the MSP, 48% were people of color (including 27% Hispanic and 9% Black) and 60% of the enrollees were women.

The Medicare Savings Program (MSP) provides low-income people enrolled in Medicare with coverage of their Medicare Part B premium, putting more than $2,000 annually back into their pockets to help meet basic needs like food, clothing, and transportation. The MSP covers Medicare-required co-payments and deductibles for the lowest-income Medicare members.  In addition, once a person is enrolled in the MSP, they are automatically enrolled in the federal Extra Help program that helps pay for medications.

Affordability is the single most important factor for people’s access to the care they need. And, doing all we can to improve the financial security of our older Rhode Islanders and people with disabilities, to help them live more securely in their home community, is good for us all.
 

LEARN MORE:

Medicare Savings Program Enrollment Increases When States Expand Financial Eligibility Criteria (AARP)