The Affordable Care Act Insurance Reforms: Where Are We Now, and What’s Next?

T he Affordable Care Act (ACA), signed into law by President Obama in March 2010, provides for comprehensive health reform in the United States. A major part of the ACA includes insurance reforms designed to make adequate and affordable health insurance accessible to nearly everyone. Five years after the ACA became law, and 1 year after major insurance reforms took effect , we discuss in this article the gains that have been made and the road ahead, with a focus on individuals with diabetes. This article is focused solely on changes in insurance plans and does not address the many other provisions in the massive ACA that affect people with diabetes, including the establishment of the National Diabetes Prevention Program, the Prevention and Public Health Fund, or menu labeling requirements. Under the old health care system, it was legal in most states to deny health insurance to people with diabetes or require them to pay more for insurance coverage simply because they had diabetes. Even for people who had insurance coverage, their plans did not necessarily cover the most basic diabetes needs, leaving them with large out-of-pocket expenses in addition to the cost of insurance. Without access to affordable care, some people with diabetes went without the care they needed by cutting back on—or even forgoing—the doctor visits, medicines, education, and testing supplies necessary to adequately manage diabetes. As a result, many people developed complications of diabetes that could have been prevented had affordable care been available to them. People with diabetes who had affordable coverage through their employer feared (and rightfully so) there would be few insurance options available to them if they left their job and did not start immediately at another job that offered good health coverage benefits. The American Diabetes Association (ADA) fought hard to ensure that health care reform would benefit people with and at risk for developing diabetes. Diabetes Advocates from around the country visited with their elected officials to share their stories about how important it was for Congress to end the discrimination that prevented people with diabetes from protecting their health. The ACA changed the health insurance landscape through numerous new insurance protections that improved access to coverage for people with diabetes, as well as the quality of that coverage. Since the ACA passed in 2010, ADA has made great progress in ensuring that the law is implemented in a way that …