affordable care act

How Will the Affordable Care Act Repeal Affect Aphasia Treatment?

The Affordable Care Act repeal is still in early stages. There will be many changes between now and the final version of the bill as it moves through the House and the Senate before it hits the White House. Still, it’s worth looking at ways treatment may be impacted if the repeal moves into law.

The New York Times compared Obama’s Affordable Care Act to the new proposal, outlining the differences. We’ll start with those changes and then segue into aphasia-specific aspects to the bill.

Overview: The National Aphasia Association’s Infographic of the Two Plans

Affordable Care Act Aphasia


Under the Affordable Care Act, people who didn’t get insurance faced tax penalties. The new bill instead proposes that those who let their insurance lapse will face a 30% penalty for 12 months when they sign up again for insurance. Companies with more than 50 full-time employees who do not provide affordable health insurance to employees will no longer have a penalty.

Lastly, tax credits to help pay for individual plan insurance will be only based on income and age, decreasing help for lower income people. Along with that, the repeal removes all cost-sharing help to cover deductibles or co-pays.

The new bill allows an increase in payments to health savings accounts.

Insurers can charge older Americans five times more than younger Americans for premiums, which means higher insurance costs. (The old ACA capped the discrepancy at three times more.)


All the popular parts of President Obama’s plan remain in place with the new bill. The repeal allows kids to stay on their parents’ insurance until they’re 26 years old. People can’t be penalized for pre-existing conditions, and insurers cannot set lifetime limits.


The new bill shrinks Medicaid. Additionally, as of 2020, Medicaid coverage for mental health or substance abuse will no longer be required. The new bill also puts Planned Parenthood on a one-year funding freeze which would shrink their ability to offer cancer screenings and other necessary health care services to women.

Aphasia-Specific Aspects of the Bill

President Obama’s plan created 10 essential health benefits (EHB) that all insurance plans need to cover. One of the 10 EHB points is coverage of “rehabilitative and habilitative services and devices,” which includes speech therapy.

Rehabilitation means:

Health care services that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled. These services may include physical and occupational therapy, speech-language pathology and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.

Habilitation means:

Health care services that help a person keep, learn or improve skills and functioning for daily living. Examples include therapy for a child who isn’t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings.

Looking Ahead

Of course, anyone who has used insurance knows that coverage varies from state to state and from plan to plan. Still, it’s important as this bill moves through Congress to note the status of the EHB section. There is a lot of discussion on how this section will look with possibilities ranging from unchanged to the benefits in place but costing patients a lot more to access coverage.

Research proves that intensive speech therapy helps with aphasia, even when started months after a stroke. Patients can benefit from intensive speech therapy for years to come. It is important that insurance keeps covering speech therapy. Ideally, coverage would increase under the new plan.

We’ll be keeping an eye on those benefits and updating this article as news emerges. Bookmark this post for easy access to these updates in the future.

What is on your mind as you read about the Affordable Care Act repeal?

Update: 3/13/17 7:15 pm:

The first objective report is out about the proposed health plan. The Washington Post writes,

According to a Congressional Budget Office projection, 14 million fewer people would have health insurance next year alone. Premiums would be 15 percent to 20 percent higher in the first year compared with the Affordable Care Act and 10 percent lower on average after 2026. By and large, older Americans would pay “substantially” more and younger Americans less, the report said.

Image: wp paarz via Flickr via Creative Commons license



  • Diane
    March 13, 2017 at 11:54 am

    That is good about the speech therapy but most people that have had a stroke are OLDER and on limited income they should be charged much less than young people . Also if. 26 year old is not in school they should not be on their parents insurance they should get a job and pay for their own . Older people may not be able to afford health insurance and die from strokes because of this plan . Aphasia org needs to not support this .

  • Melissa Ford
    March 13, 2017 at 1:38 pm

    We definitely are worried about the repeal and are watching it closely. The repeal could harm older Americans, making their insurance very expensive. We would like to see the ACA plan expand to help more people rather than shrink and harm more people while giving money to insurance companies. We’re also concerned about younger people. 1/4th of strokes are in people under 65. While children are not required to remain on their parents’ insurance, it is a benefit that allows people to go to school and get internships while they look for full-time work and an employer that will cover benefits.

  • mary spremulli
    March 14, 2017 at 8:16 am

    Health insurance is really “sick” insurance, and sick care is costly, hence, “sick care” is never going to be affordable. Patients who have chronic medical conditions like Parkinson’s or chronic communication disorders like aphasia require a different model of care than the acute care model. Community-based programs and device interventions can help to provide some of the ongoing treatment that is required beyond the acute phase of stroke recovery.

  • Lynda Henderson
    March 14, 2017 at 6:39 pm

    Please remember that speech therapy is critical for people living with dementia and their care partners/friends/family, especially for people with the language variants of Fronto Temporal Degeneration (FTD), ie semantic dementia (SD), non fluent progressive aphasia (NFPA) and logopenic progressive aphasia (LPA).
    In addition to the rehab services mentioned above (which all people living with dementia have rights to by virtue of disability), keeping communication going as language gets progressively lost is abaolutely critical for quality of life.
    FTD with its multiple variants is the most commonly occurring type of dementia occurring in people under 65. Just as stroke can affect teenagers, so can dementia.
    Please fight for those who would otherwise be “locked in”, including those with Acquired Brain Injury (ABI).

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