The Affordable Care Act (ACA) gets the job done

 

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As Congress begins its debate on changing the Affordable Care Act (ACA), it’s good to review the success the federal health care law has had in reducing the uninsured rate in the U.S.

Today, more than 30 million people are currently insured as a result of the ACA’s insurance subsidies, expanded Medicaid eligibility, state and federal outreach efforts, and market regulations.

Before the ACA, more than one-third of people who tried to buy health insurance in the individual market were either turned down, charged more or were told a condition excluded them from their health plan.

How has the ACA succeeded in increasing the insured rate? The ACA has made purchasing easier and more affordable. Consumer protections that ban discrimination for pre-existing conditions have also allowed more people to get covered.

The ACA’s primary goal is to allow anyone without employer coverage to have affordable health coverage – no matter what their current health status is.  Under the ACA, insurers must:

  • Offer a plan to everyone who applies
  • Can’t charge more based on gender or health
  • Are limited in how much more to charge older vs. younger persons
  • Can’t impose lifetime or annual benefit limits or cancel coverage.
  • Include Essential Health Benefits
  • Provide premium tax credits that reduce share of costs for incomes between $24,000 and $97,000 for a family of four.

Why is having health insurance important? Having health insurance coverage allows people to have  regular doctor visits and get timely medical care.  Americans without health insurance are less likely to go to the doctor when they need to or get preventive care and cancer screenings. Even a gap in coverage increases the likelihood someone will not get timely health care.

The Commonwealth Fund report breaks down the success of the ACA by the numbers:

Near the end of the ACA’s fourth open-enrollment period, nearly 9 million people had signed up for a plan through HealthCare.gov.  Millions of other consumers in 11 states and the District of Columbia have enrolled through states’ marketplaces. In addition, 7 million have purchased health insurance in the individual market. Expansions to Medicaid and the Children’s Health Insurance Program have allowed an additional 16 million people.

If you need assistance enrolling in health insurance, including Medicaid and Florida Kidcare,  licensed navigators from the Epilepsy Foundation of Florida can help. Call 877-553-7453 to make an appointment. Or go to efof.org/acanavigation for information on navigation sites and upcoming events.

 

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EFOF’s federally licensed healthcare navigators provide in-person assistance throughout Florida.

 

Read more: http://www.commonwealthfund.org/publications/issue-briefs/2017/feb/how-the-aca-has-improved-ability-to-buy-insurance

 

When going without health insurance is not an option

Family Health
Hector Salgado and his wife, Liliana Pinzon depend on an affordable ACA policy to stay healthy and happy.

For Liliana Pinzon and her husband Hector Salgado, the Affordable Care Act (ACA) has been a blessing. Her husband has diabetes and depends on health care coverage to get the regular check-ups and prescription medications he needs.

For this family, going without healthcare is just not an option.

“When my husband changed jobs and lost his health insurance, we were able to get a new healthcare policy through the ACA at a reasonable cost,” Pinzon said. “This has allowed us to have access to good doctors and hospitals when we need them.”

Pinzon and her husband pay $500 a month in premiums. Her five-year-old daughter Maya is on Kidcare.  Before the ACA, the family paid $2,000 a month in premiums, an unsustainable amount that became impossible after Hector switched to part-time work because of his health.

Pinzon is very grateful to have an affordable policy, too. A few years ago she had a complicated pregnancy that resulted in termination due to a fetal abnormality and knows how it important it is to have health care coverage, especially women’s well-care.  

Her Florida Blue HMO healthcare policy allows her to receive care at a Community Health Center where doctor visits cost $3 and labs are free or very low-cost. She has thyroid disease and requires annual blood exams and monthly medications.

 “The ACA offers families like mine the opportunity to choose among many different healthcare policies with different prices,” Pinzon said. “This allows you to pick a healthcare plan that meets your needs – financially and health-wise, depending on your personal circumstances and health concerns.”

According to the Commonwealth Fund, among adults ages 19 to 64 who purchased or looked for a health plan through the ACA marketplace, 70 percent had two or more plans available, an even higher percentage than options available through employer plans. In addition, thirty percent of consumers buying marketplace plans said they had five or more plans to choose from. The number of options increases in more urban areas like South Florida.

 

For her husband, Hector, age 63, the various options available in Broward County, Florida meant finding a healthcare policy that included his doctors and had a good diabetes treatment program. Salgado works part-time as a college instructor where he has no health insurance.

“Thank goodness the Affordable Care Act has been available to me,” Salgado said. “Without it I wouldn’t have been able to stay healthy and helping to support my family.”

 

Choosing a Health Care Plan can be complicated.  You can learn more about how to pick a plan here: https://www.healthcare.gov/choose-a-plan/

The Epilepsy Foundation of Florida has licensed healthcare navigators who can help you make a decision about what policy is best for you and your family. Call our statewide toll-free number to speak to a navigator and set up an appointment for a personal assistance: 1-877-553-7453. For more information on the EFOF navigation program: http://www.efof.org/acanavigation/

Read the Commonwealth Report: http://www.commonwealthfund.org/publications/blog/2017/jun/health-plan-choice-in-aca-marketplace

More Older Adults at Risk of Losing Health Insurance with ACA Reforms

Thanks to the Affordable Care Act (ACA), Susana Septimo no longer wages a desperate balancing act between staying healthy or going bankrupt.

Susana, age 62, has diabetes and glaucoma. She is a housekeeper and has no health insurance through her work. Before she purchased a health marketplace through the Affordable Care Act (ACA), she struggled to pay for medications and doctor’s visits.

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“It was very difficult,” Susana said. “I really depended on doctors and clinics helping me with free medications and low-cost blood work.”

Even the reduced fees of public clinics were difficult for her to afford. Without insurance, she used to pay $129 for her eye drops to treat her glaucoma and more than $150 for each blood screening. She managed by putting the fees for doctor’s visits and medications on her credit cards and paying the money back over time.

With the premium subsidies and cost-of-share savings (available to low to moderate wage earners through the ACA), she now pays $21 a month premium for a healthcare policy with a low-deductible that covers 94 percent of the cost of her insulin medications. Her medications cost $1.

“Thank goodness this health insurance is available to people like me,” she says. “It saved my life and has allowed me to continue to work.  I now have the security and peace of mind that my health problems can be managed.”

Prior to the ACA, older adults like Susana were most at risk of high premiums or being uninsured, according to a study by the Kaiser Family Foundation:

They were more likely than younger adults to be diagnosed with certain conditions, like cancer and diabetes, for which insurers denied coverage.  They were also more likely to face unaffordable premiums because insurers had broad latitude (in nearly all states) to set high premiums for older and sicker enrollees.

Reforms to the ACA currently being considered could result in a substantial increase in premiums for older adults and loss of share-of-costs savings altogether, which would make health insurance policies unaffordable again, especially for persons of low-to-moderate income.  If the proposed changes under the new American Health Care Act (AHCA) are enacted, over five million older adults are projected to lose health insurance by 2026, according to a recent analysis by the Congressional Budget Office.

Older adults under AHCA impacts

Source: Kaiser Foundation. Read more: http://kaiserf.am/2sRg227