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

 

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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

Ron Sarraf, a Valley Fever survivor, has hope because of the Affordable Care Act

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Ron Sarraf (r) with his husband, Daniel Berrios and step-son, Adam Berrios                

In 2006, Ron Sarraf was driving through Napa Valley in California when the spores of a fungi plant happened to be wafting through the dry, desert air.  Serraf had the misfortune to breathe in those spores, which unbeknownst to him, carried the fungal disease coccidioidomycosis, also known as “Valley Fever.”  The air-borne fungus attacks the lungs, causing flu-like symptoms and, in worst case scenarios, a chronic form of pneumonia.

Within a few weeks, Ron developed flu-like symptoms. His lungs filled with fluid; he suffered high fevers. He was initially treated for pneumonia but never got well. His fever shot up to 105, and he became delirious.  A hospital took him in as a charity case. That was the first step in a long battle to first get diagnosed and then treated. The journey would include 17 days in a hospital. For ten years, he has been on a roller coaster ride of illness followed by treatment followed by remission followed by illness again.

He is grateful the Affordable Care Act was passed, which finally allowed him to have health insurance, regardless of his employment.

 “I wasn’t even a supporter of the ACA when it passed,” Ron said. “I didn’t really understand it. Only after I became sick did I begin to understand how important it was, and how it saves lives. It saved my life.”

Ron remembers the many times in the last decade when he didn’t have insurance and had to depend on charity care or relatives to cobble together medical care and money to pay for medications.

His illness has forced him in and out the workforce, losing his insurance when he lost his employment.  One year, his elderly father helped pay for three months of medications out of his own pocket. When his father could no longer afford it, Ron could no longer take the medications, and he became severely ill.

When his illness flares up, the treatment is expensive – $8,000 a week for three weeks of infusion therapy.  The oral medications to stay in remission cost $2,000 a month.

“My medical costs are $250,000 some years,” Ron said.

Today, with his disease flaring up once again, Ron is worried sick, literally. If the ACA is changed to eliminate the protections against discrimination for pre-existing conditions, patients like him might be excluded or have to pay unaffordable premiums. Those with pre-existing conditions might be placed in “high-risk” pools that could be underfunded. The sickest, and most vulnerable patients, could be forced to compete for limited funds.  

Right now, with the changes contemplated to the ACA, Ron is very worried for his future.

“Worry and stress is the worst thing you can have when you have disease related to your immune system,” Ron said.  

And, by the way, Ron wants everyone to know this can happen to anyone.

One day, Ron was healthy, driving through a California desert town. Now he is battling a debilitating and potentially deadly disease that has upended his career and his life. 

“As far as doing the right things to stay healthy, as has been suggested by some government officials, I remind them, the disease I have is gotten through the simple act of breathing air outside in one of several western states,” Ron said. “There is no cure, no vaccine and very little future for people like me.”

The one thing that gives him hope is that the treatment will work and send him back into remission and back to work and supporting his family.

“That is my hope,” Ron said. “But that will only be if I am able to have the health care that I need. What’s going to happen to me if I don’t have it?”