By Rick Garcia
In today’s current topic of the Affordable Care Act or ACA, there’s a storm a brewing on both sides of the political aisle. Regardless of political affiliation, as we march toward 2014 when the law will be fully in effect, a good majority of our population simply do not understand the impact this will have on them and the lives of their children.
By 2014 when the law will be fully in effect, insurers will no longer be turned away due to pre-existing conditions. Additionally, most people will be required to obtain at least basic health insurance or pay a fee if they do not have health insurance.
The Affordable Care Act will provide direct financial relief to millions of insured Michigan families that struggle to pay health insurance premiums today. The new law will give families the option to shop for a plan in new state insurance marketplaces (called “exchanges”) and to receive a robust discount on their premiums (through a refundable “premium tax credit”). The Affordable Care Act will also help people who have insurance by protecting them from high deductibles, high copayments, and unexpected gaps in their insurance coverage.
The health care law provides to all Americans several new benefits and protections. The law increases efforts to reduce disparities in the health care system by investing in research about health disparities; expands initiatives to increase the racial and ethnic diversity of health care professionals; strengthens training among providers to focus on cultural issues.
The law invests in primary care professionals to ensure that all Americans have access to primary care providers and invests in health care innovations, such as community health teams, to help people manage chronic conditions, such as diabetes, high blood pressure and heart disease.
On accessibility, people without insurance, small businesses and self-employed individuals will be able to buy private health insurance through state-based health insurance exchanges. The exchanges will be in place by 2014. Uninsured people who are eligible for insurance through an exchange but do not buy it will be subject to a penalty.
The law provides access to insurance coverage before 2014 for people with pre-existing conditions who have been uninsured for at least six months. This coverage — commonly referred to as the “high-risk pools” — is now available in our state. This coverage will continue until the health insurance exchanges begin in 2014, at which time all insurance plans will be required to cover pre-existing conditions.
If you have Medicare, you’ll qualify for a new annual wellness visit, as well as mammograms and other screenings for diabetes or certain cancers.
If you reach the Medicare Part D coverage gap or “doughnut hole,” you will receive discounts on the prescriptions you fill while you’re in the gap: 50 percent on brand-name drugs and 7 percent on generics. (In 2012, the discount on generics increases to 14 percent.) The gap will gradually narrow until it disappears in 2020.
Starting in 2014, if you earn less than about $58,000 for a couple, or about $43,000 for an individual, you will receive tax credits to help you pay for health insurance bought through an exchange. (Higher income levels apply in Alaska and Hawaii.)
As for long-term care, if your husband or wife is on Medicaid and receiving care services at home, you will have the same protections for your income and other resources as do the spouses of Medicaid recipients who live in nursing homes. This provision takes effect in 2014.
At the Michigan Consumers for Healthcare Special Quarterly meeting held September 26th at Lansing Community College West Campus, Dr. Gail Christopher is vice president for programs at the W.K. Kellogg Foundation in Battle Creek, Michigan.
Gail is a nationally recognized leader in health policy, with particular expertise and experience in the issues related to social determinants of health, health disparities and public policy issues of concern to African Americans and other minority populations.
The mission of Michigan Consumers for Healthcare (MCH) is to work collaboratively with a diverse alliance of consumers, partners and policymakers to attain affordable, accessible, quality healthcare for everyone in Michigan through education, outreach, advocacy and stakeholder engagement. MCH works to build a healthy future in which:
• Healthcare is fundamental and is accessible for everyone
• Healthcare and health insurance coverage options are affordable for all people
• Healthcare and health insurance coverage options provide access to quality care that is effective, efficient, patient-centered, equitable and culturally appropriate for our diverse population
• Consumers are actively involved in every level of healthcare decision makingConsumers and their champions shape healthcare policy and regulations to advance and improve our healthcare system
This was printed in the October 7, 2012 – October 20, 2012 Edition
