When the Affordable Care Act was originally passed in 2010, not only were there disagreements on the effectiveness of the bill, but it took a recent Supreme Court decision to set the record straight.
While some are debating the semantics of the comprehensive reform that is said to improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices, others are looking for the bill to close some inequality gaps and lower disease rates that Blacks disproportionately suffer from.
The ins and outs
While there are various aspects to the Affordable Care Act, some major factors include:
n Provide insurance: An estimated 44 million Americans are uninsured. Under the law, some would be able to receive Medicaid while others would receive tax credits to help buy private insurance. Those who do not choose to purchase insurance will pay a penalty to the Internal Revenue Service that will gradually increase until 2016. There are some exemptions to this penalty.
n Medicaid expanded: States have a choice to expand Medicaid eligibility. The federal government agreed to pay the full tab for the Medicaid expansion when it begins in 2014. But after three years, states must pay a gradually increasing share that tops out at 10 percent of the cost. At Recorder press time, it was unclear as to what the State of Indiana will decide. However, according to the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured, the expansion of Medicaid under the health reform law will significantly increase the number of people covered by Medicaid in states across the country.
n State exchange: States have until the end of the year to create online insurance. It must be fully operational by 2014. In Indiana, there is a framework being built for this, but nothing has been set in stone.
n End to pre-existing condition discrimination: The law will prevent insurance companies from selectively choosing enrollees and denying claims because of pre-existing conditions, and incentivize more health care providers to work in medically underserved communities.
n End to coverage cancellations: Insurance companies can no longer drop coverage when the policy holder gets sick or makes a mistake on an application.
n Strengthening Medicare: Nearly 50 million older and disabled Americans rely on Medicare each year, and the new health care law makes Medicare stronger by adding new benefits, fighting fraud, and improving care for patients such as lowering the cost of prescription drugs.
n Note: Many of the bill’s provisions don’t go into effect until 2014.
‘Its hard to pay’
Prior to receiving Medicare, Ann-Marie Johnson had not had insurance for over 10 years. Her leukemia has caused her to have several surgeries in two years and the bills continue to pile up.
“I’m retired so I don’t have any extra money coming in,” said Johnson. “I feel terrible that I can’t pay my 20 percent (for Medicaid). It’s hard to pay. I feel that once you become a certain age you shouldn’t have to pay. If you’ve worked all your life, like me, and draw Social Security, it’s still not enough to pay these medical bills.”
In addition to her doctors and hospital bills, Johnson averages about $150 a month in prescriptions. Because of the high costs, she is unable to regularly purchase and take her medications as prescribed by her physician.
She and her husband, Bill, have also tried to receive other types of local and state assistance but have had no success.
She said that she hopes that not only does the Affordable Care Act provide her some relief, but also help her family, many of whom are uninsured.
“I really hope they take advantage of this,” she said.” In the meantime, everyday I wake up and can move, walk, talk, hear and see, I just thank the Lord.”
Providing an opportunity
Research shows that Blacks are more likely than whites to live in high-poverty communities, areas that have historically suffered from a lack of health care opportunities contributing to fewer primary care providers, hospitals and clinics.
Many of these communities face additional barriers to health care such as high levels of air, water and soil pollution, and lack grocery stores well stocked with fresh fruits and vegetables.
People of color face poorer health than the general population in the form of higher rates of infant mortality, chronic disease, such as diabetes and hypertension, and disability and premature death. Most importantly they lack the health insurance and additional finances to seek continuous health care.
“We certainly hope this bill closes those inequality gaps. It remains to be seen how our Legislature and new governor will implement new changes,” said Katie Humphreys, system vice president for advocacy for St. Vincent Health.
Matthew Gutwein, president and CEO of Health and Hospital Corp. of Marion County agrees and said although Wishard/Eskenazi Health’s core mission is to aid the underserved, they have been preparing for upcoming changes.
“People need to pay attention to this legislation, understand the way people are talking about it and ask questions of our elected officials on the why, how and when and hold them accountable,” said Humphreys.
The Affordable Care Law is said to improve access to health insurance for more than 32 million Americans. Gutwein said that there is medical evidence that when people have health care coverage as a whole, their health improves over their lifetime. Many hope people, especially Blacks, take full advantage of this opportunity to help lower disease rates.
“The No. 1 health issue in our community centers around obesity. This then leads to many other illnesses such as diabetes and heart disease. We hope that broad coverage and access to physicians will help people live a healthier life,” said Gutwein.
The health care act does offer relief and encourages primary and preventive care, but Gutwein said that people should remember that people will still get sick and there will still be some costs involved such as premiums, co-pays and general medical bills. Despite this, it’s up to individuals to truly make the new law work.
“Your personal health involves many things outside of what the doctor says. We hope people work hard to exercise, eat a healthy diet, quit smoking, drink moderately and take good care of ourselves,” said Gutwein.
Additional sources: whitehouse.gov/healthcare; Kaiser Family Foundation; and the Associated Press.