An Overview of The Affordable Care Act

The Affordable Care Act dated 9/10-13 by Judy Balsanek, Public Policy Chair

  1. NewBurstHow the Affordable Care Act Improves the Lives of American Women
    By Kathleen Sebelius, Secretary of Health and Human Services
    Posted October 24, 2013
    http://www.hhs.gov/healthcare/facts/blog/2013/10/affordable-coverage-women.html
  2. NewBurstDemocrats call for changes to Obama’s health care law
    By Tony Pugh and David Lightman — McClatchy Washington Bureau
    Published: October 23, 2013
    http://www.mcclatchydc.com/2013/10/23/206280_democrats-call-for-firings-changes.html#storylink=cpy

“AAUW’s member-adopted Public Policy Principles support ‘quality affordable health care, the right to privacy, and choice in the determination of one’s reproductive life.’  When the Affordable Care Act was signed into law in March 2010, AAUW believed that, although not perfect, many of the law’s reforms would improve the collective health of the American people. It is our hope that the elimination of preexisting conditions and gender rating in the individual and small groups markets will result in better outcomes for more women. However, AAUW remains concerned that the ACA’s restrictions on abortion coverage will undermine reproductive health care.”  (Beth Scott, AAUW Regulatory Affairs Manager)
http://www.aauw.org/resource/aauw-comments-on-affordable-care-act-insurance-market-reforms/

“All Americans, as a basic right, should have access to quality affordable health care. Failure to provide for and protect that right has had numerous consequences over time, such as dismal health outcomes for Americans compared to the rest of the developed world and excessive indirect costs that take a substantial toll on the economy. Women disparately feel these negative outcomes, as they comprise a larger share of health care consumers, often manage multiple chronic conditions and pay more out-of-pocket costs, causing their health care to be prohibitively expensive and frequently unaffordable.

When the Affordable Care Act was signed into law in March 2010, AAUW believed that, although not perfect by any stretch, many of the law’s reforms would improve the collective health of the American people. Many of AAUW’s health care priorities were directly addressed in the final legislation. It is our hope that the full implementation of the ACA’s requirements will result in better health outcomes for women. “  (Lisa Maatz, AAUW Director, Public Policy and Government Relations, 12-19-12)
http://www.aauw.org/resource/aauw-comments-on-affordable-care-act-insurance-market-reforms/


DID YOU KNOW?

Even if you already have health insurance, since The Affordable Care Act was signed into law in 2010, you’re getting benefits because of “Obamacare”:

  • 71 Million Kids & Adults with Private Insurance Have Received No-Cost Preventive Care
  • Discrimination by Insurance Companies for Children with Pre-Existing Conditions Was Banned
  • Consumers Received $1.1 Billion in Rebates from Their Insurance Companies
  • 3.1 Million More Young Adults Have Health Insurance through Their Parent’s Plan
  • Seniors Have Saved More Than $6.1 Billion on Their Prescription Drugs Since 2010.

Open Enrollment

“The major provisions of the Affordable Care Act (which aims to ensure that all Americans have health insurance) will go into effect Jan. 1, 2014.  The next significant step in implementing the law is the open enrollment process for health care coverage, which begins Oct. 1, 2013.

Open enrollment is an opportunity for people without insurance to explore different options and determine which is right for them.  Coverage begins on Jan. 1, 2014 for new enrollees.  ‘Consumers will have many avenues for exploring coverage options,’ NASW Senior Practice Associate Stacy Collins said.

At the federal level, the ‘health insurance marketplace’ website (www.healthcare.gov) is a portal where individual and families can determine their eligibility for different health insurance programs, including Medicaid, the Children’s Health Insurance Program and qualified health plans within their states, Collins said.

‘The Marketplace portal is a great tool for people to review and compare insurance plans and determine the best fit, based on their needs and budgets,’ Collins said, adding that many people will qualify for federal tax subsidies to purchase plans on the health insurance marketplace, depending on their incomes.

Each state will also have its own enrollment system, using health insurance navigators and application counselors, to assist consumers in enrolling in coverage. In addition, many states will have their own insurance marketplace portals.”  (Rena Malai, NASW News Staff, September 2013)
https://www.socialworkers.org/pubs/news/2013/09/affordable-care-act.asp?back=yes


New Health Insurance Marketplace

Beginning October 1st, Americans will be able to shop for health insurance the same way they shop for all the other important purchases in their life.  The Affordable Care Act sets up a new Health Insurance Marketplace where North Carolinians can compare plans and prices side by side then choose the one that fits their needs and their budget.  Through the Health Insurance Marketplace, they will be able to check out a selection of health insurance plans that vary in quality, benefits, price and other important features.  If they don’t have health insurance now, or aren’t getting the kind of coverage they need, they will have an opportunity to get covered.  The new insurance enables North Carolinians to:

  • Get the health care coverage they need when they need it: doctor visits, hospitalizations, preventative care, maternity care, infant care, free annual checkups, prescription coverage, free vaccinations, and more;
  • Not be denied coverage for having pre-existing conditions;
  • Look at plans on the marketplace that have terms explained and costs identified in simple language – no fine print;
  • Find out if they qualify for financial help for their new insurance plan.

Two Insurers will offer Subsidized Policies in North Carolina
In North Carolina, only two insurers will sell subsidized (financial help) policies:  Blue Cross and Blue Shield and Coventry Health Care of the Carolinas.  The Affordable Care Act primarily affects those who are uninsured or those who buy individual policies.  People who have coverage through their employers, Medicare or Medicaid are generally in compliance with the federal insurance mandate.

Earlier this year, North Carolina officials, in deciding not to cooperate with the Affordable Care Act, declined to extend Medicaid coverage to about a half-million people in our state.

States that are actively promoting the Affordable Care Act received substantial federal grants for outreach and enrollment.  North Carolina turned away about $27 million in federal assistance for promotional activities.

As a result, North Carolina’s outreach and enrollment are being handled by hospitals, nonprofits, volunteers and local agencies.  Those efforts will receive about a quarter of the federal funding the state would have received if officials here had endorsed the program.

North Carolina health officials have cleared local social service agencies to help the public shop for subsidized insurance under the Affordable Care Act.

The local health departments are bracing for an influx of people seeking help and advice on Oct. 1, the beginning of a six-month enrollment period for mandatory insurance under the new health care law. The complex law includes federal subsidies to offset household insurance costs, as well as fines for those who don’t get insured.

“As many as 1.5 million people in North Carolina will begin shopping for health insurance, the N.C. Department of Health and Human Services said in a letter this week to all county social service and public health directors.

Although North Carolina officials disavowed the Affordable Care Act earlier this year and won’t cooperate in promoting the law, they are open to social service agencies allowing trained “navigators” at their facilities to assist the public.

The navigators, funded by federal grants, are part of the new law’s outreach and enrollment program.

“We encourage all Social Services Agencies to allow navigators to work onsite if your facility can accommodate them,” DHHS wrote to the agencies on Wednesday.

“This will provide valuable assistance to those who are interested in purchasing a plan through the federal exchange.”

N.C. OKs help with health care law, ‘Navigators’ to advise public on enrolling, posted 9/20/2013
http://digital.olivesoftware.com/Olive/ODE/NewsAndObserver/

Telling the Health Care Coverage Story (In North Carolina)
890,000 could enroll

“Oct. 1 is the start date for enrollment in private health care coverage offered through a federally run insurance marketplace (part of the Affordable Care Act, ACA).

Roughly 890,000 state residents could purchase coverage, according to the Society of Actuaries.  In 2011, 300,000 North Carolinians ages 50 to 64 were uninsured, according to the AARP Public Policy Institute.  Of those, nearly 120,000 low-income residents ages 50 to 64 could have been covered if North Carolina had accepted the federal offer to expand Medicaid. “We will continue advocating for this group,” said Mary Bethel, AARP North Carolina associate state director for advocacy.

AARP North Carolina is planning tele-town halls for members this month and in November, said Audrey Galloway, associate state director for community outreach. The calls will focus on how the ACA might affect members and their families and where to find assistance in navigating the marketplace.

Pam Silberman, president and CEO of the North Carolina Institute of Medicine, a state agency, said, “People are feeling stressed, overwhelmed, worried, confused and hopeless when asked about trying to purchase health insurance.”

Discrimination prohibited
Specifics can help allay fears. People who have insurance that meets the law’s requirements are being reassured they can keep what they have and that the new law limits increases in premiums. They’re also being told that as a result of health insurance reform insurers won’t be able to deny coverage or increase rates because of an applicant’s preexisting health condition, gender or occupation.

The marketplace will provide standardized information—including benefits and costs—to help consumers and small businesses choose among qualified health plans and determine their eligibility for subsidies. For example, single people with no dependents who earn up to about $46,000 and a family of four with an income of up to about $94,000 could be eligible.

The plans offered through the exchange must cover basic health care such as doctor visits, hospital stays and prescription drugs. They can’t charge a copayment for preventive care such as mammograms, Pap smears and blood pressure or cancer screenings.

The ACA also eliminates most annual and lifetime coverage caps. Adult children are able to stay on their parents’ insurance until age 26.

Older people who buy private insurance before they are eligible for Medicare at 65 can’t be charged more than three times the rate of younger customers’ premiums.

For those covered by Medicare, the ACA gradually closes the “doughnut hole” in Medicare Part D prescription drug coverage.

During the summer, insurance companies submitted proposals to each state’s marketplace. In North Carolina, the plans and prices will be determined this month.  (September 2013)  Some insurers are likely to offer plans statewide; others may offer plans only regionally.  Coverage will begin Jan. 1 for those who enroll by Dec. 15.  For later enrollees, coverage will begin about a month after they sign up.

The ACA requires almost all Americans to have health insurance beginning next year or pay a penalty of at least $95 on their federal tax return.

To learn more about how the Affordable Care Act affects you, go to healthlawanswers.org.
Lisa H. Towle is head of Liskar Communications and a freelance writer based in Cary, N.C.
Lisa H. Towle, Posted on 08/29/2013 by TheAARPBulletin
http://states.aarp.org/telling-the-health-care-coverage-story/


Additional Recommended Readings:

What is the Health Insurance Marketplace?
https://www.healthcare.gov/what-is-the-health-insurance-marketplace/#state=north-carolina

Are You Ready? The Health Insurance Marketplace is Coming (for Women)
http://marketplace.cms.gov/getofficialresources/publications-and-articles/relaunch-drop-in-article-women.pdf

Affordable Care Act Training Materials:
http://marketplace.cms.gov/getofficialresources/training-materials/training-materials-links.html

webcasts schedules re. the Affordable Care Act:
http://marketplace.cms.gov/NewsEvents/Webinars/Spring-Summer-2013-Health-Insurance-Marketplace-Training-Schedule.pdf

Your Affordable Care Act Questions, Answered
http://www.aauw.org/2013/09/04/aca-questions-answered/

Comments on Affordable Care Act Insurance Market Reforms
http://www.aauw.org/resource/aauw-comments-on-affordable-care-act-insurance-market-reforms/

Affordable Care Act – Open enrollment begins Oct. 1 https://www.socialworkers.org/pubs/news/2013/09/affordable-care-act.asp?back=yes

Our Views:  Against the law
http://digital.olivesoftware.com/Olive/ODE/NewsAndObserver/

NC OKs subsidized insurance plans for online healthcare market
http://www.newsobserver.com/2013/07/30/3070302/nc-oks-subsidized-insurance-plans.html#storylink=cpy

Kaiser Family Foundation ‐ one of the best sources for nonpartisan information about health care reform. Website includes a great summary of the ACA, a comparison of the ACA and alternative legislation, and a detailed timeline for the ACA’s implementation.
http://www.kff.org/healthreform/8061.cfm
http://www.kff.org/healthreform/sidebyside.cfm
http://www.kff.org/kaiserpolls/trackingpoll.cfm  (latest health care tracking opinion polls)
http://www.statehealthfacts.org/  (State Health Facts)

Kaiser Health News – updates on health reform news. http://www.kaiserhealthnews.org/