By Faith Camp, NDG Contributing Writer
Imagine being diagnosed with a disease such as cancer and having to ask your doctor how much time you have left to live because you cannot afford the treatments. Imagine having to choose between feeding your children and paying for your medical bills.
These are not just scenarios, but this has been the reality of many Americans for decades.
Since the beginning of his first term, President Barack Obama has been working on changing this on behalf of millions of American families. The Affordable Health Care Act (AHCA or the Act) was created to make health care not just a privilege but a right nationwide. The Act officially went into effect on Oct. 1 with an open enrollment period spanning until March 2014.
The purpose of the Act is to make healthcare accessible and feasible for more Americans by decreasing the amount of cases where insurance companies charge astronomical fees for minimal services. It will also prohibit health insurance companies from denying or dropping coverage for individuals who have pre-existing health conditions.
Congresswoman Eddie Bernice Johnson praised the Act and said, “Insurance companies will be forced to end some of their most egregious policies: their implementation of large, unjustified premium increases caps on the amount of coverage a person can receive; and their practice of dropping people from coverage when they get sick.”
One phase of the Act implemented earlier allows young adults to stay on their parents’ health insurance until they are 26 years old. Reverend Laresa Tyson, a member of Texas Organizing Project, said this is very beneficial to young adults and their families.
“These young adults, many of whom are balancing studies and jobs, will have added peace of mind knowing that they can stay on their parents’ health plan until the age of 26. This added security will definitely be a relief to many parents as well.”
According to the U.S. Department of Health and Human Services report on the AHCA, individuals will also have more healthcare options. Texans alone will have 54 different plans accessible to them. These plans are categorized into four different categories and listed under the Health Insurance Marketplace.
The report also stated, “healthcare plans and premiums nationwide will be around 16 percent lower than original stated, “the majority (around 6 out of 10) of the individuals who are uninsured today will be able to find coverage for $100 or less per month in the Marketplace taking into account premium tax credits and Medicaid coverage.”
The plans under the Marketplace are categorized as:
Platinum
Gold
Silver
Bronze.
People who plan to visit the doctor frequently may want to select the Gold or Platinum plan. Both plans require a higher premium but offer lower costs for doctor visits or medical services.
On the other hand, the Silver and Bronze plans offer lower premiums, however, if an individual on one of these plans requires emergency care or hospitalization, they will have to pay a higher medical bill.
While the four plans differ, they all cover the following services:
Ambulatory patient services, Emergency services, hospitalization and surgery
Maternity and newborn care, Mental health and substance use disorder services, behavioral health treatment, counseling and psychotherapy
Prescription drugs, rehabilitative services including devices to help people with injuries and disabilities, laboratory services and chronic disease management
In addition to the Marketplace plans, individuals under the age of 30 or with a limited income can purchase a catastrophic health plan. This plan is described as providing a safety net for individuals who cannot afford marketplace plans but want the peace of mind of knowing they will be covered in the event of an emergency issue.
For example, studies show on average a broken leg for an uninsured person is $7,500. An individual who cannot afford the premiums for a regular health plan has the option of selecting the catastrophic plan in the event they ever experience sudden illness or need emergency treatment for an ailment such as a broken leg. Although premiums for catastrophic plans many be lower than regular health plans, the deductibles and out-of pocket costs for medical attention will be much higher.
Reverend Tyson speaking on behalf of the Texas Organizing Project and referring to the plans said the organization, “fully supports the implementation of the Affordable Care Act and believes that the law will improve the overall health of our Texas communities.”
She elaborated, “Texas families deserve access to affordable health care but sadly, nearly 1 out of 4 Texans – 6.3 million people – has no health insurance, the highest rate of uninsured in the nation.”
The Health and Human Services report listed an example of how one of the Marketplace plans would affect Texans:
“For a family of four in Texas with an income of $50,000 per year, the lowest bronze plan would only cost $57 per month.”
In addition to providing more health care options and making the Marketplace plans more affordable for Americans, AHCA will extend coverage and increase transparency in existing programs, particularly, Medicaid and Children’s Health Insurance Program (CHIP). AHCA extends funding for CHIP from 2015 until 2019 and allows more transparency with state and federal Medicaid waivers.
Under the AHCA, Medicaid providers which have been terminated in other programs will be banned from participating and the Act will prevent inappropriate payment of claims under Medicaid if charges are against the providers have been investigated and proven to be fraudulent.
In order for the Act to make healthcare more affordable and accessible to the American people, statistics show we will need approximately 2.7 million young healthy adults to sign up for the plan. Approximately 7 million people are expected to sign up for the plan by 2014.
Congressman Marc Veasey advocated for the AHCA sharing, “As Health Insurance Marketplaces come online next week, it is vital that we continue to educate American consumers, dispel partisan myths, get the uninsured enrolled in the federal marketplace in Texas, and keep them properly informed on the benefits of the health care law.”
He added, “My goal is to continue to fight for all uninsured citizens in my district, in our state, and across the country to make sure affordable health insurance is within reach for everyone.”
For more information on the AHCA, please visit Medicaid.gov or healthcare.gov.
