Four Gifts the Affordable Care Act Has Given Americans by Its Fourth Birthday

On March 23, 2014, the Affordable Care Act (ACA) turned four. In its relatively short life, the ACA has already accomplished a great deal. To celebrate, here’s a list of the top four gifts that the ACA has given to the American people:

1. No More Pre-existing Condition Exclusions

Before the ACA was law, insurance companies routinely denied people health coverage due to“pre-existing conditions,” which could range from common chronic conditions such as asthma and arthritis to diseases such as cancer or mental illness. However, as of September 2010, children could no longer be denied coverage due to a pre-existing condition, and as of January 2014, adults are now enjoying that same right.

By way of example, on HelpHub, the Illinois site that provides technical assistance to enrollment specialists, we have heard many stories about people who are beginning to obtain insurance after being told for years that they are were “uninsurable.” Families USA estimates that 64.8 million non-elderly Americans—or 1 in 4 people—have been diagnosed with pre-existing conditions that could have led to denials of coverage in the past. That’s over 5.6 million people in Illinois alone who can no longer be turned down or charged more for health insurance.

Though over half of the public know about this “gift” from the ACA, according to a January 2014 Kaiser Family Foundation tracking poll, 53% of the uninsured remain unaware of this provision. We need to continue to publicize this incredible benefit of the law.

2. Financial Help to Obtain Insurance

Aside from pre-existing condition exclusions, another major barrier to accessing health insurance has been cost. Since employers have not been required to offer coverage, many low-wage workers never received an offer of coverage and were priced out of the individual insurance market.

Through the new Health Insurance Marketplaces, the ACA created three new ways to make health insurance more affordable. The first is premium tax credits, which can be taken by Marketplace consumers in advance to lower the amount of premium the individual or family must pay for their coverage. Consumers with incomes under $45,960 for a single individual and $94,200 for a family of four are eligible for these credits. The Department of Health and Human Services reports, for example, that nearly 5 in 10 uninsured single young adults eligible for the Marketplace could pay $50 or less per month after tax credits for coverage in 2014.

The second form of financial help provided by the ACA is cost-sharing reductions. These reduce the out-of-pocket costs, such as deductibles, copays, and co-insurance, that health care consumers can expect. Cost sharing reductions are available to health insurance Marketplace consumers who make between 100% and 250% of the federal poverty level who purchase a Silver plan. Why does this matter? It means lower prices for doctors’ visits, prescription drugs, and other care that people need—which is particularly important for people who utilize a high amount of services.

Recent enrollment numbers indicate that people are signing up for these subsidies, too. As of February 2014, 85% of Healthcare.gov enrollees qualified for premium tax credits, while 67% consumers chose Silver plans, indicating that they may also qualify for cost sharing reductions.

3. Medicaid Expansion

The ACA mandated a Medicaid expansion to all qualified adults below 138% of the federal poverty level (about $15,800/year for a single individual); this mandate filled a huge coverage gap in Medicaid eligibility for low-income adults. In June 2012, however, the United States Supreme Court made this expansion optional, and currently just half the states and Washington, D.C., have expanded Medicaid. Illinois is one of those states; last July, Governor Quinn signed the Medicaid Expansion (SB 26) into law, and according to reports at the recent Illinois Health Reform Implementation Council meeting enrollment into Medicaid has already exceeded expectations.

The number of Illinois residents enrolled in ACA Adult Medicaid is now at 200,000. This includes all Supplemental Nutrition Assistance Program (SNAP) auto-enrollment and enrollment in CountyCare, the early expansion of Medicaid in Cook County, the largest county in Illinois )which includes Chicago and some of its collar suburbs). Of pending applications, the state expects another 150,000 will be eligible for ACA Adult Medicaid. Overall for 2014, it is anticipated that Illinois will enroll over 400,000 adults into the new Medicaid program. 

Together, the Premium Tax Credits, Cost Sharing Reductions and the ACA Medicaid Expansion provide low-income families with the gift of affordable health care. 

4. Essential Health Benefits

The ACA gift that people probably know the least about is the 10 Essential Health Benefits (EHB) that must be included in Medicaid and health plans in the individual and small group markets. Under EHB, not only must plans now include a range of free preventive services and screenings, but also prescription drugs, lab tests, dental and vision care for children, and mental health and substance use disorder services, among other critical services. The Essential Health Benefits package ensures comprehensive services are included in your policy so you aren’t left paying premiums for shoddy coverage.

These gifts have already started to make a huge difference to the American people. The uninsured rate is decreasing; and stories from around the country are streaming in about people who are able to see a doctor when they hadn’t for years, families who are able to afford their premiums every month, and individuals who finally have peace of mind because they have a good health insurance policy when they need it.

We can’t wait to see what the next four years of the ACA brings.

The Obamacare Lady: What made me want this job?

Last year, I accepted a position to be an In-Person Counselor with the State of Illinois. You may also have heard the terms Navigator or Assister used to describe this job. I help people with the Affordable Care Act. A few people have called me, “The Obamacare Lady.”  Yes, I help people understand “Obamacare” and help them determine what help they may qualify for in obtaining health insurance.

What made me want this job you ask? Well, I was drawn to this job for a number of reasons:

First, I like helping people. Prior to starting the training for this job, the only thing I knew about the Affordable Care Act was that it would help people like my Mother get cheaper healthcare. My Mom had a heart attack a few years ago and since then, her health insurance premiums went through the roof. And by roof, I mean they were more than a mortgage payment on a 3 bedroom house!! Yikes! That seemed crazy to me. So, I wanted to do this job to help people like my Mother and clients like Kathy. Kathy* is a small business owner and has a pre-existing condition. Her business has been quite profitable in the past, but since 2008, things have been rough. Due to the high costs of health insurance, especially with her pre-existing condition, she could not afford to pay her rent and eat if she purchased a health plan. So, she hasn’t had health insurance for years. She has been going without her medication and has just been hoping that her condition has not progressed. We met and completed an application together and found out that she is eligible for a tax credit and reduced out of pocket expenses.  She is thrilled to be able to purchase a health insurance plan for $ 150 a month. These stories are my every day.

Second, I’m all about saving money. I love to shop for the best price for everything. I wait for sales, clip coupons and save my money for a rainy day. I get a little thrill out of helping someone save hundreds of dollars on their health insurance. It’s fun for me.

Third, I like to know the facts. This has been quite the topic of conversation. Almost everyone has an opinion. Over the years, it seems our news sources now always have a particular slant one direction or another. It is pretty difficult to find someone that will give you both sides to a problem or issue. So, my solution was to get boots on the ground and learn about the ACA myself and make my own decisions.

This job is not for the faint of heart. The reason that I have kept this job is that I am persistent and resilient. On a typical day, I get to see a formerly stressed, worried and confused individual walk out of my office with a little less weight on their shoulders, a little more money in their pocket and much more confident about their future. But getting there isn’t always easy. The rules to the Affordable Care Act are complex and each person’s situation is different, but that has been the fun part of being “The Obamacare Lady.” I meet so many interesting people and have a bird’s eye view of the diversity in our state. Illinoisans are beautiful, generous and hard-working.

Back in October, when the website wasn’t working very well, every person asked me if people were treating me okay. They were concerned that someone would take their anger and frustration out on me. Not a single person did. Then, people were concerned about all “those people” that might be taking advantage and defrauding the system. They wanted to make sure there were ways in place to catch the “cheaters.” After a while, all these questions made me laugh. No. Everyone I meet with is just like you. We want the same things. We want to provide things like health insurance for ourselves and our family. We are willing to sacrifice and work hard to do it. We want to obey the law. We want to be honest and tell our truth. We want to pay our own way and don’t want anything for free. Our politics and opinions on this Affordable Care Act are varied to be sure, but the similarities among us are so close. We are too hung up on headlines and sensationalism to see it.    

By Barb Silnes

In-Person Counselor