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Health Care Forum & What I Learned....by Heather Rayne

11/01/2013



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I have recently written about the Affordable Care Act. Since writing that, I have learned some additional details...



This past week, I had the educational pleasure of attending a great forum put on by the wonderful volunteers with Enroll Racine. This was a health care informational forum presented by Kevin Kane from Citizen Action of Wisconsin. It was extremely interesting and informative so I thought I would share with you what I have learned.

A few components of the ACA are already in effect. And others are to follow January of 2014.

One example of something that is currently in effect is the rule that children cannot be denied or charged higher rates for pre-existing conditions. January of 2014, this will be true for EVERYONE. Before ACA, it was legal for insurance companies to deny children with cancer and other pre-existing conditions. It is now illegal for them to do so.

Pre-existing conditions can mean a whole pluthera of things from acne to stress to pregnancy. There is a list as long as my arm of conditions which could lead to insurance companies to denying or dropping customers. More than 1.3 million Wisconsinites under the age of 65 have been diagnosed with a pre-existing condition.
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In fact, simply being a WOMAN has been considered a pre-existing condition for many years. Right now, women pay up to 50% more than men for the exact same coverage - just because of their gender. Beginning in 2014, this will be illegal.

Also in effect now, anyone 26 years of age or under can be covered under their parent's health insurance policies. Because of this rule, it is estimated that over 6 million people are now covered due to this rule.

The ACA ensures that Americans will have the opportunity to take responsibility for their own health care coverage by making insurance accessible and affordable. It also holds insurance companies accountable for their practices. Beginning 2014, Congress will be required to choose from the same exact plans offered to all American citizens. It will be in their own best interests to keep these practices honest and ethical.

Because of the ACA, preventative care and screenings will be covered with NO deductible and NO co-pays. Preventative care is the most crucial step in our health care. Screenings, testing and wellness visits are far cheaper - for everyone - than the treatment of advanced illnesses. Not to mention, it will save lives.

A friend of mine, a woman in her 50s, is now suffering from colon cancer. Colo-rectal cancer runs in her family and she was at an increased risk. However, because she did not have insurance, she did not get a colonoscopy at the recommended age of 50 (earlier with family history). This screening would have caught the cancer early enough to avoid the multitude of surgeries and treatments she is now enduring.

There will no longer be lifetime limits on insurance plans. There are many cases in which children have met their lifetime limits before entering adolecence. If someone is diagnosed with a chronic or severe illness, it is easy to approach those limits very quickly. Medical bills are the leading cause of bankruptcy in this country. Lifetime limits will no longer be an issue.

Not only will it now be illegal for insurance companies to deny a person coverage, it will also be illegal for them to drop a customer if an illness is diagnosed. This has been a very common practice. It will be no longer.

By holding the insurance companies accountable, there will be caps on overhead and excessive profits. This will keep premiums down and used for actual healthcare and not paperwork or CEO bonuses.

The new marketplace, which will provide insurance plan options to consumers, works much like travel sites such as Travelocity or Expedia. When you log on, you will be able to enter your information and chose from different plans, companies and levels of coverage.

The marketplace is NOT for people on Medicare. Medicare will not change aside from the fact that there will be more oversight. But those on Medicare will not be affected by the ACA.

These marketplaces were designed to be set up by each individual state. However, because our Govorner chose to challenge the ACA and not comply, Wisconsin (and states in similar situations) has a marketplace set up by the federal government.

The cost of insurance premiums will be subsidized with an IMMEDIATE tax credit (subtracted directly from your premium cost) based on a sliding scale depending on income. There will also be insurance co-op options. These co-ops are non-profit and will keep the premium costs down due to competition.

Unfortunately, there are those who fall into a gap which should have been covered by Wisconsin's Badgercare system instead of the ACA Marketplace. When Walker denied the ACA funding, he denied Wisconsinites billions in federal money which was to cover those who fell into this gap. Because of that, 98,000 low income earners have been or will be kicked off Badgercare. This also added an extra $149 million to the state budget. Wisconsin CAN accept this funding at any time. It is not too late. This is crucial and something we cannot stop fighting for - but I will talk about that later.

Luckily, these people who are being denied Badgercare will have access to the ACA Marketplace. But it may be more difficult for them to afford the premiums. Again, this really needs to be something we fight for and yell about. LOUDLY. We must demand that Wisconsin takes this federal funding we - as tax payers - have coming to us. States which have complied with the ACA - states which have set up their own marketplaces - have been able to offer much more affordable plans. By not taking this funding - it hurts everyone.

There are 4 levels of plans - bronze, silver, gold and platinum. There is also a catastrophic plan as an option. The cheaper the plan, the higher the deductibles/co-pays. However, you should remember that preventative care is covered with no deductible or co-pay. So if you are young and in decent health - a lower premium plan may be all you need right now. Just make sure you keep up with your preventative care!!

We all know there have been glitches in the Healthcare.gov website. However, they are not as dire as reported. Many, many people have been able to register and enroll. It may just take a little patience at first. Things will begin to work smoothly. You can also look at the plans available to you before you even register. Simply visit www.healthcare.gov or you can call 1-800-318-2596 to talk with a person who will help you enroll. Citizen Action of Wisconsin also has a helpline 1-855-318-2596.


Next week I will attend a training on Badgercare. I will share with you what I learn there as well.

http://purplerayne.weebly.com/5/post/2013/11/health-care-forum-what-i-learned.html