by Rebecca Kavoussi

Happy Anniversary Affordable Care Act: Today marks the one year anniversary of the Affordable Care Act, and I’m celebrating not only the health reform achievements to date and still to come, but also a welcome shift in our public dialogue from debating whether all Americans should have affordable insurance coverage to how to actually get it done and make it sustainable. This article provides an overview of benefits of the law to date, a preview of what’s to come, and tips on how consumers can navigate the insurance marketplace before all of the reforms are in place.

ACA Accomplishments to Date: Several important consumer protections are already benefiting families in Washington. Children are now allowed to stay on their parents’ insurance plan up to age 26, addressing a common gap in coverage between high school or college graduation and stable employment that offers comprehensive health benefits. Gone are the days when insurance companies could deny coverage to children based on a pre-existing health condition. The federal government has also launched an “insurance finder” at www.healthcare.gov. This website is a prototype of the competitive healthcare marketplace individuals will use in 2014 to shop and sign up for coverage.

Financing assistance has been made available to states, small businesses and individuals to help them bridge to 2014, when major coverage expansions take effect. Washington received a waiver that covers half the cost of the Basic Health and Disability Lifeline programs, which provide coverage to ~70,000 very low-income, vulnerable Washingtonians. Approximately 106,000 small businesses are eligible for 35% tax credits on their tax returns this year to help offset the cost of providing coverage for their employees.

Seniors in Washington have much to celebrate with Medicare. Last year, over 54,000 of them have received a $250 rebate check to help cover the cost of prescription medications in the “donut hole”. This year seniors are seeing savings at the pharmacy as the donut hole is slowly phased out–they are only paying 50% of the cost for brand name drugs. All seniors are receiving a free annual wellness visit that includes a personalized prevention plan, as free preventive services.

What’s to Come? In the next few years policymakers, providers and health plans will be busily working on setting the infrastructure in place to support major coverage expansions in 2014. The federal government is identifying promising health care models in which to invest, with the hope of spreading them across the nation. While this focus on innovations that improve quality and reduce costs are exciting, many individuals face a bit of a wait for the next big phase of health care reform. But there is much worth staying the course for.

• All people making less than $29,000 for a family of four will be eligible for Medicaid coverage in 2014. Today the Medicaid program is only available to children, pregnant moms and the disabled. In Washington, this translates into 400,000-450,000 new insured people, almost half of Washington’s currently uninsured population. Most of these people have previously gone uninsured with little hope for affordable coverage.

• Everyone who has and wants to keep their employer-based coverage will get to keep it. But in 2014 those who are not offered coverage at work or lose their jobs will be able to shop for coverage through a web-based Exchange, a competitive health care marketplace that gives consumers more control and choice when buying insurance. The marketplace will be an easy-to-use website, similar to Travelocity that allows consumers to compare health plans and find the one that best meets their needs and budget. Members of Congress will be required to get their insurance through this marketplace—giving them the same options as millions of Americans. Most importantly, the federal government will provide significant tax credits, scaled based on income, to people making less than $73,000/year for a family of four to make sure coverage is affordable.

• Insurance companies will no longer be allowed to set annual limits on coverage, charge higher premiums for women, deny coverage or charge higher premiums for people who are sick. To make this work, all Americans will be required to obtain coverage, with exceptions only for those who cannot afford it.

• Small businesses will be able to pool their employees with other small businesses to leverage the kinds of discounts reserved for large employers today.

• As a matter of fairness, large employers will pay a shared responsibility fee if they don’t offer coverage to their employers to help ensure that taxpayers no longer foot their bill.

Getting to 2014: For many individuals, 2014 cannot come soon enough. The recession means many have lost their jobs and job-based insurance. They have either lost coverage or are paying astronomical rates through COBRA. Adults with pre-existing conditions may be locked out of insurance altogether.

Just as individuals are anxious for more affordability and security, so are states and safety net providers like community health centers and hospitals. State budgets are crumbling under the weight of the recession-related demand for services. In turn, providers like community health centers are losing state funding as the number of patients needing care is skyrocketing.

Opponents of the Affordable Care Act are criticizing temporary waivers that the Obama administration has granted to some states struggling to implement new regulations during this difficult financial time, claiming that the waivers demonstrate the ACA is not reasonable. I believe these waivers are simply recognition that the ACA does not provide a  one size fits all for every state.  They demonstrate the Administration’s flexibility and recognize the critical importance of maintaining health care infrastructure (providers, clinics, programs) as we collectively transition to major reforms in 2014.

The other distraction is the approximately 20 lawsuits filed by states against the ACA. Federal courts have expressed differing views about the law and by many expert opinions, the law will ultimately end up in the Supreme Court in the next few years. Meanwhile states and the federal government are moving forward with implementation, perhaps with the recognition that the status quo was simply unacceptable.

The only certainty about our health care system prior to the ACA is that costs would go up each year and that each of us faced total uncertainy about our own coverage. While the ACA will require many tweaks and revisions over time, it has taken off the table the issue of whether all people should have access to affordable health coverage. The focus for states, providers, advocates and other health policy thinkers now should be on the things that will make our health care system sustainable over time–improving quality of care, bringing down health care costs, improving patient experiences and encouraging health care providers to deliver the best care possible for the best value.

Tips for individuals navigating the insurance market between today and 2014:

• The Pre-existing Condition Insurance Plan allows uninsured people with pre-existing health conditions to purchase coverage. The PCIP is offered alongside the Washington State Health Insurance Pool, which existed prior to the ACA. Unfortunately, premiums for both programs are still very high, but particularly for those with very expensive conditions, these programs provide a good return on investment for those who can foot the monthly bill.

• If you lose coverage, make sure not to let your coverage lapse more than 90 days. If you re-apply for individual coverage within this time period, insurers cannot deny you coverage based on pre-existing conditions. To understand this better, visit the Office of the Insurance Commissioner’s website on individual insurance.

• You can shop for individual insurance plans with commercial insurance carriers by county here.

• You can look into coverage with the Washington Health Plan, a partnership between the Health Care Authority and Community Health Plan.

• If you are very low income, you and/or your children may qualify for other public insurance programs. Contact Within Reach for help.

• If you are unable to find affordable coverage, community clinics exist in almost every corner of the state, including several in the Rainier Valley. Their mission is to provide high quality, affordable care to all those who need it, regardless of their ability to pay. Charges are based on a sliding-fee scale.

Rebecca Kavoussi is a Rainier Valley mom and Assistant Vice President of Government Affairs for Community Health Network and Community Health Plan, organizations dedicated to expanding access to affordable health insurance and health care to all people living in Washington.

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