Affordable Care Act enrollment goes into effect Oct. 1, and many uninsured Houstonians will begin comparing new health insurance rates. Texas has the highest rate of uninsured in the country, and 28.8 percent of adults in the state lack healthcare coverage.
President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law in March 2010. It makes preventative care and other types of medical care more accessible and affordable to a larger portion of Americans.
Some provisions of the ACA – dubbed “Obamacare” – have already taken effect while others are still in the works, as federal, state and local agencies continue to fine-tune the process.
To inform Houstonians about the ACA, a forum titled “Healthcare in a Changing Landscape” was recently held at the University of Houston, and sponsored by the Children’s Defense Fund, Texas Organizing Project, Get Covered America and the Center for Children, Law & Policy.
Participants included State Rep. Garnet Coleman, Congresswoman Sheila Jackson Lee, State Sen. Sylvia Garcia and Jeness Sherrell, a Change Happens program coordinator. Change Happens is one of eight Texas organizations awarded navigator grants to assist consumers with enrolling in health insurance marketplaces.
Coleman worked with the White House on the ACA, and took the lead on behalf of state legislators in favor of the law.
“The Affordable Care Act probably benefits African-Americans more than anyone else,” Coleman said. “We have a high rate of being uninsured, and also have a high rate of illnesses, such as diabetes, heart disease, hypertension and stroke.
“If people enroll through the exchanges, they will get a health insurance policy that fits their income. Before, people who had pre-existing conditions would have a hard time getting insurance.”
Coleman said the bigger misconception about the ACA is that individuals cannot afford the insurance. “The premiums are actually less for the exchange,” he said.
Exchanges are another word for state, federal, or jointly run online marketplaces for health insurance. Navigators, who act as customer service representatives, will assist with finding the appropriate insurance based on need and income.
The exchanges will offer plans that fall into one of four categories: bronze, silver, gold or platinum.
Bronze plans have the lowest premium available, and 60 percent of health care costs will be paid by the insurer. Under silver plans, insurance companies will cover 70 percent of medical costs. Gold plans will cover 80 percent of medical costs. Platinum plans will have the highest premiums and cover 90 percent of costs.
Those with limited incomes and those under 30 can purchase a “catastrophic” health plan, which protects from high medical costs. Catastrophic plans include three primary care doctor visits per year and free preventative care at no cost to the insured. However, cost assistance is not available under the plan.
Change Happens will assist residents in Harris, Brazoria, Fort Bend, Montgomery and Galveston Counties.
“The navigators will have the responsibility of maintaining expertise in eligibility, enrollment, and program specification, as well as conduct public education activities to raise awareness about the exchange,” Sherrell said.
The Third Ward non-profit will also seek to educate consumers who believe health insurance is not a necessity.
“Outreach will have to include more education on why insurance is important and the benefit of taking advantage of preventative services,” Sherrell said. “It’s not just a matter of going out and saying ‘This is what’s available.’ You have to explain why it’s necessary.”
Jackson Lee stressed that under the ACA, insurance companies will no longer be able to deny coverage based on pre-existing medical conditions.
In addition, “No insurance can prevent you from getting preventative care, such as mammograms and [wellness] exams for men.”
Jackson Lee reminded consumers to beware of scams. Attempts to defraud consumers have already been reported, as scam artists attempt to illegally gain access to personal information such as Social Security numbers, credit cards and bank accounts.
“Please do not send money to anyone if you are looking for information,” she said. “The only money you will pay is to the insurer who has a package you want.”
The above article is in Volume 82, Number 46 (September 12, 2013) of the Defender newspaper in Houston, Texas.