Confused About Health Care? Demystifying the ACA act

January 16, 2013

I just had to sign up on new insurance and holy moly was it confusing. I also looked into insurances for small businesses so I can understand options my husband can have for his business , if he had to cover the family on an independent insurance. Parents Magazine had this great article on understanding the ACA act which influences many freelancers and small business owners. I found it quite helpful and was less confused!


Confused About Health Care?

We spoke with Kathleen Sebelius, Secretary of the Department of Health & Human Services, to demystify the Affordable Care Act (ACA). This is what your family needs to know.Edited by Jessica Leigh Hester from Parents Magazine

Parents: Which parts of the act impact women and families?

Kathleen Sebelius: In 2010, preventive services started to be offered without co-pays. This was a way to encourage things like folic-acid supplements, immunizations, and mammograms, because we know that prevention or early detection is cheaper and healthier than treating a problem. Then, in August 2012, we rolled out a series of benefits aimed specifically at women. These include free HIV screening, contraception, and pre- and postnatal maternity benefits such as gestational-diabetes screenings and breastfeeding supplies and support. Too many women have been faced with policies that don’t cover maternity care, and if something goes wrong along the way—they end up with an emergency C-section or they have a baby who has complications and needs to stay in the NICU—it could mean bankruptcy. Beginning in 2014, most plans will be required to cover maternity care and 47 million women will have access to preventive services without out-of-pocket costs.

Under the ACA, will families who already have insurance need to get new coverage?

If you like your insurance, you don’t have to do anything. Your coverage is not going to go away. Otherwise, starting in 2014, when you’re shopping for coverage on your own or you’re a small-business owner who can’t find affordable coverage for yourself or your employees, you’re going to have some additional choices. Each state will have an online Affordable Insurance Healthcare Exchange.

Editor’s note: Consumers will be able to see which plans they’re eligible for, compare plans, and select one online.

What else is ahead that families should know about?

Right now, a lot of women can be charged up to 50 percent more for exactly the same coverage that a man has—even if that coverage doesn’t include maternity care—because the practice of “gender rating” is legal until 2014. But after that, insurers will not be able to charge women more for their health coverage.

Also, starting in 2014, no one can be denied coverage because they have a pre-existing condition. For women, a pre-existing condition could mean you’re a breast cancer survivor, you’re a victim of domestic violence, or you’ve had a Cesarean section in the past. Right now, insurance companies can refuse to insure you or refuse to pay for any kind of complication that may arise in the future from those circumstances. But those rules will change across the board. What I like to say is, “Being a woman will no longer be a pre-existing condition.”

People will also have more flexibility when it comes to leaving their jobs. I know women who work only for the insurance. They may hate their job, but they or a family member have a health condition, and they say, “I can’t leave.” Those choices will be a thing of the past. You will be reassured that, no matter the circumstance, whether you have a pre-existing condition, have difficulty paying for health insurance, or lose or change jobs, the law will help you get access to affordable coverage.

Our reader Kristin Lupo asked, “Will the law help cover expenses for kids with autism or other types of developmental delays?”

There are some specific autism screenings recommended by experts for children at a very young age that will be covered without any co-pay or coinsurance. The ACA will also remove financial barriers for recommended behavioral health services. And a young adult [under age 19] with an autism diagnosis can’t be locked out of the market because of a preexisting condition. In addition, the child may remain on a parent’s plan until age 26, as can any young adult without his or her own insurance coverage.

How will the act affect reimbursement for military families?

It won’t. TRICARE is the federal government’s program that covers the military and their families. The ACA affects private insurance plans, so TRICARE is not impacted by this.

This question from mom Stephanie Dixon sums up how many readers feel: “Most of us, regardless of our political bent, are struggling financially. How will the ACA help the average working-class citizen?”

Before the law, families had co-pays every time they got a flu shot or had their kids immunized. Under ACA, those costs cease to exist. Whatever the circumstances—even if you have a preexisting condition, have difficulty paying for insurance, or lose or change jobs—the law helps you get access to affordable coverage. Also, some consumers don’t realize that people who have insurance are currently paying for many people who come into the emergency room with no insurance at all. When a person is uninsured and cannot afford to pay for care, the cost of care is absorbed and passed on in the form of higher premiums to those who are in a position to pay, which drives medical costs up across the board. In the two and a half years since the law was passed, we’ve seen the slowest rise in health-care costs that we’ve had in the last 30 years.

How does your role as a mother and new grandmother [to 17-week-old grandson] inform the work you do with healthcare?

A lot of things that were statistics on a page are now very meaningful to me. I watched my son and daughter-in-law plan for a baby, want to conceive a baby, have the experience of going to prenatal care, think about birthing, and use lactation-support services. Watching all of this up close and personal at every step along the way, I thought about how many parents would not have had that coverage if the ACA had not been passed and signed into law. We had gone to the Institute of Medicine and asked doctors, researchers, and experts to look at health plans and tell us what the gaps were for women’s services. A lot of health plans had no maternity coverage; a lot of women don’t even think about that until they get pregnant, and then it’s too late, so they’re doing it 100 percent out of pocket, or don’t get screened forgestational diabetes, or have to pay for infants’ immunizations. Now, 47 million women will have access to preventive services without out-of-pocket costs. That’s a huge deal.