Affordable Care Act

Hispanic Heritage Month just ended, and we would like to recognize this important time by sharing the last in a series of guest blogs from Silvia Gallardo of the National Association of Hispanic Nurses, Phoenix Chapter. Today, Silvia writes about, what she sees,  as the merits of the Affordable Care Act….and the work that still needs to be done. We believe it is important to hear what our partners think about our state’s key health issues in order to continue moving toward our long-term goal of one day making Arizona the Healthiest State in the Nation!

The Affordable Care Act (ACA) Law is a controversial topic. Nobody likes to be forced into buying insurance and even less to pay fines for not having it. However, as any other team member in the medical field, I have to acknowledge that our healthcare system is fractured, and everybody is paying the price. Many people were not taking care of their health due to the inability to afford healthcare, and visits to the emergency room became routine for many individuals due to chronic conditions like hypertension and diabetes

Among the benefits of the ACA law are that it:

  • regulates premium increases from employers,
  • protects consumers with preexisting conditions,
  • has no coverage limits,
  • offers preventive services for free, and
  • provides insurance for young adults, under their parent’s umbrella, until age 26. 

Moreover, the ACA provides an alternative for people who are uninsured by employers or buy their own coverage through the Insurance Marketplace. The Marketplace might be a confusing place for new internet users, and it could be necessary for some to find guidance if they are not familiar with insurance terminology.

Regardless of the wealth of information available about the ACA online, there is a great need for health insurance literacy in our communities. For example, many patients have difficulties understanding the difference between a co-payment and a deductible. The out of pocket limits on health insurance plans offered by the Marketplace is $6,850.00 for individuals and $13,700.00 for families. Also, the Affordable Care Act provided Medicaid Expansion for many states, something that really helped Arizona, for example, because for several years the Arizona Health Care Cost Containment System (AHCCCS), our local Medicaid, was only granted to individuals with children, leaving a multitude of non-elderly people who lived in poverty without health insurance for years. Thanks to Medicaid Expansion, these individuals are getting help.

As healthcare professionals, nurses are instrumental for consumers to understand the importance of healthcare prevention, something that saves money in the Marketplace. The Marketplace offers several levels of insurance, depending on individual healthcare needs and income. There are four categories of plans with four levels of coverage:

  • Platinum (Insurance covers 90%/Consumer covers 10%);
  • Gold (80%/20%);
  • Silver (70%/30%), and
  • Bronze (60%/40%).

For example, a healthy 35 years-old lady with an annual income of $26,000.00, was able to find a Bronze plan for $45.00 per month. Her deductible is $6,850.00 but she will be able to obtain preventive services for free and her co-payment per doctor visit is $50.00. This may sound great, but this plan may not work for a patient with CAD, CHF, and diabetes since he or she may require more care.

As people become more educated about the ACA, we begin to realize that every situation is different – which makes it hard to imagine a ‘one size fits all’ universal plan that will work for everyone. A health insurance plan must be chosen according to the patient’s needs and possibilities. Also, there are dental plans available, since dental care is not covered by many of the offered plans.

Perhaps the ACA is not perfect (Remember the 2014 glitch?), but we feel that it might be getting better with time. Something needed to be done about our healthcare system, and I think the ACA has been the first step forward toward change.

 

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