ACA Update

By Michelle Putnam, Associate Director of Research & Advocacy

Remember the contentious days of summer 2010, when the entire nation was engulfed in a debate over passage of the Affordable Care Act? Raucous town hall meetings were held across the country, special interest groups were vehement, and we were left to sort through all the political rhetoric to try and figure out how the health law would impact us. Fast forward to summer 2014, when lawmakers in Congress are still vehement over the Affordable Care Act, special interest groups are filing lawsuits against the law, and we are left to sort out how Obamacare has impacted us. Some things never change.

The good news is that now, four years out, it is easier to see how the Affordable Care Act has benefited people with chronic health conditions, particularly people with bleeding disorders. Thanks to Obamacare, pre-existing conditions clauses and lifetime caps are a thing of the past. Insurance companies must spend the majority of their profits covering health services, and people cannot be charged more just because they have a health condition. In addition, over 100,000 young adults in Georgia were able to stay on a parent's health plan, giving them access to continuous coverage while they finish school or search for a job.

This past year saw the launch of one of the last provisions of the Affordable Care Act: the Health Marketplace. These online hubs allow people who don't have access to insurance through an employer or Medicare to shop for health coverage and compare plans and premiums. Some people, depending on their income, also get help paying for premiums. As written in the law, each state would set up its own Health Marketplace. Georgia, along with 27 other states, refused to set up these Marketplaces and instead allowed the federal government to step in and run Marketplaces in these states. Although the website suffered from technical hang-ups due to overwhelming demand and planning missteps, over 316,000 Georgians signed up for health plans in the Health Marketplace during last year's open enrollment period (October 2013 through March 2014).

For people with bleeding disorders and other chronic conditions, this open enrollment process was at times frustrating (some things never change). For example, some shoppers had a hard time finding out if their hemophilia treatment centers were in-network. For others, especially those living in southwest Georgia, they found out that they didn't have as many coverage options as people living in other areas of the state (remember, insurance companies can choose which regions they want to serve and set rates based on these regions). Hemophilia of Georgia social workers diligently sorted out which doctors were in-network and helped answer questions about what services a plan covers.

The federal Marketplace has solved many of its initial technical problems and is working to ensure a seamless enrollment period for the 2015 plan year. Already, more insurers have signed up to offer products in the Marketplace. Coventry and Cigna have both signed on, giving people more choice when open enrollment begins again this November. Alliant Health Plans, Blue Cross Blue Shield, Kaiser Permanente, Peach State Health Plan, and Humana are already participating in the Marketplace.

Granted, the Marketplace is designed for people who do not get insurance from their employer or from another source, like Medicare or TRICARE. Still, no matter where you get your insurance, most health plans must offer a base level of coverage. All plans now include free preventive services, like flu shots and mammograms. In Georgia, over 2 million people took advantage of these free services. In addition, insurance companies must spend 80% of their profits on providing health care services to customers, rather than funneling the majority of profits directly to shareholders. If an insurance company doesn't do this, it will have to issue refunds to some consumers. This year, about 300,000 Georgians will receive refunds from their insurer, which may come in the form of a check or lower premiums.

A major part of the health law is the Medicaid expansion, which extends Medicaid to adults who make less than $15,856 a year. Although this expansion has helped 5.2 million people gain health coverage across the nation, Georgia has refused to participate in this popular part of the law. As a result, 500,000 Georgians are left with no affordable coverage: they cannot participate in Medicaid expansion and they cannot access premium tax credits in the Marketplace. This refusal not only affects Georgia citizens, it also affects rural hospitals, which are closing because they do not have enough insured patients to keep their doors open. This expansion would bring in about $40 billion to Georgia over the next 10 years and would create over 70,000 jobs. The program is fully paid for until 2016, when the federal government then pays for 90% of the cost. Governor Deal has steadfastly refused to expand the program, and during this past legislative session, Republican lawmakers made it much harder for him to do so in the future.

Even with the successes of the Affordable Care Act and the positive effect it has had on many people and on lowering overall health care spending, it still faces challenges. If you want to stay current on the Affordable Care Act, here are some useful resources: www.kaiserhealthnews.org and www.georgiahealthnews.com. In addition, you can always reach out to Hemophilia of Georgia. If you have any questions or want to share a story about how the ACA has impacted you, feel free to contact Michelle Putnam at mputnam@hog.org or by calling the HoG office. We love to hear from you!