Five years ago Congress passed the Affordable Care Act (ACA), President Obama’s signature policy initiative. The chief objective of the law was to reduce the number of uninsured Americans. Judging by the latest enrollment figures, that’s exactly what has happened.
Since passage of the law – which led to the expansion of Medicaid and paved the way for the creation of online health insurance Marketplaces with tax credits to help low and moderate-income individuals purchase health coverage -- about 16 million Americans have gained insurance.
According to a new report from the U.S. Department of Health and Human Services, uninsured rates have dropped significantly among Latinos and African Americans compared to whites. For example, before the implementation of the ACA the uninsured rate for Latinos was 41.8 percent. By the first quarter of this year, it had fallen by 12.3 percent resulting in 4.2 million more Latinos gaining health insurance coverage under the new law.
Consumers Often Need Help After They Gain Health Insurance
The federal health reform law works no place better than New York. An eye-popping 2.1 million New Yorkers enrolled in health insurance through the New York State of Health Marketplace by the end of the second open enrollment period, which began on November 15, 2014 and ended on February 15, 2015. Nearly 90 percent of new enrollees were uninsured at the time of their enrollment.
My organization, whose mission is to address the root causes of poverty and remove barriers preventing low-income New Yorkers from achieving their full economic potential, works with the State to expand access to affordable, quality healthcare for all New Yorkers. To that end, CSS sponsors the State’s largest Navigator program consisting of a network of 33 community-based organizations, Chambers of Commerce and business-serving groups that help individuals, families and businesses enroll in health coverage. In addition, CSS and its partner organizations – the Empire Justice Center, Medicare Rights Center and The Legal Aid Society – administer Community Health Advocates (CHA), an all-payor health care consumer assistance program which helps New Yorkers understand and use their health insurance and, if uninsured, access low-cost services. (CHA "Helpline" 888-614-5400)
While Navigators are important local resources for people who need enrollment assistance, they are not funded to address the post-enrollment needs of consumers. As we have found, successful enrollment in health insurance is only the beginning of the process. That’s because the health insurance system remains complicated, even more so for those with no previous health coverage experience. Typically, these consumers come back to Navigators after enrollment seeking help understanding insurance concepts like deductibles, co-payments, co-insurance, maximum out-of-pocket costs, following complex processes to resolve insurance disputes, filing complaints and appealing health plan decisions.
To cement the successful implementation of the ACA, the gaps left by the federal health care reform law need to be filled in a way that creates a stronger coordinated and collaborative community-based infrastructure to improve coverage and access to services and programs.
Access Health NYC
The City Council has an opportunity to do just that by funding a budget initiative called Access Health NYC that would augment existing service programs and build capacity for new ones through the collective expertise, networks and services of a coalition of community-based organizations.
Access Health NYC would serve two basic functions: it would improve health access by linking individuals who are eligible for coverage under the ACA to Navigators. It would also link those who cannot enroll in health coverage through the state’s Marketplace to existing safety net health care services. This includes undocumented immigrants who are unaware that these programs exist, or are afraid to use them. Funding would be provided to up to 50 community based groups to engage it outreach, education and referral to CSS’s Helpline for complex cases and post-insurance enrollment help.
New York City had its own City-wide consumer assistance program for over 10 years until it had to be dismantled when City Council funding was eliminated in 2010. Fortunately, the State stepped in and secured federal funding for a statewide consumer assistance program. The elimination of City funding means a reduction in services for New York City from its height of 26 CBOs to now just eight. On the bright side CHA now has a statewide network of 21 CBOs. While this transition has brought valuable services to upstate communities, New York City has lost important resources for its undeserved communities. The Council can restore those resources and we urge it to do so by funding Access Health NYC.