“Obamacare” is Working. And There’s Still Work to Do

David R. Jones, The Urban Agenda

The Affordable Care Act (aka “Obamacare”) was created to improve health insurance coverage and to make it more affordable for the 47 million people in this country without insurance.

Four years after its passage the health reform law is working, and working well – despite efforts to stymie its success.  To start, millions of young adults under 26 accessed coverage on a parent’s plan, older Americans saved money on prescription drugs due to Medicare fixes, and those with insurance gained access to preventive care – for free.  This year, eight million Americans signed up for insurance through the new health plan “marketplaces.”  And New York has already exceeded its three-year goal of enrolling 1.1 million New Yorkers.

NY State of Health

Today, the NY State of Health, the Official Health Plan Marketplace is a model for other states. Before the Marketplace launched, 2.6 million New Yorkers were uninsured. Half of these uninsured New Yorkers worked full time, could not afford their job-based health insurance or their employers did not offer it.

A report on the first open enrollment period of the Marketplace shows just how successful it has been at increasing health coverage in New York. In just the first six months, nearly one million New Yorkers enrolled in health plans on the NY State of Health. More than 80 percent of these enrollees reported not being insured when they applied for insurance. About 74 percent of the 370, 604 people who enrolled in Qualified Health Plans (QHP) were eligible for financial assistance. And of those enrolled in subsidized QHPs, more than half (53 percent) have incomes at or below 200 percent of the Federal Poverty Line, or $36,600 for a family of three.

Another Success Story

More than half of those who obtained coverage this year through the NY State of Health live in New York City. Tamika (she did not want her last name used) of Brownsville, Brooklyn aged out of her mother’s employer-based health plan in May 2013. At the time, the 26-year-old call center supervisor at a private hospital was receiving ongoing care for hearing problems.

When she was dropped by her mother’s insurer, Tamika amassed more than $2,500 in medical bills from seeing ear and throat specialists for a severe ear infection. Like so many uninsured people, Tamika’s employer-based insurance was too expensive ($400 per month) and she made too much to qualify for Medicaid.

For six months she went without health coverage. Then in October, her father suggested she contact my organization, the Community Service Society, about enrolling in health insurance under Obamacare. In the last year, CSS and a network of 38 partner organizations have helped enroll individuals, families and businesses in 61 of the state’s 62 counties in health plans. One of our state-certified health counselors (Navigator) helped Tamika get subsidies and enroll in a Silver Plan with a final monthly premium of $140 and an annual deductible of $250.

“Everyone in my family has insurance. I wanted to act responsibly and not have to worry if I needed to have surgery or see a specialist,” said Tamika. With her Marketplace plan, Tamika was able to get the health care services she needed. This past April Tamika started a new job that offered employer-based health insurance that was affordable.

The Work Continues

ACA continues to engender strong feelings from both sides of the political spectrum.  But if you ask opponents of the law  what they would replace it with, they don’t have an answer. Meanwhile, the experience in New York suggests that the law is working. More young people are becoming insured, costs are coming down, and over a million New Yorkers now feel secure that they can go get a check-up and see a doctor when they need to, without breaking the bank. 

While the ACA is here to stay, unawareness and misperceptions about it still abound. For example, according to a recent Kaiser Family Foundation poll, only 37 percent of respondents were aware that people who enrolled in health coverage under Obamacare had a choice between private health plans. A quarter of the respondents thought people were being enrolled in a “single government plan.” And more than 37 percent did not know enough about the law to offer an answer.

The next open enrollment is in November.  Until then, there are ongoing enrollment opportunities for small businesses, people who qualify for Medicaid, and people who qualify for Special Enrollment Periods. We can share the success that New York experienced by telling our friends, family, and neighbors that there are opportunities to get insured.  Together we can create a new dialogue about the ACA and work towards a healthier nation where all individuals can get the health care they need.

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