Over 30% of all Latinos are uninsured for health care. In 2010, when the health reform law was being debated in the public and in the halls of Congress, 46 million and millions more undocumented individuals lacked this important coverage. The high rates of uninsurance carry a large human toll, leading to unnecessary illness and disease, hospitalization and institutionalization, disability, and premature death. It also destabilizes our health care system, straining the emergency rooms and increasing the cost of health care spending, which in turn makes the health care system less dependable and less accessible.
Throughout 20 Days of ACA, we have discussed some of the ways people will gain coverage, for instance, through expanded access to Medicaid. We will also discuss later in the series how, starting in 2014 employers with over 50 employees must provide health insurance or face fines. But what about people whose employers are not compelled to provide insurance and who are not covered through public health programs like Medicare and Medicaid?
This is where the “exchanges” we have alluded to in previous posts comes into play.
So what exactly are these “exchanges?”
Exchanges are essentially new marketplaces, where individuals and small groups will be able to compare health insurance plans, determine their eligibility for public health coverage options (like CHIP and Medicaid), and enroll in the health insurance plans that correspond to them. Exchanges will also help families determine if they are eligible for government tax subsidies or credits to assist them in enrolling in new health insurance plans offered on the exchange.
The health reform law not only creates these exchanges, but also puts in place a series of regulations and protections in order to ensure quality and predictability across plans.
One of the ways health reform does this is by requiring that all insurance plans offered in these state exchanges cover a set of “essential health benefits.” These benefits are broken down into ten “buckets” of services that must be covered. We have already talked about two of these buckets, maternity & newborn care and preventive health, but the other buckets include services like mental health, substance abuse counseling, pediatric care including oral and vision, and emergency services.
The ACA also requires that outreach and enrollment, including an insurance plan’s summary of benefits as well as information about appealing insurance decisions, in the state exchanges be culturally and linguistically appropriate.
Health plans offered in the exchanges are also prohibited from discriminating on the basis of a consumer’s “pre-existing” or current health status.
States are responsible for creating these exchanges and opening them up in late 2013. The federal government has provided guidelines as well as millions of dollars to help states do so.
How will this benefit Latinas, their families and their communities?
The availability of new health insurance exchanges starting in 2014 means Latinas and their families will have more options for coverage.
Starting in 2014, individuals and families living at 133% to 400% of the federal poverty rate (in 2010, this meant an annual incomes between $14,403 and $43,320 for an individual and between $24,352 to $73,240 for a family of three) will be eligible for tax credits in order to off-set some of the costs of enrolling in new health plans on the exchange.
Additionally, permanent residents will be able to purchase insurance through the exchanges and will be eligible for tax credits. According to reporting from FamiliesUSA, 5.7 Latino permanent residents will be eligible to enroll in these plans.
While we know that expanding access to health insurance is an important step towards securing meaningful access to quality and affordable health care for Latinas, their families and their communities.
And by requiring that these plans offer a floor of “essential health benefits,” this coverage will more meaningful for Latinas, for instance, since majority of individual and small group insurance plans do not currently cover maternity care.
To find out information about what your state is doing to establish exchanges, the Kaiser Family Foundation has create a state-by-state resource here.
Keep stopping by for more in 20 Days of ACA!