The Affordable Care Act: Helping the "Young Invincibles"

Just who are these “young invincibles”?  The term describes young adults between the ages of 18-29 who may seem uninterested in health insurance and believe they can afford to go without coverage— and are therefore, “invincible”. Unfortunately, this belief is false. Of course, not all young adults think they are invincible and none of them actually are. While this is a mostly healthy demographic, many of them desperately need health insurance to obtain necessary health care, and many more of them know that they should have it in case of emergency.  In addition, the parents of many of these young adults are keenly aware that if their son or daughter experiences a significant medical need, it is they who will be paying for it, one way or another. These parents want coverage for their child, even if it is not a priority for the young adult.  If given the chance to have affordable health insurance, many young adults leap at the opportunity. And thanks to the Affordable Care Act (ACA), as of November 2011, 13.7 million young adults aged 19-25  did just that, by either staying on their parents’ health insurance or rejoining it. 

These not-so-invincible young invincibles often struggle with obtaining, navigating, and affording health insurance. The uninsured rate among this group in 2009 was 14.8 million, an increase of 4 million from the past decade. This group is a large part of the 50 million people in 2010 living in the United States without health insurance and the ACA addresses their coverage directly. The dependent coverage provision encompassed in this law permits young adults under the age of 26 to remain on their parents’ private health insurance plan, even if the adult child lives in a different house in a different state, or even if the child is married. This policy went into effect on September 23, 2010; six months after President Obama signed the ACA into law. Since then, millions of young adults have gained or retained health insurance through their parents.

But young people must confront more than misconceptions about their own mortality—there are other reasons this group lacks health insurance. One unfortunate practice that serves as a barrier for young women’s access to health care is the practice of gender rating. Women are routinely charged more than double the premium compared to the amount men pay for the same health insurance coverage. This existing practice causes young adult women to delay getting needed health care because of the cost. Some states banned this practice, but in states where gender rating is not prohibited, 95% of bestselling health insurance plans charge women more for the same exact plan. The ACA makes it against the law in 2014 in all states for health insurance companies to charge women higher premiums solely based on gender. This provision reflects the ACA’s mission to make quality health insurance accessible and affordable.

Another reason this group often lacks coverage is simply the high cost of insurance. A national survey reported 40% of young adults had outstanding medical bills and were in medical debt. Often falling through the cracks of our healthcare system, there are many uninsured young adults in this country who lack reliable, affordable access to basic medical care. This is also a group that is likely to just be starting out in their careers, and making difficult choices about whether to pay for health insurance or rent. Luckily the ACA provides a new category of Medicaid eligibility for single, childless adults who have a household income at or below the 133% Federal Poverty Level (FPL) — or about $14,800 annual income for a single individual.  Currently, the eligibility criteria for Medicaid excludes low-income young adults from Medicaid if they do not have a disability or a child, thus leaving many young adults uninsured. For example, a 19-year-old who has just lost their AllKids insurance—Illinois public health insurance for children—may likely join the uninsured population. Under this ACA provision, however, the Medicaid program will change its eligibility criteria in 2014 to include single, childless adults.

Changing the Medicaid eligibility will finally allow many low-income young adults to receive much needed health care. Individuals who will be insured in 2014 because of the Medicaid changes will be called the newly eligibles, and the cost of their care is covered at 100% by federal funding until 2020, and after that, it will be covered at least at 90%.  This provision has the potential of covering 429,300 residents in Illinois.

While many young adults will be newly eligible for Medicaid or eligible to remain on their parent’s insurance, not everyone will be. For young adults for whom neither Medicaid nor the dependant coverage provision is available, there is an alternative of signing up to buy health insurance from their state’s Exchange in 2014.  An Exchange is an online site that will offer many comprehensive health insurance plans. It will allow the consumer to shop and compare plans so that they can ultimately find the one that best suits their needs and budget. Through the Exchange, there will be a variety of private health insurance plans available in a central online location that is both easy to navigate and written in plain English to allow for full transparency. There will also be financial assistance in the form of subsidies and tax credits available for those who qualify. The financial assistance will be available for individuals who make an income of up to 400% of the FPL – that’s a monthly income of $3,723 for a young single person.  An Exchange can be created by the state, the federal government, or in collaboration by both state and federal governments to offer quality and affordable health plans. Through the Exchanges, young people will have affordable and quality health insurance options to choose from.

Given the benefits and protection that it provides to young adults, we can see that the Affordable Care Act is working to help them access affordable and quality healthcare. By 2014 when the Exchanges are launched, the Medicaid expansion is in place, and all the other provisions are fully implemented, many more young adults will be able to take care of their health easily, affordably and efficiently. Unfortunately none of us are invincible, but the Affordable Care Act is a great tool in helping young adults (and everyone else) control their own healthcare.

Andrea Kovach, Staff Attorney 
Viviane Clement, Healthy Futures Vista
Sargent Shriver National Center on Poverty Law

(This post originally appeared in the Shriver Brief on August 31, 2012)
 

The Affordable Care Act Upheld: Addressing America's Health Care Crisis

Today’s Supreme Court decision in National Federation of Independent Business v. Sebelius means that the Affordable Care Act remains the law of the land. As Chief Justice Roberts said in the majority opinion, Congress has the power to enact the individual mandate and the Medicaid expansion, the two provisions challenged in the case.

People with insurance and people without insurance should be relieved that the process of reform can now move forward and make health care more secure. All of them have spent sleepless hours worried about the cost, lack of control, lack of choice, and absence of peace of mind associated with our current system. The Affordable Care Act (ACA) has tools to address all of these issues, although much still depends on decisions made at the state and local level, where officials must now continue implementing this important work.

The Court’s decision means that the benefits of the Affordable Care Act that are already in place will not have to be reversed.

• Health insurers will have to make their policies easier for customers to comprehend.
• Insurance companies will have to spend a higher portion of your premiums actually providing health care.
• Young adults up to age 26 can now remain on their parents’ insurance policies.
• Over 60,000 “uninsurable” people have health insurance through the ACA’s Pre-Existing Condition Insurance Program.
• No child can be denied coverage by an insurance company due to a pre-existing health condition. Adults will win that protection in 2014.
• Every Medicare beneficiary who hits the prescription drug “donut hole” receives a 50% discount on their brand name and generic prescription drugs. As of March, Illinois Medicare beneficiaries who had triggered into this benefit were getting about $636 a month in savings.
• States receive significant federal grants to help them hold insurance companies accountable for unreasonable rate increases.
• Preventive services are free under all types of public or private health insurance. Thus, last year 18.9 million Medicare recipients received free annual checkups and preventative services.
• Women no longer need a referral from a primary care physician before seeing a gynecologist.
• Medicare premiums are lower than they would have been without the law.

Looking down the road a bit, the Court’s decision means that the full benefits of the law will be implemented on schedule:

• In 2014, 30 million Americans will gain coverage and no longer be uninsured.
• In consumer-friendly marketplaces, insurers will have to disclose all of their information in uniform and comprehensible language, so consumers can compare and make choices.
• No one will be denied coverage or charged a discriminatory rate due to a preexisting condition.
• Starting in 2014, all health plans will have to include maternity care.
• Seniors will have even more help paying for their prescriptions, eventually closing the Medicare doughnut hole.

Starting in 2014, the Affordable Care Act expands Medicaid to cover all 16 million Americans with incomes under 138% of the federal poverty level who are not currently eligible for Medicaid. The Act provides 100% federal funding to cover the costs of this expansion for the first years, and then settles in at 90% funding after five years. The Supreme Court’s decision today upholds Congress’s power to enact this expansion, and we encourage all the states to take full advantage of this wonderful opportunity.

The decision, however, also says that the federal government may not take away all of a state's existing Medicaid funding if it decides not to participate in the expansion. Medicaid law has always provided that, if states disobey the conditions Congress has imposed on the receipt of Medicaid funding, the federal government has several different remedies, one of which is to withdraw all federal funds. That remedy has never actually been used by the federal government, even though there have been many disputes involving state noncompliance with Medicaid conditions. So the threat that the federal government might deploy that remedy if a state failed to carry out the ACA's Medicaid expansion was highly theoretical. In today's decision, however, the Court ruled that a state's refusal to adopt the ACA's Medicaid expansion cannot trigger the removal from a state of all of its existing Medicaid funding. The ruling is unclear about exactly what the states' options are and what other remedies the federal government may have in those circumstances. As we study the decision further, we will address these Medicaid issues more in depth in future blogs. Of course, we urge all states to take advantage of the federally funded Medicaid expansion to bring coverage to their lowest income uninsured.

Tonight, people all over the country, men and women, of all ages, socioeconomic statuses, and political beliefs, can breathe a bit easier knowing that the reforms launched in March 2010 will continue and that America is moving toward quality, affordable, comprehensive health care for all.

John Bouman, President
Sargent Shriver National Center on Poverty Law

(This post was co-authored by Caitlin Padula and originally appeared in the Shriver Brief on June 28, 2012)

The Affordable Care Act: Dollars Flowing into Illinois

There’s no debating that Illinois could use some healthcare help. The state is ranked the 29th healthiest state—not the absolute bottom, but nowhere near the top. A recent poll also listed Illinois as the 31st most obese state and 25th for diabetes—not exactly stellar statistics. The same source noted that ,while Illinoisans benefit from high usage of early prenatal care and a comparative availability of primary care doctors, the state faces severe challenges, including prevalent binge drinking, high pollution levels, and a high rate of preventable hospitalizations.

These problems are not insurmountable. However, we all know the state is in a budget crisis. Governor Quinn has announced a plan to drastically reduce spending and raise revenues for Medicaid. We understand the state budget crisis, but obviously, people in Illinois need medical services, and the state is currently struggling to provide them.

Luckily, the Affordable Care Act is there to throw a lifeline out to health service providers and state agencies and especially to the real people who need healthcare. Thanks to the ACA, the states will spend about $90 billion less on healthcare with the implementation of the law than they would have spent without it. Thousands of people will still be getting the increased services mandated by the Act, but much of the funding will be federal rather than state.

It’s important to note that these benefits are not in the distant future; Illinoisans from birth to retirement are already benefiting from the Affordable Care Act.

Assistance from the ACA starts when kids are young; the ACA has already provided:

• $10.3 million for Maternal, Infant, and Early Childhood Home Visiting Programs. These programs bring health professionals into individual homes to connect families to the services they need to raise happy and healthy kids. These services include prenatal care, pediatric care, education, and parenting skills. 
• $191,000 for Family-to-Family Health Information Centers, organizations run by and for families with children with special health care needs.
• $4.9 million for expanding and improving school-based health centers. Illinois funds 38 school-based clinics that provide screenings, physicals, exams, and more to students.
• $555,000 to support the Personal Responsibility Education Program, which educates youth on abstinence and contraception to prevent teen pregnancy and sexually transmitted infections, including HIV/AIDS.

The ACA is also spending money putting people to work at improving healthcare! Illinois has received:

• $400,000 to support the National Health Service Corps, by assisting Illinois in repaying educational loans of health care professionals in return for their practice in health professional shortage areas. This program is designed to help medical, dental, and mental health providers who choose to work in needy communities to repay their student loans. This is a particularly critical program because these professionals provide medical and dental care that individuals desperately need; the program allows professionals to provide care to needy individuals without worrying about their reimbursement rates or their ability to pay back debt.
• $5.1 million for health professions workforce demonstration projects. This program is designed to supplement the workforce in areas that are either already short-staffed or expected to be in the future. The Illinois Workforce Investment Board’s report noted shortages of both registered nurses and licensed practical nurses in Illinois. 

And the ACA helps elderly Illinoisans, too!

• $457,000 to support Aging and Disability Resource Centers (ADRCs). ADRCs help seniors and people with disabilities understand long-term care options including community care. 

So far, Illinois has received $170.7 million in grants due to the Affordable Care Act. These grants are creating tangible improvements to the physical and fiscal health of our state. Thanks, Affordable Care Act!

This article, written by Caitlin Padula, was originally posted on The Sargent Shriver National Center on Poverty Law's blog, The Shriver Brief. 

The Affordable Care Act: Fulfilling Promises, Cutting Costs

Did you know that the Affordable Care Act has alreadyexpanded affordable preventive health coverage to 54 million Americans?

If you’ve been following the Shriver Brief health care blogs, you probably remember reading about the Affordable Care Act mandate that insurance companies provide a specified list ofpreventive health care services to policy holders without charging a co-payment or deductible. Services like screenings for blood pressure and cholesterol; testing for Type 2 diabetes, obesity, and colorectal cancer; and alcohol and tobacco cessation counseling, among others are included in the mandate. Additional preventive health services like childhood immunizations; screenings for hearing, vision, and oral health; as well as testing for autism, HIV, and obesity, among others must be provided free of co-payment for children’s care. And starting in August of this year, insured women will be able to receive a set of women’s preventive health benefits like well-woman visits, FDA-approved contraception, mammograms, breastfeeding support and supplies, and domestic violence screening and counseling, also without cost-sharing. The health reform law requires that all of these free preventive health services are provided by insurance companies for anybody with a new or a so-called “non-grandfathered” insurance plan. And the mostrecent research shows that people—tens of millions of people—are already receiving these preventive services, for free!

According to a study conducted by the Kaiser Family Foundation, “31% of all workers were covered by plans that expanded their list of covered preventive services due to the Affordable Care Act.” Using this data, the Department of Health and Human Services (HHS) was able to calculate just how many people are benefiting from expanded preventive health coverage across the country.HHS estimates that 54 million Americans—and counting—have received one or more of the Affordable Care Act’s mandated preventive health services free of co-payment or cost-sharing. This number breaks down to over 20 million women, 14 million children, and 19.5 million men making use of their increased access to affordable and essential preventive health care. Illinois was among the top five states to benefit the most, with almost 2.4 million Illinois residents receiving free preventive health care services! And this number will only continue to grow as more and more people choose to enroll in new or “non-grandfathered” health plans, and as the health reform lawrolls out its final stages in 2014, adding 16 million individuals to the private health insurance market.

These kinds of meaningful, money-saving provisions in the Health Reform law are making a real impact at a time of need, when many individuals and families affected by the recession have been resorting to cutting back on basic medical care to make ends meet. A Kaiser Family Foundation study conducted in 2009 found that 53 percent of American families were cutting back on medical care because of the cost. In 2010, the Commonwealth Fund reported that 25 percent of Americans were cutting back on recommended tests like blood pressure tests, colonoscopies, mammograms, and other potentially life-saving cancer screenings. And just recently, a study from the University of North Carolina’s medical school found that, during the height of the recession, adults between the ages of 50 and 64 received 500,000 fewer colonoscopies compared to the couple of years before the economy turned, even though the colonoscopies can cut the risk of dying from colon cancer in half. The good news is the Affordable Care Act is increasing access to many of these preventive health tests and screenings at a price Americans can afford.

Households all over the country are pinching pennies trying to stay afloat during hard economic times. Thank you, Affordable Care Act, for working diligently to make sure that nobody’s health is sacrificed because of the cost of care.

Coauthored by Caitlin Padula and Rachel Gielau.
This post was originally published as part of The Shriver Brief's weekly “Did You Know” blog series, which highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health.