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Breaking Down the Affordable Care Act

Hello all! I am the new Health Care Reform Intern at the Wisconsin Alliance for Women’s Health (WAWH) and I have the honor of dealing with all-things healthcare reform! My job is to research, learn, and analyze what this reform means not only for women in Wisconsin but for American citizens as a whole.

For my first blog, I wanted to highlight some of the major points that I have learned my first month with WAWH. With all of the controversy surrounding the Affordable Care Act (ACA), it is difficult to sort out what is fact and what is biased opinion. It seems that each publication has their own agenda and will spin the ACA and its components to support the argument they are trying to make. However, the ACA is not about one party versus another- it is about trying to make positive change in a system that has not been working for women and their families. This constant struggle between political parties makes it difficult for Americans to really understand what the law is and what it means for them. Although there are many biased publications, there are also many publications that are reliable sources for Americans to get the information that they need to understand  the ACA. Based on what I’ve learned in my first month on the job, I have compiled a list of seven facts about the ACA that I believe are very important to know and can help clear up the misinformation about the healthcare reform. It is hard to summarize everything I have learned so far in a few bullet points, but it’s a start!

1. With the ACA, each healthcare plan must have 10 essential health benefits to meet the minimum standard. These include:

  • Ambulatory Patient Services
  • Emergency Services
  • Hospitalization
  • Maternity and Newborn Care
  • Mental Health and Substance Use Disorder Services
  • Prescription Drugs
  • Rehab Services
  • Lab Services
  • Preventive Wellness Services
  • Pediatric Services

This is important to know about the ACA because this provision of the law is one of the reasons why some people received cancellation notices from their insurers when the ACA was implemented. Insurance companies were not simply kicking people off their plans – they were actually required to cancel some of the health plans they offered because they did not meet the minimum standards required by the ACA. You can go to www.healthcare.gov for more information on the 10 essential benefits and learn why some past health care plans were insufficient and why new standards were needed.

2. Under the ACA, many preventative services will be fully covered which will expand services for women and pregnant women. These services include: mammograms, anemia screenings, cervical cancer screenings, urinary tract or other infection screenings, and more. There are also other preventative services offered for men and children. These preventative services will truly help in cutting medical costs because of the simple fact that it costs less to prevent disease than it does to treat it.

3. Contraceptive methods and counseling will be covered for all women. Methods such as birth control pills, intrauterine devices, emergency contraception, and patient education and counseling will be covered. With this, all women will be able to access proper family planning strategies and will be able to have the power to have a family at the most appropriate time.

4. ‘Individual Mandate’ for health insurance was originally a Republican idea. The individual mandate requires that all citizens buy health insurance or they will incur a yearly penalty if they do not purchase health insurance. The Heritage Foundation is a conservative think tank that came up with the idea of the individual mandate to help people take responsibility for themselves. Originally, the Democratic idea was for universal health care and the Marketplace strategy was adapted from a successful health care reform in Massachusetts head by Mitt Romney. Obamacare was actually a compromise to implement both Republican and Democrat ideas. See an article about this from the New York Times for more information: http://www.nytimes.com/2012/02/15/health/policy/health-care-mandate-was-first-backed-by-conservatives.html?_r=1&

5. Before the ACA, being a woman could be seen as a “pre-existing condition” Now because of the ACA, women can no longer be excluded from health care coverage because of their gender. Other “pre-existing” conditions that could be reasons for insurance companies to deny coverage before the ACA include domestic violenceand previous Cesarian sections. With the ACA, insurance companies are no longer able to deny people coverage due to pre-existing conditions, including so-called “conditions” such as these.

6. Gender based rating is now illegal under the ACA. Women can no longer be charged more for health care because they are women. Before the ACA, a woman could pay on average 40-70% more for the same health insurance plan as a man.

7. Open enrollment for the Health Insurance Marketplace ends March 31st, 2014 and will open again on November 15, 2014 for the year 2015. The penalty for an individual in 2014 who has not purchased health insurance is $95 OR 1% of your taxable income, WHICHEVER IS HIGHER. These values increase in the coming years to $325 OR 2% of income in 2015 and $695 or 2.5% of income in 2016. However, there are ways for lower income individuals and families to get financial help with coverage. This chart from www.healthcare.gov can help you see if you qualify for financial help for purchasing healthcare!

Save Money on Coverage

So enroll in the marketplace today and get covered

Again, these are just some of the important points that I have learned surrounding the ACA and although they may seem basic, there’s still a lot of work to do to make sure Wisconsin women understand how we win with the ACA.  I encourage you to conduct your own research and be a critical consumer so that you can see for yourself which aspects of the law can benefit you and your needs.

Here are a few great sites and resources I’ve used to help introduce me to all-things ACA:

HealthCare.govhttps://www.healthcare.gov/

Kaiser Family Foundationhttp://kff.org/health-reform/

National Women’s Law Center: http://www.nwlc.org/our-issues/health-care-%2526-reproductive-rights/health-care-reform

National Women’s Health Network: https://nwhn.org/

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Enrollment ClosesFebruary 15th, 2015
Plenty of time to Get Covered
Learn about the Health Insurance Marketplace & your new coverage options.

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