Archive for September, 2012

The Affordable Care Act and African Americans: Translating Law into Practice

The Affordable Care Act and African Americans: Translating Law into Practice

On March 23, 2010, President Obama signed the Affordable Care Act (ACA), informally referred to as “Obamacare.” Together with the Health Care and Education Reconciliation Act, the ACA represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965.

The ACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of health care. It provides a number of incentives, including subsidies, tax credits, and fees, to employers and individuals to increase coverage. Additional reforms are aimed at improving healthcare outcomes and streamlining the delivery of health care.

In response to the passage of this historical law, a number of parties sued, claiming that the reform law was unconstitutional. A coalition of 26 states participated in the lawsuit against the ACA. The challenge was based upon three of the Affordable Care Act’s core provisions: 1) the significant Medicaid expansion, which is expected to make available health care coverage to 16 million new people; 2) the employer mandate, which requires firms employing 50 or more people to offer health insurance or pay a shared responsibility requirement if the government has to subsidize an employee’s health care; and 3) the individual mandate, which requires that all individuals not covered by an employer sponsored health plan, Medicaid, Medicare or other public insurance programs, purchase and comply with an approved private insurance policy or pay a penalty (unless the individual is a member of a recognized religious sect exempted by the Internal Revenue Service, or waived in cases of financial hardship).

On June 28, 2012 the Supreme Court rendered a final decision to uphold the health care law.

The Governors of Florida, South Carolina, Texas, Louisiana, and Wisconsin have opted out of the plan, despite the fact that the vast majority of the costs are covered by the federal government, including taxes their citizens will pay, regardless of whether the state opts out or not. Opting out of the plan would leave a significant portion of their citizens without health care. Texas boasts the highest percentage of uninsured residents in the country, at 27.6% (over 6 million residents), followed by Florida (21% or 3.85 million people); the expansion of Medicaid in this state would have covered 951,622 people.

Historically, African Americans have faced significant barriers to accessing affordable health insurance and these barriers have contributed to significant health disparities, including the highest all-cause death rate of all races and ethnicities, and the highest death rate for heart disease, cancer, and diabetes than any group in the U.S. There are also disparities in access to care; 21% of African Americans are uninsured and 20% do not have a regular doctor, compared with less than 16% of whites. Consequently, African Americans are more likely to use the emergency department as their regular place of care than their white counterparts or delay or forego medical and dental care and prescription drugs. At a 13.7% death rate per 1000 births, African American babies are dying at twice, and sometimes three times the rate of any other racial or ethnic group. Of all women living with HIV/AIDS, 65% are African American and African Americans as a whole represent 40% of people with HIV/AIDS who die. We desperately need affordable health care.

Under the Affordable Care Act, millions of African Americans are already benefiting:
Ban on discrimination based on pre-existing conditions: Insurance companies are banned from discriminating against anyone with a pre-existing condition, such as cancer or having been pregnant.

Free preventive services to help you stay healthy or prevent a condition from getting worse: All Americans joining a new health care plan can receive recommended preventive services, such as cancer, diabetes and blood pressure screenings, with no out-of-pocket costs.

No lifetime dollar limits on claims: Insurance companies are banned from imposing lifetime dollar limits on health benefits: freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 10.4 million African Americans are free from worry as a result of this law.

Access to coverage for young people: Insurance companies are now required to allow parents to keep their children up to age 26 on their insurance plans. This means that 410,000 African American young adults have gained coverage because of the new health care law.

Freedom to choose a plan and provider: African Americans joining new insurance plans have the freedom to choose from any primary care provider and OB-GYN in their health plan’s network, without a referral. Affordable Insurance Exchanges (one-stop marketplaces where consumers can choose a private health insurance plan that fits their health needs) will offer to the public the same kinds of insurance choices members of Congress will have. The new law also provides middle-class tax credits to families to help pay for private health insurance. And it expands the Medicaid program to families of four with incomes of up to $29,000. This will result in as many as 6.8 million African Americans becoming eligible for health coverage.

Increased health security for seniors and people with disabilities: Seniors can receive recommended preventive services such as flu shots, diabetes screenings, as well as a new Annual Wellness Visit, free of charge. So far, more than 2.4 million African Americans with Medicare have already received one or more free preventive service, including the new Annual Wellness Visit. In addition, millions of people with Medicare will receive a 50% discount until the gap in prescription drug coverage is closed (in 2020) on their brand name prescription drugs.

Funding for community clinics: Increased funding for more than 1,100 community health centers in all 50 states, enabling them to double the number of patients they serve from 19 million to nearly 40 million by 2015. Nearly 26% of patients served by community health centers in 2010 were African American.

More health providers in underserved communities: New resources to boost the number of doctors, nurses and health care providers in communities where they are needed most, as well as diversify the workforce, so racial and ethnic minorities are better represented. Investments have been made in the National Health Service Corps (NHSC) program that has allowed for nearly three times the number of NHSC clinicians working in underserved communities across America than there were 3 years ago. While African Americans make up 5.7% of doctors, they make up 22% of the NHSC loan repayment program recipients.

When all is said and done, the ACA will result in 6.8 million more African Americans becoming eligible for health care coverage. However, advocacy is needed to continue to educate and outreach to African Americans to ensure that we have a voice in the way that the new healthcare law is implemented in our state. Yes, we must advocate for a fair and equal application of the law to reap the full benefits. So, get involved! Partner with organizations, agencies, and churches to bring information about the Affordable Care Act into African American communities, teaching them about the benefits, how to access benefits, and how to train and teach others. Dedicate sermons to the issue of health. Talk about prevention and wellness and how to build healthy African American communities. Host healthy potlucks and spend the afternoon in creative and fun exercise activities designed for the entire congregation. Contact the California Black Health Network to find out how you can get involved: cablackhealthnetwork.org.

The Affordable Care Act was designed so that all Americans can make health insurance choices that work for them while guaranteeing access to care for the most vulnerable in our county. Exercise your rights. Educate yourself. Get involved. Vote!

To your health,

KDL

September 1, 2012 at 11:51 pm 1 comment


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