As librarians prepare to support the implementation of the HealthCare Marketplace and to refer patrons to Affordable Care Act resources,
I highly recommend reading the following two Discussion Papers and sharing them with your colleagues.
Helping Consumers Understand and Use Health Insurance in 2014, by Kavita Patel, Mallory West, Lyla Hernandez, Victor Wu, Winston Wong, and Ruth Parker, May 29, 2013
This paper explains the basics of health insurance and summarizes changes from the Affordable Care Act (ACA). It provides definitions for common health insurance related terms like premium, deductible, and formulary. This discussion paper is helpful to brush up on your knowledge of public and private insurance and get up-to-date with specific changes with the Affordable Care Act.
This discussion paper explains public insurance programs (Medicare, Medicaid and the Children’s Health Insurance Program, Department of Veterans Affairs Health Benefits, TRICARE, and the Indian Health Services) and private insurance. It outlines how the ACA changes Medicare, Medicaid, and private insurance. This paper summarizes important ACA changes to health insurance:
Summary: Public Health Insurance
- “Some preventative services are now available without co-pays or deductibles for Medicare beneficiaries.
- The ACA closes the prescription drug donut hole to help Medicare beneficiaries with prescription drug out-of-pocket expenses.
- The ACA bans Medicare Advantage plans from increasing co-pays and deductibles on certain services.
- States can choose to expand Medicaid eligibility to everyone under 133 percent of the federal poverty level.
- Indian Health Services can offer new services to the Native American population.”
Summary: Private Health Insurance
- “Easier enrollment for employees.
- New coverage options for young adults and those with pre-existing conditions.
- New financial protections.
- New marketplaces to buy health insurance.
- New subsidies and tax credits available to low-income individuals and families.”
Buy Health Insuranace or Pay the Tax
After January 1, 2014, all Americans will be required to purchase health insurance. Americans without coverage will have to pay an additional tax of $95 per adult or 1 % of the individual’s income, whichever is greater. The tax for dependent children without health insurance is half the adult tax. Exceptions to the tax include: American Indians; undocumented immigrants; incarcerated individuals; people with religious objections; people who have been uninsured less than 3 months; people for whom the lowest-cost health plan would exceed 8 percent of their income; and people whose income is below the tax-filing threshhold.
Amplifying the Voice of the Underserved in the Implementation of the Affordable Care Act, by Kavita Patel, Ruth Parker, Antonia Villarruel, and Winston Wong, June 21, 2013
At the IOM Roundtable on Health Literacy, “a prevailing theme was the importance of the patient voice in the health care delivery system and the need for organizations to adopt programs that consistently incorporate this voice.” This discussion paper shares the importance of “amplifying the patient voice” and “communicating in ways meaningful to the community about new opportunities to invest in its health, converge at a critical time in our country’s great test in expanding health care access to all Americans. For those invested in the sucessful implementation of the ACA, particularly the expansion of health care coverage through the establishment of state health insurance marketplaces and the expansion of Medicare eligibility, work must begin swiftly not only to communicate about coverage options, but also to empower and engage grassroots organizers and communities in the process.” The paper discusses how complex it is for most Americans to understand and access health insurance. For persons with low health literacy and limited English proficiency, it is even more challenging.
Communities need to get creative to help the uninsured access the Health Insurance Marketplace. The ACA provides some funding for CBO’s to support outreach for newly eligible consumers of health insurance under the ACA. This discussion papers makes note that, “The initial process of enrollment for insurance coverage through the marketplace or via Medicaid is but one step in the empowering those individuals to become informed consumers.”