When the Affordable Care Act was passed in 2010, it contained a long list of target dates. One of the most anticipated ones was January 2014, the month by which hundreds of thousands — if not millions — of uninsured Americans were expected to gain health coverage.
Now that the long-awaited date has arrived, public health officials are eagerly looking forward to the health benefits that coverage will provide — and hoping that recent implementation glitches are a thing of the past.
On Oct. 1, the federal Health Insurance Marketplace opened online at www.healthcare.gov with a goal of allowing uninsured Americans to easily purchase affordable health insurance. The marketplace is a virtual site where Americans can shop for and compare insurance plans to fit their needs or for the needs of small business employees.
Unfortunately, the debut of the marketplace site was hampered by technical problems that prevented many users from completing their transactions during October and November. But on Dec. 1, the Centers for Medicare and Medicaid Services announced that the website capacity was stable enough to have 50,000 users at a time, thanks to hardware upgrades and software fixes. On Dec. 2 alone, 1 million visits and 18,000 enrollments were logged, CMS reported.
Between the site’s launch and the end of November, 364,682 Americans selected marketplace insurance plans, the U.S. Department of Health and Human Services announced on Dec. 11. Another 803,077 Americans were eligible for Medicaid or the Children’s Health Insurance Program, meaning about 1.2 million Americans were positioned to receive health coverage in 2014. About 1.9 million users applied and were eligible for a plan but had not selected one yet.
In remarks on Dec. 3, President Barack Obama noted that the website is just one component of the Affordable Care Act, which is working successfully, providing access for preventive services, allowing insurance coverage for young adults and saving seniors money on prescription drugs.
“What’s important for everybody to remember is not only that the law has already helped millions of people, but that there are millions more who stand to be helped,” Obama said.
While the initial marketplace enrollment numbers were impressive, they fell short of original estimates, according to an Associated Press report, which said that HHS had expected 500,000 people to sign up in October alone. However, “It is a little early to be reading much into the numbers,” said Jennifer Tolbert, MPH, MSW, director of state health reform at the Kaiser Family Foundation and an associate director for the foundation’s Commission on Medicaid and the Uninsured, in November.
“I think what we’ve learned over the years in our experience with new health insurance, to the Medicaid program over the years — and frankly with the Massachusetts implementation of health reform — is that it starts slowly and will ramp up over time,” Tolbert told The Nation’s Health.
Updates on enrollment via HealthCare.gov are expected to be announced monthly. Participants had until Dec. 23 to enroll in plans that began Jan. 1. Overall enrollment for coverage starting in 2014 ends March 31. Those who miss that deadline will be able to enroll for 2015 coverage starting in November.
Another challenge in recent months was reports that some Americans’ insurance plans were being canceled or replaced with costlier plans, running contrary to a pledge President Barack Obama made that people would be able to keep their current plans if they liked them. As a result, CMS introduced a transitional policy allowing insurance companies to continue existing plans through 2014.
Under the policy, insurers are required to send notices to consumers whose plans were canceled that explain what reforms their plans may not include — such as not being denied coverage based on a pre-existing condition — and their right to choose a plan in the Health Insurance Marketplace. However, it is up to state insurance commissioners to decide whether they will allow insurance companies to provide the same plans. And in some cases, allowing people to keep their plans goes against state laws that require plans to include reforms.
Among the new Affordable Care Act provisions that took effect this month are rules that prevent insurers from denying coverage based on pre-existing health conditions and stop insurers from setting annual limits on essential health benefits.
For some Americans who live in states that expanded Medicaid coverage, Jan. 1 also meant they were covered by an insurance plan perhaps for the first time in their adult lives. As of Nov. 26, 25 states and the District of Columbia had decided to expand Medicaid, according to the Kaiser Family Foundation. As many as 11 million Americans could receive coverage either through Medicaid or CHIP through 2022, according to the Congressional Budget Office.
Reform spotlighted at Annual Meeting
With marketplace enrollment kicking off a month before and January 2014 just around the corner, the Affordable Care Act was a popular topic of discussion during the five days of APHA’s 141st Annual Meeting and Exposition in Boston in November. More than 50 Annual Meeting scientific sessions focused on health reform, exploring its impact on issues such as immigrant health, health equity, the public health workforce and reproductive health services.
The meeting also offered an opportunity for attendees to interact with health insurance navigators, who are trained to offer unbiased help on health insurance, the marketplace, qualified health plans and programs such as Medicaid and CHIP.
Massachusetts navigators, including Angelo Sanca, CHW, of the Boston Public Health Commission, were stationed at the APHA Policy Center booth at the meeting expo to answer questions about the Health Insurance Marketplace and help people sign up for coverage.
“Working in the health field as a health advocate, it’s quite frustrating and painful to see families without health insurance struggling, paying medical bills versus putting food on their tables,” Sanca told The Nation’s Health.
President Barack Obama speaks on the Affordable Care Act at the White House in November. The law has already helped millions of people and will help many more, he noted in December. Between the marketplace site’s Oct. 1 launch and the end of November, almost 365,000 Americans selected insurance plans.
Photo by Win McNamee, courtesy Getty Images
Among the other topics discussed at the Annual Meeting was the Affordable Care Act’s mental health benefits. Under the law, mental health and substance abuse services are among the 10 categories of essential health benefits that marketplace plans and Medicaid coverage must include.
As of Jan. 1, small group employer plans and individual health insurance plans bought in the marketplace are required to cover mental health and substance abuse disorder care. Also, insurers can no longer deny coverage or raise premiums based on a pre-existing mental illness or substance abuse disorder.
Nearly 46 million Americans were living with a mental illness in 2011, and about one-fifth to one-third of the nation’s uninsured have mental and substance abuse disorders, according to the Substance Abuse and Mental Health Services Administration.
In California alone, nearly 1.6 million adults have some type of mental illness and 541,600 of them are uninsured, according to research presented at the Annual Meeting by APHA member David Grant, PhD, director of the California Health Interview Survey at the University of California, Los Angeles Center for Health Policy Research.
Under the Affordable Care Act, if all 541,600 people moved to public coverage, it could reduce the percentage of people with unmet need from nearly 90 percent to about 66 percent, said Grant, who used 2009 California Health Interview Survey data.
“We do expect that may take some time, but we think there’s significant potential,” Grant said during the presentation. “Unmet needs in California will remain high. The mental health treatments for the uninsured are unlikely to change or improve in the near future.”
State progress on health insurance enrollment was also a popular topic at the Annual Meeting. Among the states that have seen success are Kentucky, which had enrolled more than 32,000 people in plans as of early November, and Arkansas, which saw a 14 percent reduction in uninsured residents, according to Annual Meeting presenter Jessica Kendall, MPH, director of outreach at Enroll America. The nonprofit group is working to maximize the number of uninsured Americans who enroll in health coverage made available by the Affordable Care Act.
“What we need to make sure happens is consumers know what they can do, that they know where they can set up an account,” Kendall said.
For more information, visit http://bit.ly/APHAHealthReform and www.healthcare.gov.
- Copyright The Nation’s Health, American Public Health Association
