The Affordable Care Act: Implications for Social Workers

12 Jul

ImageBy: Adrienne Gavula, MSW, LSW
Relationship Manager, NASW Ohio Chapter

Now that some of the heated rhetoric surrounding healthcare reform has slowed, it is time to critically look at the legislation and its effects on social workers and our clients, especially in Ohio.

The most controversial part of the legislation is the individual mandate and the penalty or tax, whichever you would like to call it. Kaiser Family Foundation has created an easy-to-read diagram to help you get the facts about what people will be taxed/penalized if they do not get health insurance.

The next piece that seems controversial is the health insurance exchanges. There is a detailed NASW Practice Perspective about them, but basically they are state-based markets where individuals and small businesses can purchase affordable health insurance, all the while ensuring that each plan meets the federal requirements (emergency services, maternity/newborn care, mental health…).

Originally the Affordable Care Act expanded coverage for low-income individuals with the expansion of Medicaid up to 133% (instead of 100% currently) of the Federal Poverty Level. The ACA mandate that required states adopt a Medicaid expansion up to 133% FPL or risk losing all Medicaid funding was struck down by the Supreme Court. States can still voluntarily adopt the expansion, but they are no longer required to do so. Governor Kasich has not said whether Ohio will adopt the expansion.

Those with incomes between 133% and 400% FPL will be eligible for a sliding-scale federal subsidy to purchase insurance on the exchanges. You can see if you are eligible for a subsidy by using Kaiser Family Foundation’s Health Reform Subsidy Calculator.

To calculate your FPL, you can use this.

The idea is that this is one-stop shopping for health care, and eligibility will be determined for Medicaid, CHIP (Children’s Health Insurance Program) and exchanges. There is room for social worker involvement, and NASW Ohio Chapter is ready to advocate for social workers and our clients. States can create their exchanges based on need and should include representatives from consumer groups (you and your clients!), health insurance industry, employers, etc… We can advocate for social work services to be essential patient benefits in the plans.

Ohio has until January 1, 2013 to create a state-based exchange that the Department of Health and Human Services approves or the federal government will assume responsibility for running a health insurance exchange in Ohio (Kaiser Family Foundation).On July 3, 2012 Governor Kasich said that Ohio will probably let the federal government run the exchanges for Ohio, and on July 11, 2012 Lt. Governor Mary Taylor said that the state does not plan to set up the exchange.

Here are some other provisions that have either gone into effect or will go into effect:

  • If you have a preexisting medical condition health insurance companies cannot deny you coverage
  • If you are age 26 or younger then you can stay on your parent’s insurance
  • Health plans are required to spend at least 85% of every dollar on your healthcare
  • If a health plan wants to increase your premiums they must now justify it and open that justification up to public comment
  • No more lifetime limits on how much your health plan will cover
  • Health plans must cover preventative care with no copay/cost. One of the biggest concerns is that with the focus on primary care/prevention there may not be a pool of primary care providers big enough to serve everyone coming into the healthcare market. Due to this, there are provisions in the ACA that provide incentives for doctors and nurses to work in primary care settings
  • The new Community First Choice Option allows states to offer home and community-based services to disabled people through Medicaid rather than institutional care in nursing homes
  • There are incentives for physicians to join together to form Accountable Care Organizations to increase care coordination. You can read more about ACOs here.

View the ACA Timeline.

When I was practicing clinically I worked with HIV+ individuals. Many of my clients worked but could not access their employer’s healthcare because of their HIV status, and the few that could access healthcare had a hard time with costs related to their HIV care. The copays for medication ranged from $50-$300/pill/month (many were taking three pills/month) and a $50-$100 copay for doctor’s appointments, which were usually every three months. There is no livable wage and because of that incomes have not kept up with the cost of healthcare for someone to fully afford what is needed to keep them and their family healthy.

For people to reach their full potential they need access to healthcare. You have to be healthy to work. You have to be healthy to be a fully-invested parent in a child’s life. You have to be healthy to care for your aging parents. And you have to be healthy to participate and experience all that life has to offer. The Affordable Care Act brings us one step closer to ensuring that our clients get the healthcare they need to reach their full potential.

Social workers have long been pioneers in the fight for universal healthcare coverage. Secretary of Labor Frances Perkins included universal healthcare on the 12-item agenda she brought to President Roosevelt in 1933, and that was the only item on her agenda that did not pass into law.

While NASW will continue to advocate for a fair and just healthcare system for every American, we believe the ACA will have a tremendously positive impact on the future of our nation.

View frequently asked questions about the ACA on National NASW’s blog.

Test your Affordable Care Act knowledge at Kaiser Family Foundation and let us know your score and share with us your thoughts on how the ACA will affect you and your clients.

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