When the Supreme Court upheld the Affordable Care Act recently, policymakers and those in the medical community who serve people of color hailed the decision as a victory. But many African-Americans still wonder what this law really means to them and how it can help play a role in reversing many of the health disparities facing black Americans.
To get answers to these questions, emPower magazine spoke with Marjorie Innocent, Ph.D., Vice President of Research and Programs for the Congressional Black Caucus Foundation (CBCF). Below, in her own words, she describes five initiatives within the Affordable Care Act that could have a direct impact on low-income communities and people of color.
Impact #1: The Expansion of Medicaid
(The Act) will help to expand health care coverage for low-income populations. It will expand coverage through the Medicaid program by increasing the income limit to 133 percent of the federal poverty threshold. It will also increase the range for individuals who can now quality for Medicaid. Historically, Medicaid was for the elderly, the disabled, or those with young children. They did not qualify for Medicaid. Now, individuals 18-64 will qualify as long as they fall within that 133 percent ceiling of the federal poverty level.
If you are a part of a certain economic level for Medicaid, as long as your state is willing to accept the additional support, the federal government is going to supply the extra funding for Medicaid. The one caveat of the Supreme Court ruling was that the federal government couldn’t force states to accept the expansion of Medicaid by withholding funds that were already earmarked for them. The federal government will actually cover the cost of that expansion for at least a couple of years, and over time will reduce that to 90 percent. States will have to come up with the 10 percent. That’s a pretty significant amount of support to states. While we recognize that a lot of states are dealing with financial pressures, the reality is that making the additional funds available to expand Medicaid at a rate of 10 percent out of their state coffers over the next few years will ultimately cost them less over time than not addressing the health care needs of people who need it and having to deal with greater health care cost later.
Impact #2: Subsidies to Individuals Without Insurance
The law also provides subsidies for people who do not currently have health insurance. They will be able to purchase affordable and quality health insurance that meets certain minimum benchmarks in terms of the services it provides. The subsidies will be available for people with incomes up to 400 percent of the federal poverty level. This is major, especially with our health care system. It is almost impossible to be able to get health care without some form of insurance because it is so costly, whether it’s public or private. So either you have it through your job, buy it yourself or receive Medicaid, Medicare, or veteran’s benefits. For the vast majority of Americans, the ability to be able to pay for care out of pocket—whether it’s regular care or urgent care, if something happens to them—is not that financially feasible. So that’s the funding piece of the equation.
We’re hoping the law will change our country’s mindset about health care and help shift how we handle health in America, from a reactive model where we seek care when we need it, which is usually too late, versus using health care to prevent diseases. Or if you have a chronic medical condition, it is contained before it gets worst.
The mandatory coverage kicks in 2014. Many states are moving forward in implementing their health insurance exchanges, which is a market place that will be controlled by states so insurance companies can offer the minimum range of services that they have to provide by law. People will be able to select what plan they want for themselves and families. The likelihood of people potentially misunderstanding or misinterpreting information and being mislead by an insurance company will get reduced over time.
Impact #3: Receiving Necessary Screenings to Prevent or Slow Down Diseases
We (African- Americans) tend to get diagnosed after we’ve had cancer for some time. We get diagnosed later than our white counterparts and are diagnosed with greater severity of the disease, whether it’s cancer, diabetes or other chronic conditions. Overtime, this means higher costs in care and/or a greater negative impact on the quality of life. This law changes how we do business around health care to really focus on prevention and receive care early and on a regular basis. This doesn’t mean people need to go to the doctor all the time. It means certain services, such as recommended annual screenings from major diseases for the vast majority of adults, will be done at no cost to them based on the recommended frequency. You don’t have to pay a co-pay, and there won’t be any co-insurance.
If you’re a healthy person and you want to get an MRI, you will have to pay for that, unless there’s some clear indication of risk. For a person who needs to manage a certain type of cancer, it is possible that they can get the appropriate screening at a reduced cost and would be part of the recommended regiment. The whole point is to have disease management.
Impact #4: Health Centers In At-Risk Communities
This health care system will encourage prevention by having more primary care physicians with the expansion of Community Health Centers, which have played an instrumental role in providing health care to underserved communities with very high rates of various diseases. There will be an expansion in underserved areas—urban, rural and suburban. However, primary based health care is also going to be expanded throughout the medical system, even for those who are able to pay for their care through existing insurance or out of pocket. We’re going to see more primary care physicians actually being part of the medical system and more primary care physicians being able to take on patients.
Living in DC, I have had some challenges with identifying primary care physicians who are taking patients actively because they have a full load. The system requires more medical professionals to serve patients. I think it is going to be a real potential for employment. For those who are going into medicine, they should take a serious look at primary preventive care such as a physician, nurse practitioner or a physician’s assistant. This is where there will be need. More people are now going to come into the health care system on a regular basis, as opposed to when they only need care. We will need more primary care doctors to provide those services. The career opportunity is going to be considerable.
Impact #5: Better Coordination among Doctors
From a system standpoint, there will be a greater effort to coordinate health care—especially for those who have more complicated medical illnesses and multiple chronic conditions—among providers. It will become less of a “stop here, stop there” kind of process for patients. Providers will speak to each other and will be more aware of the recent medications or complications of the people they are caring for. That way, they will be able to better explain what it is that they need to do to make sure their patients are proactive with their own care; all of this is going to take part over time as the law gets fully implemented.
To help African-Americans navigate the new health plan, the CBCF released, “Understanding Health Reform: A Community Guide for African-Americans.” You can download it here.