Affordable Care Act

Moving Forward

with the Affordable Care Act


See December 2012 Update

In July 2012, the Supreme Court ruled that the major provisions of the Affordable Care Act (ACA), including the individual mandate, are constitutional. With that ruling, action to implement the federal law moved to each of our states and state capitols.

While the courts have decided, the political issues of the ACA are still hotly contested. These include: Medicaid expansion requirements; governors wanting to wait until after the November election to make a decision on implementation; and some leaders in Congress attempting to repeal the law. The bottom line is that the law is constitutional and in less than 18 months, January 2014, all states must be operating a Health Care Exchange and have decided whether or not to expand Medicaid.

As leaders in the community and providers of services assisting the very people the ACA is intended to serve, The Benefit Bank® (TBB™) state affiliates are well-positioned to guide the implementation of key provisions of the Act. One area of focus should be outreach and education for consumers. It is also important for TBB state affiliates to be aware of the issues around Medicaid expansion and begin to advocate for its adoption in their state.

Another way of assessing financial insecurity is through measuring the resources families have to address emergencies. According to the 2012 Assets & Opportunity Scorecard, over 1 in four families (27%) are living in "asset poverty," meaning that they do not have enough financial means to cover their expenses for three months. Related to asset poverty is net worth: total liabilities (credit card debt, mortgage debt, and loans) subtracted from total assets (home, car, and savings). Given the correlation between net worth and income, it is not surprising that net worth has decreased from $94,500 in 2006 to 70,600 in 2009 (the year data was most recently available).

The ACA recognizes the importance of consumer education and assistance in ensuring access to affordable health care by supporting Navigator and Consumer Assistance programs (CAPs). Both of these are charged with providing enrollment assistance and education for consumers.

The duties of Navigators include: educating consumers; providing impartial information that is culturally and linguistically appropriate; and facilitating enrollment in qualified health plans. These functions align with the expertise of TBB affiliates. Working with clients to access public benefits, TBB staff know the importance of outreach and education in reaching individuals who may be eligible, especially ones who are culturally diverse. On a daily basis, TBB counselors educate clients about public benefits and assist in the application process. These skills easily transfer to facilitating enrollment in qualified health plans.

Like Navigators, CAPs provide outreach and education, as well as assist with enrollment in health insurance programs. In addition, they assist with providing information on consumer rights and responsibilities, and help with appeals. In October 2010, the federal Department of Health and Human Services (HHS) awarded a total of $29 Million CAP grants to 35 states, 4 territories, and the District of Columbia. To continue and expand this work, HHS is providing an additional $29.9 million to support CAPs.

CAPs help people understand their rights and responsibilities and resolve problems with their health coverage. These are services that fit well with the responsibilities of TBB counselors. TBB affiliates should work with the leadership of their state to implement or expand CAPs . To identify CAPs in your state, as well as other consumer resources, go to HealthCare.gov.

For the day-to-day life of TBB clients, few provisions of the ACA will have as great an impact as Medicaid expansion. If all states implement the expansion, 15 to 17 million uninsured individuals will have access to coverage. For adults earning less than 100% of the Federal Poverty Income Guidelines (FPIGs), Medicaid expansion is their only option for health care under the ACA. Only individuals with income above 100% of the guidelines will be able to purchase insurance through the exchanges.

Some governors have argued that Medicaid expansion will be too costly. It is true that the expansion will result in a slight cost to states. However, the federal government will bear nearly all of the cost between 2014 and 2022, with 100% federal dollars from 2014 to 2016. In addition, Medicaid expansion will save states some money. States will have to use fewer dollars to pay hospitals for providing care for uninsured citizens. And, Medicaid expansion saves lives. According to a recent study conducted by Harvard researchers, in states that increased Medicaid eligible to individuals not normally qualified the number of deaths decreased significantly.

As the elections unfold, it will be easy to have your attention pulled from implementation of the ACA, but do not be distracted. TBB affiliates should push for full implementation and use their position in the community to become involved in the Navigator and/or Community Assistance programs.

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Last Update 12/12