Wrapping up a cut of meat, he is taken aback by the question, “Are you going to enroll for insurance through the Maryland Health Connection?” Yaseen* Reza, a healthy man in his late 20s works for a halal grocer. Unmarried, uninsured and a citizen, he has heard about the Affordable Health Act (ACA also termed Obamacare), after the government shutdown, but doesn’t know how it applies to him.
Medical debt is a top cause of bankruptcy in the United States and 42.6 million Americans under the age of 65 live without health insurance. “[The new law] is particularly important in addressing racial and ethnic health inequalities,” shares Suzanne Schlattman, Deputy Director for Development and Community Outreach, Maryland Citizens' Health Initiative Education Fund, Inc. at a news briefing arranged by New America Media.
On October 1st, Americans began shopping for mandated health coverage that is affordable. Enrollment will continue until March 31, 2014. Health insurance coverage will start in January 2014. Under the new law, all legal residents are required to have health insurance, including lawfully present: green card holders, refugees, asylees, and non-immigrant visa holders, so now is the time to start shopping using the health exchanges.
Maryland has the lowest rates for insurance plans.
Maryland chose to set up its own exchange instead of relying on the federal exchange. Using the internet, any resident of Maryland can access the Maryland Health Connection, a “one-stop health insurance marketplace where individuals and families can shop, compare and select a health plan.” The site has experienced glitches as thousands have tried to register for healthcare ‘that is finally affordable.’
Consumers who have questions or cannot log on to the exchanges can use organizations called ‘connectors’. Connectors have staff called navigators that can help them choose the best insurance for their needs.
As a leader among the rest of the states, Maryland’s early acceptance of the plan put it in a position to take advantage of federal grants. “Because we acted so early, we didn't get weighed down in the political rhetoric that other states got weighed down in,” says Schlattman.
As a Marylander, Reza has the choice to take the full amount of the tax credit immediately to knock down the amount his insurance will cost him or he can wait until the end of the year and receive the tax credit as a part of his tax refund.
Marketplaces are set, no matter what state a consumer lives in, he or she will be able to use the federal marketplace to apply for coverage, compare options, and enroll.
Washington D.C.has its own exchange, and Virginia chose to use the federal exchange. The federal and state exchanges are shopping malls of health coverage and include a range of options so consumers can pick a plan that meets their needs and their budget. They can check if they qualify for lower costs on health insurance, based on modified adjusted gross income or free or low-cost coverage available through Medicaid or the Children’s Health Insurance Program.
Benefits for Young Adults
Lisa Ahmad* is a first year medical student. She wants to know if she should buy the expensive insurance from her university or will she be covered by her parents’ insurance if they choose to buy through Maryland Health Connection. Ahmad has a preexisting condition as she crushed her metatarsals in a car accident. Leigh Cobb, Health Policy Director at Advocates for Children and Youth, says that all plans will also have to cover children through their parents insurance, up to the age of 26.
Beginning in 2014, no insurance plan in the country can turn down or charge more money because someone is sick or has an on-going health issue (a pre-existing condition). This is true even if someone was turned down or refused coverage due to a pre-existing condition in the past.
They also can’t charge women more than men.
Consumers can look forward to other positive aspects of the new healthcare act, such as no more lifetime limits on health care coverage.
All plans must also cover preventative and wellness care, as well as chronic disease management, at no extra cost to the consumer, including flu and pneumonia shots, routine vaccinations, and screenings for cancer. And essential health insurance benefits are included; meaning a doctor visit, hospitalization, emergency care, maternity and newborn care, pediatric care, prescription drugs, laboratory tests, and substance abuse treatment. The new healthcare act will also allow access to mental health services, which is acutely needed especially for refugees or recent immigrants, many of whom are from war torn countries.
Reza is healthy, strong and doesn’t think he will get sick. He falls under a large category of males called the young invincibles, those who do not get insurance because it is too expensive. They are predominantly Black, Asian or Hispanic men, according younginvincibles.org, a DC based advocacy group that lobbied the government to address critical youth policy issues.
Reza now realizes that unless he gets insurance, he could incur a penalty on his tax returns: $95 per adult and $47.50 per child, or 1 percent of a household’s total income, whichever is greater. By 2016, adults pay as much as $695 and $347.50 per child for a $2,085 family maximum, or 2.5 percent of the household income. Depending on how many hours he works and his income, according to the federal poverty line (FPL), he may be eligible for free or subsidized health insurance.
Options for All
When the Muslim Link spoke to the principal of the school at Islamic Community Center of Laurel (ICCL), she said that many of the teachers have insurance through their husbands’ employment but there are teachers who have no insurance, and they are often the only breadwinners in the family. Under ACA, a family of six, earning $43,596 – $126,360, or a couple earning between $21,405 – $62,040 can qualify for eligible federal subsidies. She was excited about spreading the news in the community.
These teachers and other consumers can purchase subsidized coverage, and choose between four levels: Bronze, Silver, Gold, and Platinum (in order of least to most comprehensive). In general, more comprehensive plans have higher premiums, but also have lower out-of-pocket costs. Bronze level coverage is the lowest level of coverage most people are required to have under health reform; on average bronze plans cover 60 percent of enrollees’ total costs. In the Silver level, on average the insurance pays 70 percent of the cost and the patient pays 30 percent. The most comprehensive plans are Gold and Platinum plans, which cover 80 and 90 percent of enrollees’ total costs, respectively.
The benefits to Americans who already have health insurance through their employers is that all “preventative care” will now be available at no out-of-pocket cost. That means no co-pay on a whole gamut of tests including blood pressure screenings, vaccinations, and STD/HIV screenings.
Unless... their plans are ‘grandfathered’. This mean some health plans are exempt from some ACA’s rules and protections to allow a smooth transition and so businesses and individuals can keep current policies without having to make substantial changes. Consumers will need to check if their current plans are grandfathered.
For someone already enrolled in Medicaid, nothing changes, and he or she does not have to enroll again.
Consumers should note that plans offered through the exchange will not cover dental or vision; these will have to be purchased separately.
New immigrants and ACA
The Riaz* family attends ICCL, they are documented immigrants but have been in the country for less than five years. A doctor in his country of origin, Shahid Riaz* works at a local gas station to pay the bills, as he is not certified as a physician. They have two children. Through the masjid grapevine they learn that they can apply for health insurance through the exchange.
“My parents visit from overseas every year; they stay with us for six months; they are green card holders. What are their options under the new Maryland health care law?,” asks Adel Hassan* of Prince George’s County. This question is asked many times by different community members. Legal immigrants, such as green card holders, are eligible for qualified health plans through MHC, but not for Medicaid until they have lived in this country for five years, according to the law.
Lawful permanent residents (green card holders), who pay taxes in the US, are required to have a qualified health insurance plan, irrespective of whether or not they live in the USA on a long term basis or visit the United States only for a few months in a year.
Since no or low income non-citizens do not qualify for Medicaid (or have to wait for 5 years to qualify), they will be required to buy insurance while they are in the country. Insurance will be subsidized according to their income. Undocumented immigrants cannot use the exchange to purchase insurance.
ACA for the Self Employed and Small Businesses
Amir Sahib is a self employed contractor with a family. He works at Fifth Tribe, a software firm, and wonders how he can get affordable insurance for his family without paying high insurance rates. Kristie Arslan, former CEO of the National Association of Self Employed helped write the law. She says that a majority of small businesses in the United States are self employed.
The Self Employed Benefit Institute states that 28 percent of self employed are currently uninsured. They are particularly challenged due to the practice of underwriting, which will not be allowed anymore.
According to Arslan, the new law minimizes how much an insurance company can charge Sahib and others like him, reducing out of pocket expenses. Another issue has been cost, due the extremely high economies scale. Exchanges are pooling mechanisms and allow states like Maryland to group all of their residents together and negotiate a better price for all. Sahib and his family will have expanded coverage options under the ACA.
Jameel Ramirez*, runs a non-profit with more than 50 employees in the DC Metro area and is baffled by the jargon. He doesn’t know what his responsibility is as an employer. Since Ramirez has more than 50 full-time employees, under the employer mandate he will suffer a penalty if he does not provide insurance to his employees by 2015. However, Ramirez can use the MHC to shop for insurance for his employees. Even if he was a ‘for profit’ employer the same rules would apply. The exchanges streamline the regulatory burden for Ramirez compared to if he was doing it all on his own.
Employers with less than 50 employees, like halal restaurants, software firms or smaller start-ups can choose to offer health coverage and have their costs offset by the Small Employer Health Care Tax Credit.
The Muslim Community Prepares for ACA
Dr. Sufia Syed is a doctor at Dar us Salaam Medical Clinic (DUS) in Greenbelt, Maryland. The clinic has been preparing for a year for the changes in the healthcare law. The clinic sees many uninsured patients, and she is concerned how the clinic will handle the influx of new patients when the insurance kicks in, in January, when the clinic is already packed. “More people with coverage is great, but finding specialists that handle Medicaid and state insurance is difficult.”
She is right in her concerns. “The networks will be narrower than the networks typically offered to large groups of employees in the commercial market,” says Joseph Monday, a spokesman for the insurance company, Cigna, to the New York Times.
Masjid Muhammad in DC held an informational session for its congregants, as many of the worshippers are uninsured and want to learn how to register.
Muslim Community Center’s Health Clinic in Silver Spring, MD has been preparing, too. According to the director, Dr. Azad Ejaz, the clinic is changing its infrastructure to accept insurances in addition to Medicaid, and is applying for Medicare.
They will hold a community health fair on October 13, 2013 where a county employee and navigators will be available to assist with information and registration. “Most people were not able to log in to the application process online, that is why we are hosting the fair,” said Azad.
FAITH Social Services in Herndon is training an employee with a Virginia based navigator to assist community member enroll and for advocacy.
Others around the area are preparing as well. With buses provided by the Montgomery County Muslim Foundation, the MCC Senior Program took seniors to White Oak Recreation Center this week to learn about the changes affecting seniors due to the new healthcare law.
Community clinics such as DUS, safety-net clinics like MCC and federally run community health centers will play a major role in the success of the ACA. A majority of the patients at the safety-net clinics — which serve mostly low-income individuals and families — will be automatically absorbed in the law’s expansion of Medicaid, the nation’s public health insurance plan. At this time Virginia has decided not to expand Medicaid.
There are some broader concerns about the Affordable HealthCare Act. “Where will the money come from to pay for this?” wonders Dr. Imran Chowdhry of Howard County.
Dr. Saleem Farooqui, a specialist based near Ellicott City, MD has questions about a continuing shortage of doctors, both primary care and specialists. “The training required is longer (more fellowships after residencies). Medicare reimbursements to physicians continue to decline, medical school debt is increasing, malpractice is on the rise, and primary care physicians closing up shops because they can't meet overhead expenses.”
In the coming months the potency of these concerns will be tested as the nation watches Maryland, a leader in the healthcare reform game, very closely.