The Affordable Care Act: Increasing Access Through Awareness
Familiarity with the Affordable Care Act (ACA) is critical for social workers helping clients obtain access to mental and physical health services – even if it means knowing what hasn’t changed under the 2010 law. To help demystify this ponderous piece of legislation, the School of Social Work’s Leadership Learning Community on Nov. 7 invited Kathryn Smolinski, director of Legal Advocacy for People with Cancer and an adjunct assistant professor for Wayne State University Law School, to Thompson Home to provide an overview of the ACA’s major components.
Under the ACA, Smolinksi noted, insurers can no longer require health histories before pricing their plans or deny new policy holders treatment for pre-existing conditions – a huge victory for people with chronic health conditions. Men and woman are now covered at the same rate (meaning women will no longer pay higher rates as a consequence of labor and delivery costs) and all insurance policies purchased under the individual mandate must contain 10 essential services. These are: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder substances, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
Smolinksi also explained Michigan’s expansion of Medicaid to 133% of the Federal Poverty Level, meaning that those living at or near poverty (about $30,000 per year for a family of four) can receive health care. The expansion, effective April 1, will also eliminate the asset test, meaning that poor individuals will not need to deplete their savings before becoming eligible for coverage.
What should social workers keep in mind as the ACA rolls out? First off, clients eligible for Medicare and veterans’ health benefits should continue to consult those respective programs. Second, clients receiving Medicare are vulnerable to scams. Predators may call them, citing changes under the ACA and asking for personal information, Medicare numbers and bank account information. As Smolinksi noted, Medicare clients do not need a new card and no one from Medicare will be contacting them.
Finally, “the marketplaces” or “exchanges” – interchangeable names for places to buy health insurance online – can be complicated, but there is help. The federal government has spent millions of dollars to train, support, and certify patient “navigators” who partner with local medical systems to help people figure out how the ACA marketplaces work. Wayne State M.S.W. student Gwendolyn Crawford, who has completed the Navigation Training, said she’s so eager to see people access care she starts conversations about the ACA with strangers on the bus!
As social workers we enjoy the special trust of our clients and can help them understand and enjoy their rights. With the ACA, essential mental and physical health services are now among these rights, so let’s each do our part to learn about this law and spread the word!