By Michael Romain
MAYWOOD, THURSDAY — Before his discussion on the Affordable Care Act, U.S. Rep. Danny K. Davis (D-7th) was compelled to talk about a Congress that’s known more for its general dysfunction than for its ability to pass legislation.
“We don’t get much accomplished in Congress, because we’re divided,” he said at a town hall held in Village chambers last Thursday.
The reference to the ideological warfare being pitched at the federal level was more than an aside. The Patient Protection and Affordable Care Act, derisively known as “Obamacare” among many on the right, has reached a critical stage in its implementation.
Open enrollment in the federal government’s new Health Insurance Marketplace, an essential component of the Act, begins October 1st. The Marketplace, or exchange, is an online resource where citizens can quite literally shop for the healthcare plan that best serves their needs and budgets. It will also let them know the status of their eligibility for low-cost or free coverage through programs such as Medicaid and the Children’s Health Insurance Program (CHIP).
In the run-up to the enrollment date, officials at both the federal and state level have launched a massive nationwide public relations blitz to counter opponents of the healthcare law intent on seeing it fail.
Republicans are using the legislative recess to tour the country, actively discouraging individuals and institutions from enrolling in the program and drumming up support to starve the healthcare law of the federal money necessary for its enforcement.
Democrats such as Rep. Davis are making their own rounds in advance of community navigators, individuals hired by the government to go out in the community, inform people of the new law and encourage them to enroll. A crowd of about forty gathered inside of Village chambers to hear Mr. Davis and Charles Watkins, regional coordinator or Illinois’ Health Insurance Marketplace, expound on the details of the new legislation.
As Rep. Davis recalled, the government’s public relations tactic isn’t new to “Obamacare.”
“Many of the War on Poverty services had people go door-to-door to let them know that a new service was in town. [In my time] we had community health agents who would drag you to the clinic or let you know that the clinic was down the street,” he said.
According to Mr. Watkins, Illinois has received $27 million in grant funding to replicate the valiant efforts of those community health agents in a 21st century context. The grant money will go to reputable community organizations throughout the state to train people to assist in the enrollment process—only this time, much of that assistance will be online.
“They’ll go through all the health plans […] and help you compare side-by-side the advantages of the different plans,” Mr. Watkins said of the community navigators.
He also pointed out some of the major provisions of the new law, which include the end of rescission, or the practice by insurance companies of arbitrarily canceling policies; the elimination of annual policy limits and lifetime limits on the amount of healthcare expenditures to which individuals are entitled; and the elimination of certain ratings restrictions that allow insurance companies to deny coverage based on factors such as age, household size and residency.
Throughout Mr. Watkins’ presentation, several residents expressed some concern about certain facets of the law.
One man in attendance expressed concern with the apparent lack of lead agencies in the Proviso Township area that would get a share of the $27 million in grant money. He wanted to know what kind of benchmarks Mr. Watkins’ office would include to ensure that Proviso Township is sufficiently served by the navigators.
Mr. Watkins said that many of the lead organizations have sub-grantees, such as the Proviso Health Authority, that would serve the Proviso Township area.
“We’ll be methodically plotting out my region to look where the needs are. We’re pulling out all the stops on this initiative, but there are a number of organizations that will be providing services to the western suburbs and the west side of Chicago,” Mr. Watkins said.
When Ms. Loretta Brown’s mother had Alzheimer’s, Ms. Brown was the primary caretaker, but for a long time her mother’s disease went uncovered. “I was told the problems [my mother] was having weren’t physical. So does [the current law] expand coverage?”
“Yes,” Mr. Watkins said. “There are a minimum of ten benefits that must be covered with each plan. I feel very confident that if you had the same family situation that you just described and you were to go into the market and look at health plans, you’d find at least one plan with the coverage you just described.”
Mr. Watkins also pointed out that for seniors in general, there are a variety of benefits that will come with the law. Perhaps the most significant is the closing of the Medicare Part D coverage gap, also known as the Medicare donut hole. According to medicare.gov, the donut hole is the “temporary limit on what the drug plan will cover for drugs, which “begins after you and your drug plan have spent a certain amount for covered drugs.”
“The donut hole is closing because the Affordable Care Act and will be completely closed by 2020,” Mr. Watkins said. In the meantime, “Medicare recipients should’ve received a rebate check this year and should receive one next year,” he said. The check was sent out by the federal government to help defray the costs of the donut hole.
In addition to the gradual elimination of the donut hole, the Act will also encourage medical care providers to take a more holistic approach to geriatric care, according to Mr. Watkins. “This means essentially having a group of different doctors work together to decide what is the best care” for the particular senior citizen they’re treating.
Mrs. Loretta Robinson asked a question on behalf of a much younger demographic. “You’ve got the 26-year-old unemployed, uninsured and not getting money. Will they be eligible to afford a plan?” she said.
Twenty-six is the new age at which parents can no longer carry their children on the their health plans. Before the Act, the cutoff age was twenty-three. Mr. Watkins said that these young individuals would fall into a newly expanded Medicare category called ACA Adult.
Rep. Davis noted, however, that the hardest aspect of insuring young people under 35 is not necessarily lack of income, but the sense of invincibility shared among the demographic. It’s a reality for which the government seems to have game-planned.
“One of the really hard to reach populations are the ‘young invincibles’,” Rep. Davis said. “They need to be insured as well to protect themselves and their families. So, what we’ve found is that the most influential people in the lives of young people, especially males, are the female authority figure in their lives (moms, grandmothers, sisters). Encourage young people to find out about the health plans […] please encourage the young people to get with it early, especially those under 35. We want them to be protected and their families to be protected.”
Mr. Watkins informed the audience that the Act addresses the issues of low healthcare coverage and unemployment at the same time. The $27 million of grant funding is going to organizations to hire people all over the state as community navigators at $13-15/hour with benefits.
But for all of the details that were discussed, Rep. Davis was careful to keep what he considered the larger significance of Obamacare in focus.
“This is the most important piece of legislation to pass in this country since Medicare and Medicaid,” said Rep. Davis. “Before then, many members of our family and senior citizens had no medical care at all. My mother used to go all the way from Ashley County, AK to Little Rock to get dialysis treatment.
“The real deal on the Act is to try to reduce the cost of healthcare. The best way to reduce that is to convince people to take better care of their own health […] We really don’t have to die […] You know that black men in this country die ten years sooner than white ones? African-American men have lowest life expectancy in the country […] We’re trying to get rid of some of the disparities that exist […] Hopefully the Act will help with this.” VFP
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