Thoughts About This ACA

Marketplace - Affordable Care Act - Obamacare - Eight months ago these terms were terms all foreign to me. I would frequently see them mentioned on news outlets, in scholarly discourses at my university, and from every family friend who was either pro- or con- President Barack Obama. Whenever I heard any talk about the Affordable Care Act (ACA), my eyes would glaze over while my mind would zone out thinking about anything but health insurance. It seemed like every single person I ran across had an opinion about this “Obamacare” thing.

Partially out of fear of exclusion at dinnertime arguments, but mostly out of an interest in experiencing the interface of health policy and medicine, I embarked on an eleven-month adventure with PHC as an Insurance Specialist at Health Center 2, helping the people of South Philly enroll in health insurance. Now, after months of assisting patients navigate the ACA mandated health insurance Marketplace, I feel like I, too, am qualified to give my thoughts about the Affordable Care Act and the enrollment process.

Since mid-November I have been involved in enrollment as a Certified Application Counselor where I help patients purchase plans through the Marketplace, a federally facilitated exchange where patients can compare and, ultimately, choose a competitively priced health plan. Though I see more people qualified to enroll in the state funded medical assistance program than in the health insurance marketplace, I still did serve many patients who qualified for the marketplace through their citizenship status and/or income. As I was going through the enrollment process with these marketplace consumers, I repeatedly came across people who completed the health insurance application but did not enroll in a plan. When following up with them to ask why this was the case, the most common answer was, unsurprisingly, the price of the plan.

When educating a consumer, I try to be as open and upfront as I can. First, I make sure he/she knows the importance of health insurance and the massive risk he/she is taking if he/she does not enroll. I also make them aware of the penalty they could potentially incur if they do not enroll in any type of health insurance plan. And, equally as pertinent to the consumer, I make them aware of all costs of the plan including deductibles, prescriptions, hospital visits, and doctor’s visits.  It is usually at this point that the consumer makes the decision to move on with enrollment or pay the tax penalty.

I remember three potential marketplace consumers who did not enroll because of the cost of prescriptions. These patients took multiple medications that were not “preferred” or were in a costlier tier of coverage within the plan making it unaffordable.. This decision was mirrored at times while explaining a deductible, or the amount of money one has to pay before the plan begins paying (as specified by the plan). They decided that they were better off incurring a penalty and risking their health than paying all the fees within the plan.

I have been reading in the news recently about the effectiveness of the Affordable Care Act. Twelve million people have signed up for health insurance through the marketplace. For many of these folks, this means security against an unpredictable health scare. And, in the long term, this will amount to less spending on healthcare, and, hopefully, more of a focus on preventative medicine and alternative therapies. Many of my patients have been extremely pleased with the plans that they purchased which gives me hope for the evolution of the health care system. However, since the insurance industry works on unclaimed benefits, healthy, but cautious, consumers who are strapped for cash are implicitly penalized. Such is the case with the lower income consumers that I saw who believe that the plans offered to them are too expensive and unaffordable. These consumers should not be ignored by the ACA.

My first year of enrollment has included various reactions from clients. From hugs one day to strong verbal exchanges the next, I understand that the ACA is a new piece of legislation and as such, is imperfect and a work in progress. However, until we reach that inconceivable state where everybody is happy, I will continue to have thoughts about the ACA and be “that guy” at a party who argues about the economic and sociological implications of Obamacare.

This post was written by PHC member Srihari Balasubramanian.
Srihari serves at the Philadelphia Department of Public Health - Health Center #2 as an Insurance Specialist.