I’ve already written about the promotion of the ACA among AIDS organizations and the dangers of the HIV/AIDS community falling into that spin vortex. Today, my attention was brought to the spin being offered to the LGBT community.
Secretary of Health & Human Services Kathleen Sebelius gave an address on March 26 about LGBT Health Awareness Week touting how the ACA is “helping millions of Americans gain access to care by creating coverage options for people with pre-existing conditions, and under the law, beginning in 2014, every American will have access to health care through Affordable Insurance Exchanges, new competitive marketplaces where Americans will be able to purchase affordable coverage and have the same choices of insurance that members of Congress will have.” At the end of the transcript of the address was a link to a “fact sheet” about how the ACA will benefit LGBT people, so of course I went to it.
Here, in my new tradition, is my response to each point they make. My part is in bold, the rest is their exact words.
There is some evidence suggesting that at least a portion of the LGBT community is disproportionately uninsured. This makes the new coverage options under the Affordable Care Act that much more important to them. The Affordable Care Act is making new coverage options available to Americans, including those without access to coverage through a domestic partner or employer and those with pre-existing health conditions:
Already, qualifying Americans who are uninsured due to a pre-existing health condition have access to health insurance at an affordable rate through Pre-Existing Condition Insurance Plans. And can anyone making less than $100,000 per year afford the sky high premiums and ridiculous deductibles of these plans? In Illinois, which has a state-run plan, I (a 56-year-old non-smoker in Chicago) would have to come up with $489 per month for a $1,000 deductible plan and then have to pay 20% of my total costs (insurance pays 80% after the deductible has been met). In Indiana, which has a federally-run plan, I would pay $395 per month for a “standard” plan and $532 for an “extended” one, with again, varying high deductibles and the assurance that “The maximum you will pay out-of-pocket for covered services in a calendar year is $6,050 in-network/$7,000 out-of-network.” So even if I go with the cheapest choice, and not including the 20% not covered, I would be paying $10,790, more than 25% of my income.
Young adults are able to remain on a parent’s health plan until they turn 26 if the plan covers dependent children and if coverage isn’t offered to them through their job. Of course, if their or their parents’ job has crappy insurance with high co-pays and deductibles, their access to actual care is still limited.
In 2014, the Medicaid program will be expanded to cover Americans with income at or below 133% of the federal poverty level (FPL). What they don’t like to tell us is that the FPL is ridiculously low – 133% for one person is $14,856, only $224 less than a minimum wage earner would make, so anyone struggling to live on $200% of FPL ($22,340) would make “too much” to qualify. This expansion will increase access to care for low-income adults. Perhaps for a few, but in order to do so, it would have to be allowed to happen in the first place. Indications from the recent Supreme Court hearings would seem to point to a less than high probability of that happening.
Also in 2014, Affordable Insurance Exchanges, new competitive insurance marketplaces, will be established where millions of Americans and small businesses will be able to purchase affordable coverage and have the same choices of insurance that members of Congress will have. Tax credits will help middle class families afford health insurance. My problem with this is that the people who come up with the language of “affordable” anything are very rarely people who have never been able to afford whatever they’re applying it to. According to them, the pre-existing condition insurance is “affordable.” According to them, my $40,000-per-year salary puts me in a category of being able to “afford” the highest rate on a sliding scale fee chart. And as far as these ”premium tax credits” go, according to the website, “These premium tax credits are paid on an advance basis to the health insurance provider, which will reduce the monthly premiums owed by families to purchase coverage.” Seriously? They really expect us to believe that there will never be insurance companies that say they never got that money and thus deny our claims? Or that the amount of premiums will mysteriously continue to rise, even though the tax credits don’t?
New benefits will make it easier for consumers to get and keep their health coverage. For example, the Affordable Care Act prohibits insurance companies from refusing coverage to, or limiting the benefits of, children (under age 19) because of a pre-existing medical condition. The day after this provision went into effect, most of the major insurance companies suddenly decided they weren’t going to sell children’s policies anymore.
In 2014, discriminating against anyone with a pre-existing condition will be illegal. They won’t be able to deny coverage, perhaps, but they can certainly charge more for it, as the “high risk insurance” has proven. And the law prohibits insurance plans from canceling an individual’s coverage just because of a mistake on his or her paperwork. Woo hoo.
LGBT individuals have encountered discrimination in the health care system for decades, and many studies have shown that LGBT people are affected by chronic disease at a higher rate than straight people. The new law has already made significant progress toward ending some of the worst insurance company abuses and helping ensure that LGBT Americans have access to coverage when they need it most. For example, the Affordable Care Act ends lifetime dollar limits on key benefits and restricts annual dollar limits until they are ended in 2014, allowing for long-term comprehensive treatment of chronic diseases. Once again, 2014’s provisions will never come. If the Supreme Court doesn’t strike down the whole law, Republicans will pick away at it until lifetime and annual limits are restored to the insurance companies.
In addition, the federal website designed to help all consumers find the health insurance best suited to their needs makes it easy to locate health insurers that cover domestic partners. HealthCare.gov’s insurance and coverage finder now includes a “same-sex partner” filter, allowing same-sex couples to eliminate plans which would not cover both people from the list of plans available in their area. Consumers looking for information on domestic partner coverage will also have access to HealthCare.gov’s regular features, such as the ability to sort based on the enrollment, a plan’s out-of-pocket costs or other categories. The same-sex partner filter is also available for small employers looking for information on the small group market. OK, at least you’ll be able to see whether or not your state thinks your relationship is valid and deserves the same benefits that straight married couples get.
Preventive Care for Better Health
The Affordable Care Act is taking significant steps toward improving access to preventive care. Non-grandfathered health plans now must cover recommended preventive care services without charging deductibles, co-payments, or co-insurance. The problem here is that there has yet to be consensus on what exactly “recommended preventive care services” are. Insurance companies will fight tooth and nail to limit those services to the least costly, least effective, least conclusive procedures available. Need an MRI to check that lump you found in your breast? Too bad – an x-ray will be “just as good.”
In addition, the Affordable Care Act is funding preventive efforts for communities, including millions of dollars to use evidence-based interventions to address tobacco control, obesity prevention, HIV-related health disparities, better nutrition and physical activity. The Department of Health and Human Services is working with community centers serving the LGBT community to employ proven prevention strategies. OK, as long as “community centers” are still open for business instead of being shut down for lacking of funding.
Improving Care and Fighting Disparities
The Affordable Care Act is making other investments that will help address health disparities experienced by the LGBT community. Funding is going toward building a more diverse and culturally competent health care workforce, as well as investing in community health centers to serve up to 20 million more patients. Again, though funding WAS set aside within the ACA for community health centers, budget cutters have and will continue to get rid of it and more and more community health, and mental health, centers will close their doors. And through increased research and data collection on health disparities, policymakers will have the knowledge and tools they need to continue to address health issues in LGBT communities.
Small Business Tax Credits
The Affordable Care Act helps small business and small tax-exempt organizations afford the cost of providing health coverage for their employees. Americans who own a small business with fewer than 25 employees and provide health insurance may qualify for a small business tax credit of up to 35% (up to 25% for non-profits) to offset the cost of the insurance. This will make the cost to small employers of providing insurance much lower. Of course, under the proposed funding for HR 676, small business employers would only pay 7.4% healthcare tax—no rising premiums, workers’ comp, separate payments for dental and vision, no more negotiating healthcare in union or pension contracts. AND employees would have access to the care they need with none of the stress of how to pay the bills—healthier, happier, more productive work force.
Historically, people living with HIV and AIDS have had a difficult time obtaining private health insurance and have been particularly vulnerable to insurance industry abuses. Currently, fewer than one in five (17%) people living with HIV have private insurance and nearly 30% do not have any coverage. It’s actually more like 70% of HIV-positive people in the U.S. rely on Medicaid, Medicare, and ADAP for their healthcare. The Affordable Care Act makes it easier for people living with HIV/AIDS to get coverage through the Pre-Existing Condition Insurance Plans. Sure, if they can afford the huge cost and prohibitive deductibles. The ban on pre-existing condition exclusions will extend to all Americans in 2014, along with expanded Medicaid eligibility, the creation of Affordable Insurance Exchanges, and new tax credits for middle class families to help them afford insurance. Unless, of course, there IS no ACA by 2014. Plan B, people!
People with HIV/AIDS also face barriers to obtaining care from qualified providers. Consistent with the goals of the President’s National HIV/AIDS Strategy, the Affordable Care Act makes considerable strides in addressing these concerns and advancing equality for people living with HIV and AIDS. What does this mean, exactly? Examples, please. Investments in prevention, as well as improving care coordination, will help people living with HIV/AIDS get the treatment they need.
I’ve said it before, I’ll say it again. This law is not what President Obama wanted when he started down the rocky road of changing the system we have. It is not what the majority of Americans (gay or not) want, certainly not what we, as single-payer advocates, will accept. The only question is whether or not we will stand by and let all the machinations of Republicans and the decision of the Supreme Court open a window of opportunity for us that we will not take advantage of.
If the ACA is repealed in full, we must be there, relentlessly, fiercely, to hold single-payer up as the only solution. DUH gives us a chance to do that.