Countdown to Coverage: Opening Day

Today’s opening of the new Health Insurance Marketplace is kind of a big deal–for health care access, for Texas, for the nation, and for CPPP.  Many of you know that the Center was founded in 1985 by the Benedictine Sisters of Boerne with a mission to improve health care access for “poor and disenfranchised Texans.”

Given that mission, and having worked here at CPPP for nearly 19 years, I am excited about the roll-out of new health coverage in 2014 under the Affordable Care Act (ACA) because, for the first time, our nation is creating a system to make comprehensive health care available to nearly all Americans, not for free, but at a “sliding-scale” price that works for your budget.  It’s not a perfect system, and I know that there will be bumps and delays as the new systems roll out.  But the fact that the U.S. is finally trying to break down the financial barriers to a decent standard of health care is of enormous significance.  And with the Census reporting Texas still has more than 6 million (one in four) uninsured, no state has more to gain than ours!

Most Texans who are already insured through work will not interact with the new Marketplace, but folks who are uninsured today or buying directly from an insurance company really owe it to themselves to go the www.healthcare.gov and check out new options.

Health plans in the Marketplace won’t leave out major parts of health care–every plan will include prescriptions, mental health, maternity, and must cover any pre-existing condition—so you won’t have hard choices about benefits.  Instead, one of the biggest choices will be whether you prefer a lower monthly premium (with the risk of paying more out of pocket later when you need care), or a higher monthly premium but less out of your pocket at the doctor’s office or pharmacy.  Another big choice is to pick a plan that includes the doctor or clinic that you want to use, and will give you access to any special medications or services you need.

As Megan Randall blogged here last week, the sneak preview of Texas Marketplace rates provided by US HHS last week showed that with the “premium credit” discounts available, some low-income Texans will have the option to get a “bronze” plan with zero monthly premium cost!  That will be tempting, no doubt, but may not really be the least expensive choice for a person who needs regular health care visits or prescriptions.  It is really important that folks facing the trade-off between low monthly premiums on the one hand, and higher costs when you need care on the other hand, take a careful look at their health care needs, and get any help they need to make a good choice.

Texans must first submit an application to get those premium and co-pay discounts, and that can be done online at www.healthcare.gov, over the phone, by mail, or in person at a local community agency.  You can look up place to get in-person help at www.healthcare.gov, with a special link to search by zip code at www.localhelp.healthcare.gov.

It is important to know that thousands of Texans working for community-based agencies across Texas have been trained and certified to help out with the new systems, and to help individuals and families sort through the choices so they can make their own decisions.  Our governor has said he opposes the ACA, and he wants to add Texas requirements for the specially trained “Navigators” helping Texas consumers under federal grants to community-based agencies.  But you should know that privacy and protection of personal information is a big focus of the federal training for Navigators, and that in-person help from Navigators and other trained and certified in-person helpers is moving on ahead, despite his actions.

Today is a big day!  Celebrate, tell your friends and families, and do your part to help folks in your community learn about their new choices for affordable health care, and where they can get the information and help they need.

Comments
2 Responses to “Countdown to Coverage: Opening Day”
  1. Dylan Armstrong says:

    As a high school student just learning about the state of health care in our country, I’m encouraged by the fact that the government is finally taking real steps towards ensuring health care access for everyone in this nation at reasonable prices. I know this new health care plan is not perfect, but it is a good start and I hope to see it continue to evolve and succeed.
    The next important step our citizens must embrace is to take responsibility for their own health and wellness. America is fat! We all need to take our fitness seriously and get out and start exercising and eating healthy. Young people like me need to stop our bad habits of eating unhealthy fast foods and playing too many video games all day. We also need some more time to play and be active instead of having to spend hours at school in a desk and at night hunched over our homework. We need more opportunity to play sports and have fun being active – not just getting cut from the competitive teams that are so exclusive. I would like to see better, healthier food options offered at schools. I would like to encourage young children to be more active. Schools should have active play options before and after class and during the day at recess. Kids should be educated on healthy food options and not have excessive sugar and sweets offered at every turn. Without vital active play time, our kids have become sedentary, anti-social, and unhealthy. Childhood obesity and the incidence of diabetes in children is becoming an epidemic. In addition to healthy eating and exercise habits, Americans need to take our preventative care more seriously too! Brushing your teeth and flossing twice a day and visiting the dentist twice a year can help prevent gum disease and painful tooth decay. Following annual preventative health appointments can catch deadly and costly diseases early before while they are more treatable. This could save on our health care costs exponentially. Flu shots should be more widely used for applicable patients. They are an inexpensive way to help keep the flu away and help avoid doctor visits and missed work or school days. Sufficient sleep is also a key component to preventative health. Getting 8 – 10 hours of sleep refreshes the mind and body and helps boost the immune system to defend against sickness. Doctors and health administrators also need to do their part to help reduce costs by reducing wasteful and inefficient processes. They should also focus on better educating patients on preventative steps they can take to improve their health and avoid illness. If everyone took responsibility for their part, we could once again be proud of our nation’s health status and health care system.

  2. Morgan says:

    Health care reforms like this one are crucial for those living paycheck to paycheck. Most people barely have the money to pay bills, so paying for health insurance is usually not a high priority. With the Texas government making health care more affordable they’re creating a step for the working poor to climb onto. Lowering the prices and still allowing them the freedoms of picking their doctors among other things, is the most recent health care reform being passed in Texas. I feel as though this will be helpful to a certain extent, I think it will be helpful for the working poor to have a reduced price however that money has to come from somewhere and this heavy load usually falls upon the tax payers shoulders. The people who create these reforms often have good intentions, however there efforts get tossed aside by the uproar of disapproval from the middle and upper classes. It should be a compromise, I feel as if families taking advantage of the cut prices for health care should only be allowed to do so for an allotted time. Also, tax payers should only have to pay for health care until they reach a certain sum of money and then they will no longer be required to do so. This would help both sides of the argument come to a reasonable agreement, however there will still be those select few who don’t agree with anyone no matter the deal. If I were a tax payer, I would help out even after my allotted amount was reached, because I have empathy for the people who work three jobs with 2 kids. These ‘working poor’ are doing everything possible to make ends meet so I don’t see helping them as much as possible that big of a sacrifice.

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