Health Care Freedoms Gained Under The ACA
When Ohio voters passed the “health care freedom” amendment on November 8, many believed that they were voting for more freedom in health care and against the health care reform act (ACA). However the reality is the opposite. Instead the ACA gives health care consumers greater freedom than ever before. Here are some new “freedoms” gained under the act:
1. The freedom to change plans if you are no longer satisfied.
Under the ACA, health insurance companies would no longer be allowed to reject anyone because of pre-existing conditions and must cover all pre-existing conditions. Therefore under the ACA, if your health insurance company raises their premiums too high or takes too long to pay a claim; you can change to another plan without worrying whether you will be covered. This gives Americans the freedom to change health insurance if they are no longer satisfied with their existing plan.
2. The freedom to opt out of your employer’s plan if it does not meet your needs.
Since employers are paying the lion’s share of the premiums, they also make the choice of which plans to offer to their employees. Most often that decision is made based on the employer’s cost or what the business owner likes, not the needs and desires of the employees. If your employer’s plan does not include your doctor, has too high a deductible or contribution for your liking; under the ACA you have the choice of opting out of the employer’s plan and seeking a plan more to your satisfaction through the state exchanges.
3. Peace of mind that no matter how many claims you file or how large your medical costs may be, you cannot lose your health insurance for those reasons.
Under the ACA, health insurance companies are forbidden to impose lifetime caps on coverage or to have sub limits on certain medical procedures. In addition, policy rescission, the cancellation of health insurance because claims have been filed, is forbidden (except in the case of fraud). This part of the ACA is already in effect.
4. Peace of mind in knowing what is in your policy.
Because of a requirement that health insurance policies being sold through the state exchanges must be “qualified,” that is they must cover certain medical procedures and treatments, the consumer would know that any policy offered through an exchange would cover most commonly used medical services and not have any hidden exclusions or limitations.
5. The freedom to be able to afford a health insurance policy through the exchanges.
The major road block to many people becoming insured is that they simply cannot afford health insurance. Under the ACA, if one’s income is less than 135% of the federal poverty level, they would be eligible for Medicaid. If one’s income is between 135% and 400% of the FPL they would be eligible for a premium subsidy based on their income. The details of how this subsidy would be applied are being worked out.
6. The freedom to start your own business without losing your health insurance
Many people would like to start their own business or work for a smaller company, but they are held back because by doing so, they would lose their health insurance and either would have to pay much more or would not be able to get health insurance on their own. The same applies to people who lose their jobs or would like to work for a smaller company that does not offer as good of a health insurance plan. If one leaves the large company, whether to strike out on his/her own or because of a lay-off, they would be able to get affordable health insurance through the exchanges.
The passage of the Affordable Care Act has given Americans many new “freedoms” about how they can get their health insurance. The only “freedom” that is lost is the freedom to be irresponsible and refuse to get covered somewhere. However, part of living in a free society is that we all have to shoulder some responsibility. Since the exchanges are not effective until January 1, 2014, most of these freedoms are two years away.
Lee Kamps
Lee has been working with Medicare, Medicaid and private health insurance since he began working at the Erie County Welfare Department in January 1973 where a major part of his job was determining eligibility for Medicaid. He went into the private insurance business in 1977 with Prudential Insurance Company and within a short time had become one of the company’s top sales agents. In 1982, he was promoted into management where he managed two field offices and as many as thirteen sales agents. After leaving Prudential in 1986, Lee decided to become more focused on health insurance and employee benefits. He has advised many local employers on how to have a more cost effective employee benefit program as well as conducted employee benefit meetings and enrollments for many area employers. The companies Lee has worked with ranged from small “mom and pop” businesses to local operations of large national companies. Lee received his B.S. degree from Kent State University where he has been active in the local alumni association. He has completed seven of the ten courses toward the Certified Employee Benefit Specialist designation. He has taught courses in employee benefits and insurance at Cleveland State University and local community colleges. In addition, Lee is an experienced and accomplished public speaker. He has been a member of Toastmasters International where he achieved the designation of “Able Toastmaster – Silver” in 1994. He has also served as a club president, Area Governor and District Public Relations Officer in Toastmasters as well as winning local speech contests. Lee has also been a member of the Greater Cleveland Growth Association’s Speaker’s Bureau where he was designated as one of the “official spokespeople for the Rock and Roll Hall of Fame” prior to the hall’s opening in 1995. He has given talks and presentations before many audiences including civic organizations, AARP chapters and many other community groups. With the implementation of the Medicare Modernization Act (Medicare drug bill) in 2006, Lee has shifted his focus to Medicare and helping Medicare beneficiaries navigate the often confusing array of choices and plans available. As an independent representative, Lee is not bound to any one specific company or plan, but he can offer a plan that suits an individual person’s needs and budget. In addition, Lee is well versed in the requirements and availability of various programs for assistance with Medicare part D as well as Medicaid. While he cannot make one eligible, he can assist in the process and steer one to where they may be able to receive assistance.