You can’t turn on the TV or radio anymore without hearing about the Affordable Care Act , with people taking a stand either for or against the legislation. While we have been talking about it for many years now, the crux of the law is going into effect this month, when many previously uninsured (and, in some cases, uninsurable) people will begin to receive health-insurance coverage. The purpose of the law is to insure as many Americans as possible, with the hopes of improving the overall health outcomes of the country. With more than 40-million Americans uninsured to date, this is a daunting task. However, we know that lack of access to health care is one of the leading causes of poor health. LGBT Americans are over twice as likely to not have health insurance, so our communities are affected to an even greater degree.
I work at Mazzoni Center, where we provide care to people regardless of their insurance status. In fact, about 35 percent of our patients do not have health insurance, and we are able to care for them through a combination of grants and donations. However, there is a limit to what we can do in our office. Although it is affordable to treat common outpatient illnesses like colds and flu, STDs, menstrual disorders and depression, more serious conditions require more expensive testing and clinical specialty referrals that are not covered by those grants. For example, a simple X-ray can cost $150 (at a discount) and an MRI will run over $1,000!
Are you young and healthy? Do you wonder why you, of all people, should examine your options, and potentially enroll in a plan that will cost you a few-hundred dollars a month? Here are the three main reasons why that answer should be yes!
1. It’s the law. Starting in 2014, all Americans are now required to prove they have health coverage. The penalty for not having it is a hit on your taxes at the end of the year. So, you won’t feel that impact right away, but you will come 2015. Many people will qualify for Medicaid (no-cost) or subsidized health-coverage (lower-cost) plans. Going to www.healthcare.gov is a good place to start, and to see if you qualify for a subsidized plan.
2. Young, healthy people keep costs down. If you are young and healthy, and you buy into an insurance plan, it keeps the price lower for everyone. In that way, sicker people don’t have to pay an arm and a leg for coverage. Because “pre-existing” conditions are no longer a reason an insurance company can deny you or charge you more, we all pay the same rate. The only way to reduce that rate is to have more people in the plan, including healthy people. 3. You never know what can happen. You may think that, because you are healthy today and not in immediate need of health care, insurance is something you can safely avoid. But far too often, I see young folks come into our office without insurance, and they wind up having expensive medical needs. For instance, I treated a 23-year-old man a few years ago with testicular pain — he figured it was just a normal pain, but it turned out to be cancer. He needed surgery and radiation therapy, costing tens of thousands of dollars. Thankfully, he qualified for Medicaid, which covered the costs. However, if he had to pay out of pocket, it would have financially ruined him. I frequently see young women with abnormal periods who need further testing than what I can provide in our office. Although I can refer them to other locations for testing, it usually costs thousands of dollars and, in most cases, is beyond what they can afford out of pocket. Health insurance is the key to protecting against those “just-in-case” scenarios.
When looking at plans within the new Affordable Care marketplaces, it’s important to remember that health insurance is not free, and it doesn’t cover 100 percent of your health-care costs (except Medicaid). You will have a monthly premium to pay. There will be co-pays for doctor’s visits and prescriptions. Sometimes that’s a flat-dollar amount, sometimes it’s a percentage of the bill (if this applies to you, make sure you find out the cost before you get a test!). Some plans have deductibles, which means you pay all costs up to that amount before the insurance kicks in. Usually, the higher the deductible, the less expensive the monthly premium is — which is fine, unless you get sick. If you are a person who needs frequent medical care, a high-deductible plan is not for you.
So where do you start? It’s important to visit the www.healthcare.gov website to find out if you qualify for free or discounted health care. You can also call 800-318-2596 for information. To learn more about how the health-care law specifically affects LGBT Americans, you can also visit www.strongfamiliesmovement.org/lgbt-health-care-guide or www.out2enroll.org. If you are a current patient or client at Mazzoni, we have a dedicated ACA patient navigator on staff to help walk you through the process. You can reach her by phone at 215-563-0658 ext. 332.
Let’s face it: No matter our age or fitness level, we all get sick once in a while. Some of us get really sick and need to utilize the health-care system a lot. The only way to make sure that you can access the health care you need, when you need it, is to be insured. On a brighter note, if we all went for routine check-ups and age-appropriate screenings, many diseases could be prevented, or at least caught early enough to treat. So ask your friends and family about their plans for health coverage in 2014. Let’s keep each other healthy!
Robert Winn is medical director at Mazzoni Center.