Affordable Care Act’s impact on the uninsured

The Rev. Gregory Gross estimates he has helped hundreds of uninsured people obtain health coverage over the past year. In that time, he has seen a man cry with relief and another eager to visit a doctor for the first time since childhood.

Gross, an ordained United Methodist deacon, serves the AIDS Legal Council of Chicago as an in-person counselor and outreach specialist. That means he helps people navigate the new system under the Affordable Care Act. He also works with many United Methodist congregations across Chicago to help people sign up for insurance and make the best use of it. 

Gross can attest how the health care law, also known as Obamacare, helps people — and how it falls short.

“Millions of people have obtained health care for the first time or for the first time in a great while," said Gross, who also is the family ministries coordinator at Berry United Methodist Church in Chicago.

"Health care is a right for all and not a privilege for those with financial means. Now those who have never had health care are able to finally see a doctor or therapist."

More insurance enrollment

Despite a rough start with the federal healthcare.gov website and some individual plans canceling coverage, the law does appear to be achieving its goal of increasing access to health insurance.

The percentage of uninsured U.S. adults has dropped from 18 percent in 2013 to 13.4 percent, as of midway 2014, according to a survey by the Gallup-Healthways Well-Being Index. That’s the  lowest quarterly rate in more than six years of tracking the uninsured.

Put another way, the New York Times reports that about 10 million more people have insurance this year because of the Affordable Care Act.

The steepest drops were in states that embraced the Affordable Care Act — choosing to expand Medicaid and set up insurance marketplaces either on their own or in partnership with the federal government.

For example, the uninsured rate fell from 15.5 percent in 2013 to 12.3 percent this year in Illinois, which chose to expand Medicaid and partner with the federal government in its state marketplace. Arkansas saw the biggest decline in its uninsured population, going from 22.5 percent to 12.4 percent.

One of the formerly uninsured is Randall Wensil, a hairstylist. He had been without health insurance for a year when Gross encouraged him to sign up for coverage through the state marketplace, Get Covered Illinois.

Wensil said Gross answered his questions during enrollment, and the hairstylist learned he qualified for federal subsidies that reduce the cost of his monthly premiums.

“There were more choices than I thought there would be,” Wensil said. “I wanted better coverage than I was able to afford. But I feel that some coverage is better than none.”

Specifically, he said, the limited nature of his plan means he had to change primary care doctors and he can only use certain hospitals in the Chicago area. Still, he said, the coverage is “a lot better” than what he had when he worked for the Hair Cuttery salon chain from 2006 to 2012.

Needed improvements

Gross has worked with HIV/AIDS patients for six years and decided to become an insurance navigator in part to help people living with the virus. He said that when he gave people their diagnosis, too often their first concern was health insurance.

“Many people were afraid to get tested for HIV for fear that they’d have a ‘pre-existing condition’ since they were between jobs, or (they were) afraid their employer would find out through their employer-sponsored coverage,” Gross said.

Now, the law bans insurance companies from discriminating against people based on their health status or capping their coverage when they get sick. Still, Gross said, companies have found ways of making certain medicines and services cost-prohibitive. For example, he said, all the insurance companies in Illinois have put HIV drugs and cancer treatments in their top-tier of medications. Under some plans, individuals have to pay 25 percent or even 50 percent of a top-tier drug’s cost.

“When an HIV medication can cost $2,500 a month, having to pay 50 percent for the medication is outrageous,” he said. “In essence, companies have found a way to tell people: ‘We don’t want your business.’”

He sees other ways the law needs improvement.

“Working within the market-based system we have, I’d like to see even more competition in the exchanges so that costs go down and health care becomes even more affordable,” he said. “Even within areas of the same state, prices vary greatly.”

In Chicago, an individual may have 65 plans to choose from while someone living in the more rural area around Rochelle, Ill., may have only 32 options. “This means that person’s coverage is more expensive,” Gross said.

He also noted that the insurance system remains overly complicated for most people to navigate on their own. “I’ve spent two hours and spoken with 10 different people at one insurance company to sort out an issue with a client,” he said. “And even then it was only because I knew what to ask for that we were able to resolve the issue.”

Ultimately, he said, he would like the United States to move toward a system that provides universal coverage such as found in Canada, Japan, parts of Latin America and much of Europe.

Difference Medicaid expansion makes

Likely the simplest way to improve the Affordable Care Act in the near future is for more states to expand Medicaid coverage, Gross said. So far, 27 states and the District of Columbia have opted for the Medicaid expansion.

The expansion, largely supported through federal funds, provides coverage for low-income adults making up to 138 percent of the federal poverty level. As it stands, some Americans make too little money to qualify for federal subsidies and too much to qualify for Medicaid in states without the expansion. For these Americans, health insurance remains financially out of reach.

Each week, Gross visits state psychiatric hospitals to assist patients in applying for Illinois’ Medicaid expansion.

Gross recalled helping one middle-aged man who had major surgery a decade ago. The procedure saved his life, but because the man did not have insurance, he went bankrupt and lost everything. He subsequently had a breakdown and was being treated at the state hospital for major depression and suicidal tendencies.

“Once we were done with the application, he just sat there sobbing, saying, ‘I have insurance? I really have insurance,’” Gross said. “Tears of relief just flowing.”

As a United Methodist deacon, Gross said he is called to serve people at the margins of society. Helping people make use of the new health care law, he said, “has been an incredible way to do just this.”

Hahn is a multimedia news reporter for United Methodist News Service. Contact her at (615) 742-5470 or [email protected].