How to get access to local health care

by Leslie Bek

mcacI am attempting to do something almost as monumental as designing a national access to health care system for all Americans. I am going to write about it.

My intent was very simple in scope at its origin. I wondered, “How has the implementation of the federal Affordable Care Act impacted the services of the Medical Care Access Coalition in Marquette and around the region?”

First, the thought of digesting the voluminous Affordable Care Act brings to mind an assortment of things. Perhaps you have tried to herd cats? Or pick up Jell-O off a table? Predict the weather? Pick the needle out of the haystack?

Turns out it is not that difficult. Because, since its inception over a decade ago, the Marquette-based Medical Care Access Coalition has had knowledgeable, caring and compassionate local people available to help and fill in the uninsured and underinsured gaps. This time, there are more options.

Let’s start with MCAC.

In 2001, following several years of discussion and discernment, a local group of concerned citizens took on a project with many moving parts. Our community was a mirror of a national problem––lack of access to quality, affordable health care, with dignity for all.

Could these people find a way here at home that would meet this need of their neighbors and the most vulnerable in their community? Could we afford it? Could we afford to wait for a national solution? Surely they could identify donated resources and health care providers willing to volunteer their expertise and create a system. They did, right here at home.

The outcome was the Medical Care Access Coalition, a faith- and community-based nonprofit organization. It remains today comprised of civic leaders and representatives from medical, public health, mental health/substance abuse, faith-based and consumer groups.

The Coalition’s Medical Access Program, Plan C (MAP-C) enrolls uninsured or underinsured people who do not qualify for state or federal health assistance. MAP-C is a volunteer referral network that enables clients to have access to a basic continuum of care including primary care, specialty care, labs, radiology and prescriptions.

Affordable Care Act – The Basics

The implementation of the federal Affordable Care Act, commonly referred to as Obamacare, will be impacting all Americans with opportunities to access health care.

It will also bring about many challenges as individuals with varying circumstances (uninsured, previously insured, unemployed, under-employed, employed with children, etc.) attempt to answer the question, “What does this all mean for me?”

The new health law went into effect in 2010, with the past few years comprised of system preparation and a large dose of politics. The five greatest impacts begin with implementation or roll out January 1. The top five:

1. The long-standing insurance industry practice of turning people down or charging them extra because of preexisting health problems has been outlawed. In some cases the preexisting clauses were effective as early as 2010.

2. Low- or moderate-income households may get financial help through a new tax credit that they can use right away to help pay for their premiums in a state or federal marketplace where they can shop for insurance.

These individuals also may qualify for reduced cost-sharing (copayments, coinsurance, and deductibles).

3. With the exception of foreign tourists, undocumented residents, prisoners and a few other exceptions, everyone in the United States is now required to have some kind of health insurance.

4. All plans must cover the care you need, called “essential benefits,” including doctor visits, hospital stays, preventive care, prescriptions and more.

5. Persons without health insurance will have to pay a penalty at income tax time.

The biggest addition to the health care system in 2014 is the idea of shopping for and buying individual health insurance in “marketplaces,” which opened for business October 1, 2013.

These new marketplaces apply to those who currently buy their own insurance or were uninsured. The marketplace is a kind of virtual insurance store where everyone can compare and sign up for the private insurance plan of his or her choice with no questions asked about preexisting conditions or medical history.

This year only, an “open enrollment” period through the marketplace began October 1, 2013, and ends March 31, 2014. Future enrollment periods will be October 15 to December 7.

Small businesses can compare plans and purchase through the SHOP (Small Business Health Options Program).

Expanded Medicaid Eligibility

Medicaid is the joint federal and state funded program that provides health care for low-income children and adults. Coverage includes access to primary care doctors, preventive care and routine check-ups.

Prior to the new law, about sixty million people, mostly children, pregnant women, individuals with disabilities and people at least sixty-five years old who need help at home or live in nursing homes qualified for Medicaid. Most low-income working adults younger than sixty-five could not receive Medicaid.

Now, with the passage of the ACA, all very low income people are going to be eligible for Medicaid, including adults without dependent children, covering up to seventeen million more Americans. At least ninety percent of the cost of this expansion was to be paid for with federal funds.

This is only in the states that opted to expand Medicaid. Michigan has done so, and the program is called “Healthy Michigan.”

Too much information? OK. Online resources offer more information on federally qualified health centers, expanded Medicaid, Medicare and children’s health insurance programs.

MCAC 2014 Edition

Today, MCAC serves Marquette, Alger and Schoolcraft counties. The original coordination of donated goods and volunteer health care services continues.

“While many people are able to move from uninsured to insured, ACA still leaves some people out of health care coverage. There are gaps and glitches. Everything is constantly changing and each person’s circumstances dictate new challenges and opportunities,” said MCAC executive director Melissa Hall.

MCAC staff are trained as ACA-Certified Application Counselors. They are able to help individuals determine whether they qualify for financial help with insurance premium payments, assist with the marketplace and determine what coverage options are available.

MCAC enters 2014 with the same original vision: access to quality, affordable health care, with dignity for all. This year everyone has more options.

So how has the implementation of the federal Affordable Care Act impacted the services of the Medical Care Access Coalition in Marquette and around the region?

I think MCAC had the herding cats part under control a while ago. Any Jell-O on the table is surrounded. They have found the needle in the haystack.

And the weather? Well, if it impacts access to quality health care, MCAC is part of the solution.

– Leslie Bek

Find local health care access help

For more information, contact Certified Application Counselors at Medical Care Access Coalition in Marquette at 226-4407; or ACA Navigator Michelle Bellinger at 228-6522 ext. 205, at the Alger-Marquette Community Action Board (AMCAB).

Four additional MCACs are located throughout the U.P., with each offering services unique to its local needs. Contact www.upmcac.org

More resources online:

localhelp.healthcare.gov
enrollmichigan.com
www.healthcare.gov

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