American College of Physicians: Internal Medicine — Doctors for Adults ®

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ACP can help members, patients access insurance options

From the October ACP Internist, copyright © 2013 by the American College of Physicians

By Robert B. Doherty

The Affordable Care Act, otherwise known as ACA or “Obamacare,” began to expand health insurance coverage for millions of Americans on Oct. 1. Congressional opponents of the law have vowed to continue their efforts to block it, but there is no plausible scenario in which this could happen.

This means that health care reform is entering a new stage, one of practical nuts-and-bolts implementation, even as the political controversy rages. As the public becomes more aware of the marketplaces for individual insurance that went live on Oct. 1, many will seek help from their physicians in understanding the coverage options available to them. Internists will need to be prepared to help their uninsured patients get covered, even as many are understandably concerned that this could turn out to be another burden for their practices and staff.

Helping patients sign up for ACA coverage may be especially troubling to physicians who personally disagree with “Obamacare.” But when it comes to patients seeking counsel from their own physicians on how to sign up, ACP hopes all of its members will lend a helping hand, notwithstanding their own politics and views.

For internists to be able to offer help to their patients, they will need access to understandable, accurate and practical information from a source that they trust. The College is committed to being this trusted source. In early September, ACP launched a new resource center on its website detailing the new health insurance marketplaces in each state. I encourage members (and even nonmember physicians) to review it.

The resources include a landing page, “Help Your Patients Enroll in Health Insurance Marketplaces,” that includes an overview of the materials available through ACP, links to state-specific resources, FAQs on the questions patients may have about enrollment in the marketplaces and FAQs on questions physicians may have about the ACA. Also included on the landing page are links to resources from other organizations—consumer groups, the government and others—that ACP has evaluated and determined to be accurate and useful.

There are also state-by-state guides to help patients enroll that were developed by ACP’s staff policy experts. Each state’s guide includes resources for physicians and resources that physicians can give to their patients. The state-specific physician resources describe how the marketplaces in each state can help residents find affordable coverage, why having health insurance can help prevent sickness and avoidable deaths, what number of residents in the state under the age of 64 were uninsured, how the state’s marketplace will make it easier for patients to shop for insurance that meets their needs, a link to the marketplace for the state and a link to a collection of brief videos introducing the marketplaces.

Each state’s guide also provides links to organizations in the state where patients can find people certified as health insurance navigators: those who are trained to assist the public in understanding and choosing among the health insurance plans available through the marketplaces. Some states have links to information about certified application counselor organizations, which are community health centers or other health care providers, hospitals, non-federal governmental or non-profit social service agencies in a state with a Federally Facilitated marketplace or a State Partnership Marketplace.

Also included in the state-specific patient resources is a one-page downloadable PDF that physicians can give to their patients. It explains, in simple language, that starting in 2014, most individuals will have to pay a fine if they don’t have health insurance, and if they need health insurance, they will be able to purchase it through the state’s health insurance marketplace. It explains that they may be eligible for financial assistance to help with premiums and out-of-pocket costs.

It further explains that it is important even for young and healthy patients to purchase health insurance, because doing so will give them the peace of mind of knowing that they will be more able to afford their medical expenses if they have an accident or get sick, and that they may qualify for health coverage tax credits or Medicaid depending on their income, family size, and a few other factors. The PDF includes a link to the state marketplace, a fact sheet explaining the changes in health insurance in the state (if available from the state marketplace) and English- and Spanish-language resources from the federal government on how to enroll. It also provides links to information on where patients can get help in person.

As more information becomes available, ACP will continually update these online resources. Annals of Internal Medicine also plans to publish a series of short, informational articles, authored by ACP public policy staff and the chair of the College’s Health and Public Policy Committee, on different aspects of the law’s implementation, starting with an inaugural article on health insurance exchanges.

The College’s initiatives to help with ACA implementation aren’t limited to providing practical resources. ACP will continue to be a strong advocate in Congress and, through its chapters, in state legislatures for policies to ensure effective implementation of the ACA’s programs. The College will also continue to influence the regulations implementing the law.

Implementation of Obamacare is complicated, because our health care system is complicated. Inevitably, problems will occur, and public confusion may very well be commonplace, at least in the early stages. But because the ACA offers the best hope for providing nearly all Americans with access to affordable coverage, the College is committed to helping cut through the confusion so that people can get the coverage promised to them, and urges its members to do the same.

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