Issues: Healthcare

Health Care in North Carolina

Without access to affordable, quality health care, you and family can be in big trouble.  It’s hard enough to pay the regular bills every month, nevermind if you or a loved one gets seriously ill.  Lawmakers in North Carolina and in Washington are eager to cut spending on programs that can help you, while at the same time giving generous tax breaks to the very same insurance companies who are raising your premiums. 

Never before have the programs we hold dear, such as Social Security, as well as new and innovative reforms, such as the Affordable Care Act, been so attacked and vilified by the right.  It’s time we tell our elected representatives in Washington and in Raleigh that we have had enough!

Affordable Care Act

Where should the priority in health care be: on your health, or on the profits of the insurance companies? This should not be a difficult question for lawmakers, but it is becoming increasingly difficult to convince elected officials that it is their job to protect you, not the insurance industry.  Yet when faced with a choice to increase taxes on working families or increase the guaranteed profits for the insurance industry, your representatives choose the latter again and again and again.

National health reform will provide security and stability to anxious families in North Carolina. After all of the provisions of reform are enacted by 2019, about 95 percent of non-elderly legal residents of North Carolina will have insurance coverage.

For the estimated 1.8 million uninsured in our state, reform will mean the chance to purchase affordable coverage and obtain needed medical care. For the insured population it will mean new protections against insurance company abuses. It will also give individuals and families the security to know that even if they lose a job they will be able to obtain affordable coverage.

See how the Affordable Care Act helps you, your employer, or someone you care about:

Seniors: The ACA strengthens Medicare and saving seniors money by continuing to crack down on waste, fraud and abuse while giving seniors the peace of mind that they won’t ever fall back into the prescription drug “donut hole.”  It provides an additional $300 million for stronger enforcement and gives the government more authority to increase oversight of companies participating in Medicare and Medicaid.  It also keeps seniors healthy by giving them preventive care without a co-pay or a deductible. It’s about empowering seniors to have more freedom and giving them back control over their health care decisions.

Women:  The ACA finally prevents insurance companies can no longer charge a woman more just because of her gender and end the practice of branding a woman as a pre-existing condition, simply because of a Caesarean section or because she was a victim of domestic violence.  It means women can no longer be dropped from their insurance because they get sick, their children can no longer be denied care because of a pre-existing condition, and women and their families can receive preventive health care without a co-pay.  The ACA bans insurers from denying care to children because of a pre-existing condition, giving security to as many as 17 million children and their parents nationwide.

Young Adults: The Affordable Care Act Allows 1.2 Million Young Adults To Stay On Their Parents Coverage. Because of the Affordable Care Act, 1.2 million young adults under the age 26 have health coverage because they were allowed to stay on their parents plan. That means they - and their parents - have the peace of mind to know they have coverage if they get sick in the event they cannot find a job with health insurance as soon as they graduate from college.

Small Businesses:  Meaningful health reform means giving small businesses the level playing field they deserve.  The ACA gives small businesses the choice and the freedom to come together to get the same rates as larger companies and allows small businesses know that they can afford to offer their employees’ health care and that there are tax breaks to make it possible.  Before the Affordable Care Act was passed, a study from the Small Business Majority found health care costs were rising so much that it would cost 178,000 jobs by 2018. The law lowers health costs to small businesses through tax credits and other cost containment measures, meaning they can use those savings and invest them in job creation.

Chronic Disease Sufferers: People with chronic diseases and pre-existing conditions can no longer be put back at the mercy of insurance companies – giving peace of mind to those 129 million Americans that they will never again be unable to find coverage.  Insurance companies will not be able to drop your coverage when you get sick or limit the care you receive and it makes sure insurance companies spend your premium dollars on care, not profits, and cracking down on excessive premium rate hikes. 

While most provisions are implemented in 2014, many benefits in the health care reform bill will provide immediate help to struggling individuals and families. Within the first year these include:

  • Insurers that offer dependent coverage for policyholders must allow parents to enroll children up to age 26.
  • New insurance plans are barred from denying coverage to children with pre-existing conditions.
  • Insurance companies are barred from placing caps on the dollar value of lifetime benefits and will cover many preventive services at no charge to enrollees.
  • Provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010. 
  • Health reform delivers short- and long-term benefits to North Carolina families. It provides new protections for the insured and uninsured alike.
Health Exchanges in NC

As anyone who has tried to shop for health insurance knows, the current market doesn’t work for consumers. It’s impossible to compare plans because every plan has different benefits and out-of-pocket costs. There’s no good objective information on quality, and individual consumers and small businesses have no power to negotiate with insurers: take it or leave it.

The ACA was written to fix that by setting up a new health insurance marketplace called an “exchange.” Plans in the exchange will be required to cover certain categories of benefits, meet cost-sharing targets, and be rated on quality. The ACA leaves it up to states to decide whether the exchange, acting on behalf of consumers, can negotiate with health plans for the best deal or whether the exchange must take every plan that meets the minimum requirements. This is a critical decision that will determine whether we fix the problems with the health insurance market or leave health insurers in control.

Beginning in 2014, consumers can choose an insurance plan through a new online marketplace. The plans sold in this marketplace will be required to meet quality standards and cover a minimum set of health benefits, and millions of families will get subsidies to help pay their premiums. Members of Congress will be required to purchase coverage in the new marketplace, choosing from the same plans as everyone else.

The rules are still being developed, but below are answers to some basic questions about how the new marketplace will work.

What is a health insurance exchange?

A health insurance exchange is a new marketplace to give consumers better health insurance choices. Beginning in 2014, the marketplace will let consumers compare plans apples-to-apples, enforce high quality standards, and bring down costs by improving consumers’ buying power. The marketplace will mostly be online, like a travel website, but there will be special help for people without internet access or limited internet knowledge.

What type of health plans will be offered?

Plans can be HMOs, PPOs, high-deductible, or other kinds of plans. To be sold in the marketplace, plans must cover a required list of health benefits, meet guidelines for co-pays and other cost-sharing, have an adequate number of doctors in the network, and meet other quality standards. In addition to other private plans, every marketplace will have at least two non-profit plans to choose from. Some marketplaces also may have “co-op” plans that are set up by consumers to compete with plans offered by insurance companies. Ideally, the marketplace will have the power to negotiate with plans to make sure they offer the best value, but insurance companies want to force the marketplace to sell every plan, even if it isn’t a good deal.

Who can buy insurance in the marketplace?

Any U.S. citizen or legal resident can choose to buy insurance in the marketplace. Members of Congress and their staffs will also buy insurance there, giving them the same options as millions of Americans. By 2019, about 23 million people will buy insurance in the marketplace. Undocumented immigrants cannot buy insurance in the marketplace.

Will insurance be affordable?

Yes. People who don’t have good insurance through their job or a government program, like Medicare or Medicaid, may be eligible for financial help paying for premiums. This help is available for families with income up to $75,000 for a family of three; the more income you earn, the lower your subsidy will be. The subsidy will be available at the start of the year and then will be recorded on your taxes as a tax credit. People who have high incomes can purchase in the exchange but won’t get subsidies.

Do I have to buy insurance there? Can I keep the insurance I have now?

No one is required to buy insurance through the marketplace. Insurance will still be sold outside, too, and you can keep the plan you have today if you think it’s a better deal. Most people will still get insurance through their job, like they do today. Premium subsidies can only be used inside the marketplace.