As mothers, daughters, wives and leaders of households, women often steer the health care choices of families. Thus in the coming years, women will also be a major force toward implementing health care reform and the landmark Affordable Care Act.
Whenever we enroll a child into newly available health insurance, whenever we convince parents to get mammograms or colonoscopies that will be free under Medicare in 2011, each time we appeal an insurance company’s denial of care, or when we choose health insurance in new marketplaces beginning in 2014 — we will be helping to shape the future of health care in America. In fact, much of the ACA depends upon the actions and choices of patients, with women often taking the lead.
Many ACA laws are already in effect. For example, nursing mothers in most workplaces are now entitled to time and private space to pump breast milk for a child’s first year of life. Did you ever think the feds would mandate this? It’s a new era.
The ACA’s main goal is for nearly every American to have health insurance. New opportunities are already available, and uninsured members of your family may qualify. If someone in your family has been denied health insurance because of a pre-existing illness, check out the new ‘high-risk pool’ insurance plans available now. Log onto Healthcare.gov to find local options, and get your loved one covered. Medicaid has been expanded, so someone in your family may be newly eligible. By September 23, you can insure your children under your own health plan until they are age 26, and insurance companies will have to accept all children under age 19 with pre-existing illnesses.
Patients (and the women often guiding them), might possibly exert the most influence on health care reform through two important ACA measures — appeals processes that should be in place by Sept. 23, and the new health insurance marketplaces in effect by 2014.
In the words of President Obama, the ACA aims to protect patients against the worst abuses of health insurance companies. The ACA provides many safeguards against insurance companies denying coverage. Yet the devil is still in the details when it comes to holding insurers more accountable toward paying for care. To fight against insurance companies taking our premiums, then trying not to pay for medical care, the federal government is cracking down on fraud, waste and abuse. The ACA eliminates life-time caps on health insurance benefits, while mandating that insurance companies now must spend at least 85 percent of their dollars on medical care, rather than on profit and administration.
We the public can do our part to keep insurance companies honest through new appeals processes which should be in place by Sept. 23 for new insurers. If you feel your new insurer is unfairly denying care, or is stalling on time-sensitive care, you will be able to appeal to the insurer itself, but also to an external review process. The ACA leaves it up to individual states to institute these appeals processes, but the federal government will hear grievances if state processes are inadequate.
These appeals processes will be an all-important aspect of health reform — which will be driven by patients making appeals, and therefore reliant upon all of us.
Another crucial step is that by 2014, we can shop for health insurance in new exchanges offering comparisons between different plans. So if we see an insurance company hiking rates by 70 percent in one year, for example, or if an insurance company has a reputation of not paying for care (yes, this will still happen under the ACA), the new exchanges will offer options. Collectively, by choosing insurance for our families, we’ll determine which insurers succeed or fail, and thus shape the landscape of American health care.
The lady of the house has always had a large role in steering the health care choices of her family. Now with the new Affordable Care Act, the actions of women on behalf of their families will collectively shape the future of health care in America.
Dora Calott Wang, M.D., is Assistant Professor of Psychiatry at the University of New Mexico School of Medicine. A graduate of the Yale School of Medicine and the UCLA Neuropsychiatric Institute, she received her M.A. in English literature from the University of California, Berkeley, and has been the recipient of a writer’s residency from the Lannan Foundation. Her memoir, The Kitchen Shrink: A Psychiatrist’s Reflections on Healing in a Changing World was published by Riverhead Books, The Penguin Group.