BY: MIKE BARE
The passage of Affordable Care Act (ACA) is perhaps the most impactful event of recent memory on the field of prevention.
For the first time in Wisconsin, there is nearly universal access to preventive health benefits as part of BadgerCare and private health insurance plans. I say “nearly” because while individuals with incomes between 100% and 400% of the federal poverty level (FPL) in Wisconsin are now able to access premium and cost-sharing subsidies in the federal health insurance marketplace, decisions made by Wisconsin’s Legislature and current Governor have also made it difficult for some to access quality and affordable health coverage with preventive benefits. The population with incomes between 100% and 200% of the FPL will struggle to choose between paying a premium and cost-sharing for health insurance or paying for food, housing, child care, car payments, etc. Some in that population were previously eligible for BadgerCare but will now have to transition to private health insurance.
Individuals enrolled in BadgerCare, Medicare, and most private health insurance plans will now receive preventive care with no cost-sharing (i.e. deductibles, copays, or coinsurance). That preventive care will include mental health screenings; alcohol and drug use screening; tobacco screening and cessation services; obesity and diet screening and counseling; HIV and STI screening and prevention counseling; immunizations and flu shots; and several other benefits. Those benefits are expanded for women to include breast cancer screening, contraception (with exemptions for certain religious employers), domestic violence screening and counseling, prenatal supplements, well-woman visits, and more. Children are eligible for additional services with no cost-sharing, including autism screening, fluoride supplements, hearing and vision screening, lead exposure screening, developmental screenings, and other benefits.
These lists read like an auctioneer naming our biggest health concerns in the prevention field.
The ACA also includes a number of consumer/patient protections that will allow more people to have insurance coverage who could not before. Children can now stay on their parents’ plans until age 26. Insurers can no longer 1) deny coverage to people who have preexisting conditions, 2) rescind insurance coverage, or 3) impose lifetime or annual limits. Some of the at-risk populations of greatest concern in the prevention field include those with chronic conditions, mental illness, or substance use disorders who were all potentially subject to insurers’ discriminatory practices. Today, their conditions do not limit their access to quality and affordable health coverage.
The ACA authorizes $15 billion over its first five years for “expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth” in health care costs. Wisconsin has received more than $18.3 million in funding through Community Transformation Grants, and investments in prevention programs, public health workforce initiatives, and public health infrastructure projects. Unfortunately, this effort has never been fully funded by Congress.
Whether the impact of the ACA is successful on our prevention efforts depends heavily on individuals getting and staying enrolled in health coverage. The Community Advocates Public Policy Institute has been heavily involved in researching and advocating for solutions to help individuals make their payments so they can stay insured. We were excited by CVS’s recent announcement that each of their retail stores will soon become a location for individuals to pay health insurance premiums.
A primary objective for all of us working in the prevention field should be ensuring that all individuals are enrolled in quality and affordable health coverage. A number of resources are available to help individuals enroll, including http://e4healthwi.org and http://www.healthcare.gov.