Saturday, June 18, 2011

Affordable Health Care Update

I attended a lecture Thursday night on the status of the Affordable Care Act (health care reform) that became law in March of 2010. There was a lot of interesting information, not all of it new, that I think anyone with a mental health challenge ought to know. We do, after all, have a chronic condition that requires regular medical care, and the bills can be a lot higher than we can afford.

You probably know that there is now a sort of exchange where people with pre-existing conditions can go, but do you know how to find it? Go to (in California), or call 877-428-5060 Monday through Saturday. I’m sure they can give you information on out-of-state sources to contact, as well.

Here’s a quick summary of the provisions active so far: lifetime coverage limits have ended, no pre-existing conditions are allowed for children under 19, coverage can’t be dropped midstream, and Medicare (which many of us are on) has eliminated copays and deductibles for preventive care. So if you need a checkup or a mammogram and you don’t have money, go anyway. Also, parents can keep children on their insurance to the age of 26. Those are a few of the more important items.

Now here’s a rundown of additions for 2011: Most important for Medicare Part D beneficiaries, there’s a 50% discount on brand name drugs during the infamous “donut hole” period (which won’t be eliminated till 2020). Also, Medicare payments are supposed to now be connected to quality outcomes – so you aren’t given just the cheapest treatment whether it is right for you or not. The speaker I heard also claimed that access to long term care at home and in the community is increased, and that community health centers are expanded. What that looks like in real terms, I don’t know. Also, insurance must use 80 to 85% of your premiums ON HEALTH CARE.

Some of the things coming up:

2012   - a voluntary option for long term care insurance

2013   - increase of payments for Medicaid primary services. Increase of Medicare
doctors and nurses

2014   – Insurance exchanges come online for individuals and small businesses.
-       Discrimination due to pre-existing conditions or gender ceases.
-       Medicaid is expanded to everyone below 133% of the poverty level, which right now is $29,000 for a family of 4.
-       No more annual limits to coverage

2020   - Medicare Part D “donut hole” terminated

I also understand that ultimately on the California State Exchange insurance will limit out-of-pocket expenses to a maximum of $11,000 in any calendar year. So you won’t get wiped out by one big injury or illness. I don’t know what year that becomes law.

You can find out anything else you need to know at the new federal website: (or in Spanish at

And if you’re already stuck with a big bill, get help here:

All this information is courtesy of the Unitarian Universalist Legislative Ministry of California, which can be reached at or 916-441-0018. I’m sure they’ll be happy to refer you to out-of-state sources.

Good health to all, and I’ll see you next week.

Deborah is the author a one self-help manual, Is There Room For Me, Too? 12 Steps & 12 Strategies for Coping with Mental Illness.  You might also like to explore her award winning comic romance novels set in the 1800s in England. See,, Kindle, or Apple's iBookstore.