Myron Isley’s story is troubling, but far from unique, when it comes to the 45.5 million U.S. citizens currently without health insurance, according to the Centers for Disease Control and Prevention.
The 51-year old Isley had been an accountant in the Baltimore area when his career was cut short by a series of health challenges that left him on five prescription medications a day.
Last June, he suffered a heart attack as a result of two blocked arteries.
This year doctors diagnosed him with acute anemia after he became lightheaded and passed out. Internal bleeding was found at the same time. Isley was told his body was not creating enough blood for his organs to properly function.
Most recently, at the end of July, he lost his coverage due to the back-to-back health issues.
“You run out of sick days,” he said he was told by his supervisors at the Columbia, Md.-based company where he had worked for four years. “They just couldn’t hold my job anymore.”
So he was forced to depend on a company, Magnet Entertainment LLC, he and his wife created in September 2010. The entertainment consulting firm is now his sole source of income.
He and his wife, a local producer, recently attended a forum at Empowerment Temple on the intricacies of the new health care reforms. The forum was one of many being held throughout the state to prepare residents for Oct. 1, the beginning of the open enrollment period for health choices.
That date marks the launch of the health insurance marketplace, an important pillar of reforms for the healthcare and health insurance industries.
Uninsured citizens living in any state can use the HealthCare.gov website to review and select plans, but some states, such as Maryland, have state partnership exchanges, through which the state manages its federally-mandated health care insurance marketplace.
The Maryland Health Connection, the state’s health insurance marketplace apparatus, will service Maryland residents.
After a tough battle to push the bill through Congress, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law on Mar. 23, 2010.
It was a task that proved unsuccessful for many American presidents including Theodore and Franklin Roosevelt, Truman, and Clinton.
Under the act, children became eligible to stay on their parent’s insurance until age 26 regardless of marital status or residence the same year.
The law also made it illegal for insurance companies to place lifetime, or even annual, limits on coverage benefits. In the 2010 law, insurance companies are also prohibited from rescinding coverage because of technical mistakes on applications or other errors.
“This legislation will also lower costs for families and for businesses and for the federal government, reducing our deficit by over $1 trillion in the next two decades. It is paid for. It is fiscally responsible. And it will help lift a decades-long drag on our economy,” said Obama in statements just before the bill became law, later released by the White House.
Preventative care under the law became easier to access with the establishment of a $15- billion Prevention and Public Health Fund.
Plans beginning after Sept. 23, 2010 by federal law now include preventative care and screening services, such as colonoscopies and mammograms, with no co-pay, co-insurance or deductible requirements.
Health officials, advocates and lawmakers in the state say that the changes-some of which have already taken place-will help put end to health disparities for middle- and low-income families.
For instance, disputed claims will now be addressed by provisions in the law for an external review process that was created shortly after the law was enacted.
“Of all the forms of inequality, the inequalities in health are the worst,” said Maryland Del. Shirley Nathan-Pulliam (D-Baltimore County), who addressed the Empowerment Temple healthcare forum.
“Prevention is key,” said the Jamaican-born lawmaker, who said she didn’t truly learn what racially-charged health care disparities looked like until she moved to Baltimore.
Sponsored by the Maryland Health Connection, churches have been a vital force in spreading the word about what the wave of changes, often called “Obamacare,” will mean in real terms for everyday Americans trying to make ends meet.
“We have about 730,000 people in our state that don’t have health insurance,” said Tequila Terry, director of Plan and Partner Management for the Maryland Health Benefit Exchange (MHBE), before explaining why health care insurance is so important and how the new system will affect average citizens.
Under the PPACA all plans must include as core benefits coverage for ambulatory care, doctor’s visits, hospitalizations, maternity care, mental health and substance abuse services.
Prescription coverage and medical tests must also be included in plans.
“You never know when you might wake up and something is wrong,” said Terry, whose younger sister awoke one morning to find part of her face contorted and paralyzed as a result with Bell’s palsy, a disorder of the nerve that controls movement of the muscles in the face.
“No one insurance company would cover her,” said Terry, detailing an ordeal not unlike the situations many sick Americans faced before insurance companies were prohibited from refusing to cover pre-existing conditions.
“She had to make a decision everyday whether she was going to go to the doctor, fill prescriptions, or deal with the pain.”
Under the federal health care reform law, seniors receive help with prescription medications. Forum attendees also learned that the income threshold for Medicaid has changed.
An uninsured Marylander making less than $15,856 could be eligible for Medicaid coverage, reduced premiums or lowered insurance costs. That number is $21,404 for households of two people, and $32, 499 for families of four.
Choices made during the open enrollment period, which begins Oct. 1, will establish the health care coverage that is to begin Jan 1, 2014.
The Maryland Children’s Health Program (MCHP) is also available to help cover minors.
Under the law, the nation’s population is to be covered by a plan offered through an employer, an individual plan chosen from the health insurance marketplace, by a parent’s insurance for those 26 and younger, or a plan recognized by the Health and Human Services Secretary.
There is a downside, however, U.S. citizens who are not covered by health insurance will face fines, which are set to increase annually and are to be added to income tax liability.
“Beginning in 2014, most individuals will be required to maintain minimum essential coverage or pay a penalty of $95 in 2014, $350 in 2015, $750 in 2016 and indexed thereafter; for those under 18, the penalty will be one-half the amount for adults,” according to a summary of the law prepared by Senate Democrats.
“Exceptions to this requirement are made for religious objectors, those who cannot afford coverage, taxpayers with incomes less than 100 percent [of the] Federal Poverty Level, Indian tribe members, those who receive a hardship waiver, individuals not lawfully present, incarcerated individuals, and those not covered for less than three months.”
Members of the House of Representatives have already voted to postpone the penalties for the individual mandate, set to go into effect in April 2014, for one year. The open enrollment period will end Mar. 31, 2013.
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