Coverage & Care During the Covid-19 Public Health Emergency

It amazes me every day that the Patient Protection and Affordable Care Act (PPACA) was passed merely 10 years ago, and that Marketplace plans, Marketplace financial assistance, and the protections and guarantees that the law requires of those plans have only been available since 2014.

Since that time, the Health Coverage program at Foundation Communities (a program I am privileged to manage), has worked closely with providers and organizations that serve individuals living with complex medical needs, such as cancer and HIV. These provider relationships are so important to my team because we share the same mission--supporting individuals as they navigate life’s unplanned and unexpected challenges.

At best, Americans have access to a system of health that can be somewhat functional, in terms of their immediate and long-term needs. At worst, our for-profit healthcare system (like most systems) is inherently dysfunctional.  Health coverage is exceedingly complicated, bureaucratic and, by design, exclusionary.  My program and larger organization operates upon the assumption that systems that fail people, but that broken systems learned and navigate.  I believe this theory of change is one we hold in common with the incredible navigators and team associated with Breast Cancer Resource Center.

It has been a focus and a goal of the Health Coverage program to assist those previously stigmatized or discriminated against by the health delivery system, especially those with complex medical needs, such as individuals living with HIV or cancer. In the days before the ACA, a person unlucky enough to have had an accident or diagnosis could access coverage and care at the discretion of health insurance companies, who could charge more or deny coverage based on a person’s medical needs. There were very few protections associated with coverage and care; there were limits what care individuals could receive, and protections that limited what health insurance companies had to pay.  And of course, many individuals never even had access to those limitations—as they might well be denied health insurance due to pre-existing conditions.

Fortunately, the ACA (often referred to as Obamacare) created live-altering (and life-saving) access and the associated protections of health coverage and care that Americans need.

Until the passage of the ACA, the protections and care only provided to those with the financial resources and luck to have not experienced a major medical event, were not a guaranteed right to anyone. The magnitude of this are immeasurable.

The most frequent misunderstanding I hear, when it comes to health insurance, is from clients who are not sick, who do not currently have any medical needs, and thus, may not understand the importance of coverage when it comes to their health. These individuals will tell my team that they are not sick, or that they have always had jobs that offered them health coverage.

Unfortunately, the most frequent year round reason a client comes to us, usually outside of the limited dates during which one can enroll in comprehensive health insurance, is because they have had an accident, learned of a diagnosis or had to quit their job due to an unexpected medical issue.

In March of 2020, millions of Americans began to lose their job-related income, and the security of health insurance their employers offered, further demonstrating the importance of the protections the ACA offers.

Starting November 1 through December 15, the Health Coverage team at Foundation Communities is prepared and ready to assist anyone who needs to enroll in health insurance through the ACA Marketplace.  Due to the pandemic, and for the first time in our program’s history, our enrollment services will be via phone and virtual support for these very important 45 days.

We urge anyone who has lost their employer provided health insurance or those who previously had an ACA Marketplace insurance plan to reach out today to ensure they find a health insurance plan that works best for them and their family. 95% of the clients we serve receive financial assistance to pay for monthly premiums. People can get started by visiting prosperhealthcoverage.org or calling 512-381-4520 for an enrollment appointment or to ask questions. Please remember, everyone’s situation is unique and we work to find a personalized solution that can meet an individual’s need. While not everyone is eligible for Marketplace plans or for the financial assistance made available by the Marketplace, our program strives to help all clients understand their eligibility and to point them towards alternative resources, if the Marketplace is not a fit for them.

Now more than ever, people can and should gain the sense of security that comes from having comprehensive health insurance. The pandemic has taught us that we cannot take our health or security for granted.

For more information please contact the Health Coverage program at Foundation Communities or contact the BCRC.  

Arianna AnayaArianna Anaya

Arianna Anaya is the program manager for Austin-area nonprofit Foundation Communities’ Prosper Centers Health Coverage Program.  Arianna has worked closely with providers and service organizations that serve clients with complex medical needs like cancer and HIV.  She has played a key role in the provision of processes and trainings that have enabled her program’s enrollment of more than 5,000 individuals in Marketplace health insurance each Open Enrollment season.

Arianna Anaya

Health Coverage Program Manager

Prosper Centers | Foundation Communities

 

 

 

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