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Cynder Sinclair: Local Implications of Supreme Court Decision on Affordable Care Act

The federal law, while not perfect, will ensure health-insurance coverage for thousands of South Coast residents and all Americans

The federal Affordable Care Act (ACA), intended to reform our country’s health-care system to provide health care for 50 million uninsured Americans, was enacted in March 2010. Its implementation is planned to roll out in stages through 2020.

Cynder Sinclair
Cynder Sinclair (Elite Henenson / Noozhawk file photo)

Recently, the constitutionality of this legislation was challenged, and on June 28, the Supreme Court ruled that it is constitutional. Therefore, its implementation continues on track.

Some provisions have already taken place, and others are scheduled to be enacted in the coming years. The complexity and timeline of this legislation creates many questions. Below are answers to a few of the more common questions.

Who Will Benefit Directly from This Law?

Individuals who earn less than 133 percent of the federal poverty level ($29,327 a year for a family of four) and have no health insurance will benefit directly from the ACA due to the expansion of Medi-Cal. California may include individuals who earn up to 200 percent of the federal poverty level. In Santa Barbara County, this represents about 25,000 individuals who will qualify for Medi-Cal in 2014.

Many of these people refrain from seeking medical care when they are sick, even though Santa Barbara Neighborhood Clinics will serve anyone regardless of their ability to pay, because they are uncomfortable accepting a “handout.” Sometimes holding on to dignity is one of their few options in life. Even paying at the sliding-fee scale rate offered at SBNC means that many of these individuals would have to choose between health care and food or rent payment.

So they wait — they wait until they are “sick enough” to go to a doctor. Often this means they go to the hospital emergency department, which dispenses excellent but costly care. Going to one of SBNC’s clinics would be a much more cost-effective way to receive quality health care, especially if the patient goes when he or she first gets sick. Of course, the best scenario is for patients to use our wide variety of prevention services that result in a healthy lifestyle.

Who Are These People, and How Does Their Lack of Access to Health Care Affect Others?

Many low-income people living on the South Coast are the ones who prepare and serve our meals at restaurants; they clean our homes and keep our gardens beautiful; they care for our children; they clean our hotel rooms. Most hold down three or more jobs — they are the working poor who live among us.

A lack of access to health care often means they are too sick to go to work or school. If they go to their jobs or schools in spite of being sick, they spread illness to others and often perform at substandard levels. Clearly, a lack of health care has a negative economic impact on local businesses and a detrimental effect on community health.

But there is another more powerful implication. What does it say about a community or a country that allows large numbers of people to suffer from a lack of health care? I have heard that a community’s value can be measured by the way it cares for the most vulnerable among them. Using this yardstick, health-care reform will raise our communities to a much higher level of value. Our own community can be proud that we provide access to excellent health care to everyone regardless of their ability to pay.

What Are Other Ways the ACA Will Affect Us?

By 2014, almost everyone will be required to be covered by health insurance — either private or government-run. Those without coverage will pay a penalty to the Internal Revenue Service. However, Health Benefit Exchanges will be available to consumers to help them compare available insurance plans and choose the one that best fits their needs. For those unable to afford insurance, federal subsidies will be available. In addition, by 2014, insurers will no longer be able to deny coverage to individuals due to pre-existing conditions.

Which Provisions of the ACA Are Already in Effect?

There are several provisions of the ACA that took effect beginning in 2010, including:

» Parents are allowed to keep their children on their insurance up to age 26.

» There are no more co-payments allowed for preventive care.

» Children cannot be denied coverage because of health problems.

» A temporary program that helps individuals with pre-existing health problems get coverage since the permanent program doesn’t take effect until 2014.

» Medicare recipients are on track to save money on prescriptions.

» Insurers are not allowed to impose lifetime limits on benefits.

In conclusion, while not perfect, the ACA represents the largest expansion of our country’s social safety net in more than 45 years, touching virtually every citizen’s life. It accomplishes the noble goal of ensuring that 50 million additional Americans have access to health care. Many benefits have already been enacted, and more will be implemented over the coming years.

However, the law is complex and hard for many Americans to understand. In addition, it has endured dramatic political attacks from a variety of sources. At SBNC, we do not engage in politics, but we do applaud the removal of barriers to access to health care for millions of low-income people. We look forward to serving them with dignity and compassion.

— Cynder Sinclair is the CEO of Santa Barbara Neighborhood Clinics.

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