By Barbara Vinograde
How will the federal Affordable Care Act affect the Iowa City Free Medical and Dental Clinic? The answer to this question is important to many people in our community.
The component of the ACA most likely to affect Free Clinic patients is the Medicaid expansion; in Iowa, the expansion is called “Health and Wellness.” Under Iowa’s expansion, people between the ages of 19-64 with incomes up to 138 percent of the federal poverty Level will become eligible for coverage. There will be no monthly premiums for the first year and if members complete what are called “preventive/wellness activities,” premiums may not be required in the following years.
Most of our patients have incomes that fall within this range: 138 percent of poverty level for a single person is $15,856; for a family of two, it is $21,404; and for a family of four, it is $32,499. For our patients with incomes between 138 percent and 400 percent of the federal poverty level, the ACA provides assistance with insurance premium subsidies and tax credits through the new state exchange, or marketplace.
This sounds pretty good. But it is important to recognize that access to insurance — by itself — is not the answer to reforming our current system. Rather, it is the first step on the road to health care reform, the first step in creating a system where all people have access to affordable care.
Enrollment for Iowa’s Health and Wellness begins on Oct. 1. The Department of Human Services estimates that more than 33,000 Iowans will enroll in fiscal year 2013-14 and an additional 66,500 in fiscal year 2014-15. Between 2014 and 2019, approximately 150,000 newly enrolled Iowans will need to find primary care providers and establish medical homes.
There is already a shortage of primary care providers, especially those who accept Medicaid, and with thousands of new enrollees, it may be difficult to meet the high demand. Newly insured Iowans who are unable to find a provider and a medical home will continue to not have access to needed care.
There will be people who remain uninsured in 2014. For example, people unable to afford insurance, even with subsidies. People who make too much money to qualify for subsidies but cannot afford the premiums. People who are exempt from the individual mandate — who are uninsured for less than three months or exempt from filing federal tax returns.
There will be people who fall through the cracks, unable to navigate the system due to its complexity. People who choose to pay the penalty for not having insurance rather than paying the premiums. Naturalized citizens in our country less than five years will not be eligible for coverage. And undocumented immigrants will remain uninsured.
At the Free Clinic, it is a priority for us to stay well-informed about the Affordable Care Act and to share information with our community, our supporters, and our patients. It will take time to implement all of the ACA’s requirements and changes and to see how our patients are affected.
During this time, we believe the need for our services will continue. We don’t have all the answers, but our commitment to provide quality, comprehensive medical and dental care to the underserved in our community remains strong.
For more information about the ACA and Iowa’s marketplace, please visit www.healthcare.gov.
For marketplace enrollment assistance, call the National Call Center: (800) 318-2596.
Barbara Vinograde is executive director of the Iowa City Free Medical and Dental Clinic. Comments: BVinograde@freemedicalclinic.org