Feds out to enroll LGBT Americans in health coverage

Community leaders from across the country gathered at the White House on Sept. 12 to learn how they can help hundreds of thousands of uninsured LGBT Americans get health care coverage.

Less than two miles away, at the U.S. Capitol that day, tea party Republicans led by Wisconsin Rep. Sean Duffy continued to try to derail implementation of key elements of the Affordable Care Act, including the opening of the health insurance marketplaces on Oct. 1. Republicans in the U.S. House have held more than 40 votes aimed at repealing or weakening the ACA or, as it is widely known, Obamacare. 

U.S. Health and Human Services Secretary Kathleen Sebelius, addressing LGBT leaders at the White House and a wider online audience, seemed confident they’d fail. “Thanks to all of you, this law is now a reality and it is going to happen in spite of some of the best efforts of our friends at the Hill,” she told the crowd. “This is what we call a law. It was passed. It was signed. It was upheld by the Supreme Court. And the president got re-elected. This is a law, and the people are entitled to these benefits.”

Sebelius was focused at the forum on making sure LGBT Americans know their rights, responsibilities and options under the ACA. “Here is the fact you all need to keep in mind,” she said. “One in three lower-income LGBT adults in America doesn’t have health insurance. We are talking about a community that can be hugely impacted by what’s about to happen.”

Starting in 2014, the ACA prohibits insurers from denying coverage or charging a higher premium based on a pre-existing condition, including HIV or AIDS. The law also prohibits insurers from charging someone more because of gender, sexual orientation or gender identity.

“Being a woman is no longer a pre-existing condition,” said White House senior adviser Valerie Jarrett. “Being LGBT is no longer a pre-existing condition.”

The ACA also has removed dollar limits on lifetime coverage and, starting in 2014, annual limits on coverage will be illegal.

Under the ACA, health insurance plans also will have to provide preventive care, including annual check-ups, mammograms, HIV testing, cancer and diabetes screening, and vaccinations without co-pays or deductibles.

To access those benefits, people must be covered. Uninsured Americans can find coverage in online marketplaces opening Oct. 1, while the underinsured or overcharged can shop for better plans or take advantage of tax credits.

“State health exchanges will open with various levels of readiness and competition,” said William Melville, a market analyst at the HealthLeaders-InterStudy. “Pennsylvania and Wisconsin have robust insurer participation despite a hands-off approach from state governments. The important thing to remember at this stage is that exchanges are very volatile and subject to changes good and bad – and each of these changes will have a corresponding impact on companies doing business in the health care space.”

Community leaders

“But here’s what we know, unless they know how to connect with those benefits, all of this is just paper,” said Sebelius, who talked with LGBT leaders just after an ACA briefing with the president and cabinet.

So HHS is relying in part on community leaders – such as Jason Rae of the Wisconsin LGBT Chamber of Commerce and Paul Fairchild of the Cream City Foundation, who attended the White House briefing – to spread the word about the marketplaces. 

The community leaders asked to share the “get covered” message play particularly important roles in states such as Wisconsin, where the Republican right is working against the ACA and an expansion of Medicaid and has ceded responsibility for the marketplace to the federal government.

Surveys show that many residents in such states mistakenly think they can’t access the marketplace or have the protections of the ACA. And correcting the confusion may be more difficult in those states, because federal money for outreach is less than in cooperating states. An Associated Press survey found that government spending for outreach will be about 46 cents per capita in Wisconsin and $9.23 per capita in West Virginia.

Filling the void in states with administrations hostile to Obamacare are nonprofits, businesses and community advocates.

In the LGBT community, national organizations such as the Center for American Progress, the Federal Agencies Project and the
Sellers Dorsey Foundation are working with local and state leaders on the Out2Enroll outreach initiative.

“Like so many people across the country, LGBT community members have questions about what the health reform law means  to them,” said Christopher Labonte of the Sellers Dorsey Foundation. “Out2Enroll’s targeted outreach and enrollment program will offer the kind of community-specific information and resources LGBT people need to navigate these new options.”

A new Kaiser Family Foundation analysis estimated that Americans who buy their own insurance will receive tax credits averaging $2,700 next year for coverage through the new marketplaces, also called exchanges.

“Tax subsidies are an essential part of the equation for many people who buy insurance through the new marketplaces next year,” said KFF president Drew Altman, adding that about 48 percent of Americans with individual coverage should be eligible for credits. “They will help make coverage more affordable for low- and middle-income people.”

The credits subsidize premiums for those who don’t have access to affordable coverage through work and who have incomes between 100 percent and 400 percent of the federal poverty level – about $11,500–$46,000 for a single person or $24,000-$94,000 for a family of four.

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