The Affordable Care Act Turns Two

The Affordable Care Act (ACA), also called “Obamacare,” is entering its second year of full implementation in 2015. The ACA is a major shift in our American way of providing and paying for healthcare to create healthier families and communities. It will take years before we understand its full impact. But two things are certain: It is the current law of the land, and it will keep evolving over time.

The old model of healthcare coverage and insurance was broken. It left too many people falling through the cracks of the healthcare system. Without access to doctors and preventive care, emergency rooms in hospitals took the brunt of caring for people when they got so sick that they could not put off getting help. This often caused financial problems, including bankruptcies. The cost of “uncompensated care” at hospitals was passed along to everyone else through higher insurance rates, taxes, or other costs.

The ACA is designed reduce this burden on communities and individuals. First, it is changing aspects of the healthcare and insurance industries. But it also requires people to make some changes. The old model focused on “sick-care” rather than on keeping you well. You went to the doctor only when you were sick and received treatment for your symptoms. The medical providers got paid for the tests and treatments they gave you. With the ACA model, the goal is for providers to create a partnership with you before you get sick. This helps you stay as well and healthy as possible for as long as possible. It also helps cut back on the need for costly care that is often too late. Medical providers are more incentivized to provide preventive care. And, when people stay healthy longer, they are happier and more productive.

A state of good health is a complicated, individual map of family genes, environmental effects, mental health status, and personal choices. Everyone responds differently to all of these factors. However, some things are absolutely clear about supporting good health. The first is mainly common sense – supporting people in making better choices, such as quitting smoking, getting regular exercise, eating healthfully, and taking medications regularly. The second is helping people with behavioral (mental) health needs. If someone is depressed, for example, it can be hard to feel motivated to exercise, eat well, or simply take care of themselves. The new model of healthcare helps people with their behavioral health, including substance abuse issues, as part of their physical healthcare. The third thing we know is that living in healthy communities promotes healthy families and healthy individuals.

Insurance companies, clinics, doctors, nurses, community health workers, and complementary health providers – such as acupuncturists, chiropractors, and nontraditional healers – must all work together in more collaborative and coordinated ways under the ACA to help keep people and communities healthy. But this new approach works only when people realize that they are the drivers of their own health. They succeed when they partner with their doctor, clinic, and other providers. One of the first things a person should do is find a primary care provider (PCP) to be their care partner. With the PCP, the person maps out a proactive plan for wellness and care, along with a plan should unavoidable illness or injury occur. For example, if the person has a strong family history of diabetes, activities such as regular testing and learning how to prevent diabetes through exercise, diet and managing stress should become part of the plan. The provider’s job is to coach, advise and check in regularly. The patient’s role is to make personal choices that keep his or her health in the best state possible.

Under the ACA, almost everyone is required to have insurance, either through their job, government programs, or buying it themselves. Help in buying insurance is available through the New Mexico Health Insurance Exchange. Depending on your income level, you can get help to pay monthly premium costs. Also, if you choose a Silver plan, and are eligible, the government can help you with some of the other costs too, like deductibles and copays for services and medications.

There are many places to find help with choosing the best plan for you and your family or answering your questions. The Exchange website is a good place to start: You can enroll online or find an Enrollment Counselor or Insurance Broker to help you on the phone or in person. There is no charge to you for this service.

Having healthcare coverage is vital to everyone’s wellbeing and financial health. It is worth working through the details to get coverage, even if it seems complicated. A healthy community is one where everyone has access to the kind of care they need, when they need it – and it starts with you. Together we can improve the health and wellness of all New Mexicans.

Winter 2015

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