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Frustration with obtaining health insurance under the Affordable Care Act​​​​​​​​​​

The following is a de-identified composite of calls made to the ACA-sponsored Risk Management Helpline, operated by Anne Marie “Nancy” Wheeler, J.D., an attorney licensed in Maryland and the District of Columbia. This information is presented for educational purposes. For specific legal advice, please consult your own local attorney.

Question: I am a counselor in private practice. Approximately half of my clients are people with limited financial means, although not all are eligible for Medicaid. Many are self-employed and Spanish is their primary language.

Answer: Let’s start with a brief explanation of the timing under the Affordable Care Act regulations. Open enrollment for the new Health Insurance Marketplace (also known as health insurance exchanges) began on October 1, 2013. Short delays in implementation for small businesses and people who plan to use Spanish language enrollment were announced on September 26, 2013. See http://www.reuters.com/article/2013/09/26/us-usa-healthcarebusiness-idUSBRE98P0V520130926 (Retrieved October 17, 2013). Unfortunately, computer glitches have indeed frustrated many people -- whether English or Spanish speaking -- seeking to use the system. See http://www.nytimes.com/2013/10/13/us/politics/from-the-start-signs-of-trouble-at-health-portal.html?pagewanted=2&_r=0 (Retrieved October 18, 2013.) Compounding the problem were the political bickering and federal government shutdown.

Once the kinks are worked out, the marketplace should function similarly to an online travel-booking site, such as Expedia. Health insurance consumers should be able to obtain side-by-side comparisons of various health insurance benefits and premiums, including subsidies or tax credits that are available to some consumers, based on income. The open enrollment period will continue through March 31, 2014 and benefits may begin as early as January 1, 2014 for those applicants who successfully sign up by mid-December, 2013.

Each state has a marketplace, operated either by the state, through a federal-state partnership, or by the federal government. Mental health and substance use disorder coverage, including psychotherapy, is on the list of “essential health benefits” available to consumers. Although general and specific information is now available at www.healthcare.gov, you may wish to suggest to your clients (especially those who are relying on Spanish language website capability) that they wait until the end of November or beginning of December to sign up. Hopefully, the problems will be fixed or the government may announce an extension of time in which to sign up for health insurance coverage.

Printed with permission from the American Counseling Association (counseling.org​)​

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