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With the Affordable Care Act, in 2014 uninsured boomers get access to coverage

It’s a story that senior advocates at Elders In Action and representatives of AARP Oregon have heard too often: Older adults who were laid off during the recession and are now without health insurance are struggling with health care costs.

by: MERRY MACKINNON - With affordable health care, many people won't have to resort to cutting their prescription pills in half to save money.

They don’t have Medicare because they’re in their 50s or early 60s. They may have a chronic medical condition and are paying for their healthcare out of pocket, cutting prescription pills in half to save money and delaying treatments such as knee surgery despite arthritic pain. They may be low-income, but not poverty stricken, so they’re not eligible for Medicaid.

And if they have a health crisis, it could tip them into a financial crisis.

“There are people falling through the cracks,” said Briana Winterborn, Elders in Action personal advocacy specialist.

Winterborn said her Portland nonprofit agency’s case files are full of examples of clients, adults 60 and older, who are dealing with heath care and other issues and requesting personal advocates to help with paperwork and other guidance.

“We only work with folks who are living independently,” Winterborn said, adding that, for now, she knows of no process in place to help uninsured seniors find health insurance, unless they can afford it or are eligible for the Oregon Health Plan (Medicaid). “We usually try to get them into a clinic,” she said.

But with the passing of the Affordable Care Act, in 2014 the uninsured and under-insured will have new options. For many uninsured now struggling with healthcare costs, the biggest change coming in 2014 is that Medicaid will enroll more people.

The state of Oregon will be expanding Medicaid by raising income eligibility above the federal poverty level, said AARP Oregon State Director Gerald Cohen.

“That will be the most far-reaching change that will affect those who are financially struggling and currently uninsured or under-insured,” Cohen said.

The second significant change, according to Cohen, will be affordable health insurance available on state-based Insurance Exchanges. The exchanges, called a one-stop marketplace, will allow consumers to compare private health plans and to purchase plans, which, depending on income, could include a tax credit.

“They’re still working on setting a standard benefit package,” Cohen said. “In theory, you’ll be able to pick a plan you can afford.”

Cohen said the third change concerns pre-existing medical conditions. Under the Affordable Care Act, insurance companies won’t be allowed to deny insurance based on pre-existing conditions. “And insurance companies can’t charge a higher premium, either,” he added.

Cohen said these and other aspects of the Affordable Care Act will make for a more equitable, inclusive healthcare system.

“When individuals have both peace of mind and ability to access quality health care, they are far better off emotionally, physically and financially,” he said.