The Bridge Between Insurance and Health Outcomes

While my role as a health insurance specialist with the Department of Public Health, Ambulatory Health Services does not provide direct disease prevention or clinical services, getting access to health insurance is an important step in receiving access to these important benefits. My role is to serve as a liaison between patients, and insurance companies, as well as the Pennsylvania Department of Human Services who processes Medical Assistance applications. In my role as an Insurance Specialist, I am able to assist patients with applying for insurance, as well as educate them about what health insurance can mean for their day to day life.
 

One of the provisions of the Affordable Care Act is called the individual mandate, which requires everyone to sign up for health insurance if it is considered affordable. Affordability is defined as being 8.05% or less of your income and in the case that you cannot find affordable coverage through the Health Insurance Marketplace you are able to apply for an exemption. If you do not sign up for insurance you are hit with a fine which serves as an incentive to get all people who can, signed up for health insurance. With the increase in the fine for being uninsured in 2016, more patients and members of the community have begun to come into my host site, Health Center 10, looking for health insurance simply to avoid being fined on their tax return later on. However, many people are learning for the first time what it means to have health insurance and how it can provide much more than avoiding a hefty fine. People who have never had insurance before are learning what health insurance can do for getting access to a primary care physician, and their long term health outcomes. Most who are eligible for Medical Assistance are more proactive in getting access because this insurance is paid for by the state. After Medicaid Expansion in Pennsylvania just last year, many people who are eligible for Medicaid are still surprised to learn about their eligibility. However, those who are not eligible for Medical Assistance are often unaware of tax credits they qualify for on the Federal Health Insurance Marketplace.

Because the term “ObamaCare” has a variety of connotations, I prefer using the term “The Affordable Care Act” when referring to health insurance purchased through the Federal Health Insurance Marketplace. Not only is this the technical and accurate name, it also reveals more about one of the overall purposes of the bill which is to give middle class American’s access to health insurance that is more affordable than what they would otherwise have access to. In my experience with the Affordable Care Act so far, patients have been pleasantly surprised at the tax credits they are able to receive in getting help paying for their monthly premiums.

Unfortunately for a long time being healthy came at a high cost in the United States before the implementation of the Affordable Care Act. Many preferred to stay uninsured and often did not care about the risk they were taking in the case of a medical emergency. However, I try to explain to patients that health insurance is not just a safety net in case you need help paying for a medical emergency. Healthy people can benefit from health insurance too, as insurance companies provide a variety of resources. Whether it is appointments with specialists, tips for healthy living, preventative care, and education, these benefits are not to be ignored while considering health insurance. Serving as an insurance specialist does not allow me to gain clinical experience, but I am able to give patients education and access to resources which will improve their health outcomes and help them live a healthier lifestyle.
 

This blog post was written by NHC Philadelphia member Megan Houston.
Megan serves as the Insurance Specialist at Philadelphia Department of Public Health-Ambulatory Health Services, Health Center 10.