Enrollment begins in the new Health Insurance Marketplace created by the Affordable Care Act (ACA) in less than a month, and coverage starts January 1, 2014. This is especially important for the uninsured living in rural areas.(1,2) Community health centers are gearing up to help the uninsured understand whether they will be eligible for coverage through Arizona’s Medicaid program called AHCCCS, or receive help paying the premium for a health plan they buy on the new Marketplace. Navigators and Community Assistance Programs are being trained to help.
Health Insurance for Rural Arizona Uninsured
Arizona rural areas have higher uninsured rates than in large cities, and lower rates of employer-based health insurance coverage. Before there was a Marketplace, a person or family trying to buy health insurance on their own had higher rates (premiums) to pay. By using the Marketplace, individuals and families will have many options, and decide on a plan that best meets their needs. Insurers offering plans in the new Marketplace cannot turn you down because you have a health problem like diabetes or high blood pressure, or drop you from the plan if you get sick. Insurers are required by law to clearly tell you what your cost will be and the benefits included in the plan you buy. Insurers must cover 10 essential benefits including:(3)
- Hospital visits,
- Emergency care,
- Ambulatory services,
- Prevention and wellness care, as well as chronic disease management
- Prescription drugs
- Maternity and newborn care
- Mental Health and substance use disorder services (including behavioral health treatment)
- Rehabilitative and habilitative services and devices
- Laboratory services
- Pediatric services, including oral and vision care
Many uninsured may be eligible for AHCCCS, as Arizona restores Medicaid eligibility for childless adults, and expands Medicaid as allowed by the ACA. On October 1, Health-e-Arizona Plus will help people find out if they are eligible for AHCCCS, and other Arizona assistance programs such as Nutrition Assistance (SNAP), Temporary Assistance to Needy Families (TANF), and others. Eligibility determination, program enrollment, verification and renewal will be faster once the new system is in place. It will also be connected to Arizona’s federal health insurance Marketplace system.
Many living in rural areas lack access to reliable internet services, making online Marketplace enrollment difficult. Community health centers, call centers, navigators and community assistance programs will help the uninsured get the information they need about eligibility, health plan options, and how to enroll. In August, four Arizona Navigator organizations were funded to help the uninsured get information whether they live in big cities or in rural areas.(3)
Rural Health Care Providers and the ACA
Rural physicians, hospitals and community health centers will benefit when coverage starts January 1, 2014. Uncompensated care will decrease as more are covered.
ACA requires insurers to pay for preventive care services. Preventive services are free for patients – they will not pay a co-pay or deductible for them. To meet the pent up demand of the newly insured, the National Health Service Corps increased to 166 the number of rural Arizona clinicians.(2)
The Health Resources and Services Administration (HRSA) implemented the ACA Early Childhood Home Visiting Program to improve maternal and child health. In 2013, Arizona had 11,000 home visits for evidence-based counseling and interventions.(2)
- Glasgow, N., Morton, L. W., & Johnson, N. E. (Eds.). (2004). Critical issues in rural health. Blackwell Pub.
- Mary Wakefield speech at AZ Rural Health Conference. (2013). Available at http://www.hrsa.gov/about/news/speeches/2013/08211340thazrural.html
- Essential Health Benefits: Arizona Department of Insurance (2012). Available at http://www.azgovernor.gov/hix/documents/Grants/EHBReport.pdf
- Coburn AF, Lundblad JP, MacKinney AC, McBride TD and Mueller KJ. The Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look. Columbia, MO: Rural Policy Research Institute, 2010. Available at www.rupri.org/Forms/Health_PPACAImpacts_Sept2010.pdf
Joni L. Dean has an MPH from University at Albany and a BS in Health Information Management from Temple University. She is currently a DrPH student at University of Arizona focusing on Health Policy & Management with research interests in Accountable Care Organizations and Medicaid quality health outcomes.
Dan Derksen, MD is a graduate of the University of Arizona College of Medicine in 1984 and completed his family medicine residency at the University of New Mexico where he worked as a faculty member for 25 years. He joined the MEZCOPH faculty in the fall of 2012 as a Professor and Section Chair of the Health Policy & Management and Community, Environment and Policy Division. He is the Director of the Center for Rural Health.