Insured Texans are already noticing some changes as the sweeping reforms from the Patient Protection Affordable Care Act take effect.
Traffic is picking up in local clinics as patients and families become aware of some aspects of the law, which provides for preventative care, prohibits insurance companies from dropping coverage for ill patients, drops lifetime limits and prevents insurance companies from discriminating against patients with preexisting conditions.
Levi and Kelly Nevarez of Andrews, and their three children are covered under a family policy from his employer, and say they are glad that preventative care is now covered 100 percent.
"I think it is wonderful," said Kelly Nevarez, who just had their third child less than a month ago. The Nevarez's recently took their oldest son Keagan for a checkup at the Texas Tech Family Health Clinic in Odessa .
The Nevarez family is among the 54 million Americans with private health insurance who gained preventive service coverage with no cost-sharing under the PPACA, including 3,836,000 in Texas.
The Nevarez's said they were concerned when they were told by his employer that the company was switching insurance providers.
"Fortunately we had no changes in premiums or coverage," said Levi Nevarez, who works for Cimarex Energy in Midland. "We are very blessed."
Beginning August 1, women in Texas can now get coverage-- without cost-sharing--of even more preventive services they need. That means 3,412,175 women in Texas will now have guaranteed access to additional preventive services without cost-sharing for policies renewing on or after August 1.
In addition, health care providers say local clinics are seeing more young adults ages 18-26 who are now covered under their parents' policies. Thanks to this provision which is already in effect, 3.1 million young people have gained coverage nationwide and 375,000 young adults in Texas gained coverage under the new law.
"We are seeing more young adults are coming to our clinics because before they did not have insurance and now they are covered on their parents insurance," said Dr. Gary Ventolini, regional dean for Texas Tech University Health Science Center. "That has been beneficial."
Under PPACA health care coverage will be required for U.S. citizens and legal residents by 2014. And standard requirements will be put in place.
"Starting in 2014 there will be a standard and there will be required maternity, mental health and emergency coverage," said Stacey Pogue, a policy analyst for the Center for Public Policy Priorities, an Austin-based non-profit research organization.
Employers are not required to offer coverage, but a penalty applies to employers with 50 or more employees who do not offer coverage. The penalty is $2,000 a year for each full time employee not offered minimum essential coverage.
Once the new insurance marketplace otherwise known as the insurance exchange is up and running, consumers will have the ability to shop for affordable coverage.
"Small employers and individuals will be able to buy coverage," Pogue explained. "Also, if you are self employed you haven't had a lot of options," Pogue said. "In 2014 they (self employed) will be able to go to the exchange and buy coverage. It is a world of difference for the folks who have been locked out of coverage."
Local organizations are working to inform the public of the health care reform laws, currently in effect, and those coming in 2014.
"We've been talking about health care reform since 2010," said Raynetta Williams, a benefits counselor at the Area Agency on Aging of the Permian Basin Regional Planning Commission.
"We talk about the benefits of the health care (with) reference to preventative coverage and prescription drug coverage," Williams said. "What they are excited about are the preventative services. We encourage them to talk to their physicians on what they might need."
Another big thing -- for people who are not getting job based insurance in 2014 people who are low and moderate income will be able to go to the exchange and get sliding scale subsitdies to pay for insurance.
If employees opt out of health care insurance either with an employer or with the exchange, they will be penalized through the Internal Revenue Service. The plan calls for the employee or consumer to pay $95 or 1 percent of the annual income in 2014; $325 or 2 percent of annual income in 2015; $695 or 2.5 percent of income in 2016 and 2.5 percent of the annual income in 2017. The penalties to consumers cap at 3 percent.
But local health care professionals say that not everyone is aware of the changes -- like the fact that mammograms are covered along with other preventative procedures like colonoscopies and cancer screenings.
"The people that do have insurance aren't aware of all the benefits," said J.R. Edmiston, director of patient financial services at Medical Center Hospital. "Insurance is not something you focus on until you need it."
And this helps with the high cost of out-of-pocket health care expenses. For example, a colonoscopy, which previously required a co-pay, is now covered 100 percent. Insured patients have no expense for the procedure that costs around $2,500 at the hospital, Edmiston said.
"It is not a financial decision anymore it is a health care decision," Edmiston said.
Contact Celinda Hawkins on twitter @OAciti, on Facebook at OA Celinda Hawkins or call 432-333-7779. ___
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