The Patient Protection and Affordable Care Act helps individuals like Royal in a variety of ways:
Starting in 2010, there will be increased funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years. Community Health Centers charge a sliding fee scale based on income, thus making care more affordable for someone like Royal.
Also in 2010 there will be new standards for non-profit hospitals to protect uninsured patients. These protections include written financial assistance policies clearly stating eligibility guidelines & how to apply, protections from being overcharged, and measures that prohibit extraordinary collection actions against patients. Another important change for Royal is that his eligibility levels for Medicaid cannot be reduced.
And finally, an interim high-risk pool will be established to provide immediate access to insurance for Utahns who for at least 6 months have not been able to get coverage because of a pre-existing condition.
In 2013, Medicaid payments for primary care services provided by primary care doctors increased, giving Royal greater access to physicians than he has today.
And in 2014, individuals like Royal will be able to obtain insurance even with their pre-existing conditions; they will be able to buy insurance through a new online, state-based marketplace called an exchange. Based on income, there will be a cap to the amount a family will be charged for premiums and out-of-pocket.
Medicaid will be expanded to all individuals under age 65 with incomes up to 133% FPL. In addition, adults cannot be denied coverage for pre-existing conditions nor can health premiums be rated based on health status. Health plans will also not be able to impose annual or lifetime benefit caps.