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Why you need to prepare today to speak with members about their ACA coverage – and Medicare members, too.

As more and more press is now becoming devoted to the repeal of the ACA, health plans will be finding themselves receiving calls from concerned members about what all of this means to them. Then, there are added concerns for seniors. And as an insider in this industry, I find myself reflecting on the sections of the ACA affecting the health system as a whole.

What members are likely to question…

Of course, Under 65 members will be calling with concerns about whether they will continue to have coverage, but the savvy senior population may also start wondering what is going to happen to some of the benefits they enjoy as a result of the ACA.

This is the time for health plans to be prepared to respond. Although no one has all the answers right now about what is going to happen, health plans can make sure that their reps are prepared with responses that recognize and validate the members’ concerns with empathy and promise transparency on the unfolding details as soon as they are available.



Other topics to ponder…

The ACA, as you likely know, too, is huge. Its entirety begins with Section 2711 and ends with Section 10909. Those sections devoted to the exchanges are found in Sections 1311-1313. Of course, there are other sections devoted to important items like pre-existing conditions, but there’s a host of items, large and small, regardless of each of our personal feelings on some of the more visible points:

  • sections that provide seniors with the ultimate elimination of the Part D donut hole and the ban on lifetime limits
  • the right of working nursing mothers to have a private place to express milk for their children
  • the free preventive care that seniors now receive
  • nutrition labeling in restaurants to help those who need that knowledge for health reasons … just to name a few

There are other sections in action now that provide help to those who use them – and impact myriad aspects of the health system at large:

  • advanced nursing degree grants
  • hospice reform
  • the independence at home demonstration project
  • the nursing home compare website
  • school-based health centers
  • training for more family practitioners



It’s quite a package, with so many implications. I’d imagine anyone could find both pros and cons: provisions to give a thumbs up and others a thumbs down. My hope would be that reforms and revisions go at a thoughtful enough pace to ensure the baby doesn’t go out with the bath water.

This link will take you to the full ACA law. If you haven’t looked at it recently, this is feeling like a good time to get ahead of the many queries to come.