I have a leather couch in my office. And a coffee table with a box of tissue. Countless men and women have sat on that couch, the color draining from their faces as we've worked through their post-divorce budget. In my twenty years as a practicing divorce lawyer, I have learned that nothing is more frightening to most divorcing people than facing the fact that there is a very real possibility that they cannot afford to protect their health and more importantly, the health of their children.
Divorce not only encompasses the separation of a wife and a husband, but often includes separating you from access to health insurance. And in many cases, you have to face the harsh reality that you can't afford health insurance for your children.
Imagine facing the loss of your marriage, your home, your financial security, and your health insurance. And what if you're a breast cancer survivor or you have a chronic illness like heart disease or high blood pressure? Or what if your child has a chronic illness like diabetes? Now add this to the emotional upheaval that every divorcing person feels. And if you're switching jobs or entering the job market after being out for a few years, you know that a lot of jobs now offer few or no health benefits.
So, there we sit on the leather couch, itemizing the budget. And when we get to the line for health insurance and costs of health care, we both take a deep breath. Not only is the cost of health insurance incredibly expensive, but there are co-pays and deductibles. Even if you can afford the insurance, which can cost several hundred dollars a month, there are co-pays for each visit and there is typically a per person deductible - for you and each child. Health care is simply not affordable for many divorcing men and women.
Of course I'd heard about the Affordable Care Act, but to be honest I didn't really understand how it would work. But as I found myself working through budget after budget for my divorce clients, the name of the Act began to resonate with me. "Affordable." Hmm. My friend, attorney Roberta Riley is an expert in women's health insurance, so I called her up and took her to lunch to explore how the ACA might help my clients. Boy was I pleasantly surprised. Here's what I learned:
There are three main ways that the Affordable Care Act will help divorcing men and women:
1. All preventative care will be fully covered and there will be no co-pays;
2. Insurance premiums will offered on a sliding scale based on a percentage of income for individuals with low to moderate incomes - Medicaid may be expanded to make care available to those with very low incomes - depending on the State; and
3. Children will be fully covered for dental and vision.
We all know that the co-pays can really add up for the average family because there are co-pays for every visit, and many plans have increasing deductibles, so the out of pocket expenses can equal the amount of the monthly premium some months. And not very many divorcing people have a few hundred extra dollars in their budget to keep up with these costs.
Under the Affordable Care Act, here are some of the preventative care visits that will not require a co-pay: pap smears, mammograms, maternity care, pediatric well child exams, blood pressure checks, diabetes checks, cholesterol checks, immunizations, and mental health treatment. And as of August 1, 2012, all contraceptive care is one hundred percent covered with no co-pay. This will be a huge relief for men and women facing the harsh reality of having to budget on a significantly reduced income.
So, how will this all work? Obviously, the system is going to be confusing at first. But there will be people available to help everyone find the best policy for their family. These folks will be called "navigators," and anyone can talk to a navigator, in person, on the phone, or online. The navigator will help them go over all of the available options. Once the policy is chosen, the insurance can be purchased at an insurance exchange, which is like a supermarket for insurance.
For most people, their premium will be based on their income. So, if you're going through divorce and find yourself in either the low or moderate income category, your insurance premium will be based on a sliding scale.
For example, in the lowest income category, an individual's insurance premium cannot exceed 3-3.5% of their income. (Someone making $2,000 per month would have a premium of about $70 per month!)
For individuals with a moderate income, the premium will not exceed 9% of their income. (Someone making $4,000 per month would have a premium of about $360 per month.)
As far as health care insurance for those with very, very low incomes, each state will have the option of expanding their Medicaid plan.
Children are given the best benefits of all. They are fully covered for all preventative visits, no co-pays and they have fully covered dental and vision care.
In addition, there are some other important benefits for divorcing men and women under the Affordable Care Act.
For example, under the ACA if you're going through a divorce you can take your husband's or wife's insurance with you. This is called "portability." And when you're ready, you can contact a navigator and find a new affordable policy that meets your unique health care needs.
If you are going through divorce and want to open a small business, you will be able to offer health insurance to your employees by taking advantage of a new tax break. To find out about and fully understand these options, a small business owner can contact a navigator who can explain how this works.
Perhaps one of the best things about the ACA is the fact that pre-existing conditions are fully covered. Nothing is scarier than facing divorce knowing that your chronic illness may not be covered if it flares up. And the same holds true for your children. Everything is covered, no matter when it was first diagnosed. And some current insurance policies consider domestic violence to actually be a pre-existing condition. This will end under the ACA. Any health concerns stemming from domestic violence will be fully covered.
So, once the ACA takes full effect in 2014, if you're going through a divorce you will at least have the peace of mind in knowing that your family's health care needs will not only be affordable, but you will have access to excellent care for all of their health care needs.