By Jackie Jones

President Obama signed the final revision of the Patients Protection and Affordable Care Act. Now, the real work on health care reform is just beginning.

The parsing of intent has already started as health insurance companies and opponents of the bill are raising questions about who is covered and who is left out. Fourteen states plan to file suit to try to kill the bill – or at least portions of it – contending that it is unconstitutional.

But there are some benefits to Americans, particularly African Americans who are struggling with double-digit unemployment approaching 20 percent, less access to health care and disproportionate representation for a variety of chronic illnesses, including heart disease, hypertension and diabetes.

Immediately, insurance companies will no longer be able to refuse to pay for treatment of children’s pre-existing conditions, young adults may remain on their parents’ health insurance policies until their 26th birthday; insurance companies cannot drop people from coverage when they get sick and those uninsured from pre-existing conditions will be able to access insurance through a temporary subsidized high-risk pool.

The hitch – and isn’t there always at least one? – is that some of the highly touted provisions of the act will not take effect until 2014. For example:

• Insurance companies will be banned from denying health insurance coverage to people of all ages because of pre-existing conditions.
• Families and children with moderate incomes (up to about $88,000 for a family of four) will be able to get help paying for health insurance coverage.
• State insurance exchanges will enforce minimum benefit standards for health insurance coverage.
• Insurers initially took issue with the pre-existing condition language, arguing that it pertained only to children who were already insured. The uninsured, they suggested, would have to wait until 2014, like everyone else.

After Health and Human Services Secretary Kathleen Sebelius said the law was intended to include all children, the insurance companies issued a statement Tuesday saying they would honor the Obama Administration’s interpretation of the law.

Sparring over what constitutes a pre-existing condition is nothing new, said Deborah Reid, senior attorney for the National Health Law Program (NHeLP), a public service law firm that represents the interests of under- and un-served communities.

Before health insurance reform, Reid said, “some insurers excluded women for being pregnant and domestic violence survivors or people who’ve had certain cancers. We think (the new law) applies to everybody.”

The new law expands Medicare coverage, making it easier for many low-income Americans to qualify for health care, and requires public programs to collect data on race, ethnicity, language, gender, socioeconomic status and disabilities, making it easier to identify and reduce health care disparities. It also reauthorizes the Office of Minority Health through 2016.

As a result, African Americans and other people of color should gain better access to health care coverage.

“The most beneficial to low-income Americans is the increased Medicare portion of the bill that starts in 2014,” Reid said. “To be eligible most people think all you have to be is low-income, but that’s not exactly how it works. Before the law you had to fit into certain categories and meet the income requirement.”

Under the new law, the complicated formula is largely eliminated. So, for example, a family of four with an annual income of $29,300 that previously would have been ineligible now qualifies for coverage.

“That’s really big news because a lot of people work at jobs where health insurance isn’t offered and they can’t afford health insurance on their own and up to now they went without,” Reid said. “ These people have been going to the emergency room because they had no health insurance.”

Another benefit that will help many people with chronic illnesses is The Class Act, which sets up the first national government-run long-term care insurance program, to be offered primarily through employers.

According to a report in The New York Times, the act, a pet project of the late Sen. Edward Kennedy, would provide assistance for the disabled who need help with basic daily activities, including bathing, getting in and out of bed and getting dressed – services that many disabled Americans could not afford and who don’t have family or caretakers who can assist them regularly.

Further, according to The Times, the act does not screen applicants, so people who previously might not have qualified for long-term care may enroll. It does not cover the total cost of such care, but provides cash payments to lend a helping hand. Participants will pay monthly premiums and can start receiving benefits after a five-year vesting period, regardless of age.

Insurance industry lobbyists tried unsuccessfully to get the provision stripped from the final health care bill, arguing that the premiums were set too low and too many people will sign up for the plan, making it impossible to be self-sustaining. Proponents, however, said the act will help participants choose the kind of assistance that best suits them and give many the opportunity to live independently longer.

Seniors and others on Medicare will find the new law will reduce the so-called “donut hole,” a gap between different levels of coverage and provide a 50 percent discount on brand name drugs during the donut hole phase.

Previously, Medicare only covered the first $2,850 spent on health care and prescriptions. Coverage did not pick up again until the patient reached $4,850 in expenditures. Under the new law, the minimum amount will increase to $3,330.

The new law also provides money for comprehensive sex education, to be administered by the Centers for Disease Control and Prevention (CDC), to reduce unintended pregnancies and sexually transmitted infections, including HIV/AIDS.

According to the CDC, young African Americans, ages 13 to 29 make up half of all new HIV infections. Of that group, gay men and young black males make up 55 percent of the new infections. Further, the CDC says African Americans are disproportionately exposed to other STDs, weakening the body’s resistance to the virus that causes AIDS.

The law is not a cure-all, though.

Legal immigrants must wait five years to qualify for health care, and no coverage for illegal residents could pose a threat to public health if they contract an illness like tuberculosis and cannot get treatment. Federal limits on abortion, even to the extent that some health care providers may feel they cannot even advise women that the procedure is an option they can consider, raises questions about whether women will get complete reproductive health care. And the lack of the much touted public option, which could have provided competition to private insurers and served as a model for coverage and access was left on the cutting room floor.

Reid said NHeLP was disappointed that those elements weren’t in the final legislation, but believed overall there is much to like in the new law.

“It will help,” Reid said. “It won’t help everybody we want to help but for a whole lot of other people it will help.”

Jackie Jones is a freelance writer as well as a career and fitness coach for those who want to get their lives in shape.