The Affordable Care Act and Social Work

The Affordable Care Act (ACA) dramatically expands access to health care coverage, and as a result, social workers are taking on roles as care providers and care coordinators — working between hospitals, homes, and communities.

What is the Affordable Care Act?

Under this legislation, all Americans are now required to obtain health care coverage or pay a penalty, and insurers are no longer able to exclude individuals with pre-existing conditions or increase premiums because of gender or health status. Individuals are allowed to stay on their parents’ health care plans until age 26. In addition, an estimated 19 million people will be newly eligible for Medicaid.

Health care coverage options must be available in either a federal- or state-run marketplace, and insurers operating in the marketplace are required to offer four levels of coverage. According to the Kaiser Family Foundation, lower-level plans will cover about 60 percent of an individual’s medical costs, while higher-level plans will cover about 90 percent of the costs. All plans must include a package of essential health benefits, including hospitalization, prescription drugs, maternity and newborn care, and mental health and substance abuse disorder services.

The Congressional Budget Office estimates that because of the ACA, about 95 percent of the legal, non-elderly population will have coverage in 2021, compared with 82 percent without the ACA. This will be partially due to a major expansion of Medicaid. The ACA provides states with additional funding to expand Medicaid to cover adults younger than 65 with income up to 133 percent of the federal poverty level. According to HealthCare, those who are eligible receive free or low-cost health coverage, “regardless of disability, family status, financial resources, and other factors” that used to be considered in Medicaid eligibility. Find out which states have expanded Medicaid. It is important to note that more than 20 states have not coordinated extra Medicaid funding allowing them to meet the goals of the ACA.

Social Work and the ACA

With the ACA’s increased emphasis on preventive care and community-based treatment, social workers have an opportunity to bridge the gap between physical and mental health, taking on the role of a “care coordinator,” working between patients and physicians.

The New York City Health and Hospitals Corporation defines care coordinators as social workers who work with patients to create a plan that addresses mental health, physical, and social service needs. These services can include:

  • Community resource planning and coordination
  • Connecting patients with specialists and other health care providers
  • Advance directives
  • Helping patients understand chronic conditions
  • Crisis intervention
  • Counseling for emotional adjustments and lifestyle changes
  • Assistance with legal issues, transportation, or applications for financial aid

While the benefits of community-based treatment and preventive care are already widely recognized, the ACA further incentivizes hospitals and care providers, imposing sanctions when patients come back too soon after being released, increasing the value of community-based preventive care programs. One such program is a Health Home.

What is a Health Home?

A Health Home is a free program (not a physical location) that helps patients manage the care and services that they need. Beneficiaries are paired with care coordinators who help them better understand and manage their conditions, outside of the hospital setting.

Patients may be eligible for Health Home care if they have:

  • Two chronic conditions, including:
    • Substance abuse
    • Mental health condition
    • Asthma
    • Diabetes
    • HIV or AIDS
    • High blood pressure
    • Heart disease
  • One chronic condition and the risk of developing a second
  • A serious and ongoing mental health condition

Social Workers’ Role in Health Care Reform

The ACA specifically mentions social workers as key players in implementing health care reform, which means they will likely have an opportunity to shape policy by advising policymakers on the following aspects of health care reform:

  • Effect and influence of social and environmental factors: Health care issues are much larger than the individual, and social workers will recognize how policy should best account for these factors.
  • Appropriate timeline and perspective: Social workers interact with individuals of all ages and think in terms of a life span, as opposed to short-term goals.
  • Advocacy: Social workers concern themselves with matters that extend beyond their individual clients. Social equity surrounding the access of care is a paramount concern of social work professionals, and as a result, social workers can become health care advocates in their communities.
  • Comprehensive care planning: Effective care, and thus policy, must take into account families, communities, and service providers.
  • Access expansion: Social workers understand that between human services, clinics, hospitals, mental health facilities, the community, and the home, there are many places where access to care is denied or not aligned with the other phases of the treatment process.
  • Social work education: Medical education typically focuses on identifying and treating disease and physical illness, while social work education focuses instead on prevention, community support, and case management. There will be more social workers bringing their unique educational background to the health care system.

Significant expansions to health care services through the Affordable Care Act, particularly for low-income individuals, as well as an emphasis on community-based preventive care, will likely create more career opportunities for social workers in the United States. With more people than ever obtaining health care coverage, there will be a high demand for social workers who can act as care coordinators to help recipients connect their benefits across their care providers, communities, and homes. As the health care landscape continues to change, social workers will be key players in advising and implementing improvements.

Acknowledgment: Thank you to Susan Einbender, Associate Professor at University of California-Dominguez Hills, for consulting with us in the creation of this post.