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(The Root) — When Naomi Hollis' job ended last October, she remained remarkably focused. The permanent part-time employee had been with the company for five years, long enough to have health benefits, but those were scheduled to stop at month's end. 

"I was thinking practically," the 46-year-old Birmingham, Ala., resident said. "I tried to get a lot of health stuff done before my insurance ended. I stocked up on medication, let my doctors know what was going on, arranged for some treatment — discounted or charity — moving forward."


She was particularly concerned because she knew that once her insurance expired it was unlikely she'd be eligible for new coverage. Hollis — who was concerned about her health issues becoming public, so she spoke to us using a pseudonym — has a pre-existing condition: atherosclerosis, which led to three heart attacks when she was in her late 30s and early 40s.

The pre-emptive chats worked in most cases. "The doctors who were willing to work with me said, 'Continue coming. We will find ways to absorb or reduce your copay.' I was charged a Medicaid rate for my cardiologist," she said.

But even the most cooperative doctors can only do so much. Hollis now has been unemployed for nearly a year, and her medications don't come cheap. "I was supposed to take a statin [a drug designed to stabilize arterial plaque and reduce the risk of repeat heart attacks], but that drug is about $60 a month," she said. "I've got $1.40 in my account." She has, with no small amount of trepidation, forgone the statin in favor of paying other bills, such as her mortgage.

Count Hollis among the many African Americans looking forward to Oct. 1 and the start of the open enrollment period for the health care marketplace made possible by the Affordable Care Act.


Even as key elements of the ACA are set to go into effect, House Republicans have threatened to shut down the government this week if the bill moves forward. Early Sunday morning, the House voted to continue funding the government with the caveat that the ACA be delayed for a year. President Barack Obama, who calls the current health care system unacceptable, has vowed to veto any legislation against ACA.

Starting Tuesday, people will get a chance to enroll in the health care marketplace, a one-stop shop where they can compare health insurance options based on benefits, price and quality. The open enrollment period ends March 31, 2014. Every state will have a marketplace, though who runs the marketplaces varies depending on where people live. Some states will run their own marketplace, the federal government will run some marketplaces and some marketplaces will be run by state and federal government partnerships. (To find out about your state's marketplace, click here.)


"In state after state there will be affordable options available for people who have been uninsured," said Dr. J. Nadine Gracia, deputy assistant secretary for minority health and the director of the Office of Minority Health at the Department of Health and Human Services.

African Americans are, not surprisingly, in the worst shape in the pre-ACA system. We are less likely to have health insurance than other Americans. We are less likely to have access to a primary care physician, often relying on the emergency room for medical treatment. And when we do have a doctor, we're less likely to receive quality care.


"In the black community, there are health disparities — higher rates of obesity, diabetes, asthma, certain types of cancer. Part of that has been because of a lack of health insurance. Not having health insurance is the most significant driver of health disparities in our community," said Gracia. "More than 20 percent in the black community don't have access to quality care, don't have access to the services that will keep us healthy."

Before the ACA, insurance companies could deny people from coverage for pre-existing conditions. Women were charged premiums up to 50 percent higher than men. "Just being a woman was considered a pre-existing condition," Gracia said.


In January 2014, when coverage kicks in for plans purchased by Dec. 15, millions of Americans will have access to affordable health care. Some provisions of the health care law, signed in March 2009, are already in place, benefiting millions of black people:

* About 7 million African Americans with private insurance have access to expanded preventive services without having to spend a cent. These services include blood pressure and cholesterol screenings, colonoscopies, flu shots, Pap smears and mammograms for women, and well-child visits. (For a complete list of expanded preventive services, click here.)


* The 4.5 million elderly and disabled African Americans covered by Medicare also have access to an expanded list of preventive services with no cost-sharing, including annual wellness visits, diabetes, colorectal cancer and osteoporosis screening and mammograms.

* More than 500,000 African Americans between ages 19 and 25 who would have been uninsured have coverage through a provision of the ACA that allows them to stay under their parents' health plans whether they're in college or in the workforce.


By 2016 an estimated 7 million African Americans who would otherwise be uninsured will gain coverage. The health law will also provide these benefits in 2014:

* Medicaid coverage expands to include low-income Americans (about $15,400 for an individual or $31,400 for a family of four). This expansion includes adults without dependent children, who previously have not been eligible. Currently, adults who don't have children "don't qualify for Medicaid no matter how poor they may be," says Alan Weil, executive director of the National Academy for State Health Policy.


* Individuals with higher incomes (up to 400 percent of the federal poverty guidelines, about $92,200 for a family of four) will be eligible to purchase subsidized coverage from the marketplace.

* People with pre-existing conditions can no longer be denied coverage. (This already applies to children.)


* The National Health Service Corps workforce will be tripled. African-American physicians make up about 18 percent of Corps physicians, far exceeding their 6 percent share of the national physician workforce. Corps physicians agree to work in underserved areas of the country in exchange for help repaying their medical school loans.

* About 19 million patients are seen in community health centers; roughly 26 percent (1 in 5) of those patients are African Americans. According to Gracia, the ACA increases the funding available to these centers nationwide, as well as expanding the services they provide.


* Under the ACA, Health and Human Services is implementing the first-ever Action Plan to Reduce Health Disparities, which will upgrade data collection standards to better understand and close gaps in the quality of health and health care.

The Affordable Care Act is "the biggest transformation in health care in 50 years," HHS Secretary Kathleen Sebelius said during a gathering of health journalists earlier this year, "particularly in communities of color."


Hollis agrees. "I am glad that pre-exisiting conditions will no longer bar me from affordable health care," she said. "I will have coverage, and that's not a small thing."

Kendra Lee is a Northern Virginia-based health journalist and the executive editor of Follow her on Twitter.

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