A Legacy to be Proud of, Medical Insurance and Access to Health Care

Rafael Gonzalez, Esq.

If you have ever lost a loved one, someone really important to you, due to health problems or sickness, you know and understand pain, suffering, and struggle. If you have experienced such a loss, you also know the effects such a prolonged process has, not only on your loved one, but on his or her family, friends, and co-workers. 

The reality of the sickness, the physical and mental challenges such sickness brings are alone, in and of themselves, overwhelming, sometimes insurmountable. The reality of the devastating effects on the body and mind, the realization that neither will ever be the same, that what had been your life is no longer and will never be again, the despair that comes along with the knowledge and understanding that things will only get worse, that there is no improvement, that you will not be able to enjoy even the simplest things you once took for granted.

As the sickness progresses, and it becomes all consuming for everyone around him or her, the guilt about the burden this is placing on those around him or her becomes overwhelming as well. The economics of the situation are at center stage. How to afford the care becomes central, as the sick individual can only watch his or her family in pain, suffering, and financially struggle, going without.

This is the backdrop. That is the situation. In order to move forward, we must all understand the severity of such a situation, the overwhelmingness of such circumstances, the dire needs, the incredibly urgent nature of what is happening, and the devastation the situation is creating for everyone involved.

Millions of Americans go through such a struggle every day. Millions of working poor find themselves in such circumstances every day. No where to turn, no where to go, no options, no choices, no plans, nothing. Nothing but death staring you in the face, and a destiny of pain, suffering, and struggle for those around them who survive this ordeal.

If you have ever experienced anything anywhere near it, or if you have lived through a similar situation, or had a family member, or a close friend go through something like this, you have asked yourself why? You have wondered why? In a country with such amazing resources, incredible talent, unbelievable access, giving people, advanced technology, and unmatched know-how, why does such needs exist? Why can't we create a process that gives sure such individuals access to health insurance and medical care, a system that would have the ability to medically take care of the illness, and assure his or her family members will be able to eat, and pay the rent, and keep the light on.

For me, this is the essence of the Affordable Care Act, and the reason why when asked to help and assist in putting ACA together, and spread the news of its benefits, I committed to doing so. This is what ACA does for our mothers and fathers, for our brothers and sisters, for our friends and colleagues, for all Americans, especially for those who are challenged by the economics of such a situation. Getting to a doctor to treat the disease, getting to a hospital to have the surgery, or getting to a clinic to have the evaluation or testing necessary, it is the most basic component of this equation and it must be made available to every American in such dire circumstances.

We cannot allow good folks, well meaning individuals, working or not, rich or poor, educated or not,  black or white, born here or an immigrant, gay or straight, male or female, young or old, we cannot allow or put up with Americans going without, to struggle in such despair. We are better, we are giving, we are thoughtful, we are capable, we are humane. At the core of ACA lies this principle as its bedrock, that as a country we cannot allow our moms and dads, our bothers and sisters, our friends and colleagues to suffer because of lack of medical care or access to such medical care because of lack of insurance.

For years, the reality in our country was that millions of Americans were locked out of our health care system because they couldn’t afford insurance or because they had pre-existing conditions. Women were charged more than men simply because they were women. Blacks and Hispanic Americans who needed coverage the most were too often unable to obtain it because of high premiums. At the same time, rising health care costs posed a significant threat to our economy, eroding workers’ paychecks and adding to our deficit.

Although it wasn't easy, and remains a fight today given the House and Senate attempts, the Affordable Care Act became law. As a result, over 15 million Americans are today receiving Medicaid because of ACA's Medicaid Expansion, and close to 10 million Americans have purchased health insurance because of ACA's Exchange Subsidies. Since 2014, when the law became effective, over 25 million more Americans now know the security of having health insurance, the security and piece of mind that comes with knowing they will not be that burden to their family, that they will not be forcing a choice to either treat the disease or feed their family or pay for rent. 

In addition, as many as 129 million Americans with pre-existing conditions can no longer be denied coverage or charged more as a result. Now almost 140 million Americans are guaranteed free preventive care, like certain cancer screenings and vaccines. ACA didn't stop there. It made improvements in the quality of care in hospitals, making historic investments to make sure our health care system puts patients first. And ACA also changed the way we pay for care, paying doctors for what works, improving the safety and effectiveness of health care that patients receive. ACA also helped doctors and hospitals coordinate with each other by unlocking health data. And it is giving patients more information and tools to stay healthy.

After nearly a century, we thought we had at last succeeded in leaving our kids and grandkids a country where pre-existing conditions exclusions were a thing of the past, a country where insurance options are within our reach, and health care is no longer a privilege, but a right. As we watch a new administration and a new congress begin to undo ACA, with what is clearly a mean spirited vision or plan for a replacement, let us all engage, vocalize, communicate, and express the concerns that had brought us to this point in time and history. Let us be clear and vigilant. As a country, we cannot allow it to happen again.

As we learn of new proposals that may not provide all Americans with the same protections, let us all remind our elected officials, urge everyone around us, and personally remain steadfast that as a country we cannot allow our moms and dads, our bothers and sisters, our friends and colleagues to suffer because of lack of medical insurance or access to medical care.

About Rafael Gonzalez

Rafael Gonzalez was born in Havana, Cuba, in 1964. Escaping communism, Rafael and his family migrated to Madrid, Spain, in 1969. Seeking freedom and opportunity, Rafael and his family immigrated to Miami, Florida, in 1974. This early experience continues to guide his principles and ideas on service, leadership, commitment, dedication, education, freedom, and financial security.

Knowing that a higher education would provide him the tools with which to serve his community, after graduating from Miami High in 1983, he obtained a Bachelor’s of Science degree from the University of Florida in 1987. Truly understanding that higher education was the key to his dreams and aspirations to serving those around him, Rafael earned his Jurisprudence Doctorate degree from the Florida State University in 1990.

Based on his belief that service to those around him is at the core of success, since graduating from FSU, Rafael has worked in the areas of auto, liability, no-fault, and workers’ compensation insurance, social security, Medicare, and Medicaid, serving as corporate counsel, director, vice-president, chief legal counsel, chief executive officer, and president of the different entities he has worked at. All throughout, his focus has been on establishing, maintaining, and growing successful businesses that are committed to the ideals of responsibility, fairness, respect, opportunity, growth, commitment, and financial soundness and stability.

Today, Rafael serves as President of Flagship Services Group in Englewood, Colorado, where he is responsible for all aspects of Medicare and Medicaid compliance issues, including mandatory insurer reporting, conditional payment resolution, set aside allocations, approval, and administration, as well as special needs trusts set up, accounting, and administration.

Rafael is active on social media. He blogs at Medicare Compliance for P&C Insurers at www.flagshipservicesgroup.com/blog. He is owner and manager of several LinkedIn groups, including Medicare and Medicaid Compliance, Medicare Mandatory Reporting, Medicare Conditional Payments, Medicare Set Aside Allocations, Medicare Set Aside Administration, Florida Workers Compensation, Social Security Benefits, Hispanic Issues and Demographics, and Affordable Care Act Compliance. Rafael is also active on Twitter and Facebook.