Oct. 1 launch looms for health reformPart one in a multi-part series
Oct. 1 marks the first day of enrollment for the Patient Protection and Affordable Care Act, President Barack Obama’s comprehensive health care reform.
While some provisions of the act went into effect earlier, (prohibiting the denial of coverage for children with pre-existing conditions and allowing young adults to remain on their parents' policy until age 26), provisions requiring everyone to have health insurance will take effect Jan. 1, 2014.
Feelings regarding the overhaul and new requirements are mixed — some are happy that they will finally be able to receive coverage while others fear their premiums and deductibles will significantly increase.
The N.C. General Assembly gave state insurance department the authority to enforce the insurance provisions of the ACA that apply across the market — both inside and outside the new exchange.
The mandate for employers to offer coverage has been delayed another year while kinks are being worked out, but the individual mandate will still go into effect as planned when Health Care Marketplaces, or online health insurance exchanges, will be going live.
The exchanges will allow individuals and small businesses without coverage to compare and shop for the best plan online in a particular state. Coverage can start as soon as Jan. 1, 2014, for those who enroll Oct. 1. At HealthCare.gov, a questionnaire will walk you through your options whether you already have a plan or not.
Some states chose not to expand Medicaid, including North Carolina. According to HealthCare.gov, some people in those states won’t qualify for either Medicaid or lower Marketplace insurance costs. Kerry Hill, DOI spokesperson, said there is an upside and a downside to the fact that N.C. chose not to expand Medicaid.
“There will be a subset of the population that will not be eligible for either Medicaid based on current eligibility requirements or any federal insurance subsidies through the exchange because their income is too low,” she said. “Another subset of individuals who would have been eligible for Medicaid expansion, those with incomes between 100 percent and 138 percent FPL (federal poverty level) will be eligible for subsidies through the exchange, which they would not have been able to access had Medicaid been expanded.”
States that chose to expand Medicaid will receive federal funding to expand their programs to cover individuals making $15,800 or less a year or families of four making $32,500 a year.
According to the law, anyone who has coverage available and can afford it must buy health insurance or pay a fee — unless you live in a state that isn’t expanding Medicaid. People who don’t qualify for Medicaid or lower costs through the exchange are also exempt from paying any fee, but people must apply for coverage through the exchange before receiving an exemption.
What does it cover?
According to the U.S. Department of Health & Human Services, almost 5 million non-elderly North Carolinians have a pre-existing health condition, including more than 500,000 children.
Under the act, insurance providers will no longer be able to deny someone coverage or charge them more for coverage because they have a pre-existing condition.
“Considering my son was born with a pre-existing condition (achondroplasia) it will help him get coverage since I can't add him to my work insurance,” said Brandy Lisenby on Facebook.
Health insurance policies will have to cover a majority of preventative services under ACA, including screenings for children, pregnant women, blood pressure, cholesterol, depression, colon cancer, breast cancer, cervical cancer, diabetes, HIV and other sexually transmitted infection. All these services and more have to be provided without a person having to pay a co-pay or co-insurance.
Hill said the N.C. Department of Insurance would be responsible for ensuring that all non-grandfathered health insurance plans include the new essential health benefits, meet the new actuarial value requirements and are rated based on the new ACA rating requirements. Insurance rates may only vary now by age, tobacco use and geography.
Consumers can choose four levels of coverage. For the platinum plan, the insurer pays 90 percent on average; the gold pays 80 percent, silver pays 70 percent and in the bronze plan, the insurer pays 60 percent on average.
“The federal government will be running the exchange/marketplace in North Carolina per legislative action to prohibit the implementation of a state-based exchange or participation in a federal/state partnership model exchange,” she said.
Congress attempts defunding
Congress has voted to repeal “Obamacare” 40 times and each time it has failed. Congressman Mark Meadows, R-NC, 11th District, is against implementing the program because he said, “it’s not ready and it’s not fair.” During a recent interview, he said none of it should be implemented if even one part of it (the employer mandate) wasn’t ready.
Meadows said he is trying to garner support in Washington, D.C., to have parts of the reform defunded so it can’t be implemented until some changes are made.
“The bottom line is, for most healthy young adults, they’re going to be paying two to three times what they pay now for insurance,” he said. “It’s not going to be more affordable.”
Navigating the new law
Many people still have questions about how the new law will affect them. In an effort to help people better understand the exchanges, the federal government has issued grants to organizations to prepare people for the launch. Mountain Projects, Inc. received a $359,750 grant to provide health care navigator services in Haywood, Jackson, Macon, Swain, Graham, Clay and Cherokee counties.
Meadows said it was unrealistic to try to hire and train these navigators to understand 2,700 pages of the bill and all the regulations within 40 days. He recommended people talk to an insurance agent or expert to give them advice on the new requirements.
Hill advised seeking assistance from an agent/broker who is registered with the federal exchange, the federal call center or a certified Navigator or Application Counselor. “Check with the federal exchange to ensure the person assisting you is certified with the exchange, and be careful not to share personal information with someone who isn’t certified,” she warned. “NCDOI's Health Insurance Smart NC program is also a good resource primarily for consumers that already have insurance and have questions about changes to their existing plan.”
The Mountaineer recently asked Facebook followers how ACA would affect their families.
“I hope it allows me to get coverage… I am anxious to see. I have been uninsured for far too long,” said Mindy O’Neill Laesser.
Others said they had coverage but that ACA had made their deductible increase with their current provider.
Patricia Frisbee Meyer said she had insurance — paying $1,000 a month premium with a $2,500 deductible. Bonny Fox said she was paying $650 a month with a $3,000 deductible.
“Welcome to the high deductible health plan folks! You can plan on paying for most or all of your healthcare bills until something truly catastrophic happens,” said Jenny A. Carver. “That's if you're lucky enough to be employed by a company that hasn't reduced hours for/cut most of their full-time employees to get around offering employee benefits.”
Hill said changes in insurance premiums for individuals would depend on many factors based on individual circumstances.
“Some individuals will see reduced premiums because rating is no longer allowed based on health status and rates for older adults are limited to three times the rate for 21-year olds,” she said. “Not all individuals will be eligible for subsidies, and those who have low premiums today because they are younger and/or healthier than average may encounter significant increases.”
Hill said premiums may also generally increase as a result of new required benefits such as maternity coverage, new out-of-pocket limits which limit financial exposure in the case of a catastrophic event, and new taxes and fees to offset the cost of the federal subsidies and program operational costs.
Health care reform timeline
March 23 — President Barack Obama signs the Affordable Cart Act
June 10 — Seniors receive $250 rebate checks for drug costs
July 1 — Uninsured Americans with pre-existing conditions have access to coverage
Sept. 23 — Private insurance companies must offer free preventive services, and cannot set lifetime or annual benefit limits
Jan. 1 — Free preventive care and lower prescription drug costs for seniors
Jan. 1 — The new Innovation Center established to research, develop, test and expand ways to improve quality and reduce the cost of care.
Sept. 1 — Insurance companies must submit a rate increase request to state or federal reviewers.
Dec. 14 — Since Sept. 2010, 2.5 million Americans under 26 received health insurance under their parent’s plan.
Feb. 28 — Obama announces a bust of a Texas scheme that bilked Medicare of $375 million and credits ACA’s new tools to fight fraud.
Aug. 1 — More preventive care for women, including contraception and woman visits, are covered with no cost.
Jan. 1 — States received access to new funding to expand Medicaid.
Jan. 1 — New patients protection are fully implemented.
Jan. 1 — Consumers can choose coverage through the Affordable Insurance Exchanges.
Employer insurance mandates goes into effect.
(As a graph)
By the Numbers: Uninsured North Carolinians who are eligible for coverage through the Marketplace.
Source: U.S. Department of Health & Human Services
1,346,603 (17%) are uninsured and eligible
987,441 (73%) have a full-time worker in the family
497,215 (37%) are 18-35 years old
743,211 (55%) are White
379,704 (28%) are African American
138,385 (10%) are Latino/Hispanic
36,008 (3%) are Asian American or Pacific Islander
706,013 (52%) are male
Coming Wednesday: How the Affordable Care Act will impact business owners