July 7, 2013

Enrollment in new health care exchanges starts this fall

Charles Oliver

— In less than three months, enrollment begins in the new health care exchanges created by the  Patient Protection and Affordable Care Act, commonly known as Obamacare. Yet many Americans remain confused and uninformed about the law.

For instance, a Princeton Survey Research Associates International poll released in June found that 64 percent of those without health insurance don’t know if they will purchase it before Jan. 1, 2014. That’s when the law requires all Americans to have health insurance or pay financial penalties. A June Gallup poll showed 43 percent of Americans don’t know that they will be required to have health insurance starting next year.

Dalton’s David Walters said he has insurance through his employer. But he said he still has questions about how the law will work.

“I really don’t understand how it will affect me,” he said.

The law has the potential to affect just about everyone, but some of the first people to feel the impact will be those who currently don’t have health insurance. Starting Oct. 1 and continuing through March 30, 2014, they’ll have the opportunity to sign up for new health care exchanges where they can purchase health insurance, possibly with federal subsidies to make it more affordable, from companies that sign up to sell health insurance.

All plans sold on these exchanges must cover some benefits the federal government has declared to be essential, such as maternity and newborn care, mental health and substance abuse, and pediatric vision and dental. Those states that set up their own exchanges may also add to those benefits. Georgia did not set up a health care exchange, but all benefits currently mandated by state law will also apply to health insurance plans sold on the federal exchange in Georgia.

The plans can fall within four levels: platinum, gold, silver and bronze. Bronze plans will have the least generous benefits, with the customer paying more out of pocket but also paying lower premiums. Platinum will have the most generous benefits, with the consumer paying less out of pocket but higher premiums.

Aetna, Alliant Health Plans, Blue Cross and Blue Shield of Georgia, Coventry Health Care, Humana, Kaiser Foundation Health Plan and Peach State have signed up to sell insurance on the federal exchange. But they do not necessarily have to sell in all regions of the state.

So who is eligible to buy insurance on these exchanges? Anyone who is an American citizen or legal resident and who isn’t incarcerated.

“Anybody can go to the exchange and buy insurance,” said Al Ertel, chief operating officer of Alliant Health Plans, a Dalton-based not-for-profit provider of health insurance.

“Those who are eligible for subsidies are those who don’t have access to coverage under Medicare, Medicaid, military plans or employer-provided plans that meet minimum coverage standards and are affordable,” he said.

Employees may pay up to 9.5 percent on their W-2 income for their share of health insurance and it will be considered affordable.

The Obama administration announced last week that it will not enforce a provision of the law that requires companies with 50 or more employees to provide health insurance for workers until 2015. That provision was also set to begin Jan. 1, 2014. The federal government will also not require companies to report whether they offer insurance until 2015, so it is not immediately clear how the government will determine who is eligible for subsidies because their employers don’t offer affordable health insurance.

To be eligible for health insurance subsidies, individuals and families must also meet certain income standards.

“The financial assistance, or premium tax credit, will be available to anyone whose income is below 400 percent of the federal poverty level and above 138 percent of the poverty level if the state expanded its Medicaid coverage. If a state has not expanded Medicaid coverage it goes down to 100 percent of the federal poverty level,” said Jennifer Sullivan, director of best practices at Enroll America, a nonpartisan, national nonprofit that is trying to make sure as many Americans as possible connect with the new health care options.

Officials in Georgia declined to expand the state’s Medicaid coverage, citing potential long-term costs. The federal poverty level depends upon family size. It’s currently about $11,000 for a single person and around $23,550 for a family of four.

The amount of the subsidy will be based on what it would cost that person or family to buy the second-lowest cost silver plan available to them. Those who get the subsidies won’t get a check from the government. The subsidy will be sent to the company they choose.

The Princeton Survey poll found that 58 percent of the uninsured said they don’t know if they qualify for federal subsidies to buy health insurance that the law creates.

Georgia and 26 other states declined to set up a health care exchange and that could prove a problem for residents of those states.

The law says the subsidies are available “through an exchange established by the state.” But the IRS has interpreted the law to mean that the subsidies will also be available to those in the federal exchange. Attorneys general for some of the states that declined to set up exchanges have challenged that IRS interpretation in court. If they prevail, residents of Georgia and other states without an exchange will not be eligible for health care insurance subsidies.

So how will people sign up for these exchanges?

They can sign up online at www.healthcare.gov. The site has a great deal of information about the exchanges, the subsidies and how they will work. Thanks to a new health care data hub that allows federal agencies such as the IRS, Health and Human Services, the Social Security Administration and Homeland Security to share information, the site is supposed to be able immediately to determine who is eligible for a subsidy and how much that subsidy will be.

In addition, the law will set up “navigators,” groups that will reach out to their communities about the law and the options it makes available.

“They will do education and they will answer questions from consumers so the consumers can decide which plans to enroll in,” Sullivan said.

The Northwest Georgia Healthcare Partnership, Georgia Mountains Health and Primary Healthcare Centers have applied in partnership for one of the federal grants to act as navigators in northwest Georgia.

“The awards will be announced in mid August, and then we will go through the training necessary to become a navigator,” said Ali Whittier, health promotion and marketing director at the Healthcare Partnership.

“They are targeting the uninsured under 65 as well as rural populations and people with limited English proficiency,” Whittier said.

Whittier said the latest numbers show about 20 percent of Whitfield County residents don’t have any form of health coverage and about 24 percent of Murray County residents don’t have health insurance.