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What Do Consumers Need to Know about Health Reform’s Changes?



August 29th, 2013

This was the title of a Henry J. Kaiser Family Foundation webinar (first in a series) held on August 28. I decided I could surely learn something new about the Affordable Care Act and also could refresh my knowledge by listening to the webinar—after all, it was aimed at journalists! Following are a few tidbits that I learned.

The most common source of information on health reform is the news media, Rakesh Singh, vice president of communications at the Henry J. Kaiser Family Foundation (KFF), said. So it is good that the foundation is getting the word out to news folks.

This webinar’s aim was to explain how effects of the Affordable Care Act (ACA) “will vary for people in different circumstances,” including those with insurance coverage from an employer, those who purchase their own insurance as an individual, and those who are uninsured. Jennifer Tolbert, state health policy director at the KFF, and Karen Pollitz, a KFF senior fellow, spoke about the ACA’s individual mandate, its new coverage options (such as new state exchanges—now more commonly known as “state health insurance marketplaces”—and subsidies for people with low and moderate incomes), and new federal rules prohibiting health insurers from discriminating against people based on their pre-existing health conditions.

Most non-elderly people will continue to be covered by employer-sponsored insurance, even after health reform is implemented, Tolbert noted.

Open enrollment for a plan under one of the state marketplaces (or exchanges) begins on October 1 and runs through March 31, 2014: six months. The marketplaces will help individuals, families, and small businesses. (Read about the health reform law’s requirements for individuals.)  

Individuals eligible for Medicaid in their state can sign up at any time.

Tolbert said that for those states choosing to expand Medicaid (expansion is optional, according to the June 2012 Supreme Court decision), the program would cover people with incomes up to and including 138 percent of the federal poverty level. (That basically means an individual with income of about $15,900 or a family of four with income of $32,500, she said.) As of yesterday, twenty-five states have decided to expand Medicaid, twenty-one have decided not to, and five are still debating the question.

As for the marketplaces (or exchanges): sixteen states plus the District of Columbia will be running their own exchanges, twenty-seven will have a federally facilitated exchange, and seven will be in a “partnership exchange” (a hybrid model in which the state and federal governments share responsibility). See about the exchange in your state here. (To learn more about how exchanges help individuals and small businesses access coverage, read this Health Affairs/Robert Wood Johnson Foundation policy brief published in July. This KFF webinar focused on exchanges for individuals, however.)

Before the Affordable Care Act, people who were not eligible for coverage at work or through Medicaid or another public program could only purchase health insurance in the individual (“non-group”) market, where plans can be very expensive and the coverage they provide is often limited. Now, thanks to the ACA, insurers, starting in 2014, will not be allowed to discriminate based on health status, and policies will have to include essential health benefits (such as mental health, pediatric dental and vision services, and prescription drugs). People with low to moderate incomes can get premium subsidies on a sliding scale to purchase coverage through the marketplaces/exchanges in their states.

There, consumers also will have a choice of plans and the information to easily compare them, Pollitz said. Plans will be categorized according to different metals: Bronze plans will have the highest cost sharing requirements; next are silver, gold, and platinum.

The KFF has a useful subsidy calculator on its website. Also see PowerPoint slide no. 11 in the group of slides accompanying the webinar.

Insurers will, though, be allowed to adjust the premiums by the person’s age.

Pollitz said that the Obama administration has delayed the large-employer mandate until January 2015. Small businesses must provide coverage for their workers in 2014, however.

Journalists asked some good questions during the Q & A session of the webinar.

Following are some of the questions.

How, exactly, do people sign up for coverage? (Many ways are available—including online, telephone, and mailed paper application. In every state, enrollment assistors and navigators will help facilitate enrollment. Insurance brokers and agents are also permitted to participate, as well as insurers. For more details, listen to the webinar.)

Where do the speakers foresee the most confusion among consumers regarding the health reform law? (Pollitz said there is a low level of knowledge about the ACA, and the budget for consumer assistance in states with federally facilitated exchanges is low. Also, the lives of some people are more complicated, she said—it is hard to calculate their income or figure out which people count as being part of their household.)

Is there potential for fraud during the enrollment period? (Consumers need to be wary of unscrupulous people trying to get their personal information. Make sure to only talk to recognized assistors who are listed by the state exchanges.)

Can navigators working for the exchanges charge for their services? (No.) Can brokers charge? (Yes, they can, but most will not, as most of them get paid a commission by insurers.)

What about the penalty for people not meeting the individual mandate requirement? (Penalties will be phased in over three years, Tolbert said. Listen to the webinar for specifics. Some people are exempt, such as undocumented immigrants, people with religious exemptions, and people who simply cannot find affordable coverage.)

What about groups like Enroll America? How political are they, if at all? (The speakers said that Enroll America is a newly organized nonprofit [501(c)3] that was set up to inform consumers about the ACA. Groups that have advocated for low-income Americans to get health insurance are involved in it. The speakers did not comment directly about whether it was political. For another view, read more in a May 2013 Reuters article.)

In response to a question about young adults, one of the speakers noted that a KFF Tracking Poll found that young adults wanted health insurance coverage if they could afford it.  I suppose these results indicate that not all young people consider themselves invincible!

And in answer to a question about smokers, Pollitz said that health insurers can, in fact, charge a tobacco surcharge—that is, a premium costing as much as 50 percent more than nonsmokers are charged. The KFF website says that is the maximum, and “surcharges will vary by plan and some states do not permit insurers to vary premiums by tobacco status.”)

There are many more questions and answers! To watch the August 28 webinar, which lasts around an hour, go to http://kff.org/health-reform/event/what-do-consumers-need-to-know-about-health-reforms-changes/. PowerPoint slides are also available. And a transcript will be posted soon.

The webinar series for journalists is intended to “address key aspects” of the health reform law, its implications for consumers, and ways to connect the dots for various audiences, a KFF e-alert said. Watch for updates on the Health Reform section of its website, http://kff.org/health-reform.

 

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