Local perspectives shared in regard to the Affordable Care Act

by Brianne Eilers

Since October 1, Americans who don't have health insurance plans, or who might want to see if they can find a better plan, have had the opportunity to enroll online at healthcare.gov or via telephone at 1-800-318-2596, through an insurance exchange, often referred to as an insurance marketplace.
The insurance marketplace has been set up as part of the activation of the Affordable Care Act (ACA), also less formally known as "Obamacare,” as a way to be able to provide health insurance coverage for more people and, in some cases, make health insurance more affordable. The open enrollment period will last until March 31, 2014 and coverage can kick in as soon as January 1, 2014.
The intended purpose of the insurance exchange is to increase competition and transparency in the health insurance market, and those seeking coverage options can have the convenience of a “one-stop shop” experience.
Veterans Memorial Hospital Administrator Mike Myers explained that for plans to even be offered on the exchange, plans will have to offer a basic set of coverage. The Iowa website for the insurance marketplace is a cooperative effort between the State of Iowa and the Federal government, and it is estimated that 29 million people could use the online exchanges to find their healthcare.
The qualified health plans will offer essential health benefits including ambulatory patient services, rehabilitative services, hospitalization, maternity care, mental health treatment, substance abuse treatment, lab services, preventative and wellness services, chronic disease management, pediatric services and emergency services. “Basically, everything that any other health insurance plan that you are looking for might have, they’re required to offer,” Myers said. “And if they didn’t, then they weren’t listed on the exchange.”
Myers also noted that in the early years of these marketplaces, the focus will be on individual plans, and eventually move on to small group plans, a small business health insurance option (less than 50 employees) and those who are self-employed. “Eventually, some of the larger firms will be able to offer it,” Myers said.
The functions of the exchange are to determine eligibility, which is based on income. Those who are determined to be eligible for Medicaid will then be directed to the Medicaid website, and Medicaid will take over the process. Currently, Iowa’s Medicaid expansion plan is in the review stage at the Federal government level.
“I would expect it to be approved,” Myers said, “because it’s being touted in certain circles as a model for how a state can work with the Federal government on how to insure these people.” Myers further noted that that fact alone would help insure 150,000 additional Iowans.
Myers also explained that the health insurance provided through the exchanges isn’t all “free money.” People will be able to get tax credits, which should help the working poor get health insurance.
As will all new systems, there will be things that take time. Applications will need to be verified, especially when it comes to income. Disputes as to what individuals actually qualify for will also need to be handled. There will be a system in place to handle assistance for consumers and education of the public.
There will be navigators in place to help with the process. In Iowa, the navigators currently will be Genesis Health System, Planned Parenthood and Visiting Nurses Services. The navigators will help connect the public with services. There will also be a call center and website management, all run under the Federal government.
In the local area, the three companies offering plans on the exchange are Gundersen, Co-Opportunity and Coventry. Those looking for insurance through the exchanges will be able to view rates, as well as be sure their provider is included in the network for that plan.
Some advantages of the exchanges are that more people can look for coverage, and they may qualify for subsidies. For some, it will be totally paid for, but not everyone can expect that result. Some will also qualify for tax credits.
Employers may wonder how this will affect them, and Myers explained that full-time employees have to be offered qualified plans at the “bronze package” level or better beginning in 2015. He explained that this figure is based on the ratio of the cost of the benefits to the lowest salaried employee. At this time, part-time employees are not required to have the insurance benefit offered to them by their employer, but could use the exchange to find coverage or go through an insurance agent.
Looking at the Medicaid expansion aspect and its funding, the State of Iowa accepted federal money for the Medicaid expansion part of the program. The Federal government will pick up the full cost of the Medicaid expansion for the first three years, and then 90% of the cost after that. Myers did note that there are concerns that at some point the federal government won’t fund 90%, but Myers noted that in Iowa’s plan there is a provision that if the federal government changes its funding ratio, then the State of Iowa will have the right to change its participation status. Some states are funding the expansion fully on their own. The infrastructure and support are part of the Affordable Care Act. The expansion of Medicaid has received additional funding from money contributed from pharmaceutical companies, the Medicare trust fund, and from contributions from hospitals.
Myers did point out that there will be glitches at first. “Probably a lot of glitches,” he said. “But if you go back and look at when they rolled out Medicare and all new, big government programs, there have been glitches. This is a huge undertaking. This is a whole new process for people to get insurance.”

Gary DeVilbiss, an agent from Farm Bureau in Postville, has also been spending time to help educate the public on the changes that are being made through the Affordable Care Act. At this time, Wellmark Blue Cross/Blue Shield is not participating in the exchange, but does not rule out future participation.
DeVilbiss explained that decision by the company. "For example, if you sign up with 'Company A' (through the exchange) and you have an issue with your insurance, you can't ask 'Company A' directly. A customer would have to call into a call center out east, who would then call 'Company A' to ask the question, and then the call center is the one calling the customer back. Blue Cross felt this could be a potential customer service issue," DeVilbiss said.
From his experiences in doing public presentations on the insurance changes, DeVilbiss has noted five big misconceptions about plans being offered through the exchange. He noted that the general public is under the impression that all insurance companies on the exchange will offer all of their plans. "That's not true, most will probably offer one or two 'watered-down' plans," he noted.
Another misconception is that plans that are ACA-compliant will give coverage anywhere, at anytime. DeVilbiss says that some plans will have limited numbers of doctors' visits and limited coverage networks.
The third misconception he is commonly confronted with is that a person can buy coverage on the exchange at any time. "You will only be able to purchase from the exchange during the open enrollment period," DeVilbiss noted, but health insurance can be purchased from an insurance company or agent at any time.
A fourth misconception is that premium rates on the exchanges will be lower, which DeVilbiss said may not necessarily be true. He explained that for some, they could actually be higher, but people who qualify for subsidies will get a break.
The final common misconception DeVilbiss hears is that health insurance will only be able to be purchased from the insurance marketplaces, but that is also not true. DeVilbiss said that carriers will have a full line of health insurance solutions available through their existing agents. Agents who sell for any given company will also be able to sell the products available on the marketplace, as long as they are appointed by the carrier to do so. He also added that agents can't help individuals who qualify for a subsidy, and that only the insurance marketplace can sell policies for those who qualify for the subsidy. Companies not participating in the insurance exchanges will still continue to write health insurance policies.
For those who already have health insurance policies, the Affordable Care Act may affect them as well. DeVilbiss explained that for anyone who had a health insurance policy in place, and has not made any changes to it prior to March 23, 2010, those policies will be "grandfathered" in.
For those who have purchased policies or made changes to policies after March 23, 2010, they will need to be sure their existing policy is ACA compliant, and if it isn't, they'll need to find one that is, whether it is through the insurance marketplace or through an insurance agent.
There will also be additional taxes applied to premiums. DeVilbiss explained that there will be three static taxes and two usage taxes. There will be a patient-centered outcome research fee of $2 per person per year added to premiums, which DeVilbiss explained as a tax for research to find out what hospitals and doctors are good within certain healthcare areas and procedures.
There will also be a transitional reinsurance tax of $5.25 per person, per month. An annual health insurance fee will be applied to everyone with health insurance, which DeVilbiss said will basically be everyone, somewhere in the $7-$9 range per person, per month. There will also be a major medical service fee, for example an x-ray, and also a tax on new major medical purchases. Those who qualify will receive subsidies, but there would still be the monthly premiums to pay, as well as any co-pays.
“It’s not going to be a total hand-out,” DeVilbiss noted, and also noted that the hawk-i program will not be going away. Seniors who have Medicare benefits will not be significantly impacted, either.
To apply for healthcare coverage through the health insurance exchange/marketplace online, visit healthcare.gov or call 1-800-318-2596. To help with the enrollment process, applicants will need social security numbers for themselves or family members they want to enroll, as well as their 2012 tax return to verify income.
Those who need coverage before January 1, 2014 or want to know if their existing policy is grandfathered in or ACA compliant should contact their health insurance carrier.