By Denise Porter-Ross
Special to Frost Illustrated, Coutesy of HealthVisions of Fort Wayne
Are you feeling a bit confused about upcoming changes in healthcare reform? You are definitely not alone. With the most comprehensive healthcare reform in a generation upon us, many of us still do not understand what is happening and how it will affect us. Since Indiana is one of the states that has not yet made final decisions on some parts of the Affordable Care Act (ACA) we still have an opportunity to learn more about this issue and share our thoughts with decision makers.
A Town Hall Meeting is scheduled for 6 p.m. to 8 p.m., Aug. 29, at the Main Branch of the Allen County Public Library. Hosted by HealthVisions of Fort Wayne, Indiana Minority Health Coalition and Covering Kids of Indiana, this forum will feature local medical and healthcare professionals, non-profit organizations and elected officials as they discuss their views and concerns for Hoosiers and ACA. Fort Wayne City Councilman Glynn Hines is scheduled to facilitate this forum and the public will have the opportunity to direct questions to the people who will be instrumental on how Indiana and our local community will enact the Affordable Care Act.
“Because there is so much interest and confusion about the various components of the Affordable Care Act and how it will affect our clients, we thought that it was important that we present this information in our community,” said Renetta Williams, executive director of HealthVisions of Fort Wayne. “Not only will we hear from our representatives and decision makers on healthcare policies, but they will also be able to hear directly from local organizations on how we are preparing for implementation.”
Regardless of your point of view, there is an overwhelming amount of information—and misinformation—on the ACA and how healthcare reform will go forward. Not only are there differences of opinion based on political affiliations, but many insurance companies, healthcare providers and nonprofit organizations have devoted millions of dollars to protect their interests and project their influence into the arena. While there may be some agreement on some of the basic components that will go in to effect within the next few months, the differences in how the ACA will affect individuals and businesses is tremendous.
The Affordable Care Act, often known as “Obamacare,” expands health insurance coverage in five major areas: 1) Insurance Company Regulations, 2) Medicare Improvements, 3) Medicaid Expansion, 4) Employer Health Coverage, and 5) Individual Mandates. As part of implementation of ACA, private insurance will be available for purchase through state insurance exchanges by Jan. 1, 2014. An open enrollment period will begin on Oct. 1 for agencies to begin taking applications for this program on the federal level. These Insurance Exchanges have been designed to pool individual risks and make coverage more affordable. States can set up insurance exchanges and negotiate coverage packages with the insurance companies. Indiana will have three options: set up a state–run exchange; use the federally-run exchange, or combination with federal government. Indiana has already received more than $7 million in a federal implementation grant and our legislators must decide by Dec. 14 which path to take.
Let’s take a moment to look at each section in a little more detail. One of the resources for this information was found in a presentation prepared by State Senator Karen Tallian’s office earlier this summer. Titled Overview of the Federal Patient Protection and Affordable Care Act, the presentation is the basis for the following recap of the major components of ACA:
Insurance Company Regulations includes newly expanded coverage requirements that protect participants from exclusions for pre-existing conditions. In minority and/or poor communities that suffer disproportionately from heart disease, hypertension and diabetes, this expansion can greatly impact the quality of life for many people. Starting in 2014, an insurance company cannot turn you down or charge you more because of your pre-existing condition, nor can it refuse to cover treatment for that condition. This is also the section that allows children to remain on their parents’ policy until age 26, which is a benefit to persons unemployed or under-employed in our community.
This section also contains the 80/20 rule which says that insurance companies must spend at least 80% of premium dollars on health care and quality improvements instead of overhead, executive salaries or marketing. If not, they must provide consumers a rebate or reduce premiums. Over 145,000 Hoosier families have already received an average rebate of $99.
Under the section of Medicare Improvements, the dreaded “donut hole” will be closed. If for example, you had a $310 deductible, your medical costs were covered until you hit the max of $2,800 total costs, which comes about rather quickly if you have monthly expenses of about $250. The donut hole is that area between where your basic benefits stopped and your catastrophic coverage does not kick in until you have reached $4,550 in expenses. So basically, unless you had private funds to pay out that $1,750 difference, you couldn’t afford to get sick, and you couldn’t afford your medications to stay well.
Medicare Improvements will be funded via a new 3.8 percent surtax applied to the unearned income of high income taxpayers. For this purpose “unearned income” means income from rent, investments dividends and interest. “High income” means individuals with incomes over $200,000 or couples over $250,000.
Under the section of Medicaid Expansion, it is important to remember that Medicaid is a federal health program for low income individual that is already administered by the states. This is not a change but the ACA is simply expanding this benefit. States have the ability to determine eligibility and benefits based on income levels. Indiana spends $1.9 billion in Medicaid costs.
Originally slated to begin in 2014, the Employer Health Coverage section was to require employers with 50 of more full-time employees to offer affordable health coverage for those workers. Although there were tax credits for small businesses, this component has been pushed back one year to allow businesses to better plan for the implementation. It was expected businesses would see a reduction in premiums based on new regulations for insurance companies. Non-compliance fined can be imposed based n the number of employees. Some companies have already taken their own action to skirt this issue by reducing the quantity of workers they employ, or reducing the hours that their employees are scheduled to work.
In the final major component, Individual Mandate, the ACA includes a requirement that most people be insured. Options for coverage include Medicare or Medicaid, Employer-based insurance and Personal Coverage though the state insurance exchange. There are exemptions from this requirement for hardship if insurance costs would exceed eight percent of income or for those in a religion opposed to acceptance of benefits from a health insurance policy.
This article originally appeared in the Aug. 21 print edition.