Are we ready for Obamacare requests? Maybe not

Aug. 30, 2013 @ 05:09 PM

Public officials and even the experts agree there remains a lot they do not know about the Oct. 1 rollout of the Affordable Care Act application period.
The act requires states to provide access to an online marketplace where people, mostly those with no insurance or Medicaid clients, and small businesses can purchase private health insurance policies offering a minimum level of coverage.
Most people don’t know which insurance companies will participate in the marketplace, or about “navigation” programs to help them with their choices. Also, how subsidies will work in the marketplace is confusing for many. Even the main online portal, www.healthcare.gov, is not fully operational. North Carolina officials earlier decided to let the federal government handle the insurance exchange.
“It will be a challenge to get all of this up and running in a month,” Dr. Adam Zolotor, vice president of the N.C. Institute of Medicine, told county officials gathered Friday for a retreat at Piney Lake Conference Center. “But we do want you to tell everyone who might be eligible to apply in the marketplace. That helps with the penalty that could come for not applying.”
The law requires that all new policies, and in-force policies upon renewal by Jan. 1, 2014, must cover a package of essential health benefits, including hospitalization, emergency services and mental health treatments.
• Marketplace: Most of the experts expect that Blue Cross and Blue Shield of North Carolina will participate in the program statewide, offering health care policies with a range of premiums and co-payments. For many low-income people, government subsidies, or tax credits, could pay much of the costs. Coventry and First Carolina Care also may participate in their home regions.
• Tax credits: If not eligible for Medicaid, households with incomes at or below 400 percent of the federal poverty level may be eligible for tax credits to offset insurance premium costs based on a sliding scale related to percentage of income. Credits will be available every month to help pay premiums to match the second tier, or Silver, level.
“At the Silver level, the credits could cover the premiums for some people,” Zolotor told health officials and several county commissioners, “and at Bronze, the insurance could be free, or nearly free. Of course, policies with more features cost more.”
• Navigation: Because an estimated 78 percent of uninsured people don’t understand the new insurance options, health care agencies, nonprofit groups and volunteers will provide assistance with choices. Randolph Hospital has received a $300,000 Navigator grant. Eventually, most health care agencies are expected to have insurance counselors. Insurance company agents and brokers also will be able to assist with choices.
“There will be a lot of people rolling into the system, and we know most of them want to talk with people to help them enroll,” Zolotor said. “But navigator training has not started, and we are a month away.”
• Response: It is still uncertain how individuals and companies will respond to the changes, Zolotor said, and especially the penalties.
“Some individuals may pay the $95 per person fine for not having insurance because the premium for the insurance is $1,000 and they can not pay it,” Zolotor said, “and we are not sure that employers are ready for the fines they may have to pay if they do not provide insurance as the law requires for companies with more than 50 full-time workers. This will be a big decision for people.”
• Information: Whether the government, or the insurance companies, will launch a comprehensive information campaign is still unknown, Zolotor said.
“We could see something as Oct. 1 gets closer, and we will see stories in the media if there are problems,” he said.
 

Affordable Care Act

Subsidies: More than 800,000 mostly uninsured North Carolinians will be eligible for federal subsidies offered through the Affordable Care Act, according to estimates, and an estimated 660,000 people could purchase insurance in the new Marketplace. 

Information:  Visit Marketplace.cms.gov  or call the Marketplace call center at 1-800-318-2596.