Happy T-Day

StethoscopeIt’s October 1, 2013. Lots going on—or not, since many parts of the federal government are shut down.

But it is a very big day for the 48 million uninsured Americans who need health insurance coverage. It’s opening day for the health insurance marketplaces where uninsured Americans can explore their options for public or private health coverage. 

And I’m calling it “T-Day.” That’s my shorthand for Truth Day. Why?  Because today is the day many Americans will, one by one, family by family, begin to sort out the truth from the lies about the Affordable Care Act (ACA), also known, both affectionately and pejoratively as “Obamacare.”

Congress passed the ACA in 2010 to reform America’s health care system, tamp down its costs, improve its quality, and give all Americans quality, affordable, comprehensive health coverage. Today and in the coming days, weeks, and months, Americans without health insurance (and by “health insurance” I mean coverage by either public insurance, like Medicare, Medicaid, or the Children’s Health Insurance Program [CHIP] or private insurance) can examine the range of new options open to them, find coverage that best suits their health needs and their budgets, and sign up.     

However, what in a less fraught world would have been a win-win for the American people has become extremely contentious. Case in point—after losing in their efforts to repeal the ACA in Congress, to have it declared unconstitutional in the Supreme Court, and to defeat President Obama in the 2012 election, one wing of the Republican party is shutting down much of the federal government today in an attempt to delay the ACA. Rather than allowing the law to go into effect, they want to stop their fellow Americans from seeing the kind of health coverage they will get under the Affordable Care Act and making up their own minds about what it offers.

Hence “T-Day.” I’m betting that, once uninsured Americans actually see the options for public or private coverage available to them, people will realize that “Obamacare” is good for them and their families and that the hysteria around it was, well, unfortunate. Here’s some unsolicited advice for those uninsured Americans willing to approach the ACA with an open mind. 

First, try to clear your head of much of the rhetoric about Obamacare and resolve to rely on information sources you really trust going forward.

Second, put aside your ideas about how health insurance works or does not work, based on bad experiences you or your family have had trying to buy and use health insurance in the past.

  • The ACA has prohibited many insurance company practices that made health coverage unavailable, unhelpful, or too expensive.
  • These insurance reforms have been phasing in since the ACA was passed in 2010, but many of the most significant ones will go into effect on January 1, 2014, and will apply to the insurance plans offered on the online marketplaces opening today. Plans must: not deny coverage based on pre-existing health conditions); base their cost on the purchaser’s age, location, and whether he or she smokes (not on gender or health status); and assure that patients covered by the plan have access to services in a timely manner.

Third, if you are between 19 and 65 and your income is under roughly 138% of the Federal Poverty Limit, you may be “newly eligible” for Medicaid, even though you may have been denied in the past. And FYI, Medicaid coverage is good health coverage; states are constantly improving it with care coordination and other smart measures.

Fourth, accept the fact that having health insurance is far better for you and your family than not having it, and be willing to pay something for it if you are over the Medicaid or CHIP income ceilings. Like buying car insurance, buying health insurance protects you, your family, and society.

Fifth, take your time. Today you can begin to look at and sign up for coverage under public or private insurance, but you have lots of time to figure it out and lots of people to help you. To be covered on January 1, you need to be signed up and pay your first month’s premium by December 15. Start the learning process soon, give yourself time to think about your needs and what works for you, and then sign up. And be aware that when you sign up for an insurance plan, it’s not a lifetime commitment. There will be a chance to change every year during the “open enrollment” period and even before then if your circumstances change, for example, through marriage, divorce, adoption, or the birth of a child. 

Finally, be patient with the whole enrollment process. Lots of new websites and software and staff are starting up today. No one doubts that there will be glitches, but these will be sorted out in due time and should not prevent individuals and families from signing up to take advantage of the Affordable Care Act.

The pursuit of truth always leads us in the right direction. Investigate the facts about ACA and don’t be fooled by the rhetoric.


A Report Card for Health Reform

Report CardThe White House issued a new report recently on the states’ progress in implementing health reform. The Affordable Care Act is an extensive, complex piece of legislation; the states must complete many steps on the way to full implementation of the law. Since the process is by no means over, think of this information as a progress report like you got in grade school. It highlights strengths and reveals areas where states need to work harder before the final exam (full exchange implementation will be January 1, 2014). Naturally, states are at different places on the timeline but the overall trends are very encouraging.

Forty-four states are participating in premium rate review, which forces insurers to justify any double-digit increases in premium costs. This review process has already protected purchasers. For example, in South Carolina, state review saved consumers up to $15 million total. (To the six states not doing premium reviews—Alabama, Arizona, Louisiana, Missouri, Montana and Wyoming—what are you waiting for? Your citizens need your help.)

Even more encouraging, 28 states and Washington, D.C., are well on their way toward establishing the Affordable Insurance Exchanges. These states and D.C. have already been awarded federal establishment grants. These exchanges will function to connect consumers to insurers; through a web portal, consumers will be able to enter a few simple pieces of information and then compare different insurance plans to decide what will work best for their situation. The exchanges will select qualified insurance plans, assist consumers, and coordinate eligibility standards for the exchange and premium assistance. Another round of grants will be awarded in mid-February.

The White House report also included a snapshot of ten states’ progress toward implementing the law. The profiled states are not necessarily the farthest along in implementing the law; instead they are used to highlight the diversity of approaches and political orientations of the states. These examples work to underscore the fact that health care truly is a bipartisan issue. As the Mississippi Commissioner of Insurance aptly noted, “A healthcare exchange is not a partisan political issue. Across this nation, Republicans and Democrats alike have embraced the concept of health exchanges as a way to help individuals and small businesses more easily obtain health insurance.”

However, just because it is a bipartisan issue doesn’t mean that everyone agrees on the best way to implement the exchanges. Many stakeholders are convinced that state-run exchanges are more ideal than the federal exchange. The Boise Chamber of Commerce stated that it supported a state-based exchange “[s]o that Idaho can maintain authority over the state’s private health market.” This concern was echoed by the Pennsylvania Department of Insurance, which noted that “Pennsylvania has determined that developing a state-based health insurance exchange will work best for Pennsylvania residents.” However, some states may feel unprepared or unwilling to run their own exchanges. Those states have several choices. There will be Partnership Exchanges, which will allow states to run certain elements of the exchange while the federal government runs the other functions. Arkansas plans to pursue this option. And even though many states are making progress on their own exchanges, there is a federal exchange in the works for those states that cannot or do not want to establish and run their own exchanges. 

Just like students in a classroom, the states’ progress varies widely. However, overall the states are progressing towards implementation of the Affordable Care Act. Certain states are farther along in the process, but no one wants to be left behind!