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Count down to Health Care Reform

Wednesday, September 18, 2013

by Tristan Scott, Flathead Beacon

The Patient Protection and Affordable Care Act, also know as "Obamacare," is about to bring about the biggest change to the U.S. health care system in nearly 50 years. But as the federal government prepares to roll out the most significant regulatory overhaul of the country's healthcare system since passage of Medicare and Medicaid in 1965, the political landscape remains fractured and the public is still trying to decipher how the changes will affect them.

The Affordable Care Act (ACA) aims to increase the quality and affordability of health insurance, lower the rate of uninsured people by expanding public and private insurance coverage, and reduce the costs of health care for individuals and the government. To accomplish that it provides mechanisms like mandates, subsidies and insurance exchanges.

The U.S. Supreme Court upheld most of the Affordable Care Act in June 2012, allowing for a comprehensive overhaul of the nation's health care system. The act plans to guarantee insurance to more than 30 million people and, in some states, expand Medicaid and lower- and middle-income assistance for private coverage.

On Oct. 1, online insurance markets are scheduled to open in every state. Consumers must sign up by Dec. 15 for coverage to take effect Jan. 1.

According to a recent poll, 42 percent of the general public is unaware that ACA is about to become the law of the land, 12 percent thinks the bill was repealed by Congress and 7 percent believe it was overturned by the United States Supreme Court.

Meanwhile, 49 percent of the public reported that they do not have enough information about the health reform law to understand how it will impact their own families.

Uninsured and low-income individuals are the groups likely to benefit the most, but are the most likely to lack the proper information.

"It's such a complex law. I compare it to a 2,000-piece jigsaw puzzle and only a few of those pieces are put together so you don't know what the whole picture looks like," said John Doran, director of strategic marketing and services for Blue Cross Blue Shield, the largest health insurance provider in the state

Doran has been touring the state on a multi-year marketing campaign, hosting informational sessions in an effort to clarify the changes to individuals and businesses.

"The federal government has put some pieces back in the box," he said. "Some pieces need an X-Acto knife to make them fit, and others need a chainsaw to buzz off the big edges."

A major component of the 2,700-page Affordable Care Act, which requires all Americans to have health insurance starting next year, or pay a tax penalty, is a new Internet marketplace, or Exchange, which allows all Montanans to shop for insurance, just as though they were buying a book through Anywhere from 150,000 to 200,000 Montanans are expected to be eligible for federal subsidies to help pay for the policy.

Individuals must acquire "minimum essential coverage," or face a penalty. The penalty in 2014 is $95 (or 1 percent of income) but that amount increases each year thereafter.

Supporters of the ACA say the new Internet Exchange will make health insurance available and affordable for tens of thousands of Montanans without it.

But only those with income from 100 percent to 400 percent of the federal poverty level will be eligible for the subsidies. For a single household, that range is $11,490 to $45,960. For a family of four, it's $23,550 to $94,200.

The subsidies are highest for those with the lowest incomes. A single person earning $15,000 a year will pay, at most, 2 percent of his or her income for health insurance – $300, so if the cost of a benchmark policy is $5,000, the federal subsidy will pay $4,700 of the policy cost.

A person earning $45,000 a year, on the other hand, is expected to pay up to 9.5 percent of his or her annual income for insurance, or $4,275, so the federal subsidy on a $5,000 policy would be only about $700.

No subsidies apply to those earning more than 400 percent of the federal poverty level.

Employees with household incomes at or below 400 percent of federal poverty level will be eligible for income-indexed premium subsidies and those below 250 percent of the federal poverty level will be eligible for cost-sharing cap subsidies.

In Montana, there are approximately 40,000 uninsured adults earning less than 100 percent of the federal poverty level, and who don't qualify for coverage from Medicaid, the state-federal program that pays medical bills for the poor.

The Montana Legislature in April rejected plans to use federal money to expand Medicaid to those earning less than 138 percent of the poverty level – a measure that was expected to provide coverage to about 70,000 Montanans.

Doran said all individuals will be guaranteed the ability to purchase coverage regardless of health status, and all employers with 50 or more full-time equivalent employees must provide health benefits to employees or pay a $2,000 penalty per full-time employee per year.

To help answer Montanans' questions, on Sept. 20 a new educational website goes live at

A health care education call center will also be available at 855-508-2502.

"There is still a lot of misinformation out there and frankly just a lack of information, despite the efforts of a lot of people," Doran said.

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