Campaign Watchdog: GOP claim that health insurance going up 34 percent in Ky. mostly false

Indiana Attorney General Sues to Stop Indiana Residents from Getting ACA Subsidies

Indiana Lawsuit Article

Because of This Blog, Nathan and I Made It Onto CNN.com!

Obamacare LGBT Push

The comments really run the gamut from the usual ugly homophobic remarks to some more thoughtful ones.

Physician Shortages

CNN's Jen Christensen has a story today on a question I've been asking since the ACA was first debated:  who is going to provide care to the millions who will be newly insured?  Check out the story.

 Comparing Premiums

 

Kentucky:

Individual described below does not qualify for Medicaid.  Premiums do not include any possible subsidies offered through the ACA.

Fayette County:

1. Non-smoker, 47 year old male, 2014 income of $13,000:

a. 20 plans available, monthly premiums:  $197 to $456 (rounded)

2. Smoker, 47 year old male, 2014 income of $13,000:

a. 20 plans available, monthly premiums:  $227 to $547 (rounded)

Carter County:
1. Non-smoker, 47 year old male, 2014 income of $13,000:

a. 16 plans available, monthly premiums:  $220 to $482 (rounded)

2. Smoker, 47 year old male, 2014 income of $13,000:

a. 16 plans available, monthly premiums:  $253 to $579 (rounded)

Time for a Break

I've been working on this all day in between other work.  It is time for a break.  Some thoughts about the day:

• Before any subsidies, the private plans offered in Kentucky appear to run the gamut from $197/month to $456/month for premiums.
• Dental plans are offered too.
• There are three companies offering plans:  Humana, Anthem/Blue Cross, and Kentucky Health Connect.
• The site offers a great deal of information which will take a person a lot of time to go through unless you are knowledgeable of insurance industry terms.
• The exchanges are flooded today with potential enrollees, the press, and the insured interested looking at them.  I'm going to wait awhile before checking more so that the traffic dies down.

Confusing!

This stuff is really confusing.  I called up three of the plans to compare and now feel overwhelmed.  There is so much information provided on each plan that uses specialized terms such as coinsurance, EHB, MOOP out of network, EHB variance, etc. etc.!  Some of the information is blank for the Anthem plan. I feel lost. 

If I was urgently trying to enroll today, I would feel really frustrated about now.  The website keeps crashing, and the plans are complicated. 

I finally called KYnect again.  A kindly woman named Shavona helped me with some of the terms.  She said she and her fellow staffers are being hampered by the site being down and thus they cannot see what the callers are referring to on the callers' screens.  She was not sure why some of the columns were blank under the Anthem plan but that the updates could be affecting things.  I asked if there was a part of the website that explained these terms, and she said there is on healthcare.gov 

Also, if you choose to remain uninsured, the penalty this year is $95 or 1% of your income (whichever is greater).

Also, you must enroll and have your money received by December 15, 2013, if you want your coverage to begin January 1, 2014.

More Computer Issues

The website continues to stall or crash.  The administrators have now put up a notice about the site having issues from so many people trying to use it.

On a design note, you can mark up to 3 plans to compare.  Unfortunately, the button to view these three comparisons is on the top of the frame rather than at the bottom.   As you work through a list of plans and mark which ones to compare, it seems more intuitive to have the compare button at the bottom.

Kentucky Exchange Plans

The website continues to work slowly.  It must be a busy day being the first day the exchange is open.  Once you get to the plans page, here are the filters by which you can select and the most affordable plans.  There are other options on the next page that have not yet loaded after several minutes.

Also, keep in mind these premiums include no subsidies and do include a dental plan.

Website Is Back Up!

Medicaid Expansion

The Advisory Board Company has been updating the above map showing the status of the ACA's Medicaid expansion by state. 

The ACA originally planned for the following:

• Households earning up to 100% of the Federal Poverty Limit (FPL) ==> eligible for Medicaid (the eligibility requirement prior to the ACA)
• Households earning 101-134% of the FPL ==> eligible for Medicaid (new under the ACA)
• Households earning 135-400% of the FPL ==> receive a sliding scale subsidy to buy private insurance (new under the ACA)
• Households earning more than 400% of the FPL ==> must have insurance or pay a penalty on their taxes (This is the "individual mandate".)

The majority of Americans receive their health insurance from their employer and thus meet the individual mandate.  Other programs cover various Americans and also meet the individual mandate:

• CHIP (Child Health Insurance Program) ==>  low-income children
• VA (Veterans Administration) ==> military veterans
• Medicare ==> seniors

You can view the 2013 Federal Poverty levels at:
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Downloads/2013-Federal-Poverty-level-charts.pdf

 In a case challenging the constitutionality of the ACA, however, the US Supreme Court upheld the ACA's overall constitutionality BUT ruled that -because Medicaid is jointly funded and ran by the states and Federal government- the states could opt out of expanding Medicaid.  Most of the states with Republican governors or Republican-controlled legislatures chose to not expand Medicaid.  Their decisions stemmed from both a show of opposition to the ACA overall and also a concern that the Medicaid expansion would strain state budgets.  Under the ACA, the Federal government pays 100% of the cost of the expansion at first.  After several years states must eventually pay for 10% of the cost of covering the increased number of their citizens insured via Medicaid.

Kentucky's Democratic governor, Steve Beshear, opted to expand Medicaid in my state.  Most of the Southern states' Republican governors chose otherwise.  Arkansas' Democratic governor came up with an alternative plan.

Consequences of Not Expanding Medicaid on the Uninsured

The Kaiser Family Foundation has done a report on the consequences for states that do not expand Medicaid:

http://kaiserfamilyfoundation.files.wordpress.com/2013/07/8457-the-cost-of-not-expanding-medicaid4.pdf

Among the consequences:

• More uninsured people:  Many of the states not expanding Medicaid have the most low-income uninsured Americans (Texas, Florida, etc.).  With these citizens barred from the Medicaid option in their states, they are likely to remain uninsured.

These uninsured citizens fall into a new Medicaid donut hole because they earn too much to qualify for Medicaid in their state and too little to qualify for the new ACA subsidies.  Jim Fuquay at the Fort Worth Star-Telegram describes this problem:
http://www.star-telegram.com/2013/09/28/5202327/medicaid-doughnut-hole-leaves.html

Consequences for Hospitals

 Hospitals for decades have followed a Federal law where they must treat or at least stabilize any patient coming through their doors.  In effect, they treat everyone to some extent.  If a patient is uninsured and cannot pay, then the hospital has two options to get reimbursement for its costs:

1. It can seek funding from a Federal fund that compensates hospitals for unpaid care to the poor.
2. It can pass on its costs for treating the uninsured by raising prices for its insured patients.

To help offset the cost of the ACA, the law gradually reduces the fund that compensates the hospitals.  Remember, the original ACA had most of these uninsured, non-paying citizens moved into an insurance plan -including the Medicaid expansion.  The fund will not be reduced until at least 2014, but the reduced compensation to hospitals will leave them with few choices except to raise prices on insured patients in the states that do not expand Medicaid.  Thus, the Republican-voting and Republican-controlled states that most oppose the ACA are more likely to see average insurance premiums rise as hospitals raise their prices to cover the costs of treating the uninsured.

Not the Best Beginning...

The website keeps crashing when I go to look at actual plans.  So I called the number given for the program:  1-855-4kynect (459-6328).  Robin, the woman who answered, was helpful.  She said the website was updating and to check back online in 2-4 hours.  I'm not sure why they would be updating now rather than before the program went live? 

I also confirmed that any insurance into which I enroll today would not go into effect until January 2014.

Houston, We Have a Problem

The website crashed when I went to look for plans:

First Step:  The Website

I've logged into the website to explore the Kentucky Health Exchange:
https://kyenroll.ky.gov

The initial screening was very simple.  I do not qualify for Medicaid or the Kentucky Child Health Insurance Program (KCHIP).

Now I'm waiting to Look for Plans.  The website has been trying to connect for awhile so perhaps there are a lot of people using it right now?

Welcome

Today the new insurance exchanges created by the 2010 Affordable Care Act (ACA) open.  I am starting this blog to document what I discovered as I navigate the system.  It is my hope that my experiences help others.

First, a bit about me.  I have worked more than 16 years in Public Health, and I am a former professor of Public Health at the University of Kentucky.  I am a diabetic and thus have a "preexisting condition".  I am currently unemployed.  So, the exchanges may offer me a more affordable option to the COBRA I am paying now.

Also, I live in Kentucky.  It is the only Southern state to operate its own health exchange.  The other Southern states have opted to let the Federal government operate their exchanges or to operate them in partnership with the Federal government.

So, let the adventure begin!  Off to look into enrollment.