Decoding the ACA

Into the great unknown: Understanding the ACA

2013-09-28T23:00:00Z 2013-10-08T21:39:14Z Into the great unknown: Understanding the ACAVanessa Renderman vanessa.renderman@nwi.com, (219) 933-3244 nwitimes.com

In two days, the gates to expanded health care will open for Americans.

Tuesday is the first day to register for health insurance set forth by the Affordable Care Act, also known as Obamacare. Open enrollment lasts through March 31.

The enrollment will be opened even if politics shuts down much of the rest of the federal government, President Barack Obama said last week.

Most Americans already have some form of insurance and won't have to do anything to comply with a mandate that goes into effect Jan. 1, requiring all citizens have health coverage.

But, for the about 15 percent of the population who are uninsured, change is coming. 

The Basics

President Barack Obama signed the Affordable Care Act into law in 2010. The same day, Florida filed suit against provisions of the law, and 25 other states joined in, said Susan Zinner, associate professor of public and environmental affairs at Indiana University Northwest in Gary.

On June 28, 2012, the Supreme Court upheld the health care law.

Under the law, each state will have a health care exchange, sometimes called "the marketplace," which will offer health coverage plans of varying prices.

Some states will run their exchange, some will operate under a partnership with the federal government and some – such as Indiana – will be run solely by the federal government.

In a speech last week, Obama explained that prices will be more affordable through the exchanges because people will be buying as a group, rather than individually.

Portions of the law have been implemented, but the major part that requires nearly all citizens to have a form of medical coverage takes effect Jan. 1. Those who don't will face a $95 fine or 1 percent of their income, whichever is greater, in the first year.

Other language in the law requires employers with 50 or more full-time equivalent employees to offer affordable health care to employees. That requirement was delayed a year, giving employers until 2015 to comply.

Signing up

The first step is to visit www.healthcare.gov and choose the state in which you live, Obama said.

Users will enter basic information and select a level of coverage, and the website will present a list of insurance plans and prices, from basic coverage called the bronze level, mid-range coverage called silver, and higher end coverage called gold and platinum.

Obama compared it to booking a hotel room or shopping for an airplane flight online. The user can compare prices and plan offerings and choose the most appropriate coverage. Competition, choice and transparency will keep costs down, and some plans will be less expensive than a monthly cable bill or cellphone bill, he said.

Many people will be eligible for tax credits, which will bring costs even lower, he said.

Preparing

Groups that serve uninsured populations have been preparing for the start of open enrollment.

Beth Wrobel, CEO of the federally qualified health center HealthLinc, said Tuesday will be a big day, but workers there plan to ease into the process.

"Even though this is the start of open enrollment, we have some time," she said. "Not everything has to happen Oct. 1. This is going to be a long marathon. It's not going to be a sprint."

The goal is to walk a few patients through enrollment on the first day, see how it goes and review the process, she said.

"We are not going to be in a huge rush," she said.

There are 132,624 uninsured people younger than 65 who earn under 400 percent below federal poverty level in the six northwestern counties of the state that are served by HealthLinc.

Those individuals will be eligible for either Medicaid or coverage via the marketplace, said Ericka McCauley, marketing coordinator for HealthLinc in Valparaiso.

Open enrollment closes March 31. Plans bought in the exchange by Dec. 14 go into effect Jan. 1. Those who sign up in January or February will have coverage starting the next month.

Navigating

People trained as navigators will assist Americans in enrolling in health care, if they need it. Hospitals and health centers are the biggest organizations taking on that role.

Navigators are one example of consumer assistance to help usher people through enrollment. There also are non-navigator assistance personnel, certified application counselors, and providers, agents and brokers.

Navigators cannot sway people or advise them on which plan to choose. They can only walk them through the sign-up process and understand their options.

Resources

Because Indiana chose to have the federal government operate its health plan exchange, the state can provide limited help to consumers, said Dennis Rosebrough, communications director for the Indiana Department of Insurance.

To maintain consistency of the message in outreach and education, the federal government has "politely requested" the state not participate in that process, he said.

"We've been constrained in our outreach initiative, basically at the behest of HHS," he said.

Now, in the eleventh hour, people are gaining interest in how Obamacare will affect them, he said.

"We're getting a lot of calls," he said. "The (Gov. Mike) Pence administration is very interested in helping Hoosiers, and we will continue to be helpful and provide as much direction as we can. Ultimately, the calculations are going to be answered through healthcare.gov."

The government has set up a 24/7 call center to answer questions. That number is (800) 318-2596.

Other agencies have set up websites to explain the law to specific audiences. Indiana has www.in.gov/healthcarereform; a subsidy calculator can be found on the Kaiser Family Foundation website at http://kff.org/interactive/subsidy-calculator and the U.S. Small Business Administration has a site to help small business owners, www.sba.gov/healthcare.

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