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Subscribe to RSSThis fall, new insurance markets called exchanges will open in each state, marking the long-awaited and much-debated debut of President Barack Obama's health care overhaul.
The goal is quality coverage for millions of uninsured people in the United States. What the reality will look like is anybody's guess — from bureaucracy, confusion and indifference to seamless service and satisfied customers.
Exchanges will offer individuals and their families a choice of private health plans resembling what workers at major companies already get. The federal government will help many middle-class households pay their premiums, while low-income people will be referred to safety-net programs they might qualify for.
Most people will go online to pick a plan when open enrollment starts Oct. 1. Counselors will be available at call centers and in local communities, too. Some areas will get a storefront operation or kiosks at the mall. Translation to Spanish and other languages spoken by immigrants will be provided.
When you pick a plan, you'll no longer have to worry about getting turned down or charged more because of a medical problem. If you're a woman, you can't be charged a higher premium because of gender. Middle-aged people and those nearing retirement will get a price break: They can't be charged more than three times what younger customers pay, compared with six times or seven times today for most private plans.
If all this sounds too good to be true, remember that nothing in life is free and change isn't easy.
Starting Jan. 1, 2014, when coverage takes effect in the exchanges, virtually everyone in the country will be required by law to have health insurance or risk fines. The mandate is meant to get everybody paying into the insurance pool.
Obama's law is called the Affordable Care Act, but some people in the new markets might experience sticker shock over their premiums. Smokers will face a financial penalty. Younger, well-to-do people who haven't seen the need for health insurance may not be eligible for income-based assistance with their premiums.
Many people, even if they get government help, will find that health insurance still doesn't come cheaply. Monthly premiums will be less than the mortgage or rent, but maybe more than a car loan. The coverage, however, will be more robust than most individual plans currently sold.
Consider a hypothetical family of four with $60,000 in income and headed by a 40-year-old. They'll be eligible for a government tax credit of $7,193 toward their annual premium of $12,130. But they'd still have to pay $4,937, about 8 percent of their income or $410 a month.
A lower-income family would get a better deal from the government's sliding-scale subsidies.
Consider a similar four-person family making $35,000. They'd get a $10,742 tax credit toward the $12,130 annual premium. They'd have to pay $1,388, about 4 percent of their income, or about $115 a month.
The figures come from the nonpartisan Kaiser Family Foundation's online Health Reform Subsidy Calculator. But while the government assistance is called a tax credit and computed through the income tax system, the money doesn't come to you in a refund. It goes directly to insurers.
The Affordable Care Act is the biggest thing that's happened to health care since Medicare and Medicaid in the 1960s. But with open enrollment for exchange plans less than 10 months away, there's a dearth of consumer information. It's as if the consumer angle got drowned out by the political world's dispute over "Obamacare," the dismissive label coined by Republican foes.
Yet exchanges are coming to every state, even those led by staunch GOP opponents of the overhaul, such as Govs. Rick Perry of Texas and Nikki Haley of South Carolina. In their states and close to 20 others that are objecting, the exchanges will be operated by the federal government, over state opposition. Health and Human Services Secretary Kathleen Sebelius has pledged that every citizen will have access to an exchange come next Jan. 1, and few doubt her word.
But what's starting to dawn on Obama administration officials, activists, and important players in the health care industry is that the lack of consumer involvement, unless reversed, could turn the big health care launch into a dud. What if Obama cut the ribbon and nobody cared?
"The people who stand to benefit the most are the least aware of the changes that are coming," said Rachel Klein, executive director of Enroll America, a nonprofit that's trying to generate consumer enthusiasm.
"My biggest fear is that we get to Oct. 1 and people haven't heard there is help coming, and they won't benefit from it as soon as they can," she added. "I think it is a realistic fear."
Even the term "exchange" could be a stumbling block. It was invented by policy nerds. Although the law calls them "American Health Benefit Exchanges," Sebelius is starting to use the term "marketplaces" instead.
Polls underscore the concerns. A national survey last October found that only 37 percent of the uninsured said they would personally be better off because of the health care law. Twenty-three percent said they would be worse off in the Kaiser poll, while 31 percent said it would make no difference to them.
Insurers, hospitals, drug companies and other businesses that stand to benefit from the hundreds of billions of dollars the government will pump in to subsidize coverage aren't waiting for Washington to educate the public.
Blue Cross and Blue Shield plans, for example, are trying to carve out a new role for themselves as explainers of the exchanges. Somewhere around 12 million people now purchase coverage individually, but the size of the market could double or triple with the new approach, and taxpayers will underwrite it.
"Consumers are expecting their health insurance provider to be a helpful navigator to them," said Maureen Sullivan, a senior vice president for the Blues' national association. "We see 2013 as a huge year for education."
One goal is to help consumers master the "metals," the four levels of coverage that will be available through exchange plans — bronze, silver, gold, and platinum.
Blue Cross is also working with tax preparer H&R Block, which is offering its customers a health insurance checkup at no additional charge this tax season. Returns filed this year for 2012 will be used by the government to help determine premium subsidies for 2014.
"This tax season is one of historical significance," said Meg Sutton, senior adviser for tax and health care at H&R Block. "The tax return you are filing is going to be key to determining your health care benefits on the exchange."
Only one state, Massachusetts, now has an exchange resembling what the administration wants to see around the country. With six years in business, the Health Connector enrolls about 240,000 Massachusetts residents. It was created under the health overhaul plan passed by former Republican Gov. Mitt Romney and has gotten generally positive reviews.
Connector customer Robert Schultz is a Boston area startup business consultant who got his MBA in 2008, when the economy was tanking. Yet he was able to find coverage when he graduated and hang on to his insurance through job changes since. Schultz says that's freed him to pursue his ambition of becoming a successful entrepreneur — a job creator instead of an employee.
"It's being portrayed by opponents as being socialistic," Schultz said. "It is only socialistic in the sense of making sure that everybody in society is covered, because the cost of making sure everybody is covered in advance is much less than the cost of putting out fires."
The Connector's executive director, Glen Shor, said his state has proven the concept works and he's confident other states can succeed on their own terms.
"There is no backing away from all the challenges associated with expanding coverage," Shor said. "We are proud in Massachusetts that we overcame what had been years of policy paralysis."
Some questions and answers on how the exchanges will work
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Screw that! It will be exactly the same for me. I haven't had health insurance for nearly 40 years and never will till I go on Medicare - then I plan to milk it for every cent it'll pay.
Obama can stick his mandates up his ass!
That won't help. What we need is for all the righties to pull their heads OUT of their ass.
jp - you folks on the right have always pushed personal responsibility now that we make it a requirement you now want to show us just how irresponsible and hypocritical you are.
Do you ever wonder how past generations made it through with no insurance? My eighty eight year old aunt was talking about how she had never had a mammogram or pap smear. Never went to the doctor except to deliver her babies. Does anyone think maybe we have just become scared to live?
No. Medical science has done wonders for our general well being. Cervical cancer is one of the leading causes of death worldwide among women, and is considerably rarer in the US almost purely from pap smears.
One lucky aunt doesn't change that
If the insurance companies act in good faith rather than greed, they will profit, medical costs will stablize and this plan can work out, with a few little tweaks to make sure that unseemly, profit driven jerks don't try to derail it in the fiasco we have had since Reagan! Too many people have had to go to the emergency rooms without means to pay, which jacked up prices on everyone. Not to mention those with "pre-existing conditions", who employers and insurance companies were just to eager to drop. I've seen this! I have seen hospitals drop AIDS patients off in the street....(Hermann Hospital, Houston TX). Hospitals dropping patients that had good jobs and insurance before their illnesses. This is what Obama care was suppose to end, and all the propaganda from those who would stand to back obscene profits?
Like I said, the Health care act needs to be adjusted in the side of the consumers. This should not be taken as a free for all for the insurance companies and the medical industry as a whole. Everyone will profit and get the care that is MORALLY CORRECT if we can work together!
Yes Democrats, it's going to cost us a fortune because of you.,
and you know this how?
You always hear how "I dont want the government between me and my Doctor" Well I am
damn sure I dont want a for profit company between me and my doctor. Give me the single payer system.
what would a single payer system solve?
@Eric - What would it solve? Not much. Just cut costs by 50%, cover everyone and improve results.
um, proof?
Good luck, Obamabots. You voted for it, you'll get it. Just like the guy who fired his employees because he has to make cuts due to Obamacare requirements. Bahaha!
That guy was just a blow hard and totally irrelevant, just a political stunt ... it is for sure not a wide spread problem.
This will create thousands of good paying jobs in the health field. So they all are in school learning a new trade that will pay way better. And the employees still working for "the guy" you mentioned, well now they are getting pay and some benefits. Essentially a raise. All good.
The guy will hire people back anyway, the minute he needs them to meet his customer demands.
Here, Justice, let me fix that for you:
This will create thousands of good paying jobs in the government insurance field.
Now keep in mind that government jobs are a net loss to the economy.
Ain't it wonderful?
Then why are so many small and mid range companies (like the one I work for) planning on dumping their employee health insurance? They found it more economically feasible to just pay the penalty and let employees fend for themselves with the exchanges. These companies will be raking in huge profits. Watch for medical bankruptsies to explode and ER's overflow.
"Never Be The Same" - Good!
YEP. Part of Barry's plan to "fundamentally remake America."
When you find that you are paying more and have less to show for it, enjoy.
Once it kicks in, and people see what it actually is, most of the whining will disappear. Over the long haul, its going to save money. It will take time to iron out any wrinkles in the beginning, but I cant see there being many.
Healthcare is good. Being able to see a doctor early, is how you save all kinds of money with early treatment. Before it becomes a major operation or life long disability. Saving money and lives. Plus you have a healthier population.
A yearly check-up for everyone.
What kills me are those who think doing nothing was a better choice. There is no guarantee that this will work out perfectly but the effort is to make it work for all even the insurance companies. I am hopeful and if there are problems fix it. Do I expect free insurance, absolutely not.
Ah, the "we must do something, even if it is wrong" approach. "If there are problems fix it."
How many BILLIONS of dollars do we spend on that before we learn?
BTW: Think BILLION divided by 330 MILLION. Go ahead, you have a calculator function on your computer. Okay, now think that each person is going to owe that much - includes the newborn, the single working mother of three, the crippled, the downs-syndrome people, the eighty-year-olds, disabled vets, etc. What, they can't be expected to pay? (47% can't pay federal income taxes remember) Well, no problem, just increase your share and mine.
Now, think TRILLION. (Estimated cost of ACA)
One of the most conservative (and most heavily armed countries, 3rd after us and Yemen, i.e.handguns) are the Swiss. Guess what they have for healthcare--individual mandate.
The exchanges are nothing but an on-line information and shopping site--think Amazon. That is what the Republicans are objecting to? Information for you to make a market based decision. Go, Republicans! Yeah!
Ironically, conservative think tanks came up with the individual mandate back in the 90s. Obama thought by adopting this conservative creation instead of the public option that his healthcare bill would get Republican support. Boy, what was he smokin'?
Now, where is the republican cry for tort reform? How about voucherization of medicare? Ooops, these were just campaign positions.....now that the campaign is over they don't have one original thought in their empty heads!
It seems to be working for most part in Mass .... I wonder where that came from.
It seems to be working in Mass - if you don't consider the $10.3 BILLION federal bailout 2009 - 2011 and the fact that Mass has the highest insurance premiums in the country.
Do some researcch, people!
Gov Nikki Haley of South Carolina plans to refuse Federal subsidy of the Health plan because she thinks it will cost the state too much money, to hell with health care for uninsured citizens. But somehow she has not flinched to spend over 20 million to fix the hijacked personal information of over 4 million South Carolinians when hackers broke into unsecured state records.
I certainly hope that the new insurance programs work out for Americans. It is about time they brought themselves in line with so many other first world nations around the world that help all its citizens with healthcare coverage.
I know that many Americans, particularly conservatives, believe that federally funded programs are for the lowest members of society. However, in so many other countries, that is simply not the case. It can work wonderfully well for all. But, with America's tight cling to everything capitalistic, Americans might not be ready to do something progressive and helpful to everyone.
Health insurance help is no longer for only the lowest members of society. Think about it, with the 12k projected cost for a family of four, that is more than your mortgage and utilities combined. At least where I live. We are all getting priced out of the market.
This country would sooner dissolve before providing it's citizens with healthcare. The dictatorship of the dollar is too strong.
"When you pick a plan, you'll no longer have to worry about getting turned down or charged more because of a medical problem." Unless, of course, you're a member of a group that people love to be prejudiced against, such as smokers, the obese (and BTW, that includes more people than you think. Go look at a BMI chart; you're probably obese if you're reading this), and drug and alcohol addicts eventually. At least, according to the AP. We the people have been lied to by the left.
http://bigstory.ap.org/article/do-penalties-smokers-and-obese-make-sense
I don't know how they can penalize smokers and the obese. They aren't doing anything illegal, they are paying sin taxes already, where is the fairness?
The sin taxes go to regular state revenues. They should go to providing state healthcare and then you would be partially right. And yes, smokers should pay more because they get sicker from smoking. Everyone gets old, if you live long enough. But only smokers get sicker from smoking.
Lose weight and stop smoking. You and we will be better for it.
The proof now will be if health care costs goes down or not.
I would not bet on it but maybe the question should be how slowly will it rise, it has been going up every year before Obama Cares and sometimes at unrealistic rates.
What has the rate been, like 100 times the rate of the rest of inflation?
No shiela a about double the rate of inflation. Nonetheless it goes up because people use too much of it, most of the time without being able to understand why? The fee for service system stinks. When was the last time you walked into your doctors office and he had his rates posted on the board behind the nurse. Ever ask him how much a procedure costs? Ever get an answer before the procedure or do you find out after the doctor, lab and insurance company have had a chance to see what they can get first?
The rates are posted at my hospital and doctors office. What is not posted is all those extras that comes with whatever I am going in for.
the doc usually doesn't know either
Doctors need to be more like general contractors. I am on a high deductible plan and pay for most of my every day medical needs. Before the surgery my doctor (and his office) could not quote me a price. Then the bills came in. $102 for the first consultation $350 for the surgery and a whopping $961 for the lab/diagnosis. I never approved lab work, the doctor never asked me to authorize him to act as my agent with any other provider. The doctor may as well have sent my blank check book together with my skin lesion to whoever wanted to fill in an amount. I am contesting the charges and have written to the attorney generals of several states, insurance regulators and other federal agencies. You should be able to get an estimate for a simple mole removal and diagnosis before you get it removed. Some one in the process needs to act as general contractor.
then go take your mole to your plumber and see what he can do about it
your case will go nowhere by the way
I want my sin taxes to go towards the cost of my smoker's premium. My state can pay for it since they charge so much on a pack of cigarettes and they'll have all those taxes coming in for pot too. I am doing everyone a favor by dying 10 years early so it's only fair, don't you think?
I agree, you are already paying for smoking, there are not going to be any extra measures in prolonging your life, why pay twice for doing something perfectly legal and revenue enhancing?
I'm willing to give this program a try as my only other option is no coverage at all.
$12,130? Somebody is smoking crack. The health insurance for myself and my wife (non-smoking) is more than $15,000.
What do you expect from a government who has never balanced a budget, nor been out of debt, for its ENTIRE existence.
Go democracy.
You have a low deductible plan. I pay about 10K for my wife and me, but I have an $11,000 deductible. I am waiting for the exchange to see if there will be new competition in the market.
Unless you get sick a lot or require continual health care. You'll never reach your deductible. You might as well flush your money down the toilet. I would dump my insurance all together and strike up a cash only agreement directly with healthcare providers. The cost goes WAY down when they (the hospital) do not have to deal with the insurance company and directly with you.
The government could not manage a childs drink stand your going to get screwed over just like not raising taxes
You want to make healthcare inexpensive? Eliminate health insurance period and make it an all cash system. Recently I had an emergency room visit for a nosebleed that wouldn't quit. Bill came close to 700 dollars. Cut a deal to pay it in cash and it was reduced to under 300 dollars.
Its the middle man (health insurance companies) that are making healthcare unaffordable, GET RID OF THEM! The Incumbent President should be going after health insurance companies as viscously at he is the financial sector. Oh but he cant cause his good pard Warren Buffett owns one of the largest healthcare providers in the nation.
So, until Oct. 1, we're basically screwed.
I live in Arizona : (
Our CRAZY Governor says we won't have exchanges here. She is famously defiant to anything the Obama administration sets forth, and is notorious for cutting benefits of all sorts across the board.
I have had my own private health insurance since I became an adult. My husband and I have no known health issues, and pay $550 a month, with a $2500 deductible per person. I say "no known," health issues because we can either afford to pay for health insurance, or we can afford to go to the doctor, we cannot afford both. So we hedge our bets and pay the insurance premiums, in case of some major medical incident. I make 25k a year and my husband makes 35K a year. I work two jobs, and he works four. I would like to see my premiums go down, and my ability to seek medical care improve, but some how I just don't think that will happen. Oh, and I support Obama Care, because it isn't just about me, it is about us all!
These same old inaccurate caricatures being put forth by conservatives on the evils of health insurance reform are beyond worn out.Conservatives are always going on about how individuals have a duty to be responsible for paying their own bills & not push the cost of their upkeep onto others. At it's core, that is exactly what the Affordable Care Act does. Until now, individuals(particularly those with pre-existing conditions) trying to buy health insurance on their own have often found such coverage to be astronomically expensive (and in many cases unavailable at any price). The ACA changes all that. Starting next year, insurance companies can't charge people with medical conditions absurdly high premiums or refuse to cover them.Subsidies will be available to help lower income people buy coverage. But, the big thing the law will do is mandate that all Americans take responsibility for paying their own medical bills by getting health insurance. For the the vast majority of people(who currently get insurance through their jobs, nothing will really change. But for those who work in small businesses, or are self employed, the new law will(for the first time) make sure they can buy health insurance (and buy it at a much more affordable rate).
This whole debate has never really been (as conservatives claim) about adding vast new expenses we as a nation must fund. The fact is that everybody has already been getting medical care (but in the least efficient & most expensive way possible). Currently ,if people without insurance get sick they're forced to seek treatment in an ER when their medical condition becomes so dire that they require emergency care(that might well have been avoided altogether if they'd been getting proper preventative care). If they need costly treatment, that treatment is either paid for by the taxpayers or by those with insurance(whose premiums increase when medical costs on the insured go up to recoup the cost of the indigent care hospitals must provide the uninsured. And, people who haven't been able to get insurance & who've been building a nest egg for retirement very often become members of the indigent class themselves if they get sick. Those folks have to pay medical costs out of pocket that can swiftly eat through hundreds of thousands of dollars & bankrupt all but the very rich. After that, we all start paying the bill for the cost of their care.And, even if these folks get well, they're likely to leave the hospital dead broke & with nothing left to show for a lifetime of hard work & careful planning that should have enabled them to pay their own way in their golden years.Put all this together & you have just about as screwed up a health care delivery system as could be devised if you tried to come up with a terrible one.
No other advanced country on the face of the earth has these problems. Everybody else in the industrialized world addressed them years ago.It's a national disgrace that 50 million Americans currently lack health insurance or a way to buy it . If they're given a way to buy it at remotely affordable prices without pre-existing condition exclusions, what we have done is taken a giant step toward requiring people to take personal responsibility for standing on their own two feet & paying their own way if they get sick. And, doing this will reduce total spending on medical care in the U.S. & get the government(and the taxpayers) out of the hugely expensive business of treating 50 million citizens as charity cases & paying their medical bills if they get sick. Doing this will also reduce the U.S. budget deficit by many billions of dollars a year once health care reform is fully implemented.That amounts to a win-win situation by almost any objective measurement I can think of.
So health insurance I can't afford as it is is gonna be required of me to purchase? Now, when I say "can't afford" I mean that in a relative term. I could probably afford it if I moved into a smaller apartment or stopped having a cell phone. Basically, if I gave up frivolous luxury items I could probably afford insurance... but then I wouldn't have all that stuff.
I'd rather get ill and take my chances with whether I can afford healthcare expenses related to it than to live a life of minimalism in my material possessions. Backwards or not, that's how I feel about it. Now I'm gonna go watch Netflix on my xBox as projected by my super bright HD projector and heard through my 7.1 surround system in my 1200 square foot 2 bedroom apartment in Brooklyn.
What you're saying is that if you get hit by a bus somebody else should have to pay your medical bills because you chose to spend your money on expensive toys instead of buying health insurance. You've refused to take personal responsibility when you could have for making sure your medical bills are paid if something happens to you.You've said that you'll remain a freeloader by choice & are damned proud of it.Nobody should be forced into poverty because they got sick & have no ability to buy health coverage to pay their medical bills.But, if insurance is available & you just choose not buy it, then you are nothing but a deadbeat.And, I shouldn't have to pay for your medical care if you make such a selfish & stupid choice.
Everyone has to pay protection money to the insurance companies whether you want health insurance or not. Otherwise get hit with thousands of dollars in IRS penalties. And, something the article doesn't state, is that the insurance companies are going to be allowed to charge smokers with extremely high rates. So if you are a smoker, you may find that you can't afford to buy insurance. In that case, I suppose smokers will just have to enjoy publicly funded health insurance such as medicaid or something paid for by other folks. Mitt Romney wanted to change the plan so that people would be required to buy health insurance, and yet they could still be denied for pre -existing conditions, etc. This law is so unconstitutional that the SCOTUS had to call it a tax, otherwise the authors could be charged with failing to uphold the constitution, and treason.
this will be worse than what it is today. it can only be better when it's single payer system. but we have to go thru this phase just so people can see how terrible idea this is.
I don't know what your worried about. All you have to do is walk into a doctors office and negotiate a great rate for services. They'll all bid on your business just ask Paul Ryan thats American Captilaism at its best. Theirs no issues with healthcare.
Dunderhead. It was obama that passed this massive givaway. The dems have no idea what kind of mess this is gonna cause to the economy. The federal budget deficit....ha ha 50 million people are going to go from the state to the federal dole at 4k a pop.