OMAK Health insurance enrollment through the Affordable Care Act begins next week, and although the state has answers, there are still some major question marks.
“Will it work? I don’t think any of us know,” said Carolyn Smith with the state Office of the Insurance Commissioner.
Smith, a statewide health insurance benefits adviser (SHIBA), came to the Omak Performing Arts Center on Sept. 18 to explain the enrollment process, what people should expect from the new federal mandate, and who’s paying for it.
According to the state Department of Health, 24 percent of Okanogan County residents are uninsured. Starting Oct. 1, those people can use the Web to purchase an insurance plan through the Washington Health Benefit Exchange, www.wahb
exchange.org. The plans go into effect Jan. 1.
Some may qualify instead for Medicaid, as benefits are being expanded to include more Americans while the federal poverty level is raised. Everyone else will have their pick of more than 40 plans falling under three categories: gold, silver and bronze. Gold coverage means insurance picks up 80 percent of the tab, while silver covers 70 percent and bronze covers 60.
“We were very pleasantly surprised that the rates aren’t that much higher than they are now,” Smith said.
Under the Affordable Care Act:
• Participating insurance companies are required to offer coverage for 10 basic services, not including vision or dental for adults. Children will receive dental, and parents will be able to insure their children up to age 26.
• Nobody can be denied based on a pre-existing condition, and nobody can be dropped from his or her plan.
• Subsidies will be given to the majority of people who buy a plan, Smith said, that should make the monthly bill cheaper.
- If an uninsured person refuses to buy a plan, Smith said there’s no criminal penalty, but there will be a fee. Anyone who doesn’t qualify for Medicaid or Medicare and doesn’t purchase insurance in 2014 will pay $95 when federal income taxes are due, she said. That amount is charged to every adult in the household, and a smaller amount is charged for children without coverage. In 2015, that fee goes up to $325 per adult, and $695 in 2016.
• Large employers – those with more than 200 full-time employees – are also mandated to provide insurance. Small business owners with less than 50 employees will not be penalized if they choose not to provide insurance, Smith said, but if they do they can receive tax credit for each employee over 30. Mid-size businesses with 50-199 employees will also be eligible for the credit.
Smith also addressed what she said was a common question: “Why should we give health care coverage to someone who’s lazy, someone who doesn’t want to work?
“We’re already paying for it,” she said, noting that every time an uninsured person who can’t pay seeks medical treatment, the cost is passed down to people who do have insurance.
If Congress doesn’t approve funding for the Affordable Care Act, Smith said, “We’re in a world of hurt.
“I think it would bring chaos,” she said. “We would probably see our rates go sky-high. Some people liked what we had… but it wasn’t working for everyone.”
U.S. Congressman Doc Hastings said he has gotten an earful from Central Washington residents about the mandate and its impact locally. He, along with the rest of the House of Representatives, voted 230-189 on Monday to defund the Affordable Care Act while approving government funding through Dec. 13.
Smith said reimbursement cuts to Medicare providers, as well as new programs meant to help providers focus on quality over quantity in terms of services, will pay $577 billion of the Affordable Care Act’s total price tag, $828 billion over 10 years. Tanning salons are being required to add a 10 percent surcharge onto their services to meet their new tax bill.
The rest will be paid by taxes on companies within the healthcare industry, including pharmaceuticals and medical equipment manufacturers, Smith said. Americans making more than $200,000 per year will see their Medicare tax go up by 1 percent.
Scot Attridge, chief financial officer at Mid-Valley Hospital in Omak, said the Medicare cuts may not have an impact for the time being at critical access hospitals, which includes North Valley Hospital in Tonasket and Three Rivers Hospital in Brewster.
Medicare has instead proposed an incentive program based on value-based purchasing, Attridge said, essentially meaning “quality over quantity.” Inpatients at critical access hospitals across the state are given questionnaires at the end of their stay, and Attridge said the better the survey rating, the more a hospital may qualify for the incentive.
North Valley Hospital is anticipating a boost in revenue from newly insured patients.
“Basically, for our region we have a lot of uninsured people in our hospital district,” business development coordinator Terri Orford said. “It’s going to help our facility eliminate a lot of that bad debt and charity care.”
North Valley Hospital will have a computer available for the public to use to purchase an insurance plan through the state’s exchange website. The hospital will also host two free workshops for the public from 10 a.m. to 3 p.m. Oct. 28 and Nov. 1. Three statewide health insurance benefits volunteers will be on hand to help residents navigate the new program.
The Affordable Care Act – better known as “Obamacare” – still won’t cover everyone. In fact, the new law’s initial goal was to provide coverage for 32 million uninsured Americans, but since then, the number of uninsured has risen to 52 million people, Smith said.
In Washington, about 500,000 residents will be shopping for insurance, she said. The ones who won’t need to are already insured through their employer or another program. Undocumented immigrants are ineligible to apply for insurance.