GREENSBURG — For this reporter, listening to Cameron Wilson of Southeastern Indiana Health Organization (SIHO) give a presentation on navigating the implementation of the Patient Protection and Affordable Care Act (ACA; colloquially known as “ObamaCare”) was something akin to listening to a lecture on theoretical physics.
Cameron, who serves as SIHO’s director of fully insured products, is an expert on the ACA and knows its ins-and-outs and nuances. Cameron was on hand Tuesday morning to provide an overview of the ACA to member businesses of the Greensburg-Decatur County Chamber of Commerce. The public signup for the ACA began Oct. 1, runs through March 31, 2014, and is done exclusively online.
The basic requirements of the ACA are fairly straightforward and easily understood. At its core, the ACA requires all individuals to purchase health insurance. That coverage is purchased through government-run “exchanges,” which have recently been renamed simply, “the marketplace.” Marketplaces have been established and are run through either the Federal government or by each individual state, depending upon whether the state in question chooses to establish its own. Although Wilson is in no way a partisan player in the ACA rollout and has been tasked with simply clarifying and disseminating information, he conceded that, in large measure, the choice by states to establish individual marketplaces has largely been dictated by political-party affiliation.
In striving to achieve its goal of providing affordable coverage to all, Wilson explained, the ACA will expand both Medicare and Medicaid coverage; it also seeks to expand employer-provided insurance coverage, a fact which has made the law controversial in the business community.
Certain aspects the ACA began immediately after passage in 2010, while the bulk of the legislation won’t come into law until Jan. 1, 2014. Other pieces of the act that went into effect in 2010 will be significantly altered on Jan. 1, 2014. For example, under the ACA, from 2010 until the end of 2013, it’s illegal to deny health insurance coverage to anyone age 19 and under. Come 2014, with full ACA implementation, no one purchasing health insurance coverage, regardless of age, can legally be denied coverage because of a pre-existing condition. Full ACA implementation will also mean no annual lifetime or annual dollar limits can be place on coverage. The law will also establish caps on out-of-pocket deductibles that insured individuals and families can be required to pay; a single person can be required to pay no more than $6,350 per year out-of-pocket under the ACA, while a family can be required to pay no more than $12,700. The law also eliminates lifetime and annual dollar limits on essential health benefits.
The above aspects of the ACA, all of which have proven popular with the general public, help illustrate why the law has proven so controversial when considered in light of other ACA aspects which aren’t so popular.
Among the most controversial aspects of the ACA are the requirements that everyone must purchase coverage or pay a penalty and that businesses with 50 more full-time employees must provide health insurance coverage or pay a penalty. The ACA employer requirements have proven not only controversial, but also difficult to implement – so much so that the Federal government has delayed their implementation for a year so regulations for effectively enforcing and regulating the requirements can be more fully developed.
State Representative Randy Frye (R-Greensburg) was present at the meeting and helped illustrate the law’s controversy when he pointed out that many employers will likely opt of offering coverage and simply pay the penalty. For many businesses, Frye said, the penalty option would prove significantly cheaper. Fry also expressed dislike of the use of the word “subsidies” to describe the portion of premiums the government would be covering through the ACA. Subsidy dollars, he said, are tax dollars and are not limitless.
Wilson, however, stayed above the political fray, responding to Frye’s observations that he [Wilson] was merely a messenger, whose job is to explain and clarify, not to politicize or make statements or give opinions about the law’s fairness, effectiveness or economic impact.
Wilson also mentioned the fact that the government healthcare exchanges have been absolutely inundated with people signing up for coverage. The government, he said, had underestimated the number of people who would be signing up for coverage through the marketplaces and the amount of infrastructure necessary to accommodate them all. As a result, Wilson confessed that, to date, even he and his team have been unable to sign up on the exchanges.
Wilson went on to explain many of the other nuances surrounding the ACA, including the income requirements for government premium subsidies and minimum coverage requirements insurers must provide under the law. He also covered the levels of coverage available under the law.
One thing made clear by Wilson’s presentation is that the ACA is a complicated, massive endeavor, with many aspects that are still not well understood. More, much of the ACA is still evolving, meaning some – perhaps many – of the elements of Wilson’s presentation are apt to change in the coming months. To that end, Wilson promised to return to provide updates after the law has been in effect for several months.
The state of Indiana has opted out of setting up its own marketplaces and has instead defaulted to the Federal government market places. Thus, Decatur Countians seeking more information on the ACA or wanting to sign up for coverage should visit www.healthcare.gov.
Contact: Rob Cox 812-663-3111 x7011