Affordable care act Study: Half who buy own plans would get aid

Published: Wed, August 14, 2013 @ 12:00 a.m.

Associated Press

WASHINGTON

About half the people who now buy their own health insurance— and potentially would face higher premiums next year under President Barack Obama’s health care law— would qualify for federal tax credits to offset rate shock, according to a new private study.

Many other people, however, earn too much money to be eligible for help, and could end up paying more.

The estimate, being released today by the nonpartisan Kaiser Family Foundation, tries to answer one of the biggest remaining questions about the impact of Obama’s law on American families: Will consumers wince — or even balk — when they see the premiums for the new plans?

The study found that 48 percent of families currently buying their own coverage would be eligible for tax credits next year, averaging $5,548 per family, or 66 percent of the average cost of a benchmark “silver” policy offered through new state insurance markets.

“About half of the people won’t be paying the sticker price,” said Gary Claxton, director of the health care marketplace project at Kaiser, an information clearinghouse on the health care system. “The people who get help will get quite a lot of help.”

“Many, but certainly not all, of the people who don’t get tax credits will pay more,” he said. “How much more will be a function of a lot of different things.”

For example, some people who don’t qualify for tax credits may get jobs that offer coverage, added Claxton, a co-author of the study. And the bottom line on premiums may not be clear until sometime this fall, after the Health and Human Services Department releases rates for more than 30 states where the federal government is taking the lead setting up new insurance markets for individuals and small businesses.

People can enroll starting Oct. 1, and coverage becomes effective Jan. 1. Most people currently covered by employer plans are not affected.

The law is likely to increase the sticker price for individually purchased coverage next year for several reasons:

Insurers will have to cover people with pre- existing medical conditions, whose needs are costlier to provide for.

Policies must provide certain standard benefits, including prescription drugs, mental health and substance abuse treatment and rehabilitative services.

Policyholders’ annual out-of-pocket costs will be capped.

Article Link: http://www.vindy.com/news/2013/aug/14/affordable-care-act-study-half-who-buy-o/

 

Obamacare Presents Complex Choices For People With Disabilities

Source Link:  http://www.webmd.com/health-insurance/20130809/obamacare-presents-complex-choices-for-people-with-disabilities?src=RSS_PUBLIC

WebMD News from Kaiser Health News

By Eric Whitney, CPR
The Affordable Care Act has set new standards — called essential health benefits — outlining what health insurance companies must now cover. But there’s a catch: Insurance firms can still pick and choose to some degree which specific therapies they’ll cover within some categories of benefit. And the way insurers interpret the rules could turn out to be a big deal for people with disabilities who need ongoing therapy to improve their day-to-day lives.

Bryce Vernon is a 20-year-old film student who lives in Los Angeles and has cerebral palsy. He speaks only with the aid of a special computer mounted to his wheelchair that tracks his eye movements. Using his eyes, Vernon can indicate on a screen what letters and words he wants the computer’s voice to say.

It’s amazing technology, and Vernon gets a lot more out of it with help from speech-language pathologist Jill Tullman.

“Now Bryce, I’m want to show you this super cool random button I think you’re going to love,” Tullman tells him during a therapy session at a special camp for young people who use the technology. Vernon’s parents paid out-of-pocket for him to attend the camp.

Tullman helps him pre-load several different ways of saying goodbye.

“Bye, later dude, later, bye, I’m out of here, see ya later,” Vernon says, testing it out.

In the parlance of health policy, the work Tullman is doing with Vernon is called “habilitative services.” It’s different from the more familiar sort of rehab people often get after an injury or surgery. Habilitative services are for people who can benefit from one-on-one time with a therapist to improve daily living skills. But such services can be expensive, and not all insurance plans have covered them.

The Affordable Care Act is changing that, says health economist Lisa Clemans-Cope with the Urban Institute.

“You’re much more likely to find these benefits in a plan in the individual market [starting in 2014] than you would be today. Far more likely,” says Clemans-Cope.

This is because “habilitative services” are included within the 10 categories of essential health benefits the ACA will require in those new plans. Still, while some categories are straightforward — such as maternity care and preventive care — the category including habilitative services leaves more room for interpretation.

For instance, insurers could choose to cover physical therapy for someone with a broken bone, but not cover long-term support services for chronic conditions, such as speech therapy for kids with developmental delays.

Clemans-Cope says some insurers may arrange their benefits in a way that discourages people with expensive chronic conditions from signing up with them. And, she says, people who want to have specific therapies covered are going have to slog through some fine print to figure out if they’ll actually benefit from a particular policy. (The new policies will start to go on sale this fall and go into effect beginning Jan. 1, 2014.)

“This is a big improvement, but we should emphasize that it’s not totally fixed,” Clemans-Cope says. “And people are really going to have to get help to decide which plans cover the benefits they need. ”

Whether a person will be able to get the new therapy benefits also depends on where they live. The level of benefits insurers have to provide in each category is based on a model policy in each state, and some of those model policies are a lot more generous than others.

Jill Tappert, an activist in Colorado for people with disabilities, says a lot of details still need to be sorted out before she’ll be able to say whether the health care law has improved things much.

“I certainly hope the way the Affordable Care Act is implemented is a game changer for people in the disabilities community. It can be,” says Tappert, who spent years fighting for habilitative service coverage for her daughter who has autism. “The opportunity is there for policy makers to vastly improve lives.”

Barbara Vernon, Bryce’s mother, says Bryce is now covered by Medi-Cal, California’s Medicaid program. His primary insurance had been her employer-sponsored plan until she was laid off in 2009. She searched for private coverage for Bryce, but says, “Private was so unbelievably expensive, it was unaffordable.”

Barbara says her family’s insurance is “a patchwork,” with Bryce likely to stay on Medi-Cal even after his 21st birthday. She and her other son have an individual plan they have purchased, and her husband has an employer-sponsored plan — but it covers only the employee, not the family.

For his part, Bryce Vernon says his life is a lot better since getting the kind of help that many others may be able to get from the health law, starting in 2014. He works hard to get the most out of the technology and the therapy that lets him speak. His advice to others: “Never, ever give up.”

The new rules for what health insurance companies have to cover may still change. Federal regulators plan to review them as the health law rolls out and could make changes in 2016.

This piece is part of a reporting partnership among NPR, Colorado Public Radio and Kaiser Health News.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Long Term Care Insurance Not Covered by Obamacare Reports Association Director

August 14th, 2013 – 0 comments – Filed Under – by 

Los Angeles, CA, August 14, 2013 –(PR.com)– Long term care insurance is not included under provisions passed by Congress as part of the Affordable Care Act also known as Obamacare according to the director of the American Association for Long Term Care Insurance.

“We are getting an increasing number of calls from consumers wanting to know how to apply for long term care insurance once insurers must accept pre-existing health conditions,” explains Jesse Slome, executive director of the long term care insurance industry trade group. “Unfortunately I have to tell them long term care insurance is not included under Obamacare and is only available to those who can meet health requirements.”

Consumers are expected to start investigating insurance plans available under Obamacare next month and open enrollment starts October 1st.

“The Department of Health and Human Services abandoned any plans to implement the provision calling for a voluntary long term care insurance program which would have allowed those with existing health insurance to apply,” Slome notes. “They found the monthly premiums they’d have to charge would have been far too expensive for people to afford so they walked away and allowed Congress to repeal the CLASS Act.”

“There are about a dozen insurance companies currently offering private long term care insurance,” says Slome. About eight million Americans have some form of protection against the significant risk of needing long term care. “If you have some existing health conditions, we can advise whether pursuing a long term care insurance policy will even be possible.”

The American Association for Long-Term Care Insurance advocates for the importance of long term care planning and supports insurance professionals who market the complete range of planning products.

Consumers interested in learning more about long term care insurance protection can read four consumer guides providing helpful information on planning and reducing long term care insurance costs. They can be accessed on the Association’s website at http://www.aaltci.org/guides and no information is required to access these guides. To connect with a designated long term care insurance professional, a member of the Association, for information and no-obligation cost comparisons call the

Contact Information:
American Association for Long-Term Care Insurance
Jesse Slome
818-597-3205
Contact via Email
http://www.aaltci.org

Read the full story here: http://www.pr.com/press-release/509590

Press Release Distributed by PR.com

U.S. schools face tough decisions on Obamacare benefits

By Yasmeen Abutaleb

WASHINGTON | Wed Aug 14, 2013 7:39am EDT

(Reuters) – Hit by years of budget cuts, some U.S. public school boards are looking to avoid providing health benefits to substitute teachers and supporting staff under President Barack Obama’s reform law, education officials say.

According to the law, employers will have to offer health coverage to all full-time employees, defined as those who work an average of 30 or more hours per week each month, or else pay a fine starting in 2015.

School boards, already struggling to manage after years of state budget cuts, are trying to get ahead of the potential costs of Obamacare for the current academic year, education and labor officials say. The need to find creative solutions, or risk cutting back staff hours further, will increase as they finalize their budgets, they say.

In Pennsylvania’s Penn Manor School District, Superintendent Mike Leichliter said there is no room in its constrained budget to provide additional employee insurance. Instead of cutting hours, the district used a substitute-teacher contracting service to pay part of the salaries for 95 employees. Money for such a service does not count against the school’s budget.

“When we looked at our costs, (healthcare) was one area that really had the potential to skyrocket,” Leichliter said. “This is absolutely the worst time for school districts to be faced with mandated increases.”

The National School Board Association said many states and school districts have at least explored reducing hours, according to Linda Embrey, a communications officer. Several school officials contacted by Reuters said they could not find a way around cuts.

In Indiana’s Fort Wayne Community Schools district, one of the state’s largest, administrators reduced hours for 610 of its 4,050 employees, including substitute teachers and support staff, who were working 30 or more hours a week. Providing them with health insurance would have cost $10 million annually, said Krista Stockman, public information officer for Fort Wayne.

“You get to a point where there’s a danger that you’re cutting too much and that the quality of education you’re providing isn’t as great,” Stockman said. “We’re just going to have to do the same amount or more with less.”

Most of the employees affected are substitute teachers, classroom aides, cafeteria workers, bus drivers or similar support staff, according to school officials and labor representatives. They had not been receiving healthcare coverage from their employers in the past. Now, instead of getting such employer-sponsored benefits under the reform law, they may be eligible for government-subsidized coverage that will be offered by new state insurance exchanges starting on October 1.

SEQUESTER TAKES A SECOND TOLL

During the 2012-2013 school year, 26 states provided less money to local school districts than the prior year, and 35 states provided less funding than in 2008 (a better year), according to the Center on Budget and Policy Priorities.

This year they are also grappling with across-the-board “sequester” spending cuts introduced after Congress deadlocked over how to fix the deficit. An Obama administration official said those cuts plus the states’, and not healthcare reform, are the main reasons for staff losing work-time at schools.

“We are seeing no systematic evidence that the Affordable Care Act is leading to a shift to part-time work,” the official said. “There are a variety of factors impacting schools, including sequestration, which is cutting budgets and is a completely separate issue.”

The National Education Association is working with union leaders across the country to figure out how to encourage employers to avoid cutting hours as a result of healthcare reform, said Joel Solomon, NEA senior policy analyst. The effort has included a training session for dozens of labor representatives in June, and more sessions are planned for this year.

Solomon said one popular solution offered by the NEA is to help schools get a more precise accounting of employee hours to see whether staff are truly working an average of 30 hours a week each month when holidays and other time off are included. That has helped some schools make less drastic cuts in employee hours, he said.

Many school employees are expected to qualify for Obamacare’s tax subsidies, which are available starting in January to people who make within 400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four in 2013).

Even if they don’t, the new plans are preferable to what they currently have to buy on the individual market because insurers cannot deny coverage based on prior illness.

In Nebraska, the Plattsmouth Community School District is limiting the hours of permanent substitute teachers, who typically work every day, said Marlene Wehrbein, a labor union official who advocates for employees in the state’s public school districts.

“It creates a lot of inconsistency in staffing, and I can’t see how that would be good for students,” Wehrbein said. “How could you have a teacher teaching English four days a week and then on the fifth day you have someone else?”

(Reporting by Yasmeen Abutaleb; Editing by Michele Gershberg and Prudence Crowther)