6 Surprises From Health Insurance Reform

By Jay MacDonald

Published August 16, 2013


Mere months before major elements of the historic Affordable Care Act take effect, polls show that many Americans still don’t understand the basics of health insurance reform or the impact it will have on their lives.

As plans take shape for the opening of the first-ever public health insurance exchanges this October, the picture is slowly becoming clearer as to how President Barack Obama’s ambitious, intricately layered health care overhaul will affect the nation. Some of the impacts have seemed a bit surprising, even unfortunate.

“No single law can solve all problems,” says Linda Blumberg, a health economist and senior fellow at the Urban Institute, a Washington, D.C., think tank. “We have to take things one step at a time and know that this is going to be a continuing process of trying to reform a system that has flaws, with markets that aren’t now and never have been competitive, and evolve to (a) more efficient provision of high-quality care.”

With the full effect of health care reform just months away, here are six Obamacare consequences that are coming to light — some unforeseen, others that only seem that way.

You could lose your existing health plan

In 2009, Obama reassured Americans, “If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.”

So why are some insurers notifying policyholders that their health plan is being discontinued?

The short answer: Insurers are phasing out some plans and are replacing them with others designed to meet the new federal minimum value and affordability standards for individual and small-business plans under health insurance reform.

Technically, you can still hold onto your policy, thanks to language in the law that allowed existing health plans to be “grandfathered” in, thus exempting them from the new requirements. But experts say once you’re offered better coverage for less, why wouldn’t you make a move?

“You can keep that policy, but you may very well not want to,” says Blumberg. “A lot of people are going to be making the proactive decision to leave them, so they’ll diminish pretty significantly over time.”

Big employers may offer bare-bones coverage

Large companies with many low-income and currently uninsured workers, such as restaurant chains and retailers, are flirting with offering a barely qualifying version of barely there “mini-med” health coverage to sidestep Obamacare’s $2,000-$3,000 per-employee penalty for failing to offer qualifying coverage.

That “employer mandate” was to take effect Jan. 1 but has been delayed until 2015.

Incorporating so-called skinny coverage that may not take care of X-rays, surgery or maternity care is just one of several cost-cutting options that large employers are exploring to offset the additional expenses of health reform.

Tracy Watts, national health care reform leader at Mercer, a global research and consulting firm, says the goal for these employers is to design a bare-bones plan that costs them less than the penalty for not offering coverage and doesn’t appear too enticing to those who currently opt out of coverage or insure through their spouse.

“The question is, how many people would have to enroll before you would spend as much as you would on the $2,000 penalty, and do you think that many people would enroll?” she says.

Hospital mergers may thwart reform goals

The recent trend toward hospital consolidation would seem to work at cross purposes with health insurance reform’s central mission of seeding the private health care market with incentives that will blossom into better care at a lower cost. After all, studies have shown that when hospitals merge, just the opposite happens: Prices go up, and quality can falter.

According to the American Hospital Association, more than 550 hospitals have been acquired since 2007. A similar spike in mergers and acquisitions followed the rise of health maintenance organizations, or HMOs, in the mid-1990s.

“If you have more and more consolidation of providers (hospitals), it makes it more difficult for insurers to be tough price negotiators,” says Blumberg.

“Even if an insurer has 80% of a market, if they’re dealing with a single must-have provider system in a particular area, that provider could say, ‘You can tell me what you’re going to pay me all you want, but here’s what I’m going to accept.'”

Short of regulating prices, which is currently a political nonstarter, Blumberg says hospital consolidation “is an issue we’re going to continue to struggle with.”

Young people may benefit most from Obamacare

Despite dire predictions of “rate shock” for millennials, most of today’s young adults are best positioned to benefit from health care reform, thanks to federal subsidies that should make quality health insurance affordable for this largely unmarried, lower-earning population beginning in 2014.

Jen Mishory, deputy director of Young Invincibles, a young adult advocacy group based in Washington, D.C., says there are an estimated 21 million young Americans who are uninsured, and the overwhelming majority of them have incomes in the low-to-moderate range. Most will be eligible to purchase affordable coverage with federal assistance through the new state exchanges, beginning with early enrollment in October.

Many millennials who do have health coverage are insured through a parent’s plan until they turn 26 — another perk of health care reform.

“Young people are going to disproportionately be the largest beneficiaries of the Affordable Care Act,” predicts Ron Pollack, executive director of the health care consumer group Families USA.

Tax on ‘Cadillac’ plans hits middle class

Millions of Americans anticipate buying health insurance for the first time through new public exchanges to avoid penalties for not having insurance under health care reform’s “individual mandate” that takes effect in January. At the same time, some employers are already scaling back their group health plans to avoid a 40% excise tax on high-cost, or “Cadillac,” plans that doesn’t take effect until 2018.

The tax will hit individual plans costing more than $10,200 and family coverage costing more than $27,500 annually. A Washington, D.C.-based think tank, the Economic Policy Institute, has criticized the tax as “not well-targeted” because it’s likely to impact many unsuspecting workers with rather ordinary health plans that happen to cost a lot because of company size, job location and other factors.

The institute says the tax creates a strong incentive for employers to move toward cheaper and less-generous coverage that shifts more costs onto workers.

Watts says “about a third” of companies are making corrections now to keep their “Cadillac” plans out of the ditch, with most moving toward “consumer-driven” platforms in which employees are given a fixed sum and allowed to shop for their best health and benefits fit.

Obamacare could be good for entrepreneurs

“Job lock” aptly describes the economic force that keeps employees tied to a job for the health care coverage.

The Affordable Care Act may provide “job unlock.” A new study by the Robert Wood Johnson Foundation, the Urban Institute and the Center on Health Insurance Reforms at Georgetown University finds that health insurance reform will likely unleash 1.5 million Americans to pursue their entrepreneurial dreams.

“In the vast majority of states right now, the nongroup insurance market is very dysfunctional for a lot of people,” says Blumberg, the lead author of the study. “What the Affordable Care Act does — by creating a stable, affordable and adequate nongroup market — is it frees lots of people to make different types of work decisions than they are able to make today.”

Mishory says that’s great news for young people.

“Young people switch jobs so much as they’re building careers that the ability to do that without worrying about health insurance is huge,” she says. “They’ll be able to carve a career path that works for them and has potential positive economic impact as well.”

Read more: http://www.foxbusiness.com/personal-finance/2013/08/15/6-surprises-from-health-insurance-reform/#ixzz2c9QNWzWo

Study: Affordable Care Act Tax Credits to Average $2,700

GOVERNMENT/LAW 08/16/2013 | 

Families who buy their own insurance instead of obtaining it through an employer will receive an average tax credit of close to $2,700 starting next year, according to a new Kaiser Family Foundation study.

The tax credits are part of federal officials’ strategy for making coverage in the new Affordable Care Act-mandated health insurance marketplaces more affordable for low to middle-income families.

According to the Kaiser Family Foundation, the average tax credit of $2,672 would cover 32 percent of the average premium for a family purchasing a “silver” plan on the new exchanges. People will be eligible if they have incomes between $11,500 and $46,000 as an individual, or between $24,000 and $94,000 as a four-person family.

Source Link:  http://healthcare.dmagazine.com/2013/08/16/study-affordable-care-act-tax-credits-to-average-2700/


Understanding Obamacare: 5 Facts About the ‘Affordable Care Act’


Read more at EBONY http://www.ebony.com/wellness-empowerment/understanding-obamacare-5-facts-about-the-affordable-care-act-987#ixzz2c8aKLw4s
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We’ve heard about it in bits and pieces over the past three years —the Affordable Care Act  (ACA) also known as “Obamacare.” The political spectacle around this legislation is one thing, but what’s more important is understanding the specific details and making sense of what it really means to you. Fortunately, AARP is here to untangle the jargon and empower EBONY.com readers with the answers and information that nightly news bites don’t offer. Whether you are a senior citizen or a millennial, the Affordable Care Act can have serious impact on your health care, so take notes!

Beginning Jan. 1, 2014, the ACA will provide 6.8 million uninsured African-Americans an opportunity to get affordable health insurance coverage. The bottom line is if you are not insured, low cost or free plans will soon be available. If you already have insurance, you may be able to find an even more affordable plan.

Here are 5 facts about the ACA or “Obamacare”:

  • 3.1 million young adults have gained coverage through their parents’ health insurance plans. This includes more than 500,000 young African-American adults between ages 19 and 25, according to the U. S. Department of Health and Human Services (HHS).
  • 6.3 million seniors are paying less for prescription drugs. And if you have Medicare Part D, and you reach the coverage gap or “doughnut hole” in 2013, you will get more than a 50 percent discount on brand name prescription drugs and more than a 20 percent discount on generic drugs while in the coverage gap. The discounts will continue until 2020 when the gap will end.
  • 105 million Americans are paying less for preventative care and no longer face limits on lifetime coverage, according to HHS. The 4.5 million elderly and disabled African-Americans who receive health coverage from Medicare also have access to many preventive services with no cost-sharing, including annual wellness visits with personalized prevention plans, diabetes and colorectal cancer screening, bone mass measurement and mammograms, according to HHS.
  • 17 million children with pre-existing conditions are no longer denied coverage or charged extra. The issue of pre-existing conditions has been a consistent barrier to obtaining insurance. Under the ACA, beginning in 2014, insurance companies can no longer deny you coverage, even if you have a pre-existing condition like asthma, diabetes, high-blood pressure or even cancer. And if you or a family member gets sick or injured, insurance companies can’t cut off your coverage or cancel your plan.
  • ACA will provide greater access to affordable quality health care, and will also “invest in prevention and wellness, and give individuals and families more control over their care,” according to HHS. Because African-Americans suffer from diseases such as obesity, heart disease, and diabetes at higher levels than America’s general population, this is a critical component of the plan.

So how do you get started with the benefits? Starting October 1, 2013, you can log on to HeathCare.gov, and search the newly formed “Health Insurance Marketplace.” The website will present competing insurance agencies and help guide health care seekers—individuals, families and small businesses —to the best decisions on which plan to choose or switch over to.

For more information about the Affordable Care Act and how the law applies to you, visit AARP’s HealthLawAnswers.org Our goal is to make it plain.

Read more at EBONY http://www.ebony.com/wellness-empowerment/understanding-obamacare-5-facts-about-the-affordable-care-act-987#ixzz2c8aNmPVn
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$67M doled out to those aiding others navigate health care

Kelly Kennedy, USA TODAY8:25 a.m. EDT August 16, 2013

TAMPA — The Department of Health and Human Services on Thursday awarded $67 million in grants to 105 navigators, or groups of people who will help uninsured Americans sign up for health insurance beginning in October.

HHS Secretary Kathleen Sebelius made the announcement at the University of South Florida, which received a $4 million grant. Eight groups in Florida will receive a total of $7.8 million.

Florida is one of the three states where federal officials hope to add millions of young, uninsured and healthy adults to the pool of people who will buy health insurance through the state exchanges created by the 2010 health care law. California and Texas are the other two states.

“We know that a lot of people prefer in-person help,” Sebelius said of the navigators, adding that the helpers will receive an initial 20 hours of training, as well as additional training throughout the year.

“We know there’s a lot of work to be done, but we’ll be ready for whatever comes up,” she said.

The grants come as the law’s supporters and opponents argue about its merits and potential impact. Organizing for Action, the non-profit political group backing President Obama, released a third advertisement to explain the law’s benefits, while Crossroads GPS, a political group created by Republican strategist Karl Rove, continues its media campaign criticizing the law.

Some Republican officials, including Sen. Ted Cruz of Texas, are calling for a government shutdown at the end of September to stop funding for the law, a move that other Republican officials are calling counterproductive and suicidal for the party’s chances.

HHS looks for groups who already have networks in place, who already have connections” to be navigators, Sebelius said. “We had lots more people apply than we could fund,” she said.

Sebelius also recognized Thursday the more than 100 volunteer organizations educating people about the exchanges. The exchanges are online marketplaces where people may buy health insurance from private companies. At healthcare.gov, consumers can compare benefits and costs of several plans. They will also be able to see whether they qualify for a subsidy to help pay for insurance.

HHS officials have tried to keep the process of buying insurance but acknowledge that many Americans will still need help. A recent survey found that just 14% of Americans understood basic insurance terms, such as “premium” and “deductible.”

Often, people have been shut out of the insurance system because of pre-existing medical conditions, poverty or simply not being able to quickly choose a plan because information was not available.

Across the nation, the states have also taken a role in advertising the law. In the District of Columbia, exchange spokesman Richard Sorian said, about 35 organizations have received training to help people enroll, and a call center will be open 24 hours a day and seven days a week to answer questions, because some people who may be eligible for subsidies may work two or three jobs.

District officials have also asked for help from community leaders, such as churches, African-American groups, African-immigrant organizations and LGBT groups, as well as the Chamber of Commerce and the restaurant association.

“We see the population that is uninsured as fairly hard to reach,” Sorian said. “So we’re taking a systematic approach.”

In Hawaii, the state will start running television advertisements and they are making presentations to community organizations that will also promote the exchanges, said Brian Fitzgerald, spokesman for the Hawaii Health Connector.

“I think people are just now realizing the law takes effect Jan. 1, and they’re saying, ‘What do I need to do?'” he said. “There’s a lot of excitement.”

Illinois has just started training its navigators, and 44 community organizations will help enroll people in insurance, state health care spokesman Mike Claffey said.

In Maryland, officials are training 325 navigators and 5,000 aides known as “assistors,” said Danielle Davis, spokeswoman for the Maryland Health Connection, beginning the last week in August.

In Arkansas, the Health Connector website launched July 1 and has had 91,000 individual hits.

“We’ve had robust outreach in every county,” said Deputy Insurance Commissioner Cindy Crone. “We’ve had a lot of positive response.”

They have a state “guide” program to help the federal navigator program, but state legislators decided all of those who assist people must have licenses.

The federal government has also launched a 24-hour-a-day call center, and 1,200 community health centers are also working to educate people.

Navigators must follow strict security and privacy standards to protect personal information, such as Social Security numbers and income, Sebelius said.

On Thursday, she recognized organizations, such as the American Medical Association, NAACP, League of United Latin American Citizens and the National Baptist Convention, that are working to inform people about the exchanges.

Follow @KellySKennedy on Twitter

Source Link:  http://www.usatoday.com/story/news/politics/2013/08/15/navigators-affordable-care-act/2658753/

Health care reform: What do I need to know now?

Published: August 15, 2013

This is the first in an educational series about Health Care Reform from Blue Cross of Northeastern Pennsylvania.

The Affordable Care Act, or ACA, which is commonly referred to as Health Care Reform, was signed into law by President Obama in March 2010. And on June 28, 2012, the U.S. Supreme Court issued its landmark decision upholding the ACA provision that requires the purchase of health insurance, thus allowing all provisions of Health Care Reform to move forward as scheduled.

But if you’re still uncertain about what Health Care Reform means for you, you are not alone. A recent poll by the Kaiser Family Foundation found that much of the public remains confused about Reform, with 4 in 10 Americans unaware that the ACA is the law of the land.

What’s important for you to know right now? Let’s start with the basics.

The Affordable Care Act was intended to help more people access and afford health care coverage regardless of their health status. The law creates fundamental changes in the way health insurance options are developed, priced and offered to consumers.

While many parts of the law won’t take effect until the start of 2014, the following provisions are already in place:

1. Health care coverage for children with pre-existing conditions.

If you have a child under 19 with an illness or disability, often called a “pre-existing condition,” he or she cannot be denied coverage. Before the law was put into place, health plans could in some situations refuse to offer coverage or could limit benefits because of a pre-existing condition.

2.  If you have children under age 26, they can stay on your insurance plan.

Parents can add or keep children on their plans until they reach age 26. Your child can stay on your plan even if they are not living with you, and even if they are eligible to enroll in their own employer’s plan, unless your plan is grandfathered.

3.  Insurance coverage cannot be cancelled if you get sick and have previously made an unintentional mistake on your application.

Health plans cannot rescind, or cancel retroactively, your insurance coverage if you or your employer made an honest mistake on your application. Coverage can only be rescinded in cases of fraud or intentional misrepresentation.

4.  No lifetime limits on coverage and restricted annual limits.

The law prohibits lifetime dollar limits on coverage and also restricts and phases out the annual dollar limits a health plan can place on most of your benefits, eliminating these limits entirely in 2014.

5.  Direct access to OB/GYN services.

All health plans must provide women with direct access to participating obstetric and gynecologic care providers without the need for prior authorization or referral.

6.  No cost sharing for preventive services.

Preventive care services are covered at 100 percent. This means that covered individuals are not charged a copayment or coinsurance for these services as long as they are received from a provider within your health plan’s network.

7.  The right to an internal and external appeal of health plan decisions.

Consumers have the right to appeal decisions made by their health plans, including the denial of a payment for a service or treatment. If your plan denies payment after considering your appeal, the law gives you the right to have an independent organization conduct a medical review of that decision.

As you can see, many of the law’s provisions have already been put into action, but the most transformational aspects of Health Care Reform will take effect in 2014. In the meantime, it’s important that you learn all you can to get the most out of your health plan for you and your family. Visit www .healthcare.gov for the latest information from the U.S. Department of Health & Human Services

Blue Cross of Northeastern Pennsylvania is committed to sharing critical information about Health Care Reform. Now that we’ve looked at what’s already taken effect, watch for the next installment of this series in July to learn more about what’s changing next, and when. And visit http://www.bcnepa.com/reform anytime for more resources that can help you understand what Health Care Reform means for you.

A. Paul Holdren is senior vice president and chief sales & marketing officer for Blue Cross of Northeastern Pennsylvania.

Source Link:  http://standardspeaker.com/health-care-reform-what-do-i-need-to-know-now-1.1536330

Expert: Exchanges Could Boost Quality Reporting, Delivery Reform

Tuesday, August 13, 2013

Health insurance exchanges under the Affordable Care Act could be a mechanism for delivery reform and quality reporting, an insurance exchange expert said at an Alliance for Health Reform briefing on Friday, MedPage Today reports (Pittman, MedPage Today, 8/12).


Under the ACA, states by January 2014 must create online health insurance exchanges to provide coverage options for individuals and small businesses.

Most insurance exchanges will rely on a solid IT foundation to connect with advanced eligibility systems for Medicaid and other state-administered health programs (iHealthBeat, 6/27).

Details of Comments

Sarah Dash of Georgetown University’s Center on Health Insurance Reform said that insurance exchanges will be required to report quality measures on participating plans beginning in 2016 but that some marketplaces could ask insurers to record more data on specific items.

After the briefing, Dash said that states “might want to come up with new quality metrics that they think are important.”

According to Dash, several states will require plans sold through the exchange to report quality measures in the first year to provide consumers with more information when selecting coverage.

Dash said, “Whether consumers are going to be actively following that … I think that remains to be seen” (MedPage Today, 8/12).

Source Link: http://www.ihealthbeat.org/articles/2013/8/13/expert-exchanges-could-boost-quality-reporting-delivery-reform

Five Ways the Affordable Care Act Helps America’s Small Businesses

Ari Matusiak

August 14, 2013
05:05 PM EDT
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Small businesses are the backbone of our economy, and for the 28 million small employers across the country, healthcare is a major concern. The Affordable Care Act provides benefits and opportunities to small businesses that will help increase access to affordable coverage options.

Here are five key ways the Affordable Care Act can benefit small employers and their workers:

  1. SHOP Marketplaces: Currently, small businesses face premiums that are on average 18% higher than large businesses. On October 1, 2013, the new Small Business Health Insurance Options Program (SHOP) Marketplaces will be open for businesses, and small employers in every state will be able to shop for health coverage on a competitive marketplace, that brings unprecedented transparency to the market and gives small businesses the same purchasing clout as big businesses.
  2. Reducing Administrative Complexity: SHOP Marketplaces include web portals that provide standardized, easy-to-understand information that will make comparing and purchasing coverage easier, and will simplify the administrative challenges that businesses often face when offering plans. Visit www.HealthCare.gov to learn more about the SHOP Marketplace and to get ready for open enrollment.
  3. New Tax Credits: The small business tax credit helps small businesses afford the cost of healthcare coverage for their employees, and is already helping qualifying small businesses offset the cost of insurance by up to 35%. In 2014, this tax credit goes up to 50% and is available to qualified small businesses who obtain coverage through the SHOP Marketplace.
  4. Improved Risk Pooling: The new SHOP Marketplaces will allow small groups to pool risks and reduce administrative complexity, thereby increasing their purchasing power and reducing costs for small businesses that want to provide coverage to their workers. Business can enroll starting on October 1, 2013, through their brokers, or directly through the SHOP Marketplace. Stay connected to the latest information on the Marketplaces by going to www.HealthCare.gov.
  5. Workplace Wellness:  The Affordable Care Act creates new incentives to promote workplace wellness programs and encourages employers to take more opportunities to support healthier workplaces. Effective for plan years after January 1, 2014, final rules allow the maximum reward to employers using a health-contingent wellness program to increase from 20 percent to 30 percent of the cost of health coverage, and the maximum reward for programs designed to prevent or reduce tobacco use will be as much as 50 percent.

To help provide small business owners with the resources and information they need, the Obama Administration recently launched Businesss.USA.gov/healthcare, a one-shop where employers of all sizes can go for customizable information about how the law impacts them, based on the size, location and future plans for offering coverage. And, the Department of Health and Human Services launched a call center specifically to serve the needs of small businesses interested in the SHOP Marketplace. This call center (1-800-706-7893) is a new resource to help business owners get information to make the right decision for their bottom line and their employees. It’s open Monday-Friday from 9 AM- 5 PM, with representatives available to help in English and Spanish.

The Small Business Administration has also teamed up with Small Business Majority to offer a weekly webinar series designed to educate small business owners about what the healthcare law means for them. To sign up for a weekly Thursday Webinar before open enrollment starts on October 1, 2013, visit: www.sba.gov/community/blogs/community-blogs/health-care-business-pulse-/affordable-care-act-101-weekly-webinar-se.

Related Topics: JobsSmall BusinessEconomyHealth Care

The Challenge of Helping the Uninsured Find Coverage

Source Link:  http://www.nytimes.com/2013/08/15/us/politics/the-challenge-of-helping-the-uninsured-find-coverage.html?partner=rss&emc=rss&_r=0


Published: August 14, 2013

OAKTON, Va. — Cyndy Dailey held a job fair at her nonprofit agency here last weekend, with a major caveat: she did not yet know if she could hire.

Like many organizations across the country, Ms. Daily’s agency, Northern Virginia Family Service, is hoping to win a federal grant to help uninsured people in the state sign up for coverage under President Obama’shealth care law. With the money, she hopes to hire at least a handful of “navigators” — a new category of worker created under the law to educate consumers about new health insurance options and, starting in October, to walk them through the enrollment process.

Navigators are seen as crucial to the success of the law. As the Jan. 1 deadline approaches when most Americans will be required to have health coverage or pay a fine,  navigators are supposed to explain away confusion and fear among the legions of uninsured, helping them understand how new health insurance markets will work and whether they will qualify for subsidies to help with the cost of coverage.

But as the navigator effort gets under way across the country, it is clear that their impact will vary from state to state, with wide discrepancies in how much will be spent to hire and train navigators and how many people they will be able to reach. Many will be operating on shoestring budgets, with extremely tight time frames and hostile political climates.

“There’s definitely going to be a tremendous difference, not only in navigators but also in marketing funds,” said Andy Hyman, senior program officer at the Robert Wood Johnson Foundation. “So what we’re going to have to see in states with fewer funds is a lot more ingenuity.”

Maryland is spending $24 million on a program that will soon dispatch 325 navigators and assisters around the state. Colorado is investing $17 million on 400 “coverage guides,” and New York is spending $27 million on a similar effort.

But in states like Virginia, which declined to build their own insurance markets under the law and ceded the task to the federal government, navigators will not have much money to get the word out. The Obama administration has promised up to $54 million for navigators in the 34 states where the federal government is setting up all or part of the markets. The grants are to be awarded Thursday.

In Virginia, up to $1.4 million will be distributed to navigator groups, which may include nonprofit community organizations, trade groups, chambers of commerce, unions and other public and private entities.

“It is what it is,” Ms. Dailey said about the comparatively tiny budget for navigators in her state. “All we can do is make our best effort.”

Her agency has asked for $495,000, about a third of the total navigator funds allocated for Virginia. That would cover the equivalent of seven and a half full-time navigators (some may end up working part-time), computers and other equipment for them to do their jobs, informational materials, marketing, and continuing outreach events in five counties.

The federal government did not anticipate having to cover the cost of running the insurance markets in 34 states, which is why it has only $54 million — transferred from a fund for public health prevention programs — for navigators in those states. The health care law set aside much more money for states that built their own markets, assuming that most would do so.

To fill in the gaps, other organizations will also be working to get the word out and helping people sign up for health plans through the new markets. About 1,200 community health centers around the country, which provide medical care for the uninsured, have received a total of $150 million in federal money to help with outreach and enrollment. Virginia’s health centers received $2.5 million.

In addition, many groups that did not apply for navigator funds will nonetheless help educate the uninsured about their options, connect them with navigators or point them toward the new insurance markets.

Insurance agents or brokers may also help people sign up for coverage through the markets; insurance companies selling plans through the markets will also play a role. Northern Virginia Family Service plans to enlist a network of partner organizations, many of whom already work with the uninsured, to help with outreach and enrollment or provide space and other resources.

“Other local groups may have funding or be in a position to get volunteers to do some of this work,” said Christine Barber, a senior policy analyst at Community Catalyst, a consumer advocacy group. “Everyone is anxious to know who the navigators are so that other groups can partner with them, know who to refer people to, know how to flesh out their coalitions and their outreach.”

Navigators, who will also help small businesses and their employees learn about and enroll in health plans offered through the new markets, cannot recommend any particular health plan or receive compensation from an insurance company. They will get at least 20 hours of training and take a certification test.

Opponents of the health care law have nonetheless questioned whether navigators will know enough to help consumers understand the complexities of insurance coverage, and whether they can be trusted with the personal data that consumers will include in applications for coverage.

Ms. Dailey said her agency planned to run background checks on navigators and have them sign off on ethics policies, adding, “We will do a good job because we have all these protocols in place.”

Once the federal grants are awarded, recipients will have to move quickly to hire and train navigators and set their outreach plans in motion. Judy Robinson, whose small nonprofit group in Charlottesville, Va., hopes to win a grant to hire three navigators who would team up with at least a dozen volunteers, said she was excited about the possibility despite the pressure.

Ms. Robinson said her group, the Jefferson Area Board for Aging, was already getting calls from uninsured residents seeking information about the new insurance market.

“I’m a planner, I like to anticipate things, so it is a little hard for me,” she said. “But I’m just going to try to let go, go with the flow of it and not be upset not to have it all in place.”

Ms. Dailey said her “contingent-upon-award” job fair for navigators last weekend drew about 20 people, including retirees, recent college graduates and people with compelling personal stories about health care and insurance.

“My hope would certainly be that we could do fast-track interviews,” she said. “I think I have a good pool of folks.”

A version of this article appeared in print on August 15, 2013, on page A12 of the New York edition with the headline: The Challenge Of Helping The Uninsured Find Coverage.

Language barriers could deter minorities from benefiting from healthcare reform

  • At a panel discussion, state Assemblyman Phil Ting, D-San Francisco, promoted Assembly Bill 1263.

With California at the forefront of the most comprehensive nationwide health care reform effort in half a century, it isn’t affordability but language barriers that providers and legislators fear will prevent minorities from taking advantage of greater access to coverage.

The Affordable Care Act, which begins open enrollment in October and becomes effective Jan. 1, will make health insurance more accessible and affordable to millions of Americans who now lack insurance. But in California, where nearly 16 million people, or 43 percent, speak a language other than English — it’s 45 percent in San Francisco — implementing the act presents a challenge.

At a panel discussion about this topic Wednesday, state Assemblyman Phil Ting, D-San Francisco, promoted Assembly Bill 1263, under which California would invest $200,000 to gain $270 million in federal funds authorized by the act to fund interpreter services for state Medicaid enrollees.

Interpreters are very often “our lifeline,” Ting said, noting that many immigrant families are accustomed to having their children translate when they receive medical treatment.

The U.S. Department of Health and Human Services does not recommend using children as interpreters, especially because they often lack medical vocabulary, said panelist Annis Arthur, deputy regional manager for the department’s Office for Civil Rights.

Legislation like AB 1263 would help break down language as the barrier to health care access, Ting said.

“We can’t expect our children to be there,” Ting said. “What kind of system will they be able to access? I don’t want to hyperbolize, but in these situations it’s a case of life or death.”

Members of the Asian and Latino community helped put a human face on this issue at Wednesday’s panel.

San Francisco resident Juan Situ shared how she waited hours for an interpreter to help her fill out forms for her sister’s hospitalization, only for the situation to get no better after her procedure.

“After the surgery, the interpreter was gone and we wanted to ask the doctor why my sister was in so much pain,” Situ said in Cantonese. “Finally, the doctor came to us but there was no interpreter, so we could not communicate.”

Although California and the U.S. have great language access laws, lapses exist, said forum panelist Cary Sanders, director of policy analysis at the California Pan-Ethnic Health Network.

“Part of it is they are not aware they have the right to request language access,” she said. “That is a huge issue. We heard a couple stories today but think of all the stories we are not hearing. The system fails and we don’t know about it.”

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

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

Associated Press


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/