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Obamacare Sign-up Starts, But Questions Linger

The wait for one of the biggest pieces of Obamacare is over. Starting Tuesday, Americans who don't have access to affordable health insurance through their employers can shop for coverage in new online marketplaces, also known as exchanges. The Kansas Insurance Department has been holding meetings across the state to answer questions about the exchange.

Linda Sheppard is the Kansas Insurance Department’s Director of Health Care Policy. She says the state is ready as it can be.

“I think we’ve done everything that we can, given that we’re going to be a federal marketplace, and that we have pretty limited control over what’s going to happen,” says Sheppard.

The Obama Administration gave Kansas $31 million to develop its own exchange, but Gov. Sam Brownback sent that money back to Washington. Kansas is one of 34 states that declined to set up their own exchanges, leaving the job to the federal government. 

Insurance policies on the new exchange are grouped by the level of coverage they provide. Cheaper premiums mean the buyer will have more out-of-pocket costs for any tests, treatments, and drugs. Consumers can pay higher premiums for more comprehensive coverage. 

Most Kansans who have health insurance now get it from their employers. Most of them are expected to keep the coverage they've got rather than use the exchange. But two other groups stand to benefit from the exchange — those who haven't been able to afford coverage and those who’ve been denied coverage because of pre-existing conditions. 

Federal tax credits will offset the cost of premiums for some. The credits will all but cover the cost of premiums for Kansans living at or near the federal poverty line. Middle income Kansans may qualify for help, but not as much.

Navigators are trained to help people pick a policy

A lot of people will need help to figure out the coverage that’s right for them. Help from people like Christine Bachman. She works for Salina Family Health Care, a safety net clinic, as a navigator. That means she's received special training to help consumers sign-up for coverage in the new marketplace.
She says not many people have been asking about the coverage yet, but she expects interest to build. When it does, Bachman says her job will be to help people assess their needs and choose the policy that best meets those needs.

“Is paying higher premiums, but lower, potentially, out of cost expenses more important, or vice versa? And then they can rate it up, based on that,” says Bachman. "They’ll have that in front of them, so that they can make their own informed decision.”

Dr. Angela Walker came to the Salina meeting from Junction City, where she practices medicine at a Veterans Affairs facility.

“We have a lot of people there who are concerned about it, but they don’t know what to do,” says Walker. “We have a lot of retired military folks who are going to drop off of TriCare. They don’t have jobs, and I think there’s a concern about how they’re going to be able to afford it.”

Until now, there have been estimates of how much coverage purchased in the marketplace would cost, but no hard figures. Some people have compared those estimates to policies that were previously available, and concluded that the new marketplace won’t be as affordable as billed. 

Linda Sheppard, of the Kansas Insurance Department, says those comparisons are misleading because health insurers can no longer exclude people who are already sick, set annual or lifetime caps on benefits, or charge women more than men…

“That coverage is not even available in 2014, because the rules have changed for what the companies have to price for,” says Sheppard. “It’s not an apples-to-apples comparison, and I know that makes it really hard to explain to people.”

Some of the state’s poorest aren’t eligible for Medicaid or subsidies

Sheppard says it’s also hard to explain how some of the poorest Kansans—130,000 of them—will not qualify for Medicaid or the federal subsidies to help them buy policies through the marketplace. Congress intended that everyone below the poverty line qualify for Medicaid, rather than having to buy subsidized insurance. But Kansas lawmakers chose not to go along with the Medicaid expansion. As a result, childless adults still can’t get Medicaid under any circumstances. 

A murmur went through the crowd as Sheppard explained that they’re not eligible for subsidies.

“Unfortunately, they will do what they do now, which is go without, or go to a safety net clinic, or end up in the E.R. if they become very ill,” says Sheppard. “Their situation really hasn’t changed from where it is right now, and obviously that was not what was intended when the law was enacted.”

That’s an issue that lawmakers will likely be pushed into revisiting next year. Though the exchange won't help the poorest Kansans, it will help tens of thousands who are now uninsured to get coverage. Even so, Sheppard cautions, there are bound to be a few bugs that will need to be worked out as the exchange comes on line.

“There will be some people who will want to get on there right away, but you lose nothing by waiting for a few weeks to get on there, and let some of those bugs get worked out, hopefully, over the next few weeks,” says Sheppard.

The sign-up period continues for six months, so you have plenty of time.  If you sign up by December 15th, your coverage will begin January first.

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