New health insurance markets open Tuesday

Published 4:52 pm Monday, September 30, 2013

Oct. 1 is the day online marketplaces for health insurance enrollment launch under the Affordable Care Act (ACA), the federal government’s new health law, and Chilton County healthcare employees are preparing for questions residents might have about the law.

Coverage through the marketplaces will begin in Alabama and every other state on Jan. 1, 2014.

Clinic Supervisor Ludean Hicks at the Chilton County Health Department said Monday she had received an email from Dr. Don Williamson, State Health Officer with the Alabama Department of Public Health, containing contact information healthcare employees like Hicks can give to people who have questions about the new health law.

Hicks said the email listed 1-800-318-2596 and as public resources for questions about insurance eligibility, enrollment and more.

“I’m still learning myself,” Hicks said. “I’m hoping that people who need it will go ahead and apply for it because something is better than nothing. Most of our patients don’t have health insurance.”

Although Hicks didn’t know how many non-insured patients the Chilton County Health Department receives each year, she said she and her staff see patients who need more extensive medical services than they can afford without health insurance, and she thinks the new law could help them.

“They need medical attention, but they don’t have the means to get it,” Hicks said. “I’m hoping that they’ll take advantage of [the new law]. It stresses us out when we know they need services and can’t afford them.”

Clanton resident Chris Thornton, 36, is considering enrolling himself and his family for health insurance through the ACA since he is self-employed and doesn’t currently have insurance.

“I’m going to research it,” Thornton said of the new law. “If it’s going to benefit us, it’s fine with me. But on the other hand, if it’s going to cost me more to have it, I don’t know.

“There has to be something for people out there who can’t afford Blue Cross and Blue Shield or other insurances.”

President Barack Obama signed comprehensive health reform known as the Patient Protection and Affordable Care Act (ACA) into law in March 2010.

The law is designed to make preventive health care more affordable and available to more Americans; lower the number of uninsured people by expanding public and private insurance coverage; and decrease healthcare costs.

Created by the Affordable Care Act, Health Insurance Marketplaces, also known as Exchanges, will be set up to facilitate a more organized and competitive market for buying health insurance, according to the Henry J. Kaiser Family Foundation’s website, Beginning in 2014, Marketplaces will serve primarily individuals buying insurance on their own and small businesses, the website said. Federal subsidies in the form of premium tax credits will be available to consumers meeting income requirements to make the coverage more affordable. States are expected to establish Marketplaces–which can be a government agency or a non-profit organization–with the federal government stepping in if a state does not set one up.

Under the ACA, states can elect to build a fully State-based Marketplace, enter into a state-federal Partnership Marketplace or default into a Federally-facilitated Marketplace, according to the KFF website.

Alabama’s Marketplace decision is listed on the website as a “Federally-facilitated Marketplace,” with the structure and type of the Marketplace “NA” (not applicable).

The Affordable Care Act directs the Secretary of Health and Human Services (HHS) to establish and operate a Federally-facilitated Marketplace in any state that is not able or willing to establish a State-based Marketplace, the KFF website said.

In a Federally-facilitated Marketplace, HHS will perform all Marketplace functions, while states entering into a Partnership Marketplace may administer plan management functions, in-person consumer assistance functions, or both, and HHS will perform the remaining Marketplace functions.

The ACA expands Medicaid coverage for most low-income adults to 138 percent of the federal poverty level (FPL) ($15,415 for an individual or $26,344 for a family of three in 2012). Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. For additional information on the cost and coverage implications of the Medicaid expansion, see the following KCMU resources: The Cost of Not Expanding Medicaid (July 2013) and Analyzing the Impact of State Medicaid Expansion Decisions (July 2013).

As of Sept. 16, the status of Alabama’s Medicaid Expansion Decision was “not moving forward at this time,” with Gov. Robert Bentley opposing and the Legislature out of session. Per CMS (Centers for Medicare and Medicaid Services) guidance, there is no deadline for states to implement the Medicaid expansion, the KFF website said.