Follow up on Affordable Care Act (ACA) Obama care

 By Solomon Alemu Feyissa, M.D. 

This is a follow up to an article posted on this site on November 4, 2013 on affordable care act (ACA), Obama care. The writer encourages readers to read the original article (if they have not done yet) before proceeding with this one. 

ACA is a brand new law and is being rolled out with so many components and complexities and different moving parts. The very dynamic nature of the roll out necessitates the need for a follow up article to further explain and simplify the roll out process. 

ACA is going to affect us one way or other as health care providers or consumers of health insurance products/policies/plans therefore I encourage others to seek more information on the subject and share their opinion and contribute to overall understanding and publicity of the law particularly in the Ethiopian Diaspora community. 

For many people who don’t have current health insurance I would encourage them to visit state (depending on where you live) or federal exchange sites (www.healthcare.gov) and see if they can qualify for employer sponsored insurance, federal subsidies, Medicaid or other options. The only way to find out is by being informed and knowing our rights for health insurance under the new law. 17 states run their own health exchange/market place sites/programs while 27 have deferred it to federal exchange site and 7 states run a partnership with the federal government. We should take it on our selves to educate and help others in accessing this opportunity for health insurance. Even if some of us have employer sponsored health insurances I can assume than we have relatives and friends who could benefit from this new law. Doing so may save individuals and families thousands in health care costs. 

Additional information and updates since the last article posted on November 4, 2013 

Current mandates and exemptions

1. Large businesses with work force of >49 employees are exempted from mandatory employer sponsored enrollment for 1 more year.

2. Small businesses with work force <50 employees are exempted from optional enrollment for 1 more year. The incentive for small business owners to enroll is getting financial subsidies or tax credits/benefits/exemptions for costs related with employer heath insurance.

3. Individuals who provide their own insurance are mandated to buy a policy/plan/insurance before the end of March 2014 and currently no exemptions is provided. If not compliant will consequence in financial penalties which is going to be enforced by IRS during tax collection. 

Encouraging signs so far 

1. The roll out started by October first for federal and state exchange programs.

2. The law is getting much needed publicity and awareness.

3. Many uninsured people have visited state and federal exchange sites to shop for health insurances.

4. Consumers still have extra time to shop around for insurance policies/plans before making any choice/decision. (To get coverage by January 1, 2014 one must be enrolled by December 23, 2013)

5. Many uninsured people have signed up for state and federal exchanges so far even if the numbers are below expected.

6. Fixes to federal and state exchange programs are progressing well and showing encouraging signs. 

Ongoing challenges 

1. The law is causing some disruptions to existing individual insurance plans/policies.

2. Some people are not able to keep their individual policies or providers even if they like them and as a result are receiving letters of policy cancellation from insurers contrary to the promise made by the administration.

3. On going glitches and malfunction of the federal and state health exchange website making it difficult to shop around or sign up for plans/policies. Recent fixes are addressing this issue and making the sites much more capable and efficient. Worth mentioning that some state exchange programs are functioning very well including California, New York and Kentucky while other states exchanges are plagued with malfunction and glitches including Oregon.

4. Below expected number of people signed up for state and federal exchanges (around 100,000 signed up and 500,000 were expected)

5. Not many young and healthy people are signing up as expected which may adversely affect the risk pool if the trend continues.

6. More than expected people signed up for Medicaid (medical assistance) eligibility potentially making the program more expensive and costly for the federal and state governments than expected if the trend continues.

7. Continued opposition from republicans.

8. Only 27 states and DC are participating in the optional Medicaid (medial assistance) expansion. Other 21 states with republican governors or legislators continued to refuse to participate (opted out). Only 3 republican run states are participating (Ohio, Florida and Arizona) 

New fixes to address the challenges since the roll out 

1. Very aggressive measures to solve the glitches and malfunction of the federal online market place including bringing very capable individuals from the tech industry and allocation of extra resources to address capacity and speed of the exchange/website . This measure has already resulted in significant improvement of the online federal exchange/market place with regard to user experience, speed and capability. The site has improved tremendously and is capable of handling many more thousand policy shoppers at the same time with better speed and user experience. The improvement on the site is ongoing and is expected to make the system much more efficient, capable, fast and responsive to user experience. 

2. Plan to introduce legislation or some sort of regulation to offer options for individual policy holders to keep their plan for another year if they like their plan. ACA doesn’t guarantee this in its current form despite prior promises by administration to do otherwise. 

The writer encourages others to join the conversation and contribute to the discourse.

Tenayistilign : sign up to follow the blog for new postings.

About Tenayistilign

I am a physician trained at Jimma Institute of Health Sciences ( now Jimma University, in Jimma, Ethiopia) and Wayne State University ( Detroit, MI, USA). I teach and practice General Nephrology/Hypertension and Kidney Transplantation in the USA.
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2 Responses to Follow up on Affordable Care Act (ACA) Obama care

  1. IW says:

    Thank you Dr Solomon. Is it true people have to wait for a letter from the state if they are eligible for the Medicaid expansion. In other words, can people enroll into Medicaid expansion through the healthecare.gov?

    • solomon says:

      Very good question IW. First applicants should find out if they can qualify/meet criteria for Medicaid eligibility under the new law. Individuals under 65 years of age with income below 133 percent of the federal poverty level (FPL) ($29,700 for a family of four in 2011) will be eligible for Medicaid. For the first time, low-income adults without children will be guaranteed coverage through Medicaid in every state without need for a waiver, and parents of children will be eligible at a uniform income level across all states. Medicaid and Children’s Health Insurance Program (CHIP) eligibility and enrollment will be much simpler and will be coordinated with the newly created Affordable Insurance Exchanges.There are other non-financial eligibility criteria that are used in determining Medicaid eligibility. In order to be eligible for Medicaid, individuals need to satisfy federal and state requirements regarding residency, immigration status, and documentation of U.S. citizenship. If individuals think that they meet these criteria they don’t need to wait to receive a letter from the state rather they should be proactive and visit either a state exchange site(depending where they live) or a federal site (healthcare.gov) to apply. If one doesn’t meet the Medicaid criteria there are some other options including subsidized private insurance policies/plans and others. The exchange sites (either federal or state) should provide additional information based on individual situations.
      I guess I tried to address your question. Feel free to forward more questions.

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