Editor’s note: Next week “Affordable Health Care Act and the Small Business in Moab.”
Enrollment for the Affordable Care Act began Oct. 1.
Despite the government shut-down, enrollment has continued for the Act that was passed March 23, 2010. The mission of the act is to increase the quality and affordability of health insurance and to lower the cost of healthcare for individuals and the government.
More than 370,000 Utah residents, or approximately 13.2 percent of the population, do not have health insurance, according to the state’s Department of Health. The majority of uninsured are young adults, as approximately 20.9 percent between the ages of 19-26 are uninsured. For the 27-34 year olds, 26.1 percent do not have benefit of health insurance.
Also hard hit in Utah are self-employed workers also at 26.1 percent. Nearly 20 percent of part-time workers are also uninsured.
The Robert Wood Johnson Foundation, however, estimates that 17 percent of Utah’s population has no health insurance. That number increases for Grand County, with a whopping 23 percent without health insurance and 12.6 percent of the population falling below the federal poverty level.
Grand County’s employment patterns, which has several part-time and seasonal workers, as well as self-employed small business owners, follows the model for uninsured populations.
A mid-range, benchmark plan in Utah will average about $266 a month, according to the Health and Human Services Department. But rates can vary quite a bit depending on where a consumer lives, how old they are, how big their family is, and what type of coverage they choose.
The Moab Free Health Clinic was created to meet the needs of Grand County uninsured and under-insured population.
This year, according to program coordinator Anjelica Oien, they have served approximately 400 patients. They do not expect the implementation of the Affordable Care Act to have any impact on those numbers.
“The only thing that might change our numbers is the proposed expansion to Medicaid in Utah. We primarily serve people who make too much money to qualify for Medicaid, but can’t afford their own health insurance,” Oien said.
Utah is one of one of only seven states undecided on expansion of their Medicaid program. The rest of the country is split down the middle, typically by party rule, with half of the states accepting federal funds to expand Medicaid and half not.
“The only other impact we might see is for preventative care,” said Sean Buck, volunteer coordinator at the clinic. “Since preventive care is part of the Affordable Care Act package and will be covered by most policies, we would refer those patients to our local health care providers.”
Moab Regional Hospital Chief Executive Officer Robb Austin also does not expect any short-term impact to the hospital’s charity program or financial assistance programs.
“People who select high deductible plans and don’t have the money to pay for that first $5,000 of care, for example, will still need financial assistance,” he said. “But no one will really know anything until the plan goes into effect in January and even then, it will take at least nine months to a year to assess the impact.”
In the first days of enrollment on the ACA website, www.healthcare.gov, many users reported difficulty accessing the site and/or the inability to actually apply for the program. Two weeks later, most of the glitches seemed to be repaired.
There are four broad categories: Bronze, Silver, Gold and Platinum. In the bronze plan, the plan pays for 60-percent of the health care expenses and the individual or family pays 40-percent. In the silver plan, the plan pays 70-percent and the individual or family pays 30-percent. In the gold plan, the plan pays 80-percent and the individual or family pays 20-percent. In the platinum plan, the plan pays 90-percent and the individual or family pays 10 percent. There is also a catastrophic plan that is an option for those under 30 or those with very low income.
The Affordable Care Act follows the basic premise of traditional health insurance: The higher the payout, the higher the premium; The higher the deductible, the lower the premium.
Each policy takes into consideration age and family size resulting in different premiums. What won’t be taken into consideration are pre-existing conditions. The ACA strictly prohibits insurance providers from excluding those with previous health problems; they also cannot hike rates or cancel because of old injuries or health problems.
There is an opportunity to shop and compare plans before enrolling on the Affordable Care website.
Since Utah is one of 36 states that opted to let the federal government run its insurance exchange for individuals, all individual and family enrollments takes place through www.healthcare.gov. Small businesses enroll through AvenueH.
The enrollment period is from Oct. 1, 2013 through March 31, 2014. After that only special enrollment will be allowed. Special enrollment becomes possible when there is a significant change such as lost health insurance coverage, marriage, birth, or moving from one state to another.
In Grand County, four bidders are offering insurance plans: Altius Health Plans, SelectHealth, Regence/Blue Cross and Arches Mutual Insurance. Consumers are encouraged to read the small print when comparing plans. Some plans may have very narrow provider networks meaning your current health care provider or hospital isn’t on the approved list.
Urban Institute research suggests that 40 percent of Utah’s uninsured residents will be eligible for insurance assistance in 2014. Jason Stevenson, the communications director for the Utah Health Policy Project, said that older people with pre-existing health issues may see monthly premiums several hundred dollars less what they are now paying.
Those who don’t enroll for a health insurance policy will be penalized 1-percent of their income, or $95 per per adult and $47.50 per child, whichever is more, under the ACA law. The most a family would have to pay in 2014 is $285. Penalties will be collected through the 2014 federal income tax return.
In 2016, the penalty rises to 2.5-percent or $695 per person. The penalty increases each year to a maximum of 9.5-percent of your income.
There are many resources here in Grand County to help navigate the process.
Castle Valley residents Jil and Charlie Kulander are certified application counselors and will hold regular help sessions at the Moab Free Health Clinic between 10 a.m. and 1 p.m. beginning Thursday, Oct. 24. The free clinic will be hosting these sessions weekly through the end of the enrollment period.
Additional workshops will be held at the Grand County Public Library, Moab Regional Hospital and the Moab Free Health Clinic.