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3 Crucial Messages About Health Reform

3 Crucial Messages About Health Reform

Mia Poliquin Pross, Esq. is the Associate Director of Consumers for Affordable Health Care.

Since shortly after passage of the Affordable Care Act (ACA) in 2010, Consumers for Affordable Health Care (CAHC) has participated in a collaborative effort with 10 other organizations supported by MeHAF to get the word out on what the ACA will mean for Maine people. As part of this effort, CAHC conducts workshops across Maine where we often ask people: How many of you have heard that you must have health insurance in 2014?  Almost all raise their hands.  We then follow it up with this question: How many of you know that there will be subsidies that will help you pay for health insurance? 

Crickets.  No hands. 

Therein lies the rub, and our job as advocates during this critical year for implementation of the ACA. 

I venture to guess that many people reading this blog are health advocates or are otherwise "in the know" on health reform.  This year, our job as advocates is to remember that we know more than the average person, and to share what we know - as often as we possibly can. Our health care system (using that term loosely) is a complex, tangled web of laws and regulations and all sorts of variables and moving targets.  Putting all the wonk-talk aside, however, from our experiences at CAHC talking to real people on our HelpLine and in communities, here are 3 basic things about the ACA that all advocates and others in the know should tell people right now.

1.  "Yes, you are required to have insurance in 2014 or you may have to pay a fee at tax time, BUT most uninsured people in Maine will get help paying for that insurance."

Census data tell us that about 132,000 Mainers are uninsured. Of those, about 114,000 make less than $46,000 per year (400% of the Federal Poverty Level) and may qualify for subsidies when they enroll in a health plan through the Health Insurance Marketplace, (more about the Marketplace below). That means, over 86% of uninsured people in Maine will probably get help paying for their health insurance (or will qualify for MaineCare, pending state approval of the expansion). There are a lot of details that we can't cover here, but broadly speaking - if you're talking to a low- to middle-income uninsured person, chances are pretty good that they'll qualify for a break on the cost of their insurance through the Marketplace. NOTE: The penalty folks may have to pay with their taxes if they don't purchase insurance in 2014 (and don't qualify for one of the exceptions, including financial hardship) is $95 or 1% of income, whichever is greater, and it will go up gradually each year.  People cannot be put in jail for failing to buy insurance.

2.  "Buying health insurance will be a different experience than it is now, and you will be able to get help."

Maine people will be able to review the features of all qualified health plans in one place - the Health Insurance Marketplace. There will be a streamlined online application that people will fill out one time and see all plans available to them (in an apples-to-apples comparison) and all the assistance programs that they qualify for that will help them with the costs. If people don't want to use an online application, there will also be a paper application, and people can apply over the phone as well. If people need help filling out the application, understanding their options, or enrolling in coverage, the Marketplace will provide trained "Navigators" available in Maine to assist people one-on-one. Finally, the insurance being purchased will have a standard set of minimum benefits that cover the care most people need, and the information will be presented in a way that people can understand. 

3.  "Open enrollment starts October 1, 2013 and will last only until March 31, 2014.  If you don't enroll during this time, you may have to wait until the next annual open enrollment period."

The Health Insurance Marketplace will use "open enrollment" periods.  Outside of those periods, you can only enroll if you have a "qualifying event" (usually a major life event, like a job loss, divorce, birth, adoption, etc.).  Unfortunately, procrastination is not a "qualifying event." Open enrollment starts Oct. 1, 2013 for coverage that will start on Jan. 1, 2014.  The tail end of 2013 will be "all hands on deck" for advocates to educate as many Mainers as possible about this new option. 

Wouldn't it be great if Maine were the first state to achieve universal coverage under the Affordable Care Act?  With our relatively small uninsured population, it is an attainable target and one we hope to achieve.  CAHC is celebrating its 25th Anniversary this year and we couldn't be more proud of the important work we are tasked with in this monumental year.  We are also proud and happy to be working with a dedicated and passionate group of MeHAF grantees to inform Mainers about these new changes to our health care system. 

For more information, please visit CAHC's web site at www.mainecahc.org.  You can also find a lot of information at the official government web sites: www.healthcare.gov and http://marketplace.cms.gov.  Finally, Consumers for Affordable Health Care was designated in 2010 by Maine's Attorney General in conjunction with the Superintendent of Insurance as Maine's Consumer Assistance Program. Our toll-free, statewide HelpLine is always available to answer questions and help consumers understand their eligibility for health coverage and to appeal denials of health coverage: 1-800-965-7476.

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