Moderated by Tom Sabulis
Starting Tuesday, millions of Americans can sign up for new healthcare options through the insurance exchanges established by the controversial Affordable Care Act, also known as Obamacare. As our lead writer points out, things remain murky. There are bound to be snafus and delays. So be ready to be patient. As one market analyst told the Wall Street Journal, this is still “a soft opening.” Nevertheless, as HHS Secretary Kathleen Sebelius writes, it’s a landmark day for citizens in search of health coverage.
Commenting is open.
By Ron Bachman
Insurance exchanges start operating today. Some states built their own exchange (14), some states partnered with the federal government (17), and some decided to let the feds build the exchange (19).
We are entering a confusing world of insurance exchanges, also called insurance marketplaces. There are state, federal, and private insurance exchanges. There are single and multiple carrier exchanges. There are exchanges run by consultants, agents, associations, and insurance carriers. What is a consumer to do?
The development of marketplaces, both government and private, will change the way insurance is bought and sold. It is a new way of connecting products with customers.
Looking for lower premiums? The “Affordable Care Act,” or ACA, has few features that will actually make insurance more affordable. Studies have indicated that mandates, premium restrictions, added benefits, single risk pools and price compression will raise premiums more rapidly than if ACA had never passed. The ACA requires insurers to “community rate” their products. Individuals and small groups will not get premium reductions for healthy behaviors.
Government exchanges are for individuals and fully insured small groups. Larger employers may be included after 2017. Government exchanges are likely to be used mainly by those qualifying for federal subsidies. Government exchanges are likely to attract poor risks and high cost claimants. The government exchanges will use government paid “navigators” rather than licensed insurance agents. The government exchanges will not offer supplemental products, life insurance, or other insurance products and services.
Private marketplaces have been around for many years, but have expanded as an alternative to government exchanges. Private marketplaces are the free-market solutions for access to coverage and affordable premiums. Private marketplaces will offer individual and group products that emphasize wellness and treatment compliance for those under medical care. Emphasis on patient compliance and personal responsibility are more likely to emerge from products offered through private marketplaces.
Private marketplaces provide a transition from employer-based insurance to consumer-centered insurance. Both large and small employers will be able to purchase health insurance through private marketplaces. Private marketplaces will serve fully insured, self-insured plan, early retirees and retirees. Employees will be able to choose individual plans from participating insurers.
We are in the beginning stages of a major market revolution. Government exchanges face a daunting task – connecting insurance carriers for premiums and coverage with IRS tax records for subsidies while meeting the needs of customers, and providing services for those eligible for other government insurance programs of Medicaid, CHIP, and Medicare. Expectations are high and delivery dates have been delayed. Technology links have been questionable. Privacy, data security, and accuracy at each stage will be critical to public acceptance of government exchanges.
As private marketplaces become available, each will offer varying types of products and services. Ultimately, the success and failure of each marketplace will lead to consolidation with winners offering better products, services, convenience, help, and information for the consumer. In the end, more product competition and price transparency will lead to more people being insured and lower insurance costs will prevail. This is the way free markets create affordable products and services that consumers want to buy.
So, what are we to do? For those who want ACA to succeed the results to date are not promising. For those wanting the failure and repeal of ObamaCare, be careful of what you ask for. Government failures usually result in more government solutions to fix the problems. For those already pointing political fingers at who is to blame remember the old saying – “Every system is perfectly designed for the outcomes achieved.” The country voted, the courts ruled, and now we may have to literally live and die with the results. Welcome to confusion.
Ron Bachman writes about health care issues for the Georgia Public Policy Foundation.
By Kathleen Sebelius
This January, millions of Americans will ring in the New Year with the security and peace of mind that has eluded them for decades: They will finally have quality health insurance.
For nearly 1.7 million of our fellow citizens here in Georgia, the opportunity to obtain new, quality coverage will only be a click, call or conversation away when the six-month open enrollment period for the new Health Insurance Marketplace begins Tuesday.
Meanwhile, the 85 percent of Americans who currently have coverage will continue to benefit from new rights and legal protections. In Georgia, there are more than 2.2 million people with private insurance who are now guaranteed access to free preventive services like cholesterol tests, mammograms and blood pressure screenings. A total of 123,000 young people in Georgia from ages of 19 until they turn 26 are now able to stay on their parents’ plan. Furthermore, nearly 100,000 seniors in this state are better able to afford their prescription drugs, as we close the Medicare donut hole.
It is all thanks to the new health care law, the Affordable Care Act.
We have a number of resources available to help you and your family learn about your new options under the new law.
Our website – HealthCare.gov – is a great place to start. We think you will agree that it is not your typical government website. When you visit, you will find that information is clear, user-friendly and interactive. There is even an online web chat feature – just as if you are shopping for shoes or clothing online. And there are strong security safeguards to protect people’s personal information from fraud.
If you’d prefer to speak with someone over the phone, we have staff standing by to answer your questions 24/7 — and in 150 languages — at our call center: 1-800-318-2596.
There are also people in your community who have been trained and certified to help you in-person, at places like community health centers and pharmacies.
Coverage under the Marketplace begins as soon as Jan. 1. But to access your new and better options, you have to enroll.
Make no mistake: The plans offered on the Marketplace will be actual, honest-to-goodness health insurance. By law, they must cover a set of essential benefits, including visits to your doctor, prescription medications, hospital stays and preventive care like cancer and cholesterol screenings. Furthermore, your insurance company will be prohibited by law from denying coverage just because you have a pre-existing condition like high blood pressure or diabetes.
More good news: Being a woman will no longer be a pre-existing condition. Insurance companies are forbidden by law from discriminating against a consumer or potential consumer just because she happens to be female.
Living without health insurance can feel like you are in a non-stop game of Russian Roulette. Even if you think that you are too healthy to need coverage, we are all just an accident or illness away from a devastating medical bill. We never know when we will make that unexpected trip to the emergency room, get into a car accident, get a sudden diagnosis or simply need a new prescription.
Without insurance, we have to pay for all these things out of our own pockets.
Thanks to the Affordable Care Act, it has never been easier or more affordable to obtain coverage.
Jan. 1 will be a new day for millions of Americans. Better options for better health are only a click, call or conversation away. But to get these better options, you have to enroll, starting Tuesday.
Kathleen Sebelius is secretary of the U.S. Department of Health and Human Services.