Batesville Herald Tribune, Batesville, Indiana

January 7, 2014

New healthcare law requires consumer education

Jean Leising State Sen. District 42
The Batesville Herald-Tribune

---- — For many Americans, the federal Affordable Care Act remains a mystery. The new Healthcare.gov website appears to be improving, yet confusion regarding enrollment deadlines and provider options is widespread. Whether or not you like the idea of federal health care, it is important to be equipped with the facts to sufficiently plan for your family’s health care needs.

Some Indiana residents may be feeling the impact as they sign up to buy health insurance through the online marketplace set up by the federal government. Enrollment began Oct. 1, 2013 and ends March 31, 2014. Coverage was set to begin Jan. 1, 2014..

The federal government has made repeated attempts to apologize for the online marketplace’s substantial glitches, but the facts remain: certain Indiana residents must enroll online as soon as possible to receive coverage in 2014 and avoid paying a penalty in 2015.

You may have lingering questions and wonder if enrolling in the marketplace is the right decision for your health and finances. Many legislators—myself included—have those same questions, but as your state senator and a member of the Health Finance Commission, I want you to have as much information as possible.

Who can enroll?

The marketplace is mainly designed for those who do not receive health insurance through their jobs. In an effort to provide insurance coverage to more of these Americans, the health care law provides tax credits to certain income-eligible individuals who buy insurance from the marketplace. These tax credits are related to income, so people with less income receive larger subsidies.

What are the costs?

One of the most harmful taxes in Obamacare is the requirement that all businesses with at least 50 full-time employees must offer affordable health insurance or potentially pay a fine. The text of the law exempts employees who work less than 30 hours a week, leading some employers to cut their workers’ hours to avoid the penalty. For a business with 50 employees, the amount of the fine would be $40,000, and the penalty grows for each additional employee of the business.

Unfortunately, while some consumers may financially benefit through tax credits, insurance through the federal marketplace is subject to burdensome regulations, like limits on the premium discounts people can receive for maintaining good health. These regulations mean that many middle-class healthy Hoosiers will pay higher premiums than they do now – even if they buy insurance through the federal marketplace and receive tax credits to help cover costs.

When it comes to individuals shopping on the exchange, the costs vary widely depending on these variables: income, age and where one lives. In general, lower-income individuals and people in poor health will be able to pay less out of pocket for insurance than it currently costs because of federal tax credits.

Indiana residents should also note insurance companies are allowed to charge tobacco users up to 50 percent more than non-tobacco users, although the enforcement process is unknown.

What are the options?

For those in my district considering enrolling in the exchange, provider and hospital choices are extremely limited. Six out of seven counties in my district are limited to Anthem coverage only. Shelby county residents are eligible to receive either Anthem or MDwise coverage.

For most people, there are four levels from which to choose. Few people will qualify for a $0 payment option: Bronze Plan: You pay 40 percent and the plan pays 60 percent; Silver Plan: You pay 30 percent and the plan pays 70 percent; Gold Plan: You pay 20 percent and the plan pays 80 percent; Platinum Plan: You pay 10 percent and the plan pays 90 percent.

In addition, the deductibles and out-of-pocket maximums vary based on the plan selected and the state where an individual resides. For example, the out-of-pocket maximum for a bronze plan is $6,350 in Indiana, but the out-of-pocket maximum for a silver plan is also $6,350 in Tennessee. I strongly urge you to review the deductibles and out-of-pocket expenses by researching on www.healthcare.gov and selecting “Indiana.”

After reviewing the federal health care law’s impacts more thoroughly, the extremely limited options for southeast Indiana residents stem from a lack of insurance providers. Since Indiana’s marketplace insurance carriers are limited to Anthem and MDwise, many residents new to the exchange may have to switch health care providers. Physician options, hospital locations and even medication costs are limited on the exchange. Again, I strongly urge you to be cautious of these details when selecting your new plan.

Access to your preferred hospital or physician may still be available to you by applying for health insurance outside of the federal health insurance exchange, though tax credits are not offered for these plans. The benefits of keeping your preferred provider may outweigh the higher cost. Please check with a local health insurance agent for more information.

If you are interested in seeing how the federal health care law can affect your family, visit the following web addresses: www.healthcare.gov (Federal health care exchange), www.in.gov/healthcarereform (Indiana’s guide to navigating the federal health care law) or www.in.gov/fssa/HIP (Healthy Indiana Plan for eligible Hoosiers).

Leising can be contacted bye-mail at s42@in.gov or call 800-382-9467.