Gazette opinion: ACA can help Montanans who know how to shop

2013-06-30T00:00:00Z Gazette opinion: ACA can help Montanans who know how to shop The Billings Gazette
June 30, 2013 12:00 am

Cost is the biggest health care concern for most Americans.

So it was encouraging to hear Monica Lindeen, state insurance commissioner, announce that policies to be sold by the new federal insurance exchange are expected to cost less than policies sold without the new law.

Lindeen’s figures are based on an independent actuarial analysis of policies that three insurance carriers plan to sell on the Montana exchange starting Oct. 1. The policies can take effect as early as Jan. 1.

Meanwhile last week, Sen. Max Baucus, who helped write the Affordable Care Act, reported that provisions of the new law had rebated $1.5 million last year to Montanans whose insurance companies overcharged them.

Eighty-seven percent of Americans polled this month by Kaiser Family Foundation said it is “very important” to them personally to have health insurance.

The same Kaiser poll found that 43 percent of Americans view the ACA unfavorably and only 35 percent have a favorable opinion of the complex law.

A major goal of the affordable care act is to provide insurance to more Americans. So why is support for insurance so much stronger than support for the ACA?

Part of the reason is that disapproval comes both from those who think it goes too far in changing the U.S. health system and from those who think it fails to go far enough.

However, the biggest challenge to implementing the law is that it is extremely complicated.

The U.S. Department of Health and Human Services must do a lot of explaining and public education by Jan. 1 to deliver on this health plan.

Covering the uninsured

In Montana, about 125,000 of us who don’t have health insurance will qualify for substantial federal subsidies to pay for policies sold through the new online shopping sites. The people qualifying for these subsidies are those whose income is between poverty level and 400 percent of poverty level. That means annual income between $11,490 and $45,960 for a single person or between $23,550 and $94,200 for a family of four.

People who have pre-existing medical conditions cannot be turned down for insurance and they cannot be charged more because they are sick or disabled. However, older customers can be charged more than younger ones.

Young invincibles

The ACA already requires group policies to allow parents to keep insuring their kids to age 26. About 12,000 young Montanans are benefiting from that provision, according to Baucus’ office.

Another special provision for young adults — age 24 and younger — is the option of purchasing a low-cost catastrophic policy not available to other age groups.

Poorest left out

In Montana, uninsured people with income below poverty level will be left out of the new insurance coverage. When the law was written, it required states to expand Medicaid coverage to everyone with incomes up to 133 percent of poverty level. But last year, when the U.S. Supreme Court upheld the ACA, it struck down the mandate for states to expand Medicaid. The Montana Legislature rejected Medicaid expansion this spring.

As Mike Dennison of the Gazette State Bureau has reported, about 97 percent of Montana’s private sector businesses have fewer than 50 workers. None of these small businesses will be required by the law to offer employee health insurance. However, small business owners may choose to offer insurance and they are free to shop for it on the new exchanges. Businesses with fewer than 25 employees also may qualify for tax credits on part of their costs of providing employee health coverage.

The three companies that are planning to sell policies on the Montana exchange are Blue Cross and Blue Shield of Montana, PacificSource and the new Montana Health Co-op.

Montana BCBS received state approval last week to merge with HCSC, the nation’s third largest insurance carrier. PacificSource entered the Montana market by buying part of New West’s insurance business. The Montana Health Co-op was founded last year by Montanans as a nonprofit carrier to increase competition in the Montana market.

We encourage Gazette readers to find out how the upcoming new insurance options will or won’t affect you. Mike Dennison presented an excellent primer on ACA changes affecting Montanans in front page reports on June 23 and 24. Web sites healthcare.gov for everybody and www.sba.gov/healthcare for small businesses, offer a lot of helpful information. It’s time for Montanans to become savvier about health insurance.

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