Humana allows policyholders to keep old plans without paying more; Anthem is still deciding

Humana, one of the three insurance companies offering individual health policies on the state's insurance exchange, will allow Kentuckians to keep their insurance coverage for another year without charging them more for it.

The other two companies on the individual market are Anthem and the Kentucky Health Cooperative. Anthem hasn't responded to recent inquiries about the old policies; it said last week that it was still deciding whether or not it would extend policies that don't comply with federal health reform. Since the non-profit cooperative is a new insurance organization, it is only offering policies that comply with the law.

A Humana spokeswoman told Kentucky Health News Monday that the company communicated premium amounts to individual policyholders in October when presenting policy owners with coverage options for 2014, including the option to continue their current plan. Those premium amounts for individual policies have not changed since the most recent changes to the Affordable Care Act, she said.

Some insurance experts have warned that consumers renewing noncompliant plans will be predominantly younger and healthier, while older and sicker people will migrate to the subsidized marketplaces, which could drive up costs for plans. Some states aren't allowing insurers to renew policies. For example, Washington Insurance Commissioner Mike Kreidler said he would not allow insurers to extend the policies “in the interest of keeping the consumer protections we have enacted,” reports Kaiser Health News.

In Kentucky, at least for Humana policyholders, this is not the case. President Obama said people whose policies were being canceled because they didn't comply with the law could renew them for another year if state regulators allow it. Gov. Steve Beshear gave insurers the green light to decide whether or not to renew these policies. Humana has decided to do so without charging additional premiums short-term.

Meanwhile, Anthem is deciding what to do and some existing policy owners in other states face as much as a 24 percent increase in their premiums. Obama's extension allows non-compliant policies to stay in place only for a year. This time next year, the transition must be made to plans that are qualified under the law.

At least one insurance company will let Kentuckians keep their health insurance plan for another year if they like it

By Molly Burchett
Kentucky Health News

At least one insurance company, Humana, will be allowing Kentuckians to keep their insurance coverage for another year if they like it, even if the policies aren't compliant with the Patient Protection and Affordable Care Act.

Partially owning up to his reforms' rocky rollout last week, President Obama said people whose policies were being cancelled because they didn't comply with the law could renew their policies for another year -- if insurance companies are willing to do so and state regulators allow it. Kentucky is among the states allowing them to do so, and Humana is going along.

Humana -- and Anthem Blue Cross, if it follows suit -- will be required to tell such policyholders "what protections these renewed plans don't include" and that they have alternatives that may be better and cheaper on insurance exchanges, Obama said.

“Humana has been educating people about the full range of options, including the ability to retain their current coverage, in accordance and coordination with state law," a Humana spokesperson told Kentucky Health News. An Anthem spokesperson said the company is still reviewing its options.

About 280,000 Kentuckians -- almost all those in individual and small-group insurance market -- faced policy discontinuation, requiring them to get different insurance coverage.

Experts say there are a number of obstacles that could keep insurers from letting customers renew old policies, including the concern that the risk pools of the state's health-insurance exchange will be skewed. And, insurers will have to calculate how much they plan to charge for policies that were going to be discontinued.

“Changing the rules after health plans have already met the requirements of the law could destabilize the market and result in higher premiums for consumers,” Karen Ignagni, the president of America’s Health Insurance Plans, a lobbying group, told The New York Times.

Some insurers say the president's move is adding to the confusion that surrounds the health-care law and adding uncertainty to the insurance market. This may discourage participation from a key group, young and healthy people who are needed to make insurance exchanges sustainable, reports The Washington Post.

There is doubt that insurance companies can do all of this in less than a month to ensure coverage is in place by Jan. 1. It is unclear how, as a practical matter, the changes proposed by the president can be put into effect, National Association of Insurance Commissioners President Jim Donelon said last week. And, even if they do, the proposed changes only last a year.

Primary care clinics added to Ky. Health Cooperative's network

The Kentucky Primary Care Association, a nonprofit charitable organization that promotes access to comprehensive primary health care services for the under-served, has been added to the Kentucky Health Cooperative’s provider network. This will significantly increase prospective members’ access to clinical providers, according to a press release from the co-op.

Physicians in member clinics will be added to the provider lists maintained by the co-op and Kynect, the state's online health-insurance marketplace, in the coming weeks.

The Kentucky Health Cooperative is a new, private, non-profit, consumer-governed health insurance company and is available through enrollment on Kynect. Its coverage begins as early as Jan. 1.

“We are pleased to add the Kentucky Primary Care Association’s physicians to our growing provider network,” said Janie Miller, the co-op’s chief executive officer. "This is a partnership between like-minded organizations that will potentially benefit tens of thousands of Kentuckians.”

Kynect allows consumers to compare and select insurance plans. Consumers can also determine if they qualify for premium payment assistance, special discounts or tax credits to help decrease the cost of services.

Find out more about Kentucky Health Cooperative at www.mykyhc.org or the its Facebook page. Information about the Kentucky Primary Care Association is at http://www.kypca.net/index.cfm.

New CEO of Owensboro Health says hospitals are working to improve care, regardless of federal health reform

Philip Patterson, the new CEO of the Owensboro Health, says hospitals are moving towards health reform regardless of what happens with the Patient Protection and Affordable Care Act.

Patterson is coming to Owensboro from Bon Secours Charity Health System in New York and New Jersey, a three-hospital system with net patient revenue of nearly $500 million.  Patterson says he wants to build a stronger network for regional care in the Owensboro area.

The Affordable Care Act has changed physician and hospital payment structures, encouraging wellness participation, Patterson said in an interview with Ryan Alessi of cn|2's "Pure Politics." Patterson said the law creates incentives for hospitals to keep patients from being readmitted, and to only provide necessary care.

Regardless of what happens with the law, health organizations and providers need to be more than providers, Patterson said: They need to be health partners to their communities, to improve community members' overall health by managing care through screenings and education.

The health care law penalizes health systems for providing care that is not needed, and it encourages a change in thinking for providers who need to start providing care more economically, said Patterson. One way to do that is by building a strong network of providers who coordinate care.

"To create a sustainable system, you've got to cover a unique and significant population," he told Alessi. To cover a larger geographic area in New York and New Jersey, Patterson said, he created a loosely affiliated network of independent facilities that all worked toward the common goals of improving care coordination and quality.

As a result of Medicaid expansion in Kentucky, which now covers households earning up to 138 percent of the poverty level, an additional 400,000 people may have health insurance coverage that have never had it before.

"There's always a cost when you build something new and try to integrate a population into it," said Patterson. Unfortunately, those who lack insurance tend to have lower education levels and potentially neglected health care needs as a result of not having coverage or the perception of not having access to health care, Patterson told Alessi.

"The process of making this [integration] work is going to be clearly on the structure of health care providers as they try to manage that population to keep them out of the hospital where the most expense is," he said. Provider networks can coordinate to manage disease processes before they require care, and education and communication about how to access care is crucial, Patterson told Alessi.

Asked what will happen to hospitals if the health law is delayed or repealed, Patterson said, "It really hasn't been rolled out yet. We are still in a wait and see mode in a lot of these pieces." He said if health care systems buy into the law's overall goals, and they are already working towards the goal of better health care management. "The issue is the infrastructure and how to pay for it," he said.

"Repeal? I don't know what's going to happen there. I think as long as the goals are to create a better health model for a community, you're going to work towards them anyway," said Patterson.

Uninsured young adults may qualify for high-deductible health coverage for $50 or less per month on state exchanges

Almost half of single young adults who are uninsured may qualify for coverage for $50 or less per month under federal health reform, according to a report from the U.S. Department of Health and Human Services.

HHS says young adults often qualify for lower costs on monthly premiums through tax credits based on family size and income. A single person's income must not be more than $45,960 to qualify for a tax credit, according to the Kynect website, and lower-income families receive the most assistance.

The federal report examined the 34 federally facilitated and state-partnership marketplaces and found that 46 percent of single young adults (ages 18-34) who may be eligible for coverage could purchase a "bronze" plan with high a deductible for $50 per month or less after tax credits, and 66 percent may be able to pay $100 or less for coverage. The report also found that "an additional 1 million eligible uninsured young adults may qualify for Medicaid in the states that have opted to expand the program in 2014."  (Read more)

Find out about your eligibility at Kynect, Kentucky's online insurance marketplace.

A Ky. guide to the Patient Protection and Affordable Care Act

By Molly Burchett
Kentucky Health News

Few laws have generated as much confusion, opposition or news coverage as the Patient Protection and Affordable Care Act. Despite the flood of news stories about the law widely known as Obamacare, there is still much confusion about it.

That's not surprising. The 906-page law is complex and is accompanied by 10,535 pages of regulations. This guide to the law is designed to clear up confusion and offer various perspectives about how the law may affect you, your family or your business.

What does the Affordable Care Act do?

The law is a set of reforms that impose many requirements on insurance companies and requires all Americans, with very few exceptions, to have health coverage or pay a penalty starting Jan. 1.

Kynect home page

In addition to those mandates, the law created online health-insurance marketplaces and encouraged states to expand the federally subsidized Medicaid program for the poor and disabled. Gov. Steve Beshear expanded Medicaid and decided the state would run its own marketplace or exchange, Kynect, which launched Oct. 1.

Why did Congress pass the law?

The law is designed to extend health coverage, either through private insurance or Medicaid, to Americans without health insurance. More than 47 million Americans were uninsured in 2012, says the Kaiser Family Foundation, and about 640,000 of them were Kentuckians.

The law's rules for insurance will increase costs for many, so it provides Medicaid or subsidized coverage to help qualifying individuals pay for coverage. Those with incomes under 138 percent of the federal poverty threshold qualify for Medicaid, and those with incomes up to 400 percent of the poverty line get premium subsidies. The line for a family of four is $23,550, so such a family would qualify for subsidies if it makes less than $94,200 a year.

Who will be affected by the law?

Obamacare will affect almost everyone, but it will have less impact on people 65 and up because they're eligible for Medicare. Virtually everyone must have health insurance coverage by 2014 or pay a penalty. Beginning in 2015, employers of 50 or more full-time workers (defined as working at least 30 hours a week) must provide coverage for their employees.

Insurance companies can no longer deny coverage because of pre-existing conditions such as a disability, pregnancy, or chronic disease. Under one part of the law that took effect early, parents are able to keep their children on their insurance until the children turn 26.

The law aims to help people who can't get affordable insurance through an employer or who aren't ineligible for public coverage through Medicare or Medicaid. It also affects the self-employed, small businesses and employees of businesses that don't provide coverage.

Because the law is making fundamental changes in the health-insurance system, "In the long run, pretty much every American will be affected by Obamacare," reports Abby Hayes of The Dough Roller, a financial-advice site. "Next year, employer-sponsored insurance premiums are likely to fluctuate as insurance companies adjust their offerings."

Will the law lower health costs?

It's too soon to tell what impact the law will have on costs. Remember, there are two types of health costs: the country's overall cost and the cost that you feel in your pocketbook from the money your household spends on health services.

If you buy an insurance policy through the state exchange, www.kynect.ky.gov, your cost will depend on your individual situation, such as the size of your household and the number of smokers in it, and your income, which will determine your eligibility for subsidies or Medicaid.

Most people who buy coverage in the individual market will pay higher premiums in 2014, mainly because companies are required to cover people with pre-existing conditions and a broader range of services, such as prescriptions, than many people have been paying for.

Rates in the individual market will change yearly, as explained in a report from the Kaiser Family Foundation. It says the broader coverage, and limiting surcharges due to age, will spread the overall cost of care across the insurance marketplace, tending to lower premiums for people who are older and sicker and raise them for people who are younger and healthier. Thus, the trade-off for pre-existing coverage is the individual mandate, which requires everyone to purchase coverage to spread the cost.

Think of it this way: When you go out to eat with two grade-school children, they can order off the kids' menu, so you pay less for their smaller portions. The total bill is $30. Your kids' chicken finger platters are $5 each, and you and your spouse both have $10 items. However, if the restaurant must charge all patrons equally for the same meal, the $30 cost would be assessed differently. The cost for each individuals would be $7.50; the cost of your kids' meals would be higher and you and your spouse's meal would cost less.

Many Kentucky businesses have expressed concern about rising premiums for employee coverage. Some are moving to high-deductible plans that require employees to pay a larger share of their costs, and some may drop coverage, letting employees obtain insurance and subsidies through the government exchanges.

How do I get coverage from the exchange?

The Kynect website will determine your eligibility for Medicaid or subsidies, allow you compare plans and process the insurance application. If you don't have a computer, you can call toll-free to 1-855-459-6328 to apply or locate a local "Kynector."

Unless you qualify for a special enrollment period, you must enroll in a health plan by March 31, 2014. A "life-changing event," such as moving to a new state, major changes in income and changes in family size, can make you eligible for a special enrollment period, says Healthcare.gov, the federal website. (Kentuckians do not use the federal site because the state has its own site, Kynect.)

The date coverage starts depends on when you buy it. If you enroll before Dec. 15 and pay your first premium, your coverage starts Jan. 1. Likewise, in succeeding months, if you enroll between the 1st and 15th, your coverage starts on the 1st of the next month. If you enroll after the 15th, coverage starts the month after the next one.

What do the health plans cover?

Regardless of which plan you chose, the law requires all plans offered by any insurance company to cover these essential health benefits:

1. Ambulatory patient services (outpatient care)
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance abuse services (including behavioral health treatment)
6. Prescription drugs
7. Rehabilitative and habilitative services/devices
8. Laboratory services
9. Preventative, wellness, and chronic disease management services
10. Pediatric services (including oral and vision care) 

What will I pay for a plan?

Premiums depend on individual circumstances, such as income and the level of coverage, such as the amounts of deductibles and co-payments. Kynect is connected to federal databases — including Internal Revenue Service databases — to determine whether you qualify for assistance in paying a premium. People on Medicaid do not pay premiums.

Plans on Kynect vary widely. In addition to comparing premiums, it is important to consider deductibles, co-payments and other plan details. Kynect offers four basic types, labeled bronze, silver, gold and platinum. Bronze plans have the lowest premiums but have a $6,300 deductible. As you move up the plan spectrum to platinum, your premiums increase and your deductibles decrease. The exchange also offers people under 30 a plan that provides only catastrophic coverage with a "very high deductible" and no subsidy.

Let's consider a basic example. A 45-year-old Floyd Countian named John Smith earns $36,000 a year, which means he is eligible to buy subsidized insurance through Kynect.

The individual market in Floyd County is limited to two companies, Anthem Blue Cross and the non-profit Kentucky Health Cooperative; Humana Inc. isn't offering individual coverage there. Depending on the type of plan John chooses, his premiums will range from $182 (bronze) to $421 (platinum), with deductibles ranging from $6,300 (bronze) to $500 (platinum).

Kynect shows selected plans' ranges of premiums, 
deductibles and out-of-pocket limts.

John has several options. Let's say he decides that he needs to keep his premium payments below $250 per month because he just bought a house and is on a tight budget. He doesn't expect to have many doctor visits because he's pretty healthy, but he doesn't have enough money saved to afford a $6,300 deductible if things went south.

Considering his obligations, John decides to set aside 15 percent of his monthly income for health care. Based on this budget, he narrows his options down to three plans. The Kynect website displays them.

After eliminating the gold plan, John decides he would prefer to pay an additional $40 per month to reduce his deductible to $2,000, so he purchases the cooperative's PPO Silver plan. About 7 percent of his income each month will go toward the premium. He will save the other 8 percent ($240) to apply to his deductible, prescription drug costs and co-pays for office visits.

A $2,000 deductible means that John must pay all of his medical costs, excluding certain preventive services like immunizations and screening, until he reaches this threshold. Co-payments and premiums cannot count toward the deductible.

John really likes his family doctor, whom he's been seeing for 20 years, and the doctor is in the cooperative's network. This plan has a $30 co-pay for primary care and mental health services, and he feels comfortable paying this amount for an office visit. If he were to see an out-of-network doctor, he would pay co-insurance: 60 percent of the doctor's full charge for the visit. For prescription drugs, there is a $500 deductible, and John will pay $20 per prescription for generic drugs after reaching this amount.

John has peace of mind knowing that he's covered if he were to have an accident. The total amount he may have to pay each year is his out-of-pocket limit of $6,350, and since he has purchased this plan during the enrollment period, he will not face a penalty for not having coverage.

As he navigates the site, John sees that he qualifies for a payment assistance in the form of a tax credit that will either reduce the amount John will pay in taxes or increase his refund, depending on his personal situation; or it will reduce his monthly premiums, if he so chooses.

What happens if I don't get covered?

The penalty for 2014 will be the larger of either $95 per adult and $47.50 per child under 18, up to a total of $285 per family or 1 percent of household income in excess of $10,000 for an individual or $20,000 for a family.

For example, let's say an individual making $40,000 per year doesn't buy health insurance in 2013. This person would would pay 1 percent of $30,000, or $300, in 2014. What about a family with a $50,000 household income? It would pay a penalty of 1 percent of $50,000, or $500.

The initial penalties are much less than the cost of health insurance, but will go up each year. The minimum penalty may increase to as much as $695 per person by 2016.

What if I'm on Medicare or Medicaid?

Almost nothing will change if you have coverage through Medicaid, but there are some changes for Medicare beneficiaries. The law doesn't require Medicare beneficiaries to buy more insurance and won't force beneficiaries to see different doctors, reports Andrea Adleman of U.S. News.

Obamacare does, however, increase premiums or prescription-drug costs for some Medicare beneficiaries, and it mandates $716 billion in Medicare payment reductions over the next 10 years. These cuts are made by changing payment formulas for hospitals, nursing homes, home-health agencies, hospice agencies and Medicare Advantage plans, says the Congressional Budget Office.

The law already affects higher-income Medicare beneficiaries. Those who earn more than $85,000 ($170,000 for a couple) are paying higher Part B premiums, which cover physician and outpatient services, and for Part D, which covers prescription drugs, says Kaiser Health News. As a result of this sliding scale, about 5 percent of Medicare beneficiaries are paying more for premiums and prescription drugs.

It is projected that by 2019, 7.8 million beneficiaries will be paying the higher Part B premiums and of that group, 4.2 million will pay the higher Part D premiums. Kaiser estimated the combined premium in 2019 would be $299 to $683 a month, depending on income.

However, typical Medicare beneficiaries, those below the $85,000/$170,000 income threshold, will pay less for their premiums since the the law closes the "doughnut hole," the coverage gap in prescription benefits, by 2020. The National Council on Aging estimates the savings could reach $1,800 for some beneficiaries.

Also, both Medicaid and Medicare beneficiaries will qualify for more free preventive care, such as a yearly wellness visit, vaccinations and colorectal screenings, starting Jan. 1.

What if my employer covers me?

About 57 percent of Americans have health insurance through an employer with fewer than 200 employees, and those who are covered do not have to purchase a new plan on Kynect. If your employer’s plan covers less than 60 percent of allowed medical expenses, or costs you more than 9.5 percent of your household income, you can shop on the exchange.

Over the past 10 years, employers have been shifting more health costs to employees. Worker contributions increased 89 percent during the decade, and are 14 percent higher than in 2009, Kaiser Health News reports. So, while the nature of your work plan may be changing, this is not a direct result of the health law.

If you aren't covered by your employer or if your employer decides to drop your coverage, you must obtain coverage or face a penalty. Religious conscience and hardship exemptions to this mandated coverage exist, and you will need to complete an application to request such an exemption.

What if I'm an employer?

Steve Wilson, senior vice president of Benefit Insurance Marketing in Lexington, said in an email that employers with fewer than 50 employees are facing 2014 premium increases that may lead them to drop coverage for their employees.

Wilson said unless companies act quickly to renew early based on 2013 underwriting rules, the average 2014 renewal for his company's small business clients will increase 63 percent. He said his clients represent a broad range of industries that will, on average, pay $3,508 more per employee for coverage next year.

On the other hand, a study by the RAND Corp. says Obamacare could alleviate some of the difficulties for small employers by putting their employees into a single risk pool. The study predicts that the number of workers offered coverage will increase after the reform, mainly because more small businesses will offer coverage.

If you have a small business with 25 or fewer employees, there may be significant tax credits available through Kynect to help cover the cost of insurance.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

GOP claim that Obamacare will hike Kentuckians' premiums 34 percent is 'mostly false,' Herald-Leader says in an analysis

A Republican Party claim that Obamacare will raise Kentuckians' health-insurance premiums 34 percent is mostly false, the Lexington Herald-Leader said in a news analysis Saturday.

The National Republican Senatorial Committee made the claim in a news release attacking Democratic U.S. Senate candidate Alison Lundergan Grimes. It said, "In Kentucky, individuals will see a 34 percent increase in their health-care premiums," citing a March report by the Society of Actuaries.

But the report itself cautioned, "We suggest readers carefully consider possible variations in outcomes and the actions of competitors and regulators when using this report. We suggest that actual per-member, per-month figures generally should not be used."

And one author of the report told Herald-Leader reporter John Cheves, "We didn't even try to predict the future of premiums in that study." Randy Haught, senior scientist at Dobson | DaVanzo, a health-care consulting firm, said the study "is a heck of a lot more nuanced than that."

Read more here: http://www.kentucky.com/2013/10/25/2894759/campaign-watchdog-gop-claim-that.html#storylink=cpy

Cheves cited other health-care experts in writing, "Because there are so many variables involved and changes coming to the marketplace, it's impossible to accurately predict the law's impact on premiums."

The study did make some projections. "The NRSC picked one number from one of many charts in the 83-page report," Cheves reports. "That chart dealt with the small subset of Kentucky's population that would not be covered by employers' insurance plans or Medicaid," about 7 percent of Kentuckians. Using several variables, it estimated premiums for individual policies would average $398 a month, up from $297.

"Though premiums may rise for some Americans, particularly young adults who typically avoid big medical bills and therefore have enjoyed lower rates, different factors will push costs up and down," Cheves writes. "For example, Americans with existing medical problems now will be allowed to buy insurance, which will increase prices overall. At the same time, young people who have avoided insurance are expected to enroll, helping offset that impact. In addition, the law provides for subsidies and tax breaks to lower the final costs for many consumers."

The newspaper's "mostly false" label in its "Campaign Watchdog" series is the next-to-worst on its rating scale, between "false" and "half true."

Ky.'s successful rollout of health-insurance exchange prompts New York Times to profile Beshear as 'a man on a mission'

A weekend article in The New York Times describes Gov. Steve Beshear as a man determined to prove that the health-reform law works, and says Kentucky stands out in many ways while the federal government is struggling to fix its health-insurance website. While comparisons are difficult, Trip Gabriel reports that Kentucky's health insurance marketplace is "one of the most successful" in the country.

Kentucky is the only Southern state to operate its own insurance exchange as well as to expand Medicaid coverage. "It is an anomaly on the polarized political map, and a test — in a red state that has elected to the Senate Mitch McConnell, the Republican leader, and Rand Paul, a tea-party favorite — of whether bitterness over the law will dissolve if people decide it effectively provides affordable health care," Gabriel writes.

Gov. Steven L. Beshear, right, with employees at Kynect 
headquarters. He has said Kentuckians do not have to 
like President Obama or him to like the new health care law.

President Obama said last week that Kentucky may have had the most successful exchange launch. As of last week, some 34,000 Kentuckians had begun applications on Kynect, and more than 11,000 had signed up for plans.

At the federal level, exchanges have been plagued by technical "glitches" and to date, the Obama administration has failed to release official enrollment numbers. The Republican National Committee said Monday it was sending a Freedom of Information Act request to the Centers for Medicare and Medicaid Services, seeking Obamacare enrollment numbers, reports Caroline May of The Daily Caller.

About half a million people have started applications on the federal exchanges, administration officials said Saturday. The figure is only a snapshot of applications, and since the administration isn’t planning to release until next month the number of people who have actually enrolled in a health plan, much is left unsaid, writes Joanne Kenen of Politico. For now, it can only be said that Kentucky may have the most successful roll-out, and the governor is determined to make success a certainty.

Beshear told the Times his decision to embrace the law was not political. “To me this was a moral decision,” he said. “We’ve got 640,000 Kentuckians who don’t have access to any kind of affordable health care. The last ranking I saw, we’re 44th out of 50 in health status. You take any chronic disease or condition — heart disease, cancer, smoking, obesity, you name it — and we’re either the worst or close to the worst.”

In embracing the law, Beshear decided not to seek approval from the General Assembly for the exchange or the expansion of Medicaid, moves that brought a lawsuit and a circuit-court ruling supporting him. The state Supreme Court has been asked to hear the case, brought by tea-party activist David Adams of Nicholasville. Beshear said in a recent op-ed piece in the Times, "To those more worried about political power than Kentucky’s families, I say, 'Get over it.'"

“Steve Beshear is a man on a mission,” Al Cross, the director of the University of Kentucky's Institute for Rural Journalism and Community Issues, publisher of Kentucky Health News, told Gabriel. “He no longer has to worry about politics.” Beshear, who is in his second term, cannot seek re-election in 2015.

While many Kentuckians are concerned about Obamacare's effect on their health insurance or the state budget, Beshear blamed the law’s unpopularity on Republicans who were "demonizing" it. "You don’t have to like the president; you don’t have to like me," he told Gabriel. "Because this isn’t about him, and it’s not about me. It’s about you, your family and your children. So do yourself a favor. Find what you can get for yourself. You’re going to like what you find."

Here are tools and resources to help you understand how the health reform law impacts you, your family and your business

By Molly Burchett
Kentucky Health News

The rollout of the insurance-buying section of the Patient Protection Affordable Care Act started Oct. 1, and regardless of where you stand on the law, it's important to be informed about what will happen Jan. 1 when the law's major provisions are set to go into effect. To help you understand how the health law impacts you, your family or your business, the Foundation for a Healthy Kentucky has compiled a list of links to information about the health law.

The law, informally known as Obamacare, is a set of health care reforms signed into law by President Obama on March 23, 2010. The law includes insurance mandates and requires everyone to have health insurance or pay a penalty starting Jan. 1.  In addition to insurance mandates, both the establishment of online health-insurance exchanges and expansion of Medicaid are two essential elements of the law.

In June 2012, the Supreme Court upheld the health law in a 5-4 vote, saying its requirement that most Americans obtain insurance or pay a penalty was authorized by Congress’s power to levy taxes. The Internal Revenue Service will administer that provision of the law. The court ruling limited the law’s blanket expansion of Medicaid, which attempted to require all states to expand the program in order to receive federal funding, saying that each state could make its own decision.

The Kentucky Health Benefit Exchange, Kynect, was established in July 2012 and opened for enrollment Tuesday. Calling it “the single-most important decision in our lifetime for improving the health of Kentuckians,” Gov. Steve Beshear announced his decision to expand Medicaid in Kentucky in May. As a result of this decision, Medicaid has expanded to provide coverage to Kentuckians under 65 in households up to 138 percent of the federal poverty level—currently $15,856 for an individual or $32,499 for a family of four.

About 640,000 Kentuckians are uninsured, and 308,000 of them qualify for expanded Medicaid because their incomes are less than 138 percent of the federal poverty threshold. The remaining 332,000 Kentuckians must purchase private insurance through Kynect. Of those purchasing private plans, an estimated 83 percent will be eligible for at least some tax credit to do so, reports Kentucky Voices for Health, a group of health-reform advocates.

Currently, the federal government pays 71 percent of Medicaid costs, and the state covers 29 percent of the costs. Under Medicaid expansion, the federal government will cover 100 percent of the costs of the newly eligible people for the first three years. Starting in 2017, the federal government will cover 95 percent of the costs for this expanded population, and federal funding will phase down to 90 percent by 2020.

The Kentucky Voices for Health presentation, found here, gives more details about the overall purpose of the Affordable Care Act and its implementation in Kentucky. Get Covered Kentucky, a coalition spearheaded by Kentucky Voices for Health, compiled additional information about Medicaid expansion. Click here for these tools and resources.

Beshear says Medicaid expansion is the right choice for Kentucky, providing numerous reasons and county-level data to explain why not expanding the program would hurt both Kentucky’s health, which already ranks poorly in many health categories, and taxpayers’ bottom line. Click here to see the impact of health reform on your local community.

You may be eligible for coverage through Medicaid or tax subsidies to help you purchase private insurance. Go the the Kynect website to determine your eligibility for Medicaid coverage or private insurance subsidies and to enroll Medicaid, the Kentucky Children’s Health Insurance Program or private plans. "It’s easy to apply, with just one application to fill out. When you apply online, you get enrolled quickly. We also have insurance agents and Kynectors who will help you apply using computers," says the website. If you want to apply by mail or fax, click here for paper applications.

The law does not require small employers (businesses with 50 or fewer employees) to provide insurance coverage. If you own a small business with 25 or fewer employees, there may be significant tax credits available through Kynect to help cover the cost of insurance. Since the mandate to cover employees has been delayed for a year, businesses with more than 50 employees will not face penalties in 2014 for not providing health insurance, but they may face penalties starting in 2015.

The foundation resource page includes additional resources to help you understand health reform efforts at the federal level, including those from the Kaiser Family Foundation, which includes a subsidy calculator, the Robert Wood Johnson Foundation and a fact page from the U.S. Department of Health and Human Services. In addition, a foundation report outlines how the health law creates opportunities to address public health issues, decrease health disparities and reform care delivery.

Ky. Health Cooperative, a new kind of insurer, could help hold down rates and reshape the health-care system

By Molly Burchett
Kentucky Health News

FRANKFORT, Ky. -- A little-known but key part of federal health reform created a new kind of health insurance -- a cooperative that is neither public, like Medicare and Medicaid, or run for profit, like traditional insurance companies. And the Kentucky Health Cooperative is offering coverage this week, with the opening of the state health-insurance exchange.

Kentucky is one of 23 states with plans the law designated as Consumer Operated and Oriented, or "co-ops," designed to give for-profit companies more competition and hold down rates. The plans have received more than $2 billion in federal loans to build themselves from scratch, but have been operating largely under the radar.

Janie Miller (Associated Press photo)

"The co-op program is an extremely little known part of the Affordable Care Act," Kentucky Health Cooperative CEO Janie Miller said in an interview with Kentucky Health News. "It's been very difficult to get people to understand what the co-op is and why they should care."

The Co-Op provision was a political compromise in the Affordable Care Act, developed as an alternative to the "public option" of a government-run plan. "It's the closest thing you can probably get to a public option," said Miller. “We [cooperatives] are created to be the non-profit options in most states… specifically for the uninsured and under-insured. ”

But the co-op could also help all insurance buyers, by pushing private insurers to set premiums lower than they would without non-profit competition. "Since we are non-profit, we don’t have to add a profit margin to our products, so our price should be competitive," Miller said. 

"We believe the addition of the Kentucky Health Cooperative will be positive for Kentucky consumers by bringing more competition to the market," said Ronda Sloan, spokesperson for the state Department of Insurance, which approves premium rates. "While Humana is offering a limited service area, both Anthem and the Kentucky Health Cooperative are offering plans statewide."

Development of the co-op

The creation of this new type of insurance began in Kentucky when Joe Smith of the Kentucky Primary Care Association, a lobby for primary-care clinics, got a call from Beam Partners of Atlanta, a consultant to health plans and cooperatives, offering to help create a co-op. Smith, who spent five years organizing health cooperatives in Alaska before becoming executive director of the Kentucky group, recruited other board members and Miller, who was recently secretary of the state Cabinet for Health and Family Services.

The cooperative was the only applicant in Kentucky for the federal loans. It received $11.9 million in start-up loans and is in line for $46.8 million of reserves from the federal government. The reserve money allows the co-op to meet state requirements for solvency and enter the insurance market.

Miller said the application process was community-driven and required a business plan and an extensive feasibility study estimating how many people the co-op would likely insure. It estimates 31,000 in the first year and 65,000 after 20 years.

"That's about 10 percent of the uninsured market that would be eligible for the exchange and not the Medicaid expansion" under the reform law, to people with incomes up to 138 percent of the federal poverty level. The exchange offers tax credits to make its coverage more affordable.

In return for the federal money, and to promote sustainability and accountability, the co-op must reach specific milestone requirements to receive all of the money from the Center for Consumer Information and Insurance Oversight in the Centers for Medicare and Medicaid Services.

"Is it an uphill battle? Absolutely," Miller said.

The co-op has some limits

The law bars the cooperative from using federal loan funds to for marketing and advertising, but it is required to do education and outreach, such as press releases and community presentations, and it has hired a Louisville public-relations firm, New West, to raise its profile.

"We are finding that a lot of people, especially people who did not have insurance, don't necessarily value having health insurance every month like we do," Miller said. "But they see the value when they need health services . . . so we are doing a lot of education about what the patient protections are and about the new affordability programs" in the law, including the cooperative. Insurance from the co-op can be bought on the state health-benefits exchange, branded as Kynect, directly from the co-op website and from many brokers and agents in Kentucky..

Kentucky Health Cooperative is modeled after other successful cooperatives, such as the Group Health Cooperative of Seattle, which was founded in 1947 and has evolved from a single clinic to an organization that delivers higher-quality, affordable coverage and care to more than 650,000 members, the group's executive director of public policy said at a Co-Op Federal Advisory Board public hearing.

In preparing to launch plans on the Kentucky exchange, Miller said, the cooperative's biggest challenge has been time constraints.  The co-op has outsourced its claims processing and call center, but will have 55 employees when fully staffed by Dec. 1, Miller said. It has partnered with ProCare Rx for prescription benefits.

Since the cooperatuve is new, it had no historical data about specific claims and collections, so it contracted with Milliman, an actuary with access to millions of claims for new carriers entering the market, to ensure that health plans were adjusted for a pool of members whose risks might be higher than usual.

The cooperative's business plan projects that about 75 percent of its sales will cover individuals directly, and 25 percent will cover employees of small businesses.

What's really different?

The cooperative is a non-profit, consumer-governed health plan, where consumers can become engaged and have a say in the health plan's affairs, says Miller. "There's something about health care that says it shouldn't all be for profit."

Smith said the co-op "provides an opportunity for a value-based system that goes beyond the bottom line."

The co-op will be directly responsible to its policyholder-members because it they will govern it. By January 2016, all of its board members will have been elected by co-op members, said Miller. “Not only that, but if we collect revenues above expenses, that money goes back to our members in the form of better benefits or lower premiums,” she said.

Miller said there's another inherent possibility in the co-op's consumer governance design to engage consumers and educate them. If the ownership is truly educated, the whole design of health care can be shifted from "treat them and street them" to a focus on quality care. Members "can start putting demands on the institution that they own to start being a true health care system. That's the dream, that's the goal," said Smith.

Kentucky, Louisiana, South Carolina and Tennessee are the southern states with cooperatives. Click here for the complete list and funding totals.

Kentucky poverty rate is fifth highest in U.S., but a larger share of Kentuckians had health insurance in 2012 than in 2011

By Molly Burchett
Kentucky Health News

In 2012, as U.S. incomes remained lower and poverty rates higher than in 2007, the year before the recession, Kentucky poverty rates increased and one in four Kentucky children were living in poverty, according to estimates released Thursday by the U.S. Census Bureau. However, the percentage of Kentuckians with health insurance increased.

Kentucky had the fifth highest percentage of residents living in poverty (19.4 percent) in 2012, up from 18.8 percent in 2011. It ranked behind Mississippi (24.2 percent), New Mexico (20.8), Louisiana (19.9) and Arkansas (19.8). However, it was statistically tied with the last two states for third place because the error margin for the estimates is plus or minus 0.5 percentage points. Nationally, 2012 was the second straight year that the U.S. poverty rate had failed to improve. It remained at 15 percent, with 46.5 million people earning at or below the federal poverty line. Click here for an interactive poverty rate map from Stateline.

These findings highlight the challenges that Kentuckians face regarding economic security relative to the rest of the country. The high poverty rate should also act as a warning since it presages troubles with education, health and other areas, Terry Brooks, director of Kentucky Youth Advocates, told Chris Kenning of The Courier-Journal.

The figures are three-year rolling averages from the American Community Survey, a continuing poll of Americans. It estimated that 595,260 Kentuckians were uninsured in 2012, indicating an uninsured rate decline to 13.9 percent, from 14.7 percent. Overall, the U.S. uninsured rate dropped from 15.7 in 2011 to 15.4 percent in 2012, with the number of the uninsured statistically unchanged at 48 million. Insured rates tend to rise as employment rises.

Among the estimated 1 million Kentucky households earning less than $25,000 a year, 22.6 percent do not have health coverage. Kentuckians aged 19 to 25 had the highest percentage of unisureds for a specific age group; about 400,000 Kentuckians are in that group, and 28.1 percent of them are uninsured.

The national decline in the uninsured rate was modest compared to a bigger drop in 2011 that resulted from the federal health reform law that allowed people 26 or younger to be covered on their parents' plans. The slight dip in the national uninsured rate for 2012 was due mostly to increases in government coverage, such as Medicaid and Medicare.

Nationally, the coverage by employer-provided health insurance for people under 65 remained stable. Kentucky, Michigan and Vermont were the only states to see a statistically significant increase in the rate of private health insurance coverage from 2010 to 2012.

The Census Bureau's American FactFinder report generator provides specific information about health insurance coverage.  For example, the chart below comes from a report about the types of health insurance coverage for specific age groups, and it shows estimates of the types of coverage for Kentuckians ages from 35 through 64.

When the main provisions of the health law take effect in 2014, expansion of the state Medicaid program with federal money is expected to provide free health care to as many as 308,000 Kentuckians at up to 138 percent of the federal poverty level -- currently $15,856 for an individual or $32,499 for a family of four.

The state will also offer federal tax credits for Kentuckians who lack job-based health insurance and buy private coverage through the new state health insurance exchange, Kynect, which opens for enrollment on Oct 1. Click here to read more about Kynect or to check your eligibility for coverage or subsidies.

Earlier, the Census Bureau reported there were 46.5 million people in the U.S. living in poverty median household income remained steady from the year before and was $51,017. Kentucky had a median household income of $46,362 in 2012, compared to the U.S. median of $51,371.  Click here for an interactive median income map from Stateline.

State health-insurance exchange plans to make smokers pay 40 percent more for coverage; varied interests, observers object

By Molly Burchett
Kentucky Health News

Supporters of the Patient Protection and Affordable Care Act have touted its goal to provide health insurance to all Americans without discrimination, such as prohibiting insurers from denying coverage due to pre-existing conditions. But it allows them to charge smokers more for it, and the officials running Kentucky's health-insurance exchange plan to do just that.

When Kynect, the state's online insurance exchange, opens Oct. 1, smokers can expect to pay up to a 40 percent surcharge, not far from the 50 percent limit in the law. That has brought objections from a wide range of observers, including tobacco companies and anti-cancer activists, saying it may be well-intended but is unfair and may backfire.

"Ranked No. 1 in adult smoking and cancer deaths, Kentucky should be doing all it can to bring tobacco users under the care of medical professionals. Yet some Kentucky smokers — perhaps many — will still be unable to afford health insurance, even after historic reforms take effect next year," says a recent Lexington Herald-Leader editorial. In 2011, the last year for which figures are available, 29 percent of adult Kentuckians smoked, and that does not include those who use smokeless tobacco.

UPDATE, Sept. 11: The state Department of Insurance says the 40 percent is a ceiling, and some companies are charging less, but 40 percent is the most common tobacco surcharge on health insurance policies sold in Kentucky. "There are health care costs associated with tobacco use," spokeswoman Ronda Sloan said. "With no tobacco use surcharge, insurers would have raised rates for everyone to offset those costs. . . . Plans will provide benefits for tobacco use cessation."

Seven states (California, Connecticut, Massachusetts, New Jersey, New York, Rhode Island and Vermont) and the District of Columbia will not charge smokers higher premiums. Connecticut voted against a smoking surcharge for individual policies, saying higher individual rates would disproportionately penalize poor people who tend to smoke.

Surchage critics in Kentucky agree. "This penalty is being applied to the working poor and medically indigent," writes Dr. Kevin Kavanagh, chairman of Health Watch USA, in a Herald-Leader op-ed. "Tobacco use is inversely related to education and income. In Kentucky, 48 percent of adults without a high school diploma smoke. These are the working poor."

Since most smokers tend to have lower incomes, the surcharge could discourage them from signing up for coverage at all because they can't afford it, restricting health care access for those that need it most, critics say. Although people with incomes up to four times the federal poverty level will get premium subsidies on the exchanges, the tobacco surcharge will be added to the final rate, reports Sarah Kliff of The Washington Post.

"The smoker's premium alone will account for 24 percent to 29 percent of his salary not counting deductibles and co-pays," Kavanagh writes. "This policy clearly blocks insurability for the low-income worker." Cigarette makers say the policy amounts to discrimination against smokers, reports Kliff.

The surcharge makes sense from a strictly actuarial perspective, and is supported by the insurance industry because smokers have much higher health costs, reports WebMD Health News. Kentucky's health costs attributable to smoking add up to about $1.5 billion a year, and smoking-caused productivity losses total $2.3 billion a year, says the Centers for Disease Control and Prevention.

Read more here: http://www.kentucky.com/2013/09/08/2810231/pricing-smokers-out-of-health.html#storylink=cpy

However, punitive measures like higher premiums have not been proven to reduce smoking, say health organizations opposing the surcharge, such as the American Cancer Society and American Lung Associaton. In addition to being ineffective, higher premiums for smokers could make health insurance coverage unaffordable, leaving tobacco users without coverage for smoking-cessation programs, or any other type of coverage that Obamacare has sought to provide.

"From the longer-term perspective on how to improve people's health and contain medical costs, the tobacco penalty is a policy disaster," says the Sept. 8 Herald-Leader editorial. The Cancer Society says states would see greater public health and economic benefits from increased tobacco taxes, implementation of strong smoke-free laws and the funding prevention efforts, rather than penalizing smokers.

In closing, Kavanagh poses an important question: "Wouldn't it be better to provide these individuals access to the health care system where tobacco withdrawal could be encouraged and assisted and preventative care for other ailments can be provided?" (Read more)

Webinars to be held Thursday, Sept. 12, for small businesses to help them plan for implementation of the Affordable Care Act

What will the Patient Protection and Affordable Care Act mean for Kentucky's small businesses? A webinar Thursday, Sept. 12 is designed to address such questions about the federal health-care reform law, often called Obamacare.

The webinar will be presented twice, at 11:30 a.m. and 3:30 p.m. ET. Its topics will include tax credits available to businesses and tax-exempt non-profits, an update on the Kentucky health-insurance exchange, the concept of shared responsibility, efforts to contain costs, planning for implementation of the law, a checklist for getting ready, and tools and resources available for small businesses.

The webinar will conclude with a question-and-answer period with the presenter, Mary Huttlinger, outreach manager for Small Business Majority, a national organization focused on public-policy concerns of small businesses. The webinar is sponsored by Kentucky Voices for Health. To register for the 11:30 ET webinar, click here. For the 3:30 session, click here.

Judge OKs Medicaid expansion and health insurance exchange

A judge upheld Gov. Steve Beshear's decisions to expand Medicaid and set up the state's health-insurance exchange under federal health reform, but his adversaries say they will continue to fight in court.

Franklin Circuit Judge Phillip Shepherd's two rulings mean that implementation of the Patient Protection and Affordable Care Act, through Medicaid expansion and the health exchange will continue as planned, at least for now.

Circuit Judge Phillip Shepherd

Tea Party activist David Adams filed a lawsuit in April challenging the governor's legal authority to create the insurance exchange, which is called Kynect and begins enrollment Oct 1, without first seeking approval from the General Assembly.

Shepherd said Beshear is simply implementing a section of a federal law that has been upheld by the U.S. Supreme Court, reports Tom Loftus of The Courier-Journal. Adams said he will appeal both the Medicaid expansion and exchange orders directly to the Kentucky Supreme Court, attempting to bypass the Court of Appeals.

Republican Sen. Julie Denton of Louisville, chair of the Senate Health and Welfare Committee, told Loftus she expects major problems to occur if the administration proceeds with Medicaid expansion.

"My overriding concern from the beginning is that Medicaid is not being run well now; they’ve never gotten their hands around managed care,” said Denton. “Do we really want to expand a broken system? And do we want the government to take on another new project like the health-care exchanges?”

Beginning next year, most Americans will be required to have health insurance, and Kynect is designed to help as many as 640,000 uninsured Kentuckians get coverage through private insurance plans. The online service will allow individuals and business to shop for plans, compare benefits and determine eligibility for payment assistance or tax credits.

Beshear announced Medicaid expansion in early May

Adams challenged the constitutionality of a state law mandating that Kentucky use all available federal funds for Medicaid. Shepherd said the legislation was a clear step towards achieving a state objective, to expand health care benefits to "indigent citizens," Loftus reports.

“The Kentucky Supreme Court has held that this legislative power may be delegated to the executive branch of government in these circumstances, so long as there are standards governing the exercise of discretion, and the legislature retains the authority to withdraw the delegation,” Shepherd wrote. “Those conditions are clearly met here.”

The law calls for expansion to cover people under 65 in households up to 138 percent of the federal poverty level -- currently $15,856 for an individual or $32,499 for a family of four. The federal government will pay all the cost of newly eligible Medicaid patients from 2014 to 2017, when Kentucky will increasingly pick up part of the tab, rising to 10 percent by 2020.

Obamacare hearing highlights employers' worry and uncertainty; Yarmuth says repeal and defunding bids block needed changes

Three of Kentucky's congressmen agreement at a field hearing in Lexington Tuesday that the Patient Protection and Affordable Care Act needs changing, but had no a consensus on how it should be fixed.


From left, U.S. Reps. John Yarmuth, D-3rd District; Andy Barr, R-6th District; and Brett
Guthrie, R-2nd District, listen to Rep. Phil Roe, R-Tennessee, who chaired the hearing.

Business leaders at the hearing also called for a fix, saying the law creates challenges for employees, workers and the economy.

Republican Reps. Brett Guthrie of Bowling Green and Andy Barr of Lexington said the law should be repealed. Democratic Congressman John Yarmuth of Louisville said efforts to change the law are hindered by efforts to repeal or defund it, reports Ryan Alessi of cn|2's "Pure Politics."

Yarmuth supports changes to the law's definition of a full-time employee as one that averages 30 hours of work a week, which he says has led to unintended consequences. Many of the 130 hearing attendees also expressed concern about the 30-hour employees, Alessi reports.

The law includes a mandate that companies 50 or more full-time employees must provide those workers with health insurance or pay a $2,000 penalty per employee. Although this mandate has been delayed a year by the Obama administration, the employee mandate and complex regulations of the law has created "massive uncertainty" for U.S. employers, said Barr.

Several business owners complained about the looming mandate and uncertainty as well as the harmful financial consequences of Obamacare at the hearing, which was held by the U.S. House's Subcommittee on Health, Employment, Labor and Pension. Six of the eight speakers were Republicans expressing opposition to the law.

"What we know is what the administration is now admitting — that this massive piece of legislation is unworkable,” said Barr, who also said that the law should be permanently delayed, reports Alessi.

A majority of Americans (57 percent) disapprove of "defunding" Obamacare as a way to stop the law from being implemented, says an August poll from the Kaiser Family Foundation.  Almost 70 percent of respondents said defunding would be "using the budget process to stop a law is not the way our government should work."

Long-time Lexington restaurant owner Joe Bologna said he is concerned that Obamacare will impact people's ability to eat out.  To prepare for this and rising health costs faced by the business, he has reduced his staff from 54 to 47 and is closed on Mondays, reports Jack Brammer of the Lexington Herald-Leader. Other business people shared similar stories about the law's negative consequences.

On the other hand, Carrie Banahan, executive director of the Kentucky Health Benefits Exchange, the state's online insurance marketplace, said the law will improve Kentucky's health. There were many supporters of the law at the hearing, and some even hissed at critics of the law, reports Alessi.

“If we could get a bipartisan agreement to actually work on tweaks legislatively, I think we could dramatically improve the law and eliminate a lot of uncertainty,” said Yarmuth. Click here to read more about testimonies form the hearing or to watch cn|2 videos.

Eye exams are now required for children ages 3 to 6 when first starting public school or preschool

Add eye exams to your back-to-school checklist, because state law now requires children aged 3 through 6 who are entering a public school or preschool program for the first time to have a vision exam.

“Studies show that vision problems are a major factor in limiting children’s abilities to learn and succeed,” said Dr. Tonia Batts, a Mayfield optometrist, said in a news release from the Kentucky Optometric Association. “Having children’s eyes examined is one of the most important things parents can do to support their children’s education and good health. . . . Many problems may not be obvious to them or their children’s teachers.”

Early diagnosis and treatment can prevent loss of sight from amblyopia, which most people call "lazy eye." Half of amblyopia cases are not diagnosed until after age 5, when it is difficult to correct, Batts said. Amblyopia the leading cause of vision loss in people under age 40, more than injuries or any other disease, but if detected early, is 100 percent treatable.

Batts said an eye examination is particularly important if your child loses place while reading; avoids close work; tends to rub his or her eyes; complains of frequent headaches; squints to use only one eye or consistently performs below academic potential.

Eye exams are covered by many private insurance plans, Medicaid and the Kentucky Children's Health Insurance Plan. Private programs may also help families with eye exam expenses. The Kentucky Vision Project, sponsored by the Kentucky Optometric Association, has donated millions of dollars in vision care, says the group's news release. Sight for Students and the Lions Club have other programs that can help. To find an optometrist in your area, click here.

Employers welcome delay in coverage mandate, but individual mandate remains and many uninsured people are unaware of it

By Molly Burchett

Kentucky Health News

The Obama administration's decision to delay, for a year, the health-reform law's mandate that employers of more than 50 workers offer them coverage could jeopardize the success of the law -- which already faced several challenges.

The linchpin holding the wheels of "Obamacare" together is an individual mandate, which remains in effect. Millions of people must sign up for insurance coverage -- especially those who are healthy. About 50 million, including 640,000 Kentuckians, who haven't bought or been able to buy health insurance will have to do so or pay a tax penalty, unless they qualify for the expanded Medicaid program.

The delay in the employer mandate could reduce the number of uninsured people who will use state-based insurance exchanges to shop for insurance coverage starting Oct. 1, said Sara Rosenbaum, a professor of health law and policy at George Washington University and an advocate of the law. A White House spokeswoman disputed that, but Obama and his allies face four other broad challenges in implementing the law, as outlined in a recent Politico story by Jason Millman and Joanne Kenen:

1. Uninsured don't know they must get health coverage or pay a tax penalty

Many people know about Obamacare, but a large percentage of the uninsured do not know that they will soon be required to buy coverage, according to the most recent Gallup poll:

2. Middle-class and low-income Americans don't know about subsidies

Another part of the Obamacare message that hasn't yet gotten through to millions of Americans, at least those who need to know, is that the law offers subsidies for coverage, based on income. The challenge is that this message must get to a hard-to-reach population without inflating the law's benefits, Millman and Kenan write. And, many of those who qualify for Medicaid or subsidized coverage are low-income, may not speak English well, or may know little about health insurance.

On top of these obstacles, there can't be a consistent, nationwide message because the coverage criteria is different for states like Kentucky that aren't using a federal health insurance exchange. Kentuckians can visit the exchange website, Kynect, to see if they qualify for special discounts or tax credits to help cover the costs of coverage. For example, the website indicates that a family of four making $48,000 a year will get an estimated $252-per-month tax credit for buying insurance. For a PDF fact sheet about payment assistance, click here.

3. Appealing to young invincibles and businesses

For the new system to work, it is critical that young, healthy people buy insurance to cover the cost of care for older and sicker individuals and keep overall premium costs down. Many young people don't know what an insurance premium or co-payment is, and many don't think they need health coverage. Still, Obama administration officials have said they’re hoping 7 million people sign up for private insurance through exchanges in the first year, including 2.7 million young adults.

The delay in the employer mandate came as a relief to many employers who say it will put their businesses at the brink of survival. But the requirement has only been delayed to 2015, not repealed. Before the delay, some companies with payrolls slightly above or below the 50-employee threshold said they would cut or keep their number of full-time workers below that figure to avoid providing coverage.

Many businesses with 50 or fewer employees don't know they won't be penalized for not offering health coverage and that they can get tax credits for providing it. Kentucky businesses can use Kynect to buy coverage if they have 50 or fewer employees. Significant tax credits may be available through the site for businesses that have fewer than 25 employees with an average annual salary under $50,000; the employer must pay at least 50 percent of the premium for each employee. See the chart below or click here for more details.

4. Threats to public messaging campaigns from the opposition

While the success of Obamacare may depend upon public awareness and outreach efforts, the efforts of those opposing it create additional challenges for supporters. Many Republicans used the delay announcement to advance the cause of overall repeal or delay of the individual mandate. House Speaker John Boehner said, “I hope the administration recognizes the need to release American families from the mandates of this law as well. This is a clear acknowledgment that the law is unworkable.”

Senate Republican Leader Mitch McConnell of Kentucky said, “The White House seems to slowly be admitting what Americans already know, and what I hear consistently in my travels around Kentucky regarding the regulatory burden on employers.”

On the other hand, former White House health policy adviser Ezekiel Emanuel said on MSNBC’s "Morning Joe" that the delay of the employer mandate will affect a relatively small number of companies and is no big deal. The provision only applies to about 200,000 employers who have 50 or more employees working full-time (which the law defines as 30 hours or more a week), he said, and “94 percent already offer health insurance.”