WASHINGTON, D.C. —
The trust relationship patients have with their longtime physicians has been broken by the Affordable Care Act, Congressman James Lankford said.
“That doctor knows you — they know your file — they know how you talk to each other,” said Lankford, R-Edmond. “If you lose someone and you know how to talk to them, you’ve lost a lot of medical gain for your family.”
Americans do not like being told what to do whether they are liberal or conservative, he said. And the congressman said Americans will hear more of these types of problems as they learn more in 2014 about their new health care options under the Affordable Care Act.
With his presidential legacy on the line, Obama vowed to improve the federal exchanges to protect his landmark piece of legislation. Improvements to the federal health care exchange in December brought 1.1 million more health insurance consumers to the market place, according to the White House.
“More than half a million Americans have enrolled through healthcare.gov in the first three weeks of December alone,” Obama said.
This did not include expanding Medicaid coverage and ACA enrollments due to state-based exchanges. Enrollment surged in December with more than 2.1 million people enrolled in a private health insurance plan through the federal and state-based exchange marketplaces.
Health care insurance kicked-in for these enrollees Jan. 1. The White House still calls for a projected 7.1 million enrollees by March 31.
Obama’s goal had been to enroll 3.3 million consumers by Dec. 31. The federal website serves 36 states. Oklahoma Gov. Mary Fallin resisted the creation of a state exchange and Medicaid expansion for Oklahomans.
By November, new eligibility and renewals for Medicaid and the Children’s Health Insurance Program grew by 3.9 million, in the U.S. Additionally, young adults are able to stay on their family’s plan until they turn 26.
Lankford described a likely scenario for a cancer patient covered by the ACA. A patient covered for cancer treatment at a large area hospital will not necessarily be denied coverage there by an insurance company, Lankford said.
If an Oklahoman living with an advanced stage of cancer wanted to go to a comprehensive cancer treatment center such as M.D. Anderson in Houston, it is likely their insurance company would deny their treatment there and send them to a local hospital, Lankford said.
President Obama’s administration will blame insurance companies for being the problem, Lankford said. The next day, the administration will have a meeting with top insurance executives from the largest carriers and will promise them tax dollars to subsidize them, he added.
“Obamacare has built into it a huge bailout from insurance companies,” Lankford said. Obama is choosing winners and losers who are friendly with the administration, he said.
“This administration has gone out of its way to subsidize banks, to subsidize car companies and now also subsidizing insurance companies with federal tax dollars,” he said.
A physician whose practice does not honor federal exchange markets told Lankford last week that all of his patients on federal exchange programs are no longer his patients. The insurance companies are paying physicians a lower rate than what Medicaid pays, which has historically been the lowest rate paid by anyone, Lankford said.
Patients will have to pay cash if they choose to continue as the physician’s patient. The insurance companies pick and choose the physician to fulfill the ACA plan, Lankford said.
“That’s what’s happening now in January. People are now finding out their deductible is higher, the rates they have to pay each month is higher. Many people are finding out the doctor they went to for years is no longer on the plan they have,” Lankford said.
So insurance companies will choose younger doctors with newer practices, Lankford said.
Some insurance coverage has been made illegal to purchase because it does not meet all of the requirements of the ACA. More than 6 million people nationwide have received notification that their private insurance has been canceled, Lankford said
“They had to go then to find insurance through the federal exchange or state exchanges,” he said.
Whether or not they have lost their insurance or are merely being redirected to a plan that is compatible with ACA standards will be answered on a person-to-person basis, Lankford said.
Some of those individuals are finding they’ll have to pay significantly more with higher deductibles, he said. Other people have learned they will pay less.
“So they might have had a $500 deductible and they paid $300 a month. Now they’re finding out they’re going to pay $450 a month and their deductible is $2,000 or more.
“And, they have (less) access to doctors.”
More than 70 percent of Americans covered under the ACA will receive subsidies to offset their coverage, according to a report by Families USA, a Washington, D.C., think tank supporting the ACA.
Open enrollment began in October for the federal exchanges.
Obama apologized for the early roll-out failures, saying computer glitches had caused the system to fail.
Meanwhile the Affordable Care Act has helped keep health care costs growing at their slowest rate in 50 years, Obama said.
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what you need to know
Questions & Answers about the Health Insurance Marketplace
What is the Health Insurance Marketplace?
The Marketplace is a new way to find quality health coverage. With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options and enroll in a health plan.
Are Marketplace health plans “government insurance?”
No. Marketplace plans are through private health insurers. In Oklahoma, insurers offering plans through the Marketplace include Blue Cross Blue Shield, Community Care, Global Health, Coventry and Aetna.
Are there different types of Marketplace plans?
Yes. Marketplace plans are grouped into four categories: Bronze, Silver, Gold and Platinum. Bronze plans will typically have lower monthly premiums, but higher deductibles and out-of-pocket costs. Platinum plans typically will have the highest monthly premiums, but lower out-of-pocket cost.
How can I enroll in a Marketplace plan?
There are several ways to enroll in a Marketplace plan. You can apply online at www.healthcare.gov, over the phone or submit a paper application. Applying online is the fastest way to obtain coverage.
What information will I be asked for in my Marketplace application?
You will need to provide some information about your household size and income to find out if you can get lower costs on your monthly premiums or reduced costs for out-of pocket costs like deductibles and copays.
I have heard about premium tax credits. How do those work?
Premium tax credits go toward paying your monthly premium costs. If you are eligible for premium tax credits, you will be able to choose how much of your credit you want to go toward your premium each month. That amount will be paid directly to your insurer. Whatever amount you don’t use each month will be returned to you when you file your taxes in 2015.
What about help paying for deductibles and other out-of-pocket costs?
Assistance paying for out-of-pocket cost are called “cost-sharing reductions.” These reductions are built into Silver–level plans. If you are eligible for cost-sharing reductions, you will want to look at the Silver plans as these plans will have the lowest overall cost for you.
Will everyone receive help paying for coverage?
No, not everyone will be eligible for help paying for coverage. Your eligibility is based on several factors including income, household size, tax filing status and availability of other coverage options.
How can I learn if I can get help paying for coverage?
Once you have completed a Marketplace application, you will get a notice that will tell you what assistance you should receive.
Can I get help filling out my application?
Yes. You can either call the National Call Center at 1-800-318-2596 or make an appointment to speak with a certified assister who will help you go through the application and enrollment process.
I have heard about navigators. What are they and what do they do?
Navigators are one type of certified assister. Navigators are connected to an organization that received federal grant funds to provide outreach and enrollment assistance.
Are there other types of assisters?
Yes. There are navigators, Certified Application Counselors and In-Person Assisters. All of these types of assisters must be trained and certified to help consumers. All of them can help you walk through the application and enrollment process.
Are navigators or other assisters the same as agents and brokers?
No. Navigators and other assisters are not licensed insurance agents or brokers and they are not connected with any insurance plan. Navigators and other assisters will help you through the Marketplace application, explain your eligibility determination and provide general information about your plan options, but they do not provide advice or recommendations on which plan you should choose.
Will I have to pay anything to get help from a navigator or other assister?
No. Navigators and other assisters cannot charge for their services.
Will navigators or other assisters have access to my personal information?
Yes. A navigator or assister will need to know some information about your household size and income to be able to help explain your coverage options. You will be asked for your consent to share this information at the start of your appointment. However, an assister will never keep, share or store any of your personally identifiable information.
How can I find someone to assist me?
You can find certified assisters near you by visiting https://localhelp.healthcare.gov/ and entering your ZIP code. In Oklahoma, you also can dial 2-1-1 from anywhere in the state to be directed to assisters in your area.
Is there a deadline for enrolling in coverage?
Yes. Open enrollment for the Health Insurance Marketplace ends March 31, 2013. There will be an open enrollment period every year.
Are there any other times when I can enroll?
Yes. Moving, changing jobs, getting married, losing coverage or other life changes can open special enrollment periods where you can apply for and enroll in coverage through the Marketplace. These special enrollment periods usually last between 30-90 days after the life change.
What if I don’t get health insurance coverage?
If you do not have health insurance coverage in 2014, you may have to pay a penalty for everyone in your household who is uninsured when you file taxes in 2015. If you enroll in a plan by the end of March you will not have to pay a penalty.
What if I can’t afford insurance? Do I still have to pay a penalty?
There are many reasons why you could be exempt from paying the penalty if you do not have health insurance. Some reasons you may be able to get an exemption include: if your income is too low to file taxes, you can’t find an affordable coverage option, or you had a gap in coverage that lasted less than three months. You can learn more about exemptions you might qualify for at ww.healthcare.gov/ exemptions/.
The project described was supported by funding opportunity number CA-NAV-13-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
SOURCE: Oklahoma Primary Care Association