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Originally published: 2013-08-06 17:52:45
Last modified: 2013-08-07 13:03:29

Obamacare implementation continues

by Anna Oakes

The implementation of the Affordable Care Act's health-care changes continues with the enrollment of citizens in insurance plans through new marketplace exchanges, which is slated to begin Oct. 1.

The N.C. Department of Insurance announced July 30 that it had approved health insurance rates for three companies that intend to sell plans to the state's consumers through the Health Insurance Marketplace: Blue Cross and Blue Shield of North Carolina, Coventry Health Care of the Carolinas and FirstCarolinaCare.

All three companies will offer individual plans, while only Blue Cross Blue Shield indicated it would participate in the small group market, a NCDOI statement said.

NCDOI said the rate details were filed as trade secrets; plans and prices will not be released until Oct. 1, according to http://www.healthcare.gov, the federal government's official website on the ACA.

Also known as Obamacare, the ACA established the exchange model in an effort to provide affordable insurance policies to those who lack access to employer or government coverage.

According to the U.S. Census Bureau, 20.1 percent of Watauga County residents younger than 65 were uninsured in 2010.

Although only three insurers plan to participate in the North Carolina exchange, each company submitted multiple plan offerings, an NCDOI official said.

"If all of those are approved by the federal government, we expect that there will be a healthy number of plan options from which our citizens can choose," said Marni Schribman, NCDOI assistant public information director.


How it works

The Health Insurance Marketplace enrollment period is Oct. 1 through March 31, 2014.

Enrollees may choose between Bronze, Silver, Gold and Platinum plans, with Platinum offering the most coverage. In addition, some plans may offer a catastrophic coverage option for people younger than 30.

Persons who enroll in an insurance plan through the exchange are eligible for a federal tax credit if their incomes are between 100 and 400 percent of the federal poverty level. People who qualify can take the tax credit in the form of advance payments, with the subsidy sent directly to the insurance company and applied to monthly premium payments.

Those who already have job-based health insurance can maintain their coverage, or they could choose to switch to a marketplace plan, healthcare.gov says.

President Barack Obama is reportedly enlisting the help of celebrities to aid in the promotion of the health care exchanges. The enrollment of young, healthy people is critical to balancing the cost of premiums in the exchanges.

A nonprofit organization, Enroll America, has formed to help enroll the uninsured in the exchanges nationwide.

"Enroll America has launched the 'Get Covered America' campaign in North Carolina to start a conversation with consumers about the benefits of health coverage and the new health care options they'll have starting Oct. 1," said Jessica McCarron, an Enroll America communications official.

"Get Covered America will have staff and volunteers on the ground in North Carolina engaging people directly by going door-to-door, talking to consumers at places like grocery stores and community centers and working with local organizations -- like health centers, places of worship and schools -- to get the word out about the new marketplace."

Meanwhile, many conservatives and Republicans in Congress remain opposed to the three-year-old health reform law, and House Speaker John Boehner is said to be planning a series of House votes to disable parts of Obamacare, according to media reports.


Individual and employer mandates

Enrollment in the health-care exchange begins three months before Obamacare's individual mandate takes effect.

Beginning in 2014, the ACA requires all Americans to have minimum essential coverage or pay a tax penalty, but there are exemptions from the penalty for persons with income at the poverty level or below or persons for whom health insurance costs would be more than 8 percent of household income.

An effort by the House of Representatives to delay the individual mandate's implementation has stalled, as it failed to achieve Senate passage before Congress adjourned for its August recess.

Earlier this summer, however, the Obama administration announced it would delay another mandate - one that requires businesses with more than 50 employees to offer insurance to full-time workers or pay a fine - until 2015.


Not everyone will be covered

Although the health-care exchanges aim to insure some people not currently covered by Medicare, Medicaid or private insurance plans, the nonprofit, nonpartisan Kaiser Family Foundation estimates that about 30 million Americans will remain uninsured.

Under Obamacare, states have the option to expand Medicaid to adults with incomes up to 133 percent of the federal poverty level, but North Carolina legislators voted earlier this year to refuse Medicaid expansion. Currently in the state, Medicaid is only available to low-income people who are parents, children, seniors or disabled.

"There is a huge chunk of adults that may meet the income guideline but do not meet the other guidelines that go along with it," said Melissa Selby, executive director of Boone's free Community Care Clinic for the uninsured.

That leaves a gap between those who are eligible for and can afford subsidized health-exchange plans and those who don't qualify for Medicaid, said Selby, who anticipates no decline in demand for the Care Clinic's services once Obamacare is implemented.

"Those are really the people that are going to suffer the most," she said. "The people who are absolutely the most in need and the most vulnerable are going to continue to be uninsured. We're not going to see much difference."

Selby said her staff has worked to develop educational materials for the clinic's volunteers and patients. She said a "huge misconception" is that "everyone is going to be covered" under the ACA.