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SHERIDAN — Following a nearly 16-hour speech by U.S. Senator Ted Cruz, R-Texas, that lasted into the early hours on the Senate floor Wednesday, the Affordable Care Act, also known as Obamacare, is likely to be on many minds today.
The speech was intended to rally support for Republican efforts to defund Obamacare before the Democratic-controlled Senate conducts a test vote on a temporary spending bill that will keep the government open after the Oct. 1 start of a new budget year. Some conservative Republicans see the bill as an opportunity to force a choice between funding Obamacare and keeping the government fully functional.
While the outcome remains to be seen, Oct. 1 is a big day. It marks the day a potential government shut-down could occur, and it also marks the day open enrollment begins in the Health Insurance Marketplace.
How the marketplace works
The Health Insurance Marketplace, or exchange, will allow individuals to shop for insurance before the Jan. 1, 2014, mandate that all individuals be insured, according to a recent presentation by BlueCross BlueShield of Wyoming on the Affordable Care Act.
Cost assistance for insurance premiums, in the form of government subsidies, cost-sharing reductions and tax credits, will also be available through the marketplace to applicants who qualify based on household size and income.
While the Affordable Care Act was passed in March 2010 and some provisions of the health care reform have been enacted, the opening of the Health Insurance Marketplace is seen as the big kick-off for weightier reforms coming in 2014.
Holland Powell, president of Benefit Development Group, Inc., an employee benefit consultant and manager for large national accounts, compared the marketplace to travel websites.
“How it works will be like Travelocity or Orbitz,” Powell said. “The exchange won’t sell anything. It will be a guide where people can see products offered by health insurance carriers for individuals only.”
People will fill out an application online, by mail or in-person with a “Navigator” to participate in the Health Insurance Marketplace. Once the application is processed, applicants will be able to compare health insurance plans that are available in their area in a sort of “apples to apples” look at benefits and costs of each plan, according to healthcare.gov, the official government website for the marketplace.
Available plans will be offered by private companies and will cover the same core set of benefits known as essential health benefits. These include emergency, mental health, preventative, rehabilitation, laboratory, maternity, hospitalization, prescription drug and pediatric oral and vision care services.
Plans will be divided into bronze, silver, gold and platinum categories to represent the amount of coverage they offer and make comparisons more simple.
The application for the Health Insurance Marketplace will include household size and income levels to help applicants determine if they qualify for government assistance with their insurance plan.
People in Wyoming will use the federal website, healthcare.gov, to apply for the Health Insurance Marketplace and compare and enroll in plans. Specific plans and prices will be available Tuesday and coverage may start as early as Jan. 1, 2014.
Who can use the marketplace
The Health Insurance Marketplace is open to anyone but is targeted at the uninsured to make sure every individual in America has health insurance by Jan. 1, 2014.
Until recently, employers were going to be required to notify employees about the Health Insurance Marketplace, but that mandate was changed multiple times and eventually revoked by the Department of Labor on Sept. 11, Powell said.
Now only employers who are subject to the Fair Labor Standards Act must give notice. This includes hospitals and health care facilities, public and private schools and governmental agencies.
People who have insurance through their employer will be allowed to enroll in the marketplace and compare prices, but Powell said he didn’t think many would since employer-based coverage will likely be cheaper. Powell noted that 95 percent of employed people purchase insurance through their employer.
“It’s applying to very few people,” Powell said. “They’re trying to reach uninsured people, but those people are broke. They’re still not going to buy insurance.”
Powell compared the marketplace to car insurance. He believes those who can’t afford it still won’t buy it even though it’s required by law.
“People who have a piece of crap car don’t buy insurance,” Powell said. “They say, ‘Sue me. You’re not getting anything.’”
Powell worries that will make insurance rates increase for those who can afford insurance in order to cover those who still go to the hospital without insurance.
Starting in 2014, there will be penalties for people who don’t have insurance that will be taken out of their tax returns. Penalties start at $95 per month up to $285 or 1 percent of yearly income and increase to $695 per month up to $2,085 or 2.5 percent of yearly income by 2016.
Still, Powell encourages everyone to look at the Health Insurance Marketplace to see if it may be a better route for them. Some people may be able to cover a spouse or dependent at a cheaper rate than offered in their employer-sponsored coverage, he said.
The marketplace in Wyoming
At this point, it’s not clear how the Health Insurance Marketplace will impact Wyoming, Sheridan Memorial Hospital Chief Executive Officer Mike McCafferty said.
It may affect small businesses that don’t offer insurance but suddenly have employees who must pay for insurance through the marketplace or find a job that offers insurance.
It may impact the hospital, McCafferty said, but he isn’t sure how at this point. If uninsured people can’t afford insurance through the marketplace, they will be covered under Medicaid or Medicare, which will impact how much the hospital receives in reimbursements.
McCafferty said he sees Obamacare as a cost shift, an attempt the bend the cost curve that won’t likely work.
“The difference to cover the uninsured must be paid by taxpayers, insurance companies or health care providers by increasing rates,” he said.
At this point, Sheridan Memorial Hospital has no plans to increase its rates, but McCafferty said the future is uncertain. He said the hospital currently operates under a solid business model that has kept the hospital from increasing its rates more than 4 percent per year over the last decade. The national average has been a 7 percent increase per year.
“We try to hold costs down so that people will choose us because of our service and quality but also our costs,” McCafferty said.
For now, the hospital will continue to expand its services like it’s been doing with cancer, kidney and cardiac care in recent years. It has added more primary care physicians and continues to hold that as a goal.
“We can do great things locally but can be affected by the national government in great ways,” McCafferty said. “We are confident in our position as an organization. We recognize that our patients are our customers and we need to provide care with quality service so our patients will come back, confident in the services we provide.”
• The Sheridan Press will be publishing an in-depth look at the Affordable Care Act on Dec. 14.