OSSIPEE — The Carroll County Democratic Committee hosted a well-attended public forum Tuesday evening on the Affordable Care Act (ACA) and its implementation in New Hampshire.
Many of the 70 or so participants peppered guest speaker Alex Feldvebel, deputy commissioner of the New Hampshire Insurance Department, with questions throughout his two-hour presentation.
The forum, organized by State Rep. Edward Butler, D-Hart’s Location, was designed for employers, employees and others interested in the requirements and benefits of the ACA.
“Obamacare is something that is upon us, and we need to understand it as best we can,” Butler told the group assembled in a function room at the Sunny Villa Restaurant. However, judging from the questions, there remains much confusion about provisions within the ACA and how to access affordable care and health plans. The limited open enrollment period in the individual insurance plan market under ACA begins Oct. 1 and runs through March 31, 2014.
On the other hand, supporters of Obamacare, including Sue Sharp who attended the forum, said before ACA she would not have been covered by health insurance due to a pre-existing condition. Others in the audience said they were able to provide coverage for their older children up to age 26.
Organizers distributed copies of a 48-page PowerPoint presentation, “Health Reform Changes: What’s New for 2014?” prepared for this event by the New Hampshire Insurance Department.
Highlights of changes include a mandate that every individual carry health insurance as of 2014 or pay a penalty. Coverage includes employer coverage, individual major medical, Medicaid and Medicare. Low-income individuals will receive a limited exemption to the penalty requirement. The penalty amount starts off at $95 per uninsured household member or 1 percent of income, with penalty increase in 2015 and 2016.
“The goal is to get everyone covered and to improve the stability of the insurance risk pool,” said Feldvebel. “Insurance doesn’t work well unless everyone is in a big pool — you need healthy people to be buying coverage as well,” he said.
The ACA requires insurers to cover services in 10 categories: ambulatory services; emergency services; hospitalization; maternity and newborn care; mental health and substance abuse disorder services including behavioral health treatment; prescription drugs; rehabilitative services; laboratory services; preventative and wellness services and chronic disease management; and pediatric services including oral and vision care.
Under the ACA, levels of care coverage will be classified at “Metal Levels” labeled from Bronze to Gold in New Hampshire. For instance, a “Gold” rated plan will cover 90 percent of costs with the enrollee paying 10 percent.
The ACA creates a Health Benefit Marketplace, also known as the Exchange, where individuals will be able to purchase health insurance if they do not have a current employer sponsored plan.
Low- and moderate-income people using the marketplace will be able to obtain payment assistance to help buy health insurance.
The ACA also provides an insurance marketplace for small businesses, called SHOP. The Small Business Health Options Program (SHOP) is a new program that simplifies the process of buying health insurance for small business. For 2014, the SHOP Marketplace is open to employers with 50 or fewer full-time-equivalent employees (FTEs).
Small businesses with 24 or fewer employees may quality for the Small Business Health Care Tax Credit to offset costs if the company contributes 50 percent or more towards employees’ self-only premium costs. Small businesses may also choose to stop offering coverage to allow employees to purchase plans on the Marketplace where they can access subsidies and low-cost plans.
Feldvebel said in New Hampshire, Anthem Blue Cross Blue Shield would offer a lower cost “Pathways” plan with a limited network of 16 hospitals in the state. However, in response to queries, he added that primary care physicians outside the network could request admitting privileges for hospitals in the network. He said the Pathways plan works much like a traditional HMO, but offers insurance at a price 25 percent lower than it would have been with an open network.
“Customers are saying now, in surveys and focus groups, they would be fine with changing Primary Care Physicians for a lower priced plan. They are willing to take steps that consumers weren’t ready to take years back,” he said.
In another query, a self-employed woman asked how to determine her eligibility for plans if her income may rise and fall monthly. The response was that eligibility would be based on income claimed on the prior year’s tax return.
Feldvebel said an array of assistors, or navigators, would be available to assist consumers and the best way to start is to access www.healthcare.gov, or the Anthem site, www.anthem.com/health-insurance/resources/health-care-reform-overview.
“For me, the biggest issue is that the public is not aware of what the opportunities are,” said Feldvebel. “When I was getting a haircut, the hairdresser said she and her two children couldn’t afford (health insurance.) When I told her that under ACA, she could, she almost fell on the floor. She had no idea that was going to happen,” he said.
Butler added that unfortunately, open enrollment is only days away and forums such as this were just beginning in New Hampshire. “As you might have heard, there is some contention over the implementation of Obamacare,” he said.
“It’s a big change. The guaranteed issue is, that as of 2014 no one can be denied coverage,” added Butler. “We are going through an incredible transition, and it is going to be hard in 2014.”