GUEST COMMENTARY | Explaining the Affordable Health Care Act
by Richard Gingery, M. D.
Oct 19, 2013 | 2257 views | 0 0 comments | 34 34 recommendations | email to a friend | print
Let’s start with the invisible board. In the year 2000 the voters of Ouray County created the

Regional Service Authority Board and gave that board two crucial tasks. The first task, put simply, was that the board was responsible for overseeing the county’s assuming ownership of the Mountain Medical Clinic and keeping a medical provider in that clinic.

The second task was to provide health care access for the citizens of Ouray County. Though over the years this board has done so much of its work in the background that it has seemed at times to be an invisible board, it has been very effective at accomplishing the first task.

By the early summer of 2011 the board was able to make the final payment on the mortgage on the clinic, and it has retained enough funding to ensure that it can meet the costs of normal wear and tear on the building for some time to come.

But assuring that all the citizens of the county have access to health care is a more challenging problem. That may change with the implementation of the Affordable Care Act.

Love it or hate it, the Affordable Care Act (Obamacare) is now the law of the land. Because we were spending twice as much per person on health care as other developed nations and getting poorer outcomes with lower life spans, higher maternal and infant mortality rates, medical bankruptcies and 4,000 Americans dying each month simply because they lacked insurance, something had to be done about a health care system that was failing us.

The Affordable Care Act is not the perfect solution. Indeed, the fact that much of the law was written by the very industries that made the old model so expensive, big Pharma and the health insurance industry, is reason to believe that much remains to be done if we are to reduce medical costs to a level seen in other countries while improving outcomes to levels found in those other countries.

But the Affordable Care Act has already provided some relief for many of us in some very crucial areas. Since the act was signed into law in 2010:

• The caps on treatment for children with chronic disease have been lifted. Parents with children with hemophilia or leukemia no longer face the crushing mountain of debt associated with picking up the cost of treatment after the child had reached his or her insurance cap.

• From the day the act was signed, children were able to stay on their parents’ insurance until

the age of 26, something insignificant for healthy children, but a real boon for children

who needed ongoing treatment for chronic disease.

• .As we move into 2014 in a few months, people with “pre-existing conditions” will no longer be denied coverage.

While the law does much to rein in the most outlandish abuses of the health insurance industry,the trade-off for the industry was a demand that insurance be “mandated” so they could bring an estimated thirty million uninsured Americans into the fold. To expedite that process, many states have created an insurance exchange so that consumers had a place to turn to get their questions answered and to be steered to the insurance they might need.

Other states have opted out of the process, leaving the federal government to create the exchange. Colorado jumped on the exchange bandwagon early so that the “Connect for Health Colorado” exchange was ready to open for business on Oct. 1, 2013.

It is fair to ask, “How will the exchange affect me?” There is no one answer to that question because how the exchange affects you depends in large part on where you are with respect to any current health care coverage. If you are a senior on Medicare, or if you are among the 44.5 percent of Americans who get health care coverage through your employment, the exchange will have little or no effect for you.

Likewise, if you are already on Medicaid or you receive health care through the Veterans

Administration, you will not be affected by the exchange. However, if you buy your insurance through the individual market, or if you are currently uninsured, as are eleven Americans out of every 100, the exchange may have a significant effect both on your ability to get health care coverage and to pay for the coverage you get.

The Affordable Heath Care Act mandates that insurance companies offer coverage in at least two of four different coverage ranges – Bronze, Silver, Gold and Platinum. As a consumer, you need to understand that, for an average, the Bronze plans will cover 60 percent of your health care costs, while you will be responsible for 40 percent, the Silver plans will cover 70 percent, the Gold plans will cover 80 percent and the Platinum plans will cover 90 percent.

The premiums for the Bronze plans will be significantly lower than the premiums for the Platinum plans, but the risk of winding up deeply in debt or bankrupt with a major illness or injury is higher.

As many as 500,000 Colorado residents are eligible for a new tax credit to lower those

insurance costs. Individuals earning between $15,000 and $45,000 a year, couples earning between $21,500 and $62,000 a year or a family of four earning between $31,000 and $94,000 per year may qualify for a break on your monthly premiums or a zero-premium plan. People in these ranges may also qualify for plans with lower co-pays and deductibles based on income.

Because the eligibility level for Medicaid in the state will be raised to 133 percent of the Federal Poverty Level, many more Colorado residents may also find they are now eligible for Medicaid. Generally, using the examples above, an individual earning less than $15,000, a couple earning less than $21,500 or a family of four earning less than $31,000 per year will qualify for the expanded Medicaid coverage.

There is a catch! You can buy an insurance plan by going through the Connect for Health

Colorado Exchange, or you can buy the identical plan by going straight to an insurance broker, but if you bypass the exchange and go straight to the broker, you will not get the tax credit. Also, it is important to note that in this first year the open enrollment period began Oct. 1 and runs through March 2014.

After this first year, the open enrollment period will be from Oct. 1 to Dec. 7 each year. Your coverage can start on Jan. 1, 2014, if you have enrolled by Dec. 15, 2013. Enrollment after Dec. 15 of this year may mean you coverage may not begin until March, 2014.

Keep in mind that the penalty for not seeking coverage is real. This year the cost of not buying insurance will be $95 or 1 percent of your yearly income, whichever is higher, but by 2016 the fee will be 2.5 percent of your yearly income or $695, whichever is higher.

We on the Regional Service Authority Board would strongly advise that you check out the Connect for Health Colorado website at www.connectforhealthco.com to get all your questions answered and to be sure the information you have is current.

Among the other features that can be found on the site is a calculator so that you can determine if you or your family will be eligible for a tax credit or even Medicaid coverage, and since using the Connect for Health Colorado Exchange is the only way to actually get that tax credit, this may be one of the most valuable websites you will visit.

Dr. Gingery is the former director of Public Health for Montrose County Health and Human Services,; he currently serves on the Board of Community Options, in Montrose, that oversees operation of Ouray County’s Mountain Medical Clinic.

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