We asked readers what questions they have for the Fact Squad.
E Ryan Roth of Dayton: What is the fine if you choose to not get health care insurance anyway?
Bucklew: In 2014, the penalty is $95 per adult and $47.50 per child, up to $285 for a family, or 1 percent of family income, whichever is greater.
In 2015, the penalty is $325 per adult and $162.50 per child, up to $975 for a family, or 2 percent of family income, whichever is greater.
In 2016 and beyond, the penalty is $695 per adult and $347.50 per child, up to $2,085 for a family, or 2.5 percent of family income, whichever is greater.
Government workers usually have some form of health care insurance, thus they will not have to use these exchanges if they don’t want to.
Tina Jones Kretzer of Dayton: How will it affect people with employer health care?
Scott Streator, vice president, CareSource: The Affordable Care Act allows consumers currently employed choice about their health insurance. Employees can stay with their employers’ plan or shop for the best coverage on the exchange. The ACA states that individuals can enroll in any qualified plan of their choice and are not required to use the exchange. If someone is completely uninsured they will have more options from the qualified health plan.
Based on question by Linda Kertesz, working in Huber Heights: What are the deductibles for health plans purchased on an exchange?
Dr. Gary LeRoy, Wright State University Boonshoft School of Medicine: Information regarding products purchased on the exchange can vary based on your state of residence, income, family size, age, etc. For specific information regarding enrollment, eligibility, cost and deductibles for an insurance purchased on the exchange, go to the Marketplace at www.healthcare.gov/marketplace/individual/#state=ohio.
Joe Hamlin of Dayton: I have my own policy with (a commercial insurer). How much will my rates increase?
LeRoy: As you may have noticed in previous years, your insurer annually makes adjustments to your insurance premiums. These increases can vary greatly from year to year. For the past decade or more these premium increases have averaged about 12 percent; but can be up to 50 percent or more in some cases. It depends on a variety of factors used by your insurer to determine your medical risks.
Based on question submitted by user Screamin Mime on Facebook: What are the exemptions for requiring people to buy health insurance on the exchange?
Bucklew: You are exempt from buying insurance on the exchange if you have health insurance provided by: Medicare, Medicaid, TRICARE, VA, a plan offered by your employer, insurance bought on your own that is at least equivalent to a Bronze level exchange plan, or a grandfathered plan in existence before the ACA was enacted.
Denise Ferguson of Beavercreek: I keep hearing most people will be eligible for subsidies but I hear no income guidelines.
Bryan Bucklew, president and CEO, Greater Dayton Area Hospital Association: The subsidies are based on a number of factors including income, number of people in your family and whether your employer offers insurance. The Kaiser Family Foundation has an online calculator that can determine how much your subsidy will be at kff.org/interactive/subsidy-calculator/.
Based on question by Sue Fetzer: I get insurance through my employer that has high deductibles and high premiums. What if I would rather buy insurance on the exchange because it could be cheaper?
Bucklew: You can buy insurance on the exchange but you will not be eligible for any subsidy if your employer offers insurance. Be sure to look at the entire benefit package of any policy listed on the exchange as a cheaper plan may not be the best fit for you and your family’s health care needs during the year.
Eric Bucher of Dayton: What impact will it have on (High Deductible Health Plans) and (Health Savings Accounts)? Will it do anything to make health care costs more transparent to consumers and allow them to make better decisions, i.e. MRI at Place X for $1,400 or $400 at Place Y?
Mickey Sweeney, insurance broker, Wallace & Turner: HDHPs and HSAs will still be available, and in fact the maximum out-of-pocket guidelines for HSAs will be used for all plans. Electronic Medical Records are to make it easier for doctors to coordinate care and see your health history, as well as for consumers to communicate with providers. Plans are already keeping track of outcomes of treatments by hospitals and you’ll see comparative figures for a particular procedure — gallbladder removal, for instance — for hospitals participating. Most major health plans have this available for providers in their network and will be expanding it as more data is available.
A.J. Reuscher of Beavercreek: I have heard that there will be somewhere between 30 million and 50 million people who were uninsured that now will have the opportunity to have insurance. My question is that without adding any extra doctors, how is this feasible or even possible?
Streator: More people with health care coverage will mean a higher demand for health care access. As providers embrace electronic medical records, patient-centered medical homes, telemedicine and other health care innovations, more patients will be able to be served. This incentivizes and directs doctors to spend more time capturing patient history to help reduce errors and improve care. It also helps provide better coordinated patient care with other team members because the system is moving away from volume-based financial reimbursement. Finally the ACA attempts to decrease patient wait times by increasing the number of primary care graduating physicians. The ACA will offer loan repayment for primary care providers, nurses and other specialties.
Based on question by Philip Coon: How do we know that federal health reform won’t look at voter registration to determine who gets surgery and who gets the Aspirin?
LeRoy: Physicians and surgeons take a Hippocratic Oath to do no harm to patients or society. We do not take political or corporate entities to make potential life-altering medical decisions for our patients. I’m sure that there were probably similar concerns when Social Security, Medicare and Medicaid were introduced.
Based on question by Jarvis Kettlehake: What provisions of the law go in effect in 2014? What provisions have been delayed? SS: This is a good question, but I almost think the answer is more confusing because we don’t explain what each of those are. What do you think? I could go either way.
Sweeney: A number of provisions have been delayed due to the complexity of the required changes, including having information technology compatibility. The main ones being delayed are the employer mandate, automatic enrollment for groups of more than 200, small business wellness grants, and quality of care reporting requirements.
In 2014: Adult children covered to age 26, including grandfathered plans; deductible caps of $2,000 for individual and $4,000 for family; essential health benefits required for small employers; guaranteed issue and renewability; individual mandates; insurer fees — permanent; mandatory coverage for clinical trials; no annual dollar limits on essential health benefits; no pre-existing condition exclusions; rating restrictions/community rating (individual and small group); tax credits and subsidies for individuals and small employers; transitional reinsurance fee (2014-2016); waiting period limits to 90 days for employers.
Note that rulings are being made every week on how many provisions are to be carried out. Recently the Department of Labor confirmed that there is no penalty to employers if they don’t send the notice of Marketplace plans; this week the DOL/IRS said employers can’t let employees pay individual policies on a pre-tax basis beginning in plan year 2014 (only group plans can be pre-tax). Stay tuned.
Sue Shay of Centerville: I think I heard that under the new law, all doctors and hospitals must begin asking (and report to the feds) about each patient’s sexual preference/orientation. That failure to do so would result in a fine by the new health care law. Is this true?
Bucklew: Not true.
Cara Nolan of Dayton: Is it true that The Affordable (Care) Act is modeled after a plan written by the conservative Heritage Foundation and (former Gov.) Romney in Massachusetts?
Bucklew: There are elements from a lot of different health care plans from both conservative and liberal think tanks, including the Heritage Foundation and the Brookings Institute. Additionally, the Massachusetts health reform effort under Gov. Mitt Romney’s administration has many of the same characteristics as the Affordable Care Act.
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