MANHATTAN, Kan. – Sweeping changes in America’s health care system begin to take effect in October, which means Roberta Riportella expects to be very, very busy the next several months.
Riportella, the Kansas Health Foundation professor of community health at Kansas State University, is heading up an effort to help Kansans learn more about how the Affordable Care Act – often called ObamaCare – will affect them once the law goes into effect on Jan. 1, 2014.
In Kansas, it stands to most directly impact more than 365,000 who are currently without health insurance, many of whom now will be required to purchase insurance from private providers authorized through a ‘Marketplace Exchange.’
Kansans will begin making those choices when open enrollment begins Oct. 1.
“Kansas people who are uninsured will have a product to buy, they’ll have a marketplace to go to,” Riportella said, “and they’ll have people to help them enroll.”
The marketplace is intended to make insurance more affordable. Consumers will have a choice of private plans, and qualifying individuals and families are eligible for tax credits, she said.
Specific to Kansans:
- Providing dependent coverage to age 26 will benefit more than 25,000 young Kansas adults.
- Prescription drug discounts will save $14 million for Kansans, an average of $615 per person.
- Rebates from insurance companies will total more than $4 million.
- A reinsurance program for retirees will affect employees at more than 60 Kansas companies.
- Federal funding for public and private Kansas recipients will exceed $90 million.
“I very much want people to know that I’m not saying ObamaCare is the best or the worst; it just ‘is,’ Riportella said. “It’s the law of the land and I am here to make sure that people understand what the criteria are.
“We will have a functioning exchange in our state and come January 2014, people who don’t have insurance will have a place to go to purchase more affordable insurance.”
Riportella said that several Kansas organizations have applied for a share of $600,000 in federal grants that is allocated to Kansas for enrollment. The grants will help establish “navigators” throughout the state – many of whom will be volunteers – to help Kansans sort through numerous health care options.
In addition, she will be training K-State Research and Extension agents and staff throughout Kansas so that they can help.
“I think when people start to hear what really is in the Affordable Care Act and how most of it is protecting middle class Americans, they will feel more comfortable with it,” she said.
Riportella added that ACA makes it illegal for insurance companies to
- deny coverage to children because of a pre-existing condition like asthma or diabetes (on Jan. 1, 2014, this applies to adults, too),
- put a lifetime limit on how much care they will pay for if you get sick, or
- cancel your coverage when you get sick by finding a mistake on your paperwork.
Thus far, three companies – Blue Cross/Blue Shield of Kansas, Coventry, and Blue Cross/Blue Shield of Kansas City – are approved to provide coverage for Kansans. Those same companies provide insurance at many larger Kansas companies, and many of the benefits they offer in those plans will now be available to all citizens.
“There is a lot of preventive care that is being covered here,” Riportella said. “If people use this new health care reform insurance system the way it’s meant to be used and the incentives for using preventive care work well, then we’ll have a lot more people treated in more cost-effective settings. They will be treated outside the hospital.”
In educating more people about the law, Riportella is being careful not to position herself as being in favor of or opposed to ObamaCare.
“What I’m an advocate for is good, quality care,” she said. “I or others may have chosen to make that happen in a different way than how the Affordable Care Act is making it happen, but I do believe that ACA will help to insure more Americans, and I think that’s a positive thing.”
Highlights of the Affordable Care Act
MANHATTAN, Kan. – Roberta Riportella, a professor of community health at Kansas State University, outlines some of the key parts of the Affordable Care Act, which goes into effect on Jan. 1, 2014:
- All Americans, with some exemptions, must have health insurance; insurance companies may no longer deny coverage for pre-existing conditions.
- Individuals with insurance through their employers or private insurance do not have to change their plans, but can still compare other options. They will see improved consumer protections and coverage of preventive services with those plans.
- Individuals who qualify for Medicare or Medicaid will continue to be eligible for those programs
- Companies will be able to make insurance more affordable because there is a larger pool, or marketplace.
- Many preventive services – such as mammograms, vaccinations, blood pressure screening, tobacco cessation counseling and more – will be available for free.
- Children may stay on their parents’ health plans up to age 26.
- Differences in premiums will be based on smoking status, region of the country and some differences allowed for age.
- Women will no longer be charged more for insurance than men.
- Americans will purchase insurance through a “Marketplace Exchange,” which provides affordable choices for consumers. Policies offered through the marketplace will vary on premiums, deductibles, and co-pays, and whether or not they are high deductible plans with health savings accounts. Consumers will choose from a network of health providers.
- Plans offered in the marketplace will be bronze, silver, gold or platinum, according to the benefits offered and costs of the premium.
- Insurance companies must spend 80 cents of the premium dollar on the consumer’s health care. Previously, companies were required to spend just 40 cents on the dollar.
- Open enrollment for insurance coverage begins in October, 2013 and, for the first year, extends through March 31, 2014.