Valley View Aims to Clear Confusion Surrounding ‘Obamacare’

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During a community forum last week, Valley View Health Center set out a goal of reducing misinformation on the implementation of health care reform.

Nathan Johnson, of the Washington State Health Care Authority, spoke to a group of citizens and health care providers at Centralia College about the coming Medicaid expansion, Affordable Care Act coverage opportunities and complimentary reform efforts. 

The U.S. Supreme Court in June upheld the new law’s mandate requiring individuals to have health insurance or pay a tax penalty.

“It increases the expectation of personal responsibility,” Johnson said.

 

As part of the reform, the state is setting up its own insurance marketplace called the Health Benefit Exchange, which will begin enrollment for individuals, families and small businesses on Oct. 1 with coverage beginning on Jan. 1, 2014. 

“I’m encouraged by the idea that it’s going to be a one-stop-shop,” said Lorna Smith, a Chehalis reflexologist and small business owner.

Though the majority of peoples’ coverage will remain the same, individuals and small employers can put income information into the Exchange’s web-based portal to determine eligibility for Medicaid, the Children’s Health Insurance Program, premium tax credits and cost sharing reductions or qualified health insurance plans, then choose and enroll in coverage.

“They’ll be able to make apple to apple comparisons for the first time,” Johnson said. 

The Exchange will have representatives available on the phone and in-person to assist with the online process. Valley View, like many medical providers, has a self interest to help patients navigate the new state system and has hired two employees to assist with the process.

“We believe having coverage and preventative services is the best way to reduce costs,” said Steven Clark, the center’s executive director. “Twenty minutes is the goal to see if you qualify.” 

The Exchange will offer bronze, silver, gold, platinum and catastrophic plans with the costs determined by income, though actual rates are yet to come. People with up to 400 percent of the federal poverty level, which is an annual income of $44,680 for an individual or $76,360 for a family of three, who remain ineligible for Medicaid are eligible for premium tax credits and cost sharing reductions, determined by income.

“I felt good about the idea of looking at health care for most people,” Smith said. “It’s a silly process where we take care of them in the emergency room.”

 

The Affordable Care Act also includes private market reforms, including preventing insurers from using pre-existing conditions as exclusions, removing lifetime and annual caps on coverage, eliminating rescission, taking away cost-sharing on preventative care, and laying out essential health benefits such as substance abuse treatment and mental health services. 



“The things insurance companies were really able to use to take advantage of individuals were eliminated.” Clark said.

The law allows dependants to stay on their parents insurance until age 26, creates unified explanation of coverage documents, includes reporting requirements regarding the quality of care, ensures premium dollars fund actual care, and adds processes to review unreasonable rate increases.

 

For those who cannot afford private or subsidized insurance, Washington state has decided to participate in the Medicaid expansion, which simplifies eligibility, streamlines existing administrative processes and maximizes technology to make it more consumer friendly, according to the HCA. Additionally, Medicaid will cover a new group of adults living below 138 percent of the federal poverty level, or an annual income of $15,415 for an individual or $26,344 for a family of three. 

“Eighty-five percent of Washington’s uninsured adults will have access to affordable coverage,” Johnson said, acknowledging that some groups like undocumented immigrants will remain uninsured. “That’s an amazing and astounding, nearly universal number.”

The federal government is paying 100 percent of the state’s Medicaid expansion cost for the first three years, phasing down to 90 percent by 2020. 

“That’s $150 million in state savings, which is very significant considering the deficit that awaits the legislature,” Johnson said. “So there’s a real incentive for states to pursue the Medicaid expansion.”

Smith pointed out during the forum that the ACA or “Obamacare” is a national plan modeled after the Massachusetts’ health care reform or “Romneycare.” Smith said her cousins who live in Massachusetts actually like their new health care system. 

Additionally, Smith said, many people visit her Lewis County farm from places with some form of publicly funded health care such as Germany, Canada, France, Sweden and Denmark.

“And they just shake their heads when they hear how much our health care costs us,” she said. “Of course, I’m not as scared as some people when they hear the word socialism. ... The idea of cooperation and helping the other brother or sister up a peg is good.”

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Amy Nile: (360) 807-8235

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