News From Terre Haute, Indiana

Community News Network

September 30, 2013

Obamacare exchanges roll out with questions aplenty

Obamacare's insurance exchanges debut Tuesday and the run-up has looked a lot like a political campaign, with dueling TV ads, door-knocking volunteers and a focus on swing-state targets.

Just don't expect the usual ending to an election: a clear winner at the end of the day.

While the exchanges are expected to open on time, that milestone is unlikely to settle the 3 1/2-year grudge match over the Affordable Care Act. A long enrollment season, complicated by a threatened U.S. government shutdown and a growing list of technical glitches, means it may be as late as April before it's known how many uninsured Americans sign up under the law.

While the shutdown won't stop the roll-out, which is largely funded through mandatory appropriations that can't be curtailed by congressional inaction, it's an open question whether it will lessen public enthusiasm to enroll. Meanwhile, technical glitches are beginning to surface.

People in Oregon, for example, won't be able to enroll in a plan for the first few weeks unless they go through a broker or designated nonprofit groups, and the Obamacare exchange in the nation's capital won't include premium prices until mid- November.

The Obama administration says other glitches are inevitable as the system starts up. The question is how serious and how long it takes the exchange to fix any issues. An extended crash or a problem calculating subsidies could be an embarrassment for the White House — and sour consumers just as the administration tries to convince them to enroll.

"Is it going to be a train wreck, a complete failure? The answer is no," said Dan Schuyler, a director at Leavitt Partners, a Salt Lake City-based health-care consultant. "Is it going to be completely seamless and instantaneous? No. It is going to be somewhere in between."

The exchanges are at the heart of the law's efforts to cover more of the 48 million uninsured Americans. About 7 million people will use the system to buy subsidized insurance by the end of the first open enrollment period on March 31, according to congressional projections.

Republicans will spotlight any problem as proof the law is a disaster. Democrats say they'll overcome technical glitches and the law will sell itself as the uninsured gain benefits. Polls show most Americans side with the skeptics.

"The lights will go on Oct. 1, but they may flicker," said Jocelyn Guyer, a director at the Washington-based consultant Manatt Health Solutions. "I worry the most about people making premature judgments on the first couple of weeks."

Here's a primer on what to look for, based on interviews with consultants, insurers, analysts and state and federal officials:

Q: Who runs the exchanges?

A: Fourteen states have their own on-line exchanges, with the rest run in whole or part by the U.S. government.

Q: Who will use them?

A: The exchanges are open to people who buy coverage on their own and employees of businesses with 50 or fewer workers, as well as those currently shut out of insurance because of cost or a medical condition.

Subsidies are available, on a sliding scale, to those making as much as four times the poverty level, which is $11,500 for a single person and $24,000 for a family of four. Those making less than 138 percent of poverty will be eligible for Medicaid if they live in one of the 26 states set to expand the program.

Q: How many people will sign up early on?

A: Call it lowering expectations or a realistic assessment: either way, supporters say they don't expect a flood of enrollees this week.

Insurance buyers have to pay their first month's premium within 30 days of choosing a plan and the policies don't take effect until Jan. 1. As a result, the Obama administration says most people will wait until late November or December. Another surge may come in March as the end of the enrollment period nears.

Q: What happens if the federal government shuts down?

A: The exchanges will march on. That's because the 2010 law relies primarily on mandatory spending, which congressional inaction can't stop. It's the budget category used for benefits such as Medicare, the U.S. health plan for the elderly and disabled, and Social Security.

The U.S. Health and Human Services Department said in a Sept. 27 memo it "would continue large portions of ACA activities, including coordination between Medicaid and the marketplace" in the event of a temporary shutdown.

"Many of the core parts of the health-care law are funded through mandatory appropriations and wouldn't be affected," Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight at HHS, told reporters on Sept. 24.

Q: OK, so most of the exchanges will be up and running on time. How do you access them?

A: If all goes as planned, those not covered through work will be able to go on line or dial a call-in center, learn if they're eligible for tax credits and choose from a menu of private plans. The exchanges can be found at www.healthcare.gov.

Q: Who won't use them?

A: Most of us. People who have insurance through their jobs, about 55 percent of Americans, aren't directly affected by the law and are automatically in compliance with its mandate that everyone be insured. So are older Americans covered through Medicare.

Q: Do I have to buy insurance?

A: Yes, or pay a fine. The law requires that most Americans be insured starting Jan. 1. That can be through work, a government program like Medicare or Medicaid, or by buying on the exchanges. Those who opt out face a penalty starting next year at $95 or 1 percent of household income, whichever is higher. By 2016, it rises to $695 per individual or 2.5 percent of household income, whichever is greater.

Q: Is the technology for the exchanges in place?

A: Building the exchanges has been a massive technical lift, requiring computer systems with real-time links to dozens of state and U.S. agencies and private carriers. The administration says the system is ready to go, albeit with delays and reduced capabilities in places like Oregon and Washington.

Q: Has anything else been delayed?

A: The law requires that large companies offer benefits to anyone working more than 30 hours a week. In July, that rule was postponed until 2015 to ease the burden of compliance.

Last week, officials said a Spanish-language version of the federal website won't be ready until mid-October and an exchange for small business workers won't take enrollments until November. Nevada and California also won't transmit names of new customers to insurers for about a month, Schuyler said.

Q: Will the coverage be affordable?

A: It depends on who you are and where you live. Six in 10 uninsured people will find insurance for less than $100 a month because of subsidies and expansions to Medicaid, the administration said last week. Those who make too much for assistance may be in for sticker shock: the same report said even bare-bones coverage, known as a bronze plan, will average almost $3,000 a year for individuals.

For families, the cost of mid-level coverage, a silver plan, ranges from $559 a month to $1,216 a month in 36 states where the federal government controls the exchanges. Tax credits will reduce the cost for many: a family earning $50,000 a year may find the price of a bronze plan cut to zero in some states.

Q: How will insurers cover the costs for all those added sick people?

A: By signing up the young and healthy. The administration said it needs about 40 percent of new enrollees to be in this group to help balance costs from older, sicker customers and keep premiums stable.

Q: Do Americans understand what they're getting into?

A: No. The polls indicate consistent confusion. Three in five say the law will raise medical costs, and more say they'll be worse off under it than better, according to a Bloomberg National Poll conducted Sept. 20-23. Half also said Republicans should back off on demands to defund the law, a schizophrenic view that's persisted for months.

Q: So does anybody like this law?

A: Yes. Sixty-one percent of Hispanics and 91 percent of blacks, according to a September poll by the Pew Research Center and USA Today. That could make the sales pitch easier because those two groups comprise the bulk of the uninsured in the U.S. — 47 percent of the total, according to an analysis by the Kaiser Family Foundation. The law also is designed to benefit people with pre-existing medical conditions: insurers will no longer be able to deny them coverage.

Q: What's happening in the big states?

A: Supporters have focused on states such as Texas, Florida, Ohio and New Jersey, where many uninsured live and Republican governors refuse to help in enrollment. California, which has the most uninsured, is spending $100 million to promote its exchange while New York plans to spend $27 million to train community groups and brokers to assist consumers.

Q: How much help do consumers get?

A: The administration is spending $67 million to train health workers, hospitals and other groups, called navigators, to help people enroll. Grants didn't arrive until August, though, and many began a two-week training course this month. If they're not up to the task, enrollment may suffer.

"You're going to have tens of thousands if not hundreds of thousands of individuals who have never been exposed to health insurance before — don't know what a premium is, what a deductible is," said Schuyler, the Leavitt Partners consultant.

Q: Do Democrats think the law needs to change?

A: Some have called for changes: Families of workers whose company plan doesn't include dependents can't get subsidies. A tax credit for small businesses has been criticized as ineffective. And there are bipartisan bills in Congress to change a provision that may encourage businesses to cut workers' hours to avoid insuring them. A quick fix seems unlikely: Republicans say they won't tinker with a law they consider fundamentally flawed.

Q: What's happening with Medicaid?

A: While the government health program for low-income Americans is expanding under the law, about half the states have opted out. The Obama administration last week agreed to let Arkansas use the money to help poor citizens buy private insurance on its exchange. The deal could entice other states where Republicans have opposed the expansion.

Q: Is Obamacare making health-care more expensive?

A: Time will tell.

Medical costs have moderated in the U.S. the past three years, offering some relief to the public and private sectors alike. Prices for medical care rose 1 percent in July compared with a year earlier, the lowest growth rate since the 1960s, according to U.S. Commerce Department data.

There's a debate among economists about how much credit to give the health law compared with a weak economy and employer moves to curtail benefits. Obamacare supporters say at least some of the slowdown is thanks to regulations and pilot programs in the act aimed at reducing waste in the medical system.

With assistance from Alex Wayne and Heidi Przybyla in Washington and Alison Vekshin in San Francisco.

1
Text Only | Photo Reprints
Community News Network
  • Dangerous Darkies Logo.png Redskins not the only nickname to cause a stir

    Daniel Snyder has come under fire for refusing to change the mascot of his NFL team, the Washington Redskins. The Redskins, however, are far from being the only controversial mascot in sports history.  Here is a sampling of athletic teams from all areas of the sports world that were outside the norm.

    July 28, 2014 3 Photos

  • 'Rebel' mascot rising from the dead

    Students and alumni from a Richmond, Va.-area high school are seeking to revive the school's historic mascot, a Confederate soldier known as the "Rebel Man," spurring debate about the appropriateness of public school connections to the Civil War and its icons.

    July 28, 2014

  • Fast food comes to standstill in China

    The shortage of meat is the result of China's latest food scandal, in which a Shanghai supplier allegedly tackled the problem of expired meat by putting it in new packaging and shipping it to fast-food restaurants around the country

    July 28, 2014

  • wd saturday tobias .jpg Stranger’s generosity stuns Ohio veteran

    Vietnam War veteran David A. Tobias was overwhelmed recently when a fellow customer at an OfficeMax store near Ashtabula, Ohio paid for a computer he was purchasing.

    July 28, 2014 1 Photo

  • Screen Shot 2014-07-28 at 1.33.11 PM.png VIDEO: High-dive accident caught on tape

    A woman at a water park in Idaho leaped off a 22-foot high dive platform, then tried to pull herself back up with frightening results. Fortunately, she escaped with only a cut to her finger.

    July 28, 2014 1 Photo

  • CATS-DOGS281.jpg Where cats are more popular than dogs in the U.S.-and all over the world

    We all know there are only two types of people in the world: cat people and dog people. But data from market research firm Euromonitor suggest that these differences extend beyond individual preferences and to the realm of geopolitics: it turns out there are cat countries and dog countries, too.

    July 28, 2014 1 Photo

  • How spy agencies keep their 'toys' from law enforcement

    A little over a decade ago, federal prosecutors used keystroke logging software to steal the encryption password of an alleged New Jersey mobster, Nicodemo Scarfo Jr., so they could get evidence from his computer to be used at his trial.

    July 25, 2014

  • Russia's war on McDonald's takes aim at the Filet-o-Fish

    Russia said earlier this week that it had no intention of answering Western sanctions by making it harder for Western companies to conduct business in Russia.
    But all bets are off, apparently, when you threaten the Russian waistline.

    July 25, 2014

  • cleaning supplies Don't judge mothers with messy homes

    I was building shelves in my garage when a neighbor girl, one of my 4-year-old daughter's friends, approached me and said, "I just saw in your house. It's pretty dirty. Norah's mommy needs to clean more."

    July 25, 2014 1 Photo

  • Arizona's prolonged lethal injection is fourth in U.S. this year

    Arizona's execution of double-murderer Joseph Wood marked the fourth time this year that a state failed to dispatch a convict efficiently, according to the Constitution Project, a bipartisan legal group.3

    July 24, 2014

  • Police Brutality screen shot. Technology plays key part in battling police brutality (VIDEO)

    Allegations of police brutality are nothing new -- as long as there has been law enforcement, citizens have registered claims that some officers cross the line. But in the last few years, the claims of excessive force are being corroborated with new technology from cell phone cameras, police dash-cams and surveillance videos. 

    July 24, 2014 1 Photo

  • Facebook continues moneymaking trend

    Facebook seems to have figured out - for now at least - the holy grail for all media right now: how to make money selling mobile ads.

    July 24, 2014

  • Has the ipad lost its swag?

    July 24, 2014

  • Almost half of America's obese youth don't know they're obese

    The good news is that after decades of furious growth, obesity rates finally seem to be leveling off in the U.S.. The bad news is that America's youth still appear to be dangerously unaware of the problem.

    July 23, 2014

  • Darth Vader is polling higher than all potential 2016 presidential candidates

    On the other hand, with a net favorability of -8, Jar Jar is considerably more popular than the U.S. Congress, which currently enjoys a net favorability rating of -65.

    July 23, 2014

  • 072214 Diamond Llama 1.jpg Llama on the loose corralled in Missouri town

    A llama on the lam cruised Main Street Tuesday before it mistook a resident’s fenced backyard for a place to grab a meal and freshen up.

    July 22, 2014 2 Photos

  • An oncologist uses scorpion venom to locate cancer cells

    Olson, a pediatric oncologist and research scientist in Seattle, has developed a compound he calls Tumor Paint. When injected into a cancer patient, it seems to light up all the malignant cells so surgeons can easily locate and excise them.

    July 22, 2014

  • Screen Shot 2014-07-22 at 2.00.42 PM.png VIDEO: Train collides with semi truck carrying lighter fluid

    A truck driver from Washington is fortunate to be alive after driving his semi onto a set of tracks near Somerset, Ky., and being struck by a locomotive, which ignited his load of charcoal lighter fluid.

    July 22, 2014 1 Photo

  • mama.jpg What we get wrong about millennials living at home

    If the media is to be believed, America is facing a major crisis. "Kids," some age 25, 26, or even 30 years old, are living out of their childhood bedrooms and basements at alarmingly high numbers. The hand-wringing overlooks one problem: It's all overblown.

    July 22, 2014 1 Photo

  • Wal-Mart to cut prices more aggressively in back-to-school push

    Wal-Mart Stores plans to cut prices more aggressively during this year's back-to-school season and will add inventory to its online store as the chain battles retailers for student spending.

    July 21, 2014

  • Hospitals let patients schedule ER visits

    Three times within a week, 34-year-old Michael Granillo went to the emergency room at Northridge Hospital Medical Center in Los Angeles because of intense back pain. Each time, Granillo, who didn't have insurance, stayed for less than an hour before leaving without being seen by a doctor.

    July 21, 2014

  • Starved Pennsylvania 7-year-old weighed only 25 pounds

    A 7-year-old Pennsylvania boy authorities described as being so underweight he looked like a human skeleton has been released from the hospital.

    July 21, 2014

  • Malaysians wonder 'Why us?' after second loss of airline jet

    It was all too familiar. Grieving families rushing to airport. The flashing television graphics of a plane's last radar appearance. The uncomfortable officials before a heavy thicket of microphones.
    For many Malaysians, the disappearance of Flight 370 in March has been a long trauma from which the nation has not yet recovered.

    July 18, 2014

  • A quarter of the world's most educated people live in the 100 largest cities

    College graduates are increasingly sorting themselves into high-cost, high-amenity cities such as Washington, New York, Boston and San Francisco, a phenomenon that threatens to segregate us across the country by education.

    July 18, 2014

  • Your chocolate addiction is only going to get more expensive

    For nearly two years, cocoa prices have been on the rise. Finally, that's affecting the price you pay for a bar of chocolate - and there's reason to believe it's only the beginning.

    July 18, 2014

  • Facebook tests button to let people shop from its website

    Members on desktop computers or mobile devices can click a "buy" button to make purchases through advertisements or other posts on the world's largest social network, the Menlo Park, California-based company said Thursday in a blog post.

    July 17, 2014

  • The terrible history of passenger planes getting shot out of the sky

    What is more clear is that, if initial reports are true, this would be the deadliest incident of a civilian passenger plane being shot down in modern memory. In some instances, the causes of the disaster are still shrouded in mystery. Here are some of the worst events.

    July 17, 2014

  • 130408_NT_BEA_good kids We're raising a generation of timid kids

    A week ago, a woman was charged with leaving her child in the car while she went into a store. Her 11-year-old child. This week, a woman was arrested for allowing her 9-year-old daughter to go to the park alone. Which raises just one question: America, what the heck is wrong with you?

    July 17, 2014 1 Photo

  • web_starbucks-cof_big_ce.jpg Starbucks sees more Apple-like stores after Colombia debut

    This week Starbucks opened its first location in Colombia — a 2,700-square-foot store with a heated patio, concrete columns, mirrors on the ceiling and walls of colorful plants.

    July 17, 2014 1 Photo

  • VIDEO: New story emerges about Texas children locked in hot car

    After footage showed Texas shoppers breaking the windows of a hot car to rescue children trapped inside, additional witnesses have come forward to correct the story behind what has become a viral video.

    July 16, 2014

Latest News
TribStar.com Poll
AP Video
The Carbon Trap: US Exports Global Warming Raw: Massive Dust Storm Covers Phoenix 13 Struck by Lightning on Calif. Beach Traditional African Dishes Teach Healthy Eating Baseball Hall of Famers Inducted Raw: Shipwrecked Concordia Completes Last Voyage UN Security Council Calls for Gaza Cease-fire Raw: Sea Turtle Hatchlings Emerge From Nest Raw: Bolivian Dancers Attempt to Break Record Raw: Airstrike Shatters Fragile Calm in Gaza Israel, Hamas Trade Fire Despite Truce in Gaza Italy's Nibali Set to Win First Tour De France Raw: Corruption Trial Begins for Former Va Gov. Raw: Israel, Palestine Supporters Rally in US Kangaroo Goes Missing in Oklahoma Fox Dons 'Bondage Strap' Skirt at Comic-Con 12-hour Cease-fire in Gaza Fighting Begins Video Shows Smiling American Bomber in Syria Mobile App Gives Tour of Battle of Atlanta Sites Maine Police Investigate Deaths of Family of 5
NDN Video
'Hunger Games: Mockingjay Part 1' Sneak Peek GMA: Dog passes out from excitment to see owner Chapter Two: Designing for Naomi Watts Baseball Hall of Famers Inducted Florida Keys Webcam Captures Turtles Hatching Morgan Freeman Sucks Down Helium on 'Tonight Show' Robin Wright Can Dance! (WATCH) She's Back! See Paris Hilton's New Carl's Jr. Ad Big Weekend For Atlanta Braves In Cooperstown - @TheBuzzeronFox Chapter Two: Becoming a first-time director What's Got Jack Black Freaking Out at Comic-Con? Doctors Remove 232 Teeth From Teen's Mouth Bradley Cooper Explains His Voice in 'Guardians of the Galaxy' Deja vu: Another NYPD officer choke-holding a suspect 'Fifty Shades of Grey': Watch the Super Sexy First Trailer Now! Reports: Ravens RB Ray Rice Suspended For 1st 2 Games Of The Season Air Algerie plane with 119 on board missing over Mali Diamond Stone, Malik Newman, Josh Jackson and others showcase talent Free Arturo - The World's Saddest Polar Bear A Look Back at Batman On Film Through The Years
Parade
Magazine

Click HERE to read all your Parade favorites including Hollywood Wire, Celebrity interviews and photo galleries, Food recipes and cooking tips, Games and lots more.
  • -

     

    March 12, 2010

activity