Readers have lots of Obamacare questions. We have answers!

July 15, 2013

 Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.

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Every now and then I use this space to answer readers' questions about the Affordable Care Act and what it means for them. Ever since the employer mandate delay, I've gotten a whole lot those queries, a few of which I wanted to answer here. Let's get right to them, starting with Bill Luton from North Carolina.

I work from home, and my company is located in California. I have to buy private insurance ($600/month for family) because my coverage would be $1,700/month through my company. I'm wondering if, because the company technically does offer me insurance (out of reach though it may be), am I going to be able to buy insurance on the Exchange instead of continuing to buy private, non group, insurance through BCBS NC.

This is actually a pretty complex part of the health care law that Bill is asking about, but I'll try to make it simple. The health care law does indeed take into account whether an individual receives employer-sponsored insurance (as Bill does) in determining who is eligible to receive tax subsidies.

Anyone who receives an "affordable" offer of health insurance is not eligible to use tax credits on the public marketplace. What's affordable for a line cook at a fast food restaurant, however, might be significantly different than what a top executive at that chain can afford. That's why the health care law tethers the definition to income, defining affordable as an individual health insurance plan that costs less than 9.5 percent of a family's income.

It's worth noting here that the federal government has decided to use the cost of an individual rather than family policy in determining what counts as "affordable." So Bill's insurance might count as "affordable," even if the family plan costs more than 9.5 percent of his family's income. You can read more about this issue, which some advocacy groups have dubbed the "kid glitch," here.

Another question, from Kansas: I live in Kansas-no exchange here! How does a young person get info on federal exchange (s) available for a state without an exchange?

Kansas has indeed refused to build a health insurance marketplace. But that doesn't mean there's "no exchange:" the federal government plans to step in and stand up these web portals in states that have not gone forward with the task themselves. You can see a map of those states, right here, courtesy of Avalere Health:

A young person in Kansas will get health insurance the same way, then, as a young person in neighboring Colorado, which is running a marketplace. They'll log into a web portal, punch in personal information and choose between their options.

Last question of the day: Given that ACA precludes insurance companies from turning me down for pre-existing conditions, what would stop me from simply not buying insurance until I needed it? I can't be denied emergency care in a hospital, and if i get sick, I can just get insurance despite having a pre-existing condition. 

Excellent question! It would indeed be a great deal to purchase health insurance right at the instance you needed it, perhaps via iPhone en route to the emergency room.

It would be a great deal for the individual, at least. But if everyone did this, insurance premiums would spike; you would no longer have healthy people paying into the insurance pool. That's why the health care law has open enrollment periods, specific times when people can enroll, switch or leave their health insurance plans.

The first open enrollment period, for coverage starting Jan. 1, will run from Oct.1 through March 31. Starting in the winter of 2014, the open enrollment period will be shorter, running from Oct.15 to Dec.7.

KLIFF NOTES: Top health policy reads from around the Web.

Lessons from Part D for Obamacare's implementation. "Part D and the Affordable Care Act resulted from contentious negotiations and fierce legislative battles. Both charged the Department of Health and Human Services with creating an insurance marketplace where people could choose among competing private plans. Both involved new regulations and information-technology systems, approval of insurer bids and plans, coordination with federal departments and state governments, and the education of millions of Americans. However, the ACA’s challenges are even greater than those we faced, given the law’s complexity, size and scope." Michael Leavitt in the Washington Post.

Breastfeeding companies continue to cash in on the law. An Obamacare rule that entitles moms to free breast pumps and breast-feeding services from their insurers is opening new business opportunities for supporters of breastfeeding —and encouraging healthier babies and mothers at the same time. The venture's pitch to insurance companies and big firms that self-insure: Use their service to obtain electric breast pumps for new moms, and then to provide those moms with lactation consulting services that will support them in the goal of continuing to breastfeed their babies." Dan Mangan at CNBC.

Even without expanding Medicaid, Texas is bracing for a wave of new patients. "The Texas Health and Human Services Commission projects 240,000 children currently eligible for Medicaid but not participating will enroll in 2014 and 2015, as families seek coverage to comply with the individual insurance mandate, which takes effect on Jan. 1. An additional 200,000 people could enroll in Medicaid as a result of other new requirements created by the law, according to state health officials." Becca Aaronson in the Texas Tribune

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