Virginia’s Republican leaders have been staunch critics of the Affordable Care Act, which many state leaders see as a gross overreach by the federal government. The state filed an unsuccessful lawsuit challenging the law, has declined so far to expand Medicaid and isn’t running its own health insurance marketplace. The federal government will run it instead.
As a result, the state wasn’t eligible for millions of dollars in federal funds for consumer assistance, outreach and enrollment. Virginia is expected to have at least 16 consumer helpers in the entire state; that compares with about 80 for Montgomery and Prince George’s counties. The private and nonprofit sectors are scrambling to try to fill the gaps.
The commonwealth has about 872,000 uninsured residents, according to state officials. A little more than half are expected to be eligible for federal subsidies if they buy private insurance on the marketplace.
Because Virginia has not yet expanded Medicaid, low-income residents won’t have the same benefits as their counterparts in Maryland and the District, which broadened coverage to include more low-income adults. In Virginia, which has one of the strictest standards in the country, childless adults are not eligible for Medicaid no matter how poor, unless they’re pregnant or disabled.
But under the health-care law, Virginians who earn between 100 percent and 400 percent of the poverty level (between $11,490 and $45,960 for an individual and between $23,550 and $94,200 for a family of four) are eligible to buy subsidized policies on the marketplace.
Nine insurers plan to offer more than 200 medical plans for Virginia residents. The companies include CareFirst BlueChoice, Kaiser Foundation Health Plan of the Mid-Atlantic States and Innovation Health Insurance, a recently formed partnership between Northern Virginia’s Inova Health System and Aetna.
An analysis of insurance filings by the Kaiser Family Foundation gave these examples of potential premiums for nonsmokers in the D.C. region, which includes Arlington, Fairfax and Prince William counties:
●A 25-year-old choosing a “bronze” option would face monthly premiums ranging from $138 for a CareFirst BlueChoice policy to $241 for an Optima Health policy. Bronze plans have lower monthly premiums but higher out-of-pocket costs than other choices.
●A 50-year-old buying a “silver” plan could pay $362 for an Innovation policy or $465 for an Optima plan.
These estimates don’t take subsidies into account, so the actual cost to many consumers would be lower.
The Small Business Health Options Program (SHOP) will also be open Oct. 1 for companies with up to 50 full-time employees that want to buy small-group coverage for them.
Local social service offices and a new statewide call center will process applications for Medicaid, referring applicants to the federal marketplace whenever appropriate. State officials are hoping to have a Web site and telephone number for that call center operational by Oct. 1.
The Virginia Poverty Law Center received a federal grant in August to assist people wanting to buy insurance. It will have about 16 “navigators” working statewide to identify and help uninsured Virginians. The center will coordinate with local organizations, reaching out to specific groups, such as community college students, workers at small businesses and lower-income families.
Before Oct. 1, the law center plans to open a toll-free number and Web site for consumers who want help, including in-person assistance filling out applications.
Community health centers across the state are also hiring guides to help consumers.
In the meantime, Virginians can get information online at www.healthcare.gov and from the federal government’s call center at 800-318-2596. The call center is available seven days a week, 24 hours a day.