The good, the bad & the ugly
While politicians play games, confused citizens still need health coverage

The good, the bad & the ugly

Another change prompted by executive action – and one causing a lot of confusion – is the cutting of subsidies. The order cut reimbursements to health insurance companies, not subsidies to individuals. The subsidies are still available, but the loss for insurers is getting passed on to the people who don't qualify for subsidies./File photo

Tracy Chamberlin - 11/02/2017

Ever since the Affordable Care Act was first introduced – let alone made the law of the land – it has served as a cherry-pickers paradise of political talking points. What often gets lost in all the political posturing, though, is what it means for a Bayfield mother who is 7 months pregnant, a 10-year-old boy in Durango who breaks an arm or a 60-year-old grandmother in Ignacio who wants a flu shot.

With all the fighting, fakery and executive orders coming out of Washington, D.C., health professionals at San Juan Basin are having to work overtime to clear up the confusion and explain how it affects people living in Southwest Colorado. 

For some residents, health care costs could go up dramatically. For others, it could go the other way.

“Many people will see an actual reduction in the amount they pay,” Kevin O’Connor, certified health coverage guide with San Juan Basin Health Department, said.

Other details about the open enrollment period – which started Nov. 1 – only apply to the federal health exchange.

It’s been reported open enrollment is shorter than in years past, closing on Dec. 15. However, this is only true for the states that use the federal exchange. Colorado has its own state exchange – Connect for Health Colorado – which will be open through Jan. 12.

It’s one of many misconceptions O’Connor and his colleagues at San Juan Basin are trying to clear up.

Coverage for kids

One of the biggest question marks, which affects people no matter what state they live in, concerns the Children’s Health Insurance Program, or CHIP.

CHIP is a federal program administered by state governments – in Colorado, it’s called the CHP+ Program. No matter the acronym, this is the health insurance program for low-income kids and expectant mothers.

The problem is the U.S. Congress has not funded this program for 2018. The deadline was Sept. 30, and it quickly passed without any action from Washington.

Most state CHIP programs had enough funding left to keep participants covered for a bit, but the end is coming soon. States like Arizona, Texas, Oregon and Minnesota, for example, are expected to run out of funds before the end of the year. Colorado won’t last much longer.

“Unless funding is authorized, the CHP+ Program will end Jan. 31,” O’Connor explained.

He said program participants should be aware of the issue, but he warned them not to cancel plans to get care. The state’s Division of Insurance is monitoring developments at the federal level and will contact participants when necessary.

If Congress fails to act and the funding runs dry, participants – of which there are about 1,000 in La Plata County – will be allowed to look for coverage on the state’s health exchange for 60 days after their coverage ends.

There is also a chance Congress will pass legislation to fund the program before then.

O’Connor wouldn’t venture a guess, saying only, “We certainly hope so.”

Campaigns to push congressional delegates to act are already under way by advocacy groups in the Four Corners, Colorado and across the country. But for now, everyone is waiting to see – which is just what’s playing out with the Affordable Care Act.

On the open market

With a Republican president and Republican majority in both houses, many people expected the Affordable Care Act to be repealed in short order. But it was not.

The ACA is still the law. The mandate for companies with 50 or more full-time employees still stands. And the individual tax mandate is still in effect – residents need to have health coverage for 2018 or pay the penalty.

The tax penalty for the coming year is either 2.5 percent of a household’s adjusted gross income or $695 per adult and $347.50 per child, depending on which one is higher. There is an “unaffordability” exemption available, but residents need to apply for it. 

This year, La Plata County residents have two options on the state exchange: Anthem and Friday Health Plans (residents in Montezuma County have only one: Anthem.) It’s down from the four or five providers available in the exchange’s first year, but no different from last year in La Plata County, when just two insurers were available – although not the same two.

The real difference on the exchange is that catastrophic plans are now available under one of the executive orders coming out of the White House recently. They can be less expensive, but also offer far less coverage.

Another change prompted by executive action – and one causing much of the confusion – is the cutting of subsidies. Although many of the headlines were about cutting subsidies for individuals, what the executive order actually did, according to O’Connor, was cut reimbursements to health insurance companies.

The cost-sharing reductions, or CSRs, the subsidies that offset the cost of health insurance for qualifying individuals and families, have not been cut.

“For virtually everybody who uses Connect for Health Colorado, nothing really has changed,” O’Connor said. “The only people who are going to see a change are the people who are not eligible for assistance.”

Premium rates were already expected to go up this year, following a September announcement from the state’s Division of Insurance. The increase was estimated to be about 27 percent. With the recent executive order cutting payments to insurance companies, the increase is now much higher, more than 50 percent in some cases.

This doesn’t mean, however, everyone will pay more for health insurance. In most cases, they’ll actually pay less, according to O’Connor.

“The reality is the federal government is going to pay for it in another form,” he said.

However, the people who will feel the squeeze are the people who don’t qualify for subsidies in the first place. They’ll have to pay the higher costs without the benefit of additional help from the federal government.

According to O’Connor, a family of four earning $98,000 a year can still qualify for subsidies, so he encouraged everyone to check out their options – no matter what. Another executive order coming out of the White House cut funding for marketing and outreach, but this order hasn’t changed the marketplace in Colorado. The cut in funding for public relations and outreach only affects federal health exchange states, according to O’Connor.

He said the state exchange and San Juan Basin Health have the same budget for outreach as in years past. Next up for San Juan Basin is an open enrollment event from 8 a.m.-2 p.m. Sat., Dec. 2, at the La Plata County Fairgrounds. Health department representatives – including O’Connor – will be on hand to help with questions, enrollment and more.

The key takeaway coming from San Juan Basin Health professionals is don’t blow off the open enrollment period. Don’t assume you don’t qualify for help. And, don’t believe all the hype.

The good, the bad & the ugly

Another change prompted by executive action – and one causing a lot of confusion – is the cutting of subsidies. The order cut reimbursements to health insurance companies, not subsidies to individuals. The subsidies are still available, but the loss for insurers is getting passed on to the people who don't qualify for subsidies./File photo