Monday, November 18th, 2013
Difficult to keep up with changes to new health law
By Kathy Thompson
The story is changing daily for the Affordable Care Act.
According to Health and Human Services, more than 800,000 Ohioans were expected to sign up for health care before the end of the year, most using the Health Insurance Marketplace website.
As of last week, only 1,000 Ohioans had signed up using the problem-laden website unveiled Oct. 1, according to HHS.
Adding to the trouble was President Barack Obama's statement on Thursday that he wanted insurance policies - which had been recently dropped by companies due to 10 mandatory benefits set by the ACA - continued for at least a year.
The change has put insurance brokers and agencies into "chaos," according to Barb Gerken, a regional sales manager for CornerStone Broker Insurance Agency for Ohio.
"The plan designs were already filed and approved," Gerken said. "What he's done, I'm not sure is possible. To us, his announcement was a short way around taking the blame himself," Gerken said. "He threw the insurance companies under the bus for his implementations."
Amy Sheaks, an insurance provider with Stammen Insurance in Celina, said she has no idea what Obama's announcement is going to mean to consumers who are already shocked by the new law and policies.
"We're not sure what is going to happen," Sheaks said. "This is going to be up to the carriers."
Gerken said companies have taken great care and a lot of time and energy to conform to the new mandates.
"Now, on top of all the changes and unhappiness, the issue is becoming even more complex by that announcement and people are throwing up their hands in frustration," Gerken said. "I don't know if we'll be able to get people covered by the deadline."
Senator Sherrod Brown said he believes the health law has already benefitted millions of Ohioans by ending lifetime limits on coverage and ending discrimination based on pre-existing conditions.
"But in order for millions more to have quality, affordable health care, we need to work together," Brown said in a statement Friday. "As the President said, this action won't solve every problem for every person."
State Senator Keith Faber, R-District 12, did not respond to questions regarding the health care issue.
Local help available to purchase insurance
Local insurance providers said they are miffed that national attention has been directing consumers to the website and not local agents. Navigators are being brought in to assist those consumers using the Health Insurance Marketplace. Heidi Trombly will have completed her training in a couple of weeks, said Julie Grasson, an ACA project director in Toledo, and will be in Mercer County for a few hours every week.
"We, too, can provide residents and clients with health care insurance," said Bill Stammen, owner of Stammen Insurance in Celina. "We have been doing it for years. But have you heard the president or anyone else going on national media and telling them to go to their local providers? No."
It's one reason Stammen put an "Obamacare" sign outside his business on Main Street.
"I think people should know they have other options," Stammen said.
Stammen said insurance agents are the experts at what a client needs, which makes an agent more reliable for getting that consumer the best policy.
"Brokers and agents are the best way," Gerken agreed. "They know the client and they are the experts at the insurance field. The navigators have about 30 hours of training versus an agent who has 20 to 30 years of experience."
"We're the ones who know the markets," Stammen said. "No matter if you come to us or go on the website, you are still purchasing health insurance from the same health insurance companies. But, buyer beware."
Stammen said he doesn't believe the website will be able to fairly tell consumers what policy will be best for them.
"We know the local doctors and hospitals," Stammen said. "The website doesn't. We know what policies are going to enable and continue to allow our customers to keep their doctors and medical facilities. Does the website?"
Grasson said navigators are not allowed to give opinions, suggest certain policies over others or offer advice.
"It is true that what comes up on the healthcare website does not provide a listing of what physicians and what medications are covered," Grasson said. "That is where the navigator will further assist the individual by looking up the insurance policies the person may be interested in based on price to see if the hospital and physicians the individual utilizes are covered and as well as what the prescription formulary is for each of the policies. Grasson said there are 34 plans available for residents of Mercer County with Medical Mutual, Healthspan and Anthem Blue Cross/Blue Shield.
Dan Burke, owner of RJ Burke Insurance Agency in St. Marys, and Bob Leugers, of Leugers Insurance in Celina, agree with Stammen and Gerken.
"I think people have become frustrated trying to purchase insurance over the government website," Burke said. "We've been working in this field a long time. We know the products. We can be an advocate to the consumer."
Leugers said there is more to health insurance then going to a website and purchasing a policy.
"We're here to help the consumer if they have a claim, also," Leugers said.
Grasson said the one big advantage to using a navigator and website: finding out exactly what or if a consumer can qualify for a tax credit.
"That has to be done over the website," Grasson said.
The amount of a tax credit will depend on household income as a percentage of the federal poverty level. The premium for the second lowest level plan (the benchmark plan) is adjusted for the age of the covered person and a sliding scale that increases the taxpayer's own contribution toward the premium as household income increases.
There are also exemptions from the individual mandate, including individuals with financial hardships, those with religious objections, undocumented immigrants, individuals whose income is below the threshold required to file a tax return and those where the lowest cost health plan available exceeds 8 percent of their income.
Stammen and Burke said they don't understand why the government needed to get involved in implementing the ACA.
"As far as I'm concerned," Burke said, "the federal government is running a program they have no experience at. They are shoving this down our throats."
Stammen agrees with Burke and also said that the government "rarely does things right and efficient."
"Some of the companies will not have much of a network of providers in our rural areas," Stammen said. "They're geared for the bigger cities. I'm afraid local doctors and hospitals are going to be eliminated."
While some clients may get cheaper plans, Stammen said, those plans may not cover their current physicians or treatments.
"Consumers will find themselves having to go to Dayton or somewhere," Stammen said. "We can help with that. We're the experts."