Navigating Health Care by Billings Gazette

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Lee Montana Newspapers — The Billings Gazette, The Missoulian, The Helena Independent Record, The Montana Standard and The Ravalli Republic — have compiled this report to help Montanans navigate the Affordable Care Act.

UNDERSTANDING OPTIONS

Launch of ‘marketplace’ includes education effort, plenty of unknowns By MIKE DENNISON Lee Montana Newspapers HELENA — Health clinic director Kate McIvor says she and her counterparts across the state are excited about one of the biggest health care changes in decades: Tuesday’s roll-out of the new federal health insurance “marketplace” in Montana. “We think it will mean more access to health care for more Montanans,” she said. Yet McIvor acknowledges that her clinic in Helena — and just about everyone in the health and health insurance business — have a massive job ahead of them, getting consumers and themselves up to speed on how the marketplace will work to provide affordable coverage to Montana’s uninsured. “I don’t think many people, myself included, understand it very well,” said McIvor, executive director of the Cooperative Health Clinic in Helena. “I’m glad that we’re going to get the education so that we can all talk to patients about what it is and what it means to them. “My biggest concern is that people won’t take the initiative to sign up (for insurance). If people sign up, I think it will work.” The marketplace, an Internet shopping center for health insurance policies, is a linchpin of the 2010 Affordable Care Act, the health reform law also known as “Obamacare.” The law requires nearly all Americans to have or purchase health insurance by 2014, or pay a tax penalty. Most Americans already have coverage through their job or a government program, such as Medicare. Yet some 50 million Americans are without health coverage, including about 200,000 Montanans, and many more have bare-bones insurance that may not qualify as required coverage. The marketplace is supposed to help close that gap, offering a one-stop shop for people to buy health coverage and, for many, to get a federal subsidy to help make that insurance affordable. For low-income Montanans, the subsidies could reduce the cost of an individual health insurance policy to as little as $20 a month. For those higher up the income scale, however, the cost could be a lot higher — especially for older Montanans.

ELIZA WILEY WILEY/Independent Record

Kate McIvor, executive director of the Cooperative Health Center in Helena, said the clinic’s staffers will be on the front line of educating its customers and others in the community about the new state marketplace, an Internet shopping hub where people can buy subsidized health insurance, as part of the 2010 Affordable Care Act. The marketplace launches Tuesday. Dr. Dan Harrington, dental director, examines a patient at the Cooperative Health Center in Helena, which plans to expand its facility next year, including more dental services. ELIZA WILEY/ Independent Record

Every state has its own marketplace, and they’re scheduled to open for business Tuesday, at the web address of www.healthcare.gov. Three private insurers — Blue Cross and Blue Shield of Montana, PacificSource and the new Montana Health Co-op — will be offering policies on Montana’s marketplace.

While the Affordable Care Act has been in the news constantly, polls and anecdotal evidence indicate most citizens don’t know what the marketplace is, how to use it or what it offers. To help bridge this knowledge gap, hospitals, health clinics, insurers, insurance agents, consultants, the state insurance commissioner and other

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organizations have embarked on a broad effort to help consumers become familiar with and use the marketplace. “We’re doing whatever we can to get information out in waiting rooms, in emergency rooms, and wherever we come into contact with patients,” said John Flink, vice president of government affairs for MHA, which represents the state’s hospitals. The three insurers selling polices in the marketplace have launched marketing campaigns, state Auditor and Insurance Commissioner Monica Lindeen has a website where her office answers consumer questions about the ACA launch, and hospitals big and small are training some employees to be expert “navigators,” or certified counselors who can help consumers understand the marketplace. Julie Burton, a Billings Clinic spokeswoman, said health care providers are Please see Options, Page 3

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TRUE BL BLUE

When it’s time to find the health insurance solution that’s right for you, choose the one voice that speaks on your behalf and has been there for you since 1940—Blue Cross and Blue Shield of Montana. True Blue.

800.447.7828 | bcbsmt.com A D I V I S I O N O F H E A LT H C A R E S E R V I C E C O R P O R A T I O N , A M U T U A L L E G A L R E S E R V E C O M PA N Y, A N I N D E P E N D E N T L I C E N S E E O F T H E B L U E C R O S S A N D B L U E S H I E L D A S S O C I A T I O N

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Sunday, September 29, 2013

Options

Resources to find out more about ACA

Continued from Page 1 working together to point people to the marketplace as an option to get coverage, because they believe increased coverage means a healthier population. “Evidence shows that people with health insurance are healthier than those without health insurance,” she said. “Those with health insurance are … less likely to develop complex chronic diseases and use the emergency (room) for nonemergency needs.” A key part of the outreach will be the state’s federally funded health clinics, which serve mostly low-income Montanans, many of whom have no health insurance. The clinics’ trade group, the Montana Primary Care Association, is training navigators who can help consumers with the marketplace. All 17 clinics, from Libby to Miles City, also received grants this year both to publicize the marketplace locally and train employees about it. McIvor said her clinic will concentrate on informing lowerincome families, who often are uninsured and stand to benefit the most from the marketplace and its subsidies. The Helena Cooperative Health Center served 7,000 people last year, and half of them had no insurance. Low-income clients pay reduced prices at the center, but if they need hospital or specialized care, they usually can’t afford it, McIvor said. If those clients can get affordable health insurance through the marketplace, they might be able to get that specialized care — as well as more frequent primary care at the clinic, she said. “The mission of (the clinic) is to provide health care to everyone, regardless of their ability to pay,” McIvor said. “We’ve been doing that on a shoestring for years. “We’re hoping for our own sake and our patients’ sake that we can start bringing in more revenue and serving more people, and that we can refer (patients) to a higher level … and, with health insurance, they’ll be able to afford that care.” The Helena clinic also received a $5 million grant from the ACA to expand its services. Construction is starting this year to add another dentist, more medical exam rooms and additional counselors. McIvor said that if more patients are insured, the center can expand staff and serve more people.

HELENA — For consumers who have questions about Montana’s new health insurance marketplace and Affordable Care Act regulations and programs, several websites and phone numbers offer answers: www.healthcare.gov: The main website for the marketplace, operated by the federal government. It explains the marketplace and can guide you through the process to purchase health insurance and determine whether you can get a government subsidy to help pay for it.

ELIZA WILEY/Independent Record photos

In July, state Auditor and Insurance Commissioner Monica Lindeen and a panel of experts on the Affordable Care Act answered questions on what business owners and corporations should expect when they become required by law to provide health insurance to their employees. Lindeen’s office has a website, montanahealthanswers.com, where her office answers consumer questions about the Affordable Care Act.

If the ACA does lead to more people with health insurance, there will be more demand for primary health care, as provided at the federally funded clinics, other clinics and physicians’ offices across the state. Tom Roberts, a physician who heads the Western Montana Clinic in Missoula, said that potential increase in demand remains an unknown, but he thinks primary care professionals in Montana can handle it. “We think we have enough slack in our practices (at the clinic) that we could pick up another 10 to 15 percent of patients without too much trouble,” he said. “I don’t see it as an issue.” The big question remains, however: Will enough of the uninsured actually buy policies on the marketplace to make a dent in their numbers? Will they have the desire — and the money — to buy these policies? John Doran, director of strategic marketing services for Blue Cross and Blue Shield of Montana, said it’s hard to forecast what will happen, and that no one truly knows how this new world will unfold. “We’ve been working on our strategy for a long time, and we’ll carry it out,” he said. “But like most insurers, we’ll have to be flexible. … Our ultimate goal is to reduce the number of Montanans Heidi Wiedenheft, a physician assistant at the Cooperative Health Center in who don’t have health insurance Helena, reviews a patient’s information on her iPad before heading into an exam room. The center serves mostly low-income patients. today.”

Working together. We think that’s the key to better health care for you and your family. And now the doctors and specialists at Billings Clinic and Mayo Clinic are joining forces. We will work together to resolve your hard-to-solve medical problems and to find better answers. For you that means peace of mind, and access to the finest medical knowledge available. Right here at home. Billings Clinic and Mayo Clinic. Working together. Working for you. Billings Clinic Downtown 801 North 29th Street (406) 238-2500

Billings Clinic Miles City 620 South Haynes Avenue Miles City, MT 59301 (406) 233-7000

Beartooth Billings Clinic 2525 North Broadway Red Lodge, MT 59068 (406) 446-2345

Billings Clinic West 2675 Central Avenue (406) 238-2900

Stillwater Billings Clinic 710 N. 11th Street Columbus, MT 59019 (406) 322-1000

Billings Clinic Cody 201 Yellowstone Avenue Cody, WY 82414 (307) 527-7561

Billings Clinic Heights 760 Wicks Lane (406) 238-2575

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To find out more, visit www.billingsclinic.com/mayo

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1-800-318-2596: The federal call-in center for questions about the marketplace. www.montanahealthanswer.com: State Auditor Monica Lindeen’s website where consumers can ask and get answered questions about the marketplace and ACA. Lindeen is Montana’s top insurance regulator. 1-800-332-6148: The tollfree telephone line to Lindeen’s office, for questions about the ACA. www.kff.org/healthreform: The Kaiser Family Foundation, a nonprofit that’s probably the leading independent source on health care reform and the Affordable Care Act. The site has a wealth of information and news about the law, its effects and how it works. www.familiesusa.org/ resources/tools-for-advocates/guides/federal-poverty-guidelines.html: A site where you can see how your household income compares to federal poverty levels, which are used to determine if you’ll get a subsidy on the marketplace to offset the cost of health insurance policies. Subsidies are available for most families earning from 100 percent to 400 percent of the poverty level. — Lee Montana Newspapers

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NAVIGATING HEALTH CARE

ACA AND THE BOTTOM LINE Business owners ponder options as health insurance market shifts By MIKE DENNISON Lee Montana Newspapers HELENA — Business owner Loren Davis provides health coverage for his 28-person workforce, and wants to keep them covered — but with the coming changes under the Affordable Care Act, he’s having a tough time deciding what to do. “The most helpful thing would be for someone to come and tell me what would be the best for my employees and the business, but (my employees) have got to be covered,” said Davis, the owner of Davis Business Machines in Helena. “Everybody seems to have a little bit of knowledge, but nobody has the full knowledge.” Davis’ predicament is like that of many small business owners in Montana: The rush of new laws and insurance regulations and a shifting market has them unsure of what steps they should take, in the best interest of their workers and their bottom line. “Among small employers, the prevalent perspective is one of abject confusion,” said Jim Nys, a personnel consultant in Helena and owner of a temporary employee business. “They just don’t know what the rules are.” For individuals, the new rules of the Affordable Care Act are relatively straightforward: You must purchase or already have health insurance by 2014, or pay a tax penalty. For businesses, however, things get more complicated. The law says businesses that employ more than 50 people must provide a health insurance plan for their workers in 2014, or pay penalties. But the rules on how to count your employees are anything but simple. And don’t forget: The Obama administration postponed enforcement of that portion of the law until 2015. Businesses with fewer than 50 workers aren’t required to provide coverage for their workers. But that doesn’t mean they’ll escape the effects of the new law. They could choose to go to the new health insurance marketplace starting this week, and shop for group coverage for their workers — and get a tax credit to offset the cost of the plan, if they have 25 or fewer workers. They could tell workers to buy

ELIZA WILEY/Independent Record photos

Jim Nys, owner of a personnel firm in Helena, said business owners need to learn the ins and outs of the new Affordable Care Act rules, and get their information from unbiased sources without a political agenda.

Loren Davis, owner of Davis Business Machines in Helena, is one of many business owners who say new regulations under the Affordable Care Act are confusing, leaving him unsure of how best to provide health coverage for his employees.

individual policies on the marketplace, where some workers could get subsidies, making any policy cheaper than the business could provide them. Or, they could simply choose to do nothing, offer no health insurance for workers, and let employees figure it out on their own.

Nys, who owns Westaff and Personnel Plus, doesn’t think the “do nothing” approach is realistic. He said workers without coverage and facing the mandate to get health insurance will be asking employers why they don’t provide it, or asking for guidance and assistance on how to get it.

“If you (as a business) don’t offer health insurance, I can see one of the things that can happen is, they’re going to ask for raises because they have to go out and buy (coverage) on the marketplace,” Nys said. “Or some of them will quit and go to work for someone who does offer health insurance.” Several big employers in Montana — the state, NorthWestern Energy, large hospitals — said they don’t see the ACA affecting their employee health plans much at all, and aren’t planning major changes next year. However, they say they’ll be watching to see how the ACA affects the overall health insurance market, with the advent of the marketplace and its offer of subsidized policies for individuals. One possible effect is that some smaller employers who provide health coverage now may end the coverage and tell workers to buy subsidized coverage on the marketplace, beginning in 2014. The Montana Health Co-op, a new health insurer offering policies on the marketplace, suggests on its website that businesses might be better off adopting that plan. “All we’re really asking for is businesses to take a look at it,” said

Jerry Dworak, CEO of the Health Co-op. “That’s all we’re trying to say — just run the numbers. I firmly believe that if this thing goes through to its conclusion, that health care will not be tied to employment. It’s a whole new world Dworak out there.” But Webb Brown, president of the Montana Chamber of Commerce, said he’s not getting the sense that many Montana businesses will do that, and that they’d prefer to keep their employee coverage, if at all possible. Still, he said the uncertainty created by the new law is rippling through the employment and insurance markets and could lead to many unexpected consequences. For example, the chamber likely will end its Chamber Choices plan, which covers some 12,000 people by offering a collective plan to smaller businesses. Brown said the law no longer allows such a plan to give special benefits, because similar products must be priced the same. “The whole premise (of the law) was that this was going to be a lot simpler in the future, and I don’t think it’s going to be any simpler,” he said. “You just can’t take something this complex and wave a wand and make it easy.” Davis, the Helena business owner, said he’s been to several presentations on the new law but is still unsure what course to follow. He wants to keep health insurance for his employees, but the cost keeps rising. He’d rather not tell employees to buy policies on the marketplace, because he doesn’t like the idea of subsidized insurance — but he doesn’t want to rule out something that might benefit him and his workers. Nys said the key for business owners is to know the law as much as possible and find unbiased sources of information, ones who don’t have a political agenda. “You should actually research the law to understand what it means to you, as opposed to relying on others’ interpretation of it,” he said. “Because for any given business, it can be great, or it can be horrible. But the things that make it great or horrible are individual for that business.”

What you should know about buying health insurance on the marketplace By MIKE DENNISON Lee Montana Newspapers

mit your information, do you have to buy a policy? No. It’s like shopping on the Internet for anything — you can examine and determine prices of various items, but don’t have to buy anything.

HELENA — So, you’d like to buy health insurance on Montana’s new Internet marketplace — but you’re not sure what it is, or if it’s the right option for you? Here’s a guide to the marketplace, how to use it (or not), and its role in the Affordable Care Act, the 2010 federal health care law.

But aren’t you required to buy health insurance? The ACA requires all Americans to have health insurance next year, either a private policy or government coverage, or pay a tax penalty. If you already have health coverage through your job, a government program like Medicare, or an individual policy you plan to keep, you meet the requirement.

What is the marketplace? A federally operated Internet shopping site for individual and group health insurance policies, sold by private insurers.

How much is the tax penalty, and how is it assessed? $95 per adult and $47.50 per child in a household, up to a maximum of $285 — or 1 percent of family income, whichever is greater. It will be assessed when you pay your 2014 federal income taxes. The penalty increases in ensuing years. Some citizens are exempt from the penalty, including Native Americans, those earning less than the threshold for filing federal income taxes, and those with religious objections.

When does it open? Tuesday. Any policy purchased on the marketplace between Tuesday and Dec. 15 doesn’t take effect until Jan. 1. After the first of the year, consumers have until March 31 to buy 2014 policies on the marketplace, if they choose. Who can shop for policies on the marketplace? Anyone can shop for individual policies, and businesses with 50 or fewer employees can shop for group policies that cover their workers. the market now? It’s difficult to make that comparison, because the policies aren’t exWho is selling policies on Montana’s actly comparable to policies currently availmarketplace? Three companies: Blue Cross able. However, analyses done for the Monand Blue Shield of Montana, PacificSource tana state auditor’s office indicated most and the new Montana Health Co-op. policies on the new marketplace aren’t priced much differently than current policies. What are the marketplace’s web address and other contact information? What is covered by the policies? All The website is www.healthcare.gov, and a policies on the marketplace cover a list of “es24-hour telephone help line is 1-800-318- sential health benefits,” which include things 2596. like hospital care, surgery, doctors’ visits, mental health care, prescription drugs, maHow is it connected to the Affordable ternity care and care for newborns, physical Care Act? The 2010 Affordable Care Act — therapy, laboratory work and wellness care. often referred to as “Obamacare” — required You should examine each policy’s summary creation of an Internet marketplace in each of benefits to see what else it may cover. state, as a one-stop site to sell private health insurance policies targeted at the uninsured. Who’s eligible for a subsidy? Most It is part of the law’s goal to make health cov- people earning between 100 percent and erage available and affordable to all Ameri- 400 percent of the federal poverty level. For cans. It’s the only place where consumers can a single household, that range is $11,490 to buy a policy and get a federal subsidy to offset $45,960. For a family of four, it is $23,500 the cost of the policy. to $94,200. However, not everyone in that income range may qualify for a subsidy on How much will the policies cost? some policies. That depends on a lot of factors: Your age, Businesses with 25 or fewer employees where you live in Montana, how many family may qualify for a tax credit, on their employmembers (or, for businesses, number of em- ee group plan. ployees) are covered by the policy, the type of policy you buy and any federal tax credit or What if I earn less than 100 percent of subsidy you may receive to offset the price of the federal poverty level? You’re not elithe policy. gible for a subsidy. Will they cost more than policies on

your subsidy? First, you must buy your What’s the last date you can buy a polpolicy on the marketplace to get a subsidy. icy and avoid any tax penalty? March 31, The marketplace will ask you to estimate 2014. your taxable income for 2014 and calculate your subsidy, based on that estimate and the Will the policies on the marketplace policy you choose. or their prices change between Oct. 1 and the March deadline? No. How is the subsidy paid? Once you choose a policy, qualify for a subsidy and buy What’s the tax credit for small busia policy, the subsidy is paid directly to the in- nesses that offer coverage for employees? surer. For example, if the policy costs $400 a Up to 50 percent of the business’ contribution month and your subsidy is $300 a month, you toward the cost of the coverage. The smaller pay the insurer $100 a month and the federal the business, the larger the tax credit. government covers the remainder. How does a business qualify for the tax How much will your subsidy be? credit? It must buy its group policy on the InAgain, that depends on what type of policy ternet marketplace, have 25 or fewer employyou buy, your age and your estimated income ees with an average annual salary of $50,000 for 2014. The subsidy will be higher for those or less, and pay for at least half the cost of the in lower-income brackets, and less for those coverage. in middle- to higher-income brackets. Who can help you decide what type of What happens if your 2014 income policy is best for you? Independent insurturns out to be much different than you ance agents, the insurance companies and estimated? If you end up making a lot more insurance consultants will be dispensing than you estimated, and received a subsidy advice. Montana is training and certifying based on your original estimate, you’ll prob- agents on the marketplace. A variety of orably have to pay back all or part of the subsidy. ganizations — hospitals, clinics, physician’s If your income turns out to be lower than you offices — also will offer general advice on the estimated, there is no penalty. If your income marketplace, but are not supposed to direct changes throughout 2014, it’s recommended you to specific policies. Montana Insurance you report that to the IRS. It can be done on Commissioner Monica Lindeen also is opthe marketplace website. erating a website, www.montanahealthanswers.com, which answers consumer quesHow do you qualify for or determine If you sign onto the exchange and sub- tions.

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Simplify OBAMA CARE with Ben Surwill

AFFORDABLE CARE ACT BEGINING JANUARY 1, 2014

With OBAMA CARE, you have options: • different companies • different plans • potential subsidy’s. Call to get you health insurance questions answered today!

Montana Health Network would like to

congratulate

the following

Hospitals for their work in helping people in their communities understand the Health Insurance Exchange by training “Navigators”. These facilities are making a significant investment in the training of their staff to better serve their communities.

Hart-Albin Building 208 North Broadway, Suite 348 Billings, MT 59101 Phone: 406-248-3956 Toll Free : 877-948-3956 ben@surwill.us www.surwillinsurance.com

Big Horn Hospital Association, Hardin Beartooth Billings Clinic, Red Lodge Billings Clinic, Miles City Central Montana Medical Center, Lewistown Dahl Memorial Healthcare, Ekalaka

20 Years Experience Supporting Health Insurance For Individuals, Families, Groups, And Medicare Supplements.

Daniels Memorial Healthcare, Scobey Fallon Medical Complex, Baker

Providing Central Montana access to quality, affordable, preventative and primary healthcare.

Frances Mahon Deaconess Hospital, Glasgow Garfield County Health Center, Jordan Glendive Medical Center, Glendive Holy Rosary Healthcare, Miles City Livingston Health Care, Livingston

Accepting New Patients

McCone County Health Center, Circle

Our qualified staff is rreadyy to care care for you.

Northeast Montana Health Services, Wolf Point and Poplar Phillips County Hospital, Malta Pioneer Medical Center, Big Timber Prairie County Hospital, Terry Roosevelt Medical Center, Culbertson Roundup Memorial Hospital, Roundup Sheridan Memorial Hospital, Plentywood

Kimberlee Decker Decker, APRN specializes in Pain Management and Women’s Health.

Dr. Forke, Family Physician, looks forward to serving the families of Central Montana.

Sidney Health Center, Sidney

Dr. Jill Bolstad, Board Certified Pediatrician, offers the best in pediatric care.

Stillwater Billings Clinic, Columbus Wheatland Memorial Healthcare, Harlowton

MONTANA HEALTH NETWORK, INC. 11 SOUTH 7TH STREET, SUITE 241

406-535-6545 or 1-888-535-6545 406 1st Avenue South • Lewistown, MT www.centralmontanachc.org

MILES CITY, MONTANA 59301 (406) 234-1420 FAX: (406) 234-1423

Are You Covered? We’ve been providing quality healthcare for

Important Dates:

Montanans for over 110 years. Calming fears and

October 1, 2013 – March 31, 2014:

offering solutions is what we do. You now have new

Apply for and enroll in a plan.

options for getting healthcare insurance. As always, you can count on knowledgeable, compassionate

December 15, 2013: Enroll by this date if you want coverage to start January 1, 2014.

assistance to help you understand your choices so you can select the plan that’s right for you. To learn

St. Vincent Healthcare Education and Enrollment Fairs

more about Montana’s Health Insurance Marketplace,

Mansfield Health Education Center - 2900 12th Ave. N., Billings

visit healthcare.gov or call 800-318-2596.

October 17th October 24th

November 15th December 9th

For more information about St. Vincent Healthcare Education and Enrollment Fairs, visit svh-mt.org/marketplace or call (406) 237-3950.

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NAVIGATING HEALTH CARE

INSURING INDIANS

Basics of the Affordable Care Act — if you know nothing else, know this HELENA — The Affordable Care Act’s health insurance marketplace and individual insurance mandate are getting all the publicity now, but there’s a lot more to the lengthy, complex health care law passed by Congress in 2010. Here’s a look at some of the ACA’s other key elements: Pre-existing health conditions: As of next year, health insurers cannot deny or delay coverage for anyone because of a pre-existing health condition. Insurers also can’t use that condition to adjust rates. Limits on insurance company profits: The law requires health insurers to pay at least 80 percent of premium revenue on medical claims, and pay customer rebates if they don’t. In 2012, more than 13,000 Montana insurance customers received an average rebate of $170, totaling $1.5 million. Narrowing the “doughnut hole” for prescription drug coverage: Senior citizens on the Medicare drug plan have lower out-of-pocket costs. In 2012, nearly 10,000 Montanans got a 50 percent discount on drugs when they hit the doughnut hole, a tier of usage that’s not covered. They saved $6.5 million, an average of $656 a person.

LINDA THOMPSON/Missoulian

Young adult coverage: The law allows young adults to stay on their parents’ policy until age 26. Through 2011, some 12,000 Montanans took advantage of this provision.

Montana marketplace offers good coverage for Native Americans

Preventive services fully covered: Those on Medicare and regular health insurance generally don’t have co-payments for some preventive services, such as cancer screenings.

The Confederated Salish and Kootenai Tribal Health Clinic in Polson provides health services to Native Americans. Many Native Americans will receive a good deal on health insurance through the new marketplace being implemented as part of the Affordable Care Act.

By MIKE DENNISON Lee Montana Newspapers HELENA — For Native Americans in Montana, the Affordable Care Act’s new health insurance marketplace offers a deal that’s hard to beat. Like any other Montanans, Native Americans can shop the marketplace on the Internet starting Tuesday, buy a policy from one of three private insurers and get subsidies to help pay for it. The actual cost of the policy will depend on the consumer’s age, where they live, how many people are in the family and their income, which determines the subsidy. But many Native American families also can get something that no other marketplace shopper can get: A policy with no deductibles, no co-payments and no coinsurance — essentially, 100 percent coverage. This policy is available to Native Americans who earn anywhere from 100 percent to 300 percent of the federal poverty level. That’s a range of $11,490 to $34,470 for a single person and

$23,500 to $70,650 for a family of four. Bernie Azure, spokesman for the Tribal Health and Human Services Department on Western Montana’s Flathead Reservation, said the Confederated Salish and Kootenai Tribes and local partners will make a special effort to encourage Indian families to consider buying private policies on the marketplace. Tribal members in Montana are covered by the federal Indian Health Service, but the IHS is “woefully underfunded” and pays for only about half the needed services of its covered population, Azure said. The IHS limits what it covers, and generally won’t pay for services that aren’t considered emergencies, he said. Private health insurance policies bought through the marketplace can help fill that gap for Native Americans, Azure said — and also cover health care that Indians have been promised through various treaty rights. Getting the word out on the private insurance policies won’t necessarily be easy, Azure said.

He said a contractor working with an insurance company will be going door to door on the Flathead Reservation to talk with tribal members, telling them how working with a private health insurer can stretch their health care dollars and broaden their health care choices. Many Indian families have known only the services funded by IHS, he said. “Another big hang-up is that some people don’t have access to the Internet,” he said. “We’ll be getting that information (on the marketplace) to them. And we’ll have information at the clinics on the reservation.” An added benefit, if tribal members sign up for the private health policies, is creating more revenue for the Tribal Health Department, which plans to upgrade and expand its clinics, Azure said. The health department expansion not only will provide better health care to more tribal members, but also create good-paying jobs on the reservation, he said. “It’s a revenue-generating thing, and health care is going to be here forever,” Azure said.

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Community health center funding: These federally funded clinics, which serve lower-income customers across the state, have received more than $15 million in grants under the ACA to expand their services. Reinsurance fee: Next year, everyone with health coverage will pay $63 each to fund a reinsurance pool that will help pay for high-cost claims from those who buy policies on the marketplace. Medicare taxes on the wealthy: This year, those earning more than $200,000 ($250,000 for a married couple) saw their Medicare payroll taxes increase from 1.45 percent to 2.35 percent. They also must pay a 3.8 percent Medicare tax on investment income. Other taxes: The pharmaceutical manufacturing industry ($3 billion next year), health insurers ($8 billion next year) and medical device sales (2.3 percent this year) also are paying new taxes to help finance the health care overhaul. — Lee Montana Newspapers

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LOW INCOME CARE Are Montana’s poorest left out in the cold? Maybe, but... By MIKE DENNISON Lee Montana Newspapers

BUYER BEWARE Scammers attempting to acquire personal information

Lee Montana Newspapers HELENA — The roll-out of new elements of the Affordable Care Act this fall is already spawning scam operations that try to get people to reveal personal information both online and by telephone, Montana’s top insurance regulator says. “Con artists are taking advantage of the public’s confusion over the health care reform law,” said Monica Lindeen, state auditor and insurance commissioner. “My staff is working to set the record straight with Montanans about how ‘Obamacare’ actually works, and our investigators are ready to crack down on scammers.” Starting Oct. 1, the federal government is launching Montana’s health insurance marketplace, an Internet shopping center for policies whose price and benefits can be improved by federal subsidies. Montanans can shop for health insurance policies on the marketplace at www.healthcare.gov. They also must enter personal information on the site, such as a Social Security number and wage estimate, to qualify for any subsidies. Lindeen said scammers are setting up fake sites that ask for personal information and they are calling people by telephone and claiming to be federal employees, asking for the same information. The Better Business Bureau also says some con artists attempt to intimidate people by claiming the law requires the purchase of insurance “cards” and that consumers can be jailed if they don’t buy such cards. The law, which requires citizens to have or buy health insur-

ance by 2014, doesn’t require a card and has no jail penalties for noncompliance, the BBB notes. Lindeen said consumers should beware of unsolicited offers, which often use names sounding like a legitimate insurance company, and should not give personal information to unsolicited callers. Any suspected scammers should be reported to her office at 1-800-332-6148 or www.csi. mt.gov, she said. Lindeen lists four types of Affordable Care Act-related scams that are cropping up in Montana: n A con artist calls, claiming to be a federal employee and offering to sell a new federal insurance card, asking for personal information. n Fake websites are online with the word “exchange” across the top of the site, making it look like the new federal health insurance “exchange” or marketplace. The site asks for personal information. The real exchange site — www. healthcare.gov — begins selling policies Tuesday, and is known as the marketplace, rather than an exchange. n Senior citizens are called and told they need a new Medicare card because of changes in the Affordable Care Act, and are asked for their Medicare number. These numbers are the same as Social Security numbers and are used to commit identity theft. The ACA does not require anyone to get a new Medicare card. n Scammers are trying to sell adults younger than 26 a “new young adult policy,” to allow them to remain on their parents’ insurance policy. No such policy is needed for children to stay on their parents’ policy until age 26.

HELENA — Despite the launch next week of the federal health insurance marketplace, at least one group of Montanans is largely left out when it comes to help paying for health coverage: those earning less than 100 percent of the federal poverty level. They’re not eligible for any subsidies to help them pay for health insurance, unlike those earning from 100 percent to 400 percent of the federal poverty level. They were supposed to be covered by the federal health reform law’s expansion of Medicaid, the state-federal program that pays medical bills for the poor. But the U.S. Supreme Court in 2012 made Medicaid expansion optional in each state, and Republicans in the 2013 Montana Legislature rejected the expansion. Still, a quirk of the law could allow some who end up earning less than 100 percent of the poverty level to get a subsidy, which would pay most of their insurance premiums. When shopping for policies on the marketplace, an Internet shopping site, citizens are asked to estimate their 2014 taxable in-

come, which determines whether they’re eligible for a subsidy. If you estimate your income below 100 percent of the federal poverty level, which is $11,490 for a single person and $23,550 for a family of four, you’ll get no subsidy. But if you estimate your income at 100 percent or higher, and your actual 2014 income comes in below that threshold, there’s no penalty for estimating too high. Kathleen Stoll, director of health policy for Families USA, said the group is not encouraging people to wrongly or fraudulently report their income to get a subsidy. However, she said it wants people to be aware that in states where Medicaid was not expanded, 100 percent of federal poverty is the cutoff for getting a subsidy, and that if they honestly overestimate their income, they won’t be penalized. Citizens could face steep fines for knowingly misstating their income on forms for government assistance. But the U.S. Treasury Department says that if one merely miscalculates their income above the poverty level, and they end up earning below 100 percent, there is no penalty. In Montana, low-income

health clinics and other groups are hiring “navigators” and counselors to help people shop for health insurance on the marketplace. They said they won’t be counseling anyone to misstate their income to get subsidies. Yet they said they will look for ways to find coverage for those earning less than 100 percent of the poverty level. For example, low-income folks could become part of another household, making their combined income above the 100 percent threshold, said Bob Marsalli, executive director of the Montana Primary Care Association, which represents low-income health clinics. Stacey Anderson, public affairs director for Planned Parenthood of Montana, which is hiring navigators for its health clinics, said it has a program that provides some health services for low-income women ages 18-44, including those earning less than 100 percent of the poverty level. Some Montanans earning less than 100 percent of the poverty level also may qualify for Medicaid, in some circumstances, she said. “We do have programs that might help them,” Anderson said. Heidi Wiedenheft, a physician assistant at the Cooperative Health Center in Helena, examines a patient at the clinic recently. The center serves mostly low-income patients, and come Tuesday, it will be counseling patients on how they can sign up for subsidized private health insurance on the new state marketplace, a key component of the federal health reform law. ELIZA WILEY/ Independent Record

THERE’S A NEW CHOICE FOR AFFORDABLE HEALTH INSURANCE There’s a spirit in Montana. It’s part of who we are — and how we care about one another. Now there’s a healthcare plan that shares these values. Introducing Montana Health CO-OP — offering health insurance with an elusive quality other healthcare plans can’t match: trust. Trust because Montana Health is a CO-OP — as a member you have a voice and a vote in how it’s run. Regain your trust in healthcare with the new Montana Health CO-OP. Locally owned and operated, we’re your friends and neighbors. The CO-OP’s mission is to make health insurance available for all Montanans with lower monthly premiums and significantly lower deductibles. To learn more and to see if you qualify for a subsidy, call 855.447.2900 or visit mhc.coop. A F F O R D A B L E H E A LT H I N S U R A N C E B Y M O N TA N A N S F O R M O N TA N A N S

Enrollment begins October 1, 2013.

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NAVIGATING HEALTH CARE

VOCAL OPPOSITION TO ACA National groups organizing to undermine marketplace — but not much action here By MIKE DENNISON Lee Montana Newspapers HELENA — The federal health reform law remains highly politicized, as national conservative groups and congressional Republicans continue to call for its repeal and urge resistance more than three years after the law’s passage. But as key provisions take effect in coming months, organized resistance in Montana appears minimal. U.S. Rep. Steve Daines, RMont., who strongly favors repealing the Affordable Care Act, said that if constituents call with questions about how to use the new state health insurance marketplace under the ACA, his office will help them understand how it’s designed to work. Attorney General Tim Fox, a Republican who’s been critical of the law, said he’s encouraging state and federal officials “to resolve concerns associated with Obamacare as they arise.” “As the federal health care reform laws are further implemented, Montanans should carefully consider their options and determine for themselves whether or not it would be to their benefit to participate in the (marketplace),” he said in a statement. Each said he continues to have concerns about the marketplace, such as whether groups helping people sign up have proper security measures to protect personal information, and whether enough checks exist to assure that people aren’t submitting fraudulent information to gain health insurance subsidies. The marketplace, a federally operated website where Montanans can buy health insurance and get federal subsidies to help pay for their policies, is scheduled to launch Tuesday. Congressional Republicans have pushed to defund the law and block its implementation. Meanwhile, some conservative groups are urging active resistance to the law’s individual mandate, which requires all Americans to have or buy health insurance by 2014. FreedomWorks, based in Washington, D.C., is encouraging Americans who don’t have health insurance, particularly younger

Associated Press

Sen. Jim DeMint, R-S.C., center, joined other conservative lawmakers to criticize President Barack Obama’s national health care plan on Oct. 5, 2011, during a news conference organized by repealitnow.org.

Americans, not to buy it on the marketplace — or anywhere. Dean Clancy, vice president for public policy for FreedomWorks, said that if young people actively resist buying health insurance, the older and less healthy will overload the insurance system under Obamacare, hastening its collapse. Clancy said FreedomWorks doesn’t have any events planned in Montana. As part of its efforts, the group has partnered with Young Americans for Liberty, which has small chapters on the University of

Montana and Montana State University campuses. “Most people in the country don’t know what’s going on,” Clancy said of the Affordable Care Act launch. “The group we’re targeting, which is young adults under 40, they’re not necessarily paying attention. We’ve been using earned media and street theater to get the word out.” The U.S. House Energy and Commerce Committee, controlled by Republicans, in August sent letters to groups that won federal grants to hire “navigators” to help guide citizens through the mar-

ketplace, for buying health insurance. The letter asked the groups to provide detailed documentation by Sept. 13 of how many employees they planned to hire, their training regimen, monitoring effort, what they planned to do with any personal information gained through the process, and if they had any relationship with an insurance company. None of the three Montana groups that won navigator grants had even received the letter by Sept. 13. Bob Marsalli, executive direc-

tor of the Montana Primary Care Association, which is hiring navigators, said his group would respond if it got the letter. Marsalli said he realizes the ACA has its political opposition, but that it would be “a tragedy” if opponents actively discouraged people from using the law’s benefits. “We’re hopeful that folks will see that it’s all about Montanans having access to affordable health care,” he said. “It’s not a political football we’re talking about here. It’s about people’s health and safety.”

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Sunday, September 29, 2013

LAWMAKERS IN THE MARKETPLACE

Associated Press

In a divided and divisive Congress, conservatives in the Republican-controlled House of Representatives are cruising toward a vote to gut President Barack Obama’s health care plan as part of a temporary funding bill to prevent a partial government shutdown at the end of the month.

Do Congress and its staff get an ‘exemption’ from the Affordable Care Act? By MIKE DENNISON Lee Montana Newspapers HELENA — Come next year, members of Congress and their staffs must buy their health insurance on the new Affordable Care Act marketplace — but they’ll have the benefit of the federal government paying a large share of the price of that coverage. Critics of the law say this assistance, approved by a federal personnel ruling in August, is a “special exemption” for Congress. “It is absolutely unacceptable for Washington to impose new burdens and costs upon the American people, and then carve out special loopholes for itself,” said Rep. Steve Daines, R-Mont., who favors repealing the ACA.

Supporters of the ruling said it’s not an “exemption,” but rather a continuation of the federal government’s current payments covering a share of its employees’ health insurance. “It makes sense for members of Congress and their staff to buy their health insurance in the new marketplace,” said Andrea Helling, DAINES a spokesman for Sen. Jon Tester, D-Mont. “It also makes sense for Congress to continue to provide the existing employer support for employee health insurance premiums, and that’s what (the) ruling will allow.” Next year, members of Con-

gress and their staff must abandon their current group coverage through the Federal Employee Health Benefits Program and buy coverage on the new health insurance marketplace. Other federal employees are required to buy policies on the marketplace and can remain with their current policy. The marketplace is a new Internet shopping site for health insurance, set up in each state, where people can buy individual policies. It’s aimed primarily at the uninsured, and those who buy on the marketplace may be eligible for federal subsidies to offset the cost of the policy. Members of Congress and their staffs, however, cannot get a subsidy. In August, the U.S. Office of

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Personnel Management — with the support of the White House — said that while Congress and its staffers can’t get a subsidy, they will continue to have about 70 percent of the cost of any policy covered by their employer, the federal government. Sen. Max Baucus, D-Mont., the lead sponsor of the ACA, said he’s proud that members of Congress are getting their coverage from the same marketplaces that many uninsured Americans will use next year. “That’s the right thing to do,” he said. “And I’ll keep doing everything I can to make sure the (marketplaces) work well for all Montanans, including the Montanans who work on my team.” Daines, through a spokeswoman, said he thinks the rule is

an example of Congress “fixing a part of the law for themselves,” without relieving Americans from having to comply with it. Daines said he gets health coverage through a policy on the Federal Employee Health Benefits Program, with the federal government paying its share of the costs. He declined to say whether he would buy a policy on the marketplace next year or accept the federal share, or what he would ask his staff to do. Tester and Baucus, who also buy health coverage through the Federal Employee Health Benefits Program, said they would be shopping for health insurance on the Internet marketplace and deciding what policy is best for themselves and their families.

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THE NEW COST OF HEALTH CARE Subsidies create great deals for many Montanans – but not all

By MIKE DENNISON Lee Montana Newspapers HELENA — If you’re single, earn about $15,000 a year and have no health insurance, subsidized policies under the Affordable Care Act will be available this fall for as little as $23 a month — and with good benefits. But if you’re single and earn $30,000 a year or more and want to buy a similar policy, you may not get a subsidy, and you’ll pay the full price for coverage available on the ACA Internet marketplace in Montana. Such is the wide-ranging nature of the subsidies and cost of health insurance on the new marketplace, a linchpin of the ACA, the federal health reform law often referred to as Obamacare. The ACA requires all Americans to have health insurance by 2014 or pay a tax penalty. The Internet marketplaces, which open for business Tueday in Montana and every state across the nation, are the law’s main tool for making private health insurance affordable and available to a big chunk of the nation’s 50 million uninsured. It’s the only place where they — or anyone else, for that matter — can shop for health coverage and get a federal subsidy to help pay for the policy. It’s estimated that 150,000 to 200,000 Montanans may be eligible for subsidies as they shop for insurance on the marketplace. A Lee Newspapers State Bureau analysis of the potential subsidies and costs for policies on the Montana marketplace showed that both vary widely, depending on the size, age and income of families buying the coverage. The analysis found: n Households with lower incomes, such as those from 100 percent to 200 percent of the federal poverty level, get the best deals and the larger subsidies. The law is designed to extend good coverage to poorer families by requiring them to spend only a small portion of their income on health insurance. n Middle- and higherincome households will get lesser subsidies and pay more for coverage on the marketplace. Some may get no subsidy at all. n Families with children are probably more likely to get a higher subsidy, because the poverty level threshold for their households is higher. n Older households can expect to pay higher premiums — but if you’re older and have very low income, a lot of that premium will be offset by the subsidy. One income group, how-

ever, is largely left out in the cold: Those earning less than 100 percent of the federal poverty level, or $11,490 for a single person and $23,550 for a family of four. People in this group are not eligible for any subsidies, because they were supposed to be covered by an expanded Medicaid, the state-federal program that pays medical bills for the poor. The U.S. Supreme Court ruled in 2012 that the Medicaid expansion is optional for states and Montana’s 2013 Legislature voted against expanding Medicaid in Montana. Three companies are selling policies on the Montana marketplace, starting Tuesday: The Montana Health Co-op, Blue Cross and Blue Shield of Montana, and PacificSource. The Lee Newspapers State Bureau analysis assigned specific policies from each company to various hypothetical families, to determine what those families would pay, with the subsidies, for their coverage. Those with incomes near the poverty level can buy good policies for very little money, with the help of the subsidies. For example, a 45-year-old person earning $12,000 can get a policy with a $500 deductible and no copays for only $20 a month, after the subsidy. The deductible is what you pay out from your own pocket for medical services before insurance coverage kicks in. Anything above that amount, the co-insurance is the percentage of costs that you pay. A single, 35-year-old parent with two children earning $30,000 a year could buy coverage for the entire family for $100 a month, after subsidies, and have only a $500 deductible and 20 percent copay. The farther up the income ladder you go, however, the more you pay for a policy. A married couple at age 55 earning $50,000, with no kids, would pay $627 a month for a policy with a $2,000 deductible and 20 percent co-pay. Without the subsidy, that same policy would be $1,157 a month. The same couple earning $30,000 a year would pay only $186 a month for a similar policy, because of more generous subsidies for lower income brackets. However, a 40-year-old single person buying a PacificSource policy that has a $3,000 deductible and 50 percent co-pay would get no subsidy, and have to pay the full $236 premium each month. That’s because the premium is less than the maximum amount of income that the law says she must pay for coverage.

Insurance rates for Montanans under Affordable Care Act Here are 15 hypothetical Montana families (by size, age, income), buying a specific health insurance policy available on Montana’s exchange, telling what its premium is, the subsidy they can expect, and the final cost to them, per month. Adjusted gross annual income

Family

Policy

Monthly premium

Monthly subsidy

Your net monthly cost

Married couple Both age 55

$30,000

Montana Co-op Silver $500 deductible 20% coinsurance

$962

$776

$186

Married couple Both age 55

$50,000

Blue Cross Silver $2,000 deductible 20% coinsurance

$1,157

$530

$627

Married couple Both age 55

$75,000

PacificSource Gold $1,000 deductible 20% coinsurance

$1,210

zero

$1,210

Married couple Both age 35 Two kids

$50,000

PacificSource Silver $2,650 deductible Zero coinsurance

$770

$490

$280

Married couple Both age 45 Two kids

$50,000

Blue Cross Silver $2,500 deductible 20% coinsurance

$865

$583

$282

Married couple Both age 45 Two kids

$75,000

Montana Co-op Gold $750 deductible 30% coinsurance

$983

$269

$714

Single parent Age 35 Two kids

$30,000

Montana Co-op Silver $500 deductible 20% coinsurance

$513

$413

$100

Single parent Age 40 Two kids

$50,000

Blue Cross Bronze $3,750 deductible 30% coinsurance

$443

$187

$256

Single person Age 25

$10,000

Blue Cross Bronze $6,000 deductible Zero coinsurance

$169

zero

$169

Single person Age 25

$15,000

Blue Cross Silver $500 deductible Zero coinsurance

$207

$184

$23

Single person Age 25

$30,000

PacificSource Bronze $3,000 deductible 50% coinsurance

$185

zero

$185

Single person Age 30

$50,000

Montana Co-op Bronze $3,950 deductible Zero coinsurance

$211

zero

$211

Single person Age 40

$40,000

PacificSource Bronze $3,000 deductible 50% coinsurance

$236

zero

$236

Single person Age 55

$25,000

Montana Co-op Silver $1,750 deductible 40% coinsurance

$459

$323

$136

Single person Age 45

$12,000

PacificSource Silver $500 deductible 100% coinsurance

$300

$280

$20

The premiums above are an average of Montana’s four regional premiums. Your actual price will be a few dollars less or more, depending where you live in Montana. The policies listed are actual policies on Montana’s federal healthinsurance Internet marketplace, where consumers can shop for and buy policies starting Tuesday, to take effect Jan. 1. The “deductible” is the amount of medical costs you pay for yourself, before insurance kicks in. The “coinsurance” is the percentage of medical costs the insured pays once the deductible is met. For example, if the coinsurance is 0 percent, the insurer covers all costs above the deductible. All policies also cover some benefits 100 percent, such as basic preventive care. Subsidies are available to those earning 100 percent to 400 percent of the federal poverty level, although not everyone within that window may qualify for a subsidy. Those below 100 percent of the poverty line get no subsidy. Source: Kaiser Family Foundation, Montana state auditor, Lee Newspapers State Bureau.

ROB McDONALD/Gazette Staff

ACCURATE INCOME VERIFICATION What happens if you misstate 2014 income, when figuring health insurance subsidy? Lee Montana Newspapers

Associated Press

The short form for the new federal Affordable Care Act application. Getting covered through President Barack Obama’s health care law might feel like a combination of doing your taxes and making a big purchase that requires some research. You’ll need accurate income information for your household, plus some understanding of how health insurance works, so you can get the financial assistance you qualify for and pick a health plan that’s right for your needs.

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HELENA — If you want federal subsidies to offset the cost of health insurance you buy under the Affordable Care Act, you must tell the government your estimated taxable income for 2014. But what happens if you guess wrong? If you’re off just a bit, it shouldn’t make much difference. But if you lowball it by a bundle, you could end up having to pay back most or all of those subsidies. Here’s how it works: If you go online at Montana’s health insurance marketplace starting Tuesday to shop for a policy, you’ll be asked to submit your estimated “modified adjusted gross income” (MAGI) for 2014. For most people, MAGI will be their estimated wages, interest and dividend income — generally, all taxable income. It also includes nontaxable Social Security benefits and some pension and annuity payments. That MAGI amount will help determine if you’re eligible for a subsidy and how much that subsidy will be. For those with lower incomes, the subsidy could be substantial. The site will ask you to estimate your 2014 income. If you think your income that year will differ greatly from previously reported income, you may be asked to provide some documentation. When you file your federal in-

come tax return for 2014, the estimated income you claimed on the marketplace will be checked against your actual income. If you earned more than you estimated, and you got a subsidy for your health insurance, you may have to pay back some of the subsidy. The maximum amount of payback is tied to your actual 2014 income. If you earn anywhere from 100 percent to 199 percent of the federal poverty level, your maximum payback is $300 for an individual and $600 for a family. The maximum payback rises gradually to $1,250 for an individual and $2,500 for a family for those earning 300 percent to 399 percent of the poverty level. For those at 400 percent of the poverty level and higher, you must pay back all of the overpayment. So, if you estimate your 2014 income at a lowly $15,000, get a substantial subsidy to offset your insurance policy, and then get a much better job in 2014 or have a big capital gains and your income soars — be prepared pay back that subsidy. You also can avoid a big yearend payback by going back onto the www.healthcare.gov at any time during the year and updating your income amount, if it has increased. On the other hand, if you end up earning a lot less in 2014 than you estimated, you can go back to the website and adjust your income downward, and increase your insurance subsidy.

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ACA IN THE COWBOY STATE Federal government will manage Wyoming’s insurance marketplace Casper Star-Tribune CASPER, Wyo. — The federal government will operate a health insurance exchange in Wyoming after state leaders opted to not develop their own as required by the 2010 Affordable Care Act. Exchanges are a key aspect of the federal health reform law. They’re designed to serve as virtual marketplaces where consumers and small businesses can compare plans and purchase insurance. The marketplaces will also serve as a vehicle for subsidies intended to make it easier for Americans to afford insurance. The marketplaces will begin enrolling consumers Tuesday. Federal officials also decided to enforce insurance regulations in the ACA after learning that Wyoming’s Department of Insurance lacks the authority to enforce the rules. Wyoming passed on a collaborative arrangement with the federal government, as some states with limited regulatory systems chose to do. The Centers for Medicare and Medicaid Services will investigate consumer complaints that relate to ACA insurance regulations, such as the ban against denying people coverage because of pre-existing conditions. Wyoming’s Insurance Department will continue to oversee state regulations.

No Medicaid expansion According to various studies, between 24,000 and 41,000 people in Wyoming could eventually buy their insurance through the insurance marketplace. Another 10,600 people will receive coverage through a mandated expansion of the state’s Medicaid program, which pays for the poor and medically needy. An additional 17,000 poor adults could have received coverage through the expansion, but state lawmakers earlier this year rejected roughly $50 million in federal funds to extend Medicaid coverage. Expanding Medicaid is a centerpiece of the ACA, and he federal government has said it would pay 100 percent of the cost to extend the program for three years starting in January 2014. Support would reduce after that. The medical program currently serves over 77,000 people in Wyoming at an annual cost of more than $500 million, split evenly between the state and federal governments. The state health department has prepared studies that conclude that it would save money by expanding Medicaid. But

Health exchanges by state Under the Affordable Care Act, states may set up new private health insurance markets called “exchanges,” let the federal government run them or create state-federal partnerships. Where the states stand now: State-run exchange Federal exchange Federal-state partnership

R.I. Conn. Del. D.C.

NOTE: Alaska and Hawaii are not to scale Source: U.S. Center on Budget and Policy Priorities

many state lawmakers said they didn’t want to expand the federal program because they don’t trust federal promises to continue to pay for it.

89,000 uninsured An estimated 89,000 Wyomingites — or slightly more than one in seven — go without any form of health insurance, according to U.S. Census figures released this summer. That includes almost 10 percent of the state’s children. The numbers have implications that extend beyond those who can’t afford health care. People without insurance tend to delay seeking treatment until their conditions become serious. They often rely on expensive treatment delivered through the emergency room — with the costs ultimately being passed on to taxpayers and those with insurance. “It makes health care costs higher than they should be,” said Anne Alexander, an economist at the University of Wyoming. The Census Bureau estimates 15.4 per-

cent of Wyoming people lacked health coverage in 2012 — mirroring the national rate. Last year marked the first decrease in the number of uninsured in Wyoming since 2007. Wyoming’s uninsured rate hovered between 12 and 14 percent for most of the past decade. It ticked up at the start with the recession, then spiked between 2009 and 2011, when the uninsured population jumped by about 17,000 people, the data show. The rise coincided with a decline in the percentage of people who received coverage through an employer. That drop might have been tied to falling energy prices and companies preemptively responding to regulatory changes, Alexander said. Alexander doesn’t expect the Affordable Care Act will result in a quick drop in the state’s uninsured population. The penalties for people who don’t possess insurance are relatively small at first and people might decide it’s cheaper to pay the fine than buy coverage. Others are more optimistic. Jan Cart-

wright is a member of Projecting Healthcare: Consumer Advocates, a group that’s spoken out in favor of reforms included in the federal health care law. Cartwright is hopeful the exchange will bring coverage to more people, while also benefiting people whose current health plan provides inadequate coverage.

Education efforts Federal health officials awarded the Cheyenne Regional Medical Center and Wyoming Senior Citizens Inc. a combined $600,000 to teach consumers about the federal health insurance exchange and assist them in shopping for coverage. A state legislative committee studying exchanges voted to delay advertising the exchange being developed for Wyoming. That decision was prompted by the Obama administration’s decision to postpone another central provision of the health reform law. But the hospitals and physicians that serve as Wyoming’s health care safety net can’t afford to wait. Hospitals alone provide more than $200 million in care to people who can’t afford to pay — and that number continues to grow. Cheyenne Regional’s Wyoming Institute of Population Health plans to organize a statewide effort to educate the public. The program, called Enroll Wyoming, will focus particularly on the roughly 83,000 uninsured people living in the state, along with those who don’t have enough coverage. The institute will work with other hospitals, community mental health centers, family practice residency programs and faith community nurses to spread word about the exchanges, said Phyllis Sherard, vice president of population health for Cheyenne Regional. Medical providers will contact patients who’ve had trouble affording care in the past and invite them to educational events. The grant will provide Cheyenne Regional with money to hire the equivalent of five to six full-time employees. Those workers, called navigators, will travel the state holding events and assisting people who want to enroll in the exchange. Navigators won’t debate the merits of the health reform law, Sherard said. They will supply facts and answer questions. Wyoming Senior Citizens Inc. also plans to organize informational events, along with one-on-one counseling, said Herb Wilcox, the group’s executive director. Workers will provide information and let people make their own decisions, he said.

The health insurance is affordable,

and the information and assistance to sign up is free.

Beginning October 1, 2013, each state will be required by law to have a new online marketplace where residents will be able to buy health insurance. You may qualify for a credit to help you pay for health insurance under the Affordable Care Act.

— Montana Health Insurance Marketplace Enrollment Fairs— Free and Open to the Public

Providence St. Patrick Hospital Broadway Building Conference Center—Missoula

Providence St. Joseph Medical Center Byrnes Conference Center—Polson

Saturdays, Oct. 12, Nov. 23 and Dec. 07, 9 AM – 2 PM

Saturdays, Oct. 05, Nov. 09 and Dec. 14, 9 AM – 2 PM

• General overview of the Montana Health Insurance Marketplace and how to choose and use healthcare insurance every half hour. • Representatives from Blue Cross Blue Shield of Montana, PacificSource and the Montana Health CO-OP and Certified Application Counselors will be there to educate and help you to enroll in the plan that is right for you. • To enroll for insurance at the fair, you’ll need to provide the following information about you and your household:

  Social Security Numbers (or document numbers for legal immigrants).   Employer and income information for every member of your household who needs coverage (for example, from pay stubs or W-2 forms—Wage and Tax Statements).

  Policy numbers for any current health insurance plans covering members of your household.   A completed Employer Coverage Tool for every job-based plan you or someone in your household is eligible for. (This form will be available at the fairs). Or you can: Visit healthcare.gov to set up your account, to get more information and to sign up for an insurance plan.

Call 406-329-5740 for more information.

providence.org/montana

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CYAN 12

Sunday, September 29, 2013

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NAVIGATING HEALTH CARE

AFFORDABLE CARE ACT TIMELINE Key dates in Obama health care overhaul Associated Press Medicare was signed into law July 30, 1965, and within a year seniors were receiving coverage. President Barack Obama signed the Affordable Care Act on March 23, 2010, and the uninsured start getting coverage more than three years later on Jan. 1, 2014. Some key dates in the saga of Obama’s signature legislation: March 23, 2010 Obama signs the Patient Protection and Affordable Care Act (ACA). Democrats hail an achievement that their party pursued for more than 50 years — individuals’ right to health care. The law requires most Americans to carry health insurance starting in 2014 and bars insurers from turning away the sick. It creates state markets for middle-class people without workplace coverage to purchase private insurance, subsidized with tax credits. It expands Medicaid for the low-income uninsured. After long debate, the legislation barely passed a divided Congress, with no Republican support. Public opinion is split. March 29, 2010 Health and Human Services Secretary Kathleen Sebelius and the health insurance industry reach a deal to fix the first glitch emerging from the complex legislation: vague language that compromised a guarantee that children with pre-existing medical conditions could get coverage right away.

President Barack Obama talks about the first comprehensive alternative to the Affordable Care Act offered by a group of House conservatives on Sept. 16.

lion people. Plans also begin Affordable Care Act, but covering preventive services the drive falters in the Senat no charge. ate, where Democrats retain a majority. Since then, Nov. 2, 2010 the House has repeatedly Democrats lose control of voted to repeal, defund or the House in midterm con- in some way scale back the Fall 2010 gressional elections. Repub- law. Republican replaceDuring open enrollment, licans campaigned on a vow ment legislation has been most health insurance plans to “repeal and replace” the stymied by divisions within begin offering coverage to ACA. the party. young adults up to age 26 on a parent’s policy. The popuJan. 19, 2011 Jan. 31, 2011 lar early provision expanded The Republican-led Florida U.S. District coverage to more than 3 mil- House votes to repeal the Judge Roger Vinson rules

Associated Press

that the ACA is unconstitutional. The lawsuit by 26 states would ultimately reach the Supreme Court. April 5, 2011 Congress votes to repeal an unpopular tax requirement in the law that would have forced millions of businesses to file tax forms for every vendor selling them more than $600 in goods. Agreeing to sign it, Obama says he’ll make fixes to the ACA as warranted. June 21, 2011 The Obama administration says it will look for fixes to another glitch, a twist that would have let several million middle-class people receiving Social Security payments get nearly free insurance meant for the poor. Enacted later, the fix saved an estimated $13 billion over 10 years.

Starting October 1, you can enroll in new, more affordable health insurance plans.

Obamacare and You The new health care law, also known as Obamacare, means that all Americans must get health insurance next year. Financial help will be available based on income to make these new health insurance plans more affordable, and ensure you can find a plan that fits your (and your family’s) budget.

These new insurance plans cover important things like: • birth control and related visits at no cost to you • doctor visits • maternity • hospitalizations • ER care • other prescriptions

Planned Parenthood and You For nearly 100 years, Planned Parenthood has provided quality, affordable health care, and that’s not changing. Planned Parenthood is here to help you get the information you need to get enrolled. Go to: PlannedParenthood.org/HealthInsurance for key things you should consider as a women when choosing a health plan.

Summer 2011 Seniors hitting Medicare’s prescription drug coverage gap start getting a 50 percent discount on brand name medications, part of the health care Associated Press law’s gradual closing of the “doughnut hole.” In 2011, Health and Human Services Secretary Kathleen Sebelius speaks the typical senior in the gap in Jacksonville, Fla., on details the Affordable Care Act on Sept. saved about $600 on bills 16. averaging $1,500. tration’s lawyer fumbles his Jan. 1, 2013 Aug. 1, 2011 defense, and opponents feel Tax increases to finance Sebelius, on the recom- momentum breaking their the ACA take effect on about mendation of an expert pan- way. 2.5 million households, inel, declares that most health dividuals making more than plans will have to cover June 28, 2012 $200,000 per year and coubirth control for women as With the unlikely sup- ples more than $250,000. a preventive service, free of port of conservative Chief charge. The coverage be- Justice John Roberts, the Winter/spring, 2013 came available in 2013, as Supreme Court upholds States decide whether lawsuits proliferated from the law’s core requirement they’ll run the new insurgroups and businesses ob- that most Americans carry ance markets and expand jecting on religious grounds. health insurance, ruling their Medicaid programs. that the penalties to en- The ACA advances mainly in Oct. 14, 2011 force it are a tax Congress blue states, while most ReSebelius pulls the plug is authorized to levy. But publican-led states continue on the ACA’s long-term care the court allows states to to oppose the law. insurance program, because individually opt out of the of doubts over its long-term Medicaid expansion, which April 30, 2013 financial solvency. The pro- accounts for about half the The Obama administragram was a priority of the law’s coverage expansion. tion unveils simplified forms late Democratic Sen. Edconsumers will use to apward M. Kennedy of MasSummer 2012 ply for health insurance and sachusetts. Employers and consum- financial assistance to pay ers receive more than $1 their premiums. The first Nov. 14, 2011 billion in rebates from their version was criticized as too The Supreme Court an- insurers, which are required complicated. nounces it will hear the con- under the ACA to spend at stitutional challenge to the least 80 cents of every preJuly 2, 2013 ACA, setting the stage for an mium dollar on medical In a surprise, the White election-year decision. expenses and quality im- House announces a one-year provement, or refund the delay — until 2015 — of the Fall/winter 2011-2012 difference. law’s requirement that comRepublican presidenpanies with 50 or more worktial candidates are united Nov. 6, 2012 ers must provide affordable in their determination to Obama is re-elected to a coverage or pay fines. The repeal the ACA. Former second term, deflating Re- administration says it’s tryMassachusetts Gov. Mitt publican repeal hopes. ing to iron out burdensome Romney, whose state health reporting requirements. law was seen as a model for Nov. 8, 2012 Obama’s, says he’d sign an House Speaker John Oct. 1, 2013 executive order on day one Boehner says in an interOnline insurance marof his presidency granting a view that “Obamacare is kets are scheduled to open in waiver to all 50 states. the law of the land.” His every state. Consumers must spokesman quickly adds sign up by Dec. 15 for coverMarch 26-28, 2012 that the Ohio Republican age to take effect Jan. 1. The Supreme Court holds remains “committed to full three days of oral arguments repeal.” on the ACA. The adminis-

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