Affordable Care Act

Affordable Care Act Feb. 26, 2014

What you need to know about the Patient Protection and Affordable Care Act, which represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965.

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How to sign up

Affordable Care Act l Feb 26, 2014

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To sign up for health care insurance coverage through the Affordable Care Act:

Visit the New Mexico Insurance Exchange’s Be Well New Mexico website:

If you don’t have online access or would prefer talking to a person, you can reach the exchange’s representatives at

http://bewellnm.com/

1-855-996-6449

You can also speak to private agents endorsed by Be Well New Mexico. Here is a listing of the agents: Derek Cockrell Contemporary Benefits, LLC 511 Gidding St. Clovis, NM Ph: (575) 769-3965 Fax: (575) 769-1489

JoAnne Winslow KWS Independent INS Services Inc. 2400 N Main St. Clovis, NM Ph: (575) 762-7850 Fax: (575) 762-8998

Katha Burke Western States Insurance Group 1221 Mitchell St Clovis, NM Ph: (575) 799-3963 Fax: (575) 762-3565

Jennale Liston General Insurance Agency 500 Mitchell St. Clovis, NM Ph: (316) 253-0975 Fax: (575) 763-8825

James Lyssy Insurance Services of New Mexico, Inc PO Box 49; 631 N. 4th Street Fort Sumner, NM Ph: (575) 355-2436 Fax: (575) 355-2496

Todd Farrell Todd Farrell Insurance 1101 N Norris Ste B Clovis, NM Ph: (575) 742-1100 Fax: (575) 742-1102

Karen Greer KG Insurance Service PO BOX 761 Tucumcari, NM (714) 585-2652 Fax: (866) 724-9108

The following hospitals and health care agencies can also help walk you through the process:

Plains Regional Medical Center 2100 Martin Luther Kind Jr. Blvd Clovis, NM 88101 769-7142

La Casa Family Health Clovis Clinic 1521 West 13th Street Clovis, NM 88101 769-5030 Or 769-5032

Melrose Clinic 121 North Main Melrose, NM 88125 253-4373

Dr. Dan C. Trigg Memorial Hospital PMG Clinic 402 E. Miel De Luna Tucumcari, NM 88401 461-7100

Roosevelt General Hospital 42121 US Hwy 70 Portales, NM 88130 359-1800

La Casa Family Health Portales Clinic 1515 West Fir Portales, NM 88130 359-3826 Or 359-3857

De Baca School Based 1001 Sumner Ave Fort Sumner, NM 88119 355-7734

Presbyterian Medical Services Quay County Family Health Center 1302 E. Main Tucumcari, NM 88401 461-2200

Questions and answers about the ACA

Feb 26, 2014 l Affordable Care Act

Debra Hammer, chief communications officer for the New Mexico Health Insurance Exchange, responded to the following questions about the Affordable Care Act. All responses are paraphrased:

How many New Mexico families and households have enrolled in health insurance through the exchange since it became available? Is that more, less or about the same as you expected at this point?

At the end of January, the New Mexico Health Insurance exchange had signed up 11,600 families. This is a little less than we expected, but there have been some obstacles, like the breakdown of the healthcare.gov website. There has also been a problem with people not knowing that the deadline to enroll is March 31.

How many businesses have enrolled to insure their employees through the exchange?

Is that more, less or about the same as you expected at this point?

There are about 400 employers and employees signed up though the employer program.

Small businesses with under 50 employees are not required to offer health insurance this year, but some are taking advantage. Again, a little less than expected.

Businesses don’t face the same kind of deadlines that individuals do.

A lot of businesses registered their non-qualifying health plans last

fall, which has grandfathered them in for this year. That won’t be the case next year.

Are there problems with awareness of the exchange or that people may not know that they qualify for affordable health insurance under the exchange?

Mainly, people are surprised to know they have a deadline. NMHIX has noted a lot of interest in the exchange among New Mexico residents. People need to know they will face tax penalties this year if they don’t sign up for health care, and it will be $95 or a percentage payment based on their gross income. Persons whose household income is between 138 percent and 250 percent of federal poverty guidelines and are not insured should check out their options on NMHIX. Are employers helping you promote the exchange to encourage their employees get enrolled?

NMHIX officials have noticed that employers who have signed up are encouraging their employees to sign up for better options, like the Silver, Gold and Platinum programs, rather than for the Bronze Plan or just catastrophic coverage.

Are young families and young adults failing to enroll in health insurance in New Mexico more or less than in other parts of the country?

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About 18 percent of NMHIX enrollments from October to December were “young invincibles,” the population between 18 and 34 years of age. In January, the percentage rose to 20 percent. This is in line with nationwide enrollment among the young invincible group. NMHIX is encouraged by the increase in the percentage rate. In visits to college campuses, both main campuses and outlying, young adults are showing great interest in health insurance, and are wanting to know their options.

How are you promoting the exchange to young adults?

NMHIX representatives are visiting college and community college campuses, and NMHIX is aiming television advertising toward young adults with messages like, “A broken arm could cost you 10,000 beers.”

In another ad, a young person in a neck brace boasts that he is going to college because health insurance is enabling him to do so despite his injury.

Another message is that health insurance is available through the exchange that is less costly than the penalties for not enrolling.

What options among the health care plans are proving the most popular? Are people buying based on price more than quality?

The most popular is the Silver plan. Gold and Platinum levels do well, too. People are shop-

CMI staff photo: Kevin Wilson

Johanna Pettrey, a certified nurse practitioner, examines Taylar Phillips of Clovis at Plains Regional Medical Center.

ping based on quality, not just price. They’re going for the gold. The “metal level” — Bronze, Silver, Gold or Platinum — determines premiums, co-payments, coinsurance, deductibles, and out-of-pocket costs.

What, if any, changes would you make in how the Affordable Care Act has been implemented so far?

There have been a lot

of rolling deadlines.

People really have to stay on top of that. It’s hard to get information and people really have to stay tuned to keep up with all the information.

How is the search going for a permanent CEO for NMHIX? We expect to hire a permanent CEO by next June. The search committee is still seeking candidates.

What would the savings be to the state if all who were eligible purchased insurance through NMHIX? It’s too early to tell, but as more New Mexicans enroll in health insurance, NMHIX will start taking a measure of the impact on health care costs in general.

— Compiled by CMI staff writer Steve Hansen

Residents say insurance access net positive

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BY KEVIN WILSON kwilson@cnjonline.com

Ask Geni Flores what’s changed for her under the Affordable Care Act, and she’s got a follow-up question.

“Do you want to start,” Flores said, “with my son, my daughter or my brother?”

While they acknowledge that education about the ACA and the program rollout could have been better, a few residents contacted said the increased access to insurance and health care is a positive on balance.

Katha Burke, an agent at Western States Insurance in Clovis, said negative connotations about the ACA are upsetting to her. She said there are many benefits for clients she saw just last year that couldn’t get coverage and can now do so.

“They had to jump through

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hoops to get insurance,” Burke said. “With the ACA, there is none of that. There are no hoops to jump through; there are no health questions.”

Burke has heard stories of people who had plans canceled, and hates knowing that anybody might be inconvenienced. she said many of those plans had coverage that didn’t justify the premiums.

The premiums do have a high sticker price, when considering it’s a completely new expense for many who didn’t carry insurance.

“When you’re going from not paying anything, going from $100 to $200 is a lot,” Burke said. “We’re just trying to educate people on the reason you need health insurance.”

Flores, who teaches bilingual education at Eastern New Mexico University, said she was covered prior to the ACA,

but others in her family were not: z “My son had a pre-existing condition,” Flores said.

“He was diagnosed when he was 15 (with precancerous polyps). Because of that diagnosis — he’s 32 now — he wasn’t able to get health care.

He had no health care, even though he’s married and has kids and the kids are covered on her health plan.”

Her son, who lives in North Carolina, is now signed up for coverage. Very early in January he had a preventative test — something he may have needed to serve a six-month wait time to receive under previous insurance coverage.

Without insurance, Flores said, the tests were expensive, but she paid for one anyway a few years ago just to have peace of mind. z Flores has a brother who lives in Taos that does season-

al work. He didn’t qualify for health coverage with employers and couldn’t afford individual coverage. Also, he was paying off a pair of hospital bills for accidents. With the ACA, he received a premium he could handle. z Flores’ daughter, a single parent, had a son who qualified for Medicaid. However, she didn’t qualify for anything and stayed on her mother’s plan until she was 26.

Now 28 and in California, Flores’ daughter has found a policy that included dental coverage.

Flores hated the problems with the website rollout, but said anger about the purpose of the act escapes many.

“People don’t understand it at all,” Flores said. “Mostly people who are comfortable with their own health care accounts are quick to blame other people. People who have

the comforts of life are often quick to blame those who don’t, and blame them for being poor.”

Pilar Moreno of Portales, who opened a small business and got covered through the exchanges, said the misconception is that everybody gets free health coverage, and she knows that’s not the case.

One of Moreno’s issues is that she has found many Texas doctors don’t work with the exchange plans, and she has to go to Albuquerque instead of the shorter drives to Amarillo or Lubbock.

Moreno didn’t disclose her premium, but said paying $100 to $200 a month seems like a lot until you have to visit the emergency room, or when you find out spending one day at the hospital can easily run $4,000 if you’re not insured.

Pre-existing conditions no longer bar patients from insurance

BY ALISA BOSWELL aboswell@pntonline.com

As many others, Karen Graves was your average, every day hard worker without insurance.

But a heart attack two years ago changed all that.

After finding out she had congestive heart failure, not only was Graves forced to quit working and be placed on disability for six months, she was also unable to afford proper treatment for her condition.

“As soon as I would say I had congestive heart disease, insurance companies would reject me,” Graves said. “I couldn’t see my heart specialist because I didn’t have insurance and I couldn’t afford to pay to see him so I kept going to Quick Care.”

Graves worked as a medical transporter (which she does now), shuttling patients to and from medical appointments across New Mexico, Texas and Arizona. She was mid-route from Santa Rosa to Clovis with a patient

when she began to have trouble breathing.

“I think I scared my boss because I called him and I said my chest feels like it’s closing and I can’t breathe and he said, ‘oh my gosh, you’re having a heart attack,’” she said. “Not the thing to say to calm me down at that moment.”

She laughed.

“I got my patient, made it back to town and went straight to emergency, and they immediately threw me in a room because my boss had already talked to them.”

Graves said she had to see a nurse practitioner at Quick Care to get her heart and blood pressure medications because she could not afford to see the heart specialist she needed.

Graves said she was receiving $163 per week from disability but she aver saged $150 per month in medical bills and paid $160 per month for rent.

She was barely making ends meet and was in constant pain due to rheumatoid arthritis in her back and

fibromyalgia. Her heart condition also regularly gave her anxiety attacks.

Graves said she began to sink into a depression over her circumstances.

All that changed with the Affordable Care Act. Insurance companies are no longer allowed to reject medical patients due to pre-existing conditions.

Graves said she had worked with Mary Marez at Presbyterian Medical Services before, so she approached the certified application officer about affordable care.

“I came in here and Mary took half an hour for me to get what I needed to get,” Graves said. “I now have insurance and it’s insurance with a premium I can afford.”

Graves said Marez also helped her get a Presbyterian medical bill lowered.

She said she is paying a little more than $100 per month for her insurance premium under an affordable care plan called the Individual Silver Plan B. “What’s going to happen now is

she’s going to be able to get her prescriptions for free for the generic brands and she will pay a $5 co-pay for the name brands,” Marez said.

“She will now be able to see the heart specialist she’s needed to be able to see all these years because of the coverage she is receiving.”

Graves said being able to now have health insurance has been life-changing.

“I have real insurance now. I feel like a real person,” Graves said. “It is such a blessing to have what we have today through the market place. There is nothing I could give them that would thank them enough for what they’ve done for me.”

Marez said Presbyterian will be holding public forums to give anyone information about affordable care plans and the opportunity to sign up.

She said s a forum Curry County is planning for sometime in March will be announced once a definite date and location have been determined.

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Medicaid expansion means more qualify for coverage Affordable Care Act l Feb 26, 2014

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BY EMILY CROWE ecrowe@cnjonline.com

With the recent expansion of Medicaid coverage in New Mexico, more residents than ever can now gain access to health care coverage.

The state’s expanded Medicaid program, known as Centennial Care, is a joint state-federal program under the federal Affordable Care Act. It offers health care coverage to patients age 19 to 64 who meet income guidelines.

A single adult earning less than $1,321 monthly qualifies for the program. For a family of two, the income limit is $1,784 monthly.

“Once a child would turn 19, they were automatically dropped,” said Mary Marez, a financial counselor with Plains Regional Medical Center.

“With the doors being opened, there’s more opportunity for people to sign up. As long as they meet the income guidelines, they would be able to be put on Centennial Care.”

In September, Gov. Susana Martinez estimated that 170,000 adults throughout the state would gain coverage by 2020.

According to Plains Regional Medical Center Administrator Hoyt Skabelund, it’s still too early to tell what kind of impact Medicaid expansion has had on the hospital, but he has seen people enrolling in the program.

“We’re big supporters of expanding coverage for everyone in the community,” he said.

Skabelund said one thing he has seen recently has been a decrease in the volume of patients seeking elective medical care nationally, such as surgery and X-rays, mainly due to the increasing cost.

“Our anecdotal belief,” Skabelund said, “and when we talk to patients, is that now a lot of the insurance products that employers are buying or are available on the insurance exchange have high deductibles.”

Larry Leaming, president of Roosevelt General Hospital, also said it is hard to tell what impact the introduction of expanded Medicaid has had on the establishment.

He said it may take time for them to see the effects of the expansion because it's fresh.

While Skabelund said it’s too soon to tell if Medicaid coverage will eventually lead to an increase in patients at PRMC, he said the ongoing issue of doctor shortages in the area is not yet a concern.

“We continue to have capacity in our clinics,” he said. “We are near capacity, but we have capacity.”

Marez and other representatives at PRMC are available to help residents register for both Medicaid and Affordable Care Act coverage.

“With the doors being opened, there’s more opportunity for people to sign up. As long as they meet the income guidelines, they would be able to be put on Centennial Care.”

— Mary Marez, financial counselor

Providers still waiting to see effects of ACA

Feb 26, 2014 l Affordable Care Act

BY CHRISTINA CALLOWAY ccalloway@pntonline.com

With New Mexico Health Insurance Exchange sign-ups moving slowly, hospital administrators and health care providers say they have yet to see the effects of the Affordable Care Act. With the exception of cuts to the Medicaid program, officials said the ACA, enacted to expand affordable health insurance to uninsured New Mexicans and Americans, hasn’t had any real effect on the volume of patients they see.

“I think there’s potentially a plus and a negative,” said Plains Regional Medical Center Administrator Hoyt Skabelund. “I don’t think the smoke will have cleared for about two years.”

With the expansion of Medicaid in the state, which began Oct. 1, the state’s Human Services Department Director of External Affairs Matt

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Kennicott said more than 90,000 residents have been enrolled.

The insurance exchange has not seen a boom because enrollment deadlines have been repeatedly delayed due to the technical difficulties with the rollout of Healthcare.gov, Kennicott said.

Skabelund said the situation has hurt the hospital financially because Medicaid reimbursement money was cut to hospitals on Jan. 1. Because of these delays, the number of insured people the hospital is seeing is still low, he said.

Skabelund added that New Mexico already receives some of the lowest payments for Medicaid in the country.

“President (Barack) Obama has delayed the mandate for individuals yet he has not delayed the payment cuts. Now you’re delaying insurance you promised would offset the payment cuts,” Skabelund said. “If everyone has insurance than hospitals

Dr. Kent Zieser, who specializes in internal medicine, talks with Linda Hensley

won’t have as many losses, so the logic is they don’t have to pay as much. The negative side is the hospital payment cuts. We’re going to cover more people.”

Roosevelt General Hospital President Larry Leaming said his hospital continues to see uninsured patients, noting that many are reluctant to sign up with the exchange.

In regard to the Medicaid expansion, Leaming said he can’t tell if it’s the expansion or a bad flu season that has kept the hospital’s emergency room and clinic tied up this season.

Leaming said time will tell what effects the ACA will have on the hospital.

“No one knew what to expect,” said Leaming of the ACA rollout. “If the uninsured people in the state could get coverage as it was designed to do, that would be a wonderful thing.

For those people, most of that is unsubsidized.”

Leaming said what started out as a great idea

CMI staff photo: Kevin Wilson

during a consultation at Plains Regional Medical Center.

ended up in regulation and bureaucracy.

“It becomes so complex that it’s lost the original idea,” Leaming said.

Leaming said RGH cannot turn away indigent patients, so that group finally has a shot of getting coverage.

But Leaming said it won’t work if the insurance company payments don’t cover the cost of care.

Leaming said just because insurance companies are part of the exchange does not mean hospitals have to accept contracts with those companies.

“We’re not going to sign the contracts if they can’t pay us for what we need to do,” Leaming said. “We’re hoping that the insurance companies will come back with a decent contract at a decent price.

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Skabelund said there is concern among PRMC’s staff.

“Nothing has happened according to what was originally planned,” Skabelund said. “We know change is coming and we’re trying to figure it out.”

Skabelund said his staff has noticed patients are confused and frustrated with the exchange.

Skabelund said doctors are also seeing patients with higher deductibles delay care, such as surgery.

Skabelund added PRMC has experienced a substantial decline in its overnight patient care, and fewer patients admitted to the hospital, but the number of emergency room patients remains steady.

For La Casa, CEO Seferino Montano said about 40 percent of the

patients they see — about 7,200 — people, are uninsured.

Montano said his staff assumes at least 70 percent of that pool will be able to become insured or covered through the expansion. But he agrees with other providers that with sign-ups being delayed, it’s too early to tell.

Montano said La Casa clinics have remained stable in volume. Outreach workers at La Casa have been busy signing up patients for insurance with the assumption they will be retaining those patients, he said.

“When it’s all said and done, people who have never had insurance will at least be able to have a sigh of relief that if something catastrophic happens, ‘at least I’m covered.’”

Veterans covered under VA care meet requirements

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BY ERIC NORWOOD JR. enorwood@pntonline.com

Veterans who already have Veteran Affairs health care are covered under the new American Care Act requirements.

Any veterans who are already enrolled in VA health care are also not required to take any additional steps to meet ACA coverage standards. Enrolled veterans can also continue to use VA and other federal health care coverage such as Medicaid, Medicare, TRICARE, and private insurance.

However, non-enrollment in medical insurance for veterans and non-veterans alike can prove costly. Penalties applied to an individual’s

taxes will begin being issued in 2014.

The penalty will be $95 or 1 percent of taxable income, whichever is greater, and those penalties will rise significantly in the next two years. For those veterans who aren’t insured, there is still time to get enrolled in VA health care, and you can get it done in Clovis.

“What I would do If I was a veteran, is I would definitely apply for the VA health care, and they can come to my office to get it done,” said Matt Barela, the Veteran’s Service Officer in Clovis.

Veterans can also apply online by submitting the VA Form 1010EZ at www.1010ez.med.va.gov/sec /vha/1010ez/, or over the

phone by dialing 1-877-222VETS (8387) from Monday through Friday between 8 a.m. and 8 p.m.

Those veterans who apply and don’t qualify should apply again annually because the qualifications change every year.

Clovis veterans who are enrolled in VA health care can visit the Clovis VA Community Based Outpatient Clinic for many care services. Some of the services provided include health screening, routine or urgent care, health maintenance, management of acute and chronic diseases, and education. Amarillo features a larger facility, and Lubbock, Roswell and Hobbs have VA clinics as well.

For assistance, contact the following: Matt Barela Veterans’ Service Officer New Mexico Department of Veterans’ Services 904 W. 6th St. 762-6185

Department of Veterans Affairs Clovis VA Community Based Outpatient Clinic 921 East Llano Estacado 763-4335

Affordable Care Act l Feb 26, 2014

Agent: ACA has ‘changed the face of insurance’

Feb 26, 2014 l Affordable Care Act

BY LILLIAN BOWE lbowe@pntonline.com

The Affordable Care Act has impacted local insurance agencies in negative and positive ways.

JoAnne Winslow, agent at KWS Independent Insurance Services, Inc., said since the act, a lot more people have signed up for health insurance.

“It has changed the face of insurance,” Winslow said.

Winslow said the application process for getting health insurance is simplified, and she no longer has to ask personal medical questions.

She said people who could not afford insurance before are now coming into the office and signing up. She gave an example of a couple making less than $35,000 a year getting insurance with a premium of $150 for both.

The government is able to give a discount on the insurance to those who cannot afford it on their own, Winslow said. But those not eligible for the discount are sometimes being charged as much as triple the amount for their premium, she said.

Terry Young of Terry Young Insurance Agency said many working families are no longer able to afford their new premium under the act.

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“It is causing premiums to sky rocket and people shopping for health insurance are having difficulty paying for it,” Young said.

As an example, Winslow said, a client paying $285 saw his premium jump to more than $600. Winslow said the client could not afford the premium and refused to pay it.

Clients without insurance also face a mandated tax penalty.

“There are also people who said they were OK with paying more for the insurance. They say it is a privilege to pay the amount to help people who cannot afford health insurance,” Winslow said.

Young and Winslow said they see problems with the ACA, especially with the sustainablity of the act.

“They are using 40 percent of the fund from Medicare to help pay the premiums of the newly insured and that cannot last forever,” Winslow said.

“Businesses are having a difficult time paying for their medical insurance and I can see more people losing their jobs because their employers can not afford to pay for both the insurance and salaries,” Young said.

Winslow said she believes the rates will go down in the long run after the act has been more established.

“There are also people who said they were OK with paying more for the insurance. They say it is a privilege to pay the amount to help people who cannot afford health insurance.”

— JoAnne Winslow, KWS Independent Insurance Services, Inc. agent

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Affordable Care Act l Feb 26, 2014

With voters skeptical, Democrats inch away from Obamacare

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BY ANITA KUMAR McClatchy Newspapers

PALM SPRINGS, Calif. — Mark Kentley is the kind of voter who will help decide the short-term political verdict on the new health care law known as Obamacare.

A 27-year-old who studies business administration while working at the College of the Desert, he’s swung back and forth between the Democrats and the Republicans in the last two presidential elections. Now, he sits right in the middle of one of the most contested seats for the House of Representatives, and his dislike of the law will be a major factor in deciding who gets his vote this fall.

He resents that the government is forcing him to buy health insurance he doesn’t want. “They’re trying to reinvent the wheel,” he complained during a break at the student union.

What he and others like him decide will determine whether the Democrats ride out the storm of mistakes and protests over the new Affordable Care Act or whether the Republicans ride that to another wave of gains in the House, as they did in 2010 when they seized control.

The House district around Palm Springs is one of three in California that the Democrats could lose this fall. And the trend reaches to all corners of the country. For Democrats running for Congress in dozens of districts, the Affordable Care Act they once boasted about is one of the largest obstacles to their re-election bids in November.

In 2010, Democrats ignored the slew of attacks on the health care law only to lose more than 60 seats — and their majority — in the House and six seats in the Senate. Now they’re switching strategies, casting themselves as crusaders out to repair a broken law.

They call the law “imperfect” and “flawed.” They air televi-

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sion ads that highlight the need to “fix Obamacare.” They criticize President Barack Obama for the “disastrous” rollout of the web site, healthcare.gov, and for breaking a promise to Americans that they could keep their health insurance if they liked it. Many defy the White House and support Republican proposals to change the law.

“I would not have thought it would still be an issue. But now I think this will be an issue through the campaign,” said Brian Nestande, a state legislator and one of the Republicans vying to challenge Rep. Raul Ruiz, the Democrat seeking a second term.

They are seeking the support of voters like Kentley and others in the Coachella Valley, a diverse slice of California filled with residents young and old, wealthy and destitute, natives and part of a burgeoning Hispanic immigrant population. There are golf courses, casinos and the famous resort town of Palm Springs.

Residents are split on health care — and most everything else. In recent years, they narrowly voted for Obama twice, but supported Republican candidates for governor and the U.S. Senate. Ruiz defeated Republican Rep. Mary Bono Mack, widow of pop music celebrity-turned-politician Sony Bono, whose name adorns a freeway and an airport concourse.

“It’s a tough line to walk,” said Pete Sturges, 68, a small business owner walking his dog, Peanut, at a park in downtown Palm Springs on a recent sunny afternoon. “He has to be a moderate Democrat. He has to capitulate. He has to support it but he can’t support it too much.”

Ruiz declined to comment for this story, as did the chairman of the state Democratic Party.

Ruiz’s campaign consultant, Roy Behr, said the congressman has “credibility” on the issue because of his background as a former emergency room physician.

Ruiz was one of 39 House Democrats who defied the White House and voted for a Republican-backed bill to allow Americans to keep their health insurance plans for a year even if they did not comply with the new requirements — as Obama had promised. He was one of 22 Democrats who voted to delay the so-called individual mandate, which requires most Americans to have insurance or pay a penalty. Two other Democrats even voted to repeal the law, though both faced tough re-elections and have since decided to retire.

“I have been blunt and outspoken about my frustration with flaws in the new health care

law,” said Rep. Scott Peters, a Democrat from the San Diego area, one of the three Democrats in California and 24 to 39 nationwide in potentially vulnerable seats.

“Let’s fix it and make it better,” said Rep. Ami Bera from Northern California, the third.

“That’s the approach I took.

We’re in divided government.

Republicans and Democrats have to be able to find common ground.”

Bera, also a doctor, works to avoid being labeled with the rest of his fellow Democrats in Washington. He criticized “Washington, D.C., GOP cookie-cutter politics” to use a potentially divisive issue whether it fits the local race or not. He said the law is not what he would have preferred had he been in office in 2010, but now that it is he and others should take a pragmatic approach to try to fix it.

Doug Ose, a former Republican congressman who is running against Bera, complained that Democrats like Bera defend the law while in Washington but run away from it while in their districts. “People are tired of the two-faced nature of our public officials,” he said.

The law does remain unpopular. Only 38 percent of Americans approve of it, according to a Realclearpolitics.com average of national polls. A CBS News poll in January shows that 56 percent of people believe changes need to be made for it to work better, though only 34 percent said the law needs to be repealed.

Most Republican candidates want to repeal the law, which they argue is too expensive, too inaccessible and too confusing, though some acknowledge that parts, including those that provide insurance to people with pre-existing conditions and children up to age 26, are beneficial.

“People are frustrated with the problems continuing to mount,” said Carl DiMio, a former San Diego City Council member and a Republican candidate

running against Peters. “People are extremely upset. There are real human impacts.”

Conservative groups are spending millions of dollars on television ads in states from Alaska to North Carolina, trying to tie Democrats to the health care law or mocking them for running away from it as they look to take control of the Democratic-led Senate and gain seats in the Republican-controlled House.

Any Democratic losses, of course, could be offset by Democratic gains elsewhere.

White House press secretary Jay Carney dismissed any talk this week that health care would hurt Democrats at the polls this fall.

“This has gone from an abstract debate to one that involves real people whose lives would be adversely affected by the success of an effort to take away dramatically the benefits that they enjoy,” he said. “I think everybody who’s running on a repeal platform needs to explain why their constituents . . . should have those benefits taken away.”

The fact that some Democrats are working to stress their own complaints about the law, even in California, underscores how much it remains an open political question.

California, where Democrats run state government, was the first state to set up its own exchange, though it, too, has had problems, including long waits, flawed eligibility notices and mistakes in a physicians’ directory. Just recently, the state temporarily shut down its online marketplace for small business four months after it launched.

Here, even supporters of Obama and his health care law express frustration at repeated problems.

“I don’t know if this was the best way to go about it,” said teacher Courtney Doussett, 37, as she sipped coffee outside a Starbucks in a Rancho Mirage shopping center. “But we needed to do something.”

Employers seek ways to meet insurance requirements

Feb 26, 2014 l Affordable Care Act

BY ALISA BOSWELL aboswell@pntonline.com

Businesses and government agencies may not fare well with their insurance requirements under the Affordable Care Act, according to local officials.

The act requires businesses to offer insurance to parttime employees or pay a penalty for not doing so.

Portales city clerk Joan Martinez-Terry said it will cost the city of Portales more money now that it has to offer insurance to all of its employees. Just how much more, she doesn’t know.

“We are already talking about different ways to handle the additional expense,” Martinez-Terry said. “We are also talking about changing our personnel policies, which could mean more work all the way around. We would have to change our personnel policy to fit the law.”

Martinez-Terry said there is the possibility more work could be placed on full-time employees, enabling the city

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to cut back on part-time employees.

“They (employees) may not want to pay the premium for our plan so they may not even take our policy, but we would have to provide them the opportunity to get the insurance, whether they want to take it or not,” she said.

0“There’s a lot of things to consider and we are still trying to figure out the best way to go.”

Impacts on county agencies are about the same, according to Curry County Manager Lance Pyle. He said the county is required to offer insurance to its part-time, temporary and seasonal employees who work more than 30 hours a week for more than a 90day period.

Pyle said the county hires temporary and seasonal employees for certain projects and for the time being, the county will cut down on temporary employees and try to make sure projects are completed within a 90-day period.

Pyle said an option for gov-

ernment agencies is to hire a temp agency. The city or county would pay the agency a fee and the agency takes care of workers.

Scott Smart, vice-president of business affairs for Eastern New Mexico University, said although the university is under state insurance such as local city and county governments, state laws are different for colleges and universities.

The school is already required to provide insurance to part-time employees; that part of the act will have no impact on ENMU. Leola Patterson, business manager for Tucumcari Public schools, said public school officials don’t know the impact because ACA rules concerning schools and businesses have recently been changed.

She said her district would be having another meeting soon to study the most recent changes.

“In the beginning, we were supposed to offer anyone who works for us insurance if they

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were willing to pay their portion (of the premium),” she said. “(But) at this point, I don’t have any information.”

Under the previous rules for schools, if substitute teachers accepted school insurance, they would have to also pay the school’s portion of the premium when they were not working.

Because of the recent ACA rule changes, Robyn Snowberger, co-owner of the Clovis, Portales and other regional McDonald’s restaurants, declined to comment on ACA impacts due to not yet “knowing any definites.”

Farmer’s Electric Cooperative General Manger Lance Adkins said being under their national organization’s insurance has saved their business from having severe impacts.

“Early on during discussions regarding affordable care, our insurance leaders were forward thinking as far as providing benefits,” Adkins said. “One of the strong points in the ACA is that all

insurance plans extend coverage to your children through a certain age. Years before that plan was put into effect, we were covering our employees children (into adulthood).”

Adkins said the only challenge his company may face is having to change the insurance plans they offer to their employees because they are what the ACA calls Cadillac plans, meaning they are “richer” than what is required under the ACA. He said with Cadillac plans, their employees will be charged additional taxes on their health care.

“Either the rules can change or we can offer a different plan in future so they can get out from under that Cadillac plan,” Adkins said. “(But) That’s another great provision that being in our national association has provided is that we offer four different plans. Depending on how rich the plan is, the employee picks up coverage based on that.”

“They (employees) may not want to pay the premium for our plan so they may not even take our policy but we would have to provide them the opportunity to get the insurance, whether they want to take it or not. There’s a lot of things to consider and we are still trying to figure out the best way to go.”

— Joan Martinez-Terry, Portales city clerk

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Affordable Care Act l Feb 26, 2014