Navigating health care reform Insurance exchange counts down to launch Workers standing by to educate Michiganders on Oct.1enrollment By Robin Erb Detroit Free Press Medical Writer Nearly every Michigander will have access to basic health insurance — and be required to get it — beginning Oct. 1 as federal health reform’s largest provisions start snapping into place with the launch of each state’s Health Insurance Marketplace. For those with no insurance or bare-bones coverage, that could mean more generous benefits than they’ve ever had, once coverage becomes effective Jan. 1. That’s because the 2010 Affordable Care Act requires that 10 categories of what it calls essential benefits be offered in all plans sold on the online marketplace, also known as the state exchange. Those benefits also must be in individual and small business policies that aren’t on the exchange. That means glasses and dental care for children and mental health and substance abuse services. It means prescription drug coverage. Lab tests. Hospice care. Maternity and newborn care. “In general, people will see coverage with richer benefits and have the financial assistance to help pay for them,” said Josh Fangmeier, a policy analyst at the Ann Arbor-based Center for Healthcare Research and Transformation, which has supported health reform efforts. The details of the essential benefits will vary from state to state, and there will be limits. In Michigan, for example, that means some plans might place a limit of up to 45 days on hospice care per year. Now, a massive effort is under way — both online and on the ground — to get people primed to enroll in the Michigan exchange. The U.S. Centers for Medicare and Medicaid Services beefed up websites so that consumers can establish a personal profile and sign up for text messages. At the same time, dozens of federally funded navigators and others are being trained this month in health clinics, community centers and libraries throughout Michigan. Their job will be to guide consumers to the exchange and, if necessary, help them log on and fill out forms. “Two functions have to work hand in hand here. One is to raise awareness and street-level education. The second is... to assist in the enrollment,” said Don Hazaert, director of Michigan Consumers for Healthcare, one of the major advocates of the Affordable Care Act in Michigan. The group is one of four community-based organiza tions that learned last month it will split $2.5 million in federal money to help with enrollment efforts. Some of it will help pay salaries for extra staff. Consumers for Healthcare will use the money instead to encourage a network of about 250 health clinics and community organizations throughout Michigan to enroll consumers. For each consumer they sign up on the exchange beginning next month, the organizations will receive $25 in reimbursement from Consumers’ $1.3-million pot. Meanwhile, a national coalition of pro-health reform groups has been going door to door to find uninsured Michiganders who might need help signing up for health care. A recent national study by the group, Enroll America, found that 72% of those who would likely benefit from government subsidies to help pay for health insurance on the exchange lacked awareness of the exchange and what it will provide. In Michigan, Enroll America workers are finding the same disbelief and confusion, said Erin Knott, Michigan director of the organization. “They have a lot going on in their life, juggling jobs and just trying to make ends meet,” she said. “And this is unprecedented. Nothing like this has happened before.” Of more than a dozen workers and patrons questioned Tuesday in a Southfield strip mall that houses a hair salon, an auto repair shop, a Coney Island and a pharmacy, no one seemed to know why Oct. 1 is important. Nor did anyone know how they might benefit under the state exchange. Martin Tomaj said insurance has been far out of reach on his salary as a cook at his family’s Coney Island restaurant. He’s a student at Eastern Michigan University with tuition bills, phone bills and gas bills. His parents have gone without health insurance, too. “We just try to stay healthy,” he said, shrugging. “We’ve been lucky.” He and his parents are among the 1.3 million uninsured Michiganders who will be targeted in enrollment campaigns. Among them are some of the estimated 470,000 Michiganders who became eligible for an expanded Medicaid program just last week. Lansing lawmakers voted to expand the state’s program, also under health reform, but only after a contentious fight that dragged through the summer. The state’s exchange will function as a portal to access Medicaid benefits, too. For the most part, the exchange will be federally run because Lansing lawmakers never approved a state-run exchange. But both state and federal officials say consumers won’t notice a difference because it will carry the Michigan-specific information. Helping consumers sort through all of this is a daunting challenge, said Marti Lolli, director of Health Care Reform efforts at Priority Health. Even those who understand the exchange might opt to pay the tax penalty that starts at just $95 the first year rather than pay an insurance premium, especially for these more generous policies. For some, a strong selling point will be in the essential benefits — something that many large employers have in their plans, but that small businesses or individuals couldn’t afford in leaner policies, Lolli said. The Michigan Department of Insurance and Financial Services, which was charged with choosing the details for each essential benefits requirement, chose a Priority Health HMO plan as its benchmark plan. The Priority plan came closest to the federal essential benefits categories and it was the most cost-effective, according to the state . Exact costs for each plan might not be public until Oct. 1. And among the policies, there will be wide variations in deductibles or co-pays. Plans on the exchange will be graded in “platinum,” “gold,” “silver” or “bronze” categories depending on how much is covered. Platinum plans, for example, will cost more, but consumers will kick in about 10% of costs. Under a bronze plan, a consumer would pick up about 40% of the cost. But when it comes to understanding some of the finer print in benefits, the benefits will be the same, Lolli said: “The great thing is there will be additional uniformity for easier shopping.” Contact Robin Erb: rerb@freepress or 313-222-2708.
Posted on: Sun, 01 Sep 2013 18:49:04 +0000
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