To Your Health
“This little piggy went to market, this little piggy stayed home….” I would bet most readers would be able to complete the rhyme. It’s this rhyme that comes to mind in recent months as the advertising and education regarding the workings of the health-care-reform system increases.
As of the most recent census (2010) almost 49 million Americans, or 15% of the U.S. population, did not have health insurance coverage. This means that the uninsured did not receive health care, paid for health care completely “out of pocket” (meaning their personal wallets), used credit to pay for health care needs, or relied upon the requirement that emergency rooms provide health care in certain life-threatening situations.
The U.S. arguably offers one of the most sophisticated and comprehensive health care systems in the world. All sorts of tests, treatments, services and providers are readily available to its residents. It’s important to distinguish however, between the availability of and access to health care. Health care is available; it is not accessible to many residents because the costs are beyond reach unless a person carries health insurance.
The purpose of the Affordable Health Care Act was to provide health insurance to all citizens and legal residents at an affordable price. Making health insurance affordable cannot be accomplished in a vacuum. Doing so requires defining health care coverage, monitoring the appropriate use of services, and setting prices on services and procedures.
In designing a universal (required) health insurance product regulators included services and procedures that are contrary to Catholic teaching. The Catholic Church does not and has never opposed a universal health care system. Health care is a fundamental human need like food and housing, and individuals deserve access to basic health care products and services. The U.S. bishops as well as leaders of several other faith traditions oppose the requirement that insurance plans include (and define), among other provisions, contraceptive products and procedures as preventive care.
As of this writing, individuals who do not have access to health insurance through an employer or existing government assistance programs like Medicare and Medicaid will be able to buy insurance at an affordable price. In many cases, buyers will pay less than the full price of the insurance. The difference between the cost and the price paid will be subsidized by the government through a tax credit. (A tax credit is like having a coupon to offset the income tax liability of the taxpayer. In this case, the tax credit will be paid directly to the health insurance provider to reduce the cost of insurance to the buyer.)
While insurance coverage will not begin until Jan. 1, 2014, consumers will be able to enroll in a plan beginning Oct. 1, 2013 – just a few weeks from now. Consumers are not only invited to enroll in a plan, they are required to buy insurance no later than March 31, 2014, or be fined. (The law is complicated, and there are exceptions – this article simply outlines the basic provisions.) How does a person enroll?
In Indiana, individuals will be able to buy a plan through a Web-based, online system called an “exchange.” An exchange user will answer a few questions designed to assist the buyer in choosing the appropriate health insurance and determine if the buyer qualifies for a government subsidy to help pay for health insurance costs. Practically, the exchange is similar to buying an airline ticket through Expedia or a hotel room on Hotels.com.
Before shopping, it will be important to understand three components of health insurance: the procedures, products and services covered; the cost of the insurance; and out-of-pocket costs such as deductibles and co-insurance or co-pays. All plans sold on an exchange will be labeled based on the coverage provided and the percent of costs covered. These labels are bronze, silver, gold or platinum.
The Affordable Health Care Act defined the minimum level of health services to be provided in a plan. Consumers may buy a policy that covers more than the required basics. They should examine their personal health care needs and buy a plan that will cover the procedures and products that are most used and most expensive.
All consumers will be required to buy a plan that meets the requirements for a bronze plan. On average, a bronze plan will cover 60% of an insured’s health costs.
The cost of the insurance, or premium, will be based upon federal poverty guidelines. Household size and income are used to determine if a family is in poverty. For example, a single person making less than $11,490 each year is considered poor. A family of four is poor if household income is less than $23,550. Health insurance buyers will be eligible for a subsidy if their income is less than 400% of the federal poverty guideline.
In just two weeks, millions of people will be eligible for, in fact required, to buy health insurance. The process will be confusing at best. Enrollment assistance will be available in a variety of forms and forums. The Kaiser Family Foundation offers a useful Web site (www.kff.org/interactive/subsidy-calculator) including a subsidy calculator and answers to Frequently Asked Questions.
Here’s to your health!
Sharon Burns is Director of Catholic Charities of the Diocese of Evansville.
