A speaker talked to a group of McPherson business leaders Monday about facts and myths concerning the Affordable Care Act.

A speaker talked to a group of McPherson business leaders Monday about facts and myths concerning the Affordable Care Act.
Sheldon Weisgrau, director of Health Reform Resource Project, gives forums like the one conducted Wednesday at the McPherson Museum across the state.
Weisgrau first wished to address who the Affordable Care Act will affect. Only those people who are younger than 65 and who do not receive health care through their employers will be affected by this legislation. Those on Medicare will not be affected.

Quality care
The ACA seeks to provide rewards for quality of care. Until this point, hospitals and physicians have been reimbursed based on the number of procedures they perform and not the outcome for the patients.
In terms of the civilized world, the United States spends more on health care than any other country, but is about in the middle of the pack in terms of quality.
“The cost of health care is going up faster than anything in the economy,” Weisgrau said. “That is both our own money and what the federal government pays.”
Since the Affordable Care Act was passed, health costs growth has slowed, but that could be because there has been a general effort to shine a light on costs, Weisgrau said.

Goals of the law
The law is 906 pages with 10 titles. About 200 of the pages in the law deal directly with cost of care.
The law seeks to:
1. Provide better health insurance coverage and make it more available and affordable to legal residents of the United States.
Illegal residents can’t buy insurance in the any of ACA marketplaces, even if they wished to do so with their own money.
2. Reform health care delivery and financing to provide better quality and outcomes more cost effectively.
Weisgrau said both political parties agree payments for doctors and hospitals should be based on the quality of care their patients receive.

Expanding current system
The Affordable Care Act does not seek to create a new system of health care, but builds on the country’s existing system, he said.
Under the ACA, some people will receive insurance through private health plans, and others will receive health care through state programs, including Medicare and Medicaid.
“The government will have no more control than they did before,” Weisgrau said.
Weisgrau tried to dispel some of the myths associated with the ACA. One of those was that there will be death panels.
“One woman asked me if she was going to be put to death when she turned 75,” he said.
“The ACA does not eliminate Medicare. At the end of the day, 25 million to 30 million uninsured Americans will have insurance,” he said.
Weisgrau said the number of people who will be newly insured, depends largely on how many states decide to expand Medicaid. The U.S. Supreme Court ruled states can decide if they want expand Medicaid. Kansas is one of 35 states that have decided not to expand Medicaid at this time. This will leave people uninsured who make too little to buy their own insurance in the marketplaces, but make too much to receive Medicaid.

Pre-existing conditions
One of the more popular provisions of the law prohibits insurance companies from denying coverage based on pre-existing conditions.
To this point, insurance companies could deny coverage for a previous illness or carve out certain parts of the body not to cover. For example, Weisgrau met a person whose insurance company had denied him coverage of his urinary track because he had a history of kidney stones.
This change will mean more sick people will be entering the insurance pool. To keep premiums from going to high and keep insurance companies solvent, the government is requiring healthy people to also buy insurance.

Better pricing and tax incentives
Large groups have historically received better pricing on health insurance than small groups and businesses. The ACA will allow individuals who can’t get insurance through their employers to buy insurance as a group in the marketplaces. Some of those individuals will qualify for tax incentives to help pay their premiums. Those incentives will go straight to the insurance companies.
Business with less than 50 employees will not be required to provide insurance. If they do provide insurance, they may be eligible for a tax incentives. Weisgrau said these small businesses have been eligible for tax incentives for providing health insurance for the last three years and still may be able to claim the incentives by refiling tax returns for that time period.
Large employers will be required to provide insurance or pay penalties, but that requirement has been postponed for a year.

Do and don’ts of the ACA
Other components of the ACA include:
- Ending lifetime limits on coverage
- Ending rescissions. This is a practice in which insurance companies would review insurance policies for small mistakes and terminate a person’s policy so they would not have to pay a claim.
- Coverage for children until age 26
- Providing summary of benefits and coverage
- Meet the Medicaid loss ration. Insurance companies will be required to spend at least 80 percent of premiums on health care.

Signing up
Weisgrau said problems continue on the federal marketplace website — www.healthcare.gov. Officials have said these problems are supposed to be fixed by the end of November.
Although people have had difficulty enrolling on the site, it is a good source of information about the different plans and their costs, Weisgrau said. People have been successful enrolling by phone although it does take longer. That number is 1-800-318-2596.
Information only on the marketplaces’ plans can be found on the Kansas Insurance Department’s site, which is www.insureKS.org.
Open enrollment will be Oct. 1 through March 31. None of the marketplaces’ plans will be effective until Jan. 1. In order to have insurance through the marketplaces on Jan. 1, individuals must enroll by Dec. 15. If you want to avoid a penalty, you must enroll by March 31.
The marketplaces’ plans have several levels based on deductible and premiums. All plans are limited to a $6,300 out-of-pocket expense.
Plans will be priced on four factors — age, number of people covered, where you live and if you use tobacco.