Affordable Care Act

In this March 23, 2010 file photo, President Barack Obama signs the Affordable Care Act in the East Room of the White House in Washington. If Obama's health care law survives Supreme Court scrutiny, it will be nearly a decade before all its major pieces are in place. The law's carefully orchestrated phase-in is evidence of what's at stake in the Supreme Court deliberations that start March 26, 2012. With Obama are Marcelas Owens of Seattle, left, and Rep. John Dingell, D-Mich., right; from top left are Sen. Tom Harkin, D-Iowa., Senate Majority Whip Richard Durbin of Ill., Vice President Joe Biden, Vicki Kennedy, widow of Sen. Ted Kennedy, Sen. Christopher Dodd, D-Conn., Rep. Sander Levin, D-Mich., Ryan Smith of Turlock, Calif., Health and Human Services Secretary Kathleen Sebelius, House Speaker Nancy Pelosi of Calif., House Majority Leader Steny Hoyer of Md., Senate Majority Leader Harry Reid of Nev., Rep. Patrick Kennedy, D-R.I., House Majority Whip James Clyburn of S.C., and Rep. Henry Waxman, D-Calif. (AP Photo/J. Scott Applewhite, File)

(AP Photo/J. Scott Applewhite

The Marketplace is open for business! Or is it?

The Patient Protection and Affordable Care Act, commonly called the ACA or Obamacare, includes a very unpopular mandate that forces Americans to buy a qualified health insurance plan effective Jan. 1, 2014 or pay a penalty at tax time. As a trade off, the law also included subsidies to help people who earn 400 percent of the Federal Poverty Level or less pay for their coverage. The only way a person can claim the subsidy is to apply for coverage through a new Marketplace, and Arizona opted to utilize the Marketplace being built by the federal government rather than build our own.

Thousands of Arizonans were waiting impatiently for Oct. 1 to roll around so they could see the new plans and pricing. Today, most of them are still waiting. The Marketplace available to Arizonans has experienced severe technical issues.

The first step is to create an account. For the first 30 days I tried to create an account personally I received a message telling me the system was unavailable. On Oct. 31 I was able to create an account and then move on to step two, which is applying for subsidy eligibility. After giving quite a lot of personal information to the government and attesting to the truth of my information under penalty of perjury I submitted the application and received my eligibility results, which stated that I am not eligible for Medicaid. I was not applying for Medicaid. The system did not allow me to go any further with subsidy application or plan selection. But it did give me the opportunity to register to vote.

The system is not working well yet, and Arizonans are going to have to be patient for a little while longer.

For people whose household income is greater than 400 percent of the FPL the good news is that they do not have to wait for the Marketplace. They can apply for coverage beginning Jan. 1, 2014 through an insurance broker or directly with an insurance carrier right now. Without having to answer health questions, the application process is quicker and easier.

The new rules that govern what benefits are offered in a health plan are the same whether the plan is made available on or off the Marketplace. Pricing works the same as well, so if you don’t qualify for a subsidy you have no reason to bother with the Marketplace process.

While many people who were previously uninsurable in Arizona are ecstatic that they can now get health insurance coverage, they are generally not as happy with the premium rates. The benefit mandates, the removal of medical underwriting criteria, and the new taxes assessed on health insurance companies, pharmaceutical companies and medical supply companies have all driven up the cost of health insurance.

If you don’t qualify for a subsidy, you must absorb the additional cost yourself. For example, a 61-year-old male living in Maricopa County could pay between $426 and $752 per month for a Silver plan. A married couple ages 64 and 59 living in Anthem could pay between $743 and $1765 per month. Many people are finding these premiums hard to swallow if they don’t qualify for a subsidy.

What is even more difficult for some in Arizona is the fact that even if they like the health plan they have now they will be forced to make a change at their renewal date in 2014. The old plan designs do not meet all of the requirements of a qualified health plan as defined by the ACA.

The SHOP Marketplace for small employers has also experienced technical issues. It was originally envisioned as offering expanded choice and flexibility to employees at small firms. The system was supposed to allow employees of a small company to each choose different plans from different carriers. The employer would pay one bill each month to the Marketplace and the Marketplace would then pay the correct premiums to each of the insurance carriers involved. It was announced earlier this year that the employee choice functionality would not be ready for 2014, but that it may be available in 2015.

As a result of this delay, the only reason a business would want to purchase small group coverage through the SHOP Marketplace is if you qualify for the Small Business Tax Credit. Your insurance broker or accountant can help you determine if your business qualifies for this tax credit.

Although it’s clear that there are serious issues with ACA Marketplace implementation, Arizonans should be comforted by the fact that the federal government is very determined to fix the system as quickly as possible. If you have questions or concerns, a licensed and Marketplace-certified insurance broker can help.

• Shelly K Winson is a Chamber member and the owner of True Choice Benefits. She can be reached at (480) 206-8294 or shelly@truechoicebenefits.biz.

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