By BETSY TAYLOR
Sr. Carol Keehan, DC, CHA president and chief executive officer, is encouraging hospital leaders and their community partners to educate the uninsured about historic new opportunities to enroll in affordable health insurance coverage. New state-based insurance exchanges begin a six-month open enrollment period Oct. 1 that will give millions of Americans access to health insurance coverage.
Hospitals worked hard to pass the Affordable Care Act to reform health care and expand health insurance in the U.S., Sr. Carol said. Now, she said, the time has come to close the public's awareness gap about the law and to help people navigate the enrollment process and secure affordable, meaningful health care coverage.
"This is a historic opportunity for our country and the people in our country, both those who have insurance and those who don't have insurance, for us to have a much more intelligent health care system that's worthy of the dignity of the people of this nation," Sr. Carol said. She spoke during a Sept. 16 webcast hosted by CHA, the American Hospital Association and the Federation of American Hospitals. Leaders of the hospital associations were joined by a senior advisor from the Centers for Medicare & Medicaid Services, and an executive of St. John Providence Health System.
The speakers stressed that health systems, hospitals and the community organizations they work with have a vital role to play in educating eligible people in their local communities. Health insurance navigators and certified application counselors, who work for hospitals and in other community organizations, will assist members of the public with questions about how they enroll for private health insurance coverage on an exchange and what assistance or subsidies they qualify for to help them pay for it. Private insurance purchased through the exchange can take effect on Jan. 1. Individuals or families whose income qualifies them for Medicaid or the Children's Health Insurance Program may be eligible for immediate coverage.
Dr. Mandy Cohen, senior advisor to the CMS administrator, said there are about 41 million uninsured people in the U.S. About half of them live in eight states: California, Texas, Florida, New York, Georgia, Illinois, Ohio and North Carolina, she said, as she explained there will be an emphasis on enrolling uninsured people in those states and in reaching uninsured young adults nationwide.
"We know there are about 18 million uninsured 18- to 35-year-olds, but we also know they don't wake up every day thinking about health insurance, so it takes a lot more to break through for them to understand what the benefits are and to learn about health insurance and the economic security and the health security that insurance can bring," she said. Cohen said this cohort skews male, is 26 percent Latino and 18 percent African-American. She said about 90 percent of the uninsured will qualify for Medicaid or financial assistance to purchase a private health insurance plan through the marketplace.
Cohen said people will be able to apply for health insurance coverage online at HealthCare.gov, over the phone, through the mail and in person. People can call a hotline at (800) 318-2596 or visit the HealthCare.gov website, type in their location or zip code and get addresses of venues where they can apply in person. If they enroll online, they will enter information about themselves and/or their families, and should immediately see their eligibility for subsidies and plan designs to help them lower their monthly premiums and out-of-pocket expenses. People can compare the policies on the exchanges, see benefits available to them based on income and family size and select a plan immediately or return later to make a decision.
Cynthia Taueg, vice president for ambulatory and community health services at St. John Providence Health System, described how her Warren, Mich.-based system had shifted some of its existing community health resources to help answer questions and facilitate enrollment through the exchange. She suggested hospitals and health systems reach out to uninsured patients they've previously served to link them to coverage options. Providers can build on existing partnerships in their communities; other local organizations also may have health insurance navigators and insurance counselors to help with enrollment. She said systems should remember to educate their own associates who may not have insurance for themselves or their families about new coverage options under the ACA.
Taueg said the health reform environment related to Medicaid expansion is changing in Michigan.
The day of the webcast, Gov. Rick Snyder signed into law a measure to expand Medicaid under the ACA to about a half million residents, provided the Obama administration approves two waivers that will allow Michigan to charge income-based premiums for Medicaid coverage and offer deductions for healthy lifestyle choices. As Catholic Health World went to press, Pennsylvania Gov. Tom Corbett backed Medicaid expansion in his state, provided new requirements can be put into place, such as having participants pay monthly premiums and show that they've been looking for work. His plan would need approval from the Pennsylvania legislature and the federal government.
Medicaid expansion is a central part of the reform law's strategy to provide health coverage to many of the nation's neediest uninsured; however, Medicaid expansion became optional for states due to a U.S. Supreme Court ruling. Of the eight states with the highest concentration of uninsured, only California, New York and Illinois are among the 25 states currently moving forward with Medicaid expansion under the ACA. Ohio is among three states still debating the question. Texas, Florida, North Carolina and Georgia have said no to Medicaid expansion.
The webcast speakers said they expect there will be bumps in the road as enrollment begins through the exchanges. But Federation of American Hospitals President and Chief Executive Chip Kahn said, "Health reform is going to go forward."
Answers to many questions related to insurance exchanges can be found at the Health Insurance Marketplace and HealthCare.gov. Resources for hospital websites and staff meetings can be found at chausa.org and the Health Insurance Marketplace.
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