It will be roughly 50 days until Access Health Connecticut starts enrolling people for health insurance as part of federal health care reform. But if you don't know what Access Health is or why it's enrolling people in health coverage, you're not alone.
Access Health is the state's health insurance exchange, and will allow individuals, families and small businesses to shop for insurance.
The exchanges, which are being established throughout the country, are a cornerstone of the Patient Protection and Affordable Care Act. The federal law is slated to provide insurance to millions of uncovered Americans by 2014.
But despite endless debate on cable news channels about the health care law, many Americans are still confused about the exchanges or flat-out oblivious to them.
"Every time there are changes in the policy, it sends a confusing message to the public," said Kevin Counihan, CEO of Access Health.
A survey commissioned by Access Health showed that only 31 percent of the 851 state residents polled had heard of the state's health care exchange. About 60 percent of those surveyed said they knew little or nothing about the federal health care law as a whole.
About Access Health
Access Health Connecticut is one of only 14 state-established health exchanges. The rest were either built by the federal government, or through partnerships between the state and federal governments. Residents and owners of business with fewer than 50 employees can shop for insurance through the exchange. The basic idea is to make coverage available to people who might not have been available to afford it. Enrollment starts Oct. 1 and coverage starts in January.
According to Counihan, there are 344,000 uninsured people in Connecticut. He said he expects about 100,000 people to enroll for coverage through the exchange in its first year -- either with one of the providers on the exchange or through the expanded Medicaid that is also part of the Affordable Care Act.
Most people who don't already have insurance through another method -- such as Medicare or employer insurance -- are required to buy insurance through the exchange or face an annual tax. Theoretically, the elderly can opt out of Medicare and join the exchange, but Counihan doesn't expect many people to do that, as Medicare is less expensive.
The exchange will offer plans from three companies -- ConnectiCare Benefits, Anthem and the new insurer Healthy CT.
Each company offers "Gold," "Silver" and "Bronze" options, and premiums vary from tier to tier. Gold plans have the highest monthly premiums, but lower deductibles and copays. Bronze plans have the lowest premiums, but higher out-of-pocket costs and silver rests somewhere in between.
ConnectiCare has the lowest range of premiums for individual plans (small businesses with less than 50 full-time employees can also purchase insurance through the exchange), offering a gold plan with a $215.17 monthly premium, a silver plan with a $269.66 monthly premium and a gold plan with a $309.64 monthly premium. HealthyCT's has the highest premiums, with $245.45 a month for bronze, $310.02 a month for silver and $321.22 a month for gold.
But these are all just base rates, and premiums can vary hugely depending on the consumer's age and county of residence. For instance, HealthyCT offers a bronze plan at $270 a month for a 21-year-old in Fairfield County and $224.82 a month for a 21-year-old in Hartford County. That same HealthyCT bronze plan would cost a 64-year-old in Hartford County $674.47 a month, and a 64-year-old in Fairfield County would pay $810.69 a month.
Fairfield County generally has the highest premiums overall.
The exchange also offers subsidies and discounts, as well as access to low or no-cost insurance through Medicaid for those who qualify. Individuals who earn up to $45,960 a year may qualify for subsidies to help cover monthly insurance payments. Families also might be eligible for help, depending their size and income.
The general idea is that consumers can look at all the options available to them, and pick the choices that best meet their coverage and economic needs, said Patricia Baker, president and chief executive officer of the Connecticut Health Foundation, an independent health philanthropy that aims to improve health care access to the underserved. "(The exchange) really is a doorway to coverage for those who haven't had it in the past," she said.
Getting `young healthys' to enroll
The exchange hit at least one bump in the past week, when Aetna health insurance announced it was withdrawing from the exchange. The company pulled out for multiple reasons, one of which was that the state Department of Insurance wanted the company to adjust its rates to a level that "will not allow us to collect enough premiums to cover the cost of the plans and meet the service expectations of our customers," according to a statement from Aetna.
Susan G. Millerick, a company spokeswoman, said another factor was its acquisition of Coventry Health Care, a managed health care company based in Bethesda, Md. The company decided to "take a step back" from the exchange, but might revisit the decision in the future.
Others, meanwhile have concerns that premiums might be too high. Those include Alta Lash, executive director of United Connecticut for Action Neighborhoods, which educates consumers and advocates on a variety of issues, including health care. "I think there are some people who will still find the premiums over their heads, particularly older people," she said.
Lash also worried whether enough "young healthys" would enroll in the program, as healthy people are needed in any insurance system to help subsidize the sick people. In fact, some wonder whether healthy people may just opt to pay the relatively low yearly tax for not enrolling. For 2014, the tax is $95 or 1 percent of an individual or small business's income -- whichever is greater. The tax rises to $325, or 2 percent of income, in 2015 and $695, or 2.5 percent of income in 2016.
Given that the price tag is lower than the monthly premiums, a young person with no obvious health problems "may just opt to pay the tax," said William Gedge, senior vice president of payer relations for the Yale-New Haven Health System, the umbrella organization for Bridgeport Hospital, Greenwich Hospital and Yale-New Haven Hospital.
Other wrinkles have included the constant changes and challenges to the Affordable Care Act on the federal effort, which Counihan said many consumers have found confusing. For instance, he said, after President Obama announced a one-year delay on the mandate requiring businesses with more than 50 full-time workers to have insurance, "many people thought the whole law had been deferred," he said.
to educate others
On that score, about 300 outreach workers -- librarians, community organizers, religious leaders -- are being trained to educate the public about the exchange. Many of those workers will be stationed at local health centers, including Southwest Community Health Center in Bridgeport, and Optimus Health Care, with offices in Bridgeport, Stamford and Stratford. Others include the AmeriCares Free Clinics, which has sites in Norwalk, Bridgeport and Danbury, and plans to open a mobile clinic in Stamford in the fall.
Among those being trained is Karen Gottlieb, executive director of the clinics. Her goal is to have someone at each of the clinics who can teach interested consumers how the exchange will work.
"Our job is not necessarily to enroll them or influence them in any way," she said. "It really is just to educate them."
Most hospital officials are "clearly in favor" of the exchange as something can provide more people with coverage, Gedge said, but it likely still won't provide coverage for all of the state's uninsured.
Also, even those who are eligible might not jump right on the exchange, he said.
"I think we have to reduce our expectations about how quickly we can roll this out," Gedge said.
Counihan also encouraged cautious optimism about the exchange.
"This is a long-term play," he said. "This is not going to be an immediate fix."
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