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The need to help the poor won’t go away


Health Insurance Marketplace


The need to provide free or low-cost health care to the poor will not evaporate because of the Affordable Care Act. The Affordable Care Act will offer private insurance plans through the Health Insurance Marketplace at gov, with tax credits and subsidies to help people afford the plans. But, some of the people with the lowest incomes won’t benefit, and even if they can scrape up money for the premiums, they may have no money for co-pays and deductibles. The net result: The need to fund health care for the indigent will remain, and Volusia County’s three hospital authorities — which levy taxes to fund the care and pay the hospitals and others to do the job — won’t go away anytime soon. The West Volusia Hospital Authority collects around $16 million a year in property taxes. Here’s who gets that money: • More than $5 million goes to West Volusia’s two hospitals in DeLand and Orange City. • Another $1.5 million goes to the Family Health Source primary-care clinics. • More than $3 million funds specialty care for people too poor to pay. • Another $2.25 million is used to reimburse Medicaid. Other local agencies that provide health-related services, such as The House Next Door, Stewart-Marchman/ACT, the Good Samaritan Health Clinic, and Haven Recovery Center, also receive smaller amounts from the Hospital Authority. Administration and other nonhealth-care expenses consume about $8 million of the Hospital Authority’s $17.7 million budget. Under the Affordable Care Act, people who make between


Shopping the exchange

PAGE 3 Effects on small businesses, individuals andMedicare recipients

Affordable Care is coming Enrollment in the Health Insurance Marketplace starts Tuesday, Oct. 1 BY PAT ANDREWS

On March 23, 2010, President Barack Obama signed into law the Affordable Care Please see POOR, 5 Act, also known as “Obamacare.” The law makes comprehensive insurance reforms.

One of those reforms will come Jan. 1, when sweeping changes to health-insurance coverage will come into effect. Certified financial planner Tom Robertson of DeLand dove into the depths of federal legislation to evaluate the changes for his clients, including The Beacon newspaper.

Attorney Ted Small of DeLand specializes in the areas of business, employment and insurance. He’s also been studying the Affordable Care Act for his clients and himself. The two men offered guidance through the maze of information about coming changes in health insurance.

The intention of Obamacare BY PAT ANDREWS

The intent of the Affordable Care Act, Robertson said, is to regulate how insurance companies do business, and hold down consumers’ costs. Some provisions of the act are

already in place, including a provision that insurers of individuals and small groups must spend at least 80 percent of premiums on health-care benefits (it’s 85 percent in the large-group market). If the insurance companies don’t spend those amounts, they must rebate the difference to their

Wednesday, Aug. 28

Thursday, Aug. 29



customers. Last year’s rebates totaled $1.1 billion. According to the U.S. Department of Health and Human Services, Affordable Care will offer more choices and stronger coverage to Americans, including the 77 percent of Floridians who now have insurance coverage.

Friday, Aug. 30


The 23 percent of Floridians who have no insurance will be able to get more affordable insurance, even if they have preexisting conditions that disqualified them before. And, insurance companies won’t be able to charge Please see INTENT, 3

Saturday, Aug. 31

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Companies offering individual and small-group plans:

Start shopping the insurance exchange now


• Blue Cross/Blue Shield • Florida Health Care Plans • Health First

Continued from 1

Companies offering only individual plans: • Aetna • Cigna Health Insurance • Coventry Health Care of Florida • Humana • Molina Health Care of Florida

Companies offering only small-business plans: • John Alden Health Plans • Time Insurance Company

Enrollment is Oct. 1, 2013-March 31, 2014 co-pays. The four tiers are designed so comparisons can readily be made by consumers between various companies’ products, and so consumers can choose how they want to share the cost of their health care with an insurance company. The Florida Office of Insurance Regulation recently released information on which insurance companies will participate in the marketplace, or exchange,

Department of Health and Human Services. Many people who aren’t offered group insurance by an employer but can’t get insurance on their own will get help through the marketplace, online at Most small businesses will get tax credits by purchasing their group health-insurance through the Health Insurance Marketplace. — Pat Andrews

People who have health insurance through their employer that meets minimum requirements may choose not to change their insurance. The same goes for people who have Medicare or Medicaid coverage. Others will be able to purchase individual insurance plans either through or outside of the exchange. Uninsured individuals who are required to buy insurance, but don’t, will be charged a penalty. In 2014, that penalty will be $95 per person and $47.50 per child, or a maximum of 1 percent of family income, whichever is greater. The penalties will increase in future years. The intent of the act is to make health care more affordable, and it will, for most people, Robertson said. While younger people — those in their 20s — may pay a little more than they do now, the plan’s provisions allow them to stay on their parents’ plans until age 26. Until age 30, consumers can choose less-expensive catastrophic plans, which may be the preferred choice for young people who are in good health. Attorney Small said young people who have pre-existing medical condi-

— Pat Andrews

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Effects on individuals, small business and Medicare recipients Insurance for individuals

available: 37 least-expensive bronze plans, 39 silver plans, 36 gold plans, and 14 most-expensive platinum plans. Platinum plans will cover roughly 90 percent of a person’s health-care costs. That goes down to 80 percent for gold plans, 70 percent for silver plans, and 60 percent for bronze plans.

Independence for Life

The Health Insurance Marketplace The Affordable Care Act provides the Health Insurance Marketplace, commonly called “the exchange,” which has been set up as an online marketplace by the federal government to help two groups get insurance: individuals and small businesses. The exchange will open Oct. 1. Insurance purchased on the exchange will go into effect Jan. 1, 2014. It’s operated by the

Robertson said. “I thought it was very interesting that Humana and Aetna did not offer small-group plans,” Robertson said, and that United Health Care hasn’t entered the market at all. He suggested perhaps when these companies become more comfortable with the marketplace, more will participate. In Volusia County, a total of 126 plans will be


Enrollment on the exchange will begin Tuesday, Oct. 1, and continue until March 31, 2014. Robertson suggested people start taking a look at it now. Enrollment won’t reopen until the following October. The exchange will offer four tiers of plans: platinum is the most expensive, then gold, silver and bronze, the least expensive. A higher premium will mean lower out-of-pocket costs and

more because of pre-existing conditions. When asked what he thinks about the reforms, Robertson said, “There’s no question that our country has to entertain some sort of health-care reform.” While the Affordable Care Act is not a perfect plan, he said, “It’s a start ... and a work in progress.” Robertson would like to see all the involved parties — government, insurance companies, tort lawyers, physicians and hospital groups — roll up their sleeves and work together to make affordable health care sustainable. The way insurance and care have been delivered in the past is not sustainable, he said. A lot of misinformation is being given about the coming changes, and Robertson expects more inaccurate and false information to be thrown into

the mix as the enrollment period and the end of the year approach. Con ser vat ives i n Congress and across the country oppose government getting involved in the marketplace, and oppose the ROBERTSON law because it’s “liberal.” Lobbyists for health-insurance companies, pharmaceutical companies, hospitals and other businesses who fear loss of profits have been making an eleventh-hour attack on the plan, hoping to get the new regulations overturned in Congress. The U.S. health-care industry is worth $2.8 trillion, according to a March article by Reuters writer David Morgan.

tions will see an advantage in the new insurance options right away. People in their 40s may see a slightly higher premium in the beginning, Small said. However, subsidies available through the exchange will help pay insurance costs for people who make up to 400 percent of the federal poverty level. For a single person, that’s up to $45,960 a year; for a family of four, that’s up to $92,400 a year. The lower the income, the greater the subsidy. “There are an awful lot of tax credits and subsidies that individuals will miss out on if they drag their feet,” Small said. The Affordable Care Act provides that no one will pay more than 9.5 percent of his or her income for health insurance, and most will pay less. Small said the law’s implementation will be an “evolving process ... with changes even after it’s rolled out.” Cost will decrease and coverage will increase as everybody gets on board. Florida is one of the 27 states that have declined to build a state-based exchange or partner with the federal government in the exchange — leaving it all up to the federal government. Please see EFFECTS, 5 A CONSERVATIVE SYNAGOGUE

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Continued from 1 100 percent and 400 percent of the federal poverty-level income will be eligible for varying amounts of help with the cost of insurance. People who earn up to 250 percent of the poverty-level income will be eligible for subsidies to reduce out-ofpocket costs. The Florida Legislature rejected offers from the federal government of around $50 billion over the next 10 years to expand Medicaid and cover around a million Floridians making very low income who will remain uninsured even after Jan. 1, when the Affordable Care insurance program begins. Medicaid is normally funded 50-50 by the state and federal government. Through this offer, the federal government would have paid all the cost of Medicaid expansion for a decade. West Volusia Hospital Authority Chairwoman Kathie Shepard said most people who make less than 100 percent of the povertylevel income will be left out in the cold, unless they are single women with children, or disabled and collecting Social Security disability, or 65 and older and eligible for Medicaid supplemental insurance to their Medicare insurance. Without the Medicaid expansion, Medicaid does not cover anyone else: lowincome childless people, for example, or people whose children are grown. Affordable Care coverage is designed to help people who make at least 100 percent of the poverty level. That was predicated on plans to expand Medicaid coverage to more people who make less that 100 percent of the poverty level. So, a married couple with no dependent children who make less than $15,510 a year — 100 percent of the poverty level — will not qualify for help to pay for insurance under provisions of the Affordable Care Act, but the couple will not qualify for assistance through Medicaid, either. A family of four with an annual household income between $4,721 and $23,300, or 20 to 90 percent of the federal poverty level, would also be “left in the dark with no support,” Director Paul Dioguardi of the U.S. Department of Health and

Human Services was quoted as saying, in a July 24 Miami Herald article. The Family Health Source clinics are partly funded through the West Volusia Hospital Authority to operate public-health centers in Pierson, DeLand and Deltona. Clients pay on a sliding scale, depending on their income, and the centers accept Medicaid, Medicare and the West Volusia Hospital Authority Health Card. Family Health Source received a $121,524 grant to educate people about insurance options under the Affordable Care Act and how to apply. In the low-income group, only about one in five people know about the new law’s provisions, so the grant will pay for two staff members to direct outreach and enrollment in the program for a year, Family Health Source Director Kathy Wilkes said. Wilkes is worried that many clients will not be able to pay the premiums. Still, clients will be required to apply. That’s because the Hospital Authority is requiring it. West Volusia Hospital Authority’s attorney Ted Small recommended the move, noting that the Hospital Authority’s longstanding policy has been to be “the payer of last resort,” to save taxpayers money. Wilkes is not against the Affordable Care Act. “If we do nothing, the cost of health care is going to spiral out of control,” she said. Implementing the new law will be largely a matter of learning and adjusting its provisions as we go, she said. Administrator Mary GuskyattheGoodSamaritan Health Clinic in DeLand agrees with the others: The need to help the poor will continue. The clinic, one of 200 free clinics in Florida, moved into larger quarters at 136 E. Plymouth Ave. in April. The expanded facility, providing both medical and dental care, assists West Volusia residents who make up to 200 percent of the poverty level. Good Samaritan expanded knowing that the Affordable Care Act was coming, and with the expectation that it wouldn’t make the need for Good Samaritan’s services go away.

“People are just not making it anymore,” Gusky said. She sees people who have become sicker because they haven’t been receiving care — either medical or dental care. Gusky estimated that 70 percent of Good Samaritan’s clients don’t pay taxes because their income is so low they aren’t required to file tax returns. Free clinics provide a safety net for people who have fallen through the cracks of the health-care system, caring for around 29 million people in 1,200 clinics around the country. Most of the money comes from donations. Doctors, dentists, nurses, hygienists, technicians and office staff — everyone — volunteer their services, allowing Good Samaritan to provide free medical and dental care. The value of those donated services totaled $1.529 million for the first six months of 2013, Gusky said.

EFFECTS Continued from 3 The Kaiser Family Foundation offers an online subsidy calculator to help people get estimates of premiums and subsidy amounts. Go to www.kff. org/interactive/subsidy-calculator. Small said the application process is complex, but he

believes individuals will find it worthwhile to complete the application. The U.S. Department of Health and Human Services is working to standardize the plans, to make it simpler for consumers to figure out what coverages will be offered. The “basic” or bronze plan will be “much, much better than most existing basic plans,” Small said.

Insurance for small businesses

“Small-business owners should begin the learning curve,” Robertson said. He recommends they start shopping the plans Oct. 1. Businesses with fewer than 50 employees are not required to offer health insurance for employees. However, businesses with fewer than 25 employees may qualify for tax credits. If so, they must purchase insurance for two years in the Small Business Health Options Program, or SHOP, online at gov. These employers may also continue the coverage they now offer. If an employer offers no coverage, or offers insurance that pays less than 60 percent of medical expenses, the employer must inform employees of that. Under those circumstances, an employee is then free to shop the exchange as an individual, and may qualify for subsidies if he or she meets income requirements. If the employer’s plan

offers certain minimum essential benefits, and the coverage costs less than 9.5 percent of the employee’s income, the employee can still shop the exchange, but won’t be eligible for subsidies. It may take a while for business owners to figure out the new options. “There’s no question there will be rough spots,” Robertson said. He is willing to work with small-business owners on the transition. Communicating with employees is essential, as morale and other issues may come into play in the next few months. Offering insurance will make businesses more competitive in attracting and retaining employees, Robertson said. At the gov site, click on the “Small Businesses” button to get information on the Small Business Health Options Program, or SHOP. Also gov/healthcare will walk business owners through the law’s requirements.


not have to sign up for new insurance. Coverage for people age 65 and older will continue as usual. It is not part of the Health Insurance Marketplace. Some of the Affordable Care Act’s provisions have already benefited Medicare recipients, however. In Florida, people with Medicare saved nearly $464 million on prescription drugs last year because of discounts on brand-name drugs provided under the Affordable Care Act, according to the Kaiser Family Foundation. The foundation has put the act under a magnifying glass to analyze its effects. Medicare also now offers more preventive services as a result of the act, such as mammograms and colonoscopies without coinsurance or deductible payments, and free yearly wellness checkups. And, Medicare publications state that reductions in waste, fraud and abuse will help fund Medicare until at least 2029, due to the Affordable Care Act.

Medicare recipients will

— Pat Andrews

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