Saturday, October 19, 2013

The Affordable Care Crisis


Opposition to the current roll-out of the Affordable Care Act has grown and has come center-stage. Proponents of the new law seem to have taken a less visible role, and public opinion has gradually drifted to changing the mandate deadlines. From a practical stand point the health benefit exchanges do not seem to be entirely ready, and have generated confusion and more anxiety.  The Dept. of HHS hyped the HBX and raised unrealistic expectations.  It became more of a marketing ploy than a real value proposition.

It is time to back off and take a breath to re-evaluate the goals and what must be implemented to assure a smooth and successful health reform .  It may require major revisions during the next 24 months.   The compressed time schedule from 2010 when the law was passed until 2013 is really a very short time to transition a huge industry. Much of it evolves only if all the steps take place in an orderly fashion. It is a bit of a domino game and a false step or missed opportunity may crash the project entirely. 

Health care has not and will not been reformed by the Affordable Care Act.

Another indicator of the error in thinking, HHS failed to realize that health will still operate in an open marketplace, save for those at the bottom tier who will have to rely on a legacy medi-caid system, an antiquated poverty level, and a maze of federal-state-county eligibility system.

In the current system counties calculate benefits based upon maintance costs, also legacy and badly out of date poverty level figures. For one thing poverty levels are determined for the nation at large. Poverty level in California is far different from Poverty levels in the midwest or Arkansas as one example.  In fact poverty levels vary greatly in each state, such as a state with wide disparity  in income zones.One size will not fit all and nothing has been mentioned regarding specifics of how the medi-caid system will be modified to adapt to ObamaCare.

Obamacare and the Federal Poverty Level

Who gets help from Medicaid (AHCCCS in Arizona) and who gets help with their health insurance premiums under Obamacare?  It all depends on a person’s, or a family’s income in relation to the federal poverty level.

An individual or a family will get help with their health insurance premiums if their income is between 133% and 400% of the federal poverty level (FPL).

In addition to getting help with health insurance premiums, some people will get help with co-pays that are part of their health insurance plan. Individuals or families making less than 200% of the federal poverty level (but higher than 133%) will get this help if they enroll in a Silver plan. (I guess I need to explain the coverage levels next.)

Here is a chart that shows the FPL changes based on the number of people in a family.

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