By: Amelia Holliday — Staff Reporter
September 25, 2013
HAZARD—Kentuckians are bracing for the beginning of the unknown — otherwise known as the start of Medicaid expansions and open enrollment in the health benefits exchange (HBE), part of the Patient Protection and Affordable Care Act (ACA), on Oct. 1. And though that date is merely a week away, it seems some local health care providers have as many questions as their patients.
Karen Cooper, district director for the Kentucky River District Health Department in Perry County, said though many changes are expected to come to the health care system in the next year she has not yet been brought up to speed.
“They’ve really not told us anything. We are one of the agencies that’s supposed to be enrolling folks, but we’ve not gotten anything as far as training. I don’t know what the holdup is, but we don’t really have a whole lot of information on it,” Cooper said.
In 2010, the ACA — more commonly known as Obamacare — was signed into law, designed to reform the country’s health care system to ensure that every American has access to affordable health care. Many of these reforms have already been felt by Kentuckians, including allowing young adults to stay on their parent’s coverage until they are 26, removing lifetime limits on health benefits, and providing coverage for children with pre-existing conditions.
“The state hasn’t told us, really, what to expect,” Cooper said, adding that training is set for later this week for some of her staff.
At the beginning of October, Kentucky’s HBE, a virtual market place mandated in every state as a place to shop for health care coverage, will open and be available for use by those seeking coverage, which, once enrolled, will take effect next year.
“Basically, what the online market place is set up for is to help people find affordable health insurance,” said Zach Sturgill, an outreach enrollment specialist with the Mountain Comprehensive Health Corporation (MCHC) in Whitesburg. “It’s going to help a lot of people who don’t have health insurance.”
MCHC, like many other health care providers in the country, has prepared a team of specialists trained to help patients who may not know anything about the changes coming to the health care system. Like the training Cooper will receive, the specialists will be able to help anyone seeking new insurance under the act with any questions they may have.
“The biggest thing for us is trying to get outreach to the patients,” Sturgill added.
While there are many different variables that go into the system to decide what insurance would be most affordable for a person while giving them the best possible coverage, Sturgill said there are some basics to remember. For example, in the HBE, there are four different levels of coverage — bronze, silver, gold, and platinum — with coverage and price increasing with each level.
“We’ve had a lot of people ask, ‘Well, I’ve got insurance, do I need to go on the market place and buy some more?’ No, you’re good,” Sturgill said.
Sturgill added that if a person is already covered by their employer’s insurance they do not need to worry about getting new insurance unless they feel like it is not affordable enough for them, however, those who decide to drop their current insurance to shop on the market place will not qualify for any federal subsidies to help bring down the costs of their insurance.
With the ACA and the Medicaid expansions, Sturgill said there will be no one in the state who cannot afford health insurance thanks to federal subsidies that will be given to those who cannot afford to pay for insurance with the income they have.
According to Kentucky’s Cabinet for Health and Family Services, in 2012 17.9 percent of Perry Countians — around 4,400 people — were uninsured; statewide the previous year, 16.9 Kentuckians were uninsured. Under the HBE, 8.3 percent of that 17.9 percent will be covered; 9.5 percent will be covered with the Medicaid expansion.
“The Medicaid expansion goes up to 138 percent (of the federal poverty level). So, anybody between the ages of 19 and 64 that falls in that income range … if it falls under 138 percent they’re qualified for a Medicaid card,” Sturgill said.
Because the ACA and the expansion are all new territory for anyone, either in the health care industry or not, Sturgill said it is a learning experience for everyone in the country.
“Honestly, before I got hired here, I didn’t know the first thing about the Affordable Care Act or anything like that, and I’m sure there’s a lot of people out there, I’m sure there’s going to be a lot of people out there who do not know what they’re actually going to be eligible for. There’s going to be a lot of people who don’t know about the Medicaid expansion.”
This is where Sturgill noted the other enrollment specialists at MCHC come in. After Oct. 1, specialists will be stationed at every MCHC clinic in the area, including the Leatherwood-Blackey Clinic, to help anyone with questions about the new system.
“Even if they just want to see what they’re eligible for it would be great just to plug the information in on this portal, it takes us 20 minutes to plug your information in and the portal itself actually brings up what you’re eligible for,” he said.
Sturgill added that he and the other specialists will answer questions from anyone in the area and stressed that anyone with questions or doubts needs to just ask he or his team instead of worrying or going on rumors alone.
“It’s an all new thing,” he said. “It’s going to have some bumps down the road, but I’m sure it’s going to be OK eventually.”