Cherry Street Health Services in Grand Rapids is the largest Federally Qualified Health Center in Michigan. It provides integrated health care services at 20 locations, with approximately 800 employees and a network of 60 doctors and midlevel care providers specializing in primary care/family medicine, pediatrics, internal medicine, obstetrics/gynecology, optometry and psychiatry. The nonprofit has been preparing for Tuesday for months. But is the general public prepared for the Patient Protection and Affordable Care Act? Not likely, according to CSHS.
Oct. 1 is the first day of open enrollment in the new health insurance exchanges (also called marketplaces) mandated in each state by the PPACA. On or after Oct. 1, and before Jan. 1, people with no health insurance are supposed to go to healthcare.gov, enroll in their state’s insurance marketplace and buy insurance. They also will find out if they qualify for a subsidy from the government.
People who think Obamacare is just for the poor and unemployed may have to think again. People who have insurance and are happy with it don’t have to do anything as long as it meets the minimum coverage requirements. However, those with insurance through their employment may find they can get a better deal at the insurance marketplace, said Tiffany Aldrich, director of communications at CSHS.
As of Jan. 1, people with no insurance, or coverage that does not meet the government’s minimum essential coverage, may have to pay a fee — actually a penalty — that increases every year. It starts out at 1 percent of income, or $95 per adult, whichever is higher, for 2014, and goes up each year.
“We have got to get the word out because there are an incredible number of misperceptions out there,” said Michael Reagan, chief external relations officer at CSHS. He said the misperceptions stem from all of the politically agitated opposition to the Affordable Care Act, and in the confusion, “some people think it was repealed.”
The confusion in Michigan is worse than other states because the Michigan Legislature would not approve a state-run health insurance marketplace, despite the urging of Gov. Rick Snyder. So the federal government set it up and is running it for Michigan, and in the process, the state lost millions of federal dollars that would have helped the state organize and run its own marketplace.
The Legislature finally did listen to Snyder and passed an extension of Medicaid to include the very-low or no-income residents of Michigan — but too late to take effect by Jan. 1. Technically, those people who will qualify for insurance under Medicaid will have to personally buy some from the marketplace before Jan. 1 to cover them until April when expanded Medicaid begins.
Under Obamacare, millions of Americans will be eligible to receive health insurance through low-cost or free programs. Others who will have to purchase insurance will be able to compare different plans from different companies at their state marketplace and buy the one that best meets their needs. Some purchasers will qualify for partial government subsidies, depending on their income.
The CSHS involvement is not to sign up patients for CSHS services, said Aldrich. Its role in Obamacare is only to help individuals enroll in the insurance marketplace, and it will not choose insurance for anyone. To prepare for Obamacare open enrollment, CSHS received two federal grants to hire staff for outreach and enrollment efforts, and CSHS has been designated by the government as the Lead Regional Navigator coordinating local efforts to get people enrolled in 13 West Michigan counties.
“We want to simplify the process for everyone and make it as easy as possible to sign up for health insurance,” said Tasha Thomas, chief of clinical operations. “We are here to help everyone — Cherry Street patients and non-patients as well.”
“Health Navigators are defined and funded under the Act to make sure people have help understanding their roles and responsibility under the new law,” said Paul W. Brand, executive vice president at Alliance for Health. “Most of us have a lot to learn about what it means for us. That’s where the assistance Cherry Street provides is really helpful. If you don’t have a health insurance agent or broker, you have another trusted advisor to turn to. Don’t be shy about seeking advice and assistance. This law is complex and confusing at first — so is Medicare when you first enroll in it and Social Security when you become eligible for benefits. … We manage to make those programs work. Few who have them would give them up.”
Aldrich said young, healthy people who skip buying insurance and plan to pay the penalty may regret it because the penalty gets higher each year. The first year it is only 1 percent of income, but by 2016, the no-insurance penalty is 2.5 percent of income or $695 per adult, whichever is higher. Penalties for uninsured children are half the adult rate.
It won’t be possible to evade the penalty, either; it is added to a person’s federal income tax bill. And according to CSHS, everyone will have to have proof of health insurance on their federal income tax returns every year.
Employers with 50 or more employees working full time — 30 hours or more a week — are required to offer health insurance to their employees or pay a penalty for each employee without insurance. Some businesses have announced that many or all of their employees are being cut to fewer than 30 hours a week, but they are required before Oct. 1 to advise their work force of any changes in company health insurance benefits.
Fourteen insurance carriers in Michigan are participating in the exchange or marketplace and will post their prices there as of Oct. 1: Alliance Health and Life Insurance, Blue Cross Blue Shield Michigan, Blue Care Network of Michigan, Consumers Mutual Insurance of Michigan, Health Alliance Plan, Humana Medical Plan of Michigan, McLaren Health Plan, Meridian Health Plan of Michigan, Molina Healthcare of Michigan, Priority Health and Priority Health Insurance (plans offered under two licenses), Total Health Care USA and UnitedHealthCare.