Affordable Care Act as a Soap Opera

Affordable Care Act as a Soap Opera

-By Phil Castell

So much has happened in the past week with the Affordable Care Act (ACA), I feel like I am watching a soap opera unfold with dramatic twists and cliff hangers at every turn.

So where did we leave off last week… Oh yes, the Health Exchange Benefit Board had just decided to postpone the certification of plans for sale within the Exchange.

Let’s fast forward to the next Board meeting that was August 29th.  Once again the Exchange passed a motion to postpone the certification of the plans until a scheduled meeting today, September 4th.

The Exchange has also received an approval from the Federal Department of Health and Human Services for an extension of the plan filing deadline to file approved plans from August 31st to September 5th.

The next day, August 30th, the Washington State Office of the Insurance Commissioner (OIC) announced the approval of an additional ten plans offered by two insurance companies into the Exchange.  Seven of the ten plans were offered by Kaiser Permanente in Clark and Cowlitz Counties (down by Longview and Vancouver WA) and three by Community Health Plan of WA (CHPW).  The plan details of these newly approved plans are not currently available on the OIC web-site, but I can let you know that the CHPW plan submitted did not seek to provide any coverage for Clallam or Jefferson County residents and I would be highly surprised if the OIC added additional counties to their original submission.

So, that means nothing has changed for residents of the peninsula.  The only plans we will have available within the Exchange will be the identical plans offered by Premera Blue Cross/Lifewise.

In the OIC press release of August 30th it was also stated that Molina Healthcare had filed an appeal of its non-approval determination, so stay tuned for what could be a last minute frantic rush to gain approval of the OIC prior to Wednesday’s certification by the Exchange Board.

In addition the OIC has yet to approve a single plan for the individual non-exchange marketplace. Does anyone else hear a ticking noise that is getting louder by the second? Agents have scheduled training sessions with all the insurance companies within the next ten days or so, and it might be nice to be trained on what we can actually offer consumers.

We have all heard about the penalties for those who did not enroll.   Here is a listing of those folks who would be exempt from the penalty if they do not enroll, or otherwise have creditable coverage:

  • People with religious objections
  • Undocumented immigrants
  • Those incarcerated
  • American Indians and Alaska Natives
  • People or families with income below the tax filing threshold
  • Those whom the lowest cost Bronze Tier plans premiums would exceed 9.5% of income.

I would point out the specifics of the last group, those individuals or families for whom the lowest priced plan premiums would exceed 9.5% of their income. I think this could be a rather large group of people who are exempt from the mandate to purchase and the penalty.  So what are their options?

The ACA provided them the option to purchase a catastrophic plan, which is also available to people under the age of 30. That is if the OIC had approved any of the catastrophic plans from Premera/Lifewise. The only catastrophic plan approved by the OIC was for a Group Health plan not available in Clallam County.

The choices for those people is either do without any insurance whatsoever, or purchase a plan whose premium exceeds the 9.5% of their income threshold which the ACA deems as affordable. Not good choices either way.

I have a whole lot more to tell you, but in true soap opera manner… be sure to tune in next week for the exciting updates!

Posted on: September 3rd, 2013 at 5:50pm by jcastell. Filed under: Health Insurance
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