20 questions to help demystify (some of) Obamacare

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WHAT IS OBAMACARE AND WHY SHOULD I CARE? Obamacare, or technically, the Patient Protection Affordable Care Act, is actually a package of reforms passed in 2010 that were designed to control the escalating cost of health care and make sure formerly uninsured people — some 577,000 in Nevada alone — have access to affordable and adequate health care insurance.

WHAT IT DOES TO THE INSURANCE COMPANIES? Insurers are required to offer plans through a health-insurance exchange that is available to anyone without a company policy. Also, the law caps profits for health-insurance companies at 20 percent of proceeds, a policy that the insurance companies really, really don’t like but, according to the Health and Human Services Department, saved consumers almost $4 billion in added insurance costs last year.

WHAT DOES IT MEAN TO ME AND YOU? If you don’t have insurance, you will be required to get some, through the exchange, through a traditional policy or through your employer.

DIDN’T GOV. BRIAN SANDOVAL SUE TO BLOCK IMPLEMENTATION OF THE LAW? He did, and he and other Republican opponents lost the case before the U.S. Supreme Court. Sandoval then became one of only four Republican governors to enlist the state to run its own health-insurance exchange.

WHY DOES THAT MATTER? The state-based exchanges will be cheaper for consumers than the federally operated insurance exchanges, administrators believe.

HOW DID OTHER STATES DESIGN THEIR EXCHANGES? Seventeen states have state-based exchanges. Twenty-seven are relying on an exchange designed and operated by the federal government. Seven states are using a federal-state hybrid.

WHO IS REQUIRED TO HAVE HEALTH INSURANCE? By March 2014, just about everyone. There are a few very narrow exceptions for existing religious groups and others, but the overwhelming majority are supposed to buy insurance.

HOW MANY NEVADANS DON’T HAVE INSURANCE NOW? As noted above, about 577,000 Nevadans do not have health insurance. That number includes thousands of seniors and children who qualify for existing government-offered health-insurance plans like Medicare and Kids Count, but who are not now signed up.

HOW MANY DOES THE STATE ACTUALLY EXPECTS TO SIGN UP BY MARCH 31, 2014? About 118,000.

WHY WON’T MORE PEOPLE SIGN UP THROUGH TRADITIONAL INSURANCE OR NEVADA’S NEW HEALTH EXCHANGE? “There are some people out there who don’t want health insurance and won’t sign up for health insurance,” says C.J. Bawden, spokesman for Nevada HealthLink and the Silver State Health Insurance Exchange. “They would rather pay the penalty or they could get insurance through their employers.”

HOW BIG IS THE PENALTY FOR FAILURE TO SIGN UP FOR INSURANCE? The first-year penalty, to be enforced by 30,000 new employees of the IRS, would be $95 or 1 percent of a person’s income, whichever is more. That number rises to $325 in 2015 and $695 annually by 2016.

I CAN BARELY PAY MY BILLS NOW AND MY EMPLOYERS IS TOO CHEAP/SMALL/SKETCHY TO BUY HEALTH COVERAGE. HOW CAN I AFFORD HEALTH INSURANCE? The government will subsidize insurance for people who make up to 400 percent of the poverty line, about $46,000 annually for an individual, on a sliding scale. People at the bottom of the income ladder, making less than $18,000 annually, would pay no more than 2 percent of their annual income for insurance.

WHAT IF I DON’T PAY TAXES? Those who don’t earn enough annually to file income tax returns will not see any penalty.

WHAT IF I MAKE MORE THAN $46,000 ANNUALLY? Individuals who cannot find health insurance that costs less than 8 percent of their annual income are not required to purchase insurance, although the health-insurance exchange is expected to offer affordable plans.

WHAT IF I AM UNINSURED FOR A PERIOD OF TIME? One must be uninsured for a period of three month before the penalty would apply.

WHAT DEFINES A PLAN ON THE HEALTH INSURANCE EXCHANGE? Insurance plans on the exchange have to include reasonable costs and cover at least 60 percent of typical health-care costs for the year.

HOW DOES THIS HELP CONSUMERS? According to Michael Ginsburg, Southern Nevada director of the Progressive Leadership Alliance of Nevada (which is often a critic of the governor’s policies), the Sandoval administration has worked fairly diligently to provide consumers with a workable and affordable health exchange. “We didn’t get everything we wanted, but it’s pretty good. It’s a slightly better insurance product than what we’ve had. It’s better and cheaper in the exchange.”

WHEN CAN I SIGN UP FOR INSURANCE? The Silver State Health Insurance Exchange opens in October and people can make side-by-side comparisons of healthcare plans online. For more information, go to NevadaHealthLink.com.

WHAT IS HAPPENING TO INFORM PEOPLE OF THE NEW REQUIREMENTS? Organizations and individuals have been recruited to do outreach to various constituencies, including Hispanic communities from which people may be more familiar with fee-for-service health care. This summer, print and display ads will start appearing. In September, television advertising should start.

NEVADA AND ESPECIALLY SOUTHERN NEVADA HAVE A LOT OF HEALTH-CARE CHALLENGES — HOSPITALS CROWDED WITH UNINSURED PATIENTS, THE HOMELESS, TRANSIENTS, UNDOCUMENTED WORKERS AND VISITORS WHO DEMAND HEALTH SERVICES BUT DON’T PAY FOR THEM. WILL THIS SOLVE ALL OUR PROBLEMS? No, but it should help, Ginsburg says. There will be fewer uninsured. People who qualify for subsidized health care, but don’t know it, will find it a lot easier to get insurance. That doesn’t only apply to our citizens — it means visitors who need health care will also have insurance through their own state, and they will bring that coverage here.