October: Health Exchange bewitching hour


Our congress at work. Daily Mail UK

Our congress at work. Daily Mail UK

Leaves are falling as well as the mystery surrounding Affordable Care Act, aka Obamacare. Enrollment starts next week and do you know what to do?  I sure don’t.

Now if you live in one of the 20 some states with some forward thinkers, you will have a greater say in how this works in your life and workplace like Vermont and California.  If you are like me and live in a state with many ostrich-head-in-the sand-politicians afraid of embracing what voters clearly have supported, then you are wondering what happens when this 500 pound gorilla is unleashed on the American uninsured public on October 1, 2013.

The Easy Part – The Employer Mandate – If you are an employer with more than 50 employees, you don’t have to do much except clock your employees work hours for the year.  The congress kicked the can down the road for you to start paying anything.

Unbeknownst to most, I am a member of the League of Women Voters. So I like to mess around in political policy.  Also, I am a registered dietitian who gets paid out of pocket and through some insurances, so I am very interested on how the government regulates my income.

This is a primer on what you, average schmo-nose walking down the street, needs to know before this thing takes off, how and what info you need to take advantage.  Watch this short animated video to get the basics on where we are today.

The story thus far- A whole lot of nothing.  When you look up the 2 websites quoted the most, Healthcare.gov and Enroll America, you will find them asking a few questions about number of family members, whether you can get insurance from a family member and how much money you make.  As of yesterday there is a little more info on the 3 levels of care.  However, there is nothing about what will be offered on the exchanges.

What is a HeathExchange ? Okay, if you do not get insurance at work you can buy heath insurance from the government’s health exchange or plans set up in your state.  This is a place where you can look at various insurance policies, see what they cover and cost.

Where to go for info

Where to go for info

Below is what they need to cover, the bare bones, to be included in the insurance plan: [From Healthcare.gov]

The essential health benefits include at least the following items and services:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (such as surgery)
  • Maternity and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services

Sounds great.  I clicked on preventative services thinking I would learn about my role as a nutrition expert in this massive undertaking.  Then, I would explain it to you.  But when you click through for more information all you get is a list of foods the government thinks you should eat.  Oy!

A friend of mine is losing her insurance in November.  She went to find out online what she would be looking at.  She found nothing useful.  When she contacted one of the 2-3 insurance vendors in our part of the world, she thought there would be, as stated in the video, a chart of plans with their coverages and costs.  I don’t know how many pages of policies she showed me, but it was almost a half an inch in depth.  She would have to create her own chart to compare what the plans include.

Today is September 26.  In just over a week millions of Americans will be looking to enroll for health insurance coverage that will begin on January 1, 2014.  So how will they be able to do this?  The government will point you to a navigator.  A navigator is an association or group who applied for grant monies to help people find the best plan.  They usually are a group that has already done work like this in the past assisting the public for medicaid enrollment, so this is not their first rodeo.  On the other hand, they are still being trained.  Ever been trained on a job?  What happened to you first few clients or customers?  Please be patient.  These folks have families and will have to make decisions on stuff they weren’t trained on.  So, please put yourself in their shoes.

Here is a list of navigators throughout the US.  I contacted the ones in my state.  Glad I didn’t hold my breath waiting for the callback.  I wouldn’t be typing.

Since I am self-employed, it is very important to know how this will work.  it

My lack-of-leadership governor, Tom Corbitt. Raging Chicken Press

My lack-of-leadership governor, Tom Corbitt. Raging Chicken Press

appears that since I have no employees I can use the health exchanges.  However, because I am in Pennsylvania, my governor has decided to add some restrictions to our plan.  So, my state is in total flux because it appears what he is asking is illegal.  Gotta luv it!

I want to get this out, so I will have more either tomorrow or Monday.  Please write with any questions and I’ll try and answer them.


Any thoughts, Darling?

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