Get Covered Kentucky
Understanding the Affordable Care Act
Welcome
Regan Hunt, MPA
Executive Director of Kentucky Voices for Health
Introduction
Daniel Glaser, MPH
Western Kentucky University
Introduction and Overview
• Part 1 – The Big Picture: Understanding the Affordable Care
Act (A.C.A.)
• Part 2 – Gaining Perspective: Kentucky and the A.C.A.
• Part 3 – The Nuts and Bolts: Getting Covered with Kynect
• Part 4 – Myths, Talking Points & Future Considerations
Introduction and Overview
• Live Q&A session immediately following presentation
• On Demand recording available at:
www.kyvoicesforhealth.org
• Questions may be sent to: kvhmedicaidexpansion@gmail.com
• Use the subject line: “Get Covered Kentucky Webinar”
Part 1 – The Big Picture: Understanding
the Affordable Care Act
Question #1:
On a scale of one to ten, how would you rate your overall level
of comfort explaining the Affordable Care Act to others?
1 = Not at all
10 = Extremely comfortable
Part 1 – The Big Picture: Understanding
the Affordable Care Act
• What is the Affordable Care Act (A.C.A.)?
• Signed March 23rd, 2010
• Goals: Increase affordability and rate of health insurance; reduce
healthcare costs
• Most important provisions go into effect over the next six months
• Affects insurers, business owners, families and individuals
Major Provisions of the Act
• Provisions that Improve the Quality of Coverage
• Beginning January 1st, 2014
1. Pre-existing Conditions
• Health insurers banned from discriminating on the basis of gender or
pre-existing medical conditions for all adults / children
2.
Essential Health Benefits
• Establishes 10 categories of essential health benefits which all health
insurance plans must cover
Essential Health Benefits
1.
2.
3.
4.
5.
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including
behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease
management
10. Pediatric services, including oral and vision care)
Major Provisions of the Act
• Provisions that Improve the Quality of Coverage
• January 1st, 2014
1. Pre-existing Conditions
• Health insurers banned from discriminating on the basis of gender or
pre-existing medical conditions for all adults / children
2.
Essential Health Benefits
• Establishes 10 categories of essential health benefits which all health
insurance plans must cover
3.
No Limits on Coverage
• Insurance companies prohibited from setting annual or lifetime limits
4.
Preventive Care
• Require insurers to provide eligible individuals with free preventive
care, no co-pay or deductible
Major Provisions of the Act
• Provisions that Improve the Rate of Coverage
1.
Medicaid Expansion
• Paid for by Federal Government to expand Medicaid eligibility
• States must opt-in
• Expanded coverage begins January 1st, 2014
2.
Health Benefit Exchange
• State-by-state basis
• Online marketplace for individuals and small businesses
• Open enrollment begins October 1st, 2013
3.
Federal Tax Credits
• Subsidies to purchase private insurance via the Exchange
• Amount of tax credit based on annual income
• Goes into effect January 1st, 2014
Major Provisions of the Act
• Provisions that Enforce the Bill
1.
Individual Mandate
• Affects any individual / family not covered by their Employer,
Medicare, or another private or public insurance program
• Must become insured or pay a penalty in 2014
• $95 or 1% of income, whichever is greater
2.
Employer Mandate
• Affects businesses with more than 50 full-time employees
• Must provide health insurance or pay a penalty in 2015
• $2,000 per uncovered employee
Part 2 – Gaining Perspective: Kentucky
and the A.C.A.
Question #2:
Approximately how many Kentuckians currently lack health
insurance?
a) 310,000
b) 460,000
c) 550,000
d) 640,000
The answer is d
There are an estimated 640,000 uninsured Kentuckians!
Current Health Outcomes in Kentucky
•
•
•
•
•
•
•
•
•
•
•
50th in smoking
40th in obesity
43rd in sedentary lifestyles
41st in diabetes
48th in poor mental health days
49th in poor physical health days
50th in cancer deaths
49th in cardiac heart disease
43rd in high cholesterol
48th in heart attacks
44th in annual dental visits
Kentucky’s Uninsured Population
640,000 uninsured Kentuckians = 17.5% of population under the age of 65
Analysis of Kentucky’s Uninsured
• 308,000 (48% of uninsured) qualify for Medicaid via the
Exchange
• 332,000 (52% of uninsured) must purchase private insurance
via the Exchange
Among the 332,000 purchasing private
insurance….
17%
Qualify for at least
some Tax Credit
83%
Do not Qualify for
Tax Credit
Who is eligible for Medicaid?
• U.S. citizens or lawfully present immigrants (After 5 years)
• Annual income < 138% of Federal Poverty Line (FPL)
2013 Federal Poverty Guidelines (Annual Income)
Household Size
138%
1
$15,856
2
$21,404
3
$26,951
4
$32,499
5
$38,047
6
$43,594
7
$49,142
8
$54,689
Source: www.medicaid.gov
Who is eligible for Federal Tax Credit?
• U.S. citizens and lawfully present immigrants
• Annual income falls between 138% and 400% of FPL
2013 Federal Poverty Guidelines (Annual Income)
Household Size
138%
1
$15,856
$45,960
2
$21,404
$62,040
3
$26,951
$78,120
4
$32,499
$94,200
5
$38,047
$110,280
6
$43,594
$126,360
7
$49,142
$142,440
8
$54,689
$158,520
Source: www.medicaid.gov
400%
What about those who do not qualify?
• 91.25% of uninsured Kentuckians qualify for Medicaid or at
least some tax credit
• The other 56,000 people must purchase private insurance or
get it from their employer by March 31st, 2014.
• They may do so using the Exchange
What about small business employers in
Kentucky?
• Small businesses are those with 50 or fewer FTEs
• No requirement under the A.C.A. for them to cover their
employees
• Tax incentive for very small businesses, those with 25 or fewer
FTEs
Tax subsidies for small business owners
• Tax credit amounts may vary based on employee size and average annual
wages
• To learn more, consult the interactive calculator for Small Business Tax
Credits at healthbenefitexchange.ky.gov.
Part 3 – The Nuts and Bolts: Getting
Covered with Kynect
Question #3:
Agree or Disagree: The biggest challenge facing implementation
of the A.C.A. is getting uninsured Americans to take the
necessary steps to obtain coverage.
a) Agree. I think this is the hardest part of implementation.
b) Disagree. I think there are greater challenges out there.
Thanks for answering!
You must take action if…
• You are an adult over the age of 18
-and• You do not have insurance through either your employer, a
government program, or a private plan
-or• You do have insurance, but your current insurance plan does
not meet the minimum requirements and is not
grandfathered in
Is my current plan grandfathered?
• Must have been in existence on March 23rd, 2010 and has
stayed the same since then
• Note, the status depends on when the plan was created, not
when you enrolled in it
• Check your plan’s materials: All plans must disclose if they are
grandfathered in all materials describing plan benefits
What are the key dates to know?
• October 1st, 2013: Open Enrollment on the Exchange begins
• January 1st, 2014: Health Coverage can start
• March 31st, 2014: Open Enrollment on the Exchange ends
How to get covered with Kynect:
• What is Kynect?
• Kentucky’s Exchange, similar to Travelocity for health insurance
• Online portal to shop for and compare private health insurance
plans and enroll in government programs like Medicaid
• When does Kynect go live?
• October 1st, 2013
• Where can I go to access Kynect?
• www.kynect.ky.gov
How does Kynect work?
Create an
Account
Submit your
Application
Pick a Plan
Enroll
• Step 1: Create a user name and password
• Step 2: Submit application for verification of personal
information through the national Data Service Hub
• Step 3: Shop on the digital marketplace
• Step 4: Enroll online
Medicaid, K-CHIP or Tax Credits on
the Exchange
Create an
Account
Submit your
Application
Pick a Plan
Enroll
Screen 2
• Screen 2 will be used to identify those who are eligible
for Medicaid, K-CHIP or tax credits
How to compare plans on Kynect?
• 4 categories of insurance plans on the Kynect Exchange:
•
•
•
•
Bronze
Silver
Gold
Platinum
• Bronze plans pay a lower premium, but higher out-of-pocket
medical costs for care
• Platinum plans pay the highest premium, but lowest out-ofpocket costs
Metal Category
• Reflects how much your premium costs each month and your
portion of out-of-pocket expenses
• Metal category does not affect amount of care provided: All
plans cover the same essential health benefits
• Kynect also offers “catastrophic” plans to people under 30
years old and to some with very low incomes
How to get assistance on the
Exchange:
• “Kynecters”
•
•
•
•
•
•
Trained in-person assisters
Facilitate enrollment
Offer unbiased advice
Help resolve grievances
Available online, by phone, or in-person
English and Spanish available
• Still being trained as we speak. Expected in mid-August…
• Visit kynect.ky.gov for more information
• Call 1-855-4Kynect (1-855-459-6328)
What happens after open enrollment
ends?
• Open enrollment lasts until March 31st, 2014
• After that date you cannot use the Exchange unless you qualify
for Special Enrollment
• Must wait until October of 2014 when enrollment opens again
unless you qualify for special enrollment
How to qualify for a Special Enrollment
period?
• Special enrollment lasts for 60 days after any of the following:
• You gain or become a dependent
• You gain lawful presence as an immigrant
• An enrollment error based on the Exchange is made
• There is a one day special enrollment period every month for
members of federally recognized Indian Tribes
Kynect for small business owners
• Small businesses with 50 or fewer FTEs may also use the
Kynect Exchange
• Small-business Health Options Program, or S.H.O.P.
• Offers private, employer-based plans at the Bronze, Silver, Gold,
and Platinum level
• Helps qualified businesses calculate their tax credit
• No end to the open enrollment period
• No unexpected costs
• Owners decide their level of contribution to the plan up front and
employees pay the difference
Part 4 – Myths, Talking Points & Future
Considerations
Question #4:
In my opinion, the biggest concern most Kentuckians have with
the A.C.A. is…
a) Its overall cost to the state government
b) Its cost to individuals / families
c) Its overall effect on the quality of healthcare in Kentucky
d) Its effect on the number of healthcare options available
e) Other
Myths about the A.C.A.
Myth #1: “The Bill has not withstood its legal challenges / has
been struck down”
• Response: The A.C.A. is the law of the land and the governor
has the authority to implement the changes described in the
bill
Myth #2: “The government is going to make me drop / change
my existing coverage”
• Response: Most of the 83% of Americans who already have
health insurance can and will choose to keep it; Some plans
may be phased out because they fail to meet the minimum
coverage requirements
Myths about the A.C.A.
Myth #3: “Expanding Medicaid will bankrupt Kentucky”
• Response: The federal government pays the majority of the
cost for expansion; A.C.A. is predicted to generate $802
million in savings and 17,000 new jobs for Kentucky
Myth #4: “This Exchange is not private insurance, but ‘Medicaid
for the middle class’”
• Response: Non-Medicaid recipients using the Exchange will be
shopping for private plans offered by private insurers that are
competing for their business
Myths about the A.C.A.
Myth #5: “The government is going to use my private
information against me”
• Response: The Exchange comes with built in protections to
keep information private; rights still protected by HIPAA
Myth #6: Exchange will offer only “Limited coverage options”
• Response: There are currently projected to be at least 20 preapproved options on the Kynect Exchange; full list must be
made public by September 1st, 2013
Myths about the A.C.A.
Myth #7: “This will lead to high-cost / unaffordable premiums”
• Response: Data from other states, like Maryland, contradicts
this; Upper-limit on premiums keeps them under 9.5%
monthly income
Myth #8: “ I have employer-based insurance, so I don’t benefit
from the A.C.A.”
• Response: Still benefit from coverage of essential health
benefits, free preventive care, ban on annual / lifetime limits,
new consumer protections, and much more.
Future Concerns about the A.C.A.
in Kentucky
1. Unpopularity / Lack of understanding
• Uninsured Kentuckians are more likely to have heard about the
negative aspects of the bill than the positive
2. Shortage of health care providers
• Particularly in rural areas with the highest percentage of
uninsured who are eligible for Medicaid
3. Shortage of qualified mental health providers
• 1,683 FTE needed to meet the current need
Discussing the A.C.A. in a culturally
appropriate manner
Naming
Framing
Focusing
Reassuring
Including
• Naming: always use official terms when referring to the bill
• refrain from nicknames with potentially negative connotations
• Framing: frame the discussion through the bill’s positive
benefits for the state of Kentucky
• more funding, coverage, jobs and healthy people
• Focusing: focus discussion on implementation at the local level
• keep discussion away from government and focused on people
Discussing the A.C.A. in a culturally
appropriate manner
• Reassuring: remember that privacy is a concern
• reassure your audience that confidentiality is a priority
• Including: seek out opportunities to include minorities and
English as a second language populations
• remember Kynect is available in English, Spanish and offers a
language line
Naming
Framing
Focusing
Reassuring
Including
Further reading:
•
•
•
•
•
healthcare.gov
kynect.ky.gov
kyvoicesforhealth.org
familiesusa.org
Kaiser Family Foundation Calculator
Q & A Period
• Live Questions are being answered by:
• Erin Hoben, Medicaid Outreach Coordinator, Kentucky Voices for
Health
• On Demand recording of this webinar available at:
• kyvoicesforhealth.org
• Additional questions may be sent to:
kvhmedicaidexpansion@gmail.com
• Use the subject line: “Get Covered Kentucky Webinar”
Thank you for your participation!
On Demand recording of this webinar available at:
kyvoicesforhealth.org
Questions may be sent to:
kvhmedicaidexpansion@gmail.com