As the clock ticks toward the birth of Obamacare’s online insurance exchanges next week, Blue Cross and Blue Shield of Kansas City has revealed some details about its participation on the federal Health Insurance Marketplace that will serve area residents.
Coventry, now owned by Aetna, followed with similar confirmation Thursday that it will offer plans on the HealthCare.gov marketplaces for Kansans and Missourians. Area consumers will find 11 policy choices from Blue KC and five or eight choices from Coventry, depending on the state, the insurers said.
But it still won’t be until Tuesday, the Oct. 1 kickoff date for the individual insurance marketplaces under the Affordable Care Act, that exact policies and costs will be published.
While the two insurers did move Missouri and Kansas consumers a step closer to knowing what to expect when Obamacare goes live, here and around the country questions about the act continued to outnumber answers.
And the nation remained starkly divided in opinions about whether the massive health insurance overhaul will succeed.
President Barack Obama gave a fiery stump-style speech Thursday in defense of his signature policy achievement. Slamming “cynical ad campaigns,” the president said, “...The fact is the Republicans’ biggest fear at this point is not that the Affordable Care Act is going to fail. What they’re worried about is it’s going to succeed.”
Supporters said Obamacare implementation can forge ahead even if a congressional budget impasse produces a government shutdown.
Senate Republic minority leader Mitch McConnell argued, “The law is a mess. It needs to go.”
Even the most ardent health reform backers — who are assisting the implementation in their states — acknowledged in a conference call with reporters that technical problems will be encountered. They said the biggest challenge, however, is countering misinformation and distributing facts.
Michelle Miller, public policy liaison for the Missouri Foundation for Health, said the private philanthropy is distributing factual information, supporting a CoverMissouri.org informational website, and funding counselors who can help explain enrollment on the federal marketplace.
“It’s a difficult state to work in, but we’re in high gear with eager partners,” Miller said of Missouri, where the state legislature has opposed the Affordable Care Act at every opportunity.
Missouri legislators barred state officials from providing assistance or resources to the federal marketplace in the state. They also imposed more rules than the federal government requires on the selection and certification of “navigators,” the people empowered to help consumers understand and enroll on the marketplaces.
Separately, The Washington Post reported Thursday that the federal marketplace’s enrollment option for small-business owners — a different set of plans from those offered individual consumers — will not be fully operational until Nov. 1, a month after the individual policy side is due to open.
An official at the U.S. Department of Health and Human services said that for the first month, small-business owners need to mail or fax their information to government officials to enroll on the voluntary Small Business Health Options Program marketplace.
No employers are required to offer health coverage next year, but starting in 2014, businesses with 50 or fewer full-time equivalent employees, as well as nonprofits, can use SHOP to offer coverage to their employees through the federal marketplace. Small-business plans may enroll at any time during the coming year, unlike individuals, who have until March 31 to obtain mandated 2014 coverage.
Still, the delay for small-business plans prompted a spokesman for the National Federal of Independent Business, which has opposed Obamacare, to call for a delay in the individual mandate, too. The NFIB’s manager of legislative affairs, Kevin Kuhlman, said the law is “clearly not ready for prime-time.”Implementing the exchanges
Missouri and Kansas are among states where the federal insurance marketplace will be in effect. About a third of the states and the District of Columbia have opted to run their own marketplaces, also known as exchanges, and are at varying degrees of implementation.
D.C. officials said this week that it will delay opening its exchange because of computer glitches in figuring out which enrollees are eligible for Medicaid or for government tax subsidies to lower premium costs.
On the federal exchange, beginning Tuesday, Kansas City area consumers can expect to see Blue KC offering 11 policies with coverage options ranked as “gold,” “silver,” or “bronze,” according to the health insurance law.
The law also provides for a “platinum” plan that would cost the most and provide the richest benefits, but Blue KC didn’t indicate a platinum policy among their marketplace options.
For the five-county Kansas City area — Jackson, Clay and Platte counties in Missouri and Johnson and Wyandotte counties in Kansas — five of the plan options will be sold under a “Blue Select” label. Six other coverage options, sold under the “Preferred-Care Blue” label, will be available in the insurer’s 32-county market area.
Blue Cross and Blue Shield of Missouri covers parts of the state not covered by Blue KC.
Blue KC officials emphasized that its health insurance policies will continue to be available for purchase directly as well as on the federal exchange.
On the marketplace available in Kansas, consumers also will have access to policies offered by Blue KC, by Blue Cross and Blue Shield of Kansas, by Coventry Health Care of Kansas, and by Coventry Life Health, according to state officials.
Coventry policies offered on the federal exchange in Kansas will include two bronze plans, two silver plans and one gold level plan, an Aetna spokeswoman said.
Coventry’s offerings on the federal exchange in Missouri will include four bronze plans, two silver plans and two gold plans, she said.Tax credits a key
Federal tax credits offered under Obamacare are likely to be the deciding factor as to whether individuals or families find preferable or affordable health insurance policies on the online marketplaces. The tax subsidies are available only for policies purchased on the marketplaces.
For example, a 2014 plan providing mid-range coverage for a family of four in Kansas is expected to cost an average of $619 a month, but only $282 a month after subsidy, assuming a $50,000-a-year household income, the federal government estimated this week.
That average came from an HHS preview of plans expected to be offered to Kansans on the federal marketplace.
For a similar family of four on the Missouri side, the federal government estimated a pre-subsidy average monthly premium of $798, or $282 after subsidy.
The federal tax subsidy phases out as income rises and ends when an individual or family income exceeds 400 percent of a given year’s federal poverty level. This year’s federal poverty level for a four-person household is $23,550, so subsidy eligibility would end at an income of $94,200 for that size household.
Regulators said premiums will vary from state to state based on geographic location, insurance participants, health care providers’ costs, and individual factors such as income, age, and policy type.
Families USA, a health care advocacy nonprofit, estimates that more than half a million Missourians and a quarter million Kansans will be eligible for the federal tax credits that could help them afford insurance purchased for 2014 on the Obamacare marketplaces.
To avoid a tax penality imposed by the Affordable Care Act, individuals must have health insurance for 2014 — through an employment-based plan, through the government (such as Medicare or Medicaid), through independent purchase, or through the online insurance marketplaces.