By Maura Carley
I am a small business owner in Fairfield County and Access Health CT Board Member. I was delighted to be asked to write a piece on Obamacare. I am writing as a public health professional and not in my capacity as a board member for Access Health CT. My 35-year health care career is varied. I have a master”™s degree in public health from Yale University, worked as a hospital administrator, then as an insurance executive and later founded Health care Navigation, a health insurance consulting and advocacy firm. We do not sell insurance products. I was recently appointed to the Access Health CT Board, Connecticut”™s Insurance Marketplace under Obamacare. I was nominated and appointed by Republicans even though I am a Democrat. It is an honor to serve. The board and staff are talented, impressive and committed.
I also published a book in 2012, “Health Insurance: Navigating Traps and Gaps,” so my opinions about Obamacare, both positive and negative, are well documented.
We should be cheering the fact that on Oct. 1, individual health insurance policies will begin to be issued for Jan. 1without regard to pre-existing conditions. This is true reform. Today, in 45 of our 50 states, including Connecticut, you can”™t just buy individual insurance. Insurance companies can deny your application even for relatively minor health issues. We have dealt with people who were denied coverage because they were in the midst of a divorce and taking a drug for depression, receiving physical therapy for an injury from which total recovery is expected, were modestly overweight with well-controlled arthritis, or seeing a therapist. Last year a healthy client was denied insurance because she had an eye aneurysm which had been repaired by a laser procedure, but the insurer felt the procedure was too recent.
Connecticut established the Connecticut Health Reinsurance Association (HRA) in 1975, to provide insurance to individuals denied insurance. But HRA premiums are over $2,200/month for a 60-year-old male and over $1,000 per month for females under 30. Few can afford them.
Because most Americans have group coverage through an employer, we tend to be ignorant about individual insurance. This is ironic since many events beyond our control can foist us off that group coverage. We can be laid off, our children turn 26, a spouse can die, retire or divorce us. Obamacare will help many people losing coverage through no fault of their own.
Obamacare requires individuals to have insurance in 2014 or pay a penalty. The penalties are initially low starting at $95 a year for an individual. A concern is that young, healthy people will pay the penalty rather than buy coverage. That is a concern because if only sick people buy insurance, premiums could one day be high like the HRA. But in addition to giving each state the option of expanding Medicaid, Obamacare includes tax credits for lower-income individuals to obtain coverage as long as it is purchased through the state”™s marketplace, Access Health CT.
Both supporters and detractors of Obamacare have made ridiculous claims about how it will play out. Plainly we can”™t know until it has been operational for several years and given a chance to succeed. Expanding benefits has typically led to higher medical costs resulting in higher premiums and hence more uninsured. This was a major concern when the act was passed, but quite remarkably, health care inflation has dropped to historically low levels since 2011. No one knows why, but it is an enormously welcome trend.
Obamacare requires businesses employing 50 or more full-time equivalent employees to offer coverage, although penalties have been delayed for a year. This requirement negatively affects many employers, particularly those industries employing lower-wage workers. Affording health care coverage is a vexing problem for most businesses. As a small employer, Health care Navigation is exempt from Obamacare”™s requirements, but employees have always been covered. Yet I”™ll never forget our first employee. After COBRA ended, her husband would not qualify for individual coverage, which he needed. We obtained group coverage, but even seven years ago the annual premiums for them were almost $20,000.
Health care affordability is a national problem we have to address for the sake of our economy and future. We risk failure if businesses convert full-time jobs to part-time jobs to avoid providing coverage.
Obamacare will likely remain controversial because it is complex and raises taxes to fund entitlement benefits. Nevertheless, it is difficult to understand the extreme, irrational negativity expressed by some. Covering more Americans in a fairer manner is a good thing.
There are approximately 340,000 people in Connecticut who are uninsured. That is roughly 10 percent of our population as compared to 16 percent nationally, but 340,000 uninsured people should be unacceptable. History has shown that it won”™t be easy to cover more Americans while improving coverage affordability, but not trying shouldn”™t be a choice.
We have a tremendous opportunity to be a model for the nation in Connecticut. Connecticut has built an Insurance Marketplace that will open in October to individuals and small businesses for Jan. 1enrollment. There will be problems and glitches, but give it a chance. Later this fall, I”™ll be shopping for small group insurance through the marketplace at accesshealthct.com. Please go to the site and check it out yourself.
Maura Carley can be reached at mcarley@healthcarenavigation.com.
