The Affordable Care Act is more than 2,000 pages long, but at least one thing about the new law is clear—a lot of people don’t understand its impacts.
"The laws and rules are so specific to the individual, so it’s very hard to make a broad judgment," David Yoder, co-founder of American Exchange, said. "What we find is that someone has read an article or they’ve read something that’s applied in a broad sense, but it doesn’t necessarily mean anything for them."
American Exchange is a new local company whose leaders are helping residents nationwide connect with health insurance through marketplaces that will be open in October.
—A single 25-year-old male who makes $25,000 a year and who is not covered by an employer could get insurance for $80 to $90 a month after subsidies.
—A 24-year-old who makes $17,000 a year could get coverage for $12 a month.
Source: American Exchange leaders
President Barack Obama's Affordable Care Act will provide health care coverage to 30 million people.
Last summer, the Supreme Court ruled that the core of the health care reform act was constitutional.
Some of the act's requirements have already been implemented, and others will continue to be rolled out in coming years.
Under the act, marketplaces are being created, which will allow individuals and small business owners to shop for insurance coverage via Internet-based exchanges.
Enrollment for the exchanges starts Oct. 1, and coverage will be effective in January 2014.
People who don't already have insurance have to buy it through the exchange or pay a "shared responsibility payment" to the federal government, according to the Supreme Court ruling.
The subsidy varies by person, based on income and household size.
For the first year, the penalty for an individual who doesn’t sign up for insurance is $95 a year or 1 percent of a person's income, whichever is greater, and $47.50 for children, according to Nooga.com archives.
Leaders with American Exchange, BlueCross BlueShield of Tennessee and ExHale Healthcare Advocates—which uses industry experts to help individuals get the most out of insurance plans—agreed that the general public needs more education about the Affordable Care Act.
Members of the younger generation are often called "the invincibles" in the industry because they think they don't need health insurance. But no matter how healthy a person is, that is inaccurate.
Part of the way the act is meant to work involves young, healthy people who are needed for offsetting the cost of caring for older, sicker Americans, according to PBS NewsHour.
"That’s the struggle with this bill—can we get everybody in?" Bobby Huffaker, American Exchange co-founder, said.
Forbes.com contributor Chris Conover recently made the case that the act is not a good deal for young adults.
But according to the Center for American Progress, the majority of young adults won’t see insurance premium increases under the law.
Leaders with American Exchange, BCBST and ExHale made the case that young people who don’t currently have insurance should get it through the Affordable Care Act.
"The only way rates would be greater is for a 25-year-old male that has less benefits than what is mandated by the Affordable Care Act," Yoder said.
For example, if a young person has a plan that only covers major medical expenses but not prescription costs or doctor visits, it’s not considered a qualified health plan under the new law, he said.
The average customer doesn’t have that kind of plan, he also said.
Industry leaders said that young people don’t understand how inexpensive coverage through the Affordable Care Act will be.
They don’t understand that they may qualify for federal subsidies, which means the government will give some people money to put toward the cost of health insurance.
It depends on each person’s specific situation, but generally, rates for individual coverage under the act are going to be less expensive than what is currently available.
Leaders with American Exchange and ExHale Healthcare Advocates said they aim to provide objective, unbiased information to consumers.
Yoder and Huffaker said there’s not much reason for a young person not to get coverage.
"I don’t see any reason why someone would not want to do it unless they’re trying to make some political stance," Yoder said.
After tax credits and discounts, most young people can get coverage for between $50 and $100, although each person’s situation—depending on income, number of children and whether the person’s employer offers affordable care, among other factors—impact every person’s payment.
"No one has that crystal ball," ExHale founder and CEO Sarah O’Leary said. "If life was lived by statistics, the world would be a different place. [Young people] are thinking they are not going to get sick. They are [likely] not going to get cancer, but they might fall drunk in a bar and hit their head."
Or they could get hit by a car. They could get injured doing sports or anything active, she also said.
And there’s a more broad, philosophical issue that underlies the idea of universal health care, she said.
O’Leary doesn’t have children. And she could ask, "Why do I have to pay for your children’s education?" she said.
But education and health care are integral parts of the United States’ founding principles—life, liberty and the pursuit of happiness.
"Nothing is more important to life than health," she said. "It’s more a part of our Founding Fathers’ ideals than roads, ... than education."
About American Exchange
The company’s brokers will help customers navigate the marketplaces, which were formerly called exchanges.
American Exchange leaders are building contracts with more than 130 insurance providers in 48 states.
The company has contracts with the state’s five major health care providers: BCBST, Community Health Systems, Coventry, Aetna and Humana.
"We are not direct to customer," Yoder said. "Typically, the consumer is pushed to us in some aspect."
For example, the company has partnerships with providers and with Liberty Tax.
A health care provider may send American Exchange leaders a patient, or Liberty Tax officials might recognize that the customer is a good fit for the Affordable Care act because of their income or family size.
American Exchange gets a commission from the insurance carrier. The services are free to the consumer.
The commissions vary by insurance company and the type of plan sold. Some states put limits on the commission amount, Yoder said.
"We decided to be unconventional and have our sales team and call center reps be salaried and hourly employees," he said. "They are not aware of the amount or type of compensation paid by insurance companies. This has been instrumental in establishing trust with many of our retail partners and nonprofit partners."
On Sept. 3, the American Exchange team will be about 11 strong. And they are looking to hire.
Founders have plans to increase the number of their employees by an average of 10 a week through January.
They will be looking for licensed agents to work in the call center.
"We are going to help people either online, over the phone or in person enroll in these new exchanges," Huffaker said.
Industry leaders: Get educated, get help
Leaders that Nooga.com talked to agreed that the public should get educated and get help.
"Friends don’t let friends navigate health care alone," O’Leary said. "Don’t do it by yourself."
Politics, special interest groups, conflicting information and details that vary by individual situation can make figuring out health care scary, she also said.
Her company—which she started after being inspired to help consumers—provides one-on-one professional help to people nationwide.
And education is empowering, she said.
"When we are in a fear state, we are compromised; we are weakened," she said.
She said she has no allegiance to health care providers and that her goal is to help people save money and not be taken advantage of.
Walgreens and the Blue Cross and Blue Shield Association have joined forces to educate consumers nationwide about the federal Affordable Care Act, according to archives.
The Blue Cross and Blue Shield Association is a national federation of 38 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for nearly 100 million members.
The campaign centers on a new website, LearnAboutReform.com, which offers consumers information about the ways they will be able to purchase health insurance and the new benefits available to them.
Informational brochures will also be offered to consumers at nearly all Walgreens drugstores across the country, according to a news release.
Last week, BCBST leaders revealed research that showed that people between the ages of 26 and 35 have a lot of questions about insurance in general and about new benefits and financial assistance for shopping on the marketplace.
The local leaders launched a website—BCBST.com/KnowNow—to help residents sort out the facts.
"Our research showed that all ages and demographics valued health insurance and want to have it, but many have the perception they can’t afford it," said Carla Raynor, vice president of strategic marketing for BCBST. "But millennials in particular wanted an online resource for education that they could access at their convenience. We feel this website will help them prepare to make important coverage decisions in October, when they can make their selections."
Surveys and small group discussions demonstrated that even with simplified language, there remained a lot of questions about how the marketplace would work and who was eligible. Participants said they wanted more resources, especially online.
Five key areas that needed more understanding were identified by those who participated in the research: cost, coverage and quality, marketplace information, tax credits, and eligibility.
The new website aims to educate consumers on those topics.
—O’Leary said that every person needs to think about the act and its impacts from the perspective of "me, myself and I."
And she said that when doing research, consumers should consider the source and what their motivation is.
—How navigating the exchanges work: Consumers can go to a website to find a side-by-side comparison of options. They have to calculate estimated gross household income based on what they estimate for the upcoming year's taxable income. Then, the consumer can enter that online or give that information to a broker to calculate subsidy and payment options.
—Low- to moderate-income families with children have the most to benefit from these laws, Yoder said.
—There are about 30 different funding mechanisms the federal government is using to pay for the Affordable Care Act, such as a tax on tanning beds and the penalties for those who don't opt out, Yoder said.
—Rates vary by region in Tennessee, mostly because of the number and type of doctors available in certain areas. The cost of creating networks and administering benefits varies, Yoder said.
—Regional variation in rates is mostly because the number and type of doctors available in some regions vary dramatically, so the cost of creating networks and administering benefits can vary greatly.
—Many provisions of the law have already been instated. For example, young people can stay on their parents' insurance until they are 26 years old, and people age 19 or younger can't be denied for pre-existing conditions.
Updated @ 9:25 a.m. on 8/26/13 to correct a hyperlink.
Updated @ 10:07 a.m. on 8/26/13 to correct a typographical error.
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