Health reform law is debated and explained on KET

By Molly Burchett
Kentucky Health News

Two Kentucky Educational Television programs addressed the federal health-reform law Monday night, providing opportunities for Kentuckians to debate the Patient Protection and Affordable Care Act and ask questions about how "Obamacare" would affect them.

First, "Kentucky Tonight" host Bill Goodman sat down with a bipartsan panel to discuss the law, which went into effect Oct. 1 with the roll-out of Kynect, the state's online insurance marketplace. Then Renee Shaw hosted state officials who answered questions from callers.

The panelists were Dr. Peter Thurman, medical director of Family Health Centers in Louisville; Democratic state Rep. Mary Lou Marzian of Louisville, who was a nurse for 35 years ; Rep. Robert Benvenuti, ranking Republican on the House Health and Welfare Committee, and Dr. Ralph Alvarado, a Winchester internist and pediatrician who has run for the General Assembly three times and is planning a fourth race for the legislature.

Goodman began by asking the panelists to rank Obamacare's roll-out as an overwhelming success, an abysmal failure or somewhere in between.

Thurman, an Obamacare supporter, gave it a C even though Kynect has had many fewer problems than the federal system. He said Obamacare may not solve the huge issue of health care costs, but will those who can't afford health care access to it.

Alvarado called the roll-out a disaster, noted that not all physicians are accepting Kynect plans, and said people at the Kynect call center are getting minute-by-minute changes about the plans.

"That's not accurate," Marzian said. "You've talked to two people who had problems." She said the rollout has been a success and Kentuckians are hungry for insurance coverage, which is access to health care, and such access should be a right for all Kentuckians. "I would have been happy if we put everyone in the country on Medicare," she said.

Benvenuti said the premise of Obamacare is a failure. He said that it took $252 million of federal seed money to start Kynect, which has a $39 million annual operating budget, and that if the state could have taken the money in a block grant and used it in ways that work best for the state, a much more sustainable system could have been created.

Benvenuiti said many Kentuckians won't be able to afford the large deductibles in the Kynect plans, so the state and country are creating a dependency that can't be afforded. "Over $3 trillion will be spent over 10 years and over 35 million Americans will still be uninsured," he said.

Thurman said there has been a trend toward high deductible plans for years to shift costs to employees. Marzian said that while some deductibles are high, insurance coverage prevents you from going bankrupt if you have a serious accident, and she said the law's free preventive care will ultimately save money.

"Nothing is free," Benvenuti replied. Alvarado said about 83 percent of private physicians oppose the law, and there won't be enough doctors to provide preventive care. He said the law will not fulfill its two main goals, to reduce costs and to provide coverage to all Americans.

Alvarado objected to Obamacare's requirement to buy insurance, but Marzian said the mandate is necessary for the law to be successful. So far, she said, it has been a success. The Kynect site has has 175,000 visitors, more than 22,000 people have started insurance applications, and almost 15,000 applications have been completed.

Jean Prowse, a caller from Muhlenberg County, complained about all the political rhetoric and asked where she could get reliable, non-partisan information. Marzian directed her to the Kynect website, where Kentuckians can learn if they are eligible for Medicaid or government subsidies to help buy insurance.

Questions about Obamacare enrollment

The second show must have been more to Prowse's liking. It featured Cabinet for Health and Family Services Secretary Audrey Haynes, Kentucky Health Benefits Exchange Executive Director Carrie Banahan and Medicaid Commissioner Lawrence Kissner, who answered questions from Kentuckians about buying insurance through Kynect -- after a little bragging.

Haynes and Banahan said Kentucky's implementation of the law has exceeded expectations. In addition to the over 22,000 Kentuckians who have started applications on Kynect, more than 209,000 small businesses have started applications, Haynes said, adding, "In Kentucky, when we're trying to reach over 640,000 uninsureds, this is success."

The questions and answers on the second show were practical, not political, touching on many basic facts and a few unknown details of the law.

Regarding income limits for subsidies through Kynect, Haynes said it is important for people to call or to go online because this process is very individual. "That's why we didn't publish an individual insurance rate," she said, because there is no average.

All plans will offer the 10 essential health benefits required by the law, said Banahan.  There are four tiers of plans, with the bronze plans offering the lowest premiums and highest deductibles, and the platinum plans offering the highest premiums and lower deductibles. A catastrophic-only plan is avaialble to people under 30.

One Kentuckian with a $14,000 annual income called to ask about Medicaid eligibility, and Kissner said she would be eligible.

On the website, there is a calculator where you can enter preliminary information to determine eligibility. You can anonymously browse the website to view the "sticker price" of the plans based on this information before you register and apply, said Banahan.

If you already receive coverage from your employer or from a state program, you are only eligible for subsidies if the employer's premium that you have to pay for single coverage is more than 9.5 percent of your family income.  More than likely, you would not qualify for premium assistance, said Banahan, and you would have to pay full price for coverage through Kynect.

What if you have veteran's benefits?  Banahan said you may want to check out your coverage eligibility on Kynect.

What if you don't have a computer?  You can call the toll-free Kynect number at 1-855-459-6328 to apply or locate a local "Kynector." Kissner said the public library in your county may provide access to a computer and the Internet services.

When will the fines for not getting covered begin and how much will they be? The fines will begin in 2015. If you don't have insurance for at least nine months in 2014, the fine is $95 per household member or 1 percent of your income, whichever is greater, said Banahan. If your income is below 100 percent of the poverty line, you are not required to have health insurance. People with incomes up to 138 percent of the poverty level are now eligible for Medicaid.

If you are planning to buy insurance or sign up for Medicaid through Kynect, you must be enrolled by Dec. 15 to get coverage starting Jan. 1, said Haynes. If you want premium assistance or a tax credit, you need to purchase insurance through the exchange, but otherwise, insurance can be purchased outside of the exchange.

To explore your eligibility for premium assistance or coverage through Medicaid, visit the Kynect website.  All three experts stressed the importance of visiting the website or calling the Kynect toll-free number with any additional questions and for information specific to your needs.
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