Robert Ehlert: Learn about health exchange

June 19, 2013 

Robert Ehlert

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You sleep, but the Patient Protection and Affordable Care Act doesn't seem to need much.

Its implementation in our state is ongoing via the Idaho Health Insurance Exchange and it is going to affect you whether you like it or not.

Unless your employer insures you and has told you nothing will change - not likely - you won't be able to hit the snooze alarm come Oct. 1 (just over 100 days away) when the Idaho Health Insurance Exchange is up and running and when coverage begins for many Idahoans on Jan. 1.

We encourage you to research what is about to happen and to begin to realize that you need to bring your personal responsibility A-Game for this one. This week we spoke to people at the Idaho Department of Insurance and to members of the Idaho Health Insurance Exchange Board and asked for advice about what the typical health insurance consumer should be considering.

Though there are exceptions, beginning Jan. 1 you will need to show proof of health insurance or you later could be fined thanks to those two words "individual mandate." The first year the "penalty," which was renamed a "tax" during the ACA's consideration by the U.S. Supreme Court, is $95 per adult and $47.50 per child - up to a family maximum of $285 or 1 percent of the family income. That is modest, but in 2015 it jumps to $325/$162.50/$975/2 percent family income and jumps again in 2016 to $695/$347.50/$2,085/2.5 percent family income.

If you think you can slide and just show up at the emergency room for coverage in 2014, think again, says Rep. John Rusche, D-Lewiston, who also happens to be a physician and a member of the Idaho Health Insurance Exchange Board. If you are employed the medical service provider is going to pursue you to pay the bill.

If your employer is not going to insure you and you will be shopping for coverage in the exchange Rusche says you will benefit in three ways:

1. Going online at the exchange to use a new tool (still being created) to fill out an application that will determine your eligibility.

2. This same online process can determine eligibility for financial assistance.

3. At this same site you can choose your coverage, which Rusche said will be like booking a trip or other products on an online vendor such as Travelocity.

"As an example, some might like to have $2,000 deductible and $20 co-pay, or a $5,000 deductible and $50 co-pay," he said, emphasizing that working with the exchange will require a level of "personal responsibility."

All of the plans in the ACA exchanges will include EHBs (Essential Health Benefits): ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse coverage, prescription drugs, rehabilitative services, lab services, preventive and wellness services and pediatric services.

Who will be getting this coverage for the first time and how much is all of this going to cost us? Those numbers are being crunched as we speak. The insurance health care providers are working with the exchange to determine such things.

In the meantime, what you can do is take matters into your own hands and study how this might apply to you:

The federal perspective:

Idaho Department of Insurance:

Idaho Health Insurance Exchange Board:

Or, attend the next exchange meeting: 10 a.m. Friday at the offices of Hawley Troxell, 877 Main St, Boise.

Dial in: (888) 296-1938 Access Code: 446223

© 2013 Idaho Statesman

Robert Ehlert is the Statesman's editorial page editor. Contact him at 377-6437, or on Twitter @IDS_HelloIdaho.

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