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No info on insurance cost and carriers until health exchanges open

This article first appeared in the St. Louis Beacon, Sept. 16, 2013: Missouri consumers wanting to know who will sell them insurance and at what cost through the health reform law’s online marketplace system won’t have answers until Oct. 1, the day the program begins taking applications.

That’s the word from Nanette Foster Reilly, consortium administrator for region 7 of the U.S. Department of Health and Human Services. In addition to Missouri, the region includes Iowa, Kansas and Nebraska. She said on Friday that the agency had been working since May with insurers that want to participate in the program:

”The agreements are being signed, so the negotiations and the review period is coming to an end. The next step is for the information to be loaded and populated on healthcare.gov, between now and Oct. 1.”

Although most people eligible for the program can enroll as last as March 31 of next year, Missouri residents who are eligible for Medicaid will be able to enroll at any time, officials say.

Some have expressed concern that the marketplace system was behind schedule, but Reilly said the federal intent always had been to release names of the insurance plans and premiums on the website on Oct. 1.

“The thing that’s important to remember is that the open enrollment period for consumers is six months long. Oct. 1 is just the beginning, and consumers will have the opportunity all the way to March 31 to enroll in the marketplace in the first year.”

She added that consumers could still get coverage on Jan. 1 even if they didn’t get enroll right away and took time after the premiums are announced to decide to enroll, say, on Nov. 15. Coverage for those enrolling after Dec. 15, however, won’t go into effect until Feb. 1, she said.

Getting ready to explain

Meanwhile, groups in Missouri are revving up to educate consumers about using the marketplace to buy insurance. HHS and the Missouri Foundation for Health have both made grants to put workers on the ground to assist people needing health insurance. The workers are called navigators or certified application counselors. They are being trained to answer consumer questions and help them get enrolled.

Among those eager to see the health insurance begin is Sidney Watson, a law professor at Saint Louis University who has pushed vigorously for both Medicaid expansion, which didn’t occur, and an insurance exchange program in Missouri.

“We still need to get the word out to people” about the marketplace opening, Watson says. “Almost 80 percent of those eligible for the new insurance options don’t know it, This is true everywhere, not just in Missouri.”

Missouri is among 27 states that refused to set up their own insurance exchange programs and will have what’s called a federally facilitated marketplace, meaning the federal government is creating it. Illinois is among seven states working jointly with the federal government on what’s called a partnership marketplace. The remaining 17 states and the District of Columbia set up state-based marketplaces.

Waiting on rates

Reilly wouldn’t speculate on premium rates but acknowledged that some state-based marketplaces, such as California and Colorado, are reporting lower premiums than what consumers would pay under the older system. Yet, a few states, including Florida and Oklahoma, are suggesting rates under the reform program will be higher.

The literal marketplace is the healthcare.gov website. There consumers will be able to create a health insurance account, fill out an application, compare health care prices and buy coverage. The site is up; but, as Reilly noted, Missouri consumers won’t be able to get solid information about their costs or options until Oct. 1.

What consumers will pay will often depend on federal subsidies determined by income. Those eligible for subsidies can earn between 100 percent of the poverty rate, or $12,490 for a single individual, and 400 percent of the poverty, or $45,960 for an individual.

The Missouri Foundation for Health is funding more than the certified application counselors. It is supporting a public awareness campaign and handouts; and it is using its Cover Missouri website to get out the word about the reform law.

Ryan Barker, director of health care policy at the foundation, says between 300,000 and 350,000 Missourians out of 876,000 uninsured people in the state are eligible to buy coverage through the marketplace.

He and others predict success in getting people to enroll for health insurance. He says lots of things could go wrong initially, including making the information technology work properly. And people shopping for health insurance apparently will be required to submit earnings that show that they are eligible for subsidies. Initially that was to be done by the IRS.

“That’s not a huge stumbling block, but it’s a little bit more work for the consumer,” Barker says. “These exchanges were supposed to be as consumer friendly as possible.”

Both Ryan and Watson say the biggest stumbling block to health insurance for needy Missourians continues to be the refusal of state lawmakers to expand Medicaid. Because of that refusal, consumers earning below 100 percent of poverty are ineligible for subsidies for health insurance -- and many of the people in this income bracket are not eligible for Medicaid.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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