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Info about 'Obamacare'

Some people are loud and demanding in their approach to the the Affordable Care Act (ACA), also known as "Obamacare." Some are silent, worried, intimidated, hopeful or joyous.

I would suggest the approach to "Obamacare" is that of mindfulness. Mindfulness means the act of close and careful attention. We need information that is not an interpretation of information or a campaign slogan or a persuasive advertising blitz to promote or destroy the product itself. Instead, we need information that is the end in itself, not a means to an end. We also need to broaden our perspective beyond our individual selves, to be mindful of our family members, our neighbors, their families, our community and our society at large. How are they affected? What do we currently know? What additional information do we need and where do we get it?

So, let's focus on information we know for residents of Southern Indiana.

1. The State of Indiana did not create its own Insurance Marketplace. Kentucky did, Indiana did not. Advertisements on TV will direct Kentucky viewers to " KYNECT" to shop for insurance. Since Indiana did not set its own, we must go to "healthcare.gov", established for all states that did not set up their own "exchange." Be sure it is typed in exactly this way as there are a lot of look-alike sites.

There are multiple tabs of different topics regarding health care at the site. For instance, there is one titled "Find Insurance Options Now." That is NOT the Obamacare plan — it's if you want to buy in the private market now, before the Jan. 1, 2014, beginning of Obamacare. The tab marked "Prepare for the Insurance Market Place" is about the Obamacare plan. It is very helpful.

2. Indiana did not accept the Medicaid expansion. Kentucky did, but Indiana did not. The expansion waiver would have covered all people making 138 percent of federal poverty level (currently $33,000 for a family of four), or $45,540. It was estimated that the 944,000 uninsured in Southern Indiana would have been reduced to 428,000, reducing the uninsured by over half. On Sept. 3, 2013, Indiana renewed last year's Medicaid waiver 1115 (HIP). Even so, the healthcare.gov site will link to the Indiana Medicaid site so people can see if they qualify for a medical card under those guidelines.

3. You have a right NOT to buy health insurance. If someone can afford health coverage but does not have health insurance coverage in 2014, he or she may have to pay a fee of $95 or 1 percent of their income, whichever is higher. They also have to pay the full cost for all their care, which is NOT cheap. Health care costs account for over a third of all bankruptcies (in countries with universal health care, no one goes bankrupt or loses their home due to illness).

4. There are four categories of plans on the marketplace exchange. They are Bronze, Silver, Gold and Platinum. Like current insurance, premiums are usually higher for plans that pay more of your out-of-pocket medical costs. But all plans must have essential health care benefits, such as paying at least 60 percent of cost, no excessive deductibles, such as $5,000 out-of-pocket before your insurance kicks in, or lifetime caps. All have a maximum out-of-pocket based on your income, cover pre-existing conditions and insurance companies must have at least 85 percent of their revenue spent on care. So, no more going to the doctor or hospital with the heartbreak of having a "junk plan" that covers nothing and you've been paying for it each month.

5. There are tax credit aubsidies that pay a portion of the premium for many, many enrollees. According to a clear and transparent formula that factors in household size, household income, age and smoking status, premiums are subsidized. You can get a rough estimate of your costs and savings at this link — Kaiser Family Foundation Calculator. A more accurate estimate would be available after Oct. 1, but many of us like to plan ahead and may be pleasantly surprised. I tried out a few scenarios. It's quick; within seconds you have a rough estimate of your costs and how it was arrived at. Here are a few of my scenarios for the cost for a Silver plan:

A. A widow age 58, with a pension of $1,800 a month, would pay $103 for her monthly premium.

B. A young couple with two kids, one parent working for $15 an hour full time and the other parent working half-time at $12 an hour would have their full family covered at a premium cost to them of $205 a month. (Had we accepted the Medicaid waiver they probably would have to pay no premium).

Try out your scenario or that of a friend or family member who cannot currently get health insurance. Who has difficulty getting health insurance? The self-employed, the underemployed, adult students, retail workers, farm workers, waiters, widows, young couples, your neighbors, friends, families and many others.

What if you don't feel skilled at looking up this information on the Internet or don't have a computer? Need someone you can trust to help you check this out? You can always trust a librarian. Harrison County librarians have confirmed that they are always willing to help people do their search on the library computers. On Oct. 1, there will be designated "Navigators" to help you and other resources will be identified. Hopefully, this newspaper will help keep all of us informed, as well.

Karen Cable
Elizabeth, Ind.
October 09, 2013

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